CA1245935A - Surgical stapling apparatus - Google Patents
Surgical stapling apparatusInfo
- Publication number
- CA1245935A CA1245935A CA000460359A CA460359A CA1245935A CA 1245935 A CA1245935 A CA 1245935A CA 000460359 A CA000460359 A CA 000460359A CA 460359 A CA460359 A CA 460359A CA 1245935 A CA1245935 A CA 1245935A
- Authority
- CA
- Canada
- Prior art keywords
- staple
- wedge
- case
- staples
- thrust
- 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
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
- A61B2017/07214—Stapler heads
- A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
Abstract
Abstract of Disclosure A surgical stapling apparatus, comprising a thrust case incorporating a lengthwise groove. Said groove acco-modates a magazine containing staples, and pushers of the staples, and a wedge interacting with said pushers and seating on a carriage supported in guides running along said staple case. A surface of said wedge interacting with said pushers is curvilinear, with lines tangent to the generatrix thereof and a travelling direction of said wedge located so as to constitute an angle varying gradually from 45 deg to zero between a front part of said wedge and the back part thereof in the direction of the wedge travel during stapling procedure.
Description
~S935 The present invention relates to medical engineering, and, more specifically, to a surgical stapling apparatus.
The surgical stapling apparatus of the present inven-tion can be mos-t advantageously be used in suturing gastrointes-tial organs.
sesides, the surgical stapling apparatus according to the present invention can be used in suturiny the esophagus, lungs, vessels and other organs of human and animal bodies.
Suturing of tissues and organs representing a basic stage of surgical intervention greatly influences the possibili-ties and results of surgical operations. ~t the same time, the s-tapling procedure largely depends on technical facilities, and, particularly, on the design of the surgical stapling apparatus that would provide a means for making high-quality sutures easily without damaging adjacent tissues and organs, and would permit compensating the growing staple forming forces.
Known in the art is a surgical stapling apparatus (for example, cf. US Patent No. 3,079,606 issued March 5, 1963 to B. Bobrov et al.
The prior-art surgical stapling apparatus comprises a thrust and a staple cases linked by a sectional joint and a de-tent. The s-taple case comprises a working section incorporat-ing staple grooves arranged across a longitudinal axis of thestaple case. The staple grooves contain U-shaped
The surgical stapling apparatus of the present inven-tion can be mos-t advantageously be used in suturing gastrointes-tial organs.
sesides, the surgical stapling apparatus according to the present invention can be used in suturiny the esophagus, lungs, vessels and other organs of human and animal bodies.
Suturing of tissues and organs representing a basic stage of surgical intervention greatly influences the possibili-ties and results of surgical operations. ~t the same time, the s-tapling procedure largely depends on technical facilities, and, particularly, on the design of the surgical stapling apparatus that would provide a means for making high-quality sutures easily without damaging adjacent tissues and organs, and would permit compensating the growing staple forming forces.
Known in the art is a surgical stapling apparatus (for example, cf. US Patent No. 3,079,606 issued March 5, 1963 to B. Bobrov et al.
The prior-art surgical stapling apparatus comprises a thrust and a staple cases linked by a sectional joint and a de-tent. The s-taple case comprises a working section incorporat-ing staple grooves arranged across a longitudinal axis of thestaple case. The staple grooves contain U-shaped
- 2 -,' J, staples and staple pushers serving to drive the staples out of the staple grooves during the stapling procedure.
The staple pushers drive the staples by inte~acting with a pointed wedge adapted to move along the working ~ec-tion of the staple case.
The wedge is arranged at the end o~ a plate turned toward the working section of the staple ca~e. ~he other end of the plate mates with a carriage seated in -the groove in the staple ca~e and adapted for longitudinal movement therethrough.
~ he thrust case also incorporates a working section disposed opposite the working section of the staple case.
The working section of the thrust case mount~ a die ser-ving as a thrust o~ the staples being ejected and bent at the free ends thereof.
For this purpose, the die is provided with two rows of sockets disposed along the full length o~ the thrust case working section opposi-te the staple grooves in the staple case working section when the stapling a~paratus i8 in assembled state.
~ he detent of the staple and thrust cases of the prior art surgical stapling apparatus is devised in the ~orm o~ a ~ear rack. In mating the staple and thrust cases, teeth o~ the gear rack couple in succession and individually lock the working sections relative to each other, and, thus, permit adjusting the suture clearance ~Z`~5~335 according to the thickneæs of biological tissue baing a oined.
It is known to those skilled in the art that the suture clearance is defined as the distance between the surfaces of the suræical stapling apparatus working sec-tions which interact with biological -tissue during the stapling procedure, ID said surgical stapling apparatus, the wedge interac-ting with the staple pushers is longer than normally be-cause the wedge point angle apprDpriate for suturing and resisting the staple forming force may not be more than 15 deg. ~his feature obstructs making a suture through the full le~gth o~ the working section because distal ends of the working sections must be long enough to mount tbe long-size wedge.
There is also known a surgical stapling apparatus (c~. USSR Inventor's Certificate No. 886897~ which is the closest analogue to the surgical stapling apparatus of tbe present invention.
~ he foregoing surgical stapling apparatus comprises a thrus-t and a staple cases. The staple case incorpora-tes a lengthwise groove foxmed by side walls of the woxking section, '~he lengthwise groove accommodates a magasine shaped on the out~ide identically with the interior of the leng~h-wise groove. ~he magazine holds a plurality of U-shaped staples charged evenly in ockets along the full length of the magazine.
The same sockets accommodate staple pushers. Each pusher is devised as a right-angle prism, t~e slant surface whereof ~aces a magazine bottom surface, and the opposite flat end thereo~ faces the staples pushed thereby.
A handle in a~sembly with a ring attached to the staple case permit~ holding tbe surgical stapling appa-ratus by the hand. ~he staple pushers interact wit,h a pointed wedge adapted for movement along the working sec-tion of the staple case.
The wedge is mounted at an end of a plate facing the working section of the staple case. The opposite end of the plate is linkod with a carriage movable along the groove in the staple case.
~ he thrust case incorporates a working ~ection dis-posed opposite the working section of the staple case when the case~ are in mated s-tate. A groove provided in the working section of the thrust case along the ~ull length thereof' is formed by side walls of the working section.
The above groove accommodates a die incorporating sockets, serving as a thrust of the staples being edjected, and permi-tting bending the free ends thereof for sut~ring biological tissue.
A suture clearance adjustment device located in the working section of' the thrust case permits moving the die in parallel in the direction of the staple ca~e worki~g section, with the result that the suture clearance can be adjusted within a certain range.
The suture clearance adjustment device comprises a crank shaft carr~ing a knob serving to turn the crankshaft.
~ he die is devised in the form of a right-angle prism, the side surface whereof facing the working section of tbe Etaple case and serving to compress biological tissue being sutured incorporates sockets disposed opposite si-milar sockets in the magazine. A lengthwise groove in the die accommodates a crank of the crankshaft.
Whe~ the crankshaft is turned by the knob) the die moves toward the working section o~ the staple case and thus ~egulates the distance between the die surfaces ser-ving to compress biological tissue, and the working sec-tion of the staple case.
~ he above-mentioned feature of the prior-art s~rgical stapling apparatus permits adjusting the sutuxe clearance.
~ he tbrust case also carries a handle with a ring which permi-ts holding the case by the hand.
~ he ~oregoing surgical stapling apparatus also incor-porate~ a sectional hinge joint and a detent, serving fox interconnection of the thrust and staple cases. The sectional hinge joint is disposed in the area of inter-connection of the working sections of the staple and thrust cases, and is fuxnished with a shaft attacbed to ~Z~ 3~;
the staple case and introduced into a hole in the thrust case by o~e end thereof.
~ he ca~e detent is essentially a double-gear rack disposed beside the handle and ring assemblies.
In the prior-ar-t surgical stapling apparatus, the leDgth of the working sections o~ the thrust and staple cases is extended to pexmit arrangement at the distal eDds tbereof of a long-size wedge having a point angle of not more than 15 deg, a~d a journal of the crankshaft incorporated in the suture clearance adaustment device.
The above-mentioned relativel~ high pointing of the wedge, and, hence, the e~tended length of the ~orking parts of the surgical stapling apparatus are necessary to permit movement o~ the staple pushex~ interacting with the wedge, and to permit bending the staples during the suturing procedure.
It has been k~own (for example; cf. Periodical KHIRURGICEESKIE SSHIVAYUSC~IE APPARA~Y (Surgical Su-turing Apparatus, in Russian), Edition VII, V~IIKHAI, ~oscow, 1967, pp.13~15) tha-t the relationship between the staple fcrmi~g f`orce and the suture clearance depend-in~ on the thickness of tissue being joined 3hows that the staple forming force gradually increases i~ the ~egio~
near the minimum suture clearances, and with fur-ther Le-duction of the suture clearances; said force rises ab-~2~S935 ruptl~ with the result that the operator's effort increa-ses, and, hence, the dimensions of the surgical stapling apparatus working sections must be rather large.
In the prior-art surgical stapling apparatus wherein the wedge point angle is constant,-no allowance i8 made for -the nature of ~rowth of forces reauired to form each staple during the sature procedure, whereby the surgical stapling apparatus of large size cannot be efficiently used in suturing operative inci~ion6.
- ~he principal object of the present invention is to provide a surgical stapling apparatlls, wherein the cons-truction of the wedge will permit reducing the length of the whole surgical stapling apparatus, Another object of -the invention is to provide a sur-gical stapling appa~atus J the construction whereof will improve the service reliability and the opera-ting e~fi-ciency thereof in stitching surgical i~cisions.
A further object of the inventioD is to provide a surgical stapling apparatus o~ substantially simplified construction.
With these and other objects in view, a surgical ~tapling apparatus herein proposed comprises a -thrust c~e and a staple case incorporating a groove formed by the side walls thereof and accommodating a magazine containing staples, staple pushers and a wedge interacting with the staple pushers in ejecting the staples and seating on.a ~2~593S
carriage supported in guides ru~ning along tbe staple case, with the -thrust case furnished with a die serving as a -thrust of the staples being ejected and bent at the free ends thereo~, and also comprises a sectional hinge joint and a sectional detent interconnecting the thrust and staple cases, and a ~uture clearance adjustment de vice, wherei~, accoLding to the invention, a wedge sur-face interactin~ with the staple pushers is curvilinear~
with lines tangent to the generatri~ thexeof ard a tra-velling direction of the wedge located so as to consti-tute an angle varying gxadually ~rom 45 deg to zero between a front part of the wedge and the back part the~e-of in the direction of the wedge travel during the stapl-ing procedure.
~ he fore~oirlg wedge surfaces interacting with the pushers are devised so as to permit reducing -the wedge len~th and, hence, the overall dimensions of ~orking sec-tion distal ends extending beyond tbe suture line, and also to permit reducing -the operator's effort.
~ he above-mentioned angle range from 45 de~ to zero i5 optimum and is determined by the nature of variation of the force required for forming each staple during interaction between the re~pective staple pusher and the wedge curvilinear surface because the forces required for ejecting the staple and piercing the tissue at the ini-tial phase of interac-tio~ are no-t high and are commeasu-~ 9 3 ~
rable with the forces Dormally applied by the operatorduring movement of the wedge.
At later stages of interaction between the cuxvili-near surface of the wedge and the staple pusher, t~e staple ~orming forces are increased and are compensated by the ~orce exerted by the wedge at a respective slope angle between the tangent and the wedge curvilinear sur-face which is vertially a wedge point angle in the given area of the curvilinear surface.
~ hough the staple forming force ri6es abruptly at the final staple forming stage of the suturing procedure, the operator's e~fort is not to be increased because the v~edge point angle is zero in the wedge back part.
If the angle between the tangent and the wedge cur-vilinear surface in the front paxt of the wedge is more than 45 deg, the force to be applied by the operator for moving the wedge will e2ceed the force required for initial ejection of tbe staple and for piercing the ti~sue by the tabs thereof.
If t~!e angle between the tangent and the curvilinear surface in the front part of` the wedge is less than 45 deg the wedge overall length increases, with the re~ult that the dimensions of the working sections of the surgical stapling apparatus must be increased also, whereby diffi culties arise in making the sutures along the full length of the surgical stapling appara-tus working section and in operating the surgical s-tapling apparatus in the suture area. - 10 -~2~L5~313~;;
If the angle between the tangent and the curvilinear surface in the back part of the wedge is more than zero, it is impossible to develop a ~ufficieDt ~orce exe~ted by the wedge when a maximum staple forming force is re~
quired during suturiDg procedure.
If the angle between the tangent and the cuLvilinear su~face in the back part of the wedge is less than zero, that is~ i~ the angle is negative, the staple pusher fails to eject the staple when the wedge moves and when the pusher interacts with the wedge, whereby the tissue cannot be pie~ced by the -~taple.
~ he surgical stapling apparatus of the present in-ven-tion is relatively small-sized~ and can be e~ficieDtly handled during surgical operations, with the result tha~
jerking and irregular variation o~ the operator's e~forts can be precluded in joi~ing th~ tissue, and the manipula--tion o~ the apparatus in-troduced into the operative inci-sion can be improved.
~ he invention will now be described in greater de-tail witk reference to a preferred embodiment thereof taken in con~unction with the accompanying drawings, wherein:
~ ig. 1 is a cut-away side view of a surgical stapl-in~ apparatus, according to the presen-t inven~ion.
~ ig. 2 is a view of same taken along the arrow A of Fig 5~3~;
Fig. 3 is a scale-up out-of-position section view taken along line III-III of Fig. 1, and Fig. 4. shows a graphic relationship between an angle of incline of a tangent to a wedge surface generatrix and a suture clearance ~h~ (in mm) as compared to a graphic relationship between a staple ~orming force P (in kg) and the suture clearance "h" (in mm).
Referring now to Fig. l, a surgical stapling appara-tus, according to the present invention, comprises a thrust case l and a staple case 2 (Figs.1 and 2). The thrust case 1 incorporates a working section 3 (Fig. l) and a handle ~.
The staple case 2 incorporates a working section 5 and a handle 6. Side walls (not shown) in the s-taple case 2 form a lengthwise groove 7 running essentially through the full length of the working section 5 of the staple case 2.
The lengthwise groove accommodates a magazine 8 disposed along the full length of the groove and having an outside shape identical to an inside shape of the groove 7. The magazine 8 contains a plurality of U-shaped staples g distributed evenly along the full length of the magazine in two rows of sockets (not shown) formed by partitions lO of , .
`~2~5~3~i the ma~azine 8.
The magazine 8 also accommodates pushers 11 o~ the staples 9 disposed identically to the staples 9 and loca-ted between an inside bottom (not shown) of the magazine and the staple s ~ .
Each pusher 11 is devised in tbe form of a right-angle prisrn where~in a pointed surface (not shown) faces the bottom of the magazine 8, and an opposite flat end (not shown~ faces tne staples 9 pushed therewith.
~ he lengthwise groove 9 accommodates a wedge 12 (Fig. 3) serving for interaction with the pushers 11 o~
the staples 9. The wedge 12 incorporates a pointed front part 13 and a ~ack part 14, and is furnished with a cur-vilinear surface 15 interacti~g with the pushers 11 of the staples 9 during the suturing procedure.
~ he curvilinear surface 15 oE the wedge 12 is machined so that lines tangent to said surface and the travelling direction of the wedge 12 form an angle varying graduall~
from 45 deg to zero between the pointed part 13 and the back part '14.
The wedge 12 is attached to a carriage 16 (~ig. 1~
by any suitable method and is fa~tened by any traditional devices not described herein for clarity.
The carriage 16 is supported in guides 17 running along the staple case 2, that i8, on outer sides of side walls in said staple case 2 as ~hown in ~ig. ~.
S~35 ~ he thrust case 1 comprises a die 18 serviD~ as a thrust of the staples 9 being ejected and bent at the free e~ds thereof (not shown). ~or this purpose, the die 18 incorporates two rows of sockets 19 disposed all along the working section 3 of the thrust case 1 opposite the sockets oY the maga~ine 8 when the surgical stapling apparatus is in assembled state.
A sectional hinge joint 20 and a detent 21 serve for interconnecting the thrust case 1 and the ~taple case 2.
The sec-tional hinge joint 20 is ar~anged on distal ends oY the working sections 3 and 5. Said sectional hinge join-t 20 comprises a fixed shaYt 22 attac~ed to the working section 5 of the staple case normall~ to the side walls thereof, and incorporates a hook 23.
The hook 2~ is located on the distal end of the work-ing section 3 in the thrust case 1, and is adapted Yor catching the shaft 22.
The detent 21 is located in the area where the working sections 3 and 5 curve into the handles 4 and 6.
The detent 21 is contrived in the form of a U-shaped plate, the bottom whereof (not shown) is laid upon an out-side surface of the thrust case 1 which is opposite to the surface thereof Yacing the staple case 2. Side parts 24 of the detent 21 embracing side surfaces oY -the thrust case 1 are seated on a fixed shaYt 25 passing through the thrust case 1 normally to the side su~faces thereof.
2 ~S ~ 3 S
~ he side parts 24 form a groove (not shown) accommodat-ing a fixed shaft 26 passing through the staple case 2 normall~ to the side surfaces thereof. The side parts 24 are provided with flanges 27 (Figs 1 and 2) being pushed the operator's hand.
The detent 21 also incorporates a plate spring 28 (~ig. 1) held by a screw 29 scre~Jed into the thrust case 1.
Plate stops 30 installed on two sides of the thrust case 1 and located on the side ~urfaces thereof serve for preventing lateral displacements of the staple case 2 re-la-tive to the thrust case 1, that is, in the direction normal to the locating plane of Fig. 1.
The surgical stapling apparatus incorporates a suture clearance adjustment device 31 arranged in the carriage 16 and devised by any conventional method suitabla for the purpose and not described herein for clarity.
Referring now to ~ig. 3, the apparatus incorporates a stop 32 se.rving for locking the carriage 16 in the initial position thereof and devised in the form of a taper pin idsnti-fied by the same reference number 32, with a spring 33 ~ade integral with -the pin 32, the taper end whereof enters a recess (not shown) in a bottom part o~
the carriage 16 as shown in ~ig. 3.
~ he surgical stapling apparatus according -to the present invention used in su-ture of organs and tissue operates as follows.
~ ~S~ ~5 Prior to use, the surgical stapling apparatus must be inspected to ensure whether the carriage 16 is in its ~ull back positlon wherein the working sec-tion 5 of the staple case 2 is linked with the handle 6 thereof, and is locked by the stop 39. The thLust case l must be unmated f~om the staple case 2.
~ hen, an appropriate suture clearance must be adjusted by the suture clearance adjustment device 31 according to the thickness of the o~gan to be stitched.
The working section of the thrust case 1 is to be placed from below under the organ being stitched, ~or example, under a lung lobe, and is to be located along the line of the interlobal sulcus. ~he hook 20 is used to seapa~ate the lung parench~ma in the area whexe it joins -the bronchus, and the hook is then extracted in an upwa~d direction in such a manner as to avoid catching the blood vessels by the hook 20. The lung tissue of the interlobal salcus is placed on the die 18 between the hook 20 and the plate stops 28 installed on the working section 3 of the thrust case 1.
~ he staple case 2 is linked by the sectional hin~e joint 20 to the thrust case 1~ ~or this purpose, the shaft 22 attached -to the working section 5 of the staple case 2 is introduced into the recess of the hook 23. ~he staple case 2 and the thrust case 1 are pulled together b~
- 16 - ~
~5~35 the handles 4 and 6 till they are locked i~ mated state by the detent 21.
After the.ca~es are coupled, the side parts 24 turn abou-t the shaft 25 to a position where the grooves therein are placed opposite the projecting ends of the shaft 26 in the staple case 2 and where the sprin~ 28 returns them to the initial position thereo~, wherein the ends of the shaft 26 are seated in the grooves provided in the side parts 24.
Now the carriage 16 is moved forward along the guides 17 toward the distal end of the staple case 2. ~hile mo-ving, the carriage 16 causes the wedge 12 to travel and to interact with the pushers 11 of the staples 9. The staples 9 are ejected out of the sockets in the magazine 8, and the tabs thereof pierce the suture tissue and joint the lung tissue after the ends thereof are bent in the sockets 1~ of the die 18. At the instant of interaction between the front poiDted part 13 of the wedge 12 and the pusher 11, the force required for ejection of the staple 9 is not high, with the result that the staple 9 interacting with the curvilinear surface 15 forming an angle of 45 deg with the tangent at this point quic~ly moves to a position where the tabs thereof thrust against the sockets 19 of the die 1B.
As the staple 9 moves farther, the tabs thereof sea-ted in the sockets 1~ are caused to bend, and the respec-tive rise of the staple ~orming force occurs at a section ~:Z~ 35 of the curvilinear s~rface~ whereat the angle between the tagnent and the curvilinear surface is less than 45 deg.
The force reguired to move the carriage 16 does not vary, and the reduction of the angle between the tangent and the surface 15 results in compensation of the rising staple forming force expressed b~ the equation.
P = ~g ~ , where P is the staple forming force, F is the force requi-red to move the wedge 12 (F =c~st), and ~ is tbe angle between the tangent to the curvilinear sur~ace 15 and the direction of travel of the wedge 12.
Fig. 4 illustrates a graphic relationship between the angle ~ o~ incline of the tangent to tbe generatri~ of the curvilinear surface 15 of the wedge 12 and the suture clearance "h" (in mm) as compared to a graphic relationship between the force P (in kg) reguired for forming the staple 9 and the suture clearance "h" (in mm). Co~parison between the above-mentioned relationships clearly shows that said inclease in the force of forming the staple 9 occurring duriDg reduction of the suture clearance is accompanied by a decrease in the angle ~ of incline of the tangent to the curvilinear surface 15, with the .result that said increase i~ compensated, and the force F requir-ed for moving the wedge 12 remains constant.
This feature permits adjusting a minimum length of each section of the wedge 12 corresponding to a given force ~ ~S~ 35 re~uired for ~orming the staple 9, whereby the total length of the wedge ~2 can be substantiall~ reduced, and irregular variation of the operator' 8 efforts can be pre-cluded in stapling work.
A further increase in tbe force requlred for forming the staple 9 at a minimum stuture clearance does not lead to an increase in the force to be applied by the operator because the angle of incline of the tangent to the curvi-linear su~face 15 of the wedge 12 decLeases to zero in tbe back part thereof.
On completion of the stapling procedure, the waste part of the lung lobe is cut of~ with a scalpel along the side surfaces of -the working sections 3 and 5 of the staple case 2 and thrust case 1.
~ hen the flanges 27 of the detent 21 must be pushed down, and the staple case 2 and thrust case 1 must be unmated b~ moving the handles 4 and 6 apart.
~ he sectional hinge joint 20 must be uncoupled to permit extracting the shaf-t 22 out of the recess in the hook 23, and the surgical stapling apparatus must be re-moved from the operative lncision.
~ est samples of the surgi.cal stapling apparatus have been manufactured and tried out, and the advan-tages of the construction herein proposed have been proved.
The noval construction of the wedge permits twice reducting the length of the staple çase working section distal end extending beyond the suture limits, and, hence, ~ ~ ~S~ 3S
permi~s making a hi~h-guality su-ture in the lung through the full length of the interlobal sulcus without injuring the adjacent organs9 for example, the bronchus.
Since the force to be applied by the operator during the stapling work is reduced, tbe surgical stapling ap-paratus of the present invention inserted into the opera-tive incision can be handled easily.
The staple pushers drive the staples by inte~acting with a pointed wedge adapted to move along the working ~ec-tion of the staple case.
The wedge is arranged at the end o~ a plate turned toward the working section of the staple ca~e. ~he other end of the plate mates with a carriage seated in -the groove in the staple ca~e and adapted for longitudinal movement therethrough.
~ he thrust case also incorporates a working section disposed opposite the working section of the staple case.
The working section of the thrust case mount~ a die ser-ving as a thrust o~ the staples being ejected and bent at the free ends thereof.
For this purpose, the die is provided with two rows of sockets disposed along the full length o~ the thrust case working section opposi-te the staple grooves in the staple case working section when the stapling a~paratus i8 in assembled state.
~ he detent of the staple and thrust cases of the prior art surgical stapling apparatus is devised in the ~orm o~ a ~ear rack. In mating the staple and thrust cases, teeth o~ the gear rack couple in succession and individually lock the working sections relative to each other, and, thus, permit adjusting the suture clearance ~Z`~5~335 according to the thickneæs of biological tissue baing a oined.
It is known to those skilled in the art that the suture clearance is defined as the distance between the surfaces of the suræical stapling apparatus working sec-tions which interact with biological -tissue during the stapling procedure, ID said surgical stapling apparatus, the wedge interac-ting with the staple pushers is longer than normally be-cause the wedge point angle apprDpriate for suturing and resisting the staple forming force may not be more than 15 deg. ~his feature obstructs making a suture through the full le~gth o~ the working section because distal ends of the working sections must be long enough to mount tbe long-size wedge.
There is also known a surgical stapling apparatus (c~. USSR Inventor's Certificate No. 886897~ which is the closest analogue to the surgical stapling apparatus of tbe present invention.
~ he foregoing surgical stapling apparatus comprises a thrus-t and a staple cases. The staple case incorpora-tes a lengthwise groove foxmed by side walls of the woxking section, '~he lengthwise groove accommodates a magasine shaped on the out~ide identically with the interior of the leng~h-wise groove. ~he magazine holds a plurality of U-shaped staples charged evenly in ockets along the full length of the magazine.
The same sockets accommodate staple pushers. Each pusher is devised as a right-angle prism, t~e slant surface whereof ~aces a magazine bottom surface, and the opposite flat end thereo~ faces the staples pushed thereby.
A handle in a~sembly with a ring attached to the staple case permit~ holding tbe surgical stapling appa-ratus by the hand. ~he staple pushers interact wit,h a pointed wedge adapted for movement along the working sec-tion of the staple case.
The wedge is mounted at an end of a plate facing the working section of the staple case. The opposite end of the plate is linkod with a carriage movable along the groove in the staple case.
~ he thrust case incorporates a working ~ection dis-posed opposite the working section of the staple case when the case~ are in mated s-tate. A groove provided in the working section of the thrust case along the ~ull length thereof' is formed by side walls of the working section.
The above groove accommodates a die incorporating sockets, serving as a thrust of the staples being edjected, and permi-tting bending the free ends thereof for sut~ring biological tissue.
A suture clearance adjustment device located in the working section of' the thrust case permits moving the die in parallel in the direction of the staple ca~e worki~g section, with the result that the suture clearance can be adjusted within a certain range.
The suture clearance adjustment device comprises a crank shaft carr~ing a knob serving to turn the crankshaft.
~ he die is devised in the form of a right-angle prism, the side surface whereof facing the working section of tbe Etaple case and serving to compress biological tissue being sutured incorporates sockets disposed opposite si-milar sockets in the magazine. A lengthwise groove in the die accommodates a crank of the crankshaft.
Whe~ the crankshaft is turned by the knob) the die moves toward the working section o~ the staple case and thus ~egulates the distance between the die surfaces ser-ving to compress biological tissue, and the working sec-tion of the staple case.
~ he above-mentioned feature of the prior-art s~rgical stapling apparatus permits adjusting the sutuxe clearance.
~ he tbrust case also carries a handle with a ring which permi-ts holding the case by the hand.
~ he ~oregoing surgical stapling apparatus also incor-porate~ a sectional hinge joint and a detent, serving fox interconnection of the thrust and staple cases. The sectional hinge joint is disposed in the area of inter-connection of the working sections of the staple and thrust cases, and is fuxnished with a shaft attacbed to ~Z~ 3~;
the staple case and introduced into a hole in the thrust case by o~e end thereof.
~ he ca~e detent is essentially a double-gear rack disposed beside the handle and ring assemblies.
In the prior-ar-t surgical stapling apparatus, the leDgth of the working sections o~ the thrust and staple cases is extended to pexmit arrangement at the distal eDds tbereof of a long-size wedge having a point angle of not more than 15 deg, a~d a journal of the crankshaft incorporated in the suture clearance adaustment device.
The above-mentioned relativel~ high pointing of the wedge, and, hence, the e~tended length of the ~orking parts of the surgical stapling apparatus are necessary to permit movement o~ the staple pushex~ interacting with the wedge, and to permit bending the staples during the suturing procedure.
It has been k~own (for example; cf. Periodical KHIRURGICEESKIE SSHIVAYUSC~IE APPARA~Y (Surgical Su-turing Apparatus, in Russian), Edition VII, V~IIKHAI, ~oscow, 1967, pp.13~15) tha-t the relationship between the staple fcrmi~g f`orce and the suture clearance depend-in~ on the thickness of tissue being joined 3hows that the staple forming force gradually increases i~ the ~egio~
near the minimum suture clearances, and with fur-ther Le-duction of the suture clearances; said force rises ab-~2~S935 ruptl~ with the result that the operator's effort increa-ses, and, hence, the dimensions of the surgical stapling apparatus working sections must be rather large.
In the prior-art surgical stapling apparatus wherein the wedge point angle is constant,-no allowance i8 made for -the nature of ~rowth of forces reauired to form each staple during the sature procedure, whereby the surgical stapling apparatus of large size cannot be efficiently used in suturing operative inci~ion6.
- ~he principal object of the present invention is to provide a surgical stapling apparatlls, wherein the cons-truction of the wedge will permit reducing the length of the whole surgical stapling apparatus, Another object of -the invention is to provide a sur-gical stapling appa~atus J the construction whereof will improve the service reliability and the opera-ting e~fi-ciency thereof in stitching surgical i~cisions.
A further object of the inventioD is to provide a surgical stapling apparatus o~ substantially simplified construction.
With these and other objects in view, a surgical ~tapling apparatus herein proposed comprises a -thrust c~e and a staple case incorporating a groove formed by the side walls thereof and accommodating a magazine containing staples, staple pushers and a wedge interacting with the staple pushers in ejecting the staples and seating on.a ~2~593S
carriage supported in guides ru~ning along tbe staple case, with the -thrust case furnished with a die serving as a -thrust of the staples being ejected and bent at the free ends thereo~, and also comprises a sectional hinge joint and a sectional detent interconnecting the thrust and staple cases, and a ~uture clearance adjustment de vice, wherei~, accoLding to the invention, a wedge sur-face interactin~ with the staple pushers is curvilinear~
with lines tangent to the generatri~ thexeof ard a tra-velling direction of the wedge located so as to consti-tute an angle varying gxadually ~rom 45 deg to zero between a front part of the wedge and the back part the~e-of in the direction of the wedge travel during the stapl-ing procedure.
~ he fore~oirlg wedge surfaces interacting with the pushers are devised so as to permit reducing -the wedge len~th and, hence, the overall dimensions of ~orking sec-tion distal ends extending beyond tbe suture line, and also to permit reducing -the operator's effort.
~ he above-mentioned angle range from 45 de~ to zero i5 optimum and is determined by the nature of variation of the force required for forming each staple during interaction between the re~pective staple pusher and the wedge curvilinear surface because the forces required for ejecting the staple and piercing the tissue at the ini-tial phase of interac-tio~ are no-t high and are commeasu-~ 9 3 ~
rable with the forces Dormally applied by the operatorduring movement of the wedge.
At later stages of interaction between the cuxvili-near surface of the wedge and the staple pusher, t~e staple ~orming forces are increased and are compensated by the ~orce exerted by the wedge at a respective slope angle between the tangent and the wedge curvilinear sur-face which is vertially a wedge point angle in the given area of the curvilinear surface.
~ hough the staple forming force ri6es abruptly at the final staple forming stage of the suturing procedure, the operator's e~fort is not to be increased because the v~edge point angle is zero in the wedge back part.
If the angle between the tangent and the wedge cur-vilinear surface in the front paxt of the wedge is more than 45 deg, the force to be applied by the operator for moving the wedge will e2ceed the force required for initial ejection of tbe staple and for piercing the ti~sue by the tabs thereof.
If t~!e angle between the tangent and the curvilinear surface in the front part of` the wedge is less than 45 deg the wedge overall length increases, with the re~ult that the dimensions of the working sections of the surgical stapling apparatus must be increased also, whereby diffi culties arise in making the sutures along the full length of the surgical stapling appara-tus working section and in operating the surgical s-tapling apparatus in the suture area. - 10 -~2~L5~313~;;
If the angle between the tangent and the curvilinear surface in the back part of the wedge is more than zero, it is impossible to develop a ~ufficieDt ~orce exe~ted by the wedge when a maximum staple forming force is re~
quired during suturiDg procedure.
If the angle between the tangent and the cuLvilinear su~face in the back part of the wedge is less than zero, that is~ i~ the angle is negative, the staple pusher fails to eject the staple when the wedge moves and when the pusher interacts with the wedge, whereby the tissue cannot be pie~ced by the -~taple.
~ he surgical stapling apparatus of the present in-ven-tion is relatively small-sized~ and can be e~ficieDtly handled during surgical operations, with the result tha~
jerking and irregular variation o~ the operator's e~forts can be precluded in joi~ing th~ tissue, and the manipula--tion o~ the apparatus in-troduced into the operative inci-sion can be improved.
~ he invention will now be described in greater de-tail witk reference to a preferred embodiment thereof taken in con~unction with the accompanying drawings, wherein:
~ ig. 1 is a cut-away side view of a surgical stapl-in~ apparatus, according to the presen-t inven~ion.
~ ig. 2 is a view of same taken along the arrow A of Fig 5~3~;
Fig. 3 is a scale-up out-of-position section view taken along line III-III of Fig. 1, and Fig. 4. shows a graphic relationship between an angle of incline of a tangent to a wedge surface generatrix and a suture clearance ~h~ (in mm) as compared to a graphic relationship between a staple ~orming force P (in kg) and the suture clearance "h" (in mm).
Referring now to Fig. l, a surgical stapling appara-tus, according to the present invention, comprises a thrust case l and a staple case 2 (Figs.1 and 2). The thrust case 1 incorporates a working section 3 (Fig. l) and a handle ~.
The staple case 2 incorporates a working section 5 and a handle 6. Side walls (not shown) in the s-taple case 2 form a lengthwise groove 7 running essentially through the full length of the working section 5 of the staple case 2.
The lengthwise groove accommodates a magazine 8 disposed along the full length of the groove and having an outside shape identical to an inside shape of the groove 7. The magazine 8 contains a plurality of U-shaped staples g distributed evenly along the full length of the magazine in two rows of sockets (not shown) formed by partitions lO of , .
`~2~5~3~i the ma~azine 8.
The magazine 8 also accommodates pushers 11 o~ the staples 9 disposed identically to the staples 9 and loca-ted between an inside bottom (not shown) of the magazine and the staple s ~ .
Each pusher 11 is devised in tbe form of a right-angle prisrn where~in a pointed surface (not shown) faces the bottom of the magazine 8, and an opposite flat end (not shown~ faces tne staples 9 pushed therewith.
~ he lengthwise groove 9 accommodates a wedge 12 (Fig. 3) serving for interaction with the pushers 11 o~
the staples 9. The wedge 12 incorporates a pointed front part 13 and a ~ack part 14, and is furnished with a cur-vilinear surface 15 interacti~g with the pushers 11 of the staples 9 during the suturing procedure.
~ he curvilinear surface 15 oE the wedge 12 is machined so that lines tangent to said surface and the travelling direction of the wedge 12 form an angle varying graduall~
from 45 deg to zero between the pointed part 13 and the back part '14.
The wedge 12 is attached to a carriage 16 (~ig. 1~
by any suitable method and is fa~tened by any traditional devices not described herein for clarity.
The carriage 16 is supported in guides 17 running along the staple case 2, that i8, on outer sides of side walls in said staple case 2 as ~hown in ~ig. ~.
S~35 ~ he thrust case 1 comprises a die 18 serviD~ as a thrust of the staples 9 being ejected and bent at the free e~ds thereof (not shown). ~or this purpose, the die 18 incorporates two rows of sockets 19 disposed all along the working section 3 of the thrust case 1 opposite the sockets oY the maga~ine 8 when the surgical stapling apparatus is in assembled state.
A sectional hinge joint 20 and a detent 21 serve for interconnecting the thrust case 1 and the ~taple case 2.
The sec-tional hinge joint 20 is ar~anged on distal ends oY the working sections 3 and 5. Said sectional hinge join-t 20 comprises a fixed shaYt 22 attac~ed to the working section 5 of the staple case normall~ to the side walls thereof, and incorporates a hook 23.
The hook 2~ is located on the distal end of the work-ing section 3 in the thrust case 1, and is adapted Yor catching the shaft 22.
The detent 21 is located in the area where the working sections 3 and 5 curve into the handles 4 and 6.
The detent 21 is contrived in the form of a U-shaped plate, the bottom whereof (not shown) is laid upon an out-side surface of the thrust case 1 which is opposite to the surface thereof Yacing the staple case 2. Side parts 24 of the detent 21 embracing side surfaces oY -the thrust case 1 are seated on a fixed shaYt 25 passing through the thrust case 1 normally to the side su~faces thereof.
2 ~S ~ 3 S
~ he side parts 24 form a groove (not shown) accommodat-ing a fixed shaft 26 passing through the staple case 2 normall~ to the side surfaces thereof. The side parts 24 are provided with flanges 27 (Figs 1 and 2) being pushed the operator's hand.
The detent 21 also incorporates a plate spring 28 (~ig. 1) held by a screw 29 scre~Jed into the thrust case 1.
Plate stops 30 installed on two sides of the thrust case 1 and located on the side ~urfaces thereof serve for preventing lateral displacements of the staple case 2 re-la-tive to the thrust case 1, that is, in the direction normal to the locating plane of Fig. 1.
The surgical stapling apparatus incorporates a suture clearance adjustment device 31 arranged in the carriage 16 and devised by any conventional method suitabla for the purpose and not described herein for clarity.
Referring now to ~ig. 3, the apparatus incorporates a stop 32 se.rving for locking the carriage 16 in the initial position thereof and devised in the form of a taper pin idsnti-fied by the same reference number 32, with a spring 33 ~ade integral with -the pin 32, the taper end whereof enters a recess (not shown) in a bottom part o~
the carriage 16 as shown in ~ig. 3.
~ he surgical stapling apparatus according -to the present invention used in su-ture of organs and tissue operates as follows.
~ ~S~ ~5 Prior to use, the surgical stapling apparatus must be inspected to ensure whether the carriage 16 is in its ~ull back positlon wherein the working sec-tion 5 of the staple case 2 is linked with the handle 6 thereof, and is locked by the stop 39. The thLust case l must be unmated f~om the staple case 2.
~ hen, an appropriate suture clearance must be adjusted by the suture clearance adjustment device 31 according to the thickness of the o~gan to be stitched.
The working section of the thrust case 1 is to be placed from below under the organ being stitched, ~or example, under a lung lobe, and is to be located along the line of the interlobal sulcus. ~he hook 20 is used to seapa~ate the lung parench~ma in the area whexe it joins -the bronchus, and the hook is then extracted in an upwa~d direction in such a manner as to avoid catching the blood vessels by the hook 20. The lung tissue of the interlobal salcus is placed on the die 18 between the hook 20 and the plate stops 28 installed on the working section 3 of the thrust case 1.
~ he staple case 2 is linked by the sectional hin~e joint 20 to the thrust case 1~ ~or this purpose, the shaft 22 attached -to the working section 5 of the staple case 2 is introduced into the recess of the hook 23. ~he staple case 2 and the thrust case 1 are pulled together b~
- 16 - ~
~5~35 the handles 4 and 6 till they are locked i~ mated state by the detent 21.
After the.ca~es are coupled, the side parts 24 turn abou-t the shaft 25 to a position where the grooves therein are placed opposite the projecting ends of the shaft 26 in the staple case 2 and where the sprin~ 28 returns them to the initial position thereo~, wherein the ends of the shaft 26 are seated in the grooves provided in the side parts 24.
Now the carriage 16 is moved forward along the guides 17 toward the distal end of the staple case 2. ~hile mo-ving, the carriage 16 causes the wedge 12 to travel and to interact with the pushers 11 of the staples 9. The staples 9 are ejected out of the sockets in the magazine 8, and the tabs thereof pierce the suture tissue and joint the lung tissue after the ends thereof are bent in the sockets 1~ of the die 18. At the instant of interaction between the front poiDted part 13 of the wedge 12 and the pusher 11, the force required for ejection of the staple 9 is not high, with the result that the staple 9 interacting with the curvilinear surface 15 forming an angle of 45 deg with the tangent at this point quic~ly moves to a position where the tabs thereof thrust against the sockets 19 of the die 1B.
As the staple 9 moves farther, the tabs thereof sea-ted in the sockets 1~ are caused to bend, and the respec-tive rise of the staple ~orming force occurs at a section ~:Z~ 35 of the curvilinear s~rface~ whereat the angle between the tagnent and the curvilinear surface is less than 45 deg.
The force reguired to move the carriage 16 does not vary, and the reduction of the angle between the tangent and the surface 15 results in compensation of the rising staple forming force expressed b~ the equation.
P = ~g ~ , where P is the staple forming force, F is the force requi-red to move the wedge 12 (F =c~st), and ~ is tbe angle between the tangent to the curvilinear sur~ace 15 and the direction of travel of the wedge 12.
Fig. 4 illustrates a graphic relationship between the angle ~ o~ incline of the tangent to tbe generatri~ of the curvilinear surface 15 of the wedge 12 and the suture clearance "h" (in mm) as compared to a graphic relationship between the force P (in kg) reguired for forming the staple 9 and the suture clearance "h" (in mm). Co~parison between the above-mentioned relationships clearly shows that said inclease in the force of forming the staple 9 occurring duriDg reduction of the suture clearance is accompanied by a decrease in the angle ~ of incline of the tangent to the curvilinear surface 15, with the .result that said increase i~ compensated, and the force F requir-ed for moving the wedge 12 remains constant.
This feature permits adjusting a minimum length of each section of the wedge 12 corresponding to a given force ~ ~S~ 35 re~uired for ~orming the staple 9, whereby the total length of the wedge ~2 can be substantiall~ reduced, and irregular variation of the operator' 8 efforts can be pre-cluded in stapling work.
A further increase in tbe force requlred for forming the staple 9 at a minimum stuture clearance does not lead to an increase in the force to be applied by the operator because the angle of incline of the tangent to the curvi-linear su~face 15 of the wedge 12 decLeases to zero in tbe back part thereof.
On completion of the stapling procedure, the waste part of the lung lobe is cut of~ with a scalpel along the side surfaces of -the working sections 3 and 5 of the staple case 2 and thrust case 1.
~ hen the flanges 27 of the detent 21 must be pushed down, and the staple case 2 and thrust case 1 must be unmated b~ moving the handles 4 and 6 apart.
~ he sectional hinge joint 20 must be uncoupled to permit extracting the shaf-t 22 out of the recess in the hook 23, and the surgical stapling apparatus must be re-moved from the operative lncision.
~ est samples of the surgi.cal stapling apparatus have been manufactured and tried out, and the advan-tages of the construction herein proposed have been proved.
The noval construction of the wedge permits twice reducting the length of the staple çase working section distal end extending beyond the suture limits, and, hence, ~ ~ ~S~ 3S
permi~s making a hi~h-guality su-ture in the lung through the full length of the interlobal sulcus without injuring the adjacent organs9 for example, the bronchus.
Since the force to be applied by the operator during the stapling work is reduced, tbe surgical stapling ap-paratus of the present invention inserted into the opera-tive incision can be handled easily.
Claims
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A surgical stapling apparatus, comprising: a thrust case; a staple case; a lengthwise groove formed by side walls of said staple case; a magazine containing staples and staple drivers and seating in said lengthwise groove; said thrust case incorporating an anvil serving as a thrust receiver of said staples ejected from said magazine and for bending the staples at the free ends thereof; a wedge serving for interaction with said drivers of said staples in said magazine and disposed in said lengthwise groove; guides located along said staple case; a car-riage disposed in said guides; said wedge attached to said car-riage; said wedge incorporating a surface interacting with said staples of said magazine and shaped curvilinearly whereby lines tangent to the generatrix thereof and a traveling direction of said wedge form an angle varying gradually from 45° to zero between the front part thereof and the back part thereof in the wedge traveling direction during the stapling procedure; a sec-tional hinge joint; a detent; said sectional hinge joint and said detent serving for interconnecting said thrust case and said staple case; and a suture clearance adjustment device.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| SU833649473A SU1183082A1 (en) | 1983-08-19 | 1983-08-19 | Surgical suture apparatus |
| SU3649473 | 1983-08-19 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1245935A true CA1245935A (en) | 1988-12-06 |
Family
ID=21084403
Family Applications (2)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000455806A Expired CA1245934A (en) | 1983-08-19 | 1984-06-04 | Surgical stapling apparatus |
| CA000460359A Expired CA1245935A (en) | 1983-08-19 | 1984-08-03 | Surgical stapling apparatus |
Family Applications Before (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000455806A Expired CA1245934A (en) | 1983-08-19 | 1984-06-04 | Surgical stapling apparatus |
Country Status (6)
| Country | Link |
|---|---|
| US (1) | US4596351A (en) |
| JP (2) | JPS6048738A (en) |
| CA (2) | CA1245934A (en) |
| DE (2) | DE3426801C2 (en) |
| GB (2) | GB2145025B (en) |
| SU (1) | SU1183082A1 (en) |
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Family Cites Families (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3078465A (en) * | 1959-09-09 | 1963-02-26 | Bobrov Boris Sergueevitch | Instrument for stitching gastric stump |
| US3079606A (en) * | 1960-01-04 | 1963-03-05 | Bobrov Boris Sergeevich | Instrument for placing lateral gastrointestinal anastomoses |
| US3315863A (en) * | 1965-07-06 | 1967-04-25 | United States Surgical Corp | Medical instrument |
| US3490675A (en) * | 1966-10-10 | 1970-01-20 | United States Surgical Corp | Instrument for placing lateral gastrointestinal anastomoses |
| SU886897A1 (en) * | 1978-12-25 | 1981-12-07 | Всесоюзный Научно-Исследовательский Институт Медицинской Техники | Surgical apparatus for applying side gastroenterostomy |
| SU1022703A1 (en) * | 1979-12-20 | 1983-06-15 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Device for correcting and fixing vertebral column of patients ill with scoliosis surgical apparatus for applying compression sutures |
-
1983
- 1983-08-19 SU SU833649473A patent/SU1183082A1/en active
-
1984
- 1984-06-04 CA CA000455806A patent/CA1245934A/en not_active Expired
- 1984-06-08 GB GB08414683A patent/GB2145025B/en not_active Expired
- 1984-06-28 JP JP59132180A patent/JPS6048738A/en active Granted
- 1984-07-20 DE DE3426801A patent/DE3426801C2/en not_active Expired
- 1984-08-03 CA CA000460359A patent/CA1245935A/en not_active Expired
- 1984-08-14 DE DE3429845A patent/DE3429845C2/en not_active Expired
- 1984-08-15 GB GB08420736A patent/GB2145649B/en not_active Expired
- 1984-08-17 US US06/641,681 patent/US4596351A/en not_active Expired - Fee Related
- 1984-08-18 JP JP59172327A patent/JPS6075050A/en active Pending
Also Published As
| Publication number | Publication date |
|---|---|
| JPS6075050A (en) | 1985-04-27 |
| GB8420736D0 (en) | 1984-09-19 |
| DE3426801C2 (en) | 1986-10-02 |
| DE3426801A1 (en) | 1985-02-28 |
| DE3429845A1 (en) | 1985-03-07 |
| DE3429845C2 (en) | 1986-10-23 |
| GB2145025B (en) | 1986-05-29 |
| JPS6048738A (en) | 1985-03-16 |
| GB2145649B (en) | 1986-07-09 |
| JPS6243690B2 (en) | 1987-09-16 |
| GB2145649A (en) | 1985-04-03 |
| CA1245934A (en) | 1988-12-06 |
| GB2145025A (en) | 1985-03-20 |
| GB8414683D0 (en) | 1984-07-11 |
| US4596351A (en) | 1986-06-24 |
| SU1183082A1 (en) | 1985-10-07 |
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| Date | Code | Title | Description |
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| MKEX | Expiry |