RU1771705C - Couplinf ring and surgical apparatus for superimposing anastomosis - Google Patents

Abstract

SUMMARY OF THE INVENTION: The connecting rings for positioning the anastomoses comprise a clamping ring 1 and a ring 2 with locking needles 3 for fixing the rings 1 and 2 and their integral connection, as well as a ring 6 of soft elastic material. The surgical apparatus for applying anastomoses contains a tubular body, inside of which rings 6 of soft elastic material are mounted. Usage: in medicine for applying anastomoses, 17 ill., 2 s. and 8z.p, f-ly.

Description

Fi.1

The invention relates to medical equipment, in particular, to connecting rings for applying anastomoses to the organs of the digestive tract and to surgical devices for applying anastomoses using connecting rings. It can be used to apply inter-intestinal anastomoses to difficult to access conditions, for example, to connect the colon to the rectum at low resections.

The aim of the invention is to eliminate these drawbacks, namely, eliminating the failure of anastomoses due to premature necrosis of the tissues compressed between the rings until the walls of the connected organs grow together, expanding the ability to control the degree of compression of the connected walls, eliminating the need for a manual immersion suture and making it possible to apply reliable anastomoses in difficult conditions, for example, at low resections of the rectum, facilitating the evacuation of contents in the early stages e operations and reduce the cost of connecting rings, as well as increased contact surface and intergrowths connected walls outside the compression walls portions in the direction of the axis bodies.

Fig. 1 shows the connecting rings for applying anastomoses to the organs of the digestive tract (option I);

Fig. 2 - connecting rings (option I) in a connected state;

Fig. 3 - connecting rings with several clamping rings made of soft elastic material (option II);

Fig. 4 - connecting rings (option II) in a connected state;

Fig. 5 - connecting rings with a clamping ring, in which rings of dense and soft elastic materials are connected (option II);

Fig. 6 - connecting rings (option III) in a connected state;

Fig. 7 - connecting rings with a clamping ring made of dense and soft materials (option IV);

Fig. 8 shows connecting rings (option IV) in a connected state;

figure 9 - connecting rings with a clamping ring made of dense material with an end face (option V);

Fig. 10 shows connecting rings (V variant) in a connected state;

11 - connecting rings with a clamping ring of dense and soft elastic materials with an end face (option VI);

in FIG. 12 - connecting rings (option VI) in a connected state;

Fig. 13 is a surgical apparatus for applying anastomoses using connecting rings;

in FIG. 14 - surgical apparatus with a clamping ring made of soft elastic material fixed to the thrust head;

0 in Fig.15 is a section along aa in Fig.13; in FIG. 16 is a section along BB in FIG. 14; in FIG. 17 - thrust head with a clamping ring of soft elastic material mounted on a clamping ring of

5 dense material.

Connecting rings for applying anastomoses contain a clamping ring 1 (Fig. 1) and ring 2 with locking needles 3 and piercing needles 4. Rings 1 and 2

0 are made of dense material, such as plastic. The locking needles have a locking element near the tip, which, after a puncture of the plastic pressure ring, prevents it from being disconnected from the ring,

5 containing needles. In the exemplary embodiment of the connecting rings shown in FIG. 1, the locking needles are cylindrical and the locking elements are formed by an annular groove 5. However, the needles and the locking element may also have a different design. For example, the needles can have a rectangular cross-section, and the locking element can be made in the form of conical grooves with a cylindrical needle, spikes, or in the form of slots near the pointed end of the needle, and the locking needles may not pierce the pressure ring of dense material, but enter matching holes on

0 to this ring and interact with the locking elements with the surface of the holes for mutual fixation of the connecting rings (not shown in the drawing).

Between rings 1 and 2 of dense material, a ring 6 is installed made of soft elastic material, for example, porous rubber. In the connected state of the rings (Fig. 2), a ring of soft elastic material performs both the function of a clamping ring and the function of a spring element that makes constant elastic contact of the clamping surface 7 of the ring with the inner surface of the organ walls. The clamping surface 7 of the ring 6

5 of the soft elastic material copies well the irregularities of the inner surface of the walls of the organs and makes a gentle contact with the mucous membrane. Possesses good spring properties, ring made of soft elastic material

provides constant mutual clamping of the connected walls in the direction of the axis of the organs even in those cases when the walls located between the clamping rings have an uneven thickness.

The outer diameter of the ring 6 of soft elastic material is made larger than the outer diameter of the ring 2 with needles. Due to this, after the walls are sewn up with needles and the rings are joined together, they protrude beyond the ring 2 with the needles of the edge 8 of the ring 6 of soft elastic material and smoothly bend and form a soft pillow on which lies the corresponding portion of the connected organ. This ensures good blood supply to the connected organs located outside the axial compression and eliminates the possibility of pressure sores at the points of contact with the pressure ring.

The design of the connecting rings according to the invention provides for the possibility of installing between rings 1 and 2 (FIG. 3) of dense material, not one, but several pressure rings 6 of soft elastic material. This makes it possible to use a set of rings to connect the organs, depending on the degree of compression that the surgeon intends to provide, based on the specific conditions determined during the operation. With a constant distance between the rings 1 and 2 (Fig. 4) of dense material in their combined state, a different number of identical rings 6 of soft elastic material allows to obtain different compressive forces placed between the rings of tissue. In order to expand the ability to control the compression ratio, the rings of soft elastic material can have different elastic properties and corresponding markings, for example, by color, for convenient selection of the desired ring.

Rings b (FIG. 1) made of soft elastic material have a rectangular cross-section, in which a puncture-free puncture with their needles is ensured, uniform contact of the pressing surface 7 of the ring with the inner surface of the organ wall and compression of the walls over the entire contact surface ensuring tightness and hemostasis under relatively small conditions.

The clamping ring 6 of soft elastic material can be connected to the extreme clamping ring 1 (Fig. 5) of dense material, forming a single clamping ring. The connection of these rings can be carried out by gluing. For

so that after connecting the walls of the organs, the outer edge of the ring 2 with the needles does not cut through the organ wall, it has a fillet 9 in this place (Fig. 6).

When using a pressure ring 1 of dense material together with ring b of soft elastic material, it is advisable to use at least one other pressure ring 6 (phi1.7) of soft elastic material, which is installed on the side of ring 2 with needles. In this case, after all the rings are inseparably joined, the pressure rings 6 (Fig. 8) of soft elastic material cover the organ walls on both sides, providing more uniform compression of the walls and reducing the likelihood of premature tissue necrosis at one of the points of the circular anastomosis.

In one embodiment of the connecting rings of the present invention, the extreme pressure ring 1 (Fig. 9) has an end face 10 directed toward the ring 2 with needles. The smallest inner diameter of the rim exceeds the outer diameter of the ring 2 with needles. This embodiment of the connecting rings increases the surface 11 (Fig. 10) of the contact and fusion of the connected walls outside the areas of their compression in the direction of the axis of the organs. Due to this, the strength of the fused sections of the walls of the organs increases at the same time after application of the anastomosis and other conditions being equal, and therefore, the reliability of the anastomosis increases. It is advisable to make the inner surface 12 (Fig. 9) of the bead 10 inclined to the axis of the rings. In this case, the surface 12 forms a bell providing a smooth transition of the connected walls from the free state to the compressed one between the pressing planes of the connecting rings. In order to exclude contact of the tender mucous membrane of organs with the rigid surface of the pressure ring 1 with the collar 10, a ring 13 (Fig. 11, 12) of soft elastic material is connected to it, containing a collar 14. A collar 10 of the ring 1 corresponding in shape.

The application of anastomoses using the described connecting end is carried out using a surgical apparatus. In one embodiment of the apparatus according to this invention, it comprises a tubular body 15 (fsh 13), a thrust head 16, a rod 17, a ring 2 with locking needles 3, pressure rings 1 and 6, a cylindrical knife 18. mechanism for setting the clearance gaps and m: cup stitching (not shown in the drawing) Ring

2 with locking needles, made of solid material, is installed inside the housing 15 and mated in a movable fit with the hole 19 of the pipe. This hole serves as a guide for the ring 2 with needles when it is pushed out of the body 15 to puncture the walls of the organs and connect indivisibly to the pressure rings. The ring 2 is recessed in the hole 19 of the body so that the tips of the needles 3, 4 are inside the body without protruding beyond the end face 20. The distance from the ring 2 to the end face 20 of the body exceeds the length of the needles 3, 4 so that between the end face 20 and the tops of the needles 3, 4 remained 2-5 mm. Due to this arrangement of the rings 2 in the housing 15, the possibility of injuring the organ wall with needles 3, L when applying a purse string suture is excluded. At least one pressure ring 6 of soft elastic material is installed in the opening 19 of the housing in front of the needle ring 2. If necessary, determined during the operation, two or more rings 6 can be inserted into the pipe opening. The outer diameter of the ring 6 of soft elastic material in the free state is larger than the inner diameter of the casing pipe, which ensures reliable fixation of the rings 6 in the hole 19 pipes due to adhesion forces arising from the elastic deformation of the ring inserted into the hole. The ring 6 is inserted coaxially and the Colise 2 needles for ease of installation of the rings in the pipe hole, reliable fixation of the ring 2 with the needles in the pipe of the body and mutual fixation of the rings 2 and 6. The placement of the pressure ring of elastic material inside the body and reliable fixation in the pipe hole, exclude external influences on it, its distortions and disruption of fit during various manipulations necessary to insert the body into the cavity of the connected organ.

The tubular body of the apparatus externally has a continuous cylindrical surface, and for fitting rings 2 and b into the hole of the pipe, a bore 21 is made from the side of the entrance to the pipe. Thanks to this, and also due to the distinctive features of the proposed connecting rings, with the outer diameter of the case equal to the prototype, the thickness pipes in the area of the location of the connecting rings and equal sizes of the cross section of the ring 2 with needles, it is possible to significantly increase the diameter of the knife 18 and the hole of the ring 2, which facilitates the evacuation of soda organ organs in the early period after application of the anastomosis, Extreme in relation to ring 2 with pressure needles

the ring 1 is made of a dense material, mainly plastic, and is mounted on a thrust head 16.

In another embodiment, the apparatus

according to this invention (Fig. 14) is similar in design to the apparatus shown in Fig.13 and described above. Its distinctive feature is that the ring b of soft elastic material is fixed on the thrust head 16 and is located on the side of the housing 15, while the ring 2 with locking needles is mated to the opening 19 of the housing pipe. To securely secure the 2 s ring

needles in the hole 19 of the pipe, it is equipped with at least three protrusions 22 (Fig.15), located symmetrically on the outer surface of the ring. The diameter of the surrounding circle of the protrusions 22 of the ring removed from the housing 15 exceeds the diameter of the opening 19 of the housing pipe, and the diameter of the outer cylinder 23 of the ring 2 is smaller than the diameter of the opening 19. Thanks to this, the ring 2 with needles sits in the opening 19 s

tension, and the ring itself is in the hole 19 in the spring state due to a slight elastic deformation thereof. To enable installation of the ring 2 with needles into the tube of the housing 15, the protrusions 21 are provided with lead-in chamfers 24 (Fig. 16).

When the apparatus is executed with a clamping ring 6 of soft elastic material mounted on a thrust head, it is advisable to fix this ring on ring 1 (Fig. 17) of dense material, for example, by gluing. The diameter of the hole 25 of the ring 6 is advantageously made not less than the diameter of the knife 18 in order to facilitate the process of cutting holes in the connected walls of the organs and the clamping ring 1 mounted on the thrust head. Inside the tubular body 15 may

at least one ring 6 of soft elastic material must be installed, which, after application of the anastomosis, ensures the contact of the delicate mucous membrane of organs with the soft surface of the clamping

rings.

In order to enable the application of anastomoses with different diameters depending on the size of the connected organs, the apparatus body 15 is made with interchangeable heads for any embodiment, the sizes of which also include a replaceable stop head 16, knife 18 and connecting rings 1, 2, 6.

The connecting rings and apparatus of the first embodiment operate as follows.

First, a ring 2 with needles and a compression ring 6 of soft elastic material are inserted into the hole 19 (Fig. 13) of the pipe of the housing 15, and a compression ring 1 of dense material is fixed on the stop head 16. Then, using the mechanism for setting the clearance gaps, the stop head 1 b with the ring 1 is brought closer to the housing 15.

To apply an anastomosis, for example, the end to the end of the rectum with the colon, after removal of the affected area, the device prepared for use along with the connecting rings is inserted into the rectum until the stub head 16 leaves the stump. The stub head is withdrawn from the body 15 to a distance convenient for operation, and a purse string suture is applied in front of the body beforehand to the end of the rectum. A clamping ring 1 with a thrust head 16 is inserted into the lumen of the colon and the purse string suture imposed in advance on the end of the colon is tightened. With the help of the installation mechanism of the insertion clearances, the thrust head 16 is brought to the housing 15, the intestines attached to them are brought closer to contact. Using the piercing mechanism, the ring 2 with needles and the ring 6 located in front of it are made of soft elastic material from the pipe 19. The needles pierce the walls of the intestines and the ring 1, while the locking needles 3 fix the one-piece connecting rings, between which the walls of the rectum and colon are located. In the process of joining the rings, a cylindrical knife 18 cuts a hole in the connected intestinal walls and in the clamping ring 1 mounted on the abutment head 16. The purse string sutures and excess intestinal walls, as well as the remainder of the clamping ring, are removed together with the apparatus from the organ cavity through the anus. After removal of the apparatus, the connecting rings constantly compress the intestinal walls located between them due to the spring properties of the ring 6 of soft elastic material.

The work of the connecting rings of the apparatus with other structural options (Fig, 17) is similar to that described. The difference is only in preparing the apparatus for operation and consists in a different combination of connecting rings inserted into the hole of the cylindrical body 15 and fixed on the stop head 16. In the case of using the apparatus with interchangeable heads of the body 15 and the stop head 16, first of all, the surgeon determines the size of the connecting rings and interchangeable parts of the apparatus, depending on the specific size of the connected intestines. Then, the necessary head is installed on the housing 15 and the apparatus described above is prepared for operation.

0 Thus, the connecting rings for applying anastomoses to the digestive tract and the surgical apparatus for applying anastomoses using the connecting rings according to this invention significantly increase the reliability of the anastomoses and expand the ability to control the compression ratio of the connected walls depending on the specific conditions determined during

0 operation. Clamping rings made of soft elastic material allow the intergrowth of the connected intestinal walls to grow together without premature tissue rejection together with the connecting rings. They are

5 reduce the likelihood of ulceration of the tender mucous membrane and the possibility of bedsores in contact with the inner surface of the walls of organs. Distinctive design features

0 connecting rings and apparatus allow anastomoses to be applied that improve the conditions for evacuation of organ contents in the early stages after surgery.

Improving the reliability of anastomoses

5 due to the design of the clamping rings made of soft elastic material, for example, porous rubber, eliminates the need for additional manual immersion seams. This makes it possible to perform operations with favorable results in hard-to-reach places, for example, at low resection of the rectum.

The advantage of the proposed connecting rings is also the simplicity of design and manufacturability, allowing them to reduce their cost, which is important when using connecting rings for single use.

0All taken together of the advantages of the connecting rings and apparatus of this invention can improve the results of operations; expand the functionality of the connecting rings and epithet compared with the prototype, simplify the work of the surgeon and reduce the cost of the operation.

The effectiveness of the application of the proposed connecting rings and the patient was tested in 50 surgical operations on

Claims (9)

1. Connecting rings for applying anastomoses, comprising a clamping ring and a ring with locking needles for fixing the rings and their integral connection, characterized in that. which, in order to exclude the failure of the anastomoses due to premature necrosis of the tissues compressed between the rings until the walls of the connected organs are fused, expand the ability to control the degree of compression of the connected walls, eliminate the need for a manual immersion suture and ensure the possibility of reliable anastomoses in difficult to access conditions, for example, with low resections of the rectum, facilitating the evacuation of the contents of organs in the early stages after surgery and cheapening the connecting rings, they abzheny rings of a soft elastic material, installed between the rings. 2. Rings according to claim 1, wherein the ring is made of soft elastic material and has a rectangular cross section. 3. Rings according to claim 1, characterized in that the pressure ring and rings of soft elastic material are connected to each other. 4. Rings according to claim 1, characterized in that, with the aim of increasing the contact surface and the jointing of the connected walls outside the areas of their compression in the direction of the axis of the organs, the pressure ring is made with an end face that is directed towards the ring with needles, the inner diameter the side is made large by the outer diameter of the ring with needles. 5. Rings according to claim 4, characterized in that the inner surface of the rim is inclined to the axis of the rings in the form of a bell. 6. Rings according to paragraphs Z, 4, 5, with the exception that the ring is made of soft elastic material with a flange corresponding in shape to the flange of the ring of dense material. 7. Surgical apparatus for applying anastomoses, comprising a tubular body, a thrust head, a rod, a ring with locking needles located inside the tubular body, and clamping rings, one of which is made of dense material and is mounted on the thrust head, a cylindrical knife, a clearance setting mechanism firmware and mechanism stitching, excluding the fact that rings of soft elastic material are installed inside the tubular body, and the ring with locking needles is paired with the pipe hole for guiding the ring when piercing the walls of organs with needles and connecting it to the pressure ring of dense material, the distance from the ring with locking needles to the end of the body is not less than the length of the needles. 8. The apparatus according to claim 7, characterized in that the ring of soft elastic material is placed on the needles, and the outer diameter of the ring separated from the housing is made larger than the inner diameter of the housing pipe. 9. A surgical apparatus for applying anastomoses, comprising a tubular body, a thrust head, a rod, a compression ring of dense material mounted on the thrust head, and a ring with locking needles located inside the tubular body, a cylindrical knife, a mechanism for installing piercing gaps and a piercing mechanism, different in that the thrust head is provided with a ring of soft elastic material, which is fixed with respect to the pressure ring on the housing side, and the ring with locking needles is mated to the pipe hole case and installed from the end of the case at a distance of not less than the length of the needles. 10, The apparatus according to claim 9, characterized in that the ring with needles is provided with protrusions located on the outer cylindrical surface of the ring, the diameter of the circumference of the protrusions is larger than the diameter of the opening of the housing pipe, the protrusions are equipped with entry chamfers, and the diameter of the outer cylinder of the ring is smaller than the diameter of the hole body pipes. 1,768 6 6 FIG. 2 662 FIG. 4Fig. 3 sixteen 2 u i t m: % Fig 5 S3 i W t 1Sh Zsl iЈE Vci "NJ R S 5 Nj / AND % 0 f) 23 e “N Whose a QQ x i o w I 3 V // Mf Of c: Uj jfKfl / 5 19 P, 6 23 2    R F "/ g. /5 iA "3 6 2 15 B-6 l ;; l; Fig / 6