RU184491U1 - HOLLOW NEEDLE STAPER - Google Patents

Abstract

The stapler includes a housing (1) with control handles and two working jaws - fixed (2) and movable (3). A removable magazine (18) with needles (19) and threads (22) and a flashing mechanism is inserted into the fixed sponge (2). The proximal ends of the hollow needles (19) are mounted on a common plate (24), on both sides of which there are protrusions (26). The plate (24) moves on the rods (27). In the lateral departments of the store, movable plates (28) with cutouts (29) are installed at an acute angle to the longitudinal axis of the plates, protrusions (26) of the plate (24) are inserted into the cutouts. When the plates (28) move along the magazine axis, the plate (24) with needles moves on the rods (27) in both directions in the perpendicular direction. Sewing is done through gaskets (34) under the threads located in the movable sponge and in the magazine. In the gaskets there are means for fixing the ends of the threads ("buttons", loops, glue). The withdrawal of threads (22) from the needles (19) is carried out under the influence of mechanical or hydraulic forces.

Description

Technical field

This utility model relates to medicine, to medical equipment, namely to surgical staplers, but can be used in other areas.

State of the art

In most modern surgical staplers, metal clips are used to connect tissues, i.e., staplers. These are the well-known Russian devices UKL, UKB, UTL, UDO, NLCA, etc., and numerous "American devices from Covidien 'and Ethicon. The material for staples has changed over the years (silver, tantalum, alloy 40 KNHM, titanium). These staples have proven themselves quite well, however, they are foreign material that remains in the body for life. Scar tissue develops around the staples. Such patients are not recommended to be examined on nuclear magnetic resonance imaging (MRI) devices.

Also known are staplers using staples of absorbable material Lactomer or Polisorb (TA Premium, Poly GIA TM 75, Roticulator 55 POLY TM from Covidien). However, these staples are significantly larger than metal clips and have limited use.

Designs of surgical staplers with atraumatic needles using modern stitching threads, including absorbable sutures, are proposed .. Such devices are described in patents RU No. 2076639 dated January 10, 1993, RU No. 2074651 dated September 14, 1993, RU No. 2119771 10/7. 1993, RU 2120240 dated 03/05/1996, RU No. 2310405 dated January 13, 2004, RU No. 2322828 dated April 11, 2007, RU 2381756 dated June 18, 2008

However, these devices are not manufactured by industry, partly due to some design flaws. So in the apparatus according to patents RU No. 2076639 and RU No. 2074651, deformation of the blunt end of the atraumatic needle during the flashing process is noted. This can lead to some increase in injury to the stitched fabric.

The stapler according to patent RU 2381756 is more complex than staplers. It is applicable only in operations with wide access. Its design cannot be used in endoscopic devices.

DISCLOSURE OF THE USE OF A USEFUL MODEL

The basis of this utility model is the task to improve the design of the surgical stapler so that the disadvantages inherent in known designs are eliminated. Also needed is such a design of the stapling department of the apparatus that would allow its use both in operations with wide accesses and in endoscopic operations.

The problem is solved by the fact that it is proposed to use hollow straight needles as a conductor for modern threads. The needles are located in the same working sponge in the store with the stitching mechanism and move rectilinearly when sewing fabrics and when returning to the store. This prevents the possibility of deformation of the needle during sewing, which reduces the injury of stitched fabrics. This also reduces the size of the staplers, as the second working sponge, as with staplers, is of the minimum thickness. This makes it possible to create staplers, which can also be used in endoscopic operations.

The constant length of the hollow needle allows you to flash fabrics with a wider range in thickness than staples of the same height, because The end of the paper clip is folded when flashing. In addition, it creates the ability to select the necessary threads for each organ.

The proposed stapler has a housing with control handles at one end and two working jaws at the other, of which one sponge is stationary relative to the body, and the other sponge is movable. A removable magazine with stitching needles and a stitching mechanism is inserted into a fixed sponge, according to this utility model. Rectilinear hollow needles are connected to the stitching mechanism with the possibility of their reciprocating movement. Sewing threads are located in the cavity of the needles with the possibility of slipping out of the needles when a pushing force is applied. In the store and in the movable sponge, gaskets are provided with means for fixing the ends of the threads.

The proximal ends of the hollow needles are staggered to a common plate. In the lateral sections of the plate there are protrusions. A plate with needles is worn on guide rods located perpendicular to the longitudinal axis of the magazine, with the possibility of movement along the rods. On both sides of the needle plate are movable plates with cutouts located at an acute angle to the longitudinal axis of the corresponding movable plate. In these cutouts inserted protrusions made on the sides of the plate with needles. When moving the movable plates along the longitudinal axis of the store, the plate with needles moves on the guide rods in a direction perpendicular to the longitudinal axis of the store. So there is a flashing of tissues with needles and removal of needles from the tissues.

In one embodiment, at the proximal end of each needle, a cap is mounted with the ability to move a cap against which the end of the stitching thread inside the hollow needle abuts. In another embodiment, the proximal end of the needle is in fluid communication with the ejection and binder filament supply tube.

It is advisable that the means for fixing the threads were made in the form of “buttons” built into the upper and lower gaskets in an amount proportional to the number of hollow needles and each having a central channel for passing the corresponding needle with thread.

It is possible that elastic fibers are made at both ends of each cross-linking thread, located at an acute angle to the longitudinal axis of the thread and directed towards each other at opposite ends of the thread. This will ensure the fixation of the thread after it leaves the hollow needle in the upper and lower "buttons".

In another embodiment, for fixing the “buttons” threads in both gaskets, they can have fixed and movable parts, the movable parts being able to interact with a figured rod having extensions in the number of moving parts and a control handle located in the body of the stapler.

In another embodiment, the “buttons” can be equipped with fastening threads loops that are tightened on the stitching threads after tensioning the tightening threads.

When using glue in the central channels of the “buttons”, capsules with biocompatible glue can be installed, located with the possibility of breaking their tightness when moving the hollow needles through the channels in the “buttons”, while the pouring glue glues the stitching threads with the “buttons” or with gaskets after removal needles.

In addition, the means for fixing the ends of the stitched threads can be made in the form of an adhesive tape of biocompatible material coated with biocompatible adhesive ..

In a preferred embodiment, the ejecting and binding agent is a biocompatible adhesive which, when ejecting the stitching threads, adheres them to fabrics or to spacers, or to “buttons”.

In the future, the utility model is illustrated by a description of specific options for its implementation and the accompanying drawings, in which:

FIG. 1 depicts a surgical stapler in general view, a partial section;

FIG. 1a - the distal part of the stapler - sponges and a magazine with a stitching mechanism, a partial section, enlarged;

FIG. 2 - a magazine with a flashing mechanism, without movable plates, a longitudinal section;

FIG. 3 - a shop with a flashing mechanism, a cross section;

FIG. 4 - magazine with a flashing mechanism, with movable plates and a control rod, top view;

FIG. 5 - mobile plates of the flashing mechanism with cutouts and a control rod, isometry;

FIG. 6 - the surface of the store or movable sponge adjacent to the stitched fabrics, the option of fixing the "button" with the movable part.

FIG. 7 is the same as in FIG. 6, a variant of a “button” with a tightening thread;

FIG. 7a - “button” with a tightening thread in the section, increased;

FIG. 8 is the same as in FIG. 6, a variant of a “button” with a tightening thread with a prepared knot;

FIG. 8a - “button” with a tightening thread with a prepared single knot in a section, increased;

FIG. 8b - “button” with a tightening thread with a prepared double knot in a section, increased;

FIG. 8c - “button” with a tightening thread with a prepared retracting unit with a tension of one end of the tightening thread, in a section, increased;

FIG. 8g - “button” with a tightening thread with a prepared retracting unit with tension of the two ends of the tightening thread, in a section, increased;

FIG. 8d - “button” with a tightening thread with a prepared double retracting unit with a tension of the ends of the tightening thread, in a section, increased;

FIG. 8e - absorbable gasket on the surfaces of a magazine or a movable sponge, with stops for guiding the ends of a tightening thread, top view;

FIG. 9 - flashing thread with elastic villi;

FIG. 10 - “button” with a capsule with glue in the central channel of the “button”, a partial section, isometry;

FIG. 11 is a distal part of the stapler, a longitudinal section, a variant with fixing means in the form of adhesive tape, a partial section.

FIG. 11a is the same as in FIG. 11, enlarged;

FIG. 116 is the same as in FIG. 11 and 11a, the roll of adhesive tape is enlarged.

FIG. 12 - a crosslinking apparatus in general form, an option with forcing the adhesive mass through hollow needles, a partial section;

FIG. 12a - the distal part of the stapler - sponges and a magazine with a stitching mechanism, a partial section, enlarged;

The stapler shown in the drawings includes the following elements:

case - 1, fixed jaw - 2, movable jaw - 3, hinge of movable jaw - 4, support handle - 5, handle that controls the movable jaw - 6, handle axis - 7, handle return spring - 8, stem axis - 9, stock the movable jaw - 10, the hinge of the rod of the movable jaw - 11, the section with teeth - 12, the hook-lock of the rod - 13, the spring of the hook of the clamp - 14, the control handle of the flashing mechanism - 15, the axis of the control rod of the flashing mechanism - 16, the control rod of the flashing mechanism - 17, a shop with a flashing mechanism - 18, a hollow needle - 19, an extension at the proximal the end of the hollow needle - 20, the cap on the hollow needle - 21, the stitching thread - 22, the elastic villi - 23, the plate with nests for needles - 24, the holes in the plate - 25, the tabs on the plate - 26, the guide rods - 27, the movable plate - 28, cutouts in the movable plate - 29, protrusion for the cap on the hollow needle - 30, the top cover of the store - 31, the bottom cover of the store - 32, the grooves in the covers of the store - 33, the absorbable gasket - 34, the holes for the “buttons” - 35 , “Buttons” - 36, the central channel in the “button” - 37, the lateral channel in the “button” - 38, the protrusions in the channel of the “button” - 39, tightening the nit b - 40, the protrusions on the tightening thread - 41, the knot on the tightening thread - 42, the stops for the tightening thread - 43, the moving part of the “button” - 44, the total tightening thread - 45, the capsule with bioglue - 46, the rod ending with a cable, the mechanism for moving the movable part of the “button” of the movable sponge or common thread — 47, the handle for pulling the cable from the movable sponge — 48, the rod ending with a cable, the mechanism for moving the movable part of the “button” in a store with a mechanism for flashing or common thread — 49, the handle for pulling the rope from a store with a flashing mechanism - 50, ru axis cable tensioning seats - 51, adhesive tape - 52, the outer axis of the adhesive tape roll - 53, the sticky tape stock in the movable sponge - 54, the sticky tape stock in the store - 55, the adhesive supply tube - 56, the adhesive mass reservoir - 57, the mechanism creating pressure in the tank with adhesive mass - 58.

The following is a detailed description of the stapler.

The stapler with hollow needles contains a housing 1, in the distal section of which working jaws are installed - a fixed working jaw 2 and a movable working jaw 3. The fixed jaw 2 is integral with the housing 1, a removable magazine with needles and a sewing mechanism is inserted into it. The movable jaw 3 is connected to the housing by a hinge 4. In the proximal section of the housing 1 there is a support handle 5 and a handle 6 that controls the movement of the movable jaw 3. The handle 6 is mounted on an axis 7 fixed in the housing 1 and has a return spring 8. In the short arm, the movable of the handle 6 there is an oval-shaped cut-out for the axis 9 of the rod 10 connecting the movable handle 6 with the movable working jaw 3 through the hinge 11. In the proximal part of the rod 10 there is a small section with teeth 12. The teeth 12 engage with the hook 13 (the floor retainer zheniya movable jaw 3) which is pressed against the teeth 12 by a spring 14. Lifting hook 13 releases the movable jaw 3 from the fixation. The second movable handle 15 controls the stitching mechanism. The handle 15 is also mounted on the axis 7 with the possibility of swinging relative to it. On the handle 15 there is an oval-shaped socket for the axis 16. The axis 16 connects the handle 15 with the rod 17, which controls the flashing mechanism. The flashing mechanism is located in a separate store 18, which can be quickly changed during the operation. It is inserted into the fixed jaw 2. However, a variant is possible in which the magazine 18 is inserted directly into the apparatus body. In this case, the fixed sponge is eliminated.

The main element of the flashing mechanism (Fig. 2) is the hollow needles 19. The stitching part of the hollow needle 19 is rectilinear, the distal end of the needle is sharp. In some embodiments, the proximal portion of the needle is bent (Fig. 2 shows a bend to 180 degrees). The end of the curved part of the needle may have an extension 20. At this end, a cap 21 (FIG. 2) is inserted with limited movement along the needle. Sewing thread 22 is located inside the needle with the ability to move in the needle and exit from the sharp end of the needle. The proximal end of the thread 22 abuts against the cap 21 and when advancing the cap 21 at the proximal end of the needle, the thread 22 protrudes from the sharp end of the needle 19.

The threads 22 can be smooth, but can be with elastic spiky villi 23 located in the form of two opposite groups at the ends of each thread. The villi are oriented at an acute angle to the longitudinal axis of the thread, towards each other in opposite groups.

The proximal sections of the needles 19 are fixed in the plate 24, in which there are slots for each needle. Nests can be arranged in one, two or more rows in a checkerboard pattern (Fig. 4). There are openings 25 in the plate 24. There are protrusions 26 shown in FIG. 4 and 5. Holes 25 are created along the diameter of the rods 27. This allows you to put the plate 24 on the stationary guide rods 27 and slide along them (Fig. 3 and Fig. 4). The rods 27 are firmly fixed in the upper cover and in the lower department of the store 18 and can be located in one or two rows. The protrusions 26 located at the edges of the plate 24, are included in the cutouts 29 in the movable plates 28 (Fig. 3, 4 and 5).

Various embodiments of the mechanism are possible, moving the plate 24 with needles on both sides along the guide axes 27. The drawings (Figs. 3, 4 and 5) show two movable plates 28 located parallel to each other in the side sections of the store along its longitudinal axis perpendicular to the surface of the store adjacent to the stitched fabrics. In the upper 31 and lower 32 lids of the store there are grooves 33 in which the plates 28 are moved (Fig. 3). In the plates 28 there are cutouts 29 located at an acute angle to the longitudinal axis of the plates. The protrusions 26 of the plate with the needles 24 are placed in these cutouts. Moving the plates 28 with the cutouts 29 along the longitudinal axis of the magazine leads to the movement of the plate 24 with the protrusions 26 (together with the needles 19) along the guide rods 27 in a direction perpendicular to the longitudinal axis of the magazine, i.e. . to suturing the tissues, and with the reverse movement of the plates 28 - to removing the needles 19 from the tissues.

Both movable plates 28 are attached to the rod 17, which is connected with the handle 15 (Fig. 1). Thus, the handle 15 is the stitching of fabrics and the withdrawal of needles 19 from the stitched fabrics.

As indicated above, the thread 22 is located inside the hollow needle. The thread can be removed from the needle with a stream of air or liquid. But if the thread is elastic, it can be easily pulled out of the needle by pressing on its end. In order for the thread to automatically emerge from the sharp end of the needle after sewing the tissues, the proximal end of the needle is made curved. A cap 21 is put on or inserted into it with the possibility of slight movement along the needle. At the moment when the needle with the thread sews through the fabric, the curved proximal end of the needle drops almost to the bottom surface of the store. A protrusion 30 is provided on this surface, which presses the cap 21. This leads to the expulsion of part of the thread 22 from the sharp end of the needle. If the proximal end of the needle with cap 21 drops to the bottom of the magazine 18 and abuts against it, then the protrusion 30 may not be needed.

In embodiments in which the thread 22 is pushed out by a stream of liquid (for example, an adhesive mass), the needle 19 may be straight. In its embodiment, a flexible tube is put on its proximal end, through which the necessary liquid mass is fed into the needle.

On the surfaces of the store and the movable sponge adjacent to the stitched fabrics, there are gaskets 34 made of biocompatible, absorbable material. Gaskets exclude the possibility of teething by threads and create more favorable conditions for tissue healing. This makes it possible to flash any tissue, including bullous tissue of the lung and liver tissue. Gaskets can be continuous throughout the entire stitched surface or can be in the form of separate “buttons” 36 for each needle or for two needles located side by side. A continuous tape option with separate “buttons” is possible. Such “buttons” are located in the holes 35. As indicated above, the fixation of the ends of the stitched threads can be carried out by mechanical methods or using biocompatible adhesive joints.

Mechanical fixation is carried out in “buttons”. In each “button” there is a central channel 37 through which the needle 19 passes with a thread 22. In the central section of the “button” perpendicular to the central channel 37, a side channel 38 is provided in which the pulling thread 40 or other movable part is located, which can fix the stitching thread 22. In the lateral channel 38, the walls are roughened or provided with protrusions 39, which allow the pulling thread or other moving part to move only in one direction.

In FIG. 6 shows an embodiment of fixing the yarn 22 with a solid movable element 44 located in a “button”. This element is located in the side channel 38 "buttons". The inner end of the movable part fixes the stitched thread 22 during its movement in the “button”. The lateral surfaces of the movable part 44 have protrusions that allow the movement of the movable part in only one direction.

In this embodiment, a curly rod 47 with extensions is used, each of which corresponds to the moving part of each “button”. When moving the rod 47 with extensions, the movable parts of the “button” are moved deeper into the “button” and the threads 22 are fixed in each “button”. Stem 47 ends with a cable connecting the stem with a corresponding handle on the apparatus body.

In FIG. 7 shows a variant in which a pulling thread 40 is located in the side channel 38. The thread 40 ends with a loop located around the perimeter of the central button channel 37. The protrusions 41 are located on the tightening thread 40. The interaction of the protrusions 41 with the protrusions 39 on the walls of the side channel 38 allows the pulling thread 40 to move only in one direction. Thus, the flashing thread 22, falling into the loop of the pulling thread 40, is drawn into the side channel 38 and fixed.

In FIG. 8 shows variants with a node 42 on the tightening thread 40. In the variants shown in FIG. 8d and 8d, both ends of the assembly are pulled from the side button channel 38. Further, both ends are pulled in different directions. It is possible to pre-fix one end of the assembly 42 in a “button”, as shown in FIG. 8a, 86, 8c. In this case, you can pull one end of the tightening thread 40. The nodes can be single (Fig. 8A, 8B) and can be double (Fig. 86 and 8d). The nodes can be ordinary (Fig. 8a, 86) and there can be nodes that drag the stitched thread inside the node (Fig. 8c, 8d and 8d)

In FIG. 8 e shows a variant in which the tightening threads 40 with prepared knots 42 are arranged in gaskets without “buttons”. In this embodiment, both ends of the tightening threads, before being attached to the common threads 45, are thrown through the stops 43 provided for this, which are located on the surfaces of the movable sponge and the magazine adjacent to the stitched fabrics. This creates the conditions for the tension of the ends of the pulling threads 40 in opposite directions.

In the embodiments shown in FIG. 7 and 8, all tightening threads 40 of all the “buttons” are attached to a common thread 45 for each sponge, which extends to the side of the “buttons”. In the proximal section of the working jaws, the threads 45 have loops connecting them to the cables (or rods) located in the housing. Cable from movable jaw 3-47. Cable from the store 18-49. The cables are pulled through the housing 1 of the stapler and their ends protrude through the hole in the housing 1 (Fig. 1). Near this hole on the axis 51 there are two cable tensioning handles - a handle 48 connected to the end of the cable 47 located on the sponge 3 and a handle 50 connected to the end of the cable 49 located in the magazine 18. By turning the handles around the axis 51, the cables are tensioned and the corresponding general threads of each sponge.

First, after piercing the stitched fabrics with needles, removing the end of the thread 22 from the needle 19 and raising the needle a little, turn the handle 48, while pulling the cable 47 and the common thread 45 of the jaw 3. After fixing the threads 22 in the “buttons” of the movable jaw 3 of the needle 19 completely removed from stitched fabrics. Then turn the handle 50, which pulls the cable 49 and the common thread 45 of the magazine in the fixed jaw 2. This leads to the fixation of the threads 22 in the magazine. After that, the cables are disconnected from the common threads. The movable sponge 3 opens and the stapler is removed. Handles 48 and 50 may be located on different sides of the housing 1.

In FIG. 9 shows another embodiment of fixing the thread 22 in the “buttons”. In this embodiment, on the stitching threads 22 there are elastic spiky villi 23 located in the form of two opposite groups at the ends of each thread. The villi 23 are oriented at an acute angle to the longitudinal axis of the thread and towards each other in opposite groups. When sewing fabrics, the thread 22 is located inside the hollow needle 19 and does not touch the tissues. After removing the needle, the thread will be fixed with villi 23, mainly in the “buttons” located both in the movable sponge 3 and in the magazine 18. With respect to the stitched fabrics, the thread 22 will be fixed.

When using biocompatible adhesive compounds, the following options are possible:

In FIG. 10 shows an embodiment in which a capsule 46 with biocompatible glue is located in the middle of the central channel “buttons” 36. With the passage of needles 19 with threads 22 in the central channels of the "button" capsule 46 are punctured. The glue is poured into the central channel and glues the thread released from the needle to the walls of the “channel” central channel. In the stapling process, the thread is first released from the sharp end of the needle and the needle is raised slightly. After gluing the lower end of the thread in a movable sponge, the needle is removed from the stitched fabrics and “buttons” and the upper end of the thread is glued to the walls of the “buttons” located in the store 18.

It is possible to use adhesive tape 52 coated with biocompatible adhesive. This embodiment is shown in FIG. 11. The tape is folded into rolls located at the proximal ends of the store 18 and the movable sponge 3. The adhesive surface is best placed on the inner surface of the tape. On the surface of the roll and in its center are the axes connected by side slats. The outer axis 53 is connected to the stem 54 in the movable jaw 3, and the stem 55 in the magazine 18. Each rod (54 and 55) ends in the housing 1 with corresponding handles.

The end of the adhesive tape 52, leaving the roll, is bent through the axis 53 and glued to the beginning of the strip 34 with the sticky side. After sewing the fabrics and the distal end of the thread 22 from the needle 19, the rod 54 is moved. The outer axis 53 presses the tape with the sticky side to the gasket 34 and the “buttons” 36 in the movable sponge 3, bends the ends of the threads 22 and glues them to the gasket and “buttons”. Then remove all the needles 19 from the stitched fabrics and gaskets with “buttons”. After that, the rod 55 is moved, the adhesive tape 52 bends and glues the threads 22 to the gaskets and “buttons” in the store 18.

In FIG. 12 shows an embodiment in which a biocompatible viscous or liquid adhesive mass is used, which rapidly polymerizes under certain conditions (for example, in air, under illumination with a specific spectrum of rays or hardener). This mass, when pushed through the hollow needle 19, pushes the thread 22 out of it and glues it to the gaskets on both sides of the stitched fabrics. For this, the proximal end of each hollow needle 19 is connected by a tube 56 to the glue mass reservoir 57. After piercing the tissues, the handle 58 is pressed and the first portion of the glue mass is fed from the reservoir 57. This adhesive mass extrudes the distal ends of the threads 22 from the sharp ends of the needles 19 and glues them to the gaskets in the movable sponge 3. After fixing the distal ends of the threads 22 in the movable sponge 3, a second portion of the adhesive mass is fed, which extrudes all the threads from the needles. At the same time, the needles are completely removed from the fabrics and pads. The extruded adhesive mass glues the proximal ends of the threads to the fabrics and pads in the store 18.

These are the options for fixing the ends of the stitched threads when using hollow needles as conductors of stitching threads.

The described options for a stapler with hollow needles make it possible to create staplers for both general surgery and endoscopic operations. In this case, one size of needles is used along their length for sewing fabrics of various thicknesses. The diameter of the needles depends on the diameter of the thread used, which can be determined in advance before the operation. The use of biocompatible gaskets ensures a tight joint.

Claims (10)

1. A surgical stapler having a body with control handles at one end and two working jaws at the other, of which one jaw is stationary relative to the body and the other jaw is movable, with a removable magazine with stitching needles and a sewing mechanism inserted into the jaw, characterized in that the straight hollow needles are used, which are connected with the stitching mechanism with the possibility of their reciprocating movement, stitching threads with the possibility of slipping are located in the cavity of the needles of needles by applying the pushing force, while in the store and in the mobile sponge gaskets are provided, equipped with a means of fixing the yarn ends. 2. The stapler according to claim 1, characterized in that the hollow needles are secured with proximal ends in a checkerboard pattern on a common plate that is worn on guide rods located perpendicular to the longitudinal axis of the magazine, with the possibility of movement along the rods when moving the movable plates with cutouts located at an acute angle to the longitudinal axis of the corresponding movable plate, the protrusions made on the sides of the plate with needles are inserted into the cutouts. 3. The stapler according to claim 2, characterized in that at the proximal end of each needle, a cap is mounted to move the cap against which the end of the stitching thread inside the hollow needle abuts. 4. The stapler according to claim 1, characterized in that the means for fixing the threads are made in the form of “buttons” built into the upper and lower gaskets in an amount proportional to the number of hollow needles and each central channel for passing a corresponding needle with thread. 5. The stapler according to claim 4, characterized in that at both ends of each stitching thread there is a group of villi located at an acute angle to the longitudinal axis of the thread and directed towards each other in opposite groups, ensuring the fixation of the thread after it leaves the hollow needle in the upper and lower "buttons". 6. The stapler according to claim 4, characterized in that the “buttons” in both gaskets have fixed and movable parts, the movable parts being configured to interact with a shaped rod having extensions in the number of moving parts and a control handle located in the stapler body apparatus. 7. The stapler according to claim 4, characterized in that the “buttons” are equipped with fastening threads loops that are tightened on the stitching threads after tensioning the tightening threads. 8. The stapler according to claim 4, characterized in that capsules with biocompatible glue are installed in the central channels of the “button”, located with the possibility of breaking their tightness when the hollow needles move through the channels in the “buttons”, while the pouring glue sticks together the ends of the stitching threads with "buttons" or with gaskets after removing needles. 9. The stapler according to claim 1, characterized in that the means for fixing the ends of the stitched threads are made in the form of adhesive tape from a biocompatible material. 10. The stapler according to claim 3, characterized in that the proximal end of the needle is in communication with the biocompatible adhesive supply tube, which pushes the stitching threads out of the needle and glues the threads with fabrics, with spacers, or with “buttons”.

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