US2453056A - Surgical anastomosis apparatus and method - Google Patents

Surgical anastomosis apparatus and method Download PDF

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US2453056A
US2453056A US73403247A US2453056A US 2453056 A US2453056 A US 2453056A US 73403247 A US73403247 A US 73403247A US 2453056 A US2453056 A US 2453056A
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tube
end
clamping
ring
anastomosis
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Zack William Edwin
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Zack William Edwin
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004(bio)absorbable, (bio)resorbable, resorptive

Description

NW2, 194s. E A K 2,453,056

SURGI CAL ANAS TOMOS I S APPARATUS AND METHOD Filed March 12, 1947 2 Sheets-Sheet 1 INVENTOR. W/u AM fol/m4 A90 Z4C'K 1! TTORNE Y S Bym w N0 2, 1948. E. ZACK 2,453,056

I SURGICAL ANASTOMdSIS APPARATUS AND'METHOD Filed March 12, 1947 2 Sheets-sheaf z INVENTOR. W/LL/AM [Mr 4,90 ZACK ATTORNEYS Patented Nov. 2, 1948 1 SURGIGAL'AN'ASTOMOSIS-ABPARATUSt c l ANDMETHQD 1 This invention relatesi to surgical devices and! more particularly toanlanastomosisdeviceauseful l ini surgery for effecting theapproximationqand healing together of severed arteries, veins oriother tubular r body" parts withoutathe use. of suture materials. l r An object of the invention is-to providersim ple, effective structure for such surgical purposes that eliminates thegneed1ior-the luse of suture it material and which: may bee-left "in lplaceflpe r-e manently without deleterious efiecubeing prefer-- ablyof :non-absorbable. material, having lnoatissue reaction or of l material thatais ultimately. absorbable by the'bodyltissues. l

Another object-of the inviention is tolprovidesa q 5 surgical device ,for reflecting approximation and; healing of severed body organs or partstcoupled with the presentation oft-and maintenance .ofcontact bet-ween intima andlintima lduringathe. heal-,1

ing process a and; without, requiringa the tuseaofe suture-materials; 1- t i r l t h Still another obj ect of the invention is to: pro- 3 videla novel structureior effecting the :foregoingthatis simple in construction simpletouse, and

that may bepmanufacturedlat ccmparatiuelyfllovw 5 cost. 7

To the accomplishment .of rthewioregoing and such otherobj cuts as may hereinaitenappear the invention .consistsjinmthe ,novel constnuctionanda arrangement of parts. hereinafterrtolbe describedrgo andlthen sought to rbecdefined tin-lthesappendeda claims, reference -being-hadto theaccompanyingl t drawings forming .a partrliereofewhich ShOWQm merely .f or .the lpurposesof illustrative disclosure, h a preferred embodimenteoi the inventioni it being-.- expressly understood; however, thatchangesrmay. be.., made in a practice: within the scope-wot the claims without cligressing from the inventive-mean In ,the l drawings, l in which similar reference characters denotecorresponding pants; 1

Figural is a perspective view of one of .the threa elementsconstituting the anastomosisdevice Fig. i2 is a DBIS-DBQlliVGdJiC'tl/T. of a s econot qfzthe: three elements; l l

Fig. 3 is a perspective v Iview ofrthe, .thirdaOfthgi-t three elements; l V e r Fig.;-4 is, a longitudinal section ofthe ianas tomosisl devices in assembly-,randrillustrating its application; in. ,end to end ana'stomosislior reflectin cthe approximationintima totintima and r-heala 1 ing ofseveredevein;orlartenyapeptsa= Figs. 5-7 inclusive illustrate .diagrammaticailyr successive. steps-t in the applicationaof the (device to secure the. end to sendsanastomosisassembly 1 shown in Fig i; 1 I 1 Figs. ,8- to 10inclusi retare-diagrammatic.viewsof successive steps utilizedwinaarnzend tot side? anastomosiaf f on, exarnnlesuin inale-portals; Nein caval shunt .loperationafor? zeffectingca :Jointabee. I tvvleenthe nena Icavagwith th 7331 veinaandw 4 izjciaims. ((01. 128 334.)? a

h h 2?? Figs. 11; 12Qand.tl3larerviewssirnilar to Figsfll; I. 2 and 3v of amodification-a w h Referring. touth'e drawing and first to Figs" 1-3 inclusive, ilflldenotes an anastomosisltube. Thisttubei 10 "is =preferablyt of material "that is .nong

tissue reactant. and non-absorbableQ LA suitable; material .of; this kind .is .Nylonj awcommercial product ,definedas a synthetic fiber formingpoiyelv meric amides having proteinelike chemical Sm-1161mture derivable fromcoal, .ain'and watersoriotherc, substances and ,characterizedibyextreme uto i he ness and strength and the ability .toibelformed, f

into fibers r andainto variousshapes. n Othem-non tissue reactantimaterials .suchllasrmetals..known to have such characteristics or. synthetic g resin-s orthe like that are non-tissue reactant and pref-l v erablysnoneabsorbabler may.. be used. It Iisapos-W sible lalso' to-use absforbable Amaterials i althmigh the non-absorbable are. preferable. A suitable,

absorbable. material-sis formalized tgelatin to -t;

Which,lpolyvinylualcohol or other ."suitableslow-t 1y absorbablefproteintmaterial has been added as a vplasticizerh The. tube It has a flange ll adjacent one ,end.;. The opposite .end l 2 of the tubeahas .itswouterc surface reduced inoldiameter or tapered to pro-" videla bluntlypointed end to facilitate the use-w. of ,t'herltuhe' ID as. zwillsbedescribedl The. tube I0 "i'sprovided with. a longitudinallyrunning", slot}.

orspit l3l'.l.This. slot.l.3 extendsfrom the reduced.-

endm l2 toward the flanged end of .the tube. The; slot- 13 functions to permit temporary reduction; in tubular v-.dimensions and resilience. A pair 1 of parallelly arranged .annular-kgrooves al l, -I5 are {provided on the outer surface of the tube 10;

These grooves preferably have rounded contour as shown. in. .Fig, 4 .formpurposes presently to be described.

A pair of ringdike,clamping-members l6;-l1

aareprovideda These rings 16M! are ofthe samet'wmaterial asthe anastomosis tube l 0. In-use, they arewadapted to be slippedontonthel-body of-the. tube lfi-rwhichr-is renderedyi'eldable by reason of i slot I3, andto rest inland: be retained in thee-re "ySDBCtiVEmgI'OOVES- l4, l5. Theinternaldiameters;

of. these rings are somewhat largerrthan thevleastdiameters, of the -respectivegrooves I 4,='.ll 5 l in it whichlthey are retained during use for purposes; presently to be described. All sharpedges of the ltube l0 and rings I6, I! arepreferablmroundedw sufficiently to .prevent traumatic injury to .body

parts.

The dimensionstof= the anastomosistube ID 231116: e.

of itheeclamping rings l6, H l are: dependent upon:

3 the particular surgical 1156 1301 which they r are: to:

be puts. Forflexample, if surgery of a smallveine. or artery contemplated, the mdimensionsaof necessity will betsmaller .thanuthataofa sim'ilam anastomosisq tube for-Muse in.-:surgery oflargenw veins; arterieseor .ofhthe intestinal tract;

The device described is useful either in end to end anastomosis or in end to side anastomosis. One type of end to end anastomosis is illustrated in Figs. 4 to 7 inclusive. Therein 20 and 2| denote, for example, the severed ends of tubular body organs such as artery parts A, A which it is desired to reunite. After dissection of the body tissue (not shown) surrounding these severed ends 2|, 22, the artery portion A, for example, is drawn through the lumen of the proper size of anastomosis tube II] from the flanged end (Fig. 5), for example, by appropriate surgical forceps or clamps F, so that the severed end 20 projects forwardly of the end I2 of the tube III. The severed end 26 is then stretched and folded or drawn reversely over the blunt thinned end I2 of the tube II] and onto the tube with the aid of the forceps F to expose the intima I of the artery section A as the outermost surface lying on the tube In and with the end 20 lying approximately adjacent the flange II. The clamping ring I6 is then pushed over this arterybearing tube I until it is felt by a click or snap that the latter overlies the groove I4 which is the one nearest the annular flange II. Temporary deformation of the tube Ill by reason of slot I3 permits such movement of ring I6 onto the tube II]. The internal diameter of clamping rin I6 is so admeasured that in such position it will retain the artery portion A firmly on the anastomosis tube I0 in the manner in which it has been mounted without causing additional trauma to the artery. Thereafter, the second clamping ring I l is slid over the other artery portion A (Fig. 7). The end 2| of this artery portion is then stretched as shown in Fig. 'l'by forceps F to enlarge, the lumen of vein portion A sufiiciently to facilitate the insertion into the lumen of the exposed intima I of the artery portion A lying on the tube I0 and already mounted on the latter as described. The extent of insertion is sufii-cient to bring the end 2I substantially into abutment with the clamping ring I6. Clamping ring I l is then moved reversely on the artery portion A towards end 2I until a click or snap indicates alignment with the groove I of the tube III, at which time it functions to clamp the artery portion A to the artery portion A with the intima I and I of these two portions in direct contact.

It is seen that, with the anastomosis device of the invention, it is possible to approximate severed vein or artery portions for end to end reunion, to maintain the approximated ends in firm union with intima in contact with intima Whichis the most desirable condition for healing, and that the necessity for the use of suture materials of any kind eliminated. Since the materialof the device is non-tissue reactant, it may be left permanently in situ without deleterious effects to the patient. If of absorbable material, it ultimately is absorbed by surrounding body tissues. If non-absorbable, it has no deleterious effects because it is made of nontissue reactant materials.

It is possible also to use the device for end to side anastomosis, For example, in a portal caval shunt operation, junction with a vena cava 29 of a portal vein 30 is required. This is illustrated in Figures 8-10 inclusive. Therein, the severed end'3l of the portal vein 30 is prepared and clamped by a ring I6a to an anastomosis tube Ills in the same way as the severed end 20 of artery portion A was attached to tube Ill with its intima Ia exposed (Fig. 9). A cruciate incision 34 is. t n

made in the vena cava 29 (Fig. 8). The cut lips 34a of the cruciate incision are then drawn through the second clamping ring '18. as seen in Fig. 9 by the use of forceps Fa and retracted on the opposite side of the ring Ila by these forceps to create an enlarged lumen that is suflicient to facilitate insertion of the prepared portal veinbearing tube Ills so that the intima Ia on thelatter is brought into contact with the intima Ib in the;

enlarged lumen. Forceps Fb engaging the flange a of the tube Illa are used to facilitate the insertion, and forceps Fe are used to facilitate the holding of the vena cava 29 during such insertion. In addition, during insertion, the finger P is placed under the vena cava 29 below clamping ring I1a. When insertion into the stretched lumen Ib is completed, the clamping ring Ila is moved onto the portal vein-bearing tube Ills until the click or snap indicates its positioning over the groove (not shown) corresponding to groove I5. This functions to clamp the intima Ib of the vena cava 29 to the intima It of the portal vein 3!] and to maintain sufficient pressure without further traumatic injury during healing to accomplish the desired union. Being of nontissue reactant material, the anastomosis tube Illa and clamping rings IBa, Ila in assembled relationship as described may remain in situ after healing is complete without deleterious effects. End to side anastomosis thus is likewise possible with the device of my invention Without a1teration in its form.

In the modification of Figs. 11, 12, 13 and 14, Iflb donates an anastomosis tube similar to and constructed of the same material as the tube III of Fig. 1 except that the end I2b is solid rather than being slotted as in Fig. 1. The tube II'Ib is provided at one end with a flange b and at its opposite end with a rib Me. For cooperation with the tube I01, there are provided two clamping members I61; and Ilb of whch I (it is of the same material as the anastomosis tube In while the member He is of any suitable elastic material permitting expansion of the ring to increase the diameter of its aperture. The member I61; is provided at its inner periphery with a series of small slots I3b. The internal diameters of both clamping members Hit and Ilb slightly exceed the external diameter of the portion I2b but is slightly less than the external diameter of the rib Mb. The slots I31; function to permit temporary increase in the internal diameter of the ring I 6b. v

In utilizing the modification of Figs. 11 to 13, the clamping members I61; and |1b are applied to the tube I 0b in the same manner as previously described, the only difference being that the clamping members are slightly extended during the operation of applying them rather than the tube being slightly reduced. When in place, the clamping members I61) and Ilb serve the same purpose as the clamping members I 6 and I! of the embodiment of Figs. 1 to 3 inclusive.

It is to be understood that the particular end to end and end to side anastomosis examples described are illustrative merely. The device is useful in any surgical procedure involving the junction of tubular body parts together or of tubular parts with other body parts and in the performance of artery or vein grafts and the union of the grafted-on artery or vein with other veins or arteries or the like.

While a specific embodiment of the invention has been described, variations in structural detail within the scope of the claims are possible and are contemplated. There is no intention, therefore, of limitation to the exact details shown and described.

What is claimed is:

1. In a device of the character described, an anastomosistube having a pair of annular spacedapart peripheral grooves, a ring-like clamping member movable onto said tube and admeasured to be moved into and retained in one of said grooves, and a second ring-like clamping member movable onto said tube and admeasured to be moved into and retained in the other of said grooves.

2. In a device of the character described, an anastomosis tube having a slot to render it deformable in a portion of its length and a pair of grooves, a ring-like clamping member movable onto said tube and admeasured to snap into and be retained in one of said grooves, and a second ring-like clamping member movable onto said tube and admeasured to snap into and be retained in the other of said grooves.

3. In a device of the character described, an anastomosis tube of non-tissue reactant material adapted to have body parts mounted thereon and having a flanged end and a bluntly pointed opposite end, and having a slot extending from the bluntly pointed end toward the flanged end to provide resliency, thereby enabling temporary reduction intubular dimensions, and said tube having annular spaced-apart peripheral grooves,

a clamping ring movable onto said tube from its bluntly pointed end and admeasured to snap into a first of said peripheral grooves and a, second clamping ring movable onto said tube from its bluntly pointed end and admeasured to snap into a second of said peripheral grooves, the first of said clamping rings serving to retain a first tubular body part clamped to the outer surface of said tube and the second of said clamping rings serving to maintain a second body part approximated with and clamped to and over a portion of said first named body part carried on said tubular part.

4. In a device of the character descrbed, an anastomosis tube of non-tissue reactant material capable of remaining permanently in situ and adapted to have body parts mounted thereon, said tube having a flanged end and a bluntly pointed opposite end, and having a slot to provide resiliency for temporary deformation in application, said tube also having a, pair of annular spaced-apart peripheral grooves, a clamping ring of material like that of said tube movable onto said tube from its bluntly pointed end and admeasured to snap into a first of said peripheral grooves, and a second clamping ring of similar material likewise movable onto said tube and admeasured to snap into a second of said peripheral grooves,- the first of said rings serving to retain a first tubular body part on said tube with the intima thereof outermost, and the second of said clamping rings serving to clamp the intima of a second body part into contact with said first named intima.

5. In a device of the character described, an anastomosis tube of non-tissue reactant material capable of being left in situ, said tube having a flanged end and a bluntly pointed opposite end and having a slot to provide resilience for temporary deformation in application, said tube also having a, pair of annular spaced-apart peripheral grooves, said tube being adapted to have a tubular body part or organ pass through its lumen from annular parallelly extending peripheral the flanged end and to receive on its peripheral surface a reversely drawn projection of the tubu-v lar-body part or organ having its intima lying outermost, a clamping ring of material like that of said tubemovable onto the latter from the direction of its bluntly pointed end and admeasured to clamp said reverselyfolded portion to said tube in the first of said grooves with,- out traumatic injury to' the body part, and a second clamping ring of the same material as the first ring adapted to be moved onto said tube from the direction of its bluntly pointed end, said second clamping ring being admeasured to clamp in the second of said grooves intima of another body part or organ into contact with said first named intima without traumatic, injury to either body part.

6. In a device of the character described, an

anastomosis tube member having a fiange at one end and a rib at the remaining end, and a ringlike clamping member movable onto said tube and adapted to snap over and be retained by said rib, one of said members being of variable efiec-,

tive diameter to facilitate assembly.

'7. In a device of the character described, an anastomosis tube member having a flange at one end and a rib at the remainingend, and a ringlike clamping member movable onto said tube and adapted to snap over and be retained by said rib, one of said members being slotted to permit variation in its effective diameter to facilitate assembly. i

8. In a device of the'character described, an anastomosis tube member having a flange at one end and a rib at the remaining end, and a ringlike clamping member moving onto said tube and adapted to snap over and be retained by said rib, said tube member being slotted to permit variation in its effective diameter to facilitate assembly.

9. In a device of the character described, an anastomosis tube member having a flange at one end and a rib at the remaining end, and aringlike clamping member movable onto said tube and adapted to snap over and be retained by said rib, said ring member being slotted to permit variation in its effective diameter to facilitate assembly.

anastomosis tube member having a flange at one end and a rib at the remaining end, and a ring-like clamping member movable onto said tube andadapted to snapover and be retained by said rib, said ring member being of elastic material to permit variation in its effective diameter to facilitate assembly. t l

11. In a device of the character described, an anastomosis tube member having different diameter portions and a ring-like clamping member, movable onto said tube memberand adapted to snap into and be retained in the smaller diam .eter portion of said tube member, one of said members being of variable effective diameter to tive diameter to facilitate assembly. 7

WILLIAM EDWIN ZACK.

No references cited.

10. In a device of the character described, an

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