U.S. patent number 3,593,903 [Application Number 04/744,518] was granted by the patent office on 1971-07-20 for surgical instrument for suturing hollow organs in infants.
This patent grant is currently assigned to Vsesojuzny naushno-issledovatelsky institut khirurgicheskoi apparatury i. Invention is credited to Georgy Vasilievich Astafiev, Vitaly Rafailovich Belkin, Tatiana Lukianovna Ivanova, Elena Georgievna Kryazheva, Anatoly Nikolaevich Ozhgikhin.
United States Patent |
3,593,903 |
Astafiev , et al. |
July 20, 1971 |
SURGICAL INSTRUMENT FOR SUTURING HOLLOW ORGANS IN INFANTS
Abstract
A surgical instrument is provided for suturing hollow organs in
infants and comprises an oblong tubular body with an open tapered
front end with staple slots spaced around the periphery thereof and
an oblong hollow rod passes inside the body and is capable of axial
movement therealong. A cylindrical staple ejector is loosely
mounted on the rod and is provided with toothlike pins spaced
around its periphery to fit into the slots in the body. An elastic
member is mounted between the rod and the ejector so that a
constant travel rate is obtained for the staple ejector. A stem is
mounted inside the hollow rod so as to be free to move axially and
to rotate around its own axis when extended all the way out of said
body, the front end of the stem being pointed and supporting a
detachable tapered head having a surface facing the body with
staple bending depressions spaced around the periphery of the
head.
Inventors: |
Astafiev; Georgy Vasilievich
(Moscow, SU), Ozhgikhin; Anatoly Nikolaevich (Moscow,
SU), Ivanova; Tatiana Lukianovna (Moscow,
SU), Belkin; Vitaly Rafailovich (Moscow,
SU), Kryazheva; Elena Georgievna (Moscow,
SU) |
Assignee: |
Vsesojuzny naushno-issledovatelsky
institut khirurgicheskoi apparatury i (Moscow,
SU)
|
Family
ID: |
27429311 |
Appl.
No.: |
04/744,518 |
Filed: |
July 12, 1968 |
Current U.S.
Class: |
227/96; 227/19;
227/76 |
Current CPC
Class: |
A61B
17/115 (20130101); A61B 17/1155 (20130101); A61B
17/32053 (20130101); A61B 17/34 (20130101) |
Current International
Class: |
A61B
17/115 (20060101); A61B 17/03 (20060101); A61B
17/34 (20060101); A61B 17/32 (20060101); B25c
005/02 () |
Field of
Search: |
;227/19,76 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Custer, Jr.; Granville Y.
Claims
What we claim is:
1. An instrument for suturing hollow organs in infants, said
instrument comprising an elongated tubular body with an open
tapered forward end having staple slots spaced along the periphery
thereof; an elongated hollow rod passing inside said body and
capable of axial movement with respect thereto; a cylindrical
staple ejector freely mounted on said rod and including a plurality
of peripherally arranged pins engaged in said slots in the body; a
spring member between said rod and ejector to provide for relative
movement between the rod and the ejector; a stem disposed inside
said rod for axial movement, and for rotation about its axis in a
fully extended position relative to the body, said stem having a
pointed forward end extending out of the open forward end of the
body and a rear portion; a supporting head detachably mounted on
said pointed forward end of said stem and having a broad end
portion facing rearward in the direction of the body, said end
portion of the head having a cylindrical recess and staple bending
depressions. said depressions being provided peripherally on the
end portion of said head; means on said rod and said head for
cutting tissues placed in said recess; means coupling said stem
with the body for holding the stem in the body and manually
actuated means for axially moving said rod and ejector in said body
so that staples in said slots are pushed out of said slots to
puncture the tissues to be sutured and be bent in said staple
bending depressions.
2. An instrument as claimed in claim 17 wherein the means for
cutting tissues comprises a puncher disposed inside the body and
attached to the rod at the forward end thereof and interacting in
operation with an edge of said cylindrical recess in the end
portion of the supporting head.
3. An instrument as claimed in claim 2 wherein the spring member
comprises a split washer freely mounted on the puncher and disposed
inside said body between the forward end of said rod and the staple
ejector, the latter also being freely mounted on the puncher.
4. An instrument as claimed in claim 2 wherein the puncher includes
a cylindrical projection at the forward end thereof for forcing the
sutured tissues into said cylindrical recess of the supporting
head.
5. An instrument as claimed in claim 1 comprising a manually
actuated knob on said rear portion of the stem with a roughened
surface for moving the stem in said rod.
6. An instrument as claimed in claim 1 wherein said supporting head
has flat regions on opposite sides thereof to allow reliable
holding by a clamping means.
7. An instrument as claimed in claim 1 wherein the means coupling
the stem with the body comprises a retainer secured at the rearward
portion of the body.
8. An instrument as claimed in claim 1 wherein said manually
actuated means for axially moving the rod with the ejector
comprises movable and fixed handles, each secured to the body and
mean coupling the movable handle and rod such that when the movable
handle is moved relative to the fixed handle the rod is moved
therewith.
Description
This invention relates to surgical instruments for applying
circular staple sutures when placing anastomoses on hollow organs
and, more specifically, to instruments for placing esophageal
anastomoses in newborn infants in cases of atresia.
Known in the present day surgical practice are surgical instruments
for placing circular anastomoses between hollow organs (cf. USSR
Author's Certificates Nos. 195,041 and 141,589; patents: Great
Britain No. 942,122, U.S. No. 3,193,165, Canada No. 736,256,
Switzerland No. 407,407, France No. 1,349,201 and No. 1,461,464,
Italy No. 674,174 and 724,978, Japan No. 456,544, Belgium No.
668,917). Said instruments feature a tubular body carrying a staple
portion , said tubular body housing a central stem and a movable
hollow rod with a cylindrical knife and a staple ejector, a
detachable supporting head with depressions for bending the staple
ends and a circular recess at whose bottom a replaceable plastic
washer is located.
Located inside said supporting head, in the course of the
instrument operation, are: a stem connecting the supporting head to
the staple portion, the cylindrical knife and the tissues being
sutured which are fixed between the end faces of the staple and
supporting portions of the instrument.
The aforementioned known instruments are impracticable for suturing
the esophagus in newborn infants in the case of atresia thereof,
this being due to anatomical peculiarities inherent in newborn
infants, mostly on account of the small size of their organs, as
well as due to the fineness and delicacy of the tissues
thereof.
An instrument designed for suturing the esophagus in newborn
infants should have the diameter of its working portions (i.e., the
tubular staple portion and the supporting head) not exceeding 6 or
7 mm., since for placing anastomotic sutures, said portions are to
be introduced into the inner cavity of those sectors of the
esophagus which are to be sutured.
It is evident that the inner space of the supporting head of such a
diameter is not sufficient to accommodate all the necessary
components for obtaining a high-quality suture and for making an
incision to obtain an anastomotic aperture through which the
sutured portions are free to intercommunicate.
Appertaining to the aforementioned components are: the depressions
for bending the staples, said depressions being provided on the end
face surface of the abovesaid supporting head; the cylindrical
knife capable of cutting an aperture for a free communicating
between the sutured portions of the esophagus; the stem connecting
the supporting head of the instrument to the staple portion
thereof; the circular recess at the bottom of which the replaceable
plastic washer is provided, said recess serving to accommodate the
esophageal ends being sutured and to excise the surplus tissue to
restore a free permeability of the organ involved.
Moreover, to provide a reliable excision of the anastomotic
aperture and a minimum traumatic lesion inflicted upon the living
tissues, a slitlike gap or clearance should be provided between the
inner surface of said circular recess and the outer surface of the
cylindrical knife, said gap or clearance being in excess of twice
the maximum thickness of the esophageal walls being sutured.
A free spaces should be left between the inner surface of the knife
and the stem for the lower end of the esophagus constricted with a
purse string or circumflexional suture to freely sink
thereinto.
Apparently, it is by reason of the difficulties mentioned above
that despite the great progress in mechanization of the process of
placing sutures during surgical operations and the wide variety of
special suturing instruments available, there has not been
previously suggested any instrument which is capable of placing
anastomoses between the esophagus sections in the case of its
atresia occurring in newborn infants.
It is therefore a primary object of the present invention to
develop a small-size surgical instrument for suturing the esophagus
in newborn infants in the case of its atresia.
It is a specific object of the present invention to provide such a
surgical instrument that is capable of quickly and reliably placing
a circumferential anastomotic suture, as well as to provide a
guaranteed excision of the surplus tissue to restore the lumen of
the sutured esophagus with a minimum traumatic lesion inflicted
upon the tissues thereof during the process of placing an
anastomosis.
To accomplish the objects mentioned above, provision is made in the
body of the instrument of the invention for an elastic or springy
member capable of insuring a constant rate of travel of the staple
ejector at various rates of travel of the rod carrying a puncher,
whereas the central stem is free to move reciprocally along the
body and to rotate around its own axis when extended all the way
out of the body.
With a view to attaining a simple and reliable operation of the
instrument, said elastic member is made as a split washer loosely
set over the rear portion of the puncher and located inside the
instrument body between the end of the rod and the end face of the
staple ejector which is likewise set freely on the rear portion of
said puncher.
For the purpose of saving space, the cutting device has a puncher
associated with the rod and is adapted to interact, during the
operation, with the edge of acylindrical depression or recess
provided at the face end of the supporting head which receives the
puncher.
According to the invention said puncher is provided with a
cylindrical projection for the tissues being sutured which is
inserted into said cylindrical depression or recess in the
supporting head.
In accordance with the present invention, for the purpose of
convenience, the central stem has a cylindrical tailpiece with a
knurled or milled surface, whereas the supporting head has flat
regions for a reliable holding of said head by a clamping tool.
An embodiment of the present invention is described hereinbelow by
way of example with reference to the appended drawings,
wherein:
FIGS. 1 and 2 are, respectively, a side elevation and a plan view
of the surgical instrument for suturing hollow organs in
infants;
FIG. 3 is a longitudinal section of an operative end portion of the
instrument shown in FIGS. 1 and 2;
FIG. 4 is a section taken on line A-A of FIG. 3;
FIG. 5 is a section taken on line B-B of FIG. 1; and
FIG. 6 is a sectional view showing the operation of the instrument
according to the invention.
Referring to FIGS. 1 and 2, the instrument of the invention
comprises an oblong tubular body 1, a movable handle 2 articulated
with the body at the rear portion thereof and a stationary handle 3
rigidly coupled to the body 1.
Located inside the front portion of the body 1 is a splined bushing
4 fixed in position so as to form staple slots 5 (FIGS. 3,4) in
combination with the inner surface of the body 1.
A tubular rod 6 passes inside tubular body 1, said rod carrying at
its front end a puncher 7 threaded thereto. The puncher 7 has a
rear portion or tailpiece 8 on which is loosely supported a
cylindrical-shaped staple ejector 9 and a split spring washer 10.
The washer 10 affords the possibility for the puncher 7 to move
with respect to the staple ejector 9 over a length corresponding to
the range of the suturing gap spacing or, in other words, the
provision of the spring washer makes it possible, with the travel
of the staple ejector 9 being invariable, for the travel of the rod
6 along with the puncher 7 to vary within a required range.
The front end of the puncher 7 is fashioned as a cylindrical
portion 11 which extends beyond the body 1 (FIGS. 1,3).
The rod 6 is movable lengthwise of the instrument body 1 by means
of a linkage coupled to the movable handle 2 and including an
actuating arm 12 of fork-shape passing through an opening 13 in
body 1 so as to straddle the rod 6 on lateral surfaces 14 thereof
(FIG. 1).
In order to secure the movable handle against movement, a swivel
safety lock 15 (FIGS. 1,2) is provided.
Spaced around the periphery of the cylindrical staple ejector 9 are
toothlike pins 16 adapted to fit onto the staple slots 5 to drive
staples therefrom under the action of the rod 6 (FIG. 3).
Extending inside the tubular rod 6 and the puncher 7 is a stem 17
whose front pointed end 18 is screwed into a supporting head 19. A
knob 20 on the rear of stem 17 is cylindrical and its outer surface
is knurled to facilitate manipulation thereof (FIGS. 1 and 2).
The supporting head 19 is made up of two portions, namely, tapered
portion 21 and portion 22, so interconnected that the tapered
portion can rotate independently around its axis, while the portion
22 remains stationary (FIG. 3). This is achieved by the
construction shown in FIG. 3 wherein the tapered portion 21 is
loosely mounted on a cylindrical projection 60 of portion 22, said
portion 60 having a circular groove 42 disposed therein and loosely
accommodating end portions 41 of two screws 40 screwed into the
tapered portion 21.
At the rear of the supporting head 19 is a cylindrical recess 23
for receiving the lower end of the esophagus to be sutured by
forcible insertion by the cylindrical projection 11 on the puncher
7 (FIGS. 3 and 6).
Spaced around the periphery of the rear portion of the supporting
head 19 are staple bending depressions 24. In order to insure that
the supporting head is set in definite position with respect to the
stem 17, provision is engaged in a longitudinal groove 26 (FIG. 3)
made on projection 60 of portion 22 for a fixed guide key which
engages in a longitudinal groove 26 (FIG. 3) at the end 18 of the
stem 17. When the pointed end 18 of the stem 17 is introduced into
the supporting head 19, the guide key 25 enters the groove 26
provided on the stem 17, thus preventing the cylindrical portion 22
from rotating about the stem 17 and ensuring a strictly definite
position of the portion 22 relative to the stem in the circular
direction. The stem 17 is then further advanced into the head 19 by
rotating stem 17 while holding portion 19 against rotation as will
be explained more fully later.
The tapered portion 21 of the head is provided with two flat
regions 27 for the engagement of the supporting head 19 by a
clamping tool (FIGS. 1,2).
In order to insure that the staple slots 5 in the body 1 are in
strict alignment with the staple bending depressions 24 in the rear
end of the supporting head 19, the stem 17 occupies an angular
fixed position with respect to the instrument body 1. This is
attained by the provision of a washer 28 having a profiled opening
whose shape corresponds to that of the cross-sectional area of the
stem 17, and by the presence of projections 30 adapted to fit into
corresponding slots in the body 1 (FIG. 5).
The washer 28 is fixed to the body 1 by means of a nut 31 (FIGS.
1,2,5).
The stem 17 is provided with two transverse slots 32, 33 and an
annular recess 34 (FIG. 1).
When the slot 32 receives a swivel retainer 35 a required suturing
gap is obtained between the rear end of of head 19 and the front
end of body 1 (FIG. 1).
The slot 32 is inclined relative to the axis of the stem 17 so that
the lower portion of the retainer 35, while sliding over the walls
of the slot 32, causes the supporting head 19 either to approach
the front end of the body 1 or to move away from it within the
spacing range of the suturing gap.
The slot 33 serves for locking the stem 17 by the retainer 35 in
such a position that pointed end 18 is completely retracted inside
the body 1.
The recess 34 makes it possible for the stem 17 to rotate about its
own axis when the recess 34 is aligned with the profiled opening 29
in the washer 28, viz. With the pointed end 18 of the stem 17
extended all the way out of the body 1.
INSTRUMENT APPLICATION TECHNIQUE
Prior to making use of the instrument it should be loaded with
staples and sterilized.
This done, the instrument is prepared for operation, for which
purpose the movable handle 2 is locked by the safety lock 15, the
supporting head 19 is unscrewed from the instrument and the pointed
end 18 of the stem 17 is retracted into the body 1, whereupon the
stem is fixed in that position by the engagement of the retainer 35
in slot 33.
Then, the body 1 of the instrument is introduced perorally into the
upper blind section of the patient's esophagus.
When cylindrical projection 11 extending from the body 1 reaches
the bottom of the upper blind section of the esophagus, the stem 17
is released by withdrawing the retainer 35 from slot 33 and the
stem is moved all the way forward by manual manipulation of knob
20. As a consequence, the pointed end 18 of the stem 17 pierces the
bottom of the esophagus penetrates into the operational wound, the
cylindrical projection 11 penetrating the into the wound through
the resulting hole together with the stem 17.
By the use of any suitable clamping tool, the tapered portion 21 of
the supporting head 19 is held by its flat regions 27 provided for
the purpose, and the head 19 is introduced into the operational
wound to fit over the pointed end 18 of the stem 17 so that the
guide key 25 of the portion 22 of said head engages in the groove
26 in the stem 17. Thereupon the stem is rotated by turning knob 20
until it is screwed home into the tapered portion 21 of the
supporting head 19. When assuming that position, the stem 17 is
free to rotate, since the recess 34 provided therein is located in
the profiled opening 29 in the washer 28.
Having been made fast on the stem 17, the head 19 is introduced
into the lumen of the lower section of the esophagus. This done, a
purse string or circumflexional suture is drawn tightly around the
stem 17 and tied thereon, said suture being preliminarily placed on
the edge of the lower section of the esophagus.
Then, the head 19 together with the lower end of the esophagus
fixed thereto is brought by the knob 20 of the stem 17 closer to
the instrument body 1. When so doing, the lower end of the
esophagus drawn tight with a purse string or circumflexional suture
rests with its edge against the projection 11 of the puncher 7
extending out of the upper blind section of the esophagus and is
thus caused to insert into the recess 23 in the supporting head 19,
whereby both the upper blind section and the lower section of the
esophagus can be juxtaposed correctly and tightly. Then the stem 17
together with the supporting head 19 is fixed in that position by
the engagement of the end of retainer 35 into the transverse slot
32.
Then, the movable handle 2 is released by turning the safety lock
15 and is pressed towards handle 3, whereby suturing is
attained.
At the moment the handles 2 and 3 are brought together, a circular
staple suture is driven into place by pins 116 and an excision of
the tissues is performed (in a manner to be explained later) to
provide for a free communication between the upper blind section
and the lower sections of the esophagus that have been sutured
(FIG. 6).
The formation of an anastomotic aperture in the sutured sections of
the esophagus is effected by the puncher 7 which engages the sharp
edge 37 of the portion 22 of the supporting head 19 by its bevelled
edge 36 to punch out a round aperture.
Upon the formation of an anastomosis, the movable handle 2 is
returned to its initial position and is fixed therein with the
safety lock 15.
Then, the stem 17 is released by removing the retainer 35 and is
moved forward, thus causing the supporting head 19 to move away
from the body. Next, the body 1 of the instrument is likewise moved
slightly forward. Owing to the tapered shape of the working end 36
of the body 1 it is free to pass inside the sutured sections of the
esophagus and through the anastomotic suture thus obtained.
Once the working end of the instrument body as passed beyond the
anastomotic suture, the supporting head is brought closer to the
body by the displacement of stem 17, whereupon the entire
instrument is extracted from the esophagus.
* * * * *