U.S. patent number 3,889,683 [Application Number 05/471,687] was granted by the patent office on 1975-06-17 for surgical apparatus for suturing soft tissues.
Invention is credited to Anatoly Alexandrovich Dyachikhin, Nikolai Nikolaevich Kapitanov, Oleg Borisovich Milonov, Natalya Petrovna Petrova.
United States Patent |
3,889,683 |
Kapitanov , et al. |
June 17, 1975 |
Surgical apparatus for suturing soft tissues
Abstract
A suturing apparatus provided with two guides interhinged with
an axle with, one guide carrying a magazine for storing a plurality
of suturing staples therein, a staple pusher, a magazine
displacement lever and a pusher-actuating lever, while the other
guide carries a movable knife of a means for cutting the vessels
and ducts of the tissue being sutured between the staples applied.
Also there is provided needle-shaped dies and a member for
detaching unsutured vessels and ducts.
Inventors: |
Kapitanov; Nikolai Nikolaevich
(Moscow, SU), Petrova; Natalya Petrovna (Moscow,
SU), Milonov; Oleg Borisovich (Moscow, SU),
Dyachikhin; Anatoly Alexandrovich (Moscow, SU) |
Family
ID: |
20568963 |
Appl.
No.: |
05/471,687 |
Filed: |
May 20, 1974 |
Foreign Application Priority Data
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Sep 28, 1973 [SU] |
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1974605 |
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Current U.S.
Class: |
606/143;
227/180.1 |
Current CPC
Class: |
A61B
17/0686 (20130101); A61B 17/32 (20130101); A61B
17/128 (20130101) |
Current International
Class: |
A61B
17/12 (20060101); A61B 17/32 (20060101); A61B
17/128 (20060101); A61B 17/068 (20060101); A61b
017/32 (); A61b 017/04 () |
Field of
Search: |
;128/305,334R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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1,172,775 |
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Dec 1969 |
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GB |
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831,302 |
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Jan 1970 |
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CA |
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Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Holman & Stern
Claims
What is claimed is:
1. A surgical apparatus for suturing soft tissues, comprising: two
guides interhinged at one end; a tie spring between the guides
which normally maintains the guides at the other end in a
spaced-apart position; a magazine for storing a plurality of
U-shaped suturing staples therein disposed at the free end of one
of the guides; a pusher adapted to slide along said latter guide
for ejecting the staples from said magazine points first; twin
needleshaped dies disposed on the free ends of said guides for
seizing therebetween, as the guides are brought together, the
tissue to be staple-sutured; a means for controlling said magazine
by displacing the magazine and feeding new staples to the working
position; a means for cutting the vessels and ducts of said tissue
being sutured in the area between said applied staples, said
vessel-cutting means being disposed on the free ends of said
guides; and a member for detaching the vessels and ducts located
outside of the suturing and cutting zone, said member being
disposed on the free end of one of the guides.
2. The apparatus as claimed in claim 1, wherein the tissue-cutting
means is provided by two cooperating knives, one of which, defined
by a plate, is fixed on the end of the guide which carries the
member for detaching vessels and ducts, while the other knife, a
movable member, is defined by a lever with a cutting edge mounted
on the other guide and normally spring-loaded so that the cutting
edge is withdrawn from the immovable cutting edge, and the distal
end of the lever is provided with a projection which cooperates
with the staple pusher so that, as the pusher is executing a
backward movement, the knife lever turns against the action of the
spring, thus causing the two knives to be brought together and cut
the tissue.
3. The surgical apparatus as claimed in claim 1, wherein the staple
pusher is provided with a lever member boosting the pushing action
at the instant staples are bent, which member is defined by an
L-shaped lever interhinged with the rear end of the pusher so that
one comparatively long arm of the lever is adapted to be hand-moved
along one guide together with the pusher, while the other guide
includes a stop cooperating with the other arm of the lever, when
the long arm of the lever is completing the movement thereof,
whereupon the lever turns, exerting an additional pushing effort on
the pusher.
4. The surgical apparatus as claimed in claim 1, wherein the member
for detaching vessels and ducts is defined by an L-shaped plate or
gib secured flush with plate of the immovable knife between the
protruding ends of the needle-shaped dies which are rounded at the
tips, just as the latter L-shaped plate or gib, lest vessels and
ducts be pierced thereby.
5. The surgical apparatus as claimed in claim 2, wherein the pusher
portion which cooperates with the projection on the distal end of
the movable knife for turning the same, is defined by a separate
countersinking stop, so that with the latter stop in a sunk
position the pusher is barred from cooperating with the knife.
Description
BACKGROUND OF THE INVENTION
The present invention relates to surgical suturing apparatus
employed in surgery and, more specifically to apparatus for a
bloodless resection of soft tissues, e.g. hepatic soft tissues.
PRIOR ART
It is known in the art to employ a surgical apparatus for suturing
tissues with metal staples (U.S. Pat. No. 2,482,428), which
comprises a casing shaped as pincers defined by two guides
interhinged with an axle and connected by a spring placed
therebetween which drives the guides apart. The free end of each
guide mounts a die shaped as a curvilinear needle. On the inside of
each guide and each die there is formed a groove extending to a
staple magazine secured on one of the guides, and the groove serves
for passing and bending the staples. The magazine is of a
rectangular box-section shape and is provided with a through
longitudinal hole to allow the passage of a pusher. There are slots
defining staple seats which are formed, with a certain spacing, in
the inner surfaces of the magazine walls disposed in the guide
planes. Said magazine slots receive the staple ends so that one
staple end is disposed in the slot of one magazine wall, while the
other staple end is disposed in the slot of the opposite wall,
whereas the staple back edge faces toward the axle interconnecting
the guides. With the guides brought together, the slots of one of
the magazine staple seats are aligned with said grooves formed in
the guides. With the guides moved apart, the magazine remains on
one of the guides.
The pusher displaces along the guides of the apparatus. The
cross-sectional dimension of the pusher is such that the pusher is
able to pass in the through hole of the magazine, ejecting just one
staple therefrom. The extent of displacement of the pusher is
limited by an eccentric stop.
The magazine is adapted to displace relative to the pusher by a
distance corresponding to the spacing of the magazine staples.
The guides are immobilized in their working positions by means of
projections on the pusher.
The apparatus is handled as follows.
The surgeon moves the pusher to its extreme position toward the
axle interconnecting the guides. The spring moves the operating
ends of the guides apart. The surgeon drives the die needles
through the edges of the tissue to be sutured, brings the guides
together and moves the pusher in the direction toward the dies.
This causes the cams disposed on the pusher to actuate
spring-loaded levers which move the magazine a distance
corresponding to the staple spacing in the magazine, whereupon the
pusher projections immobilize the guides in their working
positions. As the pusher moves further, the pusher end comes to
rest against the back edge of a staple, driving the same in the
direction toward the die.
One end of the staple slides in the groove of one guide, while the
other staple end slides in the groove of the other guide. The
points of the staple transfix the tissue, reach the curved portion
of the die, and are clinched thereon, binding the tissue so that
each shank of the staple forms a ring. The height of the ring is
adjusted by the eccentric stop against which the pusher abuts in
its extreme working position.
In order that the apparatus may be detached from the sutured
tissue, the pusher must be driven back to the extreme position
toward the axle interconnecting the guides. This causes the guides
to open so that the needles are withdrawn from the tissue. To apply
the next suture, the whole sequence is repeated.
Also known is a surgical apparatus for suturing soft tissues with
U-shaped metal staples (U.S.S.R. Inventor's Certificate No.
240,171), which comprises two guides interhinged with an axle and
having a tie spring therebetween, a detachable magazine for storing
a plurality of staples, a pusher, a bearing member formed as twin
needle-shaped dies, and a magazine displacement mechanism disposed
on the guides.
The prior art apparatus have a common disadvantage, viz. a lack of
provision for bloodless cutting of the sutured vessels and ducts.
Another disadvantage of the known systems is that the curvilinear
needles have pointed ends which pierce vessels and ducts while
crushing the parenchyma of the liver.
OBJECTS AND SUMMARY OF THE INVENTION
It is an object of the present invention to provide a surgical
apparatus for suturing soft tissues, in which provision is made for
a simultaneous suturing of soft tissue at two sites at a certain
distance one from the other, as well as for cutting the sutured
tissue between the sutures so that the tissue outside of the
suturing zone is left intact.
Another object of the present invention is to provide a surgical
apparatus for suturing soft tissues, in which provision is made for
seizing vessels and ducts without causing injury thereto, e.g. in
crushing the parenchyma of the liver, with the sequence of
operations being suturing of the tissue followed by cutting
thereof, with these operation requiring no additional efforts on
the part of the surgeon.
A further object of the present invention is to provide a surgical
apparatus for suturing soft tissues, in which provision is made for
a simultaneous suturing with two staples, with the surgeon's effort
exerted on the apparatus for suturing not exceeding the effort
mounted by one finger of the surgeon's hand.
Yet another object of the present invention is to provide a
surgical apparatus for suturing soft tissues, in which provision is
made for suturing the tissue of organs, e.g. the liver, with an
abundance of closely spaced blood vessels, and for so seizing the
tissue to be sutured that the blood vessels or bile ductules
thereof are not pierced.
Finally another object of the present invention is to provide a
surgical apparatus for suturing soft tissues, in which provision is
made for tissue suturing without cutting the tissue between the
sutures.
These and other objects are attained by the provision of a surgical
apparatus for suturing soft tissues which, in accordance with the
present invention, comprises two guides interhinged with an axle
and having a tie spring therebetween, a magazine for storing a
plurality of U-shaped suturing staples which is disposed at the
free end of one of the guides, a pusher displaced along said guide
to thereby eject staples ends first from the magazine for suturing
the tissue seized between twin needle-shaped dies mounted on the
free ends of the guides, and a mechanism displacing the magazine
for feeding new staples to the working positions, in which there is
provided a device for cutting the vessels and ducts of the tissue
being sutured between the staples applied, and the free end of one
of the guides mounting a member for detaching vessels and ducts
remaining outside of the suturing and cutting zone.
Said improvement permits suturing hepatic vessels and ducts
together with the parenchyma on the remaining portion of the liver
as well as on the portion being resected in hepatectomy, with only
those vessels and ducts being cut which fall into the suturing
zone, leaving non-sutured vessels and ducts intact.
Due to this improvement, hepatectomy can be performed with a
minimal blood loss.
The surgical apparatus in accordance with one embodiment of the
invention is characterized in that the device for tissue dissection
is formed as two cooperating knives with, one formed as a plate
immovably secured on the end of the guide which mounts the member
for detaching vessels and ducts, and the other formed as a lever
with a cutting edge movably mounted on the other guide, said
movable knife being normally spring-loaded so that the cutting edge
is withdrawn from the immovable knife, and the distal end of the
lever is provided with a projection cooperating with the staple
pusher in such a manner that while the pusher is executing its
backward stroke, the knife turns against the action of the spring,
thus causing the two knives to be brought together and dissect the
tissue.
Due to said improvements, hepatic vessels and duct can be exposed
by crushing the parenchyma so that the vessels and ducts are not
impaired by the knives, and then the suturing operation can be
performed by first suturing the tissue and then cutting it between
the sutures, the tissue dissection being executed by using the
pusher movement required for the suturing operation.
The surgical apparatus in accordance with an alternative embodiment
of the invention is characterized in that the staple pusher is
provided with a lever booster which operates at the instant of
staple bending, with the lever booster formed as an L-shaped lever
interhinged with the rear end of the pusher so that one
comparatively long, arm of the lever is adapted to be hand-actuated
to move together with the pusher along one of the guides of the
apparatus, while the other guide is provided with a stop which,
when the longer arm of the lever is completing its movement,
cooperates with the other arm, whereupon the lever turns, further
passing upon the pusher.
Said improvement permits suturing simultaneously with two staples,
and the effort of a surgeon's finger being quite sufficient to
cause the lever to be moved forward and turned during the suturing
operation.
Further, the surgical apparatus in accordance with the invention is
characterized in that the member for detaching vessels and ducts is
formed as an L-shaped plate mounted flush with the plate of the
immovable knife between the protruding points of the needle-shaped
dies which are rounded at their tips, just as said L-shaped plate,
lest vessels and ducts should be pierced thereby.
Due to said improvement, vessels and ducts can be exposed for
suturing, e.g. in hepatectomy, without sustaining any damage.
Lastly, in accordance with yet another embodiment of the present
invention, the surgical apparatus is characterized in that the
pusher portion which engages the projection on the distal end of
the movable knife to turn the same, is formed as an independent
countersinking stop which sinks, barring the pusher from
cooperating with the knife.
Said improvement permits turning off the knives of an operating
apparatus with a view to performing the suturing operation alone,
should the same be required.
The invention will be better understood by reference to the
following detailed description of several preferred embodiments
thereof, taken in conjunction with the accompanying drawings,
wherein:
THE DESCRIPTION OF THE DRAWINGS
FIG. 1 is a general view of an apparatus in accordance with the
invention;
FIG. 2 is a side view of the apparatus shown in FIG. 1;
FIG. 3 illustrates a movable knife in the apparatus of FIGS. 1 and
2;
FIG. 4 is a side view of the knife of FIG. 3;
FIG. 5 illustrates an immovable knife in the apparatus in
accordance with the invention;
FIG. 6 is a side elevation of the immovable knife of FIG. 5;
FIG. 7 is a plan view of the immovable knife of FIG. 5;
FIG. 8 illustrates a staple pusher lever in the apparatus in
accordance with the invention;
FIG. 9 is a sectional view taken on line IX--IX of FIG. 8 the view
looking in the direction of the arrows;
FIG. 10 is a general view of the apparatus in accordance with the
invention, partially cutaway at the site of attachment of the
knives, with the pusher shown in the extreme position of suturing
and the pusher-actuating lever turned as far as it will go;
FIG. 11 is a general view of the apparatus in accordance with the
invention, partially cutaway at the site of attachment of the
knives, with the pusher actuating lever shown forced against the
guide and withdrawing the pusher from the needle-shaped dies and
the movable knife shown in the extreme position of cutting;
FIG. 12 illustrates the position of a vessel in the apparatus after
having been staple-sutured and prior to being cut;
FIG. 13 illustrates the position of a vessel in the apparatus after
the operations of suturing and cutting; and
FIG. 14 illustrates a vessel sutured in two places and cut between
the sutures.
DETAILED DESCRIPTION OF THE EMBODIMENTS
Referring now to the drawings, there is illustrated therein a
surgical apparatus for suturing soft tissues which is shaped as
pincers and comprises two interhinged guides 1 and 2 provided with
a tie spring 3, a detachable staple magazine 4, two pushers 5, a
bearing portion in the form of twin needle-shaped dies 6, a
mechanism 7 for displacing the magazine 4, means 8 for cutting
vessels and ducts, and an L-shaped plate or gib 9 for detaching
vessels and ducts.
The means 8 for cutting vessels and ducts comprises two detachable
knives 10 and 11, with the knife 10 being immovably coupled with
the guide 1 while the knife 11 is movably connected with the guide
2, and a movable lever 12 with a stop 13 is mounted on the pusher
5. The knife 11 is formed as a lever 14 forced against the guide 2
by a spring 15. The operating tip of the knife 11 is appropriately
shaped to ensure effective cutting action. The distal end of the
lever 14 is provided with a projection 16 which cooperates with the
stop 13. The stop 13 can be displaced by an eccentric 17 rigidly
coupled with a handle 18. The lever 12 has a projection 19
cooperating with the walls of a hole 20 in the guide 2, an axle 21
and projections 22 cooperating with grooves 23 formed in the guide
1. The knife 10 is fashioned as a plate which mounts the gib 9 for
detaching vessels and ducts. The knife 10 is interlinked with an
axle 25 by a hook 24 and secured by a screw 26. The mechanism 7 for
displacing the magazine 4 comprises a lever 27 with a slot 28 and a
spring 29, as well as a projection 30 on the pusher 5 and a
projection 31 on the magazine 4. The guide 1 mounts an eccentric
movement limiter 32 limiting the extent of displacement of the
pusher 5.
In order to prevent piercing of blood vessels and bile ductules in
the course of hepatectomy (parenchyma crushing), the protruding
ends of the needle-shaped dies 6 and of the L-shaped gib 9 for
detaching vessels and ducts are rounded at the tips.
The apparatus of this invention operates as follows:
First, the magazine 4 charged with staples is mounted on the
apparatus. Then, holding the apparatus with one hand, the surgeon
crushes the parenchyma of the liver over a small area, with all the
vessels and ducts in this area seized with the points of the guides
1 and 2. As the pushers 5 are displacing in the direction toward
the needle-shaped dies 6, the guides 1 and 2 are brought together,
the projection 30 turns the lever 27, the spring 29 of the lever 27
presses upon the projection 31, thereby turning the magazine 4. The
projections 22 slide in the groove 23.
As soon as the end of the staple reaches the curved portion of the
needle-shaped die 6, the projections 22 come out of engagement with
the grooves 23, the lever 12 turns on the axle 21, its projection
19 enters the hole 20 in the guide 2 and, pushing against the wall
on the side of the axle, boosts the effort driving the pushers 5
forward. The pushers 5 are thus moved as far the movement limiter
32 (FIG. 10).
As the pushers 5 are moving back, the lever 12 turns on the axle 21
and presses with its projection 13 upon the projection 16 of the
lever 14 which turns, causing the seized vessels and ducts to be
cut (FIG. 11). As the lever 12 is moving further, the projections
22 engage the grooves 23, and, when the pushers 5 reach their
extreme right-hand position, the guides 1 and 2 are moved apart, so
that the apparatus is ready for a repeated sequence.
To provide for the back movement of the pushers 5, the surgeon
presses his finger on the lever 12 so as to induce its back
rotation, i.e. in a direction opposite to its working direction,
which causes the projection 19 of the lever 12 to push against the
wall of the hole 20 on the side of the needle-shaped dies.
The projection 13 of the lever 12 bears upon the projection 16 of
the lever 14, turning the same on an axle 33 (FIG. 11). As the
lever 14 is turning, the knives 10 and 11 cut the seized and
sutured tissue. As the lever 12 is rotating, the projections 22
engage the grooves 23 and stop the rotation of the lever 12.
As the lever 12 is progressing toward the axle, the projection 13
comes out of engagement with the projection 16, and the knife 11 is
driven by the spring 15 to its initial position. At the end of its
movement, the lever 12 moves aside the plate which brings the two
guides together, and the spring 3 turns the guides 1 and 2 one
relative to the other.
The operating ends of the guides are moved apart, rendering the
apparatus ready for a repeated sequance.
If it not be required to cut the tissue being sutured, the knife 11
can be turned off. To this end, the handle 18 is turned through
180.degree.C. This will cause the eccentric 17 to drive the
projection 13 inside the lever 12, so that no cutting will take
place while the pushers 5 are executing their backward
movement.
* * * * *