CA1292402C - Surgical suturing instrument - Google Patents
Surgical suturing instrumentInfo
- Publication number
- CA1292402C CA1292402C CA000568716A CA568716A CA1292402C CA 1292402 C CA1292402 C CA 1292402C CA 000568716 A CA000568716 A CA 000568716A CA 568716 A CA568716 A CA 568716A CA 1292402 C CA1292402 C CA 1292402C
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- Canada
- Prior art keywords
- hollow
- hollow tube
- bush
- retainer
- rod
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Nitrogen And Oxygen Or Sulfur-Condensed Heterocyclic Ring Systems (AREA)
Abstract
SURGICAL SUTURING INSTRUMENT
Abstract of the Disclosure A surgical suturing instrument for establishing cir-cular compression anastomoses in the organs of the digestive tract comprises a rod accommodated in a hollow body coa-xially therewith and having a stationary fixed connecting ring, a hollow cylindrical knife made fast on a hollow tube which is accommodated in the hollow body coaxially there-with, a rod passing inside the hollow tube, a needle arran-gement accommodated in the hollow body and having a first ring-shaped element provided with a plurality of holes, and a second ring-shaped element coaxial with the first one and carrying a plurality of needles held thereto and adapted to pass through the connecting tring in the course of anastomos-ing. The second ring-shaped element rests upon a pusher hav-ing a hollow chamfer and a stop which is adapted to interact with a stop of the nollow body. The instrument comprises also a split bush located on the hollow tube and having a taper collar adapted to engage the hollow chamber of the pusher, and a retainer of the split bush, located on the hollow tube.
Abstract of the Disclosure A surgical suturing instrument for establishing cir-cular compression anastomoses in the organs of the digestive tract comprises a rod accommodated in a hollow body coa-xially therewith and having a stationary fixed connecting ring, a hollow cylindrical knife made fast on a hollow tube which is accommodated in the hollow body coaxially there-with, a rod passing inside the hollow tube, a needle arran-gement accommodated in the hollow body and having a first ring-shaped element provided with a plurality of holes, and a second ring-shaped element coaxial with the first one and carrying a plurality of needles held thereto and adapted to pass through the connecting tring in the course of anastomos-ing. The second ring-shaped element rests upon a pusher hav-ing a hollow chamfer and a stop which is adapted to interact with a stop of the nollow body. The instrument comprises also a split bush located on the hollow tube and having a taper collar adapted to engage the hollow chamber of the pusher, and a retainer of the split bush, located on the hollow tube.
Description
~L~92~o~
SUR~ICAL SUTURING INS'~RUME~T
~ he invention relates generally to surgical appliances and ls concerned more specifically with surgical suturing i~struments The invention can find application ~or surgery on the orga~s o~ the alimentary tract, predominantly on the intens-tines, stomach and esophagus.
Known in the present state o~ the art is a surgical instrument adapted f`or establishing anastomoses with the aid of a staple suture applied to such tubular organs as those of the digestive canal. The instrum~nt comprises a thrust die or matrix, a cylindrieal body having at least one ring o~ sur~ical staples, a mechan-ism actuating the surgical staples, and a cylindrical scalpelJ with the aid of which mechanism the staples make their way t~rou~h tubular organs and gets united at the surface of the thrust dies, w~ile the scalpel cuts o~f an excess portion of tne tubular organs being operated upon (G~, A, ~,133,735).
'~he aforesaid known instrument ma~es use of` staples which remain for a prolo~ged time or permanently in the pa-tient's or~anism. Such staples ~ail to establish a staunch suture which might inflict morbid postoperative events.
Another prior-art suturing instrument is ~nown , adapted to establlsh circular compression anastomoses in the organs of tho digestive tract. The instrument comprises a needle arrangement having a first rin~-sh~ped element provided with a plurality of holes and a second rin~-shaped element carry-ing a plurality of needles fixed in position thereon and equal i~ number to said holes in the ~irst ring-shaped element, 2 .
each o~ ~aid needle3 corresponding to one of the aforesaid holes and at least part of said needles have a locking cone at the ~r~e end thereof. Both of the ring-shaped elements are coaxially arranged and enclosed in a hoLlow body, whe-rein a rod is accommodated, coaxial with the ring-shaped element~9 said rod having at one of it~ ends a ~ixed connect-ing ring set with the aid o~ a round nut. When establishin~
an anastomosis the needles are passed through the connecting ring and some of them are fixed therein with the locking cones.
~ he instrument comprises also a cylindrical knife whose inside diameter is egual to the ~aximum nut diameter and which is secured on a hollow tube acco~odated in the housing, a rod being coaxially accommodated in said tube.
~he cylindrical knife has a mechanical actuator adapbed to interact with the hollow tube and comprising a movable h~ndle rotatably moun~ed with respect to the body and pro-vided wibh a lever which i5 to interact with the slots in the hollow bube (see Canadian Patent No. 1,162,125).
Tho ring-~haped elements of the needle arrangement and bhe connectin~ ring are ~ade o~ elastic or plasbic materia which mu9b ba biologically inerb, nontoxic and noncancero-genic~
In order bo e~bablish an end-bo-end anastomosis the instrumenb is to be placed inside the tubular organ. operated upon. 'l'he ends of the tissue of the or~ans operated upon are fixed on the rod with the aid of purse-string sutures. Once the working members of the apparatus have been brought 3~ --together and the needle arrangement has been approximated to the connecting ring, the tissues are also appro~imat-ed till contactin~ with their exterior serous surfaces~
whereupon the movable handle is depressed to actuat~ the hollow tube and the cylindrical kni~e to move conc~rrently with the travel of ths needle arrangement, whereby the needles of the second ring-shaped element are urged to pierce the tissues~ and the stationary ~ixed connecting ring is held thereto by means of the needles with the locking cones. Upon further advancing thc cylindrical knif`e cuts off th~ excess tissues and cuts through the stationary fixed ring, thus establishing an anastomotic opening through which is withdrawn the rod end ~itted with the round nut.
'~he tissue confin~d between tne needle arrangement and the connecting ring is compre~sed, thus ensuring a staunch suture, ~ollowed by reunion o~ the tissues and, 7 to 10 days af-ter urgery, tne n~edle arrange~ent and tne connecting ring which compress the tissue involved are expell~d into the interior of the hollow organ operated upon. A~terwards both the needle arrangelnent and the connecting rin~ are discharged through the natural way of elimination.
A disadvantage inherent in the known instrument resides in injury to the living tissues being satured at the instant o~ appro~imation o~ the connecting ring and the needle arrangement and suturing when the cylindrical ~nife cuts o~f the surplus tissues being stitcaed to~ether and starts cutting throu~h the connecting ring. As a result, the needles that have already been fixed in the connecting ring by the locking cones~ keep sinking into the ring till the latter is completely cut through by the knife~ thus overcompressing the tissue involved~
~ ince cuttin~ the connecting ring through by the Knife occurs simultaneously with advancing of the needles tt~ouæh said ring the latter ~ets deformed, which results in an increased suturing effort and additional injury to the living tissues being sutured.
It is an object of the invention to provide a surgical suturing instru~ent whicn, while havin~ a single mechanical actuator, ~ould make it possible to separate in time the procesq~es Or piercin~ the tissues bein~ sutured and of cutting the central opening in livin~ tissues and in the connecting ring.
It is another object of tne invention to reduce the suturing effort applied and hence to decrease the degree of traumatic lesion inflicted upon the living tissues being sutured.
~ he ~oregoin~ objects are accomplished due to the fact that a surgical suturin~ îns-trument f`or establishing cir-cular compression anastomoses in the organs of the di~estive tr~ct, comprising a needle arrangement accomlnodated in a hollow body and havin~ a first rin~-shaped element with a plurality o~ holes, an~ a ~econd ~in~-shaped element coaxial wibh the first one and carryin~ a number of needles fixed in position thereon, each of said needle~ corresponding to one of the holes in the first rin~-shaped element, while at least part of said needles have a loc~in~ cone at )2 the free end thereof`, a rod acco~modated in the hollow body, said rod carrying ab one o~ its ends a con~ecting ring ~ixed stationary with the aid of a nut, said connecting rin~ being adapted for the needles to pass through when establishi~ an anastomosis and those needles which have a locking cone get secured in position in said connecting ring, a hollow cylindrical kni~e ha~ing such an inside diameter that enables the nut to pass ~reely therethrough, said knife being held to a hollow tube which is arranged coaxially in the hollow body and which acco~modates said rod located coaxially therewith, and a mechanical actuator o~ the hollow cylindrical knife adapted to interact with the hollow tube, according to the invention, has a pusher upon one of whose ends rests the second ring-shaped element of the needle arra~gement, while its other end has a hollow cha~ar and a stop which i9 adapted to interact with a stop of the hollow body so as to restrict the travel of the second rin~~shaped element in the course of anastomosin~, a s~lit bush ~itted on the ~ullow tube and havin~ an outside taper collar adapted to enga~e the hollow cham~er o~ the pusher, and a retainer of the split bush located on the hollow tube and acco~modated inside the split bush.
To ensure against spontaneous pusher travel the instru-ment m~y have a retention device comprisin~ a cylinder-shaped ele~nent w~lich is provided with a recess and is located inside the hollow body close to the hollow tube in which a cylindrical recess i9 made, corresponding to the cylin~er-shaped element, and a handle provided on the cylinder-shaped L292fl~
element rotatably with respect to the hollaw body i~ or~or to bring the recess in the cylinder-~haped element in coinci-dence with thc cylindrical recess of the hollow tube, thus letting the hollow tube move and preparin~ the instrument for 9 uturing.
It is expediQnt that the retainer of the split bush be snaped as a hollow tube ri~idly coupled to tne hollow body and arranged coaxially therewith.
The hollow tube serving as the retainer o~ the split bush may also serve as the casin~ of trle instrument and have a length comparable with t~e rod lengt'rl.
'~'he retainer of the split bush may also comprise a bush coaxial with the rod and having a diametral openin~, and a supporting element located in the diametral opening of the bush and having its own opening co~xial witn the ~ush and adapted for tne rod to pass, said rod having a stop adapted to interact with the supporting element so as to stop the pusher and hence the needle arrange~ent at trle instant when the hollow cylin~rical Knire cuts through tne connectin~
ring.
It is ~150 expedient tha't the hollo~ tube on which the hollow cylindrical kni~'e is secured, be provided with lon-gitudinal slots located on its portion interacting with the bush o~' the split bush retainer, the slots being a~apted for t~le supporting element to slide with respect to tne nollow tube in the course of anastomosing.
~ ne hollow tube carrying the hollow cylindrical kni~e may serve as the casinæ o~ the instrument and have a lsn~th ~ Z9;240~:
comparable with that o~ the rod.
It is likewise expedie~t that the hollow body be sprin~-actuated with respect to the hollo~ tube carryin~ the hollow cylindrical knife and be adapted to interact with ~he bush of the split bush retain~r, thus contributing to less overcompression of the tissues being sutured should these be o~ considerable thickness.
It is favourable that th~ bush of the split bush retainer be spring-actuated with re pect to the hollow tube on which the hollow cyLindrical ~ni~e is made ~ast.
The herein-proposed surgical suturin~ instrument reduces the ~egree of traumatic lesioQ of' the living tissues being sutured with-in the zone of contact durin~ the suturing process.
Provision of a retention device ensure against sponta neous pusher movement when makin~ the instrument r~ady ~or suturing.
Provision of a hollo~ tube with a ~ni~`e or a hollow retainer bush as a casin~ renders the construction of the entire instrument simpler and at the same time more convenient in u~e.
Provision o~ a sprin~-actuated housin~ makes it possible to reduce -the de~ree of' injury to the tissues involved ShOUld these be of consi~erable thickness.
Provision o~ a sprin~-actuated retainer bush prevents the latter a~ainst . unlocking.
Further objects and advanta~es o~ the present invention will hereinafter become apparent from a consideration of a ~2~2~
detailed description of some exerQplary ~mbodl~e~ts thereo~
with refercnce to the accompanying drawings, wherein:
FIG. 1 is a frag~entary lon~itudinal sectional view of a surgical suturing instrumetlt, according to the inven~
tion;
FIG. 2 is a general view, partly in longitudinal section, of the surgical suturing instrumen~ of ~IG. 1, accorditl~ to the invention;
FIG. 3 is a section taken along the line III-III in FIG. 2;
FIG. 4 is a section ta~en along the line IV-IV in FT ~ . 1;
FIG. 5 is a general longitudinal sectional view o~ an alternative smbodiment of` the surgical suturing instru~ent, according to the invention;
FIG. 6 is a section ta~en along the line VI-VI in FIG. 5;
FIG. 7 is a ~eneral view of a split bush, according to the invention;
FIG. 8 is a lon~itudinal sectional view of the surgical suturing instrument while the connecting ring is being cut through, according to t~e invention; and ~ IG. 9 shows the satne as in FIG. 8 with reference to an alter~ative etnbodiment of the surgical suturing instru-rtlent.
The surgical suturing instrument for establishin~ cir-cular compression anastomoses in the organs of the diLestive tract co~prises a hollow body 1 (EIG. 1) which accommodates ~2~
g a rod 2 and a hollow cylindrical knife 3 made fa~t Otl a hollow tube 4, both the rod 2 and t~e hollow cylindrical ~nife 3 bein~ arranged coaxially with the hollow body 1. A
deta~hable needle arrangement 5 is accommodated in the body 1 coaxially there~ith, said needle arranOe~ent comprisin~
coaxial rin~-shaped ele~ent 6 and 7. A number of holes 8 aI~e made in the ring-shaped element 6 and a num~er of needles 9 are held to the rin~-shaped element 7, each of tne needles 9 corresponding to each of the holes 8. Some Or the needles 9 but at least three of them have a locking cone 10 at their free end. ~i'he ring-shapea elei~nent 6 is ~prin~-actuated ~ith respect to the element 7 by means 4~ springs 11 si-tuated round a part of` the needles 9.
~ contlecting rin~ 13 is held at one end of the rod 2 with the aid of a nut 1~, said rin~ being adapted to join t~le needle arran~ement 5 so as to fix the living tissues being ~ut~red.
'~he cylindrical ~nife 3 has an inside diameter 'd' tne size of which allows the nut 12 to pass through the interior ol' t~e ~nife 3 al`ter the ring has been cut through.
'l'he hollow tube 4 i~ arranOed in the hollow body 1 coaxially therewith and accommo~ates the rod 2.
'l'he ~nire 3 has a mechanical actuator made as a handle 14 ~FIG. 2) rotatable round a hinge Joint 15 with respect to the body l which is constituted by tnree separable por-tions lo, 17 (FIG. 3).
~ he portions 17 of the body 1 are in ~`act the compon-ents of a bush split alon~ it~ longitu~inal axis; they constitute the stationary ~ixed body 1 at the section wh~n the handle 14 is located. 'I'~e handle 14 (FIG. 2) has a lever 18 adapted to interact with the tube 4 so as to cause it to travel along with the knife 3.
The rin~-shaped element 7 (FIG. 1) rests upon a pusher 19 (FlG~ 1, 4) havin~ a hollow cha~fer 20. ~he pusher 19 has a stop 21 shaped a~ a projectio~ and adapted to interact with a stop 22 provide~ on the inner surface of the body 1 and shaped as a shoulder. Fitted on the hollow tube 4 is a plit bush ~3 which has an outside taper collar 24 correspondin~ to tne hollow chamfer 20 of the pusher 19.
A retainer is located in the interior of the split bush 23 and on tae hollow tube 4. EIG. 1 presents an embo-diment of the retainer as a hollow tube 25 ri~idly coupled to tne hollow body 1. 'r'he tube 25 is coaxial with the body 1 und serves as t~le casin~ o~ the entire instrument.
~ince its len~th is co~parable with tne len~th of the rod 2 the tube 25 encompasses the hollow tube 4 accommodat-ing t~e rod 2 at the middle portion of the instr~ment. The tube 25 being the casing of the instrument, interconnects rigidly the portions 16 and l7.
FIG. 5 present~ an ~lternative embodiment of the rstainer o~` the split bush 23, which colnpris~s a bush 26 accoMmodated in the body coa~ially with the rod ~, and a supportin~ element 27 (FIGS 5, 6) located in a diametral openin~ 2~ of tne busil ~6. An opening 2~ is provided in the element 27 coaxial therewith and with the bush 26 and adapted for the rod 2 to pass.
~ stop 3O i~ provided on the portion of the rod wnere the supporting element 27 is located, said stop bein~ shaped as a pxojection. However, the stop 3O can also be ~ade as the end face o~ the keyway in the rod 2 or else the face of a fla~ on the rod 2.
~ tle st,op 3O i~ adapted to interact with the element 27 so as to stop the pusher 19 and the needle arran~e~ent $
at the instant when the Kni~e 3 cuts throu~h the connecting rin~ 13.
With such an embodim~nt of the retainer with the bush 26 o~ the split bush ~5 it is the hollow tube 4 (FIG. 5) whiCh serves as the casing of the instrument. In this ease the length o~ the hollow tube 4 is comparable with the length of the rod 2.
~ he split bush 23 (FIG. 7) is essentially a hollow cyli~der whose si~e surface is divide,d, by tt~ou~h slots 31, into a number of prongs 32 united by a nonsplit portion 33 of th~ cylind~r itsel~. A taper collar 24 is provided at tne free end o~ each pron~ 3~. ~he number of` the pron~s 3 depends on the e~ort to be applied to the needles 9 so as to pierce throu~h tLle connecting rin~ 13 and hence on the force of suturin~ 'he instrumenb comprises also a retention device which ensules a~ainst spontaneous movement o~ the pusher 19 and is provided with a cylinder-shaped element 34 (FIG. 2, 3, 5) int~rposed between the portions 17 o~ the body 1 square with the axis of the rod 2. '~he cy-linder-shaped ele~ent 34 has a recess 35 corresponding . .
' ~ Z~
~ 12 to a cyli~drical recess 36 on the portion of the hollow tube 4 close to which the retention device is located. A
handle 37 is provided on the cylinder-shaped eleme~t 34 which turns the latter so as to bring in coincidence the recesses 35 and 36 at the instant when the hollow tube 4 iæ
unlocked for further travelling.
'~he hollow tube 4 (FIG. 5) has a number of lonæitudinal slots 38 on its portion interacting with the bush 26, said slots being adapted f`or the supporting element 27 to travel with respect to the tube 4 in the course of anastomo~ing.
The body 1 is actuated with respect to the tube 4 by a spring 39 f~itted on the nollow tube 4 between its projecti-on 40 and a projection 41 on the body 1.
The bush 26 of the retainer o~ the split bush ~3 is actuated with respect to the hollow tube 4 by a spring 42 ~itted on the hollow tube 4 between its projection 43 and t~le end of the bush 26.
The kni~e 3 is thread-~itted on the tube 4.
The rod 2 runs inside a hollow screw 44 engaged with a nut 45 which i~ rotatably l~ounted in tha ~ortions 17 o~
the body 1. 'l'he f`ree end of the rod 2 has a thread on which a nut 46 i~ fitted. When the nut 46 rotates the rod 2 is ad-~vanced ~rom the scre~ 4~ till its end 47 thrusts a~ainst the end of the ~crew 44 which is kept against rotation due to a nonround slot 48 provided in the portions 17 of the body 1.
The portions 17 of the body 1 are brou~ht to~ether with a nut 49 inside which a tube 4 passes.
The handle 37 of the retention device is composed o~
~z~
two elastic arms 50 (FIG. 3) enclosed in a 910t 51 o~ the portions 17 of the body 1.
The sur~ical suturin~ instrument of the present inven-tion operates as follo~s.
The surgical suturing instrume~t pxoposed herein i~
aimed at establishing cii~cular compression anastomoses in the hollow organs of` the diOestive tract by the end-to-end, end-to-side and side-to-side techniques. Considered below is an exemplary end-to-end anastor~osis established in the anterior resection of the rectum.
After resection has been over purse-string sutures are applied to the rectal sturnp and the ends o~ the sigmoid colon. 'r'hen the instrument is introduced through the anal orifice into the rectum with the connecting ringr 13 and the neadle arranOement 5 brou~ht together. ;~hereupon the nut 45 is rotatea ~o adv~nce the end o~ the rod ~ carrying the corlnecting ring 13 beyond the rectur~, and the purse-string suture on the rectal stump is drawn tight. Next the end of the sigrnoid colon is moved towards the end o~ the rod ~
carryin~ the connecting ring 13 and the purse-string suture on the sigmoid colon is drawn tight, whereupon the surplus threadr~ o~ the purse-~trlng sutures are cut of~ and the nut 45 i~ rotated to bring the connectingr ring 13 and the needle arran~ement 5 to~ether till the suturing position is attained. Tn~n the eler~ent 34 is rotated, by r~eans o~ the handle 37 o~ the retention device until the recesses 35 and 36 coinci~e, that is, to unlock the hollow tube ~, whereupon the handle 14 is depressed so as to rotate round the hinge joint 15. As a result, the le~er 18 in~eract~ with bhe hollow tube 4 to cause it to move along with the ~ni~e 3 and the split bush 23 held thereto, which accommodates the retainer shaped as the hollow tube 25.
~ he split bush 23 interacts, with its ~utside taper collar 24, ~ith the holloW chamfer 20 o~ the pusher 19, thus causing it to travel along with the ring-shaped element 7 of the needle arran~ement 5~ lI'he needl~s 9 pass throu~h the holes 8 in the ring-shaped element 6 and pierce the tissues being sutured and the connecting ring 13, whereupon the needles 9 having the lockin~ cones 10 are ~ixed in position in the ring 13. 'l'~en tne retainer 25 rigidly coupled to the body 1 is located in the interior of the split bush ~3, while ttle pu~her 19 interacts through its stop 21 with the stop 22 of the body 1 and ceases travelling, thus exerting no pressure on the ring-shaped e1ement 7 of the needle arran~ement 5. Upon further advancement of the hollow tube 4 the bush 23 enters tne interior of the pusher 19 (FIG. 8) without causing it to travel, while th~ ~nif`e 3 cuts through the ti~sueR being sutured and establishes an opening in tho co~necting rin~ 13.
Accordin~ to an alternative embodiment of the retainer o~ the split bush 23 (FIG. 5), travelling o~ the hollow tube ~ causes the rod 2 to interact, throu~h its stop 30, with the ~upporting element 27 wnich i8 located in the diamet-ral opening o~ the bush 26 and in the longitudin~ slots 38 o~ the tube 4 80 that the bush 26 remains stationary and is no longer located in the interior o~ the split bush 23, thereby unlocking it at tne instant ~ollowing the piercing of the connecting rin~ 13 by the needles 9 and ~`ixing therein the needles 9 provided with the lockin~ cones 10.
Upon furtner adva~cing o~ the ~ollow tube ~ the bush 23 enters the interior of the pusher 19 without c~usin~ lt to travel, while the ~nife 3 cuts off the surplus ti~sues and cuts through an opening in the connectin~ ring 13 (~IG. 9).
~hen the instrument is withdrawn from the rectum and the needle arra~gement 5 and the connecting ring 13 re~ain in the rectal lumen and will afterwàrds (in 5 to 7 days) be dischar~ed by the natural elimination way to~ether with the necrotized tissue that has been compressed between t~e needle arrangement 5 and the connectiu~ ring 13. By that day the rectal ~alls ~et united peripherally from the compres-sion zone. Before the needle arrar~ement 5 and the con-nectin~ rin~ 13 are expelled the inkestinal contents are free to pass through the opening cut by the cylindrical knife.
A total oY 1~ sur~ical procedures have been carried ou~
on test dogs with the use of the surgical suturing instru-ment considered h~rein and ~0 operations un~er clinical conditions on the Rtomach, small and lar~e intestines.
~ well-f~ormed anastomosis ~ree l`rom cicatricial thick~_ ning was observed in the test animals operated upon.
In sur~ery on the stomach Ghere were employed the rin~s o~ an appropriate diameter, which in all cases were freely discharged by the natural way of eliluination. No postoporative morbid events were observed. 'l`he patients operated upon recovered ~ to 7 days earler than the control patients due to a less degree of injury to Ghe livin~
tissues bein~ suture~.
SUR~ICAL SUTURING INS'~RUME~T
~ he invention relates generally to surgical appliances and ls concerned more specifically with surgical suturing i~struments The invention can find application ~or surgery on the orga~s o~ the alimentary tract, predominantly on the intens-tines, stomach and esophagus.
Known in the present state o~ the art is a surgical instrument adapted f`or establishing anastomoses with the aid of a staple suture applied to such tubular organs as those of the digestive canal. The instrum~nt comprises a thrust die or matrix, a cylindrieal body having at least one ring o~ sur~ical staples, a mechan-ism actuating the surgical staples, and a cylindrical scalpelJ with the aid of which mechanism the staples make their way t~rou~h tubular organs and gets united at the surface of the thrust dies, w~ile the scalpel cuts o~f an excess portion of tne tubular organs being operated upon (G~, A, ~,133,735).
'~he aforesaid known instrument ma~es use of` staples which remain for a prolo~ged time or permanently in the pa-tient's or~anism. Such staples ~ail to establish a staunch suture which might inflict morbid postoperative events.
Another prior-art suturing instrument is ~nown , adapted to establlsh circular compression anastomoses in the organs of tho digestive tract. The instrument comprises a needle arrangement having a first rin~-sh~ped element provided with a plurality of holes and a second rin~-shaped element carry-ing a plurality of needles fixed in position thereon and equal i~ number to said holes in the ~irst ring-shaped element, 2 .
each o~ ~aid needle3 corresponding to one of the aforesaid holes and at least part of said needles have a locking cone at the ~r~e end thereof. Both of the ring-shaped elements are coaxially arranged and enclosed in a hoLlow body, whe-rein a rod is accommodated, coaxial with the ring-shaped element~9 said rod having at one of it~ ends a ~ixed connect-ing ring set with the aid o~ a round nut. When establishin~
an anastomosis the needles are passed through the connecting ring and some of them are fixed therein with the locking cones.
~ he instrument comprises also a cylindrical knife whose inside diameter is egual to the ~aximum nut diameter and which is secured on a hollow tube acco~odated in the housing, a rod being coaxially accommodated in said tube.
~he cylindrical knife has a mechanical actuator adapbed to interact with the hollow tube and comprising a movable h~ndle rotatably moun~ed with respect to the body and pro-vided wibh a lever which i5 to interact with the slots in the hollow bube (see Canadian Patent No. 1,162,125).
Tho ring-~haped elements of the needle arrangement and bhe connectin~ ring are ~ade o~ elastic or plasbic materia which mu9b ba biologically inerb, nontoxic and noncancero-genic~
In order bo e~bablish an end-bo-end anastomosis the instrumenb is to be placed inside the tubular organ. operated upon. 'l'he ends of the tissue of the or~ans operated upon are fixed on the rod with the aid of purse-string sutures. Once the working members of the apparatus have been brought 3~ --together and the needle arrangement has been approximated to the connecting ring, the tissues are also appro~imat-ed till contactin~ with their exterior serous surfaces~
whereupon the movable handle is depressed to actuat~ the hollow tube and the cylindrical kni~e to move conc~rrently with the travel of ths needle arrangement, whereby the needles of the second ring-shaped element are urged to pierce the tissues~ and the stationary ~ixed connecting ring is held thereto by means of the needles with the locking cones. Upon further advancing thc cylindrical knif`e cuts off th~ excess tissues and cuts through the stationary fixed ring, thus establishing an anastomotic opening through which is withdrawn the rod end ~itted with the round nut.
'~he tissue confin~d between tne needle arrangement and the connecting ring is compre~sed, thus ensuring a staunch suture, ~ollowed by reunion o~ the tissues and, 7 to 10 days af-ter urgery, tne n~edle arrange~ent and tne connecting ring which compress the tissue involved are expell~d into the interior of the hollow organ operated upon. A~terwards both the needle arrangelnent and the connecting rin~ are discharged through the natural way of elimination.
A disadvantage inherent in the known instrument resides in injury to the living tissues being satured at the instant o~ appro~imation o~ the connecting ring and the needle arrangement and suturing when the cylindrical ~nife cuts o~f the surplus tissues being stitcaed to~ether and starts cutting throu~h the connecting ring. As a result, the needles that have already been fixed in the connecting ring by the locking cones~ keep sinking into the ring till the latter is completely cut through by the knife~ thus overcompressing the tissue involved~
~ ince cuttin~ the connecting ring through by the Knife occurs simultaneously with advancing of the needles tt~ouæh said ring the latter ~ets deformed, which results in an increased suturing effort and additional injury to the living tissues being sutured.
It is an object of the invention to provide a surgical suturing instru~ent whicn, while havin~ a single mechanical actuator, ~ould make it possible to separate in time the procesq~es Or piercin~ the tissues bein~ sutured and of cutting the central opening in livin~ tissues and in the connecting ring.
It is another object of tne invention to reduce the suturing effort applied and hence to decrease the degree of traumatic lesion inflicted upon the living tissues being sutured.
~ he ~oregoin~ objects are accomplished due to the fact that a surgical suturin~ îns-trument f`or establishing cir-cular compression anastomoses in the organs of the di~estive tr~ct, comprising a needle arrangement accomlnodated in a hollow body and havin~ a first rin~-shaped element with a plurality o~ holes, an~ a ~econd ~in~-shaped element coaxial wibh the first one and carryin~ a number of needles fixed in position thereon, each of said needle~ corresponding to one of the holes in the first rin~-shaped element, while at least part of said needles have a loc~in~ cone at )2 the free end thereof`, a rod acco~modated in the hollow body, said rod carrying ab one o~ its ends a con~ecting ring ~ixed stationary with the aid of a nut, said connecting rin~ being adapted for the needles to pass through when establishi~ an anastomosis and those needles which have a locking cone get secured in position in said connecting ring, a hollow cylindrical kni~e ha~ing such an inside diameter that enables the nut to pass ~reely therethrough, said knife being held to a hollow tube which is arranged coaxially in the hollow body and which acco~modates said rod located coaxially therewith, and a mechanical actuator o~ the hollow cylindrical knife adapted to interact with the hollow tube, according to the invention, has a pusher upon one of whose ends rests the second ring-shaped element of the needle arra~gement, while its other end has a hollow cha~ar and a stop which i9 adapted to interact with a stop of the hollow body so as to restrict the travel of the second rin~~shaped element in the course of anastomosin~, a s~lit bush ~itted on the ~ullow tube and havin~ an outside taper collar adapted to enga~e the hollow cham~er o~ the pusher, and a retainer of the split bush located on the hollow tube and acco~modated inside the split bush.
To ensure against spontaneous pusher travel the instru-ment m~y have a retention device comprisin~ a cylinder-shaped ele~nent w~lich is provided with a recess and is located inside the hollow body close to the hollow tube in which a cylindrical recess i9 made, corresponding to the cylin~er-shaped element, and a handle provided on the cylinder-shaped L292fl~
element rotatably with respect to the hollaw body i~ or~or to bring the recess in the cylinder-~haped element in coinci-dence with thc cylindrical recess of the hollow tube, thus letting the hollow tube move and preparin~ the instrument for 9 uturing.
It is expediQnt that the retainer of the split bush be snaped as a hollow tube ri~idly coupled to tne hollow body and arranged coaxially therewith.
The hollow tube serving as the retainer o~ the split bush may also serve as the casin~ of trle instrument and have a length comparable with t~e rod lengt'rl.
'~'he retainer of the split bush may also comprise a bush coaxial with the rod and having a diametral openin~, and a supporting element located in the diametral opening of the bush and having its own opening co~xial witn the ~ush and adapted for tne rod to pass, said rod having a stop adapted to interact with the supporting element so as to stop the pusher and hence the needle arrange~ent at trle instant when the hollow cylin~rical Knire cuts through tne connectin~
ring.
It is ~150 expedient tha't the hollo~ tube on which the hollow cylindrical kni~'e is secured, be provided with lon-gitudinal slots located on its portion interacting with the bush o~' the split bush retainer, the slots being a~apted for t~le supporting element to slide with respect to tne nollow tube in the course of anastomosing.
~ ne hollow tube carrying the hollow cylindrical kni~e may serve as the casinæ o~ the instrument and have a lsn~th ~ Z9;240~:
comparable with that o~ the rod.
It is likewise expedie~t that the hollow body be sprin~-actuated with respect to the hollo~ tube carryin~ the hollow cylindrical knife and be adapted to interact with ~he bush of the split bush retain~r, thus contributing to less overcompression of the tissues being sutured should these be o~ considerable thickness.
It is favourable that th~ bush of the split bush retainer be spring-actuated with re pect to the hollow tube on which the hollow cyLindrical ~ni~e is made ~ast.
The herein-proposed surgical suturin~ instrument reduces the ~egree of traumatic lesioQ of' the living tissues being sutured with-in the zone of contact durin~ the suturing process.
Provision of a retention device ensure against sponta neous pusher movement when makin~ the instrument r~ady ~or suturing.
Provision of a hollo~ tube with a ~ni~`e or a hollow retainer bush as a casin~ renders the construction of the entire instrument simpler and at the same time more convenient in u~e.
Provision o~ a sprin~-actuated housin~ makes it possible to reduce -the de~ree of' injury to the tissues involved ShOUld these be of consi~erable thickness.
Provision o~ a sprin~-actuated retainer bush prevents the latter a~ainst . unlocking.
Further objects and advanta~es o~ the present invention will hereinafter become apparent from a consideration of a ~2~2~
detailed description of some exerQplary ~mbodl~e~ts thereo~
with refercnce to the accompanying drawings, wherein:
FIG. 1 is a frag~entary lon~itudinal sectional view of a surgical suturing instrumetlt, according to the inven~
tion;
FIG. 2 is a general view, partly in longitudinal section, of the surgical suturing instrumen~ of ~IG. 1, accorditl~ to the invention;
FIG. 3 is a section taken along the line III-III in FIG. 2;
FIG. 4 is a section ta~en along the line IV-IV in FT ~ . 1;
FIG. 5 is a general longitudinal sectional view o~ an alternative smbodiment of` the surgical suturing instru~ent, according to the invention;
FIG. 6 is a section ta~en along the line VI-VI in FIG. 5;
FIG. 7 is a ~eneral view of a split bush, according to the invention;
FIG. 8 is a lon~itudinal sectional view of the surgical suturing instrument while the connecting ring is being cut through, according to t~e invention; and ~ IG. 9 shows the satne as in FIG. 8 with reference to an alter~ative etnbodiment of the surgical suturing instru-rtlent.
The surgical suturing instrument for establishin~ cir-cular compression anastomoses in the organs of the diLestive tract co~prises a hollow body 1 (EIG. 1) which accommodates ~2~
g a rod 2 and a hollow cylindrical knife 3 made fa~t Otl a hollow tube 4, both the rod 2 and t~e hollow cylindrical ~nife 3 bein~ arranged coaxially with the hollow body 1. A
deta~hable needle arrangement 5 is accommodated in the body 1 coaxially there~ith, said needle arranOe~ent comprisin~
coaxial rin~-shaped ele~ent 6 and 7. A number of holes 8 aI~e made in the ring-shaped element 6 and a num~er of needles 9 are held to the rin~-shaped element 7, each of tne needles 9 corresponding to each of the holes 8. Some Or the needles 9 but at least three of them have a locking cone 10 at their free end. ~i'he ring-shapea elei~nent 6 is ~prin~-actuated ~ith respect to the element 7 by means 4~ springs 11 si-tuated round a part of` the needles 9.
~ contlecting rin~ 13 is held at one end of the rod 2 with the aid of a nut 1~, said rin~ being adapted to join t~le needle arran~ement 5 so as to fix the living tissues being ~ut~red.
'~he cylindrical ~nife 3 has an inside diameter 'd' tne size of which allows the nut 12 to pass through the interior ol' t~e ~nife 3 al`ter the ring has been cut through.
'l'he hollow tube 4 i~ arranOed in the hollow body 1 coaxially therewith and accommo~ates the rod 2.
'l'he ~nire 3 has a mechanical actuator made as a handle 14 ~FIG. 2) rotatable round a hinge Joint 15 with respect to the body l which is constituted by tnree separable por-tions lo, 17 (FIG. 3).
~ he portions 17 of the body 1 are in ~`act the compon-ents of a bush split alon~ it~ longitu~inal axis; they constitute the stationary ~ixed body 1 at the section wh~n the handle 14 is located. 'I'~e handle 14 (FIG. 2) has a lever 18 adapted to interact with the tube 4 so as to cause it to travel along with the knife 3.
The rin~-shaped element 7 (FIG. 1) rests upon a pusher 19 (FlG~ 1, 4) havin~ a hollow cha~fer 20. ~he pusher 19 has a stop 21 shaped a~ a projectio~ and adapted to interact with a stop 22 provide~ on the inner surface of the body 1 and shaped as a shoulder. Fitted on the hollow tube 4 is a plit bush ~3 which has an outside taper collar 24 correspondin~ to tne hollow chamfer 20 of the pusher 19.
A retainer is located in the interior of the split bush 23 and on tae hollow tube 4. EIG. 1 presents an embo-diment of the retainer as a hollow tube 25 ri~idly coupled to tne hollow body 1. 'r'he tube 25 is coaxial with the body 1 und serves as t~le casin~ o~ the entire instrument.
~ince its len~th is co~parable with tne len~th of the rod 2 the tube 25 encompasses the hollow tube 4 accommodat-ing t~e rod 2 at the middle portion of the instr~ment. The tube 25 being the casing of the instrument, interconnects rigidly the portions 16 and l7.
FIG. 5 present~ an ~lternative embodiment of the rstainer o~` the split bush 23, which colnpris~s a bush 26 accoMmodated in the body coa~ially with the rod ~, and a supportin~ element 27 (FIGS 5, 6) located in a diametral openin~ 2~ of tne busil ~6. An opening 2~ is provided in the element 27 coaxial therewith and with the bush 26 and adapted for the rod 2 to pass.
~ stop 3O i~ provided on the portion of the rod wnere the supporting element 27 is located, said stop bein~ shaped as a pxojection. However, the stop 3O can also be ~ade as the end face o~ the keyway in the rod 2 or else the face of a fla~ on the rod 2.
~ tle st,op 3O i~ adapted to interact with the element 27 so as to stop the pusher 19 and the needle arran~e~ent $
at the instant when the Kni~e 3 cuts throu~h the connecting rin~ 13.
With such an embodim~nt of the retainer with the bush 26 o~ the split bush ~5 it is the hollow tube 4 (FIG. 5) whiCh serves as the casing of the instrument. In this ease the length o~ the hollow tube 4 is comparable with the length of the rod 2.
~ he split bush 23 (FIG. 7) is essentially a hollow cyli~der whose si~e surface is divide,d, by tt~ou~h slots 31, into a number of prongs 32 united by a nonsplit portion 33 of th~ cylind~r itsel~. A taper collar 24 is provided at tne free end o~ each pron~ 3~. ~he number of` the pron~s 3 depends on the e~ort to be applied to the needles 9 so as to pierce throu~h tLle connecting rin~ 13 and hence on the force of suturin~ 'he instrumenb comprises also a retention device which ensules a~ainst spontaneous movement o~ the pusher 19 and is provided with a cylinder-shaped element 34 (FIG. 2, 3, 5) int~rposed between the portions 17 o~ the body 1 square with the axis of the rod 2. '~he cy-linder-shaped ele~ent 34 has a recess 35 corresponding . .
' ~ Z~
~ 12 to a cyli~drical recess 36 on the portion of the hollow tube 4 close to which the retention device is located. A
handle 37 is provided on the cylinder-shaped eleme~t 34 which turns the latter so as to bring in coincidence the recesses 35 and 36 at the instant when the hollow tube 4 iæ
unlocked for further travelling.
'~he hollow tube 4 (FIG. 5) has a number of lonæitudinal slots 38 on its portion interacting with the bush 26, said slots being adapted f`or the supporting element 27 to travel with respect to the tube 4 in the course of anastomo~ing.
The body 1 is actuated with respect to the tube 4 by a spring 39 f~itted on the nollow tube 4 between its projecti-on 40 and a projection 41 on the body 1.
The bush 26 of the retainer o~ the split bush ~3 is actuated with respect to the hollow tube 4 by a spring 42 ~itted on the hollow tube 4 between its projection 43 and t~le end of the bush 26.
The kni~e 3 is thread-~itted on the tube 4.
The rod 2 runs inside a hollow screw 44 engaged with a nut 45 which i~ rotatably l~ounted in tha ~ortions 17 o~
the body 1. 'l'he f`ree end of the rod 2 has a thread on which a nut 46 i~ fitted. When the nut 46 rotates the rod 2 is ad-~vanced ~rom the scre~ 4~ till its end 47 thrusts a~ainst the end of the ~crew 44 which is kept against rotation due to a nonround slot 48 provided in the portions 17 of the body 1.
The portions 17 of the body 1 are brou~ht to~ether with a nut 49 inside which a tube 4 passes.
The handle 37 of the retention device is composed o~
~z~
two elastic arms 50 (FIG. 3) enclosed in a 910t 51 o~ the portions 17 of the body 1.
The sur~ical suturin~ instrument of the present inven-tion operates as follo~s.
The surgical suturing instrume~t pxoposed herein i~
aimed at establishing cii~cular compression anastomoses in the hollow organs of` the diOestive tract by the end-to-end, end-to-side and side-to-side techniques. Considered below is an exemplary end-to-end anastor~osis established in the anterior resection of the rectum.
After resection has been over purse-string sutures are applied to the rectal sturnp and the ends o~ the sigmoid colon. 'r'hen the instrument is introduced through the anal orifice into the rectum with the connecting ringr 13 and the neadle arranOement 5 brou~ht together. ;~hereupon the nut 45 is rotatea ~o adv~nce the end o~ the rod ~ carrying the corlnecting ring 13 beyond the rectur~, and the purse-string suture on the rectal stump is drawn tight. Next the end of the sigrnoid colon is moved towards the end o~ the rod ~
carryin~ the connecting ring 13 and the purse-string suture on the sigmoid colon is drawn tight, whereupon the surplus threadr~ o~ the purse-~trlng sutures are cut of~ and the nut 45 i~ rotated to bring the connectingr ring 13 and the needle arran~ement 5 to~ether till the suturing position is attained. Tn~n the eler~ent 34 is rotated, by r~eans o~ the handle 37 o~ the retention device until the recesses 35 and 36 coinci~e, that is, to unlock the hollow tube ~, whereupon the handle 14 is depressed so as to rotate round the hinge joint 15. As a result, the le~er 18 in~eract~ with bhe hollow tube 4 to cause it to move along with the ~ni~e 3 and the split bush 23 held thereto, which accommodates the retainer shaped as the hollow tube 25.
~ he split bush 23 interacts, with its ~utside taper collar 24, ~ith the holloW chamfer 20 o~ the pusher 19, thus causing it to travel along with the ring-shaped element 7 of the needle arran~ement 5~ lI'he needl~s 9 pass throu~h the holes 8 in the ring-shaped element 6 and pierce the tissues being sutured and the connecting ring 13, whereupon the needles 9 having the lockin~ cones 10 are ~ixed in position in the ring 13. 'l'~en tne retainer 25 rigidly coupled to the body 1 is located in the interior of the split bush ~3, while ttle pu~her 19 interacts through its stop 21 with the stop 22 of the body 1 and ceases travelling, thus exerting no pressure on the ring-shaped e1ement 7 of the needle arran~ement 5. Upon further advancement of the hollow tube 4 the bush 23 enters tne interior of the pusher 19 (FIG. 8) without causing it to travel, while th~ ~nif`e 3 cuts through the ti~sueR being sutured and establishes an opening in tho co~necting rin~ 13.
Accordin~ to an alternative embodiment of the retainer o~ the split bush 23 (FIG. 5), travelling o~ the hollow tube ~ causes the rod 2 to interact, throu~h its stop 30, with the ~upporting element 27 wnich i8 located in the diamet-ral opening o~ the bush 26 and in the longitudin~ slots 38 o~ the tube 4 80 that the bush 26 remains stationary and is no longer located in the interior o~ the split bush 23, thereby unlocking it at tne instant ~ollowing the piercing of the connecting rin~ 13 by the needles 9 and ~`ixing therein the needles 9 provided with the lockin~ cones 10.
Upon furtner adva~cing o~ the ~ollow tube ~ the bush 23 enters the interior of the pusher 19 without c~usin~ lt to travel, while the ~nife 3 cuts off the surplus ti~sues and cuts through an opening in the connectin~ ring 13 (~IG. 9).
~hen the instrument is withdrawn from the rectum and the needle arra~gement 5 and the connecting ring 13 re~ain in the rectal lumen and will afterwàrds (in 5 to 7 days) be dischar~ed by the natural elimination way to~ether with the necrotized tissue that has been compressed between t~e needle arrangement 5 and the connectiu~ ring 13. By that day the rectal ~alls ~et united peripherally from the compres-sion zone. Before the needle arrar~ement 5 and the con-nectin~ rin~ 13 are expelled the inkestinal contents are free to pass through the opening cut by the cylindrical knife.
A total oY 1~ sur~ical procedures have been carried ou~
on test dogs with the use of the surgical suturing instru-ment considered h~rein and ~0 operations un~er clinical conditions on the Rtomach, small and lar~e intestines.
~ well-f~ormed anastomosis ~ree l`rom cicatricial thick~_ ning was observed in the test animals operated upon.
In sur~ery on the stomach Ghere were employed the rin~s o~ an appropriate diameter, which in all cases were freely discharged by the natural way of eliluination. No postoporative morbid events were observed. 'l`he patients operated upon recovered ~ to 7 days earler than the control patients due to a less degree of injury to Ghe livin~
tissues bein~ suture~.
Claims (14)
1. A surgical suturing instrument for establishing cir-cular compression anastomoses in the organs of the digestive tract , comprising:
a hollow body;
a rod arranged coaxially with said hollow body;
a connecting ring fixed stationary on said rod;
a nut holding said connecting ring to said rod;
a hollow cylindrical knife having its interior of such a siameter that said nut is free to pass through said cylind-rical knife;
a hollow tube whereon said cylindrical knife is made fast and which is arranged in said hollow body coaxially there-with;
said rod accommodated in said hollow tube coaxially therewith;
a mechanical actuator of said hollow cylindrical knife, said actuator being adapted to interact with said hollow tube for said cylindrical knife to move;
a needle arrangement having a first ring-shaped element, a second ring-shaped element and a plurality of needles;
a plurality of holes provided in said first ring-shaped element; said plurality of needles, comprising needles each of which is fixed in said second ring-shaped element, corres-ponds to one of the holes of said plurality of holes and is free to pass through said hole in the course of anastomosing;
at least three needles out of said plurality of needles, each having a locking cone with which said needles are fixed in said connecting ring;
a pusher having a first and whereon rests said second ring-shaped element, and a second end in which a hollow chamfer is provided;
a first stop located at said second end of said pusher;
a second stop located in said hollow body and adapted to interact with said first stop so as to restrict the travel of said pusher and of said second ring-shaped element resting thereupon, whereby said plurality of needles are passed consecutively through said plurality of holes in said first ring-shaped element and through said connecting ring;
a split bush located on said hollow tube and having an outside taper collar adapted to interact with said hollow chamfer of said pusher; and a retainer of said split bush located on said hollow tube inside said split bush.
a hollow body;
a rod arranged coaxially with said hollow body;
a connecting ring fixed stationary on said rod;
a nut holding said connecting ring to said rod;
a hollow cylindrical knife having its interior of such a siameter that said nut is free to pass through said cylind-rical knife;
a hollow tube whereon said cylindrical knife is made fast and which is arranged in said hollow body coaxially there-with;
said rod accommodated in said hollow tube coaxially therewith;
a mechanical actuator of said hollow cylindrical knife, said actuator being adapted to interact with said hollow tube for said cylindrical knife to move;
a needle arrangement having a first ring-shaped element, a second ring-shaped element and a plurality of needles;
a plurality of holes provided in said first ring-shaped element; said plurality of needles, comprising needles each of which is fixed in said second ring-shaped element, corres-ponds to one of the holes of said plurality of holes and is free to pass through said hole in the course of anastomosing;
at least three needles out of said plurality of needles, each having a locking cone with which said needles are fixed in said connecting ring;
a pusher having a first and whereon rests said second ring-shaped element, and a second end in which a hollow chamfer is provided;
a first stop located at said second end of said pusher;
a second stop located in said hollow body and adapted to interact with said first stop so as to restrict the travel of said pusher and of said second ring-shaped element resting thereupon, whereby said plurality of needles are passed consecutively through said plurality of holes in said first ring-shaped element and through said connecting ring;
a split bush located on said hollow tube and having an outside taper collar adapted to interact with said hollow chamfer of said pusher; and a retainer of said split bush located on said hollow tube inside said split bush.
2. A surgical suturing instrument as claimed in Claim 1, comprising a retention device to prevent spontaneous travel of said pusher; said retention device, comprising ;
a cylinder-shaped element accommodated in said hollow body close to said hollow tube; a first recess made in said cylinder-shaped element; a second recess cylindrical in shape made in said hollow tube and corresponding to said first recess; a handle provided on said cylinder-shaped element rotatably with respect to said hollow body so ad to bring said first recess in coincidence with said second recess in order that said follow tube may travel and tnat the instrument may be prepared for suturing.
a cylinder-shaped element accommodated in said hollow body close to said hollow tube; a first recess made in said cylinder-shaped element; a second recess cylindrical in shape made in said hollow tube and corresponding to said first recess; a handle provided on said cylinder-shaped element rotatably with respect to said hollow body so ad to bring said first recess in coincidence with said second recess in order that said follow tube may travel and tnat the instrument may be prepared for suturing.
3. A surgical suturing instrument as claimed in Claim 1 or 2, wherein said retainer of said split bush is shaped as a second hollow tube arranged in said hollow body coaxially therewith and rigidly coupled thereto.
4. A surgical suturing instrument as claimed in Claim 1 or 2, comprising said retainer of said split bush, said retainer having a bush coaxial with said rod; a diametral opening made in said bush; a suppo ting element located in said diametral opening and having its own opening coaxial with said bush; said rod passing through said own opening of said supporting element; a stop located on said rod and adapted to interact with said supporting element so as to stop said pusher and accordingly said needle arrangement at t?e instant when said hollow cylindrical knife cuts through said connecting ring.
5. A surgical instrument as claimed in Claim 3, compris-ing a casing in the capacity of which is used said second hollow tube of said retainer of said split bush; said second hollow tube having a length comparable with the length of said rod.
6. A surgical suturing instrument as claimed in Claim 4, comprising said hollow tube carrying said hollow cylindrical knife and having a portion that interacts with said bush of said retainer; a number of longitudinal slots provided on said portion of said hollow tube and adapted for said support-ing element to slide therealong in the course of anastomosing.
7. A surgical instrument as claimed in Claim 4, compris-ing a casing in the capacity of which is used said second hollow tube carrying said hollow cylindrical knife; said hollow tube having a length comparable with the length of said rod;
8. A surgical suturing instrument as claimed in Claim 4, comprising a spring accommodated in said hollow body so as to actuate tne latter with respect to said hollow tube; said hollow body adapted to interact with said bush of said retainer so as to reduce overcom-pression of the tissues being sutured should those be of considrable thickness.
9. A surgical suturing instrument as claimed in Claim 4, comprising a spring fitted on said hollow tube so as to actuate said bush of said retainer of said split bush with respect to said hollow tube.
10. A surgical suturing instrument as claimed in Claim 6, comprising a casing in the capacity of which is used said hollow tube carrying said hollow cylindrical knife, said hollow tube having a length comparable with the length of said rod.
11. A surgical suturing instrument as claimed in Claim 6, comprising a spring accommodated in said hollow body so as to actuate the latter with respect to said hollow tube; said hollow body adapted to interact with said bush of said retainer so as to reduce overcompress on of the tissues being sutured should these be of considerable thickness.
12. A surgical suturing instrument as claimed in Claim 6, comprising a spring fitted on said hollow tube so as to actuate said bush of said retainer of said split bush with respect to said hollow tube.
13. A surgical suturing instrument as claimed in Claim 8, comprising a spring fitted on said hollow tube so as to actuate said bush of said retainer of said split bush with respect to said hollow tube.
14. A surgical suturing instrument as claimed in Claim 1 or 2, comprising said retainer of said split bush, which retainer has a bush coaxial with said rod; a diametral opening made in said bush; a supporting element located in said diametral opening and having its own opening coaxial with said bush; said rod passing through said own opening of said supporting element; a stop located on said rod and adapted to interact with said supporting element so as to stop said pusher and accordingly said needle arrangement at the instant when said hollow cylindrical knife cuts through said connecting ring; said hollow tube having a portion that interacts with said bush of said retainer; a number of longitudinal slots on said portion of said hollow tube and adapted for said supporting element to slide there-along in the course of anastomosing;
a casing in the capacity of which is used said hollow tube carrying said hollow cylindrical knife; said hollow tube having a length comparable with the length of said rod;
a spring accommodated in said hollow body so as to actuate the latter with respect to said hollow tube; said hollow body adapted to interact with said bush of said retainer so as to reduce overcompression of the tissues being sutured should these be of considerable thickness;
a spring fitted on said hollow tube so as to actuate said bush of said retainer with respect to said hollow tube.
a casing in the capacity of which is used said hollow tube carrying said hollow cylindrical knife; said hollow tube having a length comparable with the length of said rod;
a spring accommodated in said hollow body so as to actuate the latter with respect to said hollow tube; said hollow body adapted to interact with said bush of said retainer so as to reduce overcompression of the tissues being sutured should these be of considerable thickness;
a spring fitted on said hollow tube so as to actuate said bush of said retainer with respect to said hollow tube.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| SU4268008 | 1987-07-14 | ||
| SU874268008A SU1616624A1 (en) | 1987-07-14 | 1987-07-14 | Surgical suturing apparatus |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1292402C true CA1292402C (en) | 1991-11-26 |
Family
ID=21313207
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000568716A Expired CA1292402C (en) | 1987-07-14 | 1988-06-06 | Surgical suturing instrument |
Country Status (9)
| Country | Link |
|---|---|
| US (1) | US4957499A (en) |
| EP (1) | EP0324858A4 (en) |
| JP (1) | JPH02501273A (en) |
| CN (1) | CN1030695A (en) |
| AU (1) | AU603910B2 (en) |
| CA (1) | CA1292402C (en) |
| FI (1) | FI891182A0 (en) |
| SU (1) | SU1616624A1 (en) |
| WO (1) | WO1989000406A1 (en) |
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| GR880100632A (en) * | 1988-09-23 | 1990-10-31 | Guskov Igor A | Surgical suturing instrument |
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| US5222963A (en) * | 1991-01-17 | 1993-06-29 | Ethicon, Inc. | Pull-through circular anastomosic intraluminal stapler with absorbable fastener means |
| US5474223A (en) * | 1991-10-18 | 1995-12-12 | United States Surgical Corporation | Surgical fastener applying apparatus |
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| US5197649A (en) * | 1991-10-29 | 1993-03-30 | The Trustees Of Columbia University In The City Of New York | Gastrointestinal endoscoptic stapler |
| US5271543A (en) * | 1992-02-07 | 1993-12-21 | Ethicon, Inc. | Surgical anastomosis stapling instrument with flexible support shaft and anvil adjusting mechanism |
| US5282810A (en) * | 1992-04-08 | 1994-02-01 | American Cyanamid Company | Surgical anastomosis device |
| US5425738A (en) * | 1992-04-08 | 1995-06-20 | American Cyanamid Company | Endoscopic anastomosis ring insertion device and method of use thereof |
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| US5376098A (en) * | 1992-10-09 | 1994-12-27 | United States Surgical Corporation | Fragmentable anastomosis ring applier |
| US5454824A (en) * | 1992-10-09 | 1995-10-03 | United States Surgical Corporation | Fragmentable ring applier |
| US5346501A (en) * | 1993-02-05 | 1994-09-13 | Ethicon, Inc. | Laparoscopic absorbable anastomosic fastener and means for applying |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4573468A (en) * | 1977-05-26 | 1986-03-04 | United States Surgical Corporation | Hollow body organ stapling instrument and disposable cartridge employing relief vents |
| DE2953742C1 (en) * | 1979-07-02 | 1984-05-03 | Igor Alekseevič Guskov | Surgical device for creating ring-shaped anastomoses on the large intestine |
| US4289133A (en) * | 1980-02-28 | 1981-09-15 | Senco Products, Inc. | Cut-through backup washer for the scalpel of an intraluminal surgical stapling instrument |
| US4476863A (en) * | 1981-03-09 | 1984-10-16 | Kanshin Nikolai N | Surgical instrument for establishing circular coloanastomoses |
| US4567891A (en) * | 1981-12-31 | 1986-02-04 | Kanshin Nikolai N | Device for establishing compression anastomoses |
| SU1114405A1 (en) * | 1982-02-23 | 1984-09-23 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Surgical suturing apparatus for placing compression anastomoses on the organs of digestive tract |
-
1987
- 1987-07-14 SU SU874268008A patent/SU1616624A1/en active
-
1988
- 1988-01-27 EP EP19880905035 patent/EP0324858A4/en not_active Ceased
- 1988-01-27 JP JP63504752A patent/JPH02501273A/en active Granted
- 1988-01-27 AU AU19324/88A patent/AU603910B2/en not_active Ceased
- 1988-01-28 WO PCT/SU1988/000020 patent/WO1989000406A1/en not_active Application Discontinuation
- 1988-06-06 CA CA000568716A patent/CA1292402C/en not_active Expired
- 1988-06-27 US US07/332,452 patent/US4957499A/en not_active Expired - Fee Related
- 1988-07-13 CN CN88104344.3A patent/CN1030695A/en active Pending
-
1989
- 1989-03-13 FI FI891182A patent/FI891182A0/en not_active Application Discontinuation
Also Published As
| Publication number | Publication date |
|---|---|
| FI891182A (en) | 1989-03-13 |
| CN1030695A (en) | 1989-02-01 |
| SU1616624A1 (en) | 1990-12-30 |
| EP0324858A4 (en) | 1990-05-14 |
| AU1932488A (en) | 1989-02-13 |
| US4957499A (en) | 1990-09-18 |
| AU603910B2 (en) | 1990-11-29 |
| WO1989000406A1 (en) | 1989-01-26 |
| FI891182A0 (en) | 1989-03-13 |
| JPH02501273A (en) | 1990-05-10 |
| JPH0579336B2 (en) | 1993-11-02 |
| EP0324858A1 (en) | 1989-07-26 |
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