US 3551987 A
Descripción (El texto procesado por OCR puede contener errores)
Jan'.'5, 1971 J.'E. WILKINSON 3,551,987
' STAPLING CLAMP FOR GASTROINTESTINAL SURGERY Filed Sept. 12, 1968 2 Sheets-Sheet 2 INVIL NTOR. JJCX 5. M1. KIA/:0 BY
3,551,987 STAPLING CLAMP FOR GASTROINTESTINAL SURGERY Jack E. Wilkinson, 2411 Divisadero St., Fresno, Calif. 93721 Filed Sept. 12, 1968, Ser. No. 759,273 Int. Cl. B23g 7/10 US. Cl. 29-212 11 Claims ABSTRACT OF THE DISCLOSURE BACKGROUND OF THE INVENTION A hand-operated stomach-stapling clamp having in-line jaws and handles in a tongs-type arrangement, has been in use in gastrointestinal surgery for many years. Such clamps will perform a satisfactory closing job on tubular tissue (e.g. stomach or intestine) to the extent that the clamp can be maneuvered into a position in which the tissue is embraced between the jaws, but the initial positioning of the clamp is awkward and difficult, and in most stomach surgery cases it is impossible to place the clamp in the most advantageous position for leaving the largest and most desirable area of a stomach remaining in the patients body for active functioning.
OBJECTS The general object of the invention is to provide an improved and more efficiently-operable clamp of the type outlined above. Specific objects are to provide such a clamp:
('1) Which can be positioned so as to leave a larger functional area of a stomach intact after resection of a useless or dangerous (e.g. cancerous) portion.
(2) Which can be more easily positioned in embracing relation to tissue to be sutured after resection of adjacent tissue.
(3) Which embodies power-actuating means, local to the clamp jaws, for setting the staples without requiring movement of the jaws.
In the drawings:
FIG. 1 is a side view of a clamp embodying the invention;
FIG. 2 is a plan view thereof, with the upper jaw broken away;
FIG. 3 is a schematice plan view of the clamp as applied to a stomach to be resected;
FIG. 4 is a schematic plan View of the resected and stitched stomach;
FIG. 5 is a fragmentary vertical longitudinal sectional view of the clamp, taken on line 5-5 of FIG. 2;
FIG. 6 is a plan view thereof;
FIG. 7 is a transverse vertical sectional view taken on line 77 of FIG. 5;
FIG. 7A is a fragmentary cross-section of the staple holder; I
FIG. 8 is a fragmentary plan view of a modified form of plunger arrangement, for staggered-staple stitching;
FIG. 8A is a longitudinal section of the actuator, modified;
FIG. 9 is a fragmentary, broken-away side view of a modified form utilizing electromagnetic actuation;
FIG. 10 is a cross-sectional view of the same;
FIG. 11 is a cross-sectional view of another modified form, embodying the use of ribbon-mounted staples;
3,551,987 Patented Jan. 5, 1971 DESCRIPTION Referring now to the drawings in detail, and in particular to FIGS. 1-7, I have shown therein, as an example of one form in which the invention may be embodied, a clamp designed particularly for closing the resected end of a stomach S, said clamp embodying, in general, a pair of jaws A and B; power-operated staplesetting means C operable in jaw A; and lever handle mechanism D for closing the jaws upon a tubular tissue member engaged between them, preliminary to operation of setting means D.
Jaws A and B are both of Z-ofiset form as shown in FIG. 2, having respective major legs 10, intermediate legs 11 curved away from legs 10 at an obtuse angle, and root portions 12 extending generally parallel to and away from legs 10 and connected to handle mechanism D.
Referring to FIG. 3, the legs 10 and 11 of the jaws cooperatively define an L-shaped (or J-shapedFIG. 3) stitching area which can be extended across a stomach S in a position such as to outline a pocket-shaped residual area 113 closed by lines of stitching along two sides, leaving a resected (e.g. malignant) area 13A to be removed and disposed of. A substantial portion of the end margin of residual area 13A may as indicated at 13B, be left open for coupling to the cut end of the large intestine after resection of area 13A therefrom.
At this point it may be noted that handles D extend generally parallel to jaws A and B, but are offset to one side of the jaw axis. This greatly facilitates manipulation of the clamp into an abdominal incision and into position with its lower jaw A inserted beneath the stomach S to be resected. For example, where a conventional in-line clamp is installed in a position extending transversely across the upper area of the stomach, the incision must be widened considerably on one side just enough to make room to receive the handles, and this is usually objectionable and would be avoided if it were possible! to do so.
Jaw A embodies a channel-section casing 14 which defines an L-, J-shaped, longitudinally extending plunger chamber 15 (FIGS. 2, 5, 7) with parallel sides 17 providing guides for a disposable staple holder 18. Holder 18 is of molded plastic material having, in its face, marginal slots 19 for holding respective rows of suturing staples 25 in planes parallel to the longitudinal axis of the jaw A and perpendicular to the holder face. Staple holder 18 is of bar form, of L- or J-shape in plan, having a longitudinal configuration conforming to that of chamber 15. Communicating with chamber 15 are one or more actuator (e.g. hydraulic) cylinders 20 at which may be located at the center and near the respective ends of jaw A. Cylinders 26 are formed as bores in the lower portion of casing 14. Cylinders 20 may be three in number (at the center and near the respective ends of chamber 15 as in FIGS. 2 and 5) or may be restricted to a single one midway between the ends, as in FIG. 8A.
Mounted in the plunger chamber is a plunger unit including a piston 21 operable in each cylinder 20, and a plunger head 22 of bar form, fitted to the side walls of chamber 15 with clearance for free projecting and retracting movements. Holder 18 is seated against plunger head 22 and in the retracted position thereof, it supports the suturing staples 25 in inverted positions, with the ends of their prongs substantially flush with the tissue-engaging face of jaw A, and with the bridge portions of the staples securely held in the holder slots 19, whereby the staples may be driven through the tubular tissue S upon projection of the plunger unit.
The actuator cylinders 20 are joined to a common manifold 26 which is filled with actuator fluid (e.g. sterile water) and communicates at one end with a fitting 27 which may be connected through a conduit 28 (eg flexible hose) with a source of sterile water or other actuator fluids under pressure to drive the actuator fluid through manifold 26 and into the several cylinders 20 so as to project the plunger head 22 to the limit of its stroke determined by engagement against the underside of applicator head 16. Thus the staple holder 18 will be projected to a position where its staple-holder face is substantially flush with the tissue-engaging face of jaw A so as to drive the staples 25 through tubular tissue S and to set them against jaw B which functions as a bucking bar or anvil for closing the prongs together toward their bridge portions, with the resected margins of the tubular tissue S closed by parallel lines of stitching consisting of the rows of closed staples, as in FIG. 4.
The pistons 21 are fitted closely within their cylinders and are sealed therein by oil films whch are immiscible with the actuator fluid (e.g. water)) so as to effectively seal off the plunger chamber 15 from the manifold 26.
Jaws A and B are connected by a pivot 31 for opening to receive a tissue member S to be sutured, and for closing to flatten the tissue members between the jaws preparatory to setting the staples. Root portions 12 of the jaws project beyond pivot 31.
Handle mechanism D comprises respective handles 32 and 33 connected by pivots 34 and 35 to the ends of the root portions 12 of jaws A and B. Handles 32 and 33 are of bell-crank form, embodying short transverse toggle arms joined by a pivot 36- which moves over-center with respect to the pivots 34, 35 when the jaws A, B, are closed as in FIG. 1, thus locking the jaws against any possible opening until handles 32, 33 are manually separated to unlock the toggle. Also the toggle mechanism increases the leverage applied to jaws A, B by handles 32, 33.
OPERATION Upon closing jaws A and B by operation of handle mechanism D, the walls of a stomach S or other tubular tissue, positioned between the jaws, will be collapsed along a line determined by positioning the jaws. The diseased area of the member may then be cut away along this line, and the mechanism C then power-operated to set the rows of staples along the selected resection line. Alternatively, the line of staple-stitching can be applied first, and the diseased tissue cut away later.
Upon release of the fluid pressure, the plungers 22 will be allowed to subside to their normal positions in which plunger head 22 is withdrawn into the bottom of chamber 15.
The invention can be modified to provide for staggered stapling by utilizing a holder 18A (FIG. 8) having in staggered relation, the parallel rows of staples 25A, the staples of one row overlapping the staples of the other row of the double-row stitching in the sutured tissue. FIG. 8 also illustrates the possibility of mounting the staples in holder 18A by casting or molding them into the face of holder 18A, with their bridge portions embedded in the holder face.
FIG. 7A illustrates a preferred staple-mounting construction wherein the face of holder 18 is lined with a facing sheet 23 having channel portions 24 indented into holder slots 19 and frictionally gripping the bridge portions of the staples which are engaged with a press-fit in the channels 24.
When the staples are set and the jaws A, B are opened, the holder 18 may be left adhering to the rows of staples, pulling out of the jaw A as the tool is removed. The holder may then be pulled away from the rows of staples by manual pull applied by the surgeon, and disposed of.
As shown in FIGS. 9 and power actuation of staple holder 18 can be effected by electro-magnetic action. Actuator plunger 223, in this construction, is of soft iron and functions as a magnetic armature, the pusher face of which provides one pole and the bottom side of which provide the opposite pole, when magnetized. Plunger 18B is mounted for free shifting movement in plunger chamber 1513 of jaw A2, and is slidably guided between the walls of jaw A2 which is of non-magnetic material such as brass or hard plastic material. The bottom side of plunger 22B may be extended in an armature body 40 in order to attain more eifective polarization.
Mounted in anvil jaw B2 is a bar magnet comprising a magnetizable bar which provides the anvil face, an integral core member 46, and a winding 47 having conductor leads 48 for energizing the winding to magnetize the bar 45 and attract the armature 40, 22B so as to effect staple-driving movement of holder 18B. Bar 45 also functions as the bucking bar.
It will be apparent that the relationship of armature body 40 and magnet 46, 47 can be reversed so as to incorporate the electromagnet in parts 40, 22B and the armature in bucking bar 45.
In FIG. 11 is shown a modified holder arrangement in which the staples 25 can be attached, by soldering or by adhesive, to the margins of a holder strip 50 of thin ribbon metal or plastic material. Preferably, the staples are attached with their prongs flaring outwardly from the margins of strip 50, (FIG. 12) so as to hug the lateral walls of plunger chamber 15 when inserted therein. The actuator head 22 is retractible to permit loading of the strip of staples into plunger chamber 15, the head 22 being returned to a closed position after the loading. The strip 50 is no wider than the chamber 15, so that the walls of the latter may engage and guide the staples, while the plunger head 22 is operated to drive them through the tissue S to be sutured, while the holder strip 50 remains attached to the staples. Subsequently, strip 50 is removed from the rows of stitched staples by stripping it away manually.
FIG. 13 discloses another staple arrangement in which a series of staples are attached to narrow ribbons of soft plastic, the staples being mounted on the upper faces of the ribbons, and guided in slots 56 in the sides of a guide bar 57 removably fitted into a widened upper portion 58 of chamber 15D. Bar 57 is longitudinally coextensive with chamber 15D and has a matching configuration in plan. Staple holder ribbons 55 are inserted between the driving face of plunger head 22D and the under face of guide bar 57. Head 22D is provided with marginal rows of driving blades 55 which are projectible through guide slots 56 after piercing the margins of ribbons 55 and severing the staples therefrom. The blades 59 then drive the staples through tissue S, the ribbons 55 being left within jaw A4. Upon opening the jaws of the instrument, the guide bar 57 is removed, the ribbons 55 are taken out of chamber 15D, new sets of ribbonmounted staples are inserted, and guide bar 57 is replaced so as to confine the ribbons 55 in position for a subsequent operation. Ribbons 55 may be integral marginal portions of a single strip of plastic tape extending full width of chamber 15D as shown, or may be separate, laterally-spaced ribbons installed along respective sides of chamber 15D.
Referring again to FIG. 7A, facing 23 is of foil or sheet metal sufficiently stiff and unyielding so as to transfer driving pressure to the staples while resisting any tendency of the staples to recede by sinking into the plastic body of holder 18.
FIG. 9 illustrates, in section, how the staples 25A of FIG. 8A can be embedded in the plastic face of holder 18 instead of being mounted in slots as in FIGS. 57A.
Referring again to FIG. 2, fitting 27 includes a cylinder 72 in which a floating piston 73 transmits pressure from a fluid applied through hose 28 to the sterile fluid 74 in manifold 26, while isolating the sterile fluid 74 from the fluid in hose 28.
1. In a gastrointestinal staple-stitching clamp:
a staple-holding jaw having a tissue-engaging face and a longitudinally extending plunger chamber;
staple-driving plunger means including a plunger head in said chamber, projectible therein from a retracted position to a staple-setting position;
an elongated staple holder and a row of staples mounted thereon, said holder being fitted in said chamber above said plunger head;
power-operated pressure-applying means operating between said plunger means and said jaw to project said plunger to said staple setting position;
a bucking jaw in opposed relation to said staple-holding jaw, for flattening a tissue body against said stapleholding jaw and for turning the prongs of said staples when driven through said tissue body by said driving means;
and means connecting said jaws in articulated relation, for opening movement to receive said tissue body and for closing said jaws upon said tissue body in preparation to driving said staples.
2. A clamp as defined in claim 1, wherein said staple holder is a disposable part in the form of a bar having a longitudinal face slot in which said staples are removably mounted.
3. A clamp as defined in claim 2, wherein said holder is of plastic material and has a facing of metal foil including a channel portion lining said slot, receiving bridge portions of said staples with prongs thereof projecting, and supporting said staples against sinking into the plastic body of said holder in response to staple-setting pressure.
4. A clamp as defined in claim 1, wherein said staples are disposed in two rows, in planes parallel to. and adjacent the respective sides of the holder and normal to said tissue-engaging face.
5. A clamp as defined in claim 1, wherein said staples have bridge portions embedded in the face of said holder, and prongs projecting therefrom at right angles thereto, in two rows in planes parallel to and adjacent the respective sides of the holder.
6. A clamp as defined in claim 1, wherein said staples are disposed in two rows, in planes parallel to and adjacent the respective sides of the holder and normal to said tissue-engaging face;
and wherein the staples of one row are in staggered relation to those of the other row.
7. A clamp as defined in claim 1, wherein said holder is in the form of a tape seated against the diving face of said plunger means;
and wherein said staples have bridge portions adhering to side margins of said tape and prongs normal to the plane of said tape and disposed in two rows along said margins.
8. A clamp as defined in claim 1, wherein said holding jaw includes a removable guide bar in said chamber and defining a portion of said tissue-engaging face, and having staple-guiding slots in its sides;
wherein said driving means comprises a plurality of blades carried by said plunger means and slidably fitted in said slots;
wherein said holder comprises a soft ribbon element extending along a respective side of said chamber between said plunger means and said guide bar, and thereby supported;
and wherein said staples include bridge portions mounted on the outer face of said ribbon and detachable therefrom by shearing action of said blades in entering said slots.
9. A clamp as defined in claim 1, wherein said pressureapplying means consists of a piston projecting from the back of said plunger head, said piston being centered between its ends;
a cylinder in said staple-holding jaw, in which said piston is slidable;
and means for conducting fluid pressure into said cylinder for projecting said piston and plunger head.
10. A clamp as defined in claim 1, wherein said pressure-applying means comprises a plurality of pistons projecting from the back of said plunger head near its ends and near its center respectively;
cylinders in said staple-holding jaw, in which said pistons are slidable for projecting said plungers;
and means including a common manifold communicating with the several cylinders for applying fluid pressure into said cylinders behind said pistons to effect projection of said plunger head.
11. A clamp as defined in claim 1, wherein said pressure-applying means and plunger means comprise respective electromagnetic bars extending longitudinally in said jaws in opposed relation;
one of said bars being an electromagnet and the other being an armature, attracted by said electromagnet when the latter is energized.
References Cited UNITED STATES PATENTS 2,635,238 4/1953 Garland 72-410 3,082,426 3/1963 Miles 29212 3,098,232 7/1963 Brown 29212 THOMAS H. EAGER, Primary Examiner US. Cl. X.R. 72410