CA1162812A - Surgical instrument for staple suturing of hollow organs - Google Patents

Surgical instrument for staple suturing of hollow organs

Info

Publication number
CA1162812A
CA1162812A CA000364288A CA364288A CA1162812A CA 1162812 A CA1162812 A CA 1162812A CA 000364288 A CA000364288 A CA 000364288A CA 364288 A CA364288 A CA 364288A CA 1162812 A CA1162812 A CA 1162812A
Authority
CA
Canada
Prior art keywords
jaws
staple
spacers
instrument
jaw
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
CA000364288A
Other languages
French (fr)
Inventor
Igor A. Guskov
Nikolai N. Kanshin
Boris A. Smirnov
Vladimir M. Fedotov
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
VSESOJUZNY NAUCHNO-ISSLEDOVATELSKY I ISPYTATELNY INSTITUT MEDITSINSKOI T EKHNIKI
Original Assignee
VSESOJUZNY NAUCHNO-ISSLEDOVATELSKY I ISPYTATELNY INSTITUT MEDITSINSKOI T EKHNIKI
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by VSESOJUZNY NAUCHNO-ISSLEDOVATELSKY I ISPYTATELNY INSTITUT MEDITSINSKOI T EKHNIKI filed Critical VSESOJUZNY NAUCHNO-ISSLEDOVATELSKY I ISPYTATELNY INSTITUT MEDITSINSKOI T EKHNIKI
Application granted granted Critical
Publication of CA1162812A publication Critical patent/CA1162812A/en
Expired legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads

Abstract

ABSTRACT OF THE DISCLOSURE

Described herein is an instrument, comprising hinge--joined a staple body and a supporting body, both having longitudinal jaws. The staple body has staple magazines and a staple ejector. The supporting body has a die for the staples to bend when suturing. A recess is provided at the base of one of the jaws on the side facing the hinge joint interconnecting the instrument bodies, said recess being adapted to define a free space between the jaws when brought together. The jaws are adapted for springy elastic spacers to mount and hold thereto with a possibility of sub-sequent releasing therefrom, said spacers being arranged on the side facing the inner compressing surfaces of the jaws so as to be stitched up together with the organs being su-tured.

Description

~a~6~N~

I. Technical Field The present invention relates to a surgical instru-ment for the staple suturing of hollow organs, e.g., for establishing lateral gastrointestinal and interintestinal anastomoses to provide a decompression in the suture applied, whereby the suture elements are rejected in a period of time and are removed in a natural way, as well as to stitch-ing up considerable lengths of the mesentery.
II. Background of the Invention Known in the art are various devices for esta-blishing compression anastomoses of hollow organs of the gastrointestinal tract by compressing the tissues in the anastomotic zone with such a force that results in reject-ing the devices in a period of time and their removal in a natural way (cf., e.g., "Sutureless anastomoses in sur-gery of the gastrointestinal tract with and without per-manent magnetic field: by N.N. Kanshin et al. Records ofpathology, 1978, v. XL, issue 8, pp. 56-61 (in Russian);
"On some regularities governing the tissue compression and regeneration processes involved in establishing suture-less anastomoses of hollow organs of the gastrointestinal tract" by L.A. Pitu2ian et al. Proceedings of the USSR
Academy of Sciences, Biological series, 1979, No. 1 pp.
13-17 (in Russian). These devices are two flat plates of ~ - 2 -~;2~

a magnetic material, which attract each other, or two flat rings likewise attracting each other. However, these devices in the form of magnetic plates fail to provide primary patency of the alimentary tract, while the magnetic rings are unsuitable ~or the purpose as practical ex-perience has demonstrated, due to high stiffness and large weight.

One more suturing instrument disclosed in the USSR
Inventor's Certificate No. 571,254 is known to comprise a tubular body, a staple head linked thereto and provided with staple slots, a circular knife, a detachable thrust head with depressions and a movable screw locking the head in position, soft elastic spacers shaped as circular troughs and located on the suturing surfaces of the staple and thrust heads.

This instrument is capable of establishing com-pression anastomoses on the organs of the digestive tract using end-to-end or end to-side technique alone. The instrument is unsuitable for establishing lateral gastroin-testinal and interintestinal compression anastomoses, which are frequently encountered in modern surgical practice.

An instrument disclosed in US Patent No. 3,079,606 is known to use for establishing lateral gastrointestinal and interintestinal anastomoses by the side-to-side tech-nique.

The instrument is known to comprise hinge-joined a supporting and a staple bodies having longitudinal jaws, the former bod~J car.rying a star)le ma~azine and an e~ector to ~'eed the s-ta~les from the magazine for suturin~, and a knife ~or makin~ longitudinal inclsion lengthwise the sutures av-plied, w'nile the latter body has a die :~or the staples to bend in the course o~ suturing. ~ovJever~ this instrument suffers from a number o-f disadvantages, stemmin~ largely from its being not adar)ted ~or establishing lateral com-~res-sion anastomoses.
The afore-mentioned instrument allows spring~ elastic svacers to be mounted.on its ja~s, but establishing a late-ral compression anastomosis involves punctures .for the ~aws B to pass through, which are then to be stitched Rv manually.
6~
This~af-fect3 ~ the quality of the compression anastomosis thus established. Thou~h the zone of compression suture featu-res good biolo~ical tightness and provides for good asepsis in the course o-f tissue healing, the adjacent zone of manual sutura, even when possessing high mecnanical strength, suf-- fers from disturbed biological tightness thereo~, whereb~J
in~^lammatory and adhesion-forming process are liable to de-velop. As a result, the potency of the established anastomo-sis is reduced on which account cicatricial tissues are la-ter liable to ~orm i.n the anastomotic ~one.
Moreover, to withdraw the instrument jaws ~rom the in-terior of the hollow organs involved, a~ter their walls ha-ve been sutured with staples together with the elastic spa-cers, the latter must be separated ~rom the jaws, which pro-ves to be dif:ficult with a given construction o~ the instru~-~ . .

' G'Z~

ent. Thus, one has to enlarge the punctures made in thewalls o~ the or~ans being anastomosed9 in order to inter-sect the straps holding the spacers to the instrument jaws.
This o~ course impa ~s the quality of the compression anas-tomosis established.
Apart from a quality formation of anastomoses on the organs of the gastrointestinal tract, one more important task of a surgical intervention in these organs is to stitch up the mesentery, which needs establishin~ of any anastomo-sis. Besides, stitchin~ up the mesentery following the excision of morbidly changed intestines involves considerab-le lengths of the gastrointestinal tract, which may amount to a few scores of centimetres.
Such a case requires, apart from reliable constriction of di~ferent-size blood vessels running throu~h the mesentery, also application o~ longer sutures, i.e., needs higher pro-ductivity of the suturing instrument. ~his makes it possible to cut down the operatin~ time several fold.
The ~nown instrument as per US Patent No. 3~079,6 ~
when applied for stitching up the mesentery with the use of elastic spacers, requires some additional manipulations ~ith the cutting instruments in order to separate the s~acers from the instrument jaw, and turns of the suturing instrument ~or the spacers to take out of the bottom jawj which is far from being practicable at every time9 e.gO, deeply in the operative wound and affects adversely the productivity of the instrument.

-III. Objects of the ~nvention It is an essential object of the present invention to ~rovide an instrument for suturin~ hollow or~ans, ca~,able of establishing lateral gastrointestinal and interintesti-nal compression anastomoses featuring a separated zone of .~nanually applied suture, and of accelerating the operations of stitching up the mesentery to attain a reliable hemosta-sis .
It is another object of the present invention to pro-vide an instrument for suturing hollow organs, capable of attaining higher quality and reliabilit~ of the lateral com-pression anastomoses.
Amon~ other objects of the present invention one is to reduce the amount o~ trauma inflicted upon the tissues of the organs being sutured and provide favourable reunion of the tissues involved within the postoperative period.

IV. ~rief Description of the Inven~io~

~ he aforesaid and other objects are accomplished due to the fact that in a surgical instrument for suturing hol-low organs by means of staples, especially when establish-ing lateral anastomoses and stitching up the mesentery by means of staple~, comprising hinge-joined a supporting and a staple bodies, both provided with longitudinal jaws, and ~a~

the former body has a sta~le magazine and an ejector to feed s~aples out of the magazine for suturing, while the latter body has a die for the staples to bend in the course of suturing, according to the present invention, a recess is made at the base of at least one of the jaws on its si-de facing the hinge joint interconnecting the bodies, said recess bein~ to define a free space between the aaws when brought together, while both of the jaws are adapted for svringy elastic spacers to mount and hold thereto ~ith a possibility o~ subsequent releasing, said spacers being ar-ranged on the side facing the inner compressin~ surfaces o~
the jaws so as to be stitched up together with the organs bein~ sutured.
Provision o~ the abovesaid recess at the base of one o~
the jaws and a possibility of mounting springy elastic spacers on and holding them to the jaws (with subseguent re-leasing o~ said spacers therefrom) on the side facing the inner compressing surfaces of the jaws renders it possible to establish lateral gastrointestinal and interintestinal anastomoses featuring an isolated zone of manuall~ applied su~ure, and to accelerate the mesentery stitching-up opera-tion to give a reliable hemostasis. ~his in turn adds to the ~uality and reliability of the lateral compression anastomoses, reduces much the amount o~ trauma inflicted upon the tissues of the organs operated upon during sutur-ing and conduces to the ~ollowing favourable reunion of the tissues within the postoperative period.

In one of the embod.iments of the present inventi.on a slot is provided on the outer suriace of each of the bodies within the zone of t~e recess for one end of the spacer to ~ass thereinto, while the other end of the spacer is made fast on the vacant end of the jaw, and a movable kni~e is held to the ou-ter sur~ace of each of the bodies, said knife.
being adapted for cutting off the portion of the spacer, which is accommodated in the slot on terminating the operat-ion so as to release the spacers from the instrument iaws.
It is expedient that each o~ the spacers be made as a flat strip o~ a springy elastic material as wide as the instrument jaw, and that a strap is provided at one of the ends of the strip and is made inte~ral therewith, said strap being adapted to be accommodated in the slot, while the end of the strip is shaped as a cup-like member adapted to ~e fitted onto the jaw vacant end.

V. Brie~ Description of the Drawings Given below is a detailed description of a specific embodiment of the present invention with reference to the accompanying drawings, wherein:
FIG. 1 is a general partl~ cutaway view o~ the instru-ment for suturing hollow organs, according to the present invention;
FIG. 2 is a side view of FIG. l;
FIG. 3 is a section taken on the line III-III in ~IG. l;

FIG. ~ is a view facing the arrow B in FIG. li FIG. 5 is a section taken on the line V-V in FIG. 1;
and FIG. 6 is a lateral compression anastomosis establish-ed with the use of the instrument of FIG. 1.

VI. Detailed Description of the Invention Reference being now directed to FIGS.l, 2 and 3, the instrument for suturing hollow organs adapted, according to the present invention to establish a lateral compression anastomosis is shown to comprise a respective supporting and staple bodies 1 and 2, hinge-joined through a pin 3 (~IGS. 1 and 2). The bodies have respective longitudinal jaws 4 and 5 and are provided with rings 6. The longitudinal jaw 5 of the staple body 2 carries replaceable staple magazines 7 and 3 (FIGS. 1, 3) along with staples 9 and ejectors 10 of the staples 9. The longitudinal jaw 4 of the supporting body 1 has a die or anvil 11 for bending the staples 9. A shaped recess 12 is present at the proximal end of the jaws 4 and 5 at the base thereof. The longitudinal jaws 4 and 5 carry springy elastic spacers 13 having cup-shaped endpieces 14 and straps 15 by which they hold on the jaws 4 and 5. Slots 16 are provided in the bodies 1 and 2 at the base of the jaws 4 and 5, said slots being adapted to accommodate the straps 15 at then ends of the spacers 13 and to mount knives 17 and 18, the straps 15 of the spa-~,~ _ g _ cers 13 being a~ranged in the slots 16 before the knives 17 and 18. A slider 19 is provided on the staple bod~J 2 to ~hich there held with screws 20 a plate knife 21 and wedge--shaped ejectors 22 for the sta~les 9 to ~eed out o~ the ma-gazines 7 and 8. The e~ectors 22 are traversable in slits 23 and 24 (~IGS 1 and 3)0 The slit 23 accommodating the knife 21 has a variable shape so as to make it possible to cut through the spacers 13 and the tissues being sutured beyond the recess 12. Projections 25 are provided at the end of the pin 3 adapted to enter slots 26 (FIG. 4) in the supporting body 1 so as to form a separable single-lug lock.
I"hen brought together the supporting and staple bodies are locked by a locking pawl 27 (~IG. 5).
The surgical instrument ~or suturing hollow organs, ac-cording to the present invention, operates as follows.
In order to establish, say, a lateral gastrointestinal compression anastornoses, the supporting bod~ 1 and the stap-le body 2 are set apart and the longitudinal jaws 4 and 5 are completely introduced into the interior of the organs being sutured through punctures 28 (~IG. 6). Then the sup-~porting body 1 and the staple body 2 of the instrument are brought together and locked to each other with the rings 6 by drawing them together until locked with the pawl 27.
~ext the slider 19 along with the plate kni~e 21 and the wedge ejectors 22 is moved along the staple body of the instrument towards the longitudinal jaws 4 and 5 till meet-ing a stop. As a result nearly simultaneous suturing of the ~se elastic spacers 13 and the walls o~ the organs involved are surured and intersected to establish communication between the gastric stump and the enteric loop. ~hereupon the kni-ves 17 and 13 are advanced to intersect-the straps 15 o~
the s~acers 13, whereupon the slider 19 is returned to the initial position, the longitudinal jaws 4 and 5 are brought a~art and withdrawn from the interior spaces o~ the thus~
-sutured organs having been alread~ stripped o~ the elastic sracers 13. ~urther manipulations aimed at stitching up the punctures are carried out manuall~ according to the heretofore adopted commonly known techniques.
~ s a result of the operation per~ormed with the use o~
the instru~ent disclosed in the present invention a compres-sion anastomosis is established, isolated ~rom the punctures in the walls of the organs sutured, while these walls in the zone o~ the punctures stitched up manually, are not subjec-ted whatever to compression with the instrument jaws, which contributes to better healing o~ the walls. In a certain period o* time (7 to 10 days) the thus~sutured organs re-unite along the perimeter o~ the compression anastomosis established, while the spacers 13 along with the staples 9 are rejected and removed from the organism by natural way.
Thus, a high-qualit~ "sutureless" anastomosis is obtained conducive to good physiological ~unctions o~ the organs involved.
To stitch up the mesentery along great lengths thereof unon excision o~ morbidly changed intestine segments, the instrument is not set apart into two halves9 but is used as a clamp~ A puncture is made in the mesentery with the pointed end ol one o~ the jaws, say the jau 5, whereupon that jaw is introduced ~or the full length thereof into the mesentery. Then the aaws 4 and 5 of the respective bo-dies 1 and 2 are brought together and locked with the pawl 27, with the result that the mesentery gets uni~ormly com-~ressed between the jaws 4 and 5 fitted with the springy elastic s~acers 13 to provide good hermetic tightness. Then the mesentery is sutured by the instrument and simultaneous-ly severed along the thus-applied suture. Ne~t the jaws 4 and 5 are set apart, the instrument is withdrawn, the fresh magazines 7 and 8 and the s~acers 13 are charged into the instrument, and a next length of the mesentery is stitched up in a similar way. Stitching u~ the mesentery with the use of the herein-disclosed instrument employing springy elastic spacers ~rovides for a reliable hemostasis, while an adequate length o~ the instrument jaws ensures good pro-ductivity of suturing, which enables the operating time to be cut down several fold.
~ he herein-disclosed surgical instrument for suturing hollow organs is simple in construction and application techniques, convenient to handle and is easy-to-master by the surgeon. In addition, the instrument provides ~or estab-lishing high-quality lateral compression anastomoses and guick stitching up o~ the mesenter~ over great lengths the-reo~ to obtain a good hemostasis.

Claims (3)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLU-SIVE PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A surgical instrument for staple suturing of hollow organs, comprising a staple body provided with a first longitudinal jaw, a staple magazine mounted on said body, an ejector for staples adapted to expel staples from said magazine, a supporting body provided with a second longitudinal jaw, a die for bending staples mounted on said supporting body, said staple and supporting bodies being interconnected by a hinge, a recess at the base of at least one of the jaws on the side facing the hinge defining a free space between the jaws in a closed position thereof, both of said jaws being adapted to have springy elastic spacers releasably mounted thereon, said spacers being disposed on the side facing the inner compressing surfaces of the jaws so as to be stitched up together with the organs being sutured.
2. A surgical instrument as claimed in claim 1, wherein a slot is provided on the outer surface of each of the bodies in the vicinity of the recess for one end of the spacer to pass thereinto, the other end of the spacer being fastened on the free end of the respective jaw, and a movable knife is attached to the outer surface of each of the bodies, said knife being adapted to cut off the portion of the spacer which is accommodated in the slot on terminating the operation so as to release the spacers from the jaws.
3. A surgical instrument as claimed in claim 1, wherein each of the spacers is essentially a flat strip of a springy elastic material having the same width as the associated jaw, one of the ends of said spacer carrying an integral strap which is accommodated in the slot, the other end of the strip is being a cup-like member fitted onto the free end of the jaw.
CA000364288A 1979-12-20 1980-11-07 Surgical instrument for staple suturing of hollow organs Expired CA1162812A (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SU2856033 1979-12-20
SU792856033A SU1022703A1 (en) 1979-12-20 1979-12-20 Device for correcting and fixing vertebral column of patients ill with scoliosis surgical apparatus for applying compression sutures

Publications (1)

Publication Number Publication Date
CA1162812A true CA1162812A (en) 1984-02-28

Family

ID=20866338

Family Applications (1)

Application Number Title Priority Date Filing Date
CA000364288A Expired CA1162812A (en) 1979-12-20 1980-11-07 Surgical instrument for staple suturing of hollow organs

Country Status (7)

Country Link
US (1) US4397311A (en)
JP (1) JPS5697442A (en)
CA (1) CA1162812A (en)
DE (1) DE3046365C2 (en)
FR (1) FR2471771A1 (en)
GB (1) GB2065536B (en)
SU (1) SU1022703A1 (en)

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GB2065536B (en) 1984-01-04
FR2471771B1 (en) 1984-12-07
SU1022703A1 (en) 1983-06-15
FR2471771A1 (en) 1981-06-26
DE3046365A1 (en) 1981-09-17
DE3046365C2 (en) 1985-08-22
US4397311A (en) 1983-08-09
JPS5697442A (en) 1981-08-06
GB2065536A (en) 1981-07-01

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