U.S. patent number 3,561,448 [Application Number 04/756,583] was granted by the patent office on 1971-02-09 for blood vessel suturing apparatus.
Invention is credited to Jacob Peternel.
United States Patent |
3,561,448 |
Peternel |
February 9, 1971 |
BLOOD VESSEL SUTURING APPARATUS
Abstract
An improved clamp assembly for positioning blood vessels applies
suction to end portions of blood vessels to hold the blood vessels
in a generally cylindrical shape with outwardly flaring ends which
are held in engagement to facilitate interconnecting or sewing
together of the blood vessels. Accordingly, the clamp assembly
includes a pair of sleeves each of which defines a generally
cylindrical manifold which is connected in fluid communication with
a source of vacuum or low pressure. The manifold is also connected
in fluid communication with an interior portion of the sleeve to
thereby apply suction to the outer wall of an empty blood vessel
and draw or urge the wall of the empty blood vessel outwardly to a
shape similar to the normal shape of the blood vessel.
Inventors: |
Peternel; Jacob (Cleveland,
OH) |
Family
ID: |
25044133 |
Appl.
No.: |
04/756,583 |
Filed: |
August 30, 1968 |
Current U.S.
Class: |
606/148; 279/3;
606/150; 606/153 |
Current CPC
Class: |
A61B
17/11 (20130101); A61B 17/0491 (20130101); Y10T
279/11 (20150115); A61B 2017/088 (20130101); A61B
2017/306 (20130101) |
Current International
Class: |
A61B
17/11 (20060101); A61B 17/03 (20060101); A61B
17/30 (20060101); A61B 17/04 (20060101); A61B
17/08 (20060101); A61b 017/11 () |
Field of
Search: |
;128/334,335,346,303,297--300 ;279/3 ;132/38 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
I claim:
1. A clamp assembly for positioning blood vessels to be
interconnected, said clamp assembly comprising first positioning
means for engaging one end portion of a blood vessel, said first
positioning means including first suction means adapted to apply
suction to said one end portion of a blood vessel to thereby hold
said one end portion of a blood vessel in a predetermined shape,
second positioning means for engaging another end portion of a
blood vessel, said second positioning means including second
suction means adapted to apply suction to said other end portion of
a blood vessel to thereby hold said other end portion to a blood
vessel in a predetermined shape generally similar to the shape of
said one end portion of a blood vessel, said first and second
suction means each including means for applying suction to said end
portions in a direction parallel to the longitudinal axis of the
blood vessel so that the ends of said end portions flare outwardly
in a direction substantially perpendicular to the longitudinal axis
of the blood vessel, and support means for supporting said first
and second positioning means for relative movement therebetween and
locating said first and second positioning means in a relationship
relative to each other in which said one end portion of a blood
vessel and said other end portion of a blood vessel are adjacently
located, said means for locating said first and second positioning
means being adapted to retain the flared end portions in abutting
engagement disposed substantially perpendicular to the longitudinal
axis of the blood vessel to facilitate interconnecting said end
portions.
2. A clamp assembly as set forth in claim 1 further including first
valve means for controlling the amount of suction applied to said
one end portion of a blood vessel by said first suction means and
second valve means for controlling the amount of suction applied to
said other end portion of a blood vessel by said second suction
means to thereby enable the amount of suction applied to each of
said end portions to be independently regulated.
3. A clamp assembly as set forth in claim 1 wherein said first and
second positioning means each include a sleeve having a generally
cylindrical inner wall and an outer wall spaced therefrom to form a
manifold having a generally circular cross-sectional configuration
with a plurality of passages formed in said inner wall and
extending substantially perpendicular to the longitudinal axis of
the blood vessel between said manifold and an interior portion of
said sleeve, said manifold being operable to apply suction to an
outer surface of an end portion of a blood vessel located in said
sleeve to hold a substantial portion of the end portion of the
blood vessel in a generally cylindrical shape while said means for
applying suction to said end portion in a direction parallel to the
longitudinal axis of the blood vessel holds the end of said end
portion flared outwardly in a direction substantially perpendicular
to the longitudinal axis of the blood vessel.
4. A clamp assembly as defined in claim 3 further including means
cooperable with said generally cylindrical inner wall to reduce the
cross-sectional area defined by said interior portion of said
sleeve and in which a blood vessel is adapted to be held to thereby
enable said clamp assembly to be utilized with blood vessels of
various diameters.
5. A clamp assembly as set forth in claim 3 wherein said sleeve
includes first and second interconnected sections, said sections
being relatively movable between an open condition in which ends of
said sections are spaced apart to enable the end portion of a blood
vessel to be readily positioned between said sections and a closed
condition in which the ends of said sections are positioned in
engagement to circumscribe the end portion of a blood vessel.
6. A clamp assembly as set forth in claim 5 further including hinge
means for pivotally interconnecting said sections and actuator
means for selectively operating said sections between said open and
closed conditions.
7. A clamp assembly as set forth in claim 6 further including said
means mounted on the ends of said sections for sealing a joint
between said sections when said sections are in said open
condition.
8. A clamp assembly as set forth in claim 1 wherein said means for
supporting and locating said first and second positioning means
includes fluid conduit means connected at one end to said first
positioning means and at another end to said second positioning
means, said fluid conduit means being adapted to be connected to a
source of low pressure to thereby enable said first and second
suction means to apply suction to the end portions of blood
vessels.
9. A clamp assembly as set forth in claim 8 wherein said ends of
said fluid conduit means are resiliently interconnected and tend to
assume a first position, said means for locating said first and
second positioning means further including latch means for holding
said ends of said fluid conduit means in a predetermined
relationship with each other against the influence of said
resilient interconnection to thereby retain said one end portion of
a blood vessel in engagement with another end portion of a blood
vessel.
10. A clamp assembly for positioning blood vessels to be
interconnected, said clamp assembly comprising first positioning
means for engaging one end portion of the blood vessel and applying
suction thereto to thereby hold said one end portion of a blood
vessel in a predetermined shape, second positioning means for
engaging another end portion of a blood vessel and applying suction
thereto to thereby hold said other end portion of a blood vessel in
a predetermined shape generally similar to the shape of said one
end portion of the blood vessel, and means for locating said first
and second positioning means in a relationship relative to each
other in which said one end portion of the blood vessel and said
other end portion of a blood vessel are adjacent to thereby
facilitate interconnecting said end portions, said first
positioning means including means for applying suction to said one
end portion of the blood vessel in such a manner as to tend to
flare said one end portion outwardly, said second positioning means
including means for applying suction to said other end portion of a
blood vessel in such a manner as to tend to flare said other end
portion outwardly, said means for locating said first and second
positioning means being adapted to retain the flared end portions
in abutting engagement, said first and second positioning means
each including a sleeve having a generally cylindrical inner wall
and an outer wall spaced therefrom to form a manifold having a
generally circular cross-sectional configuration with a plurality
of passages formed in said inner wall and extending between said
manifold and an interior portion of said sleeve, said manifold
being adapted to be connected to a source of low pressure to
thereby apply suction to an outer surface of an end portion of a
blood vessel located in said sleeve to hold the end portion of the
blood vessel in a generally cylindrical shape.
11. A clamp assembly for positioning blood vessels to be
interconnected, said clamp assembly comprising first positioning
means for engaging one end portion of a blood vessel and applying
suction thereto to thereby hold said one end portion of a blood
vessel in a predetermined shape, second positioning means for
engaging another end portion of a blood vessel and applying suction
thereto to thereby hold said other end portion of a blood vessel in
a predetermined shape generally similar to the shape of said one
end portion of a blood vessel, and means for locating said first
and second positioning means in a relationship relative to each
other in which said one end portion of a blood vessel and said
other end portion of a blood vessel are adjacent to thereby
facilitate interconnecting said end portions, said first and second
positioning means each including a sleeve having a generally
cylindrical inner wall and an outer wall spaced therefrom to form a
manifold having a generally circular cross-sectional configuration
with a plurality of passages formed in said inner wall and
extending between said manifold and an interior portion of said
sleeve, said manifold being adapted to be connected to a source of
low pressure to thereby apply suction to an outer surface of an end
portion of a blood vessel located in said sleeve to hold the end
portion of the blood vessel in a generally cylindrical shape, said
sleeve having an end wall interconnecting said inner and outer
walls, said end wall having a plurality of passages therein
connected in fluid communication with said manifold for applying
suction to the end portion of a blood vessel in such a manner as to
tend to flare the end portion of a blood vessel outwardly.
Description
This invention relates to a clamp assembly for positioning and
holding blood vessels to be interconnected.
The interconnecting of blood vessels and other tubular body
elements is presently done by hand positioning and sewing or
suturing of end portions of the blood vessels. This hand
positioning and sewing of blood vessels is a time-consuming process
which is particularly onerous when a body organ, such as a kidney
or heart, is transplanted. Accordingly, it is an object of this
invention to provide a new and improved apparatus for facilitating
the interconnection of blood vessels and similar tubular body
elements.
Another object of this invention is to provide a clamp assembly
which applies suction to severed blood vessels in such a manner as
to hold them in a generally cylindrical shape and to tend to flare
the ends of the blood vessels outwardly so that the ends can be
pressed together and sutured.
Another object of this invention is to provide a clamp assembly
which applies suction to empty end portions of blood vessels to
hold them in a shape generally similar to their normal shape and to
position the ends of the blood vessels in engagement to thereby
facilitate their interconnection.
Another object of this invention is to provide a compact sewing
machine for suturing blood vessels held by a clamp assembly
constructed in accordance with the foregoing paragraph.
These and other objects and features of the invention will become
more apparent upon a consideration of the following description
taken into connection with the accompanying drawings wherein:
FIG. 1 is a schematic plan illustration of a clamp assembly
constructed in accordance with the present invention, the clamp
assembly being shown in engagement with end portions of blood
vessels to be interconnected;
FIG. 2 is a schematic illustration, taken on an enlarged scale
along the line 2-2 of FIG. 1, illustrating the relationship of a
pair of sleeves of the clamp assembly to the end portions of the
blood vessels;
FIG. 3 is a schematic sectional illustration, taken on an enlarged
scale at the position of the line 3-3 of FIG. 1, depicting one of
the sleeves of FIG. 2 in an open condition in which the sleeve is
adapted to be positioned relative to the end portion of a blood
vessel before engaging the blood vessel, the sleeve being shown in
dashed lines in a closed condition in which the sleeve engages the
blood vessels;
FIG. 4 is a schematic sectional illustration of the sleeve of FIG.
3 in the closed condition with a pair of inserts for sue in
engaging relatively small blood vessels; and
FIG. 5 is a schematic illustration on an enlarged scale, of a
compact sewing machine for suturing or sewing end portions of blood
vessels held by the clamp assembly of FIG. 1.
The present invention provides a clamp assembly which holds end
portions of empty blood vessels in a generally cylindrical shape by
applying suction to the blood vessels. This suction is applied in
such a manner as to tend to flare the ends of the blood vessels
outwardly. The flared ends of the blood vessels are positioned in
abutting engagement by the clamp assembly to facilitate
interconnecting the blood vessels by sewing or suturing the flared
ends. This sewing or suturing is advantageously performed with a
compact, automatic sewing machine.
Although a clamp assembly 10, constructed in accordance with the
present invention, can be used to facilitate the interconnection of
many different types of tubular body elements, the clamp assembly
is illustrated in FIG. 1 in association with the end portions of a
pair of blood vessels 12 and 14. The blood vessels 12 and 14 are
connected while they are held by positioning assemblies 16 and 18
with the ends 20 and 22 of the blood vessels flared outwardly and
positioned in abutting engagement (see FIG. 2). The outwardly
flaring ends 20 and 22 extend beyond the positioning assemblies 16
and 18 and can be readily stitched or sutured, as indicated
schematically at 24 in FIG. 2, from either or both sides.
Of course, the flow of blood through the blood vessels 12 and 14 is
stopped, by suitable clamps, before the blood vessels are
interconnected. The walls 32 and 34 of the empty blood vessels then
tend to collapse or assume a noncylindrical configuration. When the
blood vessels are so collapsed, it is difficult to position their
ends in matching, uniform engagement for stitching or suturing. To
eliminate this difficulty, the positioning assemblies 16 and 18
include cylindrical sleeves 36 and 38 which hold the end portions
of the blood vessels 12 and 14 in a cylindrical configuration
similar to their normal shape.
In order to hold the end portions of the blood vessels in their
normal shape, the sleeves 36 and 38 include cylindrical inner and
outer walls 42 and 44 which are interconnected by annular end walls
48 to form vacuum or suction manifolds 52 (see FIG. 2). The inner
walls 42 of the sleeves have a generally cylindrical configuration
and define a plurality of passages or apertures 56 which connect
the manifolds 52 in fluid communication with the interior of the
sleeves. The manifolds 52 are connected by a conduit arrangement 60
(FIG. 1) to a vacuum pump or low pressure source 62. Operation of
the vacuum pump 62 provides a vacuum or low pressure in the
manifolds 52 to thereby apply suction to the outer surfaces of the
blood vessel walls 32 and 34 to draw or suck the walls of the blood
vessels into engagement with the interior walls 42 of the sleeves
36 and 38. The walls 32 and 34 of the blood vessels 12 and 14 are
then held in a generally cylindrical shape similar to the shape
which they normally have when blood is flowing through the blood
vessels. In addition, this suction holds the blood vessels against
axial movement relative to the positioning assemblies 16 and
18.
The outwardly flaring ends 20 and 22 of the blood vessels 12 and 14
facilitate positioning and stitching the blood vessels while they
are held by the clamp assembly 10. This outward flaring of the ends
20 and 22 is promoted by the application of suction to the ends
through passages or apertures 66 in the walls 48. Thus, when the
positioning assembly 16 circumscribes the blood vessel 12, the end
20 of the blood vessel 12 is drawn or flared outwardly by suction
applied to the blood vessel through the apertures 66 in the end
wall 48. Although only two apertures 66 have been shown in the end
wall 48, it should be understood that the end wall 48 has a
generally annular configuration and that there are a series of
apertures in the end wall so as to apply suction to the end of the
blood vessel 12 in many different areas about the flared end 20.
The sleeve 38 of the positioning assembly 18 promotes a flaring of
the end 22 of the blood vessel 14 in much the same manner as
previously described in connection with the blood vessel 12.
To facilitate gripping or engaging the blood vessel with the
positioning assemblies 16 and 18, the sleeves 36 and 38 are movable
from an open position, shown in solid lines for the sleeve 36 and
FIG. 3, to a closed position shown in dashed lines in FIG. 3 and
solid lines in FIG. 4. To this end the sleeve 36 includes a first
or upper section 70 and a second or lower section 74 which are
pivotally interconnected at one end by a hinge assembly 78. The
hinge assembly 78 is supported on one tubular arm 80 of the conduit
arrangement 60 and enables the sections 70 and 74 to be pivoted to
the open position shown in FIG. 3 in which a relatively large
opening or mouth 84 is formed between rubber end portions 86 and 88
of the sections 70 and 74. The large opening 84 enables the
sections to be readily located on opposite sides of a blood vessel.
When so located, sections 70 and 74 are moved to the closed
position shown in dash lines in FIG. 3 by operating an actuator
handle or lever 94 which is pivotally connected to the arm 80 (see
FIG. 1). In the closed position, the rubber end portions 86 and 88
of the sections 70 and 74 are brought into sealing engagement so
that the sleeve 36 extends around or circumscribes the blood vessel
12.
Once the sleeve 36 has been positioned around the blood vessel 12,
the vacuum pump 62 is started and air is drawn through the passages
56 into the manifold 52. The air then flows through a flexible
conduit 96 to a passage 98 in the arm 80 and then to flexible
tubing 100 which is connected to the vacuum pump 62. This flow of
air and the suction applied to the blood vessel 12 is controlled by
means of a suitable valve 104 mounted on the arm 80. As was
previously explained, the inward flow of air or suction draws the
wall 32 of the blood vessel 12 outwardly into engagement with the
interior wall 42 of the sleeve 36 to give the blood vessel 12 a
generally cylindrical shape. Also, an inward flow of air through
the passage 66 and the end wall 48 tends to pull or bend the end of
the blood vessel back into an outwardly flaring position.
The sleeve 38 is generally similar in construction to the sleeve 36
and includes a pair of sections which are pivotally mounted on a
second arm 108 of the conduit arrangement 60 by a suitable hinge
assembly 109 (FIG. 1). The sections of the sleeve 38 are pivotal
between an open condition shown in FIG. 3 for the sleeve 36, and a
closed condition by operation of an actuator lever or handle 110
corresponding to the actuator lever or handle 94. The flow of air
and the suction applied by the sleeve 38 to the blood vessel 14 is
controlled by means of a valve 112 mounted on the arm 108.
To enable the sleeves 36 and 38 to be positioned in engagement with
the end portions of the blood vessels 12 and 14 when they are
separated, the arms 80 and 108 are pivotally interconnected at 114.
A spring 116 engages end portions 118 and 120 of the arms 80 and
108 and resiliently presses these end portions of the arms toward
each other to space the sleeves 36 and 38 apart to thereby enable
the separate end portions of the blood vessels 12 and 14 to be
engaged by the clamp assembly 10. Once the blood vessels 12 and 14
have been engaged in the manner previously explained, the arms 80
and 108 are manually grasped and squeezed toward each other against
the influence of the spring 116 to pivot the arms about the
connection 114 to the position shown in FIG. 1. The ends 20 and 22
of the blood vessels are then located in abutting engagement. A
suitable latch or clamp 122 is pivotally mounted at 124 on the arm
80 and engages the arm 108 to hold the arms in the position shown
in solid lines in FIG. 1 against the urging of the resilient spring
116. An adjustment screw 126 is mounted on the clamp 122 to enable
the relative position of the sleeves 36 and 38 to be adjusted. A
suitable aperture is provided in the spring 116 to enable the
flexible tubing 100 to pass through the spring.
It is anticipated that the clamp assembly 10 will be used to
facilitate the interconnection of blood vessels of different
diameters. Accordingly arcuate spacer plates 130 and 132 (FIG. 4)
are provided for use with sleeves 36 and 38 to enable the effective
diameter of the interior of the sleeves to be varied in accordance
with the size of the blood vessels. The spacer plates 130 and 132
are mounted on the sections 70 and 74 and have passages or
apertures 136 which are aligned with corresponding apertures or
passages 56 in the sleeves 36 and 38 to connect the interior of the
sleeves in fluid communication with the suction manifolds 52.
Once the ends 20 and 22 of the blood vessels have been positioned
as shown in FIGS. 1 and 2 by the clamp assembly 10, the abutting
ends of the blood vessels are stitched or sutured, as is indicated
schematically at 24 in FIG. 2, to interconnect the blood vessels.
It is contemplated that this stitching or suturing will be done
either manually or by means of a suitable sewing device. The
outwardly flaring ends 20 and 22 are held by the clamp assembly 10
so as to be easily accessible to facilitate manual or machine
sewing from either or both sides. A machine 144 which is adapted
for sewing the ends 20 and 22 of the blood vessels 12 and 14 is
illustrated in FIG. 5. However, it should be understood that many
different type of machines or devices can be used in conjunction
with the clamp assembly 10 to sew blood vessels and other tubular
body elements together. For example, a manually operated sewing
machine similar to that disclosed in U.S. Pat. No. 2,928,363 could
be used.
The sewing machine 144 is relatively compact and is electrically
operable to enable the stitches 24 to be quickly sewn with a
minimum of effort. To this end the sewing machine 144 includes
solenoid 148 which energizable to move a needle 150 through the
ends 20 and 22 of the blood vessels, that is to the left as viewed
in FIG. 5. A rack 154 is moved by the solenoid 148 with the needle
150 to drive a spur gear 156 connected to a hook 158. The hook 158
operates in a known manner to engage thread 160 extending through
an eye of the needle 150 to form a stitch on the reverse stroke of
the solenoid. The needle 150 and stitches 24 are positioned
relative to the ends 20 and 22 of the blood vessels 12 and 14 by
engagement of an end portion 161 of the sewing machine 144 with the
sleeves 36 and 38. The thread 160 is advantageously supplied to the
needle 150 from a spool 162 mounted on a casing 164 of the sewing
machine 144. The solenoid 148 is energized by pressing an actuator
button 170 connected to leads 174 and 176 from a suitable source of
power.
In view of the foregoing description, it can be seen that the clamp
assembly 10 facilitates the interconnection of blood vessels and
similar tubular elements of the body by applying suction to them to
hold them in their normal, generally cylindrical shape with the
ends of the blood vessels flaring outwardly. These outwardly
flaring ends are positioned in an abutting engagement so that they
can be readily interconnected by either manual sewing or by means
of a sewing machine, similar to the sewing machine 144 of FIG. 5.
The suction is transmitted to the sleeves 36 and 38 through hollow
tubular arms 80 and 108 which also function as a handle to locate
the sleeves in a desired relationship relative to the blood vessels
when the sleeves are in the open condition illustrated in FIG. 3.
Once the blood vessels have been engaged by the sleeves 36 and 38
and brought together against the influence of the spring 116, the
outwardly flaring ends 20 and 22 are held in engagement and are
easily accessible for sewing or suturing.
* * * * *