US 3269631 A
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Aug. 30, 1966 TIMOTHY TAKARO SURGICAL STAPLER 2 Sheets-Sheet 1 Filed June 19, 1964 INVENTOR- TIMOTHY 'I AKARO avg Q, M
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INVENTOR ATTORNEY United States Patent Wee 3,269,631 SURGICAL STAPLER Timothy Takaro, Asheviile, N.C., assignor to the United States of America as represented by the Secretary of the Army Filed June 19, 1964, Ser. No. 376,598 4 Claims. (Cl. 227-144) The invention described herein may be manufactured and used by or for the Government for governmental purposes without the payment to me of any royalty thereon.
This invention relates to a surgical suturing instrument, particularly to a stapling device for suturing an object to the inside wall of a blood vessel or other body structure. Referring more particularly to the stapling device, this invention relates to a stapler having means to (1) position the object to be sutured, and (2) complete the suturing by driving and clinching a plurality of staples simultaneously.
The classic surgical devices for approximating a wound or incision and for grafting body tissues have been, and for most purposes still are, the needle and suture. It is well known, however, that suturing by needle has its disadvantages; it is inordinately time consuming and, in some cases, exceedingly awkward due to the inaccessibility of the area to be sutured. In more recent times it has been found that metallic staples or staples made from other suitable material can be successfully used for suturing, and that in certain cases stapling is the most efiicient and effective method of suturing.
Although in certain cases stapling has been the most desirable method of suturing, this method has not been without drawbacks. For example, in inaccessible areas it is still difficult to hold the object to be sutured in the proper position. Likewise, the placing of one staple at a time, with attendant shifting of the stapler to the next stapling position, is time consuming and increases the difficulty of maintaining proper alignment of the object to be sutured. Further, care must be taken to insure that the clinching pressure of the stapler does not crush the body tissue.
Accordingly, it is an object of this invention to provide a surgical stapler which will overcome the above disadvantages.
Another object is to provide a surgical stapler with means for positioning and holding the object to be sutured.
Another object is to provide a surgical stapler with means for simultaneously driving and clinching a plurality of staples.
Another object is to provide a surgical stapler which will not crush the body tissue being stapled.
Another object is to provide a surgical stapler suitable for suturing an object to the inside wall of a body structure, specifically for positioning and suturing an artificial valve leaflet or natural cusp in the non-coronary aortic sinus of Valsalva.
The invention comprises a plier-type staple-driving jaw and staple-clinching jaw and anvil, a staple-housing unit and holding insert, a staple-driver, a catch mechanism, an adjusting screw, and an assembling pin. In the preferred embodiment, the stapler is designed to suture an artificial valve leaflet or natural cusp in the non-coronary aortic sinus of Valsalva. This semilunar valve leaflet is located at the beginning of the aorta and serves to prevent regurgitation as the blood is pumped out of the heart into the aorta.
The structural features of the invention are illustrated in the accompanying drawings, in which:
FIG. 1 is a front elevation of a preferred embodiment of the stapler;
3,269,631 Patented August 30, 1966 FIG. 2 is a front elevation view of another embodi men-t showing the stapler head and working mechanism;
FIG. 3 is a plan View of the staple-housing unit and staple-driver, with a section of the driver cut away to show the staple-holding insert;
FIG. 4 is a front elevation view of the embodiment of FIG. 2 showing the clinching operation of the stapler with the stapleaclinching jaw positioned inside the aorta; and
FIG. 5 is a partial elevation and partial sectional view taken along the line 44 of FIG. 3 and showing the interaction of the staple-driver, staple housing unit and insert, and anvil.
Referring to the drawings, reference numeral 1 designates an instrument suitable for inserting and clinching staples. The instrument comprises a staple driving jaw 2 and a staple clinching jaw 3. The handle portions 30 and 40 of the levers of jaws 2 and 3, respectively, may be of any suitable form, but for a secure grasp, scissor-type handle loops 31 and 41 are preferred. laws 2 and 3 are pivotally joined by assembling pin 4 to form a simple lapped joint such as used in ordinary scissors or pliers.
Circular, staple-clinching anvil 5 is fastened to the distal end of jaw 3 by flat headed screws 6. Anvil 5 has a reamed hole 7 in its center to provide for accurate alignment in assembling anvil 5, staple-holding insert 8, and staple-driver 9. A plurality of staple-clinching slots 10 are machined in the face of anvil 5, preferably in a semicircular pattern. Slots 10 are rectangular in section and comprise two adjacent circular arc staple-clinching segments similar to those of an ofiice stapler.
Staple-housing unit 11 is pivotally attached to stapler 1 by assembly pin 4 which passes through the yoke end of housing 11 and jaws 2 and 3. The shank of housing 11 has milled groove 12 for flush pivotal mounting of a catch mechanism that will be described in detail below. The distal end of housing 11 is in the form of a circular ring 14 containing threaded holes 15 for the screws which fasten staple-holding insert 8 Within ring 14.
Staple-holding insert 8, mounted within ring 14, has grooves 16 milled along degrees of its periphery. The number of grooves 16 is equal to the number of stapleclinching slots 10 in anvil 5 and to the number of staples to be driven simultaneously. Insert 8 contains reamed center hole 17 which is the assembly alignment hole for insert 8. When insert 8 is mounted within housing 11, the outer periphery of insert 8 fits flush with the inside face of ring 14 except for the openings formed by grooves 16. The staples to be driven are inserted in these openings.
Staple-driver 9 is circular in plan and fiat on its top surface. Driver 9 is also disk-shaped, with rake-like teeth 18 extending downward along 180 degrees of its periphery. Teeth 18 are designed to fit into the openings formed by grooves 16 of insert 8. These teeth are sufliciently long to drive the staples of housing 11 when staple-driving jaw 2 is depressed. Teeth 18 are frict-ionally seated in the openings formed by grooves 16. Assembly alignment hole 19 is reamed in the center of driver 9.
As shown in FIG. 1, the preferred catch mechanism 32 comprises a tip portion 33 pivotally mounted on jaw 2 by means of screw 34 and a rearwardly extending lever portion 35. The distal end of lever portion 35 is provided with a lateral extension 36 which is so located as to be operable by the users thumb without releasing the clamping pressure exerted on the handles 31 and 41. Tip portion 33 is provided with a notch 37 engageable with pin 38 mounted in milled groove 12 and disengageable from pin 38 upon downwardmotion of the distal end of lever portion 35. In use the notch 37 is engaged with pin 38 while the stapler is being positioned and when the staples are to be driven the catch is released by downward pressure of the users thumb on extension 36.
The embodiment of FIG. 2 has a catch 13 pivotally fastened to housing 11 by screw 13'. Open slot 20 of catch 13 is designed to slip over the pin shank of screw 21. to lock jaw 2 and housing 11 together while the stapler is being positioned. When the staples are to be driven, catch 13 is released by applying finger pressure across the serrated upper edge 22 of the catch.
Adjusting screw 23 is threaded through ja-w 3. This screw adjusts the Width of the opening between housing 11 and anvil so as to prevent crushing of the sutured tissue when the stapler jaws are closed. Lock nut 24 locks thumb screw 25 at the desired position. In the modification shown in FIG. 1 the adjusting screw assembly 23, 24 and 25 is positioned nearer to the anvil 5 than in FIG. 2 to prevent spreading of the distance between the jaws of the instrument during maximal compression of the handles.
In the operation of the specific embodiment, anvil 5 is loaded with the valve .leaflet 26, which may be either a prosthetic leaflet or a homoor auto-graft leaflet, to be sutured as shown in FIG. 2. The shape of anvil 5 is designed so that the leaflet is extended in the proper configuration for stapling and the valve leaflet is held in position by purse string sutures or ties. Grooves 16 are loaded with staples and driver 9 inserted. The anvil is inserted into the non-coronary aortic sinus of Valsalva to the proper depth and position. During this period housing 11 and jaw 2 are locked together by catch 13. When the stapler and valve are properly positioned, the catch is released and the jaws of the stapler are closed. This movement causes driver 9 to drive the staples out of their housing, through the aortic wall and the valve leaflet, and against the clinching slots where they are clinched in the manner of an ordinary stapler. The clinched staples suture the leaflet permanently, rapidly, and with ease, into the aortic sinus where it replaces a leaflet resected because of disease.
It is to be understood that the surgical stapler herein disclosed is illustrative only and that this invention includes all modifications and uses which fall within the scope of the following claims.
1. A surgical stapler for driving and clinching a plurality 0f staples simultaneously, comprising a staple-driving lever and a staple-clinching lever, said levers being pivotally connected and having handle portions at one end from said pivot and jaw portions at the opposite end,
a multiple staple-clinching anvil mounted on the jaw portion of said staple-clinching lever, a multiple staplehousing unit independently pivotally mounted to said pivotal connection and extending between said stapledriving and staple-clinching jaws, and a multiple stapledriver independently seated within and movable relative to said housing unit by said driving jaw.
2. A surgical stapler as in claim 1, said stapler further comprising means for releasably locking together the multiple staple-housing unit, multiple staple-driver, and staple-driving jaw.
3. A surgical stapler for driving and clinching a plurality of staples simultaneously, comprising a pivotally connected staple-driving lever and staple-clinching lever, said levers having handle portions at one end from said pivot and jaw portions at the opposite end, a staple-clinching anvil fastened to the jaw portion of said staple-clinching lever and containing a plurality of clinching slots, a staple-housing unit pivotally mounted to said pivotal connection and extending between said jaws, said housing comprising an outer and inner portion, the inner portion having a plurality of spaced projections which extend from the inner portion to said outer portion, the spaces between projections forming a plurality of staple-receiving openings wherein staples may be frictionally retained, a stapledriver having a plurality of teeth frictionally and independently retained above staples in said staple-receiving openings and movable relative to said openings by said driving lever, a catch releasably locking said staple-driver, housing unit, and driving jaw together, and an adjustable stop to regulate the closed interval between said anvil and said housing unit and driver.
4. The surgical stapler as in claim 3 wherein said catch is pivoted on said driving lever and comprises a locking portion cooperating with a pin on said housing unit, and an operating portion, said operating portion extending rearwardly from the locking portion to a point in proximity with said handle portions.
References Cited by the Examiner UNITED STATES PATENTS 220,932 10/1879 McGill 227-144 799,564 9/1905 Henry 227-144 2,940,451 6/1960 Vogelfanger et al. 227'19 XR 3,144,654 8/1964 Mallina et al. 22719 GRANVILLE Y. CUSTER, 111., Primary Examiner.