US3265069A

US3265069A - Anastomosis surgical instruments

Info

Publication number: US3265069A
Application number: US480541A
Authority: US
Inventors: Jr John E Healey; Edwin B Moore
Original assignee: Individual
Current assignee: Individual
Priority date: 1965-07-16
Filing date: 1965-07-16
Publication date: 1966-08-09
Anticipated expiration: 1983-08-09

Description

Aug. 9, 1966 J. E. HEALEY, JR, ETAL 3,

ANASTOMOSIS SURGICAL INSTRUMENTS Filed July 16, 1965 Sheets-Sheet 1 n5. E I

/ I 36\ Z Jbkfz E. HeaZy,Jr.,

gaze? M00? a H; INVENTORS 2 V BY 32 36 42 mym,

9, 1956 J. E. HEALEY, JR.. ETAL 3,265,069

ANASTOMOSIS SURGICAL INSTRUMENTS 4 Sheets-Sheet 2 Filed July 16, 1965 M, m r g m LU 6 5% .1 a

3 JE w g- 9, 1966 J. E. HEALEY, JR.. ETAL 3,

ANASTOMOSIS SURGICAL INSTRUMENTS Filed July 16, 1965 4 Sheets-Sheet 5 INVENTQRS John E. Heuqy, (/71, E Bailey Moo/"e ORNEY6' fl- 9, 1956 J. E. HEALEY, JR. ETAL 3,265,069

ANASTOMOSIS SURGICAL INSTRUMENTS V Fil ed July 16, 1965 4 Sheets-Sheet 4 day. 17.

INVENTORS John E. Hadley Jn, E. fiwz'ley Moore WQ ykzzwm ATTORNEYS United States Patent 3,265,069 ANASTOMOSIS SURGIQAL INSTRUMENTS John E. Henley, in, 32% Gakrnont St, Houston, Tex., and Edwin E. Moore, 48% Bellview Sh, Beilaire, Tex. Filed July 16, 1965, Ser. No. 380,541 6 Claims. (U. 128-334) This application is a continuation-in-part of our earlier application, Serial No. 216,944, filed on August 7, 1962, for Surgical Instrument, which in turn is a continuationin-part of Serial No. 161,984, filed on December 26, 1961, both now abandoned.

The invention hereinafter described relates to devices or instruments for use by surgeons in the rejoining of body ducts which in the course of operations have been severed. 'Thus, more particularly stated, the devices are especially adapted for anastomosis, and are useable in the rejoining of various body ducts including such as bile ducts, blood vessels, and the intestinal tract.

It hardly needs to be emphasized that the element of time in the completion of an operation is one of great importance. As has been the case prior to this invention, the rejoining of a single body duct usually has required fifteen to thirty minutes and, in some cases, substantially more time. This time is occupied by the careful joining of the severed ducts and their suturing to the point of complete closure. The instruments provided according to the present invention permit this portion of the surgeons task to be accomplished in a remarkably short time, in most instances from about three to five minutes. The actual step of bringing the ends of the ducts together is rendered exceedingly simple, positive, and once the ducts are in apposition, the new devices maintain a perfect meeting of the portions of the ducts which are to be repaired without the necessity for the surgeon taking further steps to assure freedom from leakage and excessive damaging pressure upon the cells of the tissue.

The devices of the invention are exceedingly simple in their construction, and because of their structural design, they are free of difiicult cleaning problems. The matter of cleanliness of instruments is one not to be overlooked since tiny crevices, cavities, and other design features do not permit certain cleansing, as a result of which, infections are introduced into the body at the site of the operation in the course of the surgery.

The new devices of this invention possess still another important attribute from the standpoint of the surgeon in that they are believed to be substantially the ultimate in ease of use and may be so utilized with the knowledge that the instruments are substantially beyond having the capacity to inflict injury or otherwise aggravate the tissue of the patient. Moreover, the association of their relatively few but important parts is accomplished in such a manner as to render the possibility of parts being left within the patients body most unlikely.

Before proceeding to set forth a description of the new devices in detail, it is desired to provide a general description of the type of device contemplated by the invention. It will be understood that devices which are within the spirit of the invention but which differ in structural design from the specific forms more particularly presented by the drawings and descriptive material of this specification, may be devised to accomplish the anastomosis of body ducts. For purposes of illustrating the invention, the drawings illustrate two forms of devices coming within the invention.

The present invention contemplates a device having two principal elements mounted [for movement relative to each other, each of said principal elements carrying a cylindrical head portion through which the ends of body ducts are passed, turned back over the outside thereof,

Patented August 9, 19

ice

i.e., the body ducts are cuffed, means being provided either as a part of the device itself or as a co-operating separate part for maintaining the cuffed ducts in position, and means adapting the device for hand operation, e.g., for forceps-type handle portions, to effect movement of the cylindrical head members to a meeting point, thereby bringing the cuifed portions of the ducts into apposition, and finally, means for maintaining positive apposition under predetermined pressure. It will be understood that the employment of a device of the character just described results in the intolerable situation that the cylindrical heads surround the body duct after suturing and cannot be removed unless means are provided permitting removal. The devices of this invention overcome this difliculty.

In one of the forms of the invention illustrated in the drawings, in order that the two principal elements may be readily removed, the cylindrical head portions comprise three elements, one being a circular outer sleeve-like element, hereinafter referred to as a sleeve, formed to a generally circular configuration except that the circle is not closed, there being enough space between the ends of the unclosed sleeve to permit it to be slipped over the body duct, the other two parts forming a cylindrical bushing remov-ably fitting tightly within the outer sleeve part so that when in position within the outer sleeve, a closed circular channel is provided for fully surrounding the body ducts, and when removed, easy removal of the cylindrical head portion from the body duct is afforded.

In the second form of the invention illustrated in the drawings, the cylindrical head portions are composed of separable arcu-ate sections, one of the sections being mounted upon a spring-urged lever arm which in turn is mounted upon the shank portion of the forceps ele ments. The spring normally biases the lever arm in a manner to position the sections of the cylindrical heads together so that a closed circular channel is formed. When it is desired to remove the forceps elements and the attached cylindrical head portions from their position surrounding the ducts, the lever arm is actuated thereby moving the attached section out of position and providing a passageway in the cylindrical head permitting the instrument to be drawn away.

For the purposes of illustration and explaining the operation of the devices of the inventon, they are described with respect to use in rejoining a severed blood vessel; however, as indicated above, they may be employed in any similar anastomosis operation. Moreover, reference is made to suturing as the method of rejoining the severed blood vessels, but it will be understood that any other acceptable method such as stapling or adhesion may be employed.

The invention herein is illustrated by drawings in which the preferred forms thereof are shown in detail.

In the drawings, FIGURE 1 is a view in side elevation showing one form of the device of this invention with its parts assembled.

FIGURE 2 is a view of FIGURE 1 in side elevation showing one of the two principal parts of the device with the bushing elements in place within the outer sleeve portion, thus completing the cylindrical head assembly referred to hereinbefore.

FIGURE 3 is a view of the second and complementary principal part of the device of FIGURE 1 in side elevation.

FIGURE 4 is an enlarge-d perspective vie-w of one of the cylindrical head assemblies as is carried by each of the two parts of FIGURES 2 and 3 showing the bushing assembly removed but oriented for association with the outer sleeve.

FIGURE 5 is an end view of the cylindrical head portion of FIGURE 4 showing the bushing in position.

FIGURE 6 is a vertical sectional view through the cylindrical heads and a blood vessel in position for suturing.

FIGURE 7 is a fragmentary portion of the pIlnClPai part shown in FIGURE 2, the fragmentary portion being enlarged and illustrating in detail the means for associating the two principal parts for relative movement.

FIGURE 8 is a side view of FIGURE 7.

FIGURE 9 is a similar fragmentary view of the principal part shown in FIGURE 3, the structure in this figure being complementary to the corresponding structure shown in FIGURE 2, also illustrating in dotted lines the complementary part shown in FIGURE 2 in position in FIGURE 9.

FIGURE 11 is a detailed sectional view, taken on the line 11-11 of FIGURE 1, of the means which serves to lock the two principal parts in the position shown in FIGURES l and 6, the means being precalibrated to control the pressure exerted at the opposite ends of the device, more particularly, the pressure applied by the cylindrical heads when they are in the operative position shown in FIGURE 1.

FIGURE 12 illustrates a form of retaining ring, the illustration being a view in side elevation.

FIGURE 13 is a sectional view along the axis of the retaining ring shown in FIGURE 12.

FIGURE 14 illustrates a second and especially preferred form of a device constructed in accordance with the invention, the drawing being a fragmentary top plan view showing, in detail, only the portion of the device beyond the pivot point of the instrument. For purposes of convenience, in describing the illustrations, two principal parts illustrated in this figure are labeled C and D.

FIGURE 15 is a side view of FIGURE 14 showing in particular principal part D.

FIGURE 16 is an inside view of one of the illustrated parts of FIGURES 14 and 15, namely principal part C, the illustration showing the sections of the head portion separated so as to permit withdrawal of the instrument from its position about a blood vessel, the manipulating lever being in depressed position.

FIGURE 17 is a fragmentary view in side elevation illustrating the relationship of the working surfaces (cylindrical head portions) of the instrument, the body ducts being omitted for purposes of clarity, when the working surfaces approach each other prior to being pressed into their final working relationship.

Referring to FIGURE 1 of the drawings, there is illustrated a device somewhat like forceps, having two principal parts A and B carrying handle portions denoted by numeral 20 adjacent their lower ends, elements A and B being assembled about a common pivot section denoted generally at 22 and being held firmly in the position shown in FIGURE 1 by the locking structure indicated generally at 24.

Numeral 26 denotes a pair of similar cylindrical head portions and, as may be seen in FIGURE 6, numeral 28 denotes a blood vessel to which the device has been applied and manipulated so as to bring the ends ofthe blood vessel into apposition. As will be seen, the blood vessel is held firmly between the heads 26 and, because of having been cuffed about the head portions, there is a flanged area of each end of the blood vessel upstanding and extending outwardly from the heads in a position appropriate for applying the closing sutures, or for otherwise effecting anastornosis of the severed vessels.

The two principal parts A and B of the device are shown separately and in greater detail in FIGURES 2 and 3. Referring to FIGURE 2,

numerals

30 and 32 denote slender shank portions having a broadened intermediate section denoted by numeral 34. As will be seen,

shank portions

30 and 32 extend from generally opposite points on the broadened section 34. The details of the it is desired to separate the two broadened portion 34 are more plainly observable in FIGURES 7 and 8 and comprise the customary forcepslike pivot area complementary to a co-operating portion to be referred to in describing FIGURE 3. Numeral 36 denotes a toothed latch element which, together with a like element 38 depending from the lower portion of the part B of FIGURE 3, comprises a preealibrated lock for parts A and B when they are in the position shown in FIGURE 1. This general latch construction is well known and is not believed to require further detailed description; however, it should be understood that in this instance the

elements

36 and 38 comprise something more than a simple latch inasmuch as they are precalibrated to provide locking of the two parts together in such a position that suflicient pressure is delivered to the circular faces of the head portions where they bring the ends of the blood vessels together as in FIGURE 6, that there is no leakage in the course of rejoining the vessel and, at the same time, excessive pressure as would injure the body tissue is not applied. As will be seen in FIGURE 11, the two

elements

36 and 38 consist of toothed members, the angle of the teeth being such as to provide a locking engagement therebetween.

Referring to FIGURE 3,

numerals

40 and 42 denote slender shank portions joined by an intermediate section 44, the latter section being more fully illustrated in FIG- URES 9 and 10 and comprising the complementary pivotal element to that of numeral 34 of FIGURE 2, whereby the forceps-like pivotal action is afforded when the two parts are in assembled relation.

Referring to FIGURES 9 and 10 of the drawings, numeral 46 denotes a pivot pin adapted to receive the cooperating part A which is provided with a cooperating bore 48.

Numerals

50 and 52 denote flanges under which broadened section 34 of part A lies when the parts A and B are in the position shown in FIGURE 1. When parts A and B, they are rotated about the pivot pin 46 to a point where the broadened section 34 is free of the overlapping

flanges

50 and 52, at which point, the two parts A and B are easily separated by lifting part A free of the pivot pin 46.

The side surfaces of broadened portion 34 which passes beneath

flanges

50 and 52 are machined to a degree which permits free rotation of parts A and B about pivot 46 to a point where heads 26 abut and further thereafter permit the relative motion of the handle portions of A and B toward each other whereby to apply the needed pressure engagement between ihead members 26.

Referring again to FIGURES 2 and 3 of the drawings, it will be observed that the cylindrical head portions 26 depend from their respective supporting shank sections 3 0 and 40 in opposite directions so that when in the position shown in FIGURE 1, similar faces are presented to each other. It should be noted that shanks 3t) and 40 extend from the outside faces of the cylindrical heads so that the said shank portions offer no obstruction to the cufiingcf the ducts.

Referring to FIGURE 4, which drical head portions 26 on an enlarged scale, numeral 54 denotes a flanged, g nerally cylindrical, sleeve portion having its outer surface machined to provide a relatively broad shallow groove 56 extending in a circular direction with respect to the sleeve 54. The groove may be regarded as being formed by circular flanges. 58 and 60. The reason for this construction will become more apparent at a later time. The internal surface of the sleeve is entzrelysmooth and machined to provide good frictional engagement with the surfaces of the bushing elements. As may be seen in FIGURE 5, the sleeve 54 is open as indicated at numeral 62 for the purpose, as explained above, of permitting passage of the blood vessel from the confines of the sleeve when it has been rejoined.

Referring again to FIGURE 4 of the drawings, there is illustrated a two-part bushing which parts are denoted shows one of the

cylinby numerals

64 and 66. The bushing may be clearly seen in position within the sleeve in FIGURES 5 and 6. Both

parts

64 and 66 are identical and comprise semi-circular sections of cylinders having circular flanges 68 which provide bearing surfaces when the parts A and B are in apposition as shown in FIGURE 6, thereby assuring complete and uniform contact of'the blood vessels at the time they are being sutured. Also, the flanged surfaces 68 serve to provide a relatively broad continuous bearing surface whereby to aid in avoiding cutting of the blood vessel when the necessary pressure is applied to stop the flow of blood at the point of apposition of the blood vessel. Additionally, it should be noted that flanges 68 aflord assistance in removing the bushing elements from their operative position within the sleeve when the suturing has been completed. It will be understood that the bushing elements when in position adjacent the inner surfaces of the cylindrical sleeves have their flange portion 68 adjacent the flange portions 58 of the sleeve itself.

Referring to FIGURES 12 and 13 of the drawings, there is illustrated a retaining ring denoted by numeral 70. Two such rings are desirable for use in conjunction with the device of the invention, they serving the purpose of retaining the cuffed portions of the blood vessels securely upon the heads 26 while the heads are being brought into the position shown in FIGURE 6. When the retaining rings have served this purpose they are severed and removed. Desirably, they are constructed of rubber and of such size as to afford firm yet not undue pressure upon the vessel cuffs.

Having described one of the devices illustrative of the invention, it is desired to explain its operation in actual use.

It will be understood that at the time the device is placed in use, the blood vessels have been clamped and severed and that the time has arrived for the rejoining of the blood vessels ends.

Considering a severed blood vessel having an end to the right and an end to the left as one views the site of the operation, parts A and B being separated at their pivot points and having their bushing elements in place, part A is passed over the right blood vessel end so that the blood vessel extends axially of the cylindrical head. The end of the blood vessel is culled closely adjacent the flanged faces 68 and retaining ring 70 is applied to secure the vessel and head in fixed engagement. Part B of the device is then applied to the left blood vessel end and similarly firmly positioned with respect to the blood vessel. The handles are then exchanged in their relative positions so as to pass the handle of part A over part B and bring the broadened portion 34 of part A into position for reception of the pivot pin 46 of part B. The two parts are in operative engagement when the bore is fully seated about the pivot pin. The handles of the device are then brought into the locking position shown in FIGURE 1, in the course of which, the blood vessels are brought into apposition as shown in FIGURE 6 and upper and lower portions of the broadened section 34 have passed beneath the

flanges

50 and 52 of part B, the latch elements engage thereby securely uniting the two elements A and B and assuring that there will be no changing of position of the blood vessels with respect to each other until such time as parts A and B have been released from their locked engagement as provided by

elements

36 and 38.

The retaining rings 70 are then severed and removed from their position about the blood vessel cuffs and the cuffs are turned up to present abutting circular flanges for suturing. The suturing having been completed, locking

elements

36 and 38 are disengaged by the application of slight pressure to the handles 20, and parts A and B are gently rotated about pivot pin 46 to a point as indicated in FIGURE 9, where they can be disengaged by the reverse of their joining. It will now be understood that when moving the parts A and B away from each other, the head portions 26 must necessarily slide along the surfaces of the blood vessels to a point somewhat remote from the point of suturing. Each of parts A and B are then separated from each other and separately removed from their positions about the blood vessels. This is accomplished by inserting a knife edge between abutting

flanges

56 and 68 and applying a gentle force axially of the head 26, there-by sliding bushings 66 from their position within the sleeve 54 and in so doing, leaving the opening existing between ends 62 of the sleeve unobstructed. It will be understood that the bushings from both parts A and B are removed. This having been accomplished, parts A and B may be removed by passing the vessel through the opening in the sleeve. At this point, the use of the device is at an end and it is removed from the site of the operation for cleaning.

The construction and operation of the second form of the invention as illustrated in FIGURES 14 through 16 will now be described. Before proceeding to the detail of the description, it may be noted that the second form is in all respects similar in construction and operation to that of the inventive form described above insofar as the pivot section of the forceps handles and the latchpressure control mechanism are concerned. For this reason, the illustrations of FIGURES 14 and 16 are fragmentary thus avoiding needless repetition.

Referring to FIGURE 14 of the drawings, numeral 72 denotes generally cylindrical flanged head portions in substantially abutting relationship, and numeral 74 denotes a blood vessel in position within the cylindrical heads for rejoining. Numeral 76 denotes a pair of lever arms to which are attached sections of the cylindrical heads. Numeral 7% denotes fragmentary portions of the forceps shanks and the pivot area therefor.

I Referring to FIGURE 15, numeral 80 and numeral 82 denote cooperating arcuate sections of the cylindrical heads 72, the points of division of the cylindrical head being denoted by numeral 84. As will be seen, the two sections as shown are approximately semicircular, the section denoted by numeral 80 being mounted on lever arm 76 for movement away from the section denoted by numeral 82 as may be seen in FIGURE 16. It will be understood that the sections may be any degree of are as desired, it being important only that they complete 360 and that the smaller section provide a passageway sufliciently large to permit easy removal from the blood vessel.

Numeral 86 denotes downwardly turned flanges depending from the lever arm serving to form a fulcrum point and mounting means for the lever arm upon the underlying shank, there being a pin 96 passing through the flanged portions and the shank of the instrument proper.

Mounted between the lever arm 76 and the shank portion 78 is a compression spring denoted by numeral 92 normally holding the lever arm in a position which places the sections of the cylindrical heads in the closed position shown in FIGURE 15. Numeral R4 denotes an upstanding ear rigidly mounted on each shank portion 78, the ear serving as a guard against lateral movement of the sections 8t when they are in the position shown in FIGURE 14 and under pressure necessary to hold the ends of the blood vessel in proper relation.

The use and operation of the device is generally similar to that illustrated in FIGURES 1-13 except that removal of the device from its position about the blood vessel after the work of rejoining is completed is effected simply by depressing lever arms 76, a may be seen in FIGURE 16, thereby opening the cylindrical head portions sufiiciently to allow the instrument to be drawn away.

All of the parts of the devices of'the invention preferably are of surgical steel, highly polished for purposes of cleanliness. As will have been observed in the course of considering the drawings and the description herein presented, the devices of this invention are substantially the ultimate in simplicity of use and design with the result that their purpose may be accomplished with great savings of time and little danger of introducing infections at the site of the operation.

The devices may be employed in rejoining ducts of different sizes by providing head portions corresponding to the various range of ducts encountered in the course of operations. As will be readily understood the head portion described herein may be attached in a manner to ermit their easy removal and replacement by heads of different size.

It is desirable to point out a particular feature of the devices not heretofore touched upon, which feature concerns the angles that the circular flanged surfaces, between which the duct is held, make with respect to a vertical line passing between them at the instant when the two heads first touch. Preferably, the devices are designed so that the heads 26 first touch upon a point adjacent their uppermost portion when the device is held in a vertical position with the heads at the top and the handles at the bottom, and that the heads depend from this point at a small angle to the vertical thereby leaving a small space between the lowermost points of the heads, i.e., the point adjacent their extreme bottom edges. It follows from what has just been stated, that when the two heads first touch, the two circular flanged surfaces do not have all points in a common plane; rather, they flare outwardly somewhat at their lower edges. This feature is found to be important in providing substantially uniform pressure at all points between circular flanged surfaces whereby to maintain the ducts under uniform pressure, and under sufiicient pressure at all points so that leakage does not occur. It has been found that when the two heads first touch, if they touch at all points on the circular flanges, i.e., all points lie in a common vertical plane upon first touching, when pressure thereafter is applied by squeezing the handles of the device, the lower edges of the circular flanges tend to act as a pivot point and, depending upon the amount of pressure applied, they tend to flare upwardly, thereby at least lessening the pressure about the top edges of the flanges and may actually separate along the top edges. As will be appreciated, this is a matter of design to be taken into consideration in the construction of the devices.

Referring to FIGURE 17 of the drawings the relationships just described is illustrated, the body ducts, for example, blood vessels being omitted for purposes of clarity in illustration. Of course, as will be understood, in actual usage the bare surfaces of the instrument do not touch, as they are covered by the blood vessels. In this figure, numeral 96 denotes the apex of the angle formed between the working surfaces, numeral $8 denoting the angle itself. When the working surfaces, that is the cylindrical head portions 26, are in the relative position illustrated in FIGURE 17, the final pressure necessary upon the instrument is yet to be applied, whereby the heads move into the position illustrated in FIGURE 6, where the blood vessels are actually shown in the position for suturing. In movement of the cylindrical heads to the position of FIGURE 6 from that position of FIG- URE 17, slight bending of the steel structure takes place, the point 96 acting as the fulcrum point. As will be appreciated, as the surfaces move to the position of parallelism of FIGURE 6, the pressure therebetween is gradually evenly distributed over the entire working surfaces where the ends of the blood vessels come into contact.

While it is believed to be perfectly clear from the foregoing as regards the point of first contact of the working surfaces, such point may be further located as lying substantially midway between the ends of and in the arcuate portions of the working surfaces which depend outermost of the device.

Having the teachings of the application before them, it will be appreciated by those skilled in the art that the construction of the device to the purpose that the working surfaces will first contact each other at a point as described above may take several forms. For example, the shank elements may have a slight bend in order to angle the working surfaces, or the bodies which carry the working surfaces may be angled slightly relative to the shank elements. Still other constructions will occur to those skilled in the art.

Having described the details of the devices and the manner of their operation, it is desired to emphasize certain aspects of the invention which are considered to be outstandingly important.

One aspect to be especially noted is the pivot area. The pivot area which affords separability of the two shank portions of the devices is felt to be highly desirable for the reasons that it permits manipulation of the shank portions individually, and the device as a whole is more easily and thoroughly cleaned than is the case Where the two parts are permanently joined.

The use of the bushing elements as a means of providing the circular flanged bearing surfaces, and which close the slots in the outer sleeves, is felt to be highly desirable for the reasons that easy cleaning of the device is permitted and that some economic advantage can be gained by using bushings of different sizes whereby to adapt the device for different size ducts, and thus save on the capital investment required for a complete stock of instruments. It will, of course, be understood that different size bushings can be used only in instances where the ducts being rejoined have sufficient flexibility to permit their being drawn over the flange surfaces for cutting. In this connection, for example, veins provide much more expansivity than do arteries. Although it is not necessary that the bushing be separated so as to provide two sections of equal arcuate dimensions, it is desirable that they be so separated since where the two parts of the bushing are equal in size, bushings are interchangeable between instruments and avoid the necessity of selecting a particular size. Where they are of different size, the selection task becomes troublesome especially where the bushings are quite small.

It will be understood that as a practical matter, the aspect of pressure which the devices develop between the head members is one which can hardly be discussed in units insofar as a particular instrument is concerned, because of the fact that the pressure to be applied is largely a matter for the decision of the surgeon considering the age of the patient, the condition of the duct, and the particular duct itself, i.e., whether it be a blood vessel, bile duct, or other duct. Accordingly, it is desirable that in constructing the devices, sufficient latitude between substantially zero pressure and an outside damaging degree of pressure be provided, thus affording the surgeon as wide a choice as possible. Within these limits, it is desirable to have a substantially infinitely variable pressure control. It may be remarked that this aspect of the present devices finds its substantial analogue in the art of the hem-ostat. If desired, a suitable member may be placed on the inner surface of the shank portions of a dimension such as to limit positively the amount of pressure which can be placed upon the cylindrical heads. Such a member is shown in FIGURE 14 of the drawings as denoted by numeral 96. Thus, even though the portion of the instrument including the forceps handles might be flexed by additional pressure, such pressure could not be transmitted to the heads.

It is desired to point out that some of the functions of this invention may be accomplished by structures differing from the specific form of the invention disclosed herein; however, not without incurring some disadvantages and losing some of the advantages afforded by the specific form disclosed. For example, the slot in the outer sleeve portion of the cylindrical head could be supplied with a suitable shaped completely detached insert whereby to close it while the device is holding the blood vessel, thereby eliminating the bushing elements and the lever arrangement. Such an insert might be an entirely separate complementary small piece of self-locking configuration.

While the invention herein has been described with respect to particular embodiments, those skilled in the art will appreciate that various modifications within the scope of the invention may be derived from the teachings herein. Accordingly, this invention is not to be restricted unduly and is to be understood to extend to all modifications which fiow from the teachings herein.

What is claimed is:

1. A surgical device especially adapted for use in the rejoining of severed tubular body ducts such as blood vessels, bile ducts and the like, comprising a pair of elongated similar elements, each of which is provided with finger holding means on one end and each being provided on the opposite end with a body providing a working surface, said elements being pivotally connected intermediate their ends for relative pivotal movement whereby the said bodies are moved to and from their working position in the manner of forceps and the like; said bodies each having a generally cylindrical form, and each having axially therethrough a generally circular channel whereby to receive said tubular body ducts; each of said bodies having discontinuous outer walls thereby affording passageways to the exterior of said bodies from said openings; means movable with respect to each of said bodies for closing said passageways; said bodies, in their movement to final working position under finger. manipulation of the said holding surfaces, first meeting at substantially a single point on their working surfaces, said point lying substantially midway between the ends of and in the arcuate portions of the Working surfaces of said bodies which depend outermost of said device, said point determining the apex of and defining an angle extending between said working surfaces of said bodies and inwardly of said device, said point thereupon acting as a fulcrum point relative to said bodies, and said angle decreasing as said bodies are moved into their final working position, said bodies being in substantial point to point contact about their opposing working surfaces in said final working position and having their cylindrical axes. substantially coincident; said holding means affording the user the development of a controlled amount of pressure between said surfaces, and means associated with said elements for restraining movement of said working surface from their working position and maintaining said pressure.

2. A device as claimed in claim 1 wherein said working surfaces are provided by a pair of cooperating generally circular flanged surfaces, each of said pair of flanged surfaces depending radially outwardly from generally cylindrically shaped bushing elements, which elements define a generally circular channel, said bushing elements comprising at least two arcuate segments of cylindrical configuration; said bushings when in working position being contained within said cylindrical bodies and each of said bodies having a slot therein extending through the walls thereof, said bushings being removable from said bodies and normally underlying said slots thereby providing walls obstructing said slots.

3. A device as claimed in claim 1 wherein each of said elements is provided with an arcuate, generally cylindrical segment extending radially from its working end, and a spring-urged lever arm carrying a second segment, complementary to said first segment, pivotally mounted on each said elements, said complementary segment extending from the working end of said lever arm and normally being urged into the position forming with said first segment said cylindrical ibodies, thereby defining said generally circular channel for the axial reception of said tubular body ducts.

4. A device as claimed in claim 1 wherein said elements are separable from each other.

5. A device as claimed in claim 2 wherein said elements separable from each other.

6. A device as claimed in claim 3 wherein said elements are separable from each other.

References Cited by the Examiner UNITED STATES PATENTS 1,151,300 8/1915 Soresi 128--334 X 2,632,661 3/1953 Cristofv 128321 2,895,478 7/1959 Post 128-334 2,940,451 6/1960 Voge-lfanger et al. 128334 2,965,900 12/1960 Inokouchi 128334 X 3,048,177 8/1962 Takaro 128334 3,144,654 8/1964 Mallina et a1. 1349 X FOREIGN PATENTS 984,590 2/1951 France. 836,548 4/ 1952 Germany.

RICHARD A. GAUDET, Primary Examiner.

DALTON L. TRULUCK, Examiner.

Claims

1. A SURGICAL DEVICE ESPECIALLY ADAPTED FOR USE IN THE REJOINING OF SEVERED TUBULAR BODY DUCTS SUCH AS BLOOD VESSELS, BILE DUCTS AND THE LIKE, COMPRISING A PAIR OF ELONGATED SIMILAR ELEMENTS, EACH OF WHICH IS PROVIDED WITH FINGER HOLDING MEANS ON ONE END AND EACH BEING PROVIDED ON THE OPPOSITE END WITH A BODY PROVIDING A WORKING SURFACE, SAID ELEMENTS BEING PIVOTALLY CONNECTED INTERMEDIATE THEIR ENDS FOR RELATIVE PIVOTAL MOVEMENT WHEREBY THE SAID BODIES ARE MOVED TO AND FROM THEIR WORKING POSITION IN THE MANNER OF FORCEPS AND THE LIKE; SAID BODIES EACH HAVING A GENERALLY CYLINDRICAL FORM, AND EACH HAVING AXIALLY THERETHROUGH A GENERALLY CIRCULAR CHANNEL WHEREBY TO RECEIVE SAID TUBULAR BODY DUCTS; EACH OF SAID BODIES HAVING DISCONTINUOUS OUTER WALLS THEREBY AFFORDING PASSAGEWAYS TO THE EXTERIOR OF SAID BODIES FROM SAID OPENINGS; MEANS MOVABLE WITH RESPECT TO EACH OF SAID BODIES FOR CLOSING SAID PASSAGEWAY; SAID BODIES, IN THEIR MOVEMENT TO FINAL WORKING POSITION UNDER FINGER MANIPULATION OF THE SAID HOLDING SURFACES, FIRST MEETING AT SUBSTANTIALLY A SINGLE POINT ON THEIR WORKING SURFACES, SAID POINT LYING SUBSTANTIALLY MIDWAY BETWEEN THE ENDS OF AND IN THE ARCUATE PORTIONS OF THE WORKING SURFACES OF SAID BODIES WHICH DEPEND OUTERMOST OF SAID DEVICE, SAID POINT DETERMINING THE APEX OF THE DEFINING AN ANGLE EXTENDING BETWEEN SAID WORKING SURFACES OF SAID BODIES AND INWARDLY OF SAID DEVICE, SAID POINT THEREUPON ACTING AS A FULCRUM POINT RELATIVE TO SAID BODIES AND SAID ANGLE DECREASING AS SAID BODIES ARE MOVED INTO THEIR FINAL WORKING POSITION, SAID BODIES BEING IN SUBSTANTIAL POINT TO POINT CONTACT ABOUT THEIR OPPOSING WORKING SURFACES IN SAID FINAL WORKING POSITION AND HAVING THEIR CYLINDRICAL AXES SUBSTANTIALLY COINCIDENT; SAID HOLDING MEANS AFFORDING THE USER THE DEVELOPMENT OF A CONTROLLED AMOUNT OF PRESSURE BETWEEN SAID SURFACES, AND MEANS ASSOCIATED WITH SAID ELEMENTS FOR RESTRAINING MOVEMENT OF SAID WORKING SURFACE FROM THIER WORKING POSITION AND MAINTAINING SAID PRESSURE.