U.S. patent number 3,805,793 [Application Number 05/343,224] was granted by the patent office on 1974-04-23 for anastomotic apparatus.
Invention is credited to Sanford J. Wright.
United States Patent |
3,805,793 |
Wright |
April 23, 1974 |
ANASTOMOTIC APPARATUS
Abstract
An anastomotic apparatus including an outer tubular member
connected with a source of vacuum pressure for holding the open end
of a donor blood vessel in contact with the side wall of a
recipient vessel, thereby permitting adhesive joining of the
vessels. To test the anastomosis seal, a source of positive
pressure is provided for pressurization of the interior of the
outer tubular member. The anastomotic apparatus also includes an
inner tubular member concentrically mounted within the outer
tubular member having a cutting head secured to the lower end
thereof which may be advanced to remove that portion of the
recipient vessel circumscribed by the sealed end of the donor
vessel. In one embodiment, the cutting head includes a plurality of
cutter blades attached to and extending axially from the lower end
of the inner tubular member. In a second embodiment, the cutting
head includes an electrical resistance heating wire for cutting the
recipient blood vessel by cauterization.
Inventors: |
Wright; Sanford J. (Everett,
WA) |
Family
ID: |
23345210 |
Appl.
No.: |
05/343,224 |
Filed: |
March 21, 1973 |
Current U.S.
Class: |
604/22; 72/71;
408/138; 606/29; 606/153 |
Current CPC
Class: |
A61B
17/32053 (20130101); A61B 17/11 (20130101); A61B
2017/00725 (20130101); A61B 2017/00707 (20130101); A61B
17/00491 (20130101); A61B 2017/1135 (20130101); Y10T
408/68 (20150115); A61B 2017/306 (20130101); A61B
2018/00291 (20130101); A61B 17/32 (20130101); A61B
18/082 (20130101) |
Current International
Class: |
A61B
17/11 (20060101); A61B 17/32 (20060101); A61B
17/03 (20060101); A61B 17/30 (20060101); A61B
18/08 (20060101); A61B 18/04 (20060101); A61B
17/00 (20060101); A61b 017/04 (); A61b 017/32 ();
A61m 005/00 (); A61m 025/00 () |
Field of
Search: |
;128/348,214R,334R,305
;72/71 ;408/138 ;137/318 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Medberry; Aldrich F.
Attorney, Agent or Firm: Gardiner, Sixbey, Bradford &
Carlson
Claims
I claim:
1. An anastomotic apparatus for joining the open lumen end of a
donor vessel to the side wall of a recipient vessel in which
biological fluids are flowing, comprising
a. support means for supporting the open end of the donor vessel in
contact with the side wall of the recipient vessel;
b. selective actuable means for holding the support means and the
open end of the donor vessel in sealed contact with the side wall
of the recipient vessel without interrupting the flow of biological
fluids in the recipient vessel;
c. hollow lumen cutting means positioned substantially within said
support means for cutting through and removing a portion of the
side wall of the recipient vessel circumscribed by the interior
edge of the sealed end of the donor vessel; and
d. selectively controlled suction means connected to the support
means for securing the removed wall portion, whereby the vessel
lumens may be brought into fluid communication.
2. An anastomotic apparatus as defined in claim 17 further
including test means connected with said support means for
pressurizing the interior of the donor vessel adjacent the seal to
test the integrity of the seal between the donor vessel and the
side wall of the recipient vessel.
3. An anastomotic apparatus as defined in claim 18 wherein said
support means includes
a trocar tip removably connected with a first end of said tubular
member, said trocar tip being rounded at the outer end to
facilitate insertion of said outer tubular member into the interior
of the donor vessel.
4. An anastomotic apparatus as defined in claim 3 wherein said
cutting means includes an inner tubular member mounted
concentrically within said outer tubular member and having cutter
head means located at a first end of said inner tubular member for
severing the side wall of the recipient vessel, said inner tubular
member being movable between a retracted position in which said
trocar tip may be secured to said outer tubular member and an
extended position in which said cutter head means may engage the
side wall of the recipient vessel circumscribed by the open end of
the donor vessel.
5. An anastomotic apparatus as defined in claim 4 wherein said
cutting means contains a central passage extending between the
other end of said inner tubular member and the outer surface of
said cutter head means, said central passage being connected with
said source of vacuum when said inner tubular member is moved to
said extended position, whereby the portion of the side wall of the
recipient vessel removed by said cutter means may be retained
against said cutter head means by a pressure differential created
by said vacuum source.
6. An anastomotic apparatus as defined in claim 4 wherein said
inner tubular member includes a pair of sealing rings mounted on
the outer surface thereof adjacent each end of said inner tubular
member and wherein said outer tubular member includes
a. a plurality of openings extending between the outer
circumferential surface of the outer tubular member and the space
between said inner and outer tubular member extending between said
pair of sealing rings, and
b. coupling means for connecting said space between said inner and
outer tubular members selectively with sources of vacuum, positive
pressure or lubrication.
7. An anastomotic apparatus as defined by claim 4 wherein said
cutter head means includes a plurality of cutter blades mounted in
an axially extending position on said first end of said inner
tubular member.
8. An anastomotic apparatus as defined in claim 18 wherein said
first end of said outer tubular member is concave with a radius of
curvature approximately equal to the radius of curvature of the
recipient vessel.
9. An anastomotic apparatus as defined in claim 3 wherein said
outer tubular member contains a plurality of apertures providing a
passage between the interior and the circumferential surface of
said tubular member and wherein said trocar tip contains a
plurality of channels also providing a passage between the interior
of said outer tubular member and the outer surface of said trocar
tip.
10. An anastomotic apparatus as defined in claim 18 wherein said
outer tubular member includes a support appendage adapted for
connection with a solid stable support.
11. An anastomotic apparatus as defined in claim 8 wherein said
first end includes a plurality of sharp points projecting axially
of said outer tubular member, whereby the recipient vessel is
prevented from twisting during the cutting operation.
12. An anastomotic apparatus as defined in claim 10 wherein said
source of vacuum communicates selectively with the interior of said
outer tubular member, whereby upon removal of said trocar tip the
open end of a donor vessel into which said outer tubular member has
been inserted may be placed in contact with a predetermined portion
of the side wall of the recipient vessel and the donor vessel may
be drawn into tight engagement with said tubular member and the
recipient vessel whenever said source of vacuum is connected with
the interior of said outer tubular member.
13. An anastomotic apparatus as defined by claim 4 wherein said
cutter head means includes cauterizing means for severing selected
portions of the side wall of the recipient vessel by cauterization,
said cauterizing means including
a. an electrical resistance heating wire extending around the
circumference of said first end of said inner tubular member;
and
b. heat insulation means for insulating the donor vessel from the
heat generated by said electrical resistance heating wire, said
heat-insulation means including an insulation ring mounted on said
first end of said inner tubular member, said insulation ring being
shaped to form a circumferential notch on the inside of said ring
for receiving said electrical resistance wire and to form a ring of
insulation between said electrical resistance heating wire and said
outer tubular member.
14. An anastomotic apparatus as defined in claim 3 further
including
a. pressure clamp means for applying a circumferential pressure to
the exterior surface of the donor vessel at a location spaced from
the sealed end thereof to form a circumferential seal between said
outer tubular member and the donor vessel; and
b. a pressure source selectively connectable with the interior of
said outer tubular member to apply a positive pressure in the space
between the recipient vessel and the pressure clamp means to test
the integrity of the seal before the recipient vessel is cut by
said cutting means.
15. An anastomotic apparatus for joining an open end of a donor
vessel to the side wall of a recipient vessel in which biological
fluids are flowing, comprising
a. support means for supporting the open end of the donor vessel in
contact with the side wall of the recipient vessel, said support
means including
1. means for holding the open end of the donor vessel in sealed
contact with the side wall of the recipient vessel without
interrupting the flow of biological fluids in the recipient vessel,
said support means including
2. an outer tubular member having an outer diameter approximately
equal to the inside diameter of the donor vessel and having a
plurality of openings extending between the outer surface and the
interior of said outer tubular member, and
3. a trocar tip removably connected with a first end of said outer
tubular member, said trocar tip being rounded at the outer end to
facilitate insertion of the tubular member into the interior of the
donor vessel, said trocar tip having a plurality of channels
extending between the interior of said outer tubular member and the
outer surface of said trocar tip;
b. cutting means for cutting through and removing a portion of the
side wall of the recipient vessel circumscribed by the interior of
the open end of the donor vessel which is in contact with the side
wall of the recipient vessel, said cutting means including
1. an inner tubular member mounted concentrically within said outer
tubular member, and
2. cutter head means located at a first end of said inner tubular
member for severing and removing a portion of the side wall of the
recipient vessel, said cutter head means containing an opening
extending between the interior of said inner tubular member and the
outer surface of said cutter head means, said inner tubular member
being movable between a retracted position wherein said trocar tip
may be secured to the interior surface of said outer tubular member
adjacent said first end and an extended position wherein the
recipient vessel may be severed;
c. selectively controlled suction means connected to the support
means for securing the removed wall portion;
d. a positive pressure source;
e. a pressurized lubrication source; and
f. coupling means for selectively connecting said selectively
controlled suction means, said positive pressure and said
pressurized lubrication sources with the interiors of said inner
and outer tubular members, whereby the exterior circumferential
surface of said outer tubular member and the outer surface of said
trocar tip may be lubricated prior to insertion into the donor
vessel by coupling said pressurized lubrication source to the
interiors of said inner and outer tubular members and whereby the
donor vessel may be drawn into tight engagement with said tubular
member and with the recipient vessel when the selectively
controlled suction means is connected with the interiors of said
inner and outer tubular members to permit the donor vessel to be
sealed to the recipient vessel and to permit the recipient vessel
to be severed by the cutting head means and, further, whereby the
integrity of the seal between the donor and recipient vessels may
be tested before the recipient vessel is severed by connecting the
interiors of the inner and outer tubular member with said positive
pressure source.
16. An anastomotic apparatus as defined in claim 18 wherein said
support means further includes suction support means for supporting
said outer tubular member relative to a recipient vessel, said
suction support means including means for frictionally engaging the
recipient vessel and vacuum passageway means for maintaining said
suction support means in frictional contact with said recipient
vessel.
17. An anastomotic apparatus for joining the open lumen end of a
donor vessel to the side wall of a recipient vessel having a lumen
in which biological fluids are flowing, comprising
a. support means for supporting the open end of the donor vessel in
contact with the side wall of the recipient vessel, said support
means including
1. an outer member shaped to fit within the lumen of the donor
vessel,
2. a source of vacuum, and
3. means for selectively connecting said source of vacuum with said
outer member to hold the open end of the donor vessel in sealed
contact with the side wall of the recipient vessel without
interrupting the flow of biological fluids in the recipient vessel;
and
b. cutting means positioned substantially within said support means
for cutting through and removing a portion of the side wall of the
recipient vessel circumscribed by the interior edge of the sealed
end of the donor vessel, whereby the vessel lumens may be brought
into fluid communication.
18. An anastomotic apparatus as defined in claim 17 wherein said
outer member includes an outer tubular member having an outer
diameter approximately equal to the inside diameter of the donor
vessel.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to apparatus for nonsuture adhesive
anastomosis of tubular body elements.
2. Description of the Prior Art
Interconnection of tubular body elements has traditionally been
performed by suturing techniques which are, at best, tedious and
time consuming. Numerous attempts have been made to improve such
techniques by the use of specialized instruments adapted to assist
the surgeon in obtaining a long lasting, highly reliable
interconnection. For example, U.S. Pat. No. 3,561,448 to Peternel
discloses a clamp assembly for positioning blood vessels to hold
the blood vessels in engagement thereby facilitating
interconnection. While such instruments are well suited for the
purposes intended, the particular requirements involved in small
vascular surgery, particularly within intracraneal spaces, makes
the manipulation of bulky equipment difficult if not
impossible.
In response to this problem, it has been proposed to employ plastic
adhesive in place of sutures thereby eliminating the need for
suturing instruments. See, for example, Suzuki et al. "A soluble
Internal Splint for Experimental Vascular Anastomosis," Journal of
Neurosurgery, Vol. 35, September 1971, pp. 35-58. However, the use
of adhesives has not eliminated the need for severing recipient
vessels prior to formation of the anastomosis. A need, therefore,
exists for providing the surgeon with a simple technique for
performing highly reliable anastomosis including the capability of
testing the anastomotic joint prior to incision of the recipient
vessel. Techniques for establishing a joint with the side wall of
an "in service" conduit prior to opening of the conduit are well
known in the plastic tubing art as disclosed in U. S. Pat. No.
2,736,335 issued Feb. 28, 1956 to Webber. However, no instrument
known heretofore has provided this capability in the anastomosis
art nor has any disclosure been made of an instrument which allows
testing of the anastomosis joint prior to cutting of the recipient
vessel.
SUMMARY OF THE INVENTION
A general object of this invention is to provide an anastomotic
appartus for joining the open end of a donor vessel to the side
wall of the recipient vessel in which biological fluids are
flowing. More particularly, the disclosed anastomotic apparatus is
adapted to support the open end of a donor vessel in contact with a
side wall of a recipient vessel, whereby the contacting surfaces
may be adhesively joined. After the adhesive has set, the
anastomotic apparatus is adapted to test the seal under pressure
and then to remove that portion of the side wall of the recipient
vessel circumscribed by the interior edge of the sealed end of the
donor vessel. Through use of the disclosed apparatus, anastomosis
may be performed without compromising the flow of biological fluids
within the recipient vessel in any way. Accordingly, the procedure
is never committed until the sealed joint has been treated. A
further advantage is that the full circumference of the recipient
vessel need never be cut since adhesive joining permits the donor
vessel to be integrally bonded with the side wall of the recipient
vessel, thereby further eliminating the need for interruption of
flow in the recipient vessel at any time. Due to the small size of
the disclosed apparatus and the minimal manipulation required for
operation thereof, anastomosis may be performed within extremely
confined spaces of a living animal such as the intracraneal spaces
of the human body.
It is another object of this invention to provide an anastomotic
apparatus including support means for supporting the open end of a
donor vessel in contact with the side wall of a recipient vessel
and including cutting means positioned within the support means for
cutting through and removing that portion of the side wall of the
recipient vessel circumscribed by the interior edge of the sealed
end of the donor vessel, whereby the interior lumens of the vessels
may be brought into communication.
Another object of the invention is to provide an anastomotic
apparatus wherein the support means includes an outer tubular
member having a outer diameter approximately equal to the inside
diameter of the donor vessel and a trocar tip removably connected
with a first end of the outer tubular member. The trocar tip is
rounded at the outer end to facilitate insertion of the tubular
member into the interior of the donor vessel.
Yet another object of this invention is to provide an anastomotic
apparatus wherein the outer tubular member includes a plurality of
openings extending between the outer surface and the interior
thereof and the trocar tip includes a plurality of channels
extending between the interior of the outer tubular member and the
outer surface of the trocar tip. The anastomotic device further
includes a vacuum pressure source, a positive pressure source, a
pressurized lubrication source and coupling means for selectively
connecting the vacuum pressure, the positive pressure and the
pressurized lubrication sources with the interiors of the outer and
inner tubular members. By this arrangement, the exterior
circumferential surface of the outer tubular member and the outer
surface of the trocar tip may be lubricated prior to insertion into
the donor vessel by coupling the pressurized lubrication source to
the interior of the outer tubular member. Furthermore, the donor
vessel may be drawn into tight engagement with the outer tubular
member and with the recipient vessel when the vacuum source is
connected with the interior of the outer tubular member to permit
the donor vessel to be sealed to the recipient vessel and to permit
the recipient vessel to be severed by the cutting means. To test
the integrity of the seal between the donor and recipient vessels,
the interior of the outer tubular member may be connected with the
positive pressure source by the above mentioned coupling means.
Still another object of this invention is to provide an anastomotic
apparatus wherein the cutting means includes an inner tubular
member mounted concentrically within the outer tubular member and
having cutter head means located at a first end of a tubular member
for severing the side wall of the recipient vessel. The inner
tubular member is movable between a retracted position wherein the
trocar tip may be secured to the interior surface of the outer
tubular member adjacent the first end and an extended position in
which the cutter head means may engage the side wall of the
recipient vessel.
Yet another object of the invention is to provide an anastomotic
apparatus wherein the cutter head means includes a plurality of
cutter blades mounted in an axially extended position on the first
end of the inner tubular member.
Yet another object of this invention is to provide an anastomotic
apparatus wherein the cutter head means includes a cauterizing
means for severing a selected portion of the side wall of the
recipient vessel. The cauterizing means includes an electrical
resistance heating wire extending around the circumference of the
inner tubular member and heat insulation means for insulating the
donor vessel from the heat generated by the electrical resistance
heating wire during the cauterization process.
Other objects and advantages of the invention will become apparent
from a study of the following specification when viewed in light of
the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a cross sectional view of an anastomotic apparatus in
accordance with this invention including inner and outer tubular
members and a trocar tip coupled to sources of vacuum, positive
pressure and lubrication;
FIG. 2 is a cross sectional view of the anastomotic apparatus of
FIG. 1 wherein the trocar tip has been removed;
FIG. 3 is a cross sectional view of the anastomotic apparatus of
FIG. 1 wherein the inner tubular member has been extended into the
cutting position;
FIG. 4 is a perspective view of an anastomotic apparatus in
accordance with this invention in combination with a prepared donor
vessel illustrating the manner by which the donor vessel is dressed
upon the anastomotic apparatus;
FIG. 5 is a perspective view of an anastomotic apparatus in
accordance with the subject invention being used during the sealing
and testing operation for joining a donor vessel to the side wall
of a recipient vessel;
FIG. 6 is a perspective view of a second embodiment of an
anastomotic apparatus of the subject invention including a
cauterization means mounted on one end of the inner tubular member
in combination with a power supply and control circuit;
FIG. 7 is a partial cross-sectional view of the cauterization means
illustrated in FIG. 6 along lines 7--7 of FIG. 6;
FIG. 8 is a perspective view of suction support means for
preventing a recipient blood vessel from turning; and
FIG. 9 is a perspective view of the suction support means of FIG. 8
in actual use.
DESCRIPTION OF THE PREFERRED EMBODIMENT
As illustrated in FIG. 1, an anastomotic apparatus 2 is disclosed
including support means 4 for supporting the open end of a donor
vessel in contact with the side wall of a recipient vessel to
permit the open end of the donor vessel to be integrally sealed by
adhesives to the side wall of the recipient vessel without
interrupting the flow of biological fluid in the recipient vessel.
Support means 4 includes an outer tubular member 6 having an outer
diameter approximately equal to the inside diameter of the donor
vessel and containing a plurality of openings 8 extending between
the outer surface and the interior of the outer tubular member 6.
The support means 4 also includes a trocar tip 10 connected by
suitable means such as screw threads 11 with a first end of the
outer tubular member 6. The trocar tip is rounded at the outer end
12 to facilitate insertion of the tubular member into the interior
of the donor vessel. Like the outer tubular member, the trocar tip
contains a plurality of channels 14 extending between the interior
of the outer tubular member 6 and the outer surface of the trocar
tip. The proportions of the device have been exaggerated in FIGS.
1-3. Overall dimensions of the outer tubular member of an
anastomotic apparatus incorporating the features of this invention
might be 4 inches in length by one-sixteenth to one-eighth inches
in diameter.
Positioned within the outer tubular member 6 is cutting means 16
for cutting through and removing a portion of the side wall of a
recipient vessel circumscribed by the interior edge of the sealed
end of a donor vessel. The cutting means 16 includes an inner
tubular member 18 mounted concentrically within the outer tubular
member 6 and having cutter head means 20 located at a first end of
the inner tubular member 18 for severing the side of the recipient
vessel. Upon removal of the trocar tip 10, the inner tubular member
18 may be movable between a retracted position illustrated in FIG.
1 and an extended position illustrated in FIG. 3 in which the
cutter head means 16 is adapted to remove that portion of the side
wall of the recipient vessel circumscribed by the sealed end of the
donor vessel. The cutter head means may include a plurality of
axially extending cutter blades 21 connected with the first end of
the inner tubular member.
Supporting the inner tubular member 18 within the outer tubular
member 6 for both longitudinal and rotational motion is a pair of
sealing rings 22, 24 mounted on the outer surface of the inner
tubular member adjacent each end, respectively thereof, and in
sealing engagement with the outer tubular member 6. Rings 22, 24
permit the inner tubular member 18 to be moved between the
retracted and extended positions illustrated in FIGS. 1 and 3,
respectively, while maintaining a sealed interconnection between
the two tubular members. Once in the extended position the inner
tubular member may be turned in a well controlled manner by a
source of rotational energy 25 such as a dental drill power
source.
The outer tubular member 6 includes a support appendage 26
integrally connected therewith. The support appendage 26 may be
connected with a solid stable support such as the skull when the
anastomotic apparatus is employed to connect intracraneal blood
vessels. The support appendage also contains a through passage 28
communicating with the space 29 between the inner and outer tubular
member and extending between the pair of sealing rings 22, 24. The
inner tubular member 18 includes a central passage 30 extending
through the entire axial length of the inner tubular member 6. The
central passage 30 extends entirely through the cutter head means
20 and communicates with the outer surface thereof.
For the reasons described herein below, the anastomotic apparatus 2
includes a source of vacuum 32, a source of positive pressure 34
and a source of lubrication under pressure 36 selectively
connectable with the through passage 28 and central passage 30 by
coupling means 38 employing a plurality of valves 40 and conduits
41 for selectively connecting sources 32, 34, 36 with the
aforementioned passages 28, 30. When the anastomotic apparatus is
assembled as illustrated in FIG. 1, passages 28 and 30 may be
connected with the lubrication source to force lubrication onto the
outer surfaces of the anastomotic apparatus through space 29,
openings 8 and channels 14, thereby to facilitate the insertion of
the apparatus into the interior of a donor vessel. This arrangement
virtually eliminates the possibility of damaging the interior
surface tissue of the donor vessel during the insertion step.
As disclosed in FIG. 2, the lower end 31 of the outer tubular
member 6 is concaved and has a radius of curvature R approximately
equal to the radius of the recipient vessel. The lwer end 31
includes a plurality of small prongs or sharp points 33 projecting
axially of member 6 for preventing the recipient vessel from
twisting during the cutting operation of the inner tubular member
18. Points 33 should not be so large as to damage or seriously
injure the recipient vessel. The anastomotic apparatus illustrated
in FIG. 2 may be connected with the source of vacuum 32 to thereby
draw a donor vessel, into which the outer tubular member has been
inserted, into contact with a predetermined portion of the side
wall of a recipient vessel and into tight engagement with the outer
tubular member. In this manner, the donor vessel may be held in a
fixed position to permit the setting of an adhesive to bring about
a permanent connection between the donor and recipient vessels.
After the adhesive has set but before the recipient vessel is
severed by the cutting head means 20, passages 28, 30 may be
connected with the pressure source 34 by coupling means 38 to
determine the integrity and completeness of the seal between the
donor and recipient vessels. The advantage of this arrangement is
that the anastomotic joint may be tested prior to severing of the
donor vessel, thereby eliminating the need for severing or cutting
through the recipient vessel before the surgeon is assured that the
adhesive bond is tight. To complete the anastomosis with the
disclosed apparatus, the vacuum source is reconnected with passages
28 and 30 by the coupling means 38 in order to again draw the donor
vessel tightly against the outer tubular member, whereupon the
inner tubular member may be advanced to an extended position as
illustrated in FIG. 3 and rotated either manually or automatically
to sever that position of the recipient vessel circumscribed by the
sealed end of the donor vessel. By connecting the central passage
30 of the inner tubular member with the vacuum source, the removed
portion of the recipient vessel is forced against the cutter head
means thereby eliminating the possibility that such portion will
become lodged within the recipient vessel.
In order to explain more clearly the operation of the disclosed
anastomotic apparatus, reference is now made to FIGS. 4 and 5 which
disclose the subject invention in actual operation. FIG. 4
illustrates a donor vessel 42 which has been prepared for
connection with a recipient vessel by placing an opening 44 in the
side wall of the donor vessel at a distance a from the open end 46
which is to be joined to the side wall of the recipient vessel.
Distance a corresponds to the operative length b of the outer
tubular member 6. As described above, the anastomotic apparatus is
connected with a source of lubrication to force lubricating
material through openings 8 and channels 14 in order to facilitate
insertion of the anastomotic apparatus into the donor vessel
without causing injury thereto.
Once the anastomotic apparatus has been inserted in the donor
vessel, the trocar tip 10 may be removed thereby exposing the
concave end 31 of the outer tubular member 6 which allows the open
end of the donor vessel to be prepared for joining with the side
wall of the recipient vessel. The open end of the donor vessel is
coated with adhesive and brought into contact with the side wall of
the recipient vessel 48 whereupon passages 28, 30 are connected
with the vacuum source 32 to draw the open end of the donor vessel
into tight engagement with the side wall of the recipient vessel.
The adhesive which has been placed between the open end of the
donor vessel and the side wall of the vessel is now permitted to
set thereby forming a bond between the subject vessels. Positive
pressure is introduced into passages 28 and 30 to test the
integrity of the formed bond before the recipient vessel is severed
by cutting means 16. To aid in this process, a pressure ring 50 may
be tightened around the donor vessel at a point above openings 8 of
the outer tubular member 6. Assuming the sealed connection to be
free from leaks of any kind, the vacuum source 32 may be
reconnected with the passages 28 and 30 in order to again draw the
donor vessel tightly against the outer tubular member 6, whereupon
the inner tubular member is advanced to an extended position
wherein rotation thereof permits cutting blades 21 to sever that
portion of the recipient vessel circumscribed by the sealed end of
the donor vessel. The anastomosis may now be completed by
withdrawing the anastomotic apparatus and closing opening 44 by any
suitable means.
Reference is now made to FIG. 6 which illustrates a second
embodiment of the subject invention which has been modified by
replacement of the cutter blades 21 with cauterization means 52 at
the lower end of the inner tubular member 18. Cauterization means
52 includes a resistance heating wire 54 connected by means of
electrical leads 56 to a pair of terminals 58 located on the upper
end of the inner tubular member 18. The terminals are connected
with a power supply and a control circuit 60 by means of electrical
leads 62.
As best illustrated in FIG. 7, the cauterization means 52 includes
a heat insulation means 64 for insulating the donor vessel from the
heat generated by electrical resistance heating wire 54. The heat
insulating means includes an insulation ring 66 mounted on the
lower end of the inner tubular member 18 wherein the insulation
ring 66 is shaped to form a circumferential notch 68 on the inside
of the ring for receiving and retaining the electrical resistance
wire 54 and to form a ring of insulation 70 between the electrical
resistance wire and the outer tubular member 6.
Returing to FIG. 6, it should be noted that inner tubular member 18
is advanced beyond the normal extended position to reveal a
plurality of openings 72 extending between the interior and
exterior surfaces of the tubular member. By this arrangement,
through passage 28 may be eliminated and the vacuum, positive
pressure and lubrication may all be supplied through a central
passage 30 of the inner tubular member. It should also be noted
that the entire anastomotic apparatus may be supported by means of
a ball joint connection 74 between the outer tubular member and a
fixed support 76. The cauterization cutting means illustrated in
FIGS. 6 and 7 is preferred over the cutting blades employed in the
embodiment of FIGS. 1-3 because cauterization prevents separation
of the various layers of the vessel between which the biological
fluids would otherwise enter.
Examples of suitable adhesives for forming the sealed joint between
the donor and recipient vessel include methyl-2-cyanacrylate and
alpha-ethyl cyanacrylate.
The inner tubular member may be eliminated altogether and replaced
by chemical cutting means such as a strong acid. According to this
method, the portion of the side wall of the recipient vessel
circumscribed by the open end of the donor vessel would be
dissolved or "eaten away" by a strong acid placed within the outer
tubular member 6. Accordingly, the cutting means of the subject
invention may be embodied in one or more cutting blades, electrical
cutting means, or chemical means.
Referring now to FIG. 8, a suction support means 78 is disclosed
for supporting the outer tubular member 6 relative to a recipient
blood vessel. The suction support 78 includes an upright stem 79
and a U-shaped bottom portion 80 wherein each side of the bottom
portion includes a pair of downwardly extending legs 82, 84. The
legs are separated by a distance approximating the diameter of the
recipient vessel. To assist in holding the recipient vessel against
turning during the cutting operation an arched surface 86 is
provided for frictionally contacting the surface of the recipient
vessel. The frictional fit is assisted by a negative pressure,
communicated to the arched surface by a passageway 88 (illustrated
in dotted lines) extending from the upper end of the stem into each
side of the U-shaped bottom portion 80.
As illustrated in FIG. 9, an attachment link 90 is provided which
contains a through bore for slidingly receiving the outer tubular
member 6 and which includes a clip 92 adapted for snap fitting
around the upper stem 79 of the suction support means 78.
A pair of knobs 94, 96 may be provided for integral connection with
the inner and outer tubular members, respectively, thereby
permitting manual turning of the inner tubular member relative to
the outer tubular member. In operation, the outer tubular member is
placed within the through bore of attachment link 90 and the
suction support means 78 is brought into contact with the recipient
vessel and held in frictional contact therewith by connecting
passageway 88 with a source of vacuum. Thereafter, the donor vessel
is placed on the outer tubular member 6 as previously discussed.
The attachment link may now be snaped onto the upright stem 79 to
secure the outer tubular member 6 relative to the recipient vessel.
The outer tubular member may now be advanced through the bore of
the attachment link to bring the donor vessel into contact with the
side wall of the recipient vessel.
An anastomotic apparatus has been disclosed which provides the
surgeon with an extremely efficient and easily manipulated device
for joining a donor vessel to the side wall of a recipient vessel
such as the blood vessels in the human body. Since the sealed joint
may be tested before the recipient vessel is severed in any way,
the risk due to improperly executed sealed joints is significantly
reduced. This apparatus has the added advantage of permitting
anastomosis interruption of the flow of biological fluids in the
recipient vessel at any time before or after anastomosis.
* * * * *