U.S. patent number 3,638,652 [Application Number 05/042,075] was granted by the patent office on 1972-02-01 for surgical instrument for intraluminal anastomosis.
Invention is credited to James L. Kelley.
United States Patent |
3,638,652 |
Kelley |
February 1, 1972 |
SURGICAL INSTRUMENT FOR INTRALUMINAL ANASTOMOSIS
Abstract
An instrument for use by surgeons particularly in cases
involving resection and anastomosis of vascular and digestive tract
organs. The instrument is dimensioned for insertion of the
principal parts of the instrument into the open ends of or through
stab wounds in the lumena after resection and the actual
anastomosis is by stapling the tissue entirely around the stoma
which is formed by an endless knife, illustrated as annular, and
the tissue cut away to form the stoma is conveniently removed with
instrument. The staples and knife are in a replaceable cartridge.
Remote power means connected by a flexible conduit allows maximized
ease of maneuverability of the principal parts of the instrument
during actual surgical procedure.
Inventors: |
Kelley; James L. (San Diego,
CA) |
Family
ID: |
21919904 |
Appl.
No.: |
05/042,075 |
Filed: |
June 1, 1970 |
Current U.S.
Class: |
227/179.1;
227/76; 227/19 |
Current CPC
Class: |
A61B
17/115 (20130101); A61B 17/32053 (20130101); A61B
2017/00539 (20130101); A61B 2017/00973 (20130101); A61B
17/1155 (20130101) |
Current International
Class: |
A61B
17/115 (20060101); A61B 17/32 (20060101); A61B
17/03 (20060101); A61B 17/00 (20060101); A61b
017/32 (); A61b 017/11 () |
Field of
Search: |
;227/19,76
;128/305,334R,334C,335 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
I claim:
1. A surgical instrument for intraluminal anastomosis,
comprising:
a cartridge having at least one row of staples forming a closed
loop;
a head receiving said cartridge and having staple pusher means
engaging the bight portions of said staples;
an actuator having an anvil and a power-operated link joining said
head and actuator and adapted to move said head, including said
pusher means toward said anvil thus discharging and clinching said
staples;
a stoma-forming knife in said head generally conforming to and
disposed inside said row of staples; and
means to disengage said link from said head, thus permitting
removal of the instrument along with the tissue excised by said
knife.
2. A surgical instrument according to claim 1 wherein said staple
pusher means in said cartridge as loaded into said head extend from
a face of said cartridge toward said head.
3. A surgical instrument according to claim 2 wherein said pusher
means is a plurality of individual pins discrete from each
other.
4. A surgical instrument according to claim 1 wherein said actuator
has means to receive said knife and said head has knife pusher
means extending similarly to said staple pusher means from said one
face of the cartridge.
5. A surgical instrument according to claim 4 wherein said knife
pusher means is an annular sleeve discrete from said knife.
6. A surgical instrument according to claim 1 wherein said actuator
comprises a small disclike element having an axial length
comparable to said head so that the axial length of the
head-actuator assembly is less than twice the diameter of the
knife.
7. A surgical instrument according to claim 1 wherein said actuator
comprises a short cylinder with a piston operatively mounted
therein to reciprocate said link and having a flexible conduit to
connect said cylinder with a source of pressurized fluid, the
flexibility of said tube making the head-actuator assembly easily
maneuverable in use.
8. A surgical instrument according to claim 1 wherein said actuator
has a cylinder with a piston therein connected to said link, and a
remote fluid pressure means operatively connected with said
cylinder.
Description
BACKGROUND OF THE INVENTION
Stapling as such in anastomosis is not new. Prior art instruments
include means for transection of organs with simultaneous stapling
of the stub ends. The provision of a stoma between parallel rows of
staples by means of a knife cutting the tissue between the rows of
staples is standard procedure, the usual steps including making
adjacent stab wounds in both lumena and inserting rectilinear forks
carried by mating portions of a prior art anastomizing instrument,
clamping the portions together and stapling in spaced rows and then
moving a knife longitudinally between the rows, with the necessary
final steps of closing the stab wounds. The intraluminal feature of
this invention is also approached in prior art end to end
anastomosis. However, in the prior art the lumena are brought
together with both open ends facing in the same direction. A
stapler-incisor instrument then is used to connect the juxtaposed
tissue with two spaced, parallel rows of staples with a stoma
therebetween and upon removal of the instrument the ends of both
lumena are closed. Finally, it is noted that provision of staples
in a cartridge and the discharging of staples in a tow,
progressively along such a row, has been done previously.
SUMMARY OF THE INVENTION
The instant invention is an instrument which actually excises a
considerable portion of tissue to form a more perfect stoma inside
an endless double row of staples. The two principal parts, both
simple assemblies, are inserted in opposite directions into the
open overlapped ends of the lumena which may face in opposite
directions and no stab wounds requiring later closing need be made.
The parts of the instrument are small and maneuverable even in "low
down" cramped surgical areas and the remote power activation
contributes to this maneuverability.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side elevation view of the apparatus with the actuator
and head connected after insertion in the open ends of overlapping
lumena shown in dashline;
FIG. 2 is a sectional view taken on line 2--2 of FIG. 1;
FIG. 3 is a sectional view taken on line 3--3 of FIG. 2, but with
the head assembly in closed position;
FIG. 4 is a sectional view similar to FIG. 3, showing the
components separated after use;
FIG. 5 is a top plan view of the staple cartridge; and
FIG. 6 is an enlarged sectional view taken on line 6--6 of FIG.
5.
DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT
The environment wherewith this invention is to be used will vary
considerably but the principal uses will include resection of
vascular and digestive tract organs with anastomosis accomplished
by stapling together juxtaposed portions of the walls of the
concerned lumena. The lumena involved in the resection, in the
example illustrated in FIG. 1, and indicated by the numerals 10 and
12 and these overlapped open ended portions face in the opposite
direction rather than in the same direction as in some prior art
procedures. The head assembly 14 is provided with a short handle 16
whereby it can be inserted into the open end of the lumen 12 and
the actuator assembly 18 is similarly inserted into the lumen 10 by
a handle portion 20 which doubles as part of a fluid power
transmission conduit 22 leading to a pedal operated control 24.
The head assembly 14 comprises a cup 26 centrally apertured to
receive a plunger 28 constituting a link with the piston 30
operating in the cylinder 32 of the activator 18. The outer end of
the cylinder 32 is closed by an end plate 34 and FIGS. 3 and 4
indicate how the fluid power conduit 22 feeds through the handle 20
into said cylinder 32.
The cup 26 initially receives the replaceable cartridge 36 which,
as first inserted in the cup 26, has preferably two radially spaced
endless rows of peripherally spaced staples 38, the drawings
showing the cartridge as a simple annulus and in this case a bead
40 or the equivalent is required on the exterior of the cartridge
for fixed indexing of the cartridge relative to the cup 26. This is
necessary because the staples 38 must be accurately aligned with
the terminal turning recesses 42 of the anvil portion 44 in the
actuator. To carry out this indexing function, again assuming that
the cylinder 32 and piston 30 are also recticylindrical, the piston
is indexed to the end plate by a pin 46 and the cup 26 has a notch
48, best shown in FIG. 4, to receive a T-bar 50 on the distal end
of the link or plunger 28. The notch 48 may be formed at the
junction of ramps 52 on the outer end face of the cup 26.
To discharge the staples 38 the cup 26 is pulled toward the anvil
44 to activate pusher means represented as a plurality of pins 54,
one for each staple, which initially are only partially entered
into the cartridge body as indicated in FIGS. 2 and 6. The pins are
flattened or strap shaped as indicated in the dash line
representation thereof in FIG. 6.
A knife 56, represented as annular, is frictionally supported on
the inner periphery of the cartridge 36 with the cutting edge
slightly inside the corresponding face of the cartridge as shown in
FIGS. 2 and 6. Pusher means for the knife is a sleeve 58 which,
like the pins 54, extends from the opposite face of the cartridge.
A recess 60 in the actuator is dimensioned for snug reception of
the knife with a shearing action.
While a hydraulic actuator is illustrated electrical or purely
mechanical actuation can be used to move the plunger 28.
The operation of the apparatus has been referred to supra but in
brief recapitulation is as follows. The organs to be anastomosed
are disposed as indicated in FIG. 1 or with both open ends facing
in the same direction, or with one or both ends closed. In the last
mentioned case one or two wounds are made to admit the head and
actuator. In any case a stab wound is made for insertion
therethrough of the plunger 28 for connection with the head 14 with
the cartridge 36 therein. Indexing of the anvil and staples is
assured when the T-bar 50 is entered in the notches 52. Depression
of the pedal control 24 forces the piston 30 to draw the head
assembly 14 toward the actuator 18 with the pusher pins 54
discharging the staples through the walls of the lumena 10 and 12.
At the same time the pusher sleeve 58 drives the knife 56 through
the tissue to be frictionally held in the recess 60 of the
actuator, there being a desirable shearing action involved during
the excising of a disk of tissue indicated at 62 as in FIG. 3.
Disengagement of the head 14 from the actuator 18 and removal of
both from the lumena 10 and 12 and closure of the open ends thereof
completes the anastomosis where the invention is used as indicated
in FIG. 1. In all cases the disk of tissue at 62 excised by the
knife 56 is more or less automatically removed with the actuator 18
creating the stoma 64 indicated in FIG. 4. The cartridge and knife
are discarded and the head 14 and actuator 18 can be sterilized for
reuse with a replacement cartridge.
* * * * *