WO1995004503A1 - Appareil pour appliquer des agrafes anastomotiques vasculaires 'cote-vers-extremite' - Google Patents

Appareil pour appliquer des agrafes anastomotiques vasculaires 'cote-vers-extremite' Download PDF

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Publication number
WO1995004503A1
WO1995004503A1 PCT/US1993/007377 US9307377W WO9504503A1 WO 1995004503 A1 WO1995004503 A1 WO 1995004503A1 US 9307377 W US9307377 W US 9307377W WO 9504503 A1 WO9504503 A1 WO 9504503A1
Authority
WO
WIPO (PCT)
Prior art keywords
flexible conduit
staple
engaging member
member means
base member
Prior art date
Application number
PCT/US1993/007377
Other languages
English (en)
Inventor
Robert L. Kaster
Perry M. Domaas
Original Assignee
Kaster Robert L
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to US07/573,856 priority Critical patent/US5234447A/en
Priority claimed from US07/573,856 external-priority patent/US5234447A/en
Application filed by Kaster Robert L filed Critical Kaster Robert L
Priority to AT93918666T priority patent/ATE207723T1/de
Priority to PCT/US1993/007377 priority patent/WO1995004503A1/fr
Priority to AU48035/93A priority patent/AU4803593A/en
Priority to DE69331066T priority patent/DE69331066D1/de
Priority to EP93918666A priority patent/EP0713373B1/fr
Priority to US08/103,196 priority patent/US5403333A/en
Priority to US08/103,290 priority patent/US5366462A/en
Priority claimed from US08/103,196 external-priority patent/US5403333A/en
Publication of WO1995004503A1 publication Critical patent/WO1995004503A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections

Definitions

  • This invention relates generally to anastomotic connection of the ends of blood vessels to the sides of other blodd vessels or other blood holding or transporting structures, such as the heart.
  • the invention relates more particularaly to the use of stpales to realize such as anastomosis.
  • Anastomosis constitutes the joinder of parts or branches to allow intercommunication between them.
  • anastomosis occurs when a blood vessel becomes joined to another blood vessel or other blood filled object such that blood can flow freely through the established junction.
  • side-to-end vascular anastomosis will be accomplished through use of sutures or specialized anastomotic connectors. These two options are often either time consuming or costly, and specialized connectors tend to expose nonorganic material in the area of blood flow.
  • simple mechanical fastening devices such as staples have been known for more than two centuries, and staples have been used in surgery since the 1920's, such use has been largely restricted to surgery of the gastrointestinal tract.
  • the apparatus is comprised very generally of a stapling tool, a staple forming tool and staple.
  • the apparatus has been particularly designed for use in side-to-end anastomosis, as where the end of a blood vessel becomes connected to the side or wall of a second blood vessel or other structure, such as the heart.
  • the stapling tool may be comprised in general of a sleeve, a core unit, a mandrel and a trigger unit.
  • the core unit may be formed of a plastic tube having a hole axially disposed through its entire length.
  • the rearward end of the sleeve has a cavity formed peripherally thereabout for use in interfacing with the trigger unit.
  • the forward end has an annularly shaped concave cavity formed therein to serve as an anvil.
  • the core unit may be comprised of a stainless steel tube that also has a hole axially disposed through its entire length. A plurality of slots are formed through its surface and parallel to its axis for a substantial portion of its length, thereby forming a plurality of fingers.
  • Each finger has a groove formed therein and disposed substantially parallel to the slots and the axis of the core unit. So configured, the fingers are flexible in a radial direction.
  • the core unit has a slot formed peripherally about its forward end to serve as a staple holding unit.
  • the exterior diameter of the core unit should be approximately the same as the interior diameter of the hole disposed axially through the sleeve, such that the core unit slidably disposed within the sleeve.
  • the mandrel may be comprised of a metal tube having a hole axially disposed through its entire length.
  • the exterior diameter of the mandrel should be such that it may be slidably passed through the hole disposed axially through the core unit.
  • a plastic tab may be affixed to one end of the mandrel to serve as a mandrel control unit.
  • the trigger unit includes a handle, a trigger and a bias unit.
  • the handle affixes to the rearward end of the core unit.
  • the trigger may be comprised of a movable plate that pivotally connects with respect to the sleeve and that interacts with the sleeve to cause the sleeve to move forward when the trigger is urged towards the handle.
  • the bias unit includes a spring disposed between the handle and the trigger to urge the handle and trigger apart from one another.
  • the staple forming tool may be comprised of a plastic rod having two tapered ends.
  • the first tapered end has a small hole formed therein.
  • the second end has a small concave cavity formed therein.
  • the staples are each comprised of 316 surgical steel having a thickness of approximately .25 mm. (.010 inches).
  • Each staple has a plurality of vessel and interior wall engaging members, and a plurality of exterior wall engaging members.
  • a connecting unit serves to operably join both groups of members.
  • a staple may be mounted on the stapling tool by positioning the connecting unit of the staple in the staple holding unit on the core unit.
  • the staple should be positioned with the plurality of vessel and interior wall engaging members oriented forwardly and with the plurality of exterior wall engaging members oriented rearward.
  • a blood vessel (either biologic or artificial, in humans or in animals) may be disposed through the hole provided in the mandrel. With the blood vessel extending somewhat beyond the forward end of the mandrel, the blood vessel tissue may be everted back over the staple such that the plurality of vessel and interior wall engaging members pierce the blood vessel and extend therethrough. The staple forming tool may then be utilized to bend the vessel and interior wall engaging members back upon themselves. Following this, the apparatus may be positioned to dispose the staple and blood vessel combination at the already provided hole in the wall of the blood vessel or other structure to which the blood vessel is to be connected. The tip of the apparatus, including the staple, may be pushed through this hole, and then pulled backwards to cause the vessel and interior wall engaging members that are already piercing the blood vessel to also pierce and engage the interior wall of the second blood vessel or other structure.
  • the trigger unit may be manipulated to cause the sleeve to move forward. This will cause the anvil positioned at the forward end of the sleeve to contact the exterior wall engaging members and urge them into a position to pierce and engage the exterior wall of the second blood vessel or other structure.
  • the mandrel may be removed by gripping the mandrel control unit and sliding it backwards through the core unit. Removal of the mandrel allows the fingers of the core unit to retract slightly, thus releasing their grip on the staple. The entire stapling tool may then be retracted from the area of the stapled anastomosis, and the anastomosis will be completed.
  • Fig. 1 comprises a perspective view of the stapling tool
  • Fig. 2 comprises a side elevational view of the mandrel
  • Fig. 3 comprises a side elevational view of the sleeve
  • Fig. 4 comprises a front elevational view of the sleeve
  • Fig. 5 comprises a side elevational view of the core unit
  • Fig. 6 comprises a front elevational view of the core unit
  • Fig. 7 comprises a side elevational, sectioned, detailed view of the core unit
  • Fig. 8 comprises an enlarged front elevational view of a staple
  • Fig. 9 comprises an enlarged side elevational view of a staple
  • Fig. 10 comprises an enlarged front elevational view of a formed staple
  • Fig. 11 comprises a side elevational view of the staple forming tool
  • Fig. 12 comprises an enlarged detailed view of one end of the staple forming tool
  • Fig. 13 comprises an enlarged detailed view of the staple forming tool
  • Fig. 14 comprises an enlarged side elevational detail view of the staple on the stapling tool
  • Fig. 15 comprises an enlarged side elevational detail view of the staple on the stapling tool with a blood vessel everted over it
  • Fig. 16 comprises an enlarged side elevational detail view of the staple on the stapling tool with the vessel and interior wall engaging members bent rearwardly;
  • Fig. 17 comprises an enlarged side elevational detail view of the staple and blood vessel combination being disposed through a hole in a wall;
  • Fig. 18 comprises an enlarged side elevational detail view of the staple and blood vessel combination being retracted against the interior side of the wall;
  • Fig. 19 is a view like Fig. 18, but showing the second set of exterior wall engaging members being pushed into their final position.
  • the apparatus of the invention can be seen to be generally comprised of a stapling tool (10) (Fig. 1), a staple forming tool (11) (Fig. 11), and a staple (12) (Fig. 10).
  • the stapling tool (10) includes generally a sleeve (13), a core unit (14), a mandrel (16) (Fig. 2), and a trigger unit (17).
  • a stapling tool (10) includes generally a sleeve (13), a core unit (14), a mandrel (16) (Fig. 2), and a trigger unit (17).
  • the sleeve (13) may be comprised of a plastic tube having a hole (18) axially disposed therethrough.
  • the rearward end of the sleeve (13) has a cavity (19) formed about the periphery thereof for interaction with the trigger unit as disclosed below.
  • the forward end of the sleeve (13) has a concave shaped cavity (21) formed annularly about the hole (18). This cavity (21) serves as an anvil for the staple (12 described below.
  • the sleeve (13) has an overall length of approximately 141.91 mm. (5.587 inches) and a diameter of approximately 9.53 mm. (.375 inches).
  • the hole (18) has a diameter of approximately 3.96 mm. (.156 inches).
  • the core unit (14) may be formed of a stainless steel tube having a hole (22) formed axially therethrough.
  • a plurality of slots (23) are formed through the surface of the forward end of core unit (14) and are disposed substantially parallel to the axis of the core unit (14). These slots extend for an approximate length of 25 mm. from the forward end (24) of the core unit (14).
  • a plurality of fingers (26) are formed. In the embodiment depicted, six slots
  • Each finger (26) has a groove (27) formed therein and disposed substantially parallel to the slots (23) and the axis of the core unit (14). So configured, the fingers (26) are flexible in a radial direction.
  • a slot (28) has been formed about the periphery of the core unit (14) proximal the forward end (24) thereof.
  • This slot (28) serves as a staple holding unit as disclosed in more detail below.
  • the core unit (14) has an overall length of approximately 152.40 mm.
  • the core unit (14) can be slidably disposed within the hole (18) provided through the sleeve (13).
  • the hole disposed through the core unit (14) has a diameter of approximately 2.54 mm. (.10 inches)
  • the mandrel (16) may be comprised of a stainless steel tube having a hole (29) disposed axially therethrough.
  • a mandrel control unit (31) comprising a plastic handle may be affixed to the rearward end thereof to allow the mandrel to be more easily grasped.
  • the mandrel tube has an overall length of approximately 157.15 mm. (6.187) inches and a diameter of approximately 2.54 mm. (.10 inches). So configured, the mandrel (16) can be slidably inserted through the hole (22) provided through the core unit (14). In addition, when fully inserted into the core unit (14), the mandrel (16) will extend slightly beyond the forward end
  • the inner hole (29) of the mandrel (16) may be of an appropriate dimension to accommodate the desired sized blood vessels that will be used with the stapling tool (10).
  • the trigger unit (17) includes generally a handle (32), a trigger (33) and a bias unit (34).
  • the handle (32) may be comprised of a plastic tab that may be connected to the rearward end of the core unit (14).
  • Two flanges (36) are attached to either side of the handle (32) and extend forwardly.
  • a pivot rod (37) connected between each flange (36) and the trigger (33).
  • the trigger (33) may be comprised of another plastic tab having a notch formed in it for allowing it to be positioned about the sleeve (13) and having holes disposed therethrough to accommodate the pivot rod (37).
  • the bias unit (34) may be comprised of a normally expanded spring that fits between the trigger (33) and the handle (32).
  • the biasing unit (34) will normally urge the trigger (17) away from the handle (32).
  • the trigger (33) may, however, be selectively urged rearwardly towards the handle (32).
  • the trigger (33) will pivot about pivot rod (37), and this will cause the upward edges of the trigger (33) to contact the notched portion of the sleeve (13). This in turn will cause the sleeve (13) to move forwardly with respect to the core unit (14). The significance of this motion will be made more clear below.
  • the staple forming tool may be comprised of a plastic rod having two cone shaped ends (38) and (39).
  • the first cone shaped end (38) has a narrow tube shaped hole (41) formed therein.
  • the second cone shaped end (39) has a concave cavity (42) formed therein.
  • the staple forming tool (11) has an overall length of approximately 127.0 mm. (5.0 inches).
  • the hole (41) formed in the first end (38) of the staple forming tool (11) has a depth of approximately 1.27 mm. (050 inches) and a diameter of approximately .396 mm. (.0156). The use of the staple forming tool (11) will be made more clear below.
  • the staple (12) may be formed of 316 stainless steel having a thickness of approximately .25 mm. (.010 inches).
  • the staple includes a plurality of vessel and interior wall engaging members (43) and a plurality of exterior wall engaging members (44). Each of these members (43) and (44) are operably joined in this embodiment through use of a connecting unit (46) comprising a band. It will be appreciated that the vessel and interior wall engaging members (43) and the exterior wall engaging members (44) are all pointed and otherwise contoured to assure proper stapling action.
  • the staple (12) may be formed through standard photo etching procession.
  • the staple has an overall length of approximately 9.891 mm. (.3894 inches).
  • the vessel and interior wall engaging members (43) are approximately 2.34 mm. (0.92 inches) in length, and the exterior wall engaging members (44) are approximately 5.28 mm. (.208 inches) in length.
  • the staple (12) may be curved about a mandrel or other appropriate object to cause the connecting unit (46) to assume an annular shape as depicted in Fig. 10.
  • the exterior wall engaging members (44) Prior to the anastomotic procedure, should each be bent twice through use of the staple forming tool (11) in the manner indicated, with the distal end curved at approximately 90° and the end more proximal to the connecting unit (46) bent slightly outward. The method of using the apparatus may now be described.
  • a staple (12) (Fig. 14) may be positioned on the forward end (24) of the core unit (14) such that the connecting unit (46) of the staple (12) becomes lodged in the staple holding unit (28) of the core unit (14) with the vessel and interior wall engaging members (43) disposed forwardly and the exterior wall engaging members (44) disposed rearwardly.
  • the mandrel (16) may then be fully disposed through the core unit (14). This positioning of the mandrel (16) will urge the fingers (26) of the core unit (14) slightly outward, and this will cause the staple (12) to be firmly held in place.
  • the end of the blood vessel to be connected to the wall of a second blood vessel or other structure may then be connected to a suture (not shown) in a manner well known to those skilled in the art of surgery.
  • the suture may be easily inserted through the hole (29) in the mandrel (16) to cause the blood vessel to become similarly disposed therethrough.
  • the blood vessel should be drawn through to extend approximately 3 mm. to 4 mm. beyond the forward end of the mandrel (16).
  • the sutured end of the blood vessel may then be trimmed to remove the suture.
  • the exposed end of the blood vessel (51) may then be everted back over the vessel and interior wall engaging members (43) such that the vessel and interior wall engaging members (43) pierce the blood vessel (51).
  • the rearward end of the blood vessel may then be gently pulled in a rearward direction to firmly anchor the blood vessel (51) over the vessel and interior wall engaging members (43).
  • the hole (41) provided in the first end (38) of the staple forming tool (11) may be operably joined with each vessel and interior wall engaging member (43) such that an operator may cause the vessel and interior wall engaging members (43) to be bent radially approximately 90°.
  • the second end (39) of the staple forming tool (11) may then be utilized to further urge the vessel and interior wall engaging members (43) substantially back upon themselves as depicted in Fig. 16.
  • the stapling tool (10) may be manipulated to urge the forward end of the tool (10), the forward end of the staple (12), and the everted end of the blood vessel (51) through a hole (52) provided through the wall (53) of a second blood vessel or other appropriate structure as indicated in Fig. 17.
  • the hole (52) provided through the wall (53) should be of an appropriate diameter to accommodate the exterior diameter of the blood vessel (51).
  • the stapling tool (10) may then be retracted somewhat to cause the plurality of vessel and interior wall engaging members ⁇ (43) to pierce and become embedded in the interior side of the wall (53) as depicted in Fig. 18.
  • the trigger unit (17) may be manipulated to cause the sleeve (13) to move forwardly and cause the anvil disposed on its forward end to contact the plurality of exterior wall engaging members (44) and thereby urge them forward into a piercing and engaging orientation as depicted in Fig. 19.
  • the mandrel (16) may be gently withdrawn from the stapling tool (10) to allow the fingers (26) of the core unit (14) to retract inwardly somewhat and thereby release their hold on the staple (12).
  • the stapling tool (10) may then be gently withdrawn as a whole, leaving the blood vessel (51) firmly connected to the wall (53) in a stapled anastomosis.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'appareil d'agrafage anastomotique vasculaire 'côté-vers-extrémité' comprend un outil d'agrafage (10), un outil (11) de formation d'agrafes et une agrafe (12). L'outil d'agrafage (10) comprend un manchon (13), une partie centrale (14), un mandrin (16) et une gâchette (17). La partie centrale (14) comprend plusieurs doigts (26) qui peuvent être poussés sélectivement vers l'extérieur par l'interaction avec le mandrin (16) pour saisir l'agrafe (12). L'agrafe (12) possède plusieurs éléments (43) d'engagement de la paroi intérieure et du vaisseau, et plusieurs éléments (44) d'engagement de la paroi extérieure.
PCT/US1993/007377 1990-08-28 1993-08-05 Appareil pour appliquer des agrafes anastomotiques vasculaires 'cote-vers-extremite' WO1995004503A1 (fr)

Priority Applications (8)

Application Number Priority Date Filing Date Title
US07/573,856 US5234447A (en) 1990-08-28 1990-08-28 Side-to-end vascular anastomotic staple apparatus
AT93918666T ATE207723T1 (de) 1993-08-05 1993-08-05 Seite und ende verbindende, vaskulare anastomoseklammervorrichtung
PCT/US1993/007377 WO1995004503A1 (fr) 1990-08-28 1993-08-05 Appareil pour appliquer des agrafes anastomotiques vasculaires 'cote-vers-extremite'
AU48035/93A AU4803593A (en) 1990-08-28 1993-08-05 Side-to-end vascular anastomotic staple apparatus
DE69331066T DE69331066D1 (de) 1993-08-05 1993-08-05 Seite und ende verbindende, vaskulare anastomoseklammervorrichtung
EP93918666A EP0713373B1 (fr) 1990-08-28 1993-08-05 Appareil pour appliquer des agrafes anastomotiques vasculaires "cote-vers-extremite"
US08/103,196 US5403333A (en) 1990-08-28 1993-08-06 Side-to-end vascular anastomotic staple apparatus
US08/103,290 US5366462A (en) 1990-08-28 1993-08-06 Method of side-to-end vascular anastomotic stapling

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US07/573,856 US5234447A (en) 1990-08-28 1990-08-28 Side-to-end vascular anastomotic staple apparatus
PCT/US1993/007377 WO1995004503A1 (fr) 1990-08-28 1993-08-05 Appareil pour appliquer des agrafes anastomotiques vasculaires 'cote-vers-extremite'
US08/103,196 US5403333A (en) 1990-08-28 1993-08-06 Side-to-end vascular anastomotic staple apparatus
US08/103,290 US5366462A (en) 1990-08-28 1993-08-06 Method of side-to-end vascular anastomotic stapling

Publications (1)

Publication Number Publication Date
WO1995004503A1 true WO1995004503A1 (fr) 1995-02-16

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1993/007377 WO1995004503A1 (fr) 1990-08-28 1993-08-05 Appareil pour appliquer des agrafes anastomotiques vasculaires 'cote-vers-extremite'

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WO (1) WO1995004503A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014145053A1 (fr) 2013-03-15 2014-09-18 Thoratec Corporation Dispositif et procédé anastomotique

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1150358A (en) * 1913-12-20 1915-08-17 John Thornton Gilmer Dowel-pin.
US2558132A (en) * 1949-02-05 1951-06-26 Lee B Green Multiple pronged double-ended fastener
US3416821A (en) * 1964-09-29 1968-12-17 Ray Lab Inc Multi-purpose building bracket

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1150358A (en) * 1913-12-20 1915-08-17 John Thornton Gilmer Dowel-pin.
US2558132A (en) * 1949-02-05 1951-06-26 Lee B Green Multiple pronged double-ended fastener
US3416821A (en) * 1964-09-29 1968-12-17 Ray Lab Inc Multi-purpose building bracket

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP0713373A4 *

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014145053A1 (fr) 2013-03-15 2014-09-18 Thoratec Corporation Dispositif et procédé anastomotique

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