RU159052U1 - BINDER WITH BINDING ELEMENTS - Google Patents

Abstract

1. A stapler comprising a body, two working jaws at its distal end, perpendicular to the body, one of which is stationary, and the second is connected to the body with the ability to move relative to the fixed jaw parallel to its working surface, fastening elements placed in the working jaws, and means for controlling the relative position of the working jaws and pushing the fastening elements through stitched fabrics, characterized in that it uses fastening elements containing each stitching a part having a tubular shape with an extension at the proximal end and a pointed rigid rod located in the duct of the tube, and a mating retaining part adapted to fix the end of the tube at any desired level after removing the rigid rod, while the flashing parts of the fastening elements are installed in the movable sponge , which is equipped with a pusher connected by means of a rod with a handle in the proximal part of the body and interacting with the heads of the rigid rods with the possibility of pushing them on the direction to the fixed sponge when puncturing tissues and removing these rods from the tubes after flashing, and a stopper that prevents the backward movement of the expanded ends of the tubes when removing the rigid rods, and the mating elements of the fastening elements are mounted in the fixed sponge. 2. The stapler according to claim 1, characterized in that in the case where the mating fixing part consists of at least two parts, one of which is movable relative to the other, the fixed jaw additionally contains

Description

Technical field

This utility model relates to medical equipment, more specifically relates to staplers, intended mainly for stitching biological tissues, but can also be used in other areas.

State of the art

Currently, staplers with metal clips are widely used in surgical practice (Russian devices UKL, UKB, UTL, UDO, NZhKA, etc., American devices from Covidien and Ethicon).

Considering that metal clips remain in the body as permanent foreign bodies, Covidien released TA Premium, Poly GIA ТМ 75 and Roticulator 55 POLY ТМ devices with absorbable staples made of Lactomer or Polysorb material. These staples consist of two parts, and their upper stitching part is U-shaped with sharp arrow-shaped ends that pierce the stitched fabrics and then snap onto the counterpart, which also has a U-shaped shape. Three sizes of stitching staples of this design are provided: for thin, medium and thick fabrics. However, the dimensions of the polymer absorbable staples exceed the dimensions of the metal brackets. These staples cannot be used to stitch dense tissues such as bronchi. Therefore, the use of these staplers is so far limited only by urology and gynecology.

Known stapler, described in patent RU, A, 2381756, published 02/20/2010. The apparatus sews biological tissues with modern absorbable sutures. The device is somewhat complicated in design.

At present, fastening elements from biocompatible absorbable materials are known (patent of the Russian Federation for utility model No. 146042 U1, published on 08.27.2014), consisting of flashing and reciprocal fixing parts. The stitching part is in the form of a thin tube with a wide hat. A rigid rod with a pointed end protruding beyond the distal end of the tube is mounted with the possibility of extraction in the duct of the tube. Such an element can pierce any biological tissue, even the walls of large bronchi. This fastening element also contains a fixing part of absorbable material, which can be made in the form of separate “washers” for each tube, clips for each tube or for two adjacent tubes, or in the form of a tape for all stitched tubes. Fixation is possible at any desired level of the duct. The remaining ends of the tubes are cut off. Therefore, for any tissue thickness, it is possible to use one tube size. This greatly simplifies the stitching of various fabrics and makes the seam more reliable. The presence of expansion at the proximal end of the tube (“cap”) and a sufficiently wide “washer”, clip or continuous tape from the distal end of the tube makes the seam airtight and prevents the eruption of any biological tissue. Therefore, these fastening elements will allow the use of a mechanical suture in all sections of surgery. However, to date, the design of the stapler is unknown, which could be used in combination with the fastening elements described above.

Disclosure of the invention

The basis of this utility model is the task of developing a convenient and reliable stapler, adapted to use the described fastening elements.

This version of the stapler contains a housing with two working jaws located perpendicular to the housing. One of the jaws is stationary, it is a continuation of the body. The second sponge is connected to the housing with the possibility of moving relative to the stationary sponge parallel to its working surface. In the movable sponge is a magazine with a stitching part of the fastening elements. The pusher of the fastening elements in the proximal part is connected with the mechanism that lowers and raises it. In the distal part, the pusher is connected with the heads of rigid rods located in the channels of the tubes. In this case, the pusher lowers the rigid rods with tubes for piercing the stitched fabrics and then lifts the rods back. In order for the tubes with wide hats to remain in the stitched fabrics when the hard rods are removed from them, a special protrusion of a triangular shape is provided along the edges of the inner cavity of the movable sponge. This protrusion allows the wide caps of the tubules only to lower, but not to rise after the removed rods.

In a fixed sponge there is a magazine with a reciprocal fixing part of the fastening elements and a mechanism for moving moving parts to fix the distal sections of the stitched tubes. The movement mechanism also contains blades that cut off the ends of the tubes protruding beyond the mate. This counterpart can be separate for each tube by “washers”, clips or a continuous tape, in which the distal ends of the tubes are fixed after removing rigid rods from them.

The location of the mate in a special store, which is inserted into a fixed sponge, is provided.

The movement mechanism is a mechanism that shifts the inner layer of a three-layer tape, or presses the moving parts of the “washers” into the fixed parts, or clamps the clips, or pulls the fixing thread or leads to the fixation of the distal sections of the tubes by other methods. It consists of a movable horizontal frame with vertical protrusions and blades. A magazine with a counterpart of fastening elements is mounted on the movement mechanism. In this case, the vertical protrusions of the movable frame are inserted into the store with the counterpart of the fastening elements and pressed against the movable sections of the fastening elements. When the horizontal frame moves, the vertical elements move the moving sections of the counterpart of the fastening elements, which leads to the fixation of the stitched tubes in the stationary sections of the counterpart. At the same time, blades mounted on a movable frame cut off the protruding ends of the tubes. This store block with the counterpart of the fastening elements and the movement mechanism is inserted into the cavity of the fixed sponge. The end of the movement mechanism is connected at the end of the fixed jaw to the clamp rod, the handle of which is located in the proximal part of the housing or to the end of the tensioning cable.

In variants in which the movement of the tubes in the "washers" is possible only in one direction (Fig. 1, 2, 3. 9, 10, 11 of patent No. 146042), only the movable frame of the locking mechanism with blades cutting off the protruding ends of the tubes is provided.

The variant of the counterpart in the form of a continuous tape, into which the distal ends of the fastening elements fall after flashing, determines the good tightness of the stitched surface and prevents the penetration of stitched fabrics.

The continuous tape in the counterpart may be in the form of a three-layer tape with a displaceable middle layer, or in the form of two coaxially arranged tubes with a displaceable inner tube, or in the form of two parallel strips with interlocking surfaces. When these tapes come together, they firmly adhere to each other and fix the stitched tubes caught between them after removing the rigid rods from them.

In the presence of a three-layer tape or coaxially located tubes, the fixation of the distal ends of the stitched tubes after removal of the hard rods from them occurs as a result of the displacement of the middle layer of the tape or inner tube. In this embodiment, there are no vertical protrusions on the movable frame of the movement mechanism. The direction of movement of the bias can be controlled by the shape of the distal end of the latch rod, which can beveled in both directions. The distal end of the rod can be of another shape, for example, the shape of an eccentric, the rotation of which drives the movement mechanism. It is also possible to displace the movable elements of the counterpart when the cable is tensioned, especially in cases in which the inner layer of the three-layer tape is replaced by a thread with loops for each tube or two parallel threads with crossbars for each tube. This simplifies the design of the counterpart of the fastening elements and the stapler itself.

In the variant of two parallel tapes, mating when squeezing them from the outside, it is necessary to replace the clamp rod with a cable, which can be pulled out by a special ring located on the body of the stapler. This cable should be attached to the device, which, when pulled along the entire seam, compresses the mating surfaces.

Brief Description of the Drawings

The invention is further explained in the description of specific options for its implementation and the accompanying drawings, in which:

FIG. 1 shows a stapler according to the present utility model in a general side view, partial section. Option mating fastening elements in the form of a three-layer tape;

FIG. 2 is the same as in FIG. 1, front view;

FIG. 3 - distal part of the body of the stapler, side view, the movable sponge is lowered;

FIG. 4 is the same as in FIG. 3, the moment of flashing fabrics with fastening elements;

FIG. 5 is the same as in FIG. 4, the rigid rods are removed from the tubular portion of the fastening elements;

FIG. 6 is the same as in FIG. 5, the tubular part of the fastening elements is fixed in the mating part in a fixed sponge;

FIG. 7 is the same as in FIG. 6, the movable sponge is raised;

FIG. 8 is a variant of a stapler with a mechanism for moving the locking elements in the form of a flexible rod, side view, partial section;

FIG. 9 is an embodiment of a movement mechanism with fixing parts in the form of drawn out loops, a top view;

FIG. 10. - embodiment of the movement mechanism for a two-row seam, in the form of parallel threads with jumpers between them according to the number of flashing tubes, top view;

FIG. 11. - embodiment of the movement mechanism in the form of threads interacting with self-tightening nodes, top view;

FIG. 12 - depicts the distal part of the body of the stapler with the fixing parts in the form of "washers", in the position after flashing, removing the rigid rods and fixing the distal sections of the stitched tubes, side view;

FIG. 13 is a side view of the mechanism for moving the moving parts of the fixing parts;

FIG. 14 is the same as in FIG. 13, top view;

FIG. 15 - store for the counterpart of the fastening elements together with the "washers", top view;

FIG. 16. - a store for the counterpart of fastening elements together with “washers”. The moving part of the “washers” is replaced by stretching parallel threads with transverse jumpers. Section in the plane of threads;

FIG. 17. - "washer" with a loop inside, side view;

Fig. 18. - "washer" with a loop, cross section;

FIG. 19. - a store with fixing parts in the form of clips, top view;

FIG. 20 is the same as in FIG. 19, but the clips are angled to the longitudinal line of the seam;

FIG. 21 - the counterpart of the fastening elements in the form of two parallel strips with a mating surface. The movement mechanism in the form of a V-cutting device connecting the tape. Longitudinal section, top view;

FIG. 22 is the same as in FIG. 21, cross section.

FIG. 23 - Stapler, as in FIG. 1, but the counterpart of the fastening elements in the form of two parallel spaced tapes with an engaging surface. Side view. The location of the fixing tapes and the device connecting the tapes with the cable and blade is shown.

Machine description

In FIG. 1 and 2 show the design of the stapler, adapted for using fastening elements disclosed in the patent of the Russian Federation for utility model No. 146042. The apparatus comprises a housing 1, at the distal end of which there is a working jaw 2 fixed to the housing, and a handle 3 of the housing is located at its proximal end. In addition, the stapler includes a movable working jaw 4, equipped with a rod 5 (see Fig. 2), which is located inside the housing 1. The rod 5 in the proximal section has a handle 6, which is connected with it by screw cutting. When the handle 6 is rotated, the rod 5 lowers and raises the movable jaw 4, relative to the fixed jaw 2. In this case, the working surface of the jaw 4 is always parallel to the working surface of the fixed jaw 2.

The movable sponge 4 has an internal cavity in which the pusher 7 is located, with a magazine installed in it with flashing parts of fastening elements. The pusher 7 has a rod 8 located in the cavity of the rod 5 (Fig. 2) of the apparatus 1. The rod 8 is possibly parallel to the rod 5. The rod 8 consists of two parts — a proximal rotating part ending with a handle 9 and a distal part at the end of which pusher 7 is fixed.

In the proximal section of the housing 1 near the handle 3 there is a latch handle 10 that can be rotated around the axis 11 relative to the fixed handle 3. To prevent accidental movement of the handle 10, a rotary fuse 13 is provided on it. A latch rod 14 is attached to the handle 10 by a pin 12 . When you press the handle 10, it moves relative to the stationary handle 3 of the housing and, accordingly, moves the rod 14.

The distal end of the rod 14 interacts with the mechanism for moving the fixing parts of the fastening elements. Shop with fastening elements mounted on a movable frame of the movement mechanism in the fixed jaw 2. The drawing shows a variant when the beveled surface 15 is made at the end of the rod 14, interacting with the end face of the frame of the movement mechanism. When you press the handle 10 (after the fuse 13 is removed), the rod 14 drops down and moves the frame of the movement mechanism. The direction of movement of the movement mechanism depends on the direction of the bevel of the surface 15 at the end of the rod 14. In the future, the option of replacing the clamp rod 14 with a cable with a corresponding change in the position of the handle 10 will be shown.

In the movable sponge 4 is a store with flashing parts of fastening elements. They are thin tubes 16 with a cap extending at the proximal end 17. A rigid rod 18 is located inside each tube 16 with a sharp end protruding beyond the distal end of the tube 16. The proximal ends of the rigid rods 18 are mounted on the plate 19. Plate 19 performs the function of a magazine for flashing parts and has a configuration adapted to be fixed on the distal end of the pusher 7 and removed from it after flashing. In FIG. 1 and 2, an embodiment is shown when the plate 19 has an I-beam type profile. However, other options are possible.

On the inner surface of the movable jaw 4 there is a locking device made in the form of protrusions 20 of a triangular shape (Fig. 2). These protrusions allow the advancement of the tubes 16 together with the expanded part 17 in only one direction. Due to this, when removing the rigid rods 18 after flashing, the tubes 16 remain in the stitched fabrics. From below, the movable sponge 4 is closed by an absorbable spacer 21 stretched to the lower edge of the working sponge 4. This spacer after stitching remains on the stitched fabrics under the caps 17 of the tubes 16 and increases the tightness of the seam.

In the fixed jaw 2 there is a magazine with fixing mating parts of fastening elements. In the embodiment of the stapler shown in FIG. 1, 2, a fastening element is used, the fixing part of which consists of two parts - stationary 22 and movable 23. In this case, the fixing part is made in the form of a three-layer tape, the outer layers of which are stationary, and the inner layer performs the function of a moving part. The three-layer tape is located on the movable frame 24 of the movement mechanism. This frame 24 is provided with blades 25 for cutting off the ends of the tubes 16 protruding beyond the mating fixing parts after flashing. At the end of the frame 24 there is a protrusion with a beveled surface 27, bonded to the middle layer of a three-layer tape and interacting with its beveled surface 27 with a mating surface 15 at the end of the rod 14, bonded to the handle 10.

In FIG. 2 shows a variant of a stapler with two rows of stitching tubes 16 arranged in a checkerboard pattern. The number of rows, if necessary, can be increased or decreased.

In FIG. 3 shows a distal section of the housing 1 and working jaws 4 and 2 in section. The movable working jaw 4 is lowered. The fabric to be stitched is fixed between jaws 4 and 2 (the stitched fabric is not shown in the drawing).

In FIG. Figure 4 shows the same distal part of the housing 1, but at the moment of flashing the tissues compressed between the lips, the rod 8 with the pusher 7 is lowered, the rigid rods 18 together with the tubes 16 passed through the compressed tissues and parts 22, 23 of the three-layer tape located in the lip 2.

In FIG. 5, in contrast to FIG. 4, the stapler is shown in the position after flashing. Rigid rods 18 are removed from the tubes 16 and raised up to their original position. In the stitched fabrics (not shown in the drawing) and in the details 20, 21 of the three-layer tape, there were only soft tubes 16 made, like the three-layer tape, from biocompatible material that resolves after a certain time.

In FIG. 6, a stapler is shown at the moment of fixing the distal ends of the stitched tubes 16 in a three-layer tape. When lowering the rod 14, its beveled surface 15 interacts with the beveled surface 27 of the frame 24, which leads to the displacement of the latter to the left. In this case, the inner layer of the three-layer tape 23 is shifted with respect to the upper and lower stationary layers 22, squeezing the thin tubes 16 and pressing them to the fixed outer layers of the tape. At the same time, the blades 25 cut off the ends of the soft tubes 16, protruding beyond the fixed lower layer of the tape.

In FIG. 7 shows the final operation of the flashing cycle. The movable sponge 4 is retracted up to its original position, the stitched fabrics with fixed fastening elements are released, the stapler can be removed.

In FIG. 8 shows another embodiment of a movement mechanism for fixing the tubes 16 in the fixing part of the fastening element. In this case, instead of a rigid rod with a beveled surface, a flexible cable 28 was used.

In this embodiment, unlike the previous one, the position of the handle 10 is changed, which in this embodiment is located below the handle 3 of the housing. To ensure the sliding of the cable 28 on the bends of the housing, rollers or guides are provided. Other embodiments of the cable tensioning mechanism 28 are also possible. In this embodiment, the direction of movement of the frame 24 and the direction of the blades 25 are changed.

In FIG. 8, the stapler is shown at the moment of displacement by the cable 28 of the movable layer of the three-layer tape 23 and fixing the distal ends of the tubes 16. At the same time, the blades 25 cut off the ends of the tubes 16 protruding beyond the lower layer.

Instead of the movable layer in a three-layer tape, you can use the thread 29 (Fig. 9) of absorbable material with loops 30 located concentrically to the tubes 16 or with jumpers 31 (Fig. 10). After removing the rigid rods 18, the tension of the thread (or threads) 29 with loops 30 or with jumpers 31 leads to the fixation of all stitched tubes 16 - loops (or jumpers) deform the ends of the tubes 16 and fix them relative to the fixed parts of the fixing parts. On the threads 29 there are triangular bulges 32, preventing the movement of the threads in the opposite direction. The ends of the threads 29 can be fixed by a clip (not shown in the drawings) at the end of the fixed part of the fixing part of the fastening element.

The entire mating fixing part with fixed and moving parts, in this case a three-layer tape, is located in a special store 33.

In FIG. 9 shows (top view) a variant of the mechanism for moving the movable part with one thread 29 having loops 30 on both sides. The stitched tubes 16 are visible in the loops 30. The thickenings 32 of the triangular shape present on the threads 29 allow the thread 29 to move only in one direction. This protects the threads 29 from backward movement, providing a firm hold.

A possible arrangement of the stitching tubes 16 in a row. In this case, the loop 30 will be located only on one side of the thread 29.

In FIG. 10 (top view) shows a parallel arrangement of three threads 29, between which there are jumpers 31 (option for arranging the fastening elements in two rows). With the displacement of the threads 29, the jumpers 31 squeeze and press the distal ends of the stitched tubes 16 to the fixed parts of the fixing tape. On the threads 29 there are also triangular thickenings 32 to prevent back slipping of the threads.

In FIG. 11 shows another use of threads with loops, but with knotted knots 34. In this embodiment, parallel threads 29 are used to which the ends of prefabricated knotted knots 34 are attached. These ends of the knots are thrown over the stops 35 so that the opposite tension is ensured the ends of the nodes when pulling parallel threads 29. The knotting of the nodes is accompanied by a tightening of the loop at the distal ends of the tubes 16 and their strong fixation relative to the stationary parts.

Shown in FIG. 12, the distal section of the stapler is adapted for another embodiment of the counterpart of the fastening elements. In this case, the fastening elements are separate fixing "washers" according to the number of tubes 16. Each "washer" consists of two parts: a stationary 22 and a movable 23 interacting with it. The "washers" are located in a magazine 33 adapted for them, installed in a fixed sponge 2 above the horizontal frame 24 of the mechanism for moving the moving parts 23. In this figure, the stitching mechanism is shown after flashing the tissues with tubes 16 and removing the rigid rods 18. The locking rod 14 is lowered, the movable horizontal frame 24 is shifted to the left and its vertical partitions 26 have displaced the movable parts 23 of the “washers” to the position of interaction with the stationary parts 22. In this case, the tubes 16 were squeezed, fixed relative to the stationary parts 22 and the protruding ends were cut off by the blades 25.

In FIG. 13 and 14 in side and top views shows the mechanism for moving the moving parts of the "washers". The mechanism includes a movable horizontal frame 24 with a protrusion at the end having a beveled surface 27 adapted to interact with a beveled surface 15 at the end of the latch rod 14. On the frame 24, vertical partitions 26 interacting with the movable washers 23 are rigidly fixed. Also, blades 25 are fixed on the frame 24 to cut off the extra ends of the tubes 16. The blades 25 are mounted at an acute angle to the sides of the frame 24. This makes it easy to cut off the extra ends of the tubes 16.

In FIG. 15. (top view) shows the magazine 33 for the counterpart of the fastening elements with “washers” located therein. The case of the store is divided into cells in which the "washers" are located. The cells have a shape that secures the fixed parts 22 of the "washers" in the case of the store and the ability to move their moving parts 23. At the bottom of the store there are slots for arranging and moving the vertical partitions 26. These partitions 26 are adjacent to the moving parts 23 of the "washers".

When moving the movable frame 24, its vertical partitions 26 move the movable parts 23 of the “washers” in the slot made in the body of the stationary parts 22 of the “washers”. This ensures reliable fixation of the stitched tubes 16 in the body of the “washers”.

Shown in FIG. 16 store for the counterpart of the fastening elements, differs from the previous one in that the moving parts of the “washers” are made in the form of threads 29 (a cut in the plane of the arrangement of threads). Sewing tubes 16 are introduced into the “washers” 16. This figure shows one row of “washers”, although there can be two or more such rows. Inside the "washers" are two parallel threads 29 with jumpers 31. On the threads 29 there are triangular thickenings 32, preventing the reverse sliding of the threads 29.

In FIG. 17 shows a “washer” with stretchable threads 29. Side view. A stitching tube 16 is inserted into the “washer”. A groove is made in the body of the “washer” to a depth of half its diameter. In the groove is a thread 29 with a jumper 31. On the thread 29 there are triangular bulges 32. When tensioning the thread 29, the jumper 31 squeezes and firmly fixes the tube 16 in the “washer”. This design can significantly reduce the thickness of the "washer". In fact, the “washer” turns into a double “button”, inside of which a loop 30 or a jumper 31 can be moved between the threads 29. The design of the stapler becomes simpler.

In FIG. 18 is a cross-sectional view of a washer. The "washer" is shown in combination with loop 30 without a long pull thread. The tube 16 is inserted into the "washer" and it is covered by a loop 30 with triangular thickenings 32. The end of the loop 30 extends beyond the "washer". In the gap between the body of the "washer" and the end of the loop 30, a vertical partition 26 of the movable frame is inserted. In this embodiment, the “washers” are not connected by a continuous thread 29 to each other. This option can also be used in combination with tying ligatures.

In FIG. 19 and 20 show two embodiments of stores with fixing parts of fastening elements in the form of clips of biocompatible absorbable material after a certain time in the body. It is possible to use a separate clip for each tube, but you can overlay one clip on two adjacent tubes.

The magazine 33 shown in FIG. 19 is adapted to accommodate clips 36 arranged horizontally in two rows in respective cells. Each clip 36 captures two adjacent stitched tubes 16. The clips 36 are snapped in by a V-shaped vertical partition 26 of the movable frame 24, the movement of which leads to compression of the clips 36 and their snapping.

In FIG. 20. The magazine 33 is shown with clips 36 positioned at an angle to the longitudinal line of the seam. Each clip 36 captures two tubes 16 in different rows. The clips are located in the appropriate cells of the store, ensuring their immobility in the store. The clips 36 are snapped in by pressing them with the vertical partition 26 of the frame 24. In this case, the vertical partition 26 has a triangular shape.

FIG. 21, 22 and 23 illustrate another embodiment of the mating fixing part of the fastening elements, which in this case is made in the form of two parallel ribbons 37 with figured protrusions 38. These protrusions provide for the engagement of the ribbons 37 with each other. The protrusions 38 may have a different configuration, however, when the tapes 37 are engaged, the fixation of the distal tubes 16 located between the tapes of the distal sections must be ensured. The connection of the tapes 37, leading to their strong adhesion, is provided by a device V having a V-shaped gripping shape 39 rotary rollers (or without them) on the inner walls. The device 39 is connected to a cable 28, which ends in the proximal section of the apparatus 1.

In FIG. 21 shows a longitudinal section of these tapes 37 with figured protrusions 38. Between the tapes are stitched portions of the tubes 16. The ends of the tapes are connected by a movement mechanism, which has the form of a V-shaped device 39 connecting parallel tapes. Special tool 39 is connected to cable 28.

In FIG. 22 shows an end view of these tapes. The figure shows two ribbed surfaces 38 on one tape, and one ribbed surface 38 on the other tape. When connecting the tapes 37, one ribbed surface latches between two ribbed surfaces of the other tape, compressing the tubes 16.

In FIG. 23 shows a stapler, as in FIG. 1. The difference is the use as a fixing part of two parallel tapes 37 with curly protrusions, which provide strong adhesion of the tapes to each other when connecting them. The figure shows the location of the parallel tapes 37 in the fixed jaw 2. At the end of the tapes is a fixture 39, which has a V-shape and a blade 25 on its lower surface for cutting off the ends of the tubes 16 extending beyond the tapes 37. The fixture 39 is connected to a cable 28 and can move along parallel tapes 37, connecting the tapes 37 to each other. The cable 28 is located along the entire fixed jaw 2 and along the apparatus body 1. The proximal portion of the cable 28 exits the apparatus body under the handle 3 and has the shape of a ring 40 or other configuration convenient for pulling the cable. When tensioning the cable 28, the device 39 moves along both belts 37, gradually connecting them. In this case, the protrusions 38 (Fig. 21) of one tape 37 snap between the protrusions 38 of the other tape 37, which provides a strong fixation of the ends of the tubes 16 located between the tapes. The excess ends of the tubes are cut off by the blade 25.

Thus, variants of the apparatus for stitching biological tissues with fastening elements according to the patent for a utility model of the Russian Federation No. 146042 are presented.

Claims (8)

1. A stapler comprising a body, two working jaws at its distal end, perpendicular to the body, one of which is stationary, and the second is connected to the body with the ability to move relative to the fixed jaw parallel to its working surface, fastening elements placed in the working jaws, and means for controlling the relative position of the working jaws and pushing the fastening elements through stitched fabrics, characterized in that it uses fastening elements containing each stitching a part having a tubular shape with an extension at the proximal end and a pointed rigid rod located in the duct of the tube, and a mating retaining part adapted to fix the end of the tube at any desired level after removing the rigid rod, while the flashing parts of the fastening elements are installed in the movable sponge , which is equipped with a pusher connected by means of a rod with a handle in the proximal part of the body and interacting with the heads of the rigid rods with the possibility of pushing them on the direction to the fixed sponge when puncturing tissues and removing these rods from the tubes after flashing, and a stopper that prevents the reverse movement of the extended ends of the tubes when the rigid rods are removed, and the mating elements of the fastening elements are mounted in the fixed sponge. 2. The stapler according to claim 1, characterized in that in the case where the mating fixing part consists of at least two parts, one of which is movable relative to the other, the fixed jaw further comprises a mechanism for moving the moving parts to fix the distal ends of the tubes after removing hard rods from them, connected by a rod with a clamp handle in the proximal part of the body. 3. The stapler according to claim 2, characterized in that the mechanism for moving the moving parts is equipped with a means of cutting off the ends of the tubes protruding beyond the mating fixing parts after flashing. 4. The stapler according to claim 3, characterized in that the mechanism for moving the moving parts is made in the form of a frame with blades and vertical partitions according to the number of mating parts, adapted to interact with the moving parts of the mating fixing part and pressing them against the stationary ones when the frame is horizontally moved relative to fixed sponge. 5. The stapler according to claim 2, characterized in that in the case when the movable parts of the mating fixing part are tightening loops, the movement mechanism is made in the form of a common thread that combines all the threads and loops and is fastened by a flexible rod with a clamp handle. 6. The stapler according to claim 2, characterized in that in the case where the mating fixing part is a three-layer tape with a movable middle layer, the movement mechanism is made in the form of a movable frame connected to the middle layer with a protrusion on the end face that has a beveled or other shape surface interacting with the counter surface at the end of the clamp rod. 7. The stapler according to claim 2, characterized in that in the case where the reciprocal fixing part is clips, the vertical partitions of the movement mechanism according to the number of clips have a configuration that allows the clips to snap into place when moving. 8. The stapler according to claim 2, characterized in that in the case where the mating fixing part consists of two parallel ribbons with figured protrusions, which ensure the adhesion of the ribbons to each other during interaction, the movement mechanism is made in the form of a pressing tape to one another installed with the possibility of movement relative to a fixed jaw along the tapes and connected by a cable to the handle of the latch.

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