U.S. patent number 3,908,662 [Application Number 05/376,931] was granted by the patent office on 1975-09-30 for device for the eversion of hollow organs and vascular stapling instrument incorporating same.
Invention is credited to Boris Fedorovich Mashinistov, Lidia Alexandrovna Potekhina, Mikhail Mikhailovich Razgulov.
United States Patent |
3,908,662 |
Razgulov , et al. |
September 30, 1975 |
Device for the eversion of hollow organs and vascular stapling
instrument incorporating same
Abstract
The present invention relates to the field of medicine, and more
particularly to vascular surgery, with particular reference to a
device for the eversion of hollow organs and a vascular stapling
instrument. According to the invention, a device for the eversion
of hollow organs, comprising a bush, whereinto the hollow organ end
to be everted is introduce, is provided with spikes, whereon the
edge of said hollow organ end is pinned, which spikes are arranged
on their base along a contour conforming to the lateral guide
surface of said bush, said base being mounted so as to move freely
along said bush. The disclosed device for the eversion of hollow
organs is recommended for use in instruments for suturing of hollow
organs and, inter alia, vascular stapling instruments.
Inventors: |
Razgulov; Mikhail Mikhailovich
(Podolsk, Moskovskoi oblasti, SU), Potekhina; Lidia
Alexandrovna (Moscow, SU), Mashinistov; Boris
Fedorovich (Moscow, SU) |
Family
ID: |
27542996 |
Appl.
No.: |
05/376,931 |
Filed: |
July 6, 1973 |
Current U.S.
Class: |
606/149;
606/155 |
Current CPC
Class: |
A61B
17/1152 (20130101); A61B 2017/1125 (20130101) |
Current International
Class: |
A61B
17/115 (20060101); A61B 17/03 (20060101); A61B
17/11 (20060101); A61B 017/11 () |
Field of
Search: |
;128/334R,334C,346 |
References Cited
[Referenced By]
U.S. Patent Documents
|
|
|
3057355 |
October 1962 |
Smialowski et al. |
3144654 |
August 1964 |
Mallina et al. |
3519187 |
July 1970 |
Kapitanov et al. |
3606888 |
September 1971 |
Wilkinson |
|
Other References
Surgery- February 1962 - Vol. 51, No. 2, pp. 216-219..
|
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Waters, Schwartz & Nissen
Claims
1. A device for the eversion of hollow organs, such as a blood
vessel, comprising: a hollow bush member having a peripheral outer
surface, the hollow organ end to be everted adapted to be
introduced into said bush member; means within said bush member for
clamping said hollow organ; spikes adapted to have the edge of said
hollow organ end pinned thereto; a base movably secured around the
outer surface of the bush member, said spikes arranged about said
base along a contour conforming to the outer peripheral surface of
said bush member; and means for moving said base,
2. A device for the eversion of hollow organs as of claim 1, in
which the spikes, whereon the edge of the hollow organ end to be
everted is fixed,
3. A device for the eversion of hollow organs as of claim 2,
wherein said means for moving the base comprises at least one
manually-operable lever with a fixed fulcrum relative to said bush
member, which lever carries on one arm thereby said movably mounted
base with spikes, while the other arm of said lever is manually
operable to transmit motion to said base in the course of eversion
of a hollow organ end, whereof the edge is fixed on the
4. A device for the eversion of hollow organs as of claim 3 said
bush member being a split bush consisting of two half-bushes
separated along a plane parallel to the longitudinal axis of said
bush, in which the base carrying the spikes is formed as two
half-rings, each half-ring enveloping one of the half-bushes and
connected by a hinge with the respective arm of
5. A device for the eversion of blood vessels as of claim 4, which
incorporates means for clamping a hollow organ mounted in said bush
at the
6. A device for the eversion of blood vessels as of claim 5 with
the clamping means formed as a flat spiral spring, whereof the
outer end is
7. A device for the eversion of hollow organs as of claim 1, in
which the spikes, whereon the edge of the hollow organ end to be
everted is fixed, are spring-loaded relative to said base so that
the diameter of the contour along which the spikes are arranged
prior to the process of eversion should be less than the diameter
of the contour along which the
8. A device for the eversion of hollow organs as of claim 7,
wherein the means for moving the base comprises at least one
manually-operable lever with a fixed fulcrum relative to said bush
member, which lever carries on one arm thereof said movably mounted
base with spikes, while the other arm of said lever is manually
operable to transmit motion to said base in the course of eversion
of a hollow organ end, whereof the edge is fixed on the
9. A device for the eversion of hollow organs as of claim 8 said
such member being a split bush consisting of two half-bushes
separated along a plane parallel to the longitudinal axis of said
bush, in which the base carrying the spikes is formed as two
half-rings, each half-ring enveloping one of the half-bushes and
connected by a hinge with the respective arm of
10. A device for the eversion of blood vessels as of claim 9, which
incorporates means for clamping a hollow organ mounted in said bush
at the
11. A device for the eversion of blood vessels as of claim 10 with
the clamping means formed as a flat spiral spring, whereof the
outer end is
12. A device for the eversion of hollow organs as of claim 1, in
which the spikes, whereon the edge of the hollow organ end to be
everted is fixed, are movably mounted on said base by hinges so
that said spikes could be
13. A device for the eversion of hollow organs as of claim 12,
wherein the means for moving the base comprises at least one
manually-operable lever, whereof the fulcrum is fixed relative to
said bush member, which lever carries on one arm thereof said
movably mounted based with spikes, while the other arm of said
lever is manually operable to transmit motion to said base in the
course of eversion of a hollow organ end, whereof the
14. A device for the eversion of hollow organs as of claim 13 said
bush member being a split bush consisting of two half-bushes
separated along a plane parallel to the longitudinal axis of said
bush, in which the base carrying the spikes is formed as two
half-rings, each half-ring enveloping one of the half-bushes and
connected by a hinge with the respective arm of
15. A device for the eversion of blood vessels as of claim 14,
which incorporates means for clamping a hollow organ mounted in
said bush at the
16. A device for the eversion of blood vessels as of claim 15 with
the clamping means formed as a flat spiral spring, whereof the
outer end is
17. A device for the eversion of hollow organs as of claim 1, which
comprises a hand drive incorporating at least one lever with a
fixed fulcrum relative to said bush member, which lever carries on
one arm thereof said movably mounted base with said spikes, while
the other arm of said lever is made so that it could be manually
actuated to transmit motion to said base in the course of eversion
of a hollow organ end,
18. A device for the eversion of hollow organs as of claim 17 said
bush member being a split bush consisting of two half-bushes
separated along a plane parallel to the longitudinal axis of said
bush, in which the base carrying the spikes is formed as two
half-rings, each half-ring enveloping one of the half-bushes and
connected by a hinge with the respective arm of
19. A device for the eversion of blood vessels as of claim 18,
which incorporates means for clamping a hollow organ mounted in
said bush member
20. A device for the eversion of blood vessels as of claim 19 with
the clamping means formed as a flat spiral spring, whereof the
outer end is
21. A device for the eversion of hollow organs according to claim
1, wherein said spikes comprise S-shaped fulcrum levers, each
having a fulcrum in the form of a hinge, one, smaller arm of said
lever comprising a wedge-shaped projection disposed below
immediately adjacent to the hinge and facing said bush member, the
other, larger arm of said lever being disposed above said hinge and
tapering down to a point whereon said edge of the hollow organ to
be everted is pinned, the base to which said spikes are movably
mounted embracing the lower part of the bush member, so as to be
axially movable therealong, the upper part of the bush member being
made replaceable with the inside diameter substantially equal to
the outside diameter of the hollow organ to be everted, the surface
of the lower end of said replaceable part of the bush member
conforming to the surface of the wedge-shaped projections of the
spikes so that with the spikes being in the uppermost position the
larger arms thereof should be drawn together and thrust against the
upper edge of the replaceable part
22. A device for the eversion of hollow organs as of claim 21,
wherein the means for moving the base comprises at least one
manually-operable lever, whereof the fulcrum is fixed relative to
said bush member, which lever carried on one arm thereof said
movably mounted base with spikes, while the other arm of said lever
is manually operable to transmit motion to said base in the course
of eversion of a hollow organ end, whereof the
23. A device for the eversion of hollow organs as of claim 22 said
bush member being a split bush consisting of two half-bushes
separated along a plane parallel to the longitudinal axis of said
bush, in which the base carrying the spikes is formed as two
half-rings, each half-ring enveloping one of the half-bushes and
connected by a hinge with the respective arm of
24. A device for the eversion of blood vessels as of claim 25,
which incorporates means for clamping a hollow organ mounted in
said bush at the
25. A device for the eversion of blood vessels as of claim 24 with
the clamping means formed as a flat spiral spring, whereof the
outer end is
26. A device for the eversion of blood vessels as of claim 22,
which incorporates means for clamping a hollow organ mounted in
said bush member
27. A device for the eversion of blood vessels as of claim 26 with
the clamping means formed as a flat spiral spring, whereof the
outer end is attached to the bush while the inner end is left
loose.
Description
The present invention relates generally to the field of medicine,
more specifically to vascular surgery, and has particular reference
to a device for the eversion of hollow organs and to a vascular
stapling machine incorporating such a device.
Those skilled in the art are aware that whenever hollow organs are
to be everted, for example in the case of end-to-end suturing of
blood vessels, all the eversion operations are performed manually
on a bush into which the hollow organ end to be everted is
introduced and on which the entire eversion process is carried out
as on a mandrel.
The bush on which the process of eversion is carried out is
generally manufactured to be convenient for the introduction
thereinto of the hollow organ end to be everted. Thus, for
instance, the bush is made to be split along a plane passing
through its longitudinal axis into two half-bushes.
Such a bush, which may be manufactured in a variety of designs and
on which all the operations of eversion are performed, is a known
device for the eversion of hollow organs. Among the above-described
designs of bushes on which the process of eversion is carried out
and which consequently are known devices for the eversion of hollow
organs, the most advanced is the split bush comprising two
half-bushes and described hereinabove.
The process of eversion employed, inter alia, in end-to-end
suturing of blood vessels is effected in this known device in the
following manner.
The half-bushes are separated from each other and the end of the
blood vessel to be everted is placed therebetween.
Then the bush is put together by joining the two half-bushes, the
end of the blood vessel being securely clamped inside the bush so
that the end of the vessel to be everted should be left outside of
the bush in surmounting relation thereto. Then the loose end of the
vessel is manually everted with pincers by turning it intima
outwards and stretching it over said bush.
Finally, the end of the vessel thus everted is fixed on the bush by
ligating it at the edge thereof or by clamping it with a cuff
clamp.
Also known is a vascular stapling instrument which incorporates a
device for vessel eversion, formed as a split bush, comprising two
half-bushes, one for each end of the vessel (cf. USSR Author's
Certificate NO. 127361, Cl.30a, 81.sub.06, issued on Oct. 9, 1958).
The vessel eversion procedure is performed in the above-described
sequence immediately prior to the stapling operation.
The above-described known device for the eversion of hollow organs
suffers from a number of serious disadvantages which impose
limitations upon its application for the eversion of hollow organs
in general, and for the eversion of blood vessels in
particular.
Thus, the process of eversion of hollow organs, and particularly
blood vessels, is rather labour-consuming, requires a lot of time
and puts a great strain on the operating surgeon, this disadvantage
being especially manifest with regard to small vessel eversion.
Another disadvantage consists in that the known device is
inapplicable for the eversion, and hence anastomosing, severely
sclerosed vessels.
Obviously, the afore-mentioned disadvantages are inherent in the
above-described vascular stapling instrument which incorporates
such a device for the eversion of these vessels formed as a
plurality of split bushes each comprising two half-bushes.
An object of the present invention, therefore, is to provide a
simple and reliable device for the eversion of hollow organs and
inter alia, blood vessels of all kinds, even severaly sclerosed,
which would required little time for the eversion procedure and
would put no great strain on the operating surgeon.
It is another object of the invention to provide an instrument for
end-to-end vessel stapling which would be built around the
foregoing eversion device.
The invention contemplates the provision at a device for the
eversion of hollow organs, wherein most manual operations involved
in the eversion of a hollow organ on the bush would be ruled out
through maximum mechanization of the entire process of hollow organ
eversion. Furthermore, the contemplated design of a device for the
eversion of hollow organs should provide for its easy incorporation
in the corresponding instruments for anastomosing of hollow organs
and, inter alia, in vascular stapling instruments.
It is further contemplated that such a device for the eversion of
hollow organs shall be designed as an individual unit (eversion
unit) forming part of said instrument for anastomosing of hollow
organs, or else as a unit kinematically linked with other units of
this instrument to provide for the required sequence of steps in a
surgical operation to suture hollow organs.
Accordingly, there is provided a device for the eversion of hollow
organs, comprising a bush, whereinto the hollow organ end to be
everted is introduced, which, in accordance with the invention, is
fitted with spikes, whereon the edge of said hollow organ end is to
be fixed, and which are arranged on a base along a contour
conforming to the lateral guide surface of said bush, said base
being adapted to move a long said bush.
It is possible to make the spikes, whereon the edge of the hollow
organ segment to be everted is to be fixed, rigidly connected to
said base of the proposed device for the eversion of hollow
organs.
The spikes, whereon the edge of the hollow organ end to be everted
is to be fixed, should be preferably made spring-loaded relative to
said base so that the diameter of the contour along which said
spikes are arranged prior to the eversion process, should be less
than the diameter of the corresponding contour at the end of the
eversion process.
It is desirable that the spikes, whereon the edge of the hollow
organ end to be everted is to be fixed, should be movably mounted
on said base by means of hinges so that the spikes could be drawn
together prior to the eversion process.
The device of this invention for the eversion of hollow organs
should be preferably provided with spikes formed as S-shaped levers
of the first order, each having its fulcrum in said hinge serving
to movably mount said spike on said base, and the smaller arm of
each lever is defined by a wedge-shaped projection which is
disposed below and immediately adjacent the hinge, so as to face
said bush, whereas the larger arm of each lever is disposed above
the hinge and tapers to a sharp point, whereon the edge of the
hollow organ end to be everted is pinned while being fixed on the
spike, and the base, whereon the spikes are movably mounted,
envelops the bottom part of the bush, wherealong said base is
adapted to move, while the upper part of the bush is made
replaceable and having an inner diameter roughly equal to the outer
diameter of the hollow organ end to be everted, and the lower end
of said replaceable part of the bush has a surface conforming in
shape to the surface of the wedge-shaped projections of the spikes
so that, with the spikes in the extreme upper position, the larger
arms thereof should be forced against the upper edge of the
replaceable part of the bush.
The proposed device for the eversion of hollow orogans should be
preferably provided with a hand actuator having at least one lever,
whereof the fulcrum should be fixed relative to said bush, said
base with spikes being movably mounted on one arm of said lever,
whereas the other arm thereof should be adapted to be manually
actuated to transmit motion to said base when everting a hollow
organ segment, whereof the edge is fixed on the spikes fitted on
said base.
It is desirable that in the proposed device for the eversion of
hollow organs, which incorporates a split bush comprising two
half-bushes separated along a plane parallel to its longitudinal
axis, the base, whereon said spikes are fixed, should be formed as
two half-rings, each of which envelops one of the half-bushes and
is connected by a hinge to the respective lever of the hand
actuator.
The proposed device for the eversion of blood vessels should be
preferably provided with a haemostatic clamp positioned in said
bush on the base thereof.
The said haemostatic clamp provided in the proposed device for the
eversion of blood vessels may be formed as a flat spiral spring,
whereof the outer end is attached to the bush while the inner end
is left loose.
It is preferred that an instrument for end-to-end staple-suturing
of blood vessels should be provided, comprising a base, a device
for the eversion of the blood vessels being sutured mounted thereon
and incorporating at least one bush with slots to accommodate said
stapled, and a mechanism for feeding and directional bending of
said stapled at the instant of stapling, which instrument should
incorporate a device for the eversion of the blood vessels being
sutured in accordance with the present invention.
The disclosed device for the eversion of hollow organs is simple in
design and easy to handle.
It may be employed in any vessel-suturing instrument, since
building the proposed device into the corresponding instrument
involves no special design effort worth mentioning and offers no
technological difficulties.
In the proposed device practically all the steps of hollow organ
eversion are mechanized, which saves a considerable amount of time
for the entire process of eversion, with the consequent time gain
for the surgical procedure associated with the suturing of the
corresponding ends of hollow organs.
The vessel-suturing instruments incorporating the disclosed device
for the eversion of hollow organs, including vascular stapling
instruments are reliable, easy to handle and applicable for the
suturing of vessels of various diameters and in various states even
severely sclerosed vessels.
The unique haemostatic clamp formed as a flat spiral and built into
the bush of the disclosed device permits considerably extending the
field of application of the corresponding vascular stapler, as it
enables operations to be performed with the blood vessels being
sutured having short ends.
The invention will be better understood from the following detailed
description thereof, as well as some specific embodiments of the
proposed device for the eversion of hollow organs and a
vascular-stapling instruments incorporating same, taken in
conjunction with the accompanying drawings, wherein:
FIG. 1 is a longitudinal section of a known bush serving as a
mandrel for the hollow organ end to be everted;
FIG. 2 is the view of FIG. 1, with the hollow organ end to be
everted introduced into the bush;
FIG. 3 is the view of FIG. 1 with an everted end of a hollow
organ;
FIG. 4 is the view of FIG. 1, with an everted hollow organ end
prepared for suturing and the other hollow organ end stretched over
the former;
FIG. 5 is a longitudinally sectioned known bush;
FIG. 6 is a known split bush comprising two pivotally connected
half-bushes, shown in axonometry (the half-bushes separated);
FIG. 7 is the view of FIG. 6, with the half bushed joined;
FIG. 8 is a known split bush comprising two half-bushes
mechanically disengaged from each other (the half-bushes brought
apart);
FIG. 9 is the view of FIG. 8, with the half-bushes joined;
FIG. 10 is a general view of branches, with half-bushes according
to FIG. 8 mounted on the working pieces thereof;
FIG. 11 is a device of this invention for the eversion of hollow
organs, built around a bush with a longitudinal slot;
FIG. 12 is a plan view of the device of this invention for the
eversion of hollow organs, comprising a split bush consisting of
two half-bushes;
FIG. 13 is a side elevation of FIG. 12, with the elements on one of
the branches;
FIG. 14 is a side elevation of FIG. 12, with the hollow organ ends
being sutured, prior to the eversion process;
FIG. 15 is a view of FIG. 14, at the end of the eversion
process;
FIG. 16 is a plan view of an alternative embodiment of a device for
the eversion of hollow organs, with the spikes being rigidly fixed
on the base;
FIG. 17 is a side elevation of FIG. 16, illustrating the elements
of the larger half-bush;
FIG. 18 is a plan view of an alternative embodiment of a device for
the eversion of hollow organs, with the spikes spring-loaded
relative to the base;
FIG. 19 is a side elevation of FIG. 18, illustrating the elements
of the larger half-bush;
FIG. 20 is a plan view of an alternative embodiment of a device for
the eversion of hollow organs, with hanged spikes;
FIG. 21 is a side elevation of FIG. 20, illustrating the elements
of the larger half-bush;
FIG. 22 is a plan view of a modification of the device of FIG.
20;
FIG. 23 is a side elevation of FIG. 22, illustrating the elements
of the larger half-bush;
FIG. 24 is a hinged spike of a portion of the device for the
eversion of hollow organs shown in FIG. 23;
FIG. 25 is a bush of the proposed device for the eversion of blood
vessels with a haemostatic clamp, shown in axonometry;
FIG. 26 is a cross-section of the bush of FIG. 25, with a
small-diameter blood vessel introduced into the bush;
FIG. 27 is the same view, but illustrating a larger-diameter blood
vessel;
FIG. 28 is a side elevation of a vascular stapler incorporating the
device for the eversion of blood vessels of this invention;
FIG. 29 is a plan view of a vascular stapler incorporating the
device of this invention for the eversion of blood vessels;
FIG. 30 is a section taken on the line XXIV--XXIV of FIG. 23,
illustrating a vascular stapler incorporating the device of this
invention for the eversion of blood vessels; and
FIG. 31 is a view taken along the arrow A of FIG. 24, illustrating
a vascular stapler incorporating the device of this invention for
the eversion of blood vessels.
In vascular surgery whenever hollow organs are to be sutured, one
of the most important procedures is their eversion, that is to say
turning the internal layer (the intima in case of blood vessels)
outwards in the form of a cuff.
In a standard procedure, hollow organs are everted on a bush (FIG.
1) formed as a thin-walled hollow cylinder of inner diameter
roughly equal to the diameter of the hollow organ to be everted, so
that the bush 1 serves as a mandrel on which the entire process of
eversion is carried out.
End 2 (FIG. 2) of the hollow organ to be everted is introduced into
the bush 1 so that its edge should extend above the said bush 1 by
5 to 6 mm.
Then this edge of the hollow organ end is everted and stretched
over the bush 1 with its internal surface outwards as illustrated
in FIG. 3, whereupon it is fixed on the bush by any known
technique, for example, ligated.
This marks the end of the eversion procedure.
All further procedures are determined by the chosen method of
anastomosing the hollow organ.
According to one of these methods, the two hollow organ ends are
sutured by a circular suture at the point where the everted ends of
both hollow organ ends are bent over. Both ends of the hollow organ
are pierced at the point of suture by staples whose ends are
subsequently bent, the second segment of the hollow organ being
everted on the second bush, as described hereinabove. Thus are
hollow organs everted in all known instruments, including vascular
staplers, as well as in the above-described known vascular stapler
which embodies the USSR Author's Certificate No. 127361.
Under another procedure, the end edge of a second end 3 (FIG. 4) of
the hollow organ is stretched over the same bush 1 on top of the
everted edge of the first end 2 of the hollow organ, whereupon the
edge of the second end 3 is likewise fixed.
As has already been noted, the eversion of hollow organs,
particularly small vessels, on an elementary device, such as a
bush, involves some difficulties, takes a lot of time and puts a
considerable strain on the operating surgeon.
Consequently, surgical engineers have concentrated much of their
effort on a search for an improved design of an eversion device,
and above all, an improved design of the bush, which is only
natural in the light of the foregoing discussion.
If the bush is provided with a longitudinal slot 4 (FIG. 5), the
process of introducing thereinto the hollow organ end to be everted
is simplified and, more serious still, the sutured segment may be
withdrawn from the bush without being drawn theralong.
FIGS. 6 and 7 illustrate a split bush comprising two half-bushes 5
and 6 interconnected by a pivot 7. With the half-bushes 5 and 6
separated, the hollow organ end to be everted may be introduced
into the bush and securely fixed therein by bringing the two
half-bushes together. Such a bush is obviously an improvement on
the solid bush or the bush with a slot described above and
facilitates the procedure of hollow organ eversion.
Yet, far more popular is a split bush comprising two half-bushes
which are not mechanically interconnected by any pivot.
The latter bush may split into two half bushes along a plane
passing through the longitudinal axis of the bush, or else along a
plane somewhat shifted relative to the longitudinal axis of the
bush.
In the former case the half-bushes have an identical cross-section,
whereas in the latter case one half-bush is larger than the
other.
Since the half-bushes 8 and 9 are not pivotally connected, it is
difficult to handle them during the process of hollow organ
eversion. For this reason these half-bushes may be fixed, for
example, on the working pieces of branches 10 and 11 (FIG. 10).
Separating the branches 10 and 11, the half-bushes 8 and 9 will
also be separated, thereby permitting the hollow organ end to be
everted and introduced into the bush between the half-bushes 8 and
9.
All the above-described design principles aiming at the improvement
in the device for the eversion of hollow organs by standard design
modifications actually fall short of the objective, i.e. to
substantially facilitate the process of hollow organ eversion as
far as the operating surgeon is concerned. It is only the approach
of the present invention based on a complete mechanization of the
process of hollow organ eversion, that has proved really effective
and met the objects described hereinabove.
In one of the specific embodiments of the present invention, the
device for the eversion of hollow organs comprises: a bush 12 (FIG.
11) having a longitudinal slot; spikes 13; a base 14 of the spikes
13, which base 14 envelops the bush 12 and has a longitudinal slot,
whereof the width is equal to that of the longitudinal slot in the
bush 12.
The base 14 of the spikes 13 is so disposed on the bush 12 that its
longitudinal slot should be opposite the corresponding slot in the
bush 12. In order to prevent the base 14 from turning around the
bush 12 and also to ensure that said base 14 can only move
lengthwise said bush 12, the latter is provided with a longitudinal
slot 15. The base 14 of the spikes 13 is provided with a set screw
16 which fixes said base 14 in its extreme upper and lower
positions.
Besides, the end of the set screw 16 enters said longitudinal
groove, thereby preventing the base 14 of the spikes 13 from
turning around the bush 12.
The process of eversion in the above-described device proceeds as
follows.
The hollow organ end to be everted is introduced into the bush 12
through the longitudinal slot therein. The base 14 with the spikes
13 is moved to its extreme upper position and fixed therein by the
set screw 16.
The edge of said hollow organ end is pinned on the spikes 13 using
pincers for the purpose. Then said base 14 with the spikes 13 is
released from its extreme upper position, using the set screw 16,
and moved to its extreme lower position, thereby causing the
eversion of the edge of said hollow organ end.
Said base 14 with the spikes 13 is fixed by the set screw 16 in its
extreme lower position, thereby securely holding on the bush the
everted hollow organ segment which may now be subjected to the
further steps of the surgical procedure.
Another embodiment of the device for the eversion of hollow organs
in accordance with the invention comprises: two branches 17 and 18
(FIGS. 12, 13) interconnected by an axle 19; a split bush 20
consisting of a larger half-bush 20' mounted on the working piece
of the branch 17 and a smaller half-bush 20" mounted on the working
piece of the branch 18; spikes 21 and 21'; a base of the spikes 21
and 21', which base consists of a half-ring 22 enveloping the
half-bush 20' and carrying the spikes 21 fixed thereon, and a
half-ring 22' enveloping the half-bush 20" and carrying the spike
21' fixed thereon; a hand actuator formed as first-order levers 23
and 23', the lever 23 being mounted by a pivot 24, serving as the
fulcrum therefor, on the working piece of the branch 18. One arm of
the first-order lever 23 is movably connected with the half-ring 22
by a hinge 25, while the similar arm of the first-order lever 23'
is movably connected to the half-ring 22' by a hinge (not
shown).
The other arms of the first-order levers 23 and 23' are provided at
the free ends thereof with keys 26 and 26' (top) and 27 and 27'
(bottom). The keys 27 and 27' (lower) in FIG. 12 are hidden from
view by the keys 26 and 26' (upper), which is the reason why their
location is indicated by dotted lines.
The eversion of hollow organs with the foregoing device is
performed in the following sequence.
By depressing the upper keys 26 and 26', the levers 23 and 23' are
turned clockwise, thereby causing the half-ring 22 with the spikes
21 and the half-ring 22' with the spike 21' to move the extreme
upper position, wherein the spikes 21 and 21' will be positioned
above the bush 20. The branches 17 and 18 are separated, thereby
causing the half-bushes 20' and 20" of the bush 20 mounted on these
branches to separate. One of the ends 28' (FIG. 14) of a hollow
organ 28 is interposed between the half-bushes 20' and 20" so that
its edge should extend upwards therefrom.
The branches 17 and 18 are brought together, thereby causing the
half-bushes 20' and 20" of the bush 20 fixed on these branches, to
be brought together and clamp the end 28' of the hollow organ 28.
The edge of one segment 28' and then the edge of the other end 28"
of the hollow organ 28 are pinned with pincers on the spikes 21 and
21' (FIGS. 12, 13). Then the levers 23 and 23' are turned
counterclockwise by simultaneously depressing the lower keys 27 and
27'. As a result, the half-ring 22 with the spikes 21 and the
half-ring 22' with the spike 21' will move to the extreme lower
position.
The edge of one of the ends 28' (FIG. 16) of the hollow organ 28 is
everted, whereupon the edge of the other end 28" of the hollow
organ 28 is stretched over the everted edge of the end 28'.
The edges of the ends 28' and 28" of the hollow organ 28 are
securely held on the bush 20 by the spikes 21 and 21'.
This completed, the next step of surgery may be commenced, for
example, the suturing of the ends 28' and 28" of the hollow organ
28 by applying a circular suture to the juxtaposed edges of said
ends 28' and 28".
After the hollow organ 28 has been sutured, the levers 23 and 23'
are turned clockwise by depressing the upper keys 26 and 26', which
causes the half-ring 22 with the spikes 21 and the half-ring 22'
with the spike 21' to move to the extreme upper position. The
spikes 21 and 21', carrying the edges of the joined ends 28' and
28" of the hollow organ 28 pinned thereon, will be positioned above
the bush 20. Then, using pincers, the hollow organ 28 is taken off
the spikes 21 and 21', the branches 17 and 18 separated and the
hollow organ 28 withdrawn out of the bush 20.
The description of the specific embodiments of the proposed device
for the eversion of hollow organs fails to bring out in sufficient
detail the design features of the spikes which, by and large,
determine the efficiency of the entire device for the eversion of
hollow organs.
The spikes may be mounted on their base rigidly, or they may be
spring-loaded relative to the base, or else they may be made
hinged.
These varieties of spikes are discussed below as mounted on a base
made up of two half-rings which envelop the respective half-bushes
of unequal size.
In one embodiment of the disclosed device for the eversion of
hollow organs, wherein the spikes are rigidly mounted on the base,
spikes 29 (FIGS. 16, 17) are integral with a half-ring 30' of a
base 30, while a spike 29' is integral with a half-ring 30" of the
base 30.
The spikes 29 and 29' are arranged along a circumference, whereof
the diameter corresponds to the external diameter of a bush 31 made
to split into two half-bushes 31' and 31". The distance L between
the diametrically opposite spikes 29 is equal to the outer diameter
of the bush 31 and remains constant throughout the process of
eversion.
The above-described type of spikes rigid mounted on their base is
easy to manufacture and reliable in operation. Nevertheless, in the
process of eversion of hollow organs some difficulties arise in
regard to the pinning on the spikes of said segments of hollow
organs to be everted, particularly when dealing with small
vessels.
In another embodiment of the proposed device for the eversion of
hollow organs, wherein the spikes are spring-loaded relative to
their base, each spike 32, 32' (FIGS. 18, 19) is made of an elastic
steel ribbon (flat spring) which, together with another steel
ribbon 33 forcing thereagainst, is anchored to a base 34 by a screw
35. The base 34 is formed as two half-rings, one half-ring 34' with
the spikes 32 enveloping a half-bush 36' of a bush 36, while the
other half-ring 34" with the spike 32', envelops a half-bush 36" of
the bush 36.
Prior to the process of eversion, when the spikes 32 and 32' are
disposed above the bush resting on its edge, the spikes are
arranged along a circumference, whereof the diameter corresponds to
the inner diameter of the bush. The distance 1 between the
diametrically opposite spikes 32 and 32' is equal to the inner
diameter of the bush 36, which facilitates the pinning of the
hollow organ end to be everted on the spikes 32 and 32'.
In the course of eversion, the spikes 32 and 32' together with the
base 34 move downwards and away from each other, so that at the end
of the eversion process the spikes 32 and 32' are arranged along a
circumference, whereof the diameter corresponds to the outer
diameter of the bush 36, thereby ensuring reliable fixation of the
hollow organ segment pinned on the spikes 32 and 32'.
In an alternative embodiment of the disclosed device for the
eversion of hollow organs, wherein the spikes are hinge-mounted on
their base, hinged spikes 37 and 37' of the most elementary type
(FIGS. 20, 21) are mounted on their base on hinges 39.
The base 38 is formed as two half-rings, one half-ring 38' with the
spikes 37 enveloping a half-bush 40' of a bush 40, while the other
half-ring 38" with the spike 37' envelops a half-bush 40" of the
bush 40.
Prior to the eversion process, the hinges spikes 37 and 37' extend
outwards above the bush.
When the hollow organ end to be everted is pinned on the spikes 37
and 37', the spikes are brought as close to the centre as possible,
thereby providing for the simplicity and speed of this operation.
More serious still, this feature reduces the probability of
injuring the walls of the corresponding hollow organ end.
In the course of eversion, the spikes 37 and 37' move downwards and
away from each other, and at the end of the operation the spikes
are arranged along a circumference, whereof the diameter
corresponds to the outer diameter of the bush 40, which ensures
reliable fixation of the hollow organ ends pinned on the spikes 37
and 37'.
An improved modification of the latter embodiment of the disclosed
device with hinged spikes is a device for the eversion of hollow
organs comprising a split bush 41 (FIGS. 22 - 24) which consists of
two half-bushes 41' and 41". The half-bushes 41' and 41" of the
bush 41 respectively have replaceable upper parts 42' and 42" and
basic lower parts 43' and 43". Hinged spikes 44 and 44' are movably
mounted on a base 46 by means of hinges 45. The base 46 is formed
as two half-rings, one half-ring 46' with the spikes 44 enveloping
one basic lower part 43' of the half-bush 41' of the bush 41, while
the other half-ring 46" with the spike 44' envelops the other basic
lower part 43" of the half-bush 41" of the bush 41.
Each spike 44 and 44' is formed as an S-shaped lever of the first
order, whereof the fulcrum is the hinge 45 serving to movably mount
said spike on the base 46.
A wedge-shaped projection 46 positioned immediately adjacent the
hinge 46 with its tapered portion towards the bush 41, serves as
the smaller arm of said S-shaped lever of the first order. The
other, larger, arm of said S-shaped lever of the first order is
positioned above the hinge 45 and ends in a sharp point, whereon
the edge of the hollow organ end to be everted is pinned when being
fixed on the spikes 44 and 44'. The wedge-shaped projection 47 of
each spike 44 and 44' provides for an interaction with the
replaceable parts 42' and 42" of the respective half-bushes 41' and
42" so that the spikes 44 and 44' are drawn together while being
moved to the initial (extreme upper) position thereof.
The device for the eversion of hollow organs illustrated in FIGS.
22 - 24 operates in the following manner.
First, the replaceable parts 42' and 42" of the half-bushes 41' and
41", respectively are installed. These replaceable parts 42' and
42" of the half-bushes 41' and 41" are so selected that their
diameter should correspond to that of the hollow organ to be
everted. Then the base 46 with the spikes 44 and 44' is raised to
the initial (upper position thereof. This causes the spikes 44 and
44' to be drawn together as a result of interaction between the
spikes 44 and 44', end the replaceable parts 42' and 42" of the
half-bushes 41' and 41" so that the distance 1 between the opposite
spikes 44 becomes equal to the inner diameter of the replaceable
part 42' of the half-bush 41'.
The above-mentioned interaction of the spikes 44 and 44' with the
replaceable parts 42' and 42" of the half-bushes 41' and 41"
respectively occurs in the following sequence.
When the base 46 is in its lower position, the spikes 44 and 44'
may occupy any random position whatever usually they are fully
swung back, i.e. brought maximum apart. As the base 46 carrying the
spikes 44 and 44' approaches its extreme upper position, the
wedge-shaped projections 47 of the spikes 44 and 44' thrust against
the end faces 48 of the replaceable parts 42' and 42" of the
half-bushes 41' and 41" and begin turning round the hinges 46,
drawing together.
The end face 48 of the replaceable part of each half-bush is made
sloping at such an angle that, when the replaceable parts 42' and
42" of the half-bushes 41' and 41" are installed in the eversion
device, the spikes 44 and 44' in their upper position will be so
disposed that the distance between the diametrically opposite
spikes 44 and 44' will become equal to the inner diameter of the
replaceable part 42' of the half-bush 41'.
The device for the eversion of hollow organs (FIGS. 22 - 24) is
simple in design, reliable in operation and, what with the
replaceable parts in the bushes, may be employed for the eversion
of a variety of hollow organs, inter alia, vessels of various
diameters. Furthermore, with the foregoing embodiment of the
disclosed device for the eversion of hollow organs, the entire
eversion procedure is in fact mechanized, thereby substantially
simplifying the process of eversion and the associated surgical
procedure. for example vascular stapling. Hence, the said surgical
procedure may be carried out with much less effort on the part of
the operating surgeon.
Serious difficulties arise in the eversion of small vessels,
particularly blood vessels.
No less than 20 mm of the vessel should be exposed, as otherwise
the vessel end cannot be ligated, nor can a haemostatic cuff clamp
be applied thereto.
Therefore, the device of this invention for the eversion of blood
vessels is provided with a haemostatic clamp mounted in the bush at
the base thereof.
FIG. 25 illustrates a unique haemostatic clamp formed as a flat
spiral spring 49 mounted at a base 50 of a smaller half-bush 51.
The outer end 52 of the flat spiral spring 49 is rigidly coupled,
for example by welding (in FIG. 25 the point of welding is
indicated at Ref. No. 53), to the smaller half-bush 51, the inner
end 54 of the flat spiral spring 49 being left loose.
The blood vessel to be everted is placed between a larger half-bush
55 and the smaller half-bush 51. With the half-bushes approximated,
the outer section 56 of the flat spiral spring 49 forces the blood
vessel against the inner surface 57 of the larger half-bush 55.
Such a design of the haemostatic clamp and its position the bush of
the device for the eversion of blood vessels allow surgery with the
exposure of short vessel ends (of the order of 4 to 5 mm). In
addition, the haemostatic clamp of this kind is highly elastic and,
whatever the diameter of the blood vessel, it ensures haemostasis
without injuring the walls of the blood vessel placed between the
half-bushes 51 and 55.
If a blood vessel 58 (FIG. 26) has a small diameter, the flat
spiral spring 49 experiences a relatively small amount of
deformation when the half-bushes 51 and 55 are brought together,
and exerts a relatively small force on the blood vessel 58. This
force, however, is quite sufficient to ensure haemostasis.
If, on the other hand, a blood vessel 59 (FIG. 27) has a large
diameter, then, on the union of the half-bushes 51 and 55, the flat
spiral spring 45 experiences a comparatively large amount of
deformation and accordingly exerts a comparatively large force on
the blood vessel 59, thereby ensuring haemostasis in this case,
too.
In the device for the eversion of blood vessels of the design
illustrated in FIGS. 22 - 24, the haemostatic clamp is disposed at
the bottom of the basic part of the bush 41, over an area 60 (FIG.
22).
The foregoing devices for the eversion of hollow organs and, inter
alia, various vessels, for example blood vessels which are also
classified as hollow organs, may be manufactured as seft-contained
devices independent of other surgical instruments.
These devices may be manufactured in a range of designs, based on
the alternative embodiments of the proposed device described
hereinabove.
However, the disclosed devices for the eversion of hollow organs
are particularly important as constituent units of various
instruments for anastomosis of hollow organs.
It should be noted that the proposed device for the eversion of
hollow organs may be incorporated in said instruments for
anastomosis of hollow organs as a self-contained unit (eversion
unit), whereof the elements take no part in any operations not
involved in the eversion of a hollow organ, or else it may form a
unit kinematically connected to the other units of said
anastomosing instruments, the latter design ensuring the required
sequence of operations of all the elements of the instrument. In
the latter case, individual elements of such an eversion unit way
take part in operations not involved in the eversion of a hollow
organ.
End-to-end vascular stapling instruments built around the disclosed
device for the eversion of hollow organs, hold particular
promise.
An end-to-end vascular stapling instrument, according to the
invention in one of its specific embodiments comprises: two
branches 61 and 62 (FIGS. 28, 29) inter connected by an axle 63; a
blood vessel eversion device 64; and a mechanism 65 for feeding and
directional bending of the staples at the instant of blood vessel
stapling.
The branches 61 and 62 are provided with a lock 66 which keeps the
branches closed (as indicated in the drawing) and prevents them
from spontaneous opening.
The branch 61 consists of a working piece 67 and a handle 68. The
branch 62 has a working piece 69 and a handle 70. The handles 68
and 70 of the respective branches 61 and 62 are formed as
rings.
The eversion device 64, mounted at the ends of the working pieces
of the branches, comprises a smaller half-bush 71, a larger
half-bush 72, a haemostatic clamp 73, a half ring 74 with a spike
75, a half-ring 76 with spikes 77 and small levers 78 and 79 which
form a hand actuator of the described device for the eversion of
blood vessels. The smaller half-bush 71 is mounted on the working
piece 67 of the branch 61, while the larger half-bush 72 is mounted
on the working piece 69 of the branch 62; the half-ring 74 envelops
the smaller half-bush 71, while the half-ring 76 envelops the
larger half-bush 72; the small lever 78 is mounted on a pivot 80 on
the working piece 67 of the branch 61, whereas the small lever 79
is mounted on a pivot 81 on the working piece 69 of the branch
62.
The ends of arms 82 and 83 of the small levers 78 and 79,
respectively, are movably connected by pivot 84 and 85 with the
half-rings 74 and 76.
The free end of the arm 86 of the small lever 78 ends in keys 88
(upper) and 89 (lower), wehreas the free end of the arm 87 of the
small lever 79 ends in keys 90 (upper) and 91 (lower). The lower
keys 89 and 91 in FIG. 29 are hidden behind the upper keys 88 and
90 and their location is accordingly indicated by dotted lines.
These keys have a shape very convenient for manual actuation of the
small levers 78 and 79. It is easy to depress both upper keys 88
and 90 or both lower keys 89 and 91 with one finger, thereby
causing the small levers 78 and 79 to turn simultaneously around
their pivots 80 and 81 clockwise or counterclockwise, respectively.
The mechanism 65 for feeding and directionaly bending of the
staples is in the main disposed on upper surfaces 92 and 93 of the
respective working pieces 67 and 69 of the branches 61 and 62. This
mechanism incorporates sliders 94 (FIGS. 30, 31) adapted to move
lengthwise their respective grooves 95, wherein they are mounted.
The grooves 95 are formed in said upper surfaces 92 and 93 radially
relative to the centre of the bush comprising the half-bushes 71
and 72. Each slider 94 has a plate 96 movably mounted thereon by a
pivot 97.
The plates 96 have longitudinal slots 98 intended to receive the
staples whereby blood vessels are sutured (the staples are not
shown in the drawings).
There are coil springs 99 disposed between the plates 96 and the
respective sliders 94, said springs holding the plates 96 at a
predetermined angle.
As staples are placed in the slot 98, the plate 96 aligns itself at
the same angle at which the staple is bent, thereby making it
possible to fix the staple relative to the bush (the drawings
illustrate the half-bushes 71 and 71 making up the bush).
The lower parts of the sliders 94 are dovetail-shaped. The grooves
95, whreinto the respective sliders 94 fit with their lower parts,
have a corresponding shape, which provides for just one degree of
freedom of slider motion in the longitudinal direction,
simultaneously minimizing the possibility of transverse (horizontal
and vertical) motion (due to free play).
The free end of each slider 94 has a horizontal transverse hole
100. These holes provide for a movable connection of the sliders
with the drive of the mechanism 65 (FIGS. 28, 29) for feeding and
directional bending of the staples whereby blood vessels are
sutured.
The actuator of the mechanism 65 for feeding and directional
bending of the staples is manual and comprises: a lever 101 movably
mounted by a pivot 102 on the working piece 67 of the branch 61; a
lever 103 movably mounted by a pivot 104 on the working piece 69 of
the branch 62; a flat spring 105 loading the lever 101; a flat
spring 106 loading the lever 103; a fork 107 movably mounted by a
pivot 108 on the free end of the lever 101; and a fork 109 movably
mounted by pivot 110 on the free end of the lever 103. The ends of
the brackets 107 and 109 enter the holes 100 (FIG. 30) in the
sliders 94, thereby providing for the kinematic connection of these
sliders with the hand actuator. There are screws 111 turned into
the faces of the free ends of the forks 107 (FIG. 24) and 109. The
screws 111 provided for the movement of the sliders 94 from the
bush centre towards the periphery as the levers 101 and 103 are
respectively urged by the springs 105 and 106 to return to their
initial positions.
The foregoing modification of a blood vessel stapled provides for
an interlock to attain a predetermined sequence of operation of its
main component units: the mechanism to feed and directionally bend
the staples cannot be actuated unless the blood vessels to be
sutured is completely everted.
The interlock is ensured in a very simple and reliable way: the
pivots 84 and 85 have elongated and bulging ends which thrust
against the respective levers 101 and 103 in the course of eversion
of the blood vessels to be sutured.
The instruments in question sutured blood vessels in the following
manner.
The branches 61 and 62 are separated. As a result, the smaller
half-bush 71 and the larger half-bush 72, respectively mounted on
the working pieces 67 and 69 of the branches 61 and 62, are
separated, the small levers 78 and 79 are turned counterclockwise,
the half-rings 74 with the spike 75 and 76 with the spikes 77 are
in the extreme lower position, and the mechanism 65 for feeding and
directional bending of the staples is in the initial position (the
levers 101 and 103 are drawn off by the springs and the sliders 94
are at a maximum distance from the bush centre). The staples are
placed in the slots 98 of the plates 96.
By depressing the upper keys 88 and 90, the small levers 78 and 79
are turned clockwise, thereby causing the half-ring 74 with the
spike 75 and the half-ring 76 with the spikes 77 to move to the
extreme upper position. One end (usually the shorter) of the blood
vessel to be sutured is inserted into the larger half-bush 72.
Actuating the handles 68 and 70, the branches 61 and 62 are brought
together, thereby causing the smaller half-bush 71 and larger
half-bush 72 to unite and envelop said end of the blood vessel. In
this position the branches 61 and 62 are fixed by the lock 66. The
said end of the blood vessel enveloped by the half-bushes 71 and 72
is securely clamped by the haemostatic clamp 73. On the side of the
adventitia the protruding edge of this end of the blood vessel is
pinned at regular intervals on the spikes 75 and 77. Then the edge
of the other end of the blood vessel is pinned on these same spikes
75 and 77. The ends of the blood vessel to be sutured are usually
pinned on the spikes 75 and 77 with pincers -- a simple enough
matter for the operating surgeon.
Following this, the lower keys 89 and 91 are simultaneously
depressed, causing the small levers 78 and 79 to turn
counterclockwise and the half-rings 74 and 76 with the ends of the
blood vessels pinned on the spikes 75 and 77 are lowered to the
extreme bottom position. In the course of this operation one end of
the blood vessel to be sutured is everted (turned intima outwards)
and the other end of the blood vessel is stretched over this
everted end of the blood vessel.
Since the half-rings 74 and 76 are lowered during the eversion of
the blood vessels being sutured, so are the pivots 84 and 85,
whereof the elongated and bulging ends release the mechanism 65 for
feeding and directional bending of the staples. To actuate the
mechanism 65 for feeding and directional bending of the staples,
hence effecting the blood vessel suturing the levers 101 and 103
are to be depressed. Turning around their pivots 102 and 104, the
levers 101 and 103 move up to the stop, thus drawing together and
displacing the forks 107 and 109.
The sliders 94, kinematically connected via the forks 107 and 109
with the levers 101 and 103, move along the grooves 95 toward the
bush centre (the drawings illustrate the smaller half-bush 71 and
the larger half-bush 72 of the bush).
The plates 96 in whose slots 98 the stapled (not shown) are
arranged, turn and provide for the directional bending of the
staples, thus ensuring the suturing of the blood vessels by these
staples.
After that the levers 101 and 103 are released and return, urged by
the respective flat springs 105 and 106, to their initial
positions.
The sliders 94, kinematically connected via the forks 107 and 109
with the levers 101 and 103, respectively, move in the grooves 95
away from the centre of the bush (the drawing illustrates the
smaller half-bush 71 and the larger half-bush 72 of the bush). By
depressing the keys 89 and 90, the small levers 78 and 79 are
turned clockwise, causing the half-ring 74 with the spike 75 and
the half-ring 76 with the spikes 77 to move to the extreme upper
position. Then, with pincers, the blood vessel is taken off the
spikes 75 and 77, the branches 61 and 62 are separated and the
stapled blood vessel released.
The above-described instrument for vascular suturing is build
around a device for the eversion of blood vessels having spikes
rigidly mounted on a base composed of two half-rings.
Obviously, other modifications of vascular staplers may employ
other embodiments of devices for the eversion of hollow organs
(with spikes spring-loaded relative to the base and with hinged
spikes), which embodiments have been described hereinabove with
reference to the accompanying drawings.
Naturally, the above-described vascular stapler may be employed for
suturing other vessels, too, for example lymphatics.
The disclosed device for the eversion of hollow organs, as well as
the vascular stapler built there around, have been subjected to
all-round experimental testing. The tests have revealed that the
proposed device considerably facilitates and speeds up the process
of eversion of hollow organs, including blood vessels, and, hence,
considerably facilitates and speeds up surgical procedures
connected with the need to suture hollow organs.
Thus, depending on the surgical situation, it takes 1 or 2 minutes
for an average surgeon to suture a blood vessel (at one point),
with not more than half a minute spent for the process of eversion,
if use is made of a vascular stapler built around the proposed
device for the eversion of hollow organs.
At the same time, with other vascular suturing instruments
employing prior art devices for the eversion of hollow organs, a
similar surgical procedure requires 3 to 5 minutes (depending on
the surgical situation), of which 2.5 to 4.5 minutes are devoted to
the process of eversion.
It has been shown experimentally that the proposed device permits
everting, and hence suturing, short vessel ends (of the order of 4
to 5 mm), whereas prior-art devices could only handle at least
20-mm long ends of the vessels to be everted and subsequently
sutured. Experiments indicate that the proposed device is suitable
for the eversion of a great range of vessels, including the
thinnest and severely sclerosed ones.
A vascular stapler employing the proposed device for the eversion
of blood vessels has been proved in numerous trails carried out on
dogs at the Organ Transplantation Laboratory of the Sklifossovsky
Emergency Aid Institute (in Moscow).
The instrument was tested in the gravest surgical situations. Thus,
it was used in such operations as homotransplantation of the head,
the kidneys, the liver and a whole set of organs.
It was also employed for simple suturing of incised blood vessels,
both arteries and veins. All in all, 40 suturings of blood vessels
were performed at the first stage of experimentation. The sutures
were invariably of the highest quality with no thrombus formation
on the suture line.
At the first stage, the follow-up period was up to two months.
Subsequently another series of god experiments was run, in which a
vascular stapled built around the proposed device for the eversion
of hollow organs was employed in various blood vessel suturing
operations.
Out of the 28 experiments (150 anastomoses) conducted with the use
of this instrument 16 were carried out at the Organ Transplantation
Laboratory. Not in a single case, irrespective of the follow-up
period (up to 18 months), was there a complication of any kind; not
a single case of thrombosis or narrowing of the vascular lumen.
At present, the proposed device for the eversion of hollow organs
and the instrument for staple-suturing of blood vessels build
around the proposed device for the eversion of hollow organs
undergo clinical trials.
* * * * *