US 3388847 A
Description (OCR text may contain errors)
June 18, 1968 v. s. KASULIN x-:TAL
SURGICAL INSTRUMENT FOR SUTURING HOLLOW ORGANS Filed Aug. ze, 1965 United States Patent O 3,388,847 SURGICAL HNS'ERUMENT FR SUTURNG HOLLW @RG-ANS Vyacheslav Sergeevich Kasulin, Sehelkovsliee Chaussee 92, korpus 7, kv. 54; Svetoslav Ivauovich Babldn, 1 Cheremushkinskaya ul. 11/9, korpus 1, kv. 16; 'atyana Vladimirovna Kalinina, Chasovaya ul. 27/12, iev. 22; Galina Mikhailovna Gambashidze, Novo-@stankiuskaya ul. 8a, kv. 16, all of Moscow, USSR.
Filed Aug. 26, 1965, Ser. No. 482,702 7 Claims. (Cl. 227-19) ABSTRACT F THE DSCLQSURE A surgical instrument having a hollow body with a. slidable hollow rod therein for ejecting staples loaded into grooves in the body to form a staple suture and bearing a cutter for excising excess tissue of the sutured organs, a stem being slidably mounted in the rod and having a pointed tip on which a head is detachably mountted, the head containing a member which acts as a counter surface for the cutter and an anvil for bending the legs of the staples, the stem being fully retractable in the body when the head is detached or extendable from the body for a piercing operation and for mounting of the head.
This invention relates to surgical instruments for applying circular staple sutures when placing anastomoses on hollow organs, and more specifically, to such instruments used for applying intraintestinal anastomosis of the rectum and large or small intestines, as well as of the gallbladder or dilated bile duct and an intestine.
Use is currently made of surgical instruments for stape suturing of the oesophagus and the stomach or an intestine, comprising a tubular body accommodating a central shank and a movable hollow rod provided with a cylindricalshaped knife and a staple ejector.
The end of the shank projecting outwards carries a working head rigidly fixed thereto; a semirigid detachable protective Washer is freely mounted at the back end face of the head.
The instruments mentioned above, however, fail to provide placing anastomoses through applying circular staple sutures without making additional incisions in the tissues being sutured.
Apart from the aforesaid, the instruments in use suffer from the disadvantage that, in the course of operation, tissues being sutured get oftentimes jammed between the knife and the semirigid detachable washer, this resulting in the disturbed (incomplete) anastomoses. Furthermore, when introduced through an intestine to the abdominal cavity, the instrument is liable to bring infection.
It is, therefore, an object of this invention to provide a surgical instrument capable of being used for placing a reliable and imper-vious aseptic circular staple suture on the walls of hollow organs juxtaposed with the external layers thereof, without making any additional incision on tissues being sutured.
Another object of this invention is to provide an instrument of the character set forth hereinabove which would enable a guaranteed separation of the knife from the semirigid detachable washer after the excision of the excess tissue.
It is also an object of this invention to provide an instrument of the character set forth in the preceding paragraphs which would feature the knife cutting edge of increased service life.
It is a further object of this invention to provide an instrument of the character set forth in the preceding paragraphs which enables Simultaneous suturing round the en- ICC tire periphery of the anastomosis being applied as Well as the excision of the excess tissue to restore the permeability of the hollow organs involved.
With the purpose of accomplishing the objects stated hereinbefore, provision is made of a surgical instrument capable of suturing hollow organs, wherein, according to the present invention, the central shank is installed with the possibility of movement inwards the body, whereas the tapered front end thereof carries a detachable composite taper head which at the back end face thereof is provided with a cylindrical-shaped depression located on the centre line of the instrument body and furnished with a circular recess accommodating the semi-rigid detachable washer which serves as a protective limiting support for the knife cutting edge when inserted into said cylindrical depression in the head.
A specific and preferred embodiment of the present invention is described hereinafter in detail by way of example with rcference to the accompanying drawings, wherein:
FIG. 1 is a general View of the surgical instrument for suturing hollow organs (longitudinal section);
FIG. 2 is a section on the line A-A of FIG. l;
FIG. 3 is a section on the line B-B of FIG. 1;
FIG. 4 is a section on the line C-C of FIG. l;
FIG. 5 is a diagram illustrating the application of an end-to-end anastomosis:
FIG. 6 is a diagram illustrating the application of a side-to-end anastomosis;
FIG. 7 is a diagram illustrating the application of an end-to-side anastomosis;
FIG. 8 is a diagram illustrating the application of a side-to-side anastomosis.
The surgical instrument of the present invention is essentially composed of oblons7 tubular body 1 (FIG. l), movable handle 2 articulated to body 1 at the rear portion thereof and fixed handle 3 rigidly coupled to said body.
Accommodated inside body 1 is hollow rod 4 the front end whereof bears cylindrical ejector 5 rigidly attached thereto, and cylindrical-shaped knife 6 having face cutting edge 7 facing outwards from the front open end of body 1. The internal surface of the front end of body 1 is provided with annular grooves 8 (FIG. 4) for accommodating the suturing staples.
Rod 4 is able to move along the axis of the body under the effect of a mechanical actuator composed of handles 2 and 3.
Provision is made at the front end of cylindrical ejector 5 of face teeth 9 engaging grooves 8 in the body and capable of pushing the staples (not shown in the drawing) out of said grooves under the action of rod 4.
inside rod 4 runs stem 1t) provided with sharp-pointed front end 11 whereat detachable composite taper head 12 is mounted, connected to said stem by means of an aperture other than round in shape (FlG. 3).
Head 12 is locked in place on stem lll by means of blind nut 13 fitted onto a threaded end portion of stern 10 and terminated with spherical end piece 14.
The rear end face of head 12 is provided with cylindrical depression 15 accommodating knife 6 While rod 4 is extending. Radial circular recess 16 and axial circular slot 17 are made in the top portion of depression 15, slot 17 having the same diameter as the cutting edge of knife 6.
Recess 16 houses semirigid detachable washer 1S which prevents the cutting edge of knife 6 from blunting and, apart from this, contributes to the complete excision of the tissue being operated.
Arranged around the periphery of the face portion of head 12 are bearing slots 19 (FIGS. 1 and 2).
The rear end of body 1 carries a screw pair composed of nut 2@ to actuate stem 1t) and collar nut 21.
Actuating nut 26 is articulated to body 1 by means of collar nut 2l. Mounted inside said collar nut 21 is retaining washer 22 which is situated in a certain relationship with reference to grooves S provided at the front end of the body. y
Prior to use, the instrument must be prepared for operation, for which purpose staples are inserted into grooves ,A head 12 is moved towards body 1 as far as it will go, whereupon the instrument must be sterilized.
The walls of the intestines to be sutured are placed between the end faces of body 1 and head 12.
With the purpose of juxtaposing the tissues being sutured, stem 10 along with head l2 is moved relative to body 1 due to rotation of actuating nut 20.
Thereafter, rod 4 is made to move forward due to pressure exerted upon ha-ndles 2 and 3, this resulting ,'m that teeth 9 of ejector S, while moving actuate the suturing staples, thereby ejecting these from grooves S and causing them to pierce the tissues being sutured with the sharppointed ends thereof, whereupon, the staples are forced into ythe bearing slots provided in head 12, where they are bent to assume a B-shape.
Further, knife 6, while moving together with rod It, constricts tissues encircled by the already formed circular suture, reaches semirigid washer 18, is then forced thereinto and resects the excess tissue thereby forming a circular anastomotic aperture.
The instrument of the invention is applicable for placing intraintestinal anastomoses of the rectumfand large or small intestines through the use of end-to-end, end-toside, side-to-end or side-to-side methods. When performing such operations, the instrument can be introduced either through the abdominal cavity or via the anus.
I. Placing end-to-end anastomosis After mobilization of the resected portion of the intestine involved, clamps are applied to both ends thereof. Then seromuscular purse-string sutures 23 and 24 (FIG. are placed on both inlet and outlet ends of the intestine past the clamps applied thereto, without tightening said purse-string sutures. Upon resecting a portion of the intestine the instrument (with the head removed and stem 10 sunk in the body) is introduced into the rectum via the anus. The instrument body with the stem sunk therein is then led to the abovesaid purse-string suture applied to the rectum. Then the clamp is removed, the stem is forced out by 5 to 6 cm., purse-string suture 23 is drawn tight to encircle the stem. Thread 25 is cut olf. Head 12 is connected to stem 10 on the side of the abdominal cavity, after removing the clamp, head 12 is introduced into the inlet end of the large or small intestine involved. Thereupon purse-string suture 24 placed on the inlet end of the intestine concerned is drawn tight underneath head 12, and thread 26 is cut off. Upon this, head 12 and body l are brought together till the complete and intimate contact of the walls bei-ng sutured with the external layers thereof. Through exerting pressure upon both handles of the instrument, an instantaneous single-motion suturing is attained, with staple stitches applied throughout the periphery of the anastomosis involved. At the same time a circular knife excises the excess tissue complete with threads used for purse-string sutures, thereby forming an anastomotic fold 2.5 to 3 mm. high, facing towards the lumen of the sutured intestines.
Upon doing so, the head is withdrawn from the body 3 to 5 mm., whereupon, through applying a light pulling effort, the instrument is extracted from the anus along with excised tissue.
II. Placing side-to-elzd anaslomosis This procedure starts with the application, without drawing it tight, of a purse-string suture to the rectum in the region of a conjectural resection thereof. Upon resecting the rectum, the instrument (less head 12 (FIG. 6) and with stern 10 sunk in body 1) is introduced into the rectum through the anus. Then body 1 of the instrument complete with stem 1) sunk therein is brought to the purse-string suture placed on the rectum, whereupon stem 10 is forced out of the body 5 to 6 cm., purse-string suture 27 is tightened to encircle the stem, thread 28 is cutoff and head 12 is connected to stem 10 on they side of the abdominal cavity.
Further, oval-shaped purse-string suture 29 is applied to the wall of the large or small intestine involved at the inlet end thereof on the side opposite to the mesentery thereof, transverse incision 3i) on the wall of the intestine y being made at the centre of the aforesaid oval-shaped suture. This done, the head of the instrument is introduced into the incision on the wall yof the intestine after which the purse-string. suture is drawn tight thereunder. The thread is cut off. The head and the body are brought together till the complete and intimate contact of the walls being sutured with the external layers thereof, whereupon suturing is accomplished.
III. Placing end-to-sde anastomoss Upon mobilization of the resected portion of the large or small intestine involved, a purse-string suture is placed on the inlet end thereof past the clamps applied thereto beforehand, without tightening said suture.
Head 12 is then taken olf the instrument, stem 10 is completely sunk into body 1, whereupon the latter is introduced into the anus and led to the region of a conjectural anastomosis. The end face of the instrument is then tightly covered with the wall of the rectum and, with the latter kept in that position, stem 10 of the instrument is forced out, thereby piercing the rectum with the sharp-pointed end thereof. Upon piercing, the point of stem 10 is pro` jected 5 to 6 cm. into the abdominal cavity, whereupon head 12 is connected to the stem. Further, the head is introduced into the inlet end of the large or small intestine involved -upon which purse-string suture 31 (FIG. 7) is dra-wn tight underneath head 12 of the instrument. This done, the thread end is cut ot. Thereupon the body and ther head are broughttogether. Both suturing procedure and extraction of the instrument are performed as set hereinabove.
IV. Placing sde-to-sz'de anastomosis This procedure starts with the application, without drawing it tight, of oval-shaped purse-string suture 32 (FG. 8) to the wall of the large or small intestine involved at its inlet end on the side opposite to the mesentery thereof. Then transverse incision 33 in the intestinal Wall is made at the centre of said oval-shaped suture.
The instrument (with head 12 removed and stem 10 completely sunk into body 1) is introduced into the rectum lvia the anus, and is then led to the region of the proposed anastomosis. The end face of the instrument is tightly covered with the wall of the rectum and, with the latter held in that position, stem 10 is extended, thereby piercing the rectum with the shrp-pointed end thereof.
Thereupon the stern end is projected 5 to 6 cm. into the abdominal cavity,y and head 12 is attached thereto. This done, head l2 is coupled with the instrument, then introduced into incision 33 made in the wall of the inlet end of the large or small intestine involved, purse-string suture 32 is drawn tight underneath said head 12 and thread 34 is cut olf. Upon this, head 12 and body 1 are brought together till the complete and intimate contact of the Walls being sutured with the external layers thereof, whereupon suturing is performed as indicated hereinbefore.
Described above are only those methods of application of the instrument of the present invention where, while placing an anastomosis, the head is connected to the body of the instrument on the side of the abdominal cavity, i.e., the instrument is to be introduced into the lumen of the intestine `with the head removed. f'
What we claim is:
1. In a surgical instrument for the suturing of hollow organs by stapling wherein said instrument has a tubular body with an open end and peripheral grooves at said end for receiving staples, a hollow rod slidaby mounted in said body and having ejector means on the front end thereof for ejecting staples from the grooves, and knife means on said rod and having a sharp cylindrical cutting edge facing outwards of the open end of the body, actuator means coupled to the rod for displacing the same between an inactive position in which the ejector means is inoperative and the knife means is retracted in the body and an operative position in which the staples are ejected from the grooves by the ejector means and the knife means is extended from the body, and a stem slidably mounted in the rod and bearing a head which serves as a support for an organ to be sutured and as an anvil for the stap'es and a counter surface for the cutting edge, an improvement comprising means detachably supporting the head on the stem, said stem including an end portion with a tip of sharp pointed form, said head enclosing said end portion of the stem when mounted thereon, and means engaging said stern for displacing the same axially in said rod between a first position in which the pointed end portion is completely retracted within the body with the head removed and a second position in which the end portion is extended from said body and the head can be placed thereon.
2. An improvement as claimed in claim 1 wherein said head has a cylindrical recess facing said body and an annular groove extending radially of said recess at the base thereof, and an annular member supported in said recess by engagement of the annular member in sai-:l groove, said annular member having a surface facing the body which is a countersurface for the cutting edge of the knife means.
3. An improvement as claimed in claim 1 wherein said head includes first and second elements, the first element being slidably and removably mounted on the end portion of the stem and having a cylindrical recess facing said body and a member in which said recess with a countersurface for the cutting edge of the knife means, said second element securing the iirst element on the stem and being hollow to receive the sharp pointed tip of the stem.
4. An improvement as claimed in claim 3 wherein said means detachably supporting the head on the stem includes thread means on said second element and the end portion of the stem, said end portion having a noncircular cross-section, the rst element having an aperture of a shape corresponding to that of the end portion and being engageable on said stem no further than thevend portion, said second element blocking movement of the rst element when threaded on the end portion of the stern.
5. An improvement as claimed in claim 3 wherein said first element is provided with an annular groove extending radially of the recess at the base thereof, said member with the countersurface for the cutting edge of the knife means being circumferentially supported in said groove.
6. An improvement as claimed in claim 5 ywherein said first element includes a rim encircling the recess, said rim having axial slots therein aligned with the peripheral staple receiving grooves in the body for bending the legs of the staples when they are ejected from the grooves.
7. An improvement as claimed in claim 5 wherein said body is provided with an annular slot extending axially at the base of the recess in alignment with the cutting edge of the knife means.
References Cited UNTED STATES PATENTS 3,193,165 7/1965 Akhalaya et al.
TRAVIS S. MCGEHEE, Primary Examiner.