US 3638652 A
An instrument for use by surgeons particularly in cases involving resection and anastomosis of vascular and digestive tract organs. The instrument is dimensioned for insertion of the principal parts of the instrument into the open ends of or through stab wounds in the lumena after resection and the actual anastomosis is by stapling the tissue entirely around the stoma which is formed by an endless knife, illustrated as annular, and the tissue cut away to form the stoma is conveniently removed with instrument. The staples and knife are in a replaceable cartridge. Remote power means connected by a flexible conduit allows maximized ease of maneuverability of the principal parts of the instrument during actual surgical procedure.
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United States Patent Kelley SURGICAL INSTRUMENT FOR INTRALUMINAL ANASTOMOSIS James L. Kelley, 3111 Kellogg, San Diego, Calif. 92106 Filed: June 1, 1970 Appl. No.: 42,075
References Cited UNITED STATES PATENTS Kasulin et a1. ..227/l9 Astafiev et a1 t.
Bacon ..128/346 Feb. 1, 1972 Attorney-Knox & Knox  ABSTRACT An instrument for use by surgeons particularly in cases involving resection and anastomosis of vascular and digestive tract organs. The instrument is dimensioned for insertion of the principal parts of the instrument into the open ends of or through stab wounds in the lumena after resection and the actual anastomosis is by stapling the tissue entirely around the stoma which is formed by an endless knife, illustrated as annular, and the tissue cut away to form the stoma is conveniently removed with instrument. The staples and knife are in a replaceable cartridge. Remote power means connected by a flexible conduit allows maximized ease of maneuverability of the principal parts of the instrument during actual surgical procedure.
8 Claims, 6 Drawing Figures SURGICAL INSTRUMENT FOR INTRALUMINAL ANASTOMOSIS BACKGROUND OF THE INVENTION Stapling as such in anastomosis is not new. Prior art instruments include means for transection of organs with simultaneous stapling of the stub ends. The provision of a stoma between parallel rows of staples by means of a knife cutting the tissue between the rows of staples is standard procedure, the usual steps including making adjacent stab wounds in both lumena and inserting rectilinear forks carried by mating portions of a prior art anastomizing instrument, clamping the portions together and stapling in spaced rows and then moving a knife longitudinally between the rows, with the necessary final steps of closing the stab wounds. The intraluminal feature of this invention is also approached in prior an end to end anastomosis. However, in the prior art the lumena are brought together with both open ends facing in the same direction. A stapler-incisor instrument then is used to connect the juxtaposed tissue with two spaced, parallel rows of staples with a stoma therebetween and upon removal of the instrument the ends of both' lumena are closed. Finally, it is noted that provision of staples in a cartridge and the discharging of staples in a tow, progressively along such a row, has been done previously.
SUMMARY OF THE INVENTION The instant invention is an instrument which actually excises a considerable portion of tissue to form a more perfect stoma inside an endless double row of staples. The two principal parts, both simple assemblies, are inserted in opposite directions into the open overlapped ends of the lumena which may face in opposite directions and no stab wounds requiring later closing need be made. The parts of the instrument are small and maneuverable even in low down" cramped surgical areas and the remote power activation contributes to this maneuverability.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. I is a side elevation view of the apparatus with the actuator and head connected after insertion in the open ends of overlapping lumena shown in dashline;
FIG. 2 is a sectional view taken on line 2--2 of FIG. 1;
FIG. 3 is a sectional view taken on line 3-3 of FIG. 2, but with the head assembly in closed position;
FIG. 4 is a sectional view similar to FIG. 3, showing the components separated after use;
FIG. 5 is a top plan view of the staple cartridge; and
FIG. 6 is an enlarged sectional view taken on line 66 of FIG. 5.
DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT The environment wherewith this invention is to be used will vary considerably but the principal uses will include resection of vascular and digestive tract organs with anastomosis accomplished by stapling together juxtaposed portions of the walls of the concerned lumena. The lumena involved in the resection, in the example illustrated in FIG. 1, and indicated by the numerals l0 and I2 and these overlapped open ended portions face in the opposite direction rather than in the same direction as in some prior art procedures. The head assembly 14 is provided with a short handle 16 whereby it can be inserted into the open end of the lumen 12 and the actuator as sembly 18 is similarly inserted into the lumen by a handle portion 20 which doubles as part of a fluid power transmission conduit 22 leading to a pedal operated control 24.
The head assembly I4 comprises a cup 26 centrally apertured to receive a plunger 28 constituting a link with the piston 30 operating in the cylinder 32 of the activator 18. The outer end of the cylinder 32 is closed by an end plate 34 and FIGS. 3 and 4 indicate how the fluid power conduit 22 feeds through the handle 20 into said cylinder 32.
The cup 26 initially receives the replaceable cartridge 36 which, as first inserted in the cup 26, has preferably two radially spaced endless rows of peripherally spaced staples 38, the drawings showing the cartridge as a simple annulus and in this case a bead 40 or the equivalent is required on the exterior of the cartridge for fixed indexing of the cartridge relative to the cup 26. This is necessary because the staples 38 must be accurately aligned with the terminal turning recesses 42 of the anvil portion 44 in the actuator. To carry out this indexing function, again assuming that the cylinder 32 and piston 30 are also recticylindrical, the piston is indexed to the end plate by a pin 46 and the cup 26 has a notch 48, best shown in FIG. 4, to receive a T-bar 50 on the distal end of the link or plunger 28. The notch 48 may be formed at the junction of ramps 52 on the outer end face of the cup 26.
To discharge the staples 38 the cup 26 is pulled toward the anvil 44 to activate pusher means represented as a plurality of pins 54, one for each staple, which initially are only partially entered into the cartridge body as indicated in FIGS. 2 and 6. The pins are flattened or strap shaped as indicated in the dash line representation thereof in FIG. 6.
A knife 56, represented as annular, is frictionally supported on the inner periphery of the cartridge 36 with the cutting edge slightly inside the corresponding face of the cartridge as shown in FIGS. 2 and 6. Pusher means for the knife is a sleeve 58 which, like the pins 54, extends from the opposite face of the cartridge. A recess 60 in the actuator is dimensioned for snug reception of the knife with a shearing action.
While a hydraulic actuator is illustrated electrical or purely mechanical actuation can be used to move the plunger 28.
The operation of the apparatus has been referred to supra but in brief recapitulation is as follows. The organs to be anastomosed are disposed as indicated in FIG. 1 or with both open ends facing in the same direction, or with one or both ends closed. In the last mentioned case one or two wounds are made to admit the head and actuator. In any case a stab wound is made for insertion therethrough of the plunger 28 for connection with the head 14 with the cartridge 36 therein. Indexing of the anvil and staples is assured when the T-bar 50 is entered in the notches 52. Depression of the pedal control 24 forces the piston 30 to draw the head assembly 14 toward the actuator 18 with the pusher pins 54 discharging the staples through the walls of the lumena I0 and 12. At the same time the pusher sleeve 58 drives the knife 56 through the tissue to be frictionally held in the recess 60 of the actuator, there being a desirable shearing action involved during the excising of a disk of tissue indicated at 62 as in FIG. 3. Disengagement of the head 14 from the actuator 18 and removal of both from the lumena l0 and I2 and closure of the open ends thereof completes the anastomosis where the invention is used as indicated in FIG. I. In all cases the disk of tissue at 62 excised by the knife 56 is more or less automatically removed with the actuator l8 creating the stoma 64 indicated in FIG. 4. The cartridge and knife are discarded and the head 14 and actuator 18 can be sterilized for reuse with a replacement cartridge.
I. A surgical instrument for intraluminal anastomosis, comprising:
a cartridge having at least one row of staples forming a closed loop;
a head receiving said cartridge and having staple pusher means engaging the bight portions of said staples;
an actuator having an anvil and a power-operated link joining said head and actuator and adapted to move said head, including said pusher means toward said anvil thus discharging and clinching said staples;
a stoma-forming knife in said head generally conforming to and disposed inside said row of staples; and
means to disengage said link from said head, thus permitting removal of the instrument along with the tissue excised by said knife.
2. A surgical instrument according to claim 1 wherein said staple pusher means in said cartridge as loaded into said head extend from a face of said cartridge toward said head.
3. A surgical instrument according to claim 2 wherein said pusher means is a plurality of individual pins discrete from each other.
4. A surgical instrument according to claim 1 wherein said actuator has means to receive said knife and said head has knife pusher means extending similarly to said staple pusher means from said one face of the cartridge.
5. A surgical instrument according to claim 4 wherein said knife pusher means is an annular sleeve discrete from said knife.
6. A surgical instrument according to claim 1 wherein said actuator comprises a small disclike element having an axial length comparable to said head so that the axial length of the head-actuator assembly is less than twice the diameter of the knife.
7. A surgical instrument according to claim I wherein said actuator comprises a short cylinder with a piston operatively mounted therein to reciprocate said link and having a flexible conduit to connect said cylinder with a source of pressurized fluid, the flexibility of said tube making the head-actuator assembly easily maneuverable in use.
8. A surgical instrument according to claim 1 wherein said actuator has a cylinder with a piston therein connected to said link, and a remote fluid pressure means operativeiy connected with said cylinder.
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