WO2002094109A1

WO2002094109A1 - Mechanical surgical device for use in anastomotic operations

Info

Publication number: WO2002094109A1
Application number: PCT/EP2002/005594
Authority: WO
Inventors: Nicola Picardi
Original assignee: Nicola Picardi
Priority date: 2001-05-24
Filing date: 2002-05-22
Publication date: 2002-11-28
Also published as: ITRM20010283A0; EP1395184A1; ITRM20010283A1

Abstract

A device (10) useful in the automatic stitching of stumps of tubular conduits in the animal body comprises simple means to grasp and drive (20, 21) a known clamp or tie (30), e.g. of the type usually utilised to hold together electrical cables, which means allow to firmly and temporarily connect at least one of said stumps to the anvil or to the head of a mechanical stapler.

Description

MECHANICAL SURGICAL DEVICE FOR USE IN ANASTOMC IC OPERATIONS

Field of invention

Present invention refers to a mechanical surgical device, and more particularly refers to a surgical device useful in suturing, able to grasp a stump of a resected anatomic tubular conduit and to fix it to the axis of a circular stapler, then bringing said stump in contact with the complementary one thus allowing to suture them. State of the art

In surgery it is often necessary to eliminate part of an anatomic tubular conduit from an animal, and more particularly human, body and then reconnect the stumps resulting from the resection. For the sake of simplicity we will hereinafter refer exclusively to the treatment of tracts of the alimentary canal, remarking however that the device according to present invention can be easily utilised also in comparable cases. Joining the stumps resulting from the resected tract is usually made by means of a mechanical circular stapler, essentially comprising two metallic elements, respectively called anvil and head, which are respectively connected to the stump downward and upward the resected tract. Usually, such a connection is made by means of a stitching of the so called "purse string suture" type, well known to the experts, implemented by passing a thread in and out around the tract to be joined, and then exerting a traction on both the thread's extremities.

Once connected to relevant stumps to be joined, head and anvil are connected together and, duly operated, brings together the stumps to touch each other, thus permitting to carry out the connecting stapling. The above connection of said metallic elements, head and anvil, to the stumps is sometimes difficult to carry out. In fact, both techniques and devices up to now utilised have a number of disadvantages, such as difficulties in obtaining standardised manual stitching and in some case in entering the zone to be treated with instruments (such as "the rake instruments for purse string") which in some specific operation areas can be cumbersome, and the necessary manoeuvring fineness, often difficult to obtain. As a consequence, not only the surgeon action is made difficult and tiring, but also there is the possibility of failures of the operation, such as stitching defects, fistulae formation, and so on, with obvious harm to the patient.

There are also some cases in which the above disadvantages are magnified by the intrinsic difficulties to enter the operating zone, or to manoeuvre into it; this is the case, for instance, of oncologic resections at the level of distal thoracic oesophagus in cases of total gastrectomy, or at the level of lower rectum, in cases of low rectal resection in carcinoma of rectal ampulla, with possible conservation of the anal function.

To the present state of the art, the above described difficulties and risks did not found a satisfying solution with reference to the facility and safety of grasping and joining the free stumps after resection of part of an anatomic conduit. Summary

An aim of present invention is to obviate to the above described inconveniences, by proposing a simple device, of limited dimensions and easy to use, able to fix a stump of an anatomical conduit around the axis of a head or of an anvil of a circular stapler.

In the use of the device according to present invention is also utilised a clamp or tie, e.g. in plastics, similar to those utilised to held together electrical cables. The device according to present invention essentially comprises an elongated body having a generically circular cross section, bearing at one of its extremities a manipulating mechanism for said tie comprising guiding means for the tie, grasping and driving means for the same as well as cutting means thereof. The opposite extremity of the device bears actuating means both for grasping and driving the clamp or tie and for cutting the same. Said grasping and driving means comprise a couple of bodies so placed as to be able to carry out rotation movements each one about an own axis, each body having surfaces apt to engage said clamp or tie and to drive it during said movements, said axes being parallel to each other.

More particularly, said grasping and driving means of the clamp or tie can be, as later described in more detail, a couple of bodies having a generically parallelpiped shape, one of which is inserted into the other one, and driven in relevant rotating movement by a pushing rod, or the like. According to another embodiment, the grasping and driving means of the clamp can be a couple of wheels each having its own obliged rotating direction, and having relevant peripheral surfaces facing to each other able to grasp and hold the clamp or tie, said wheels being driven for rotation by e.g. ratchet actuators or small, low voltage electric motors. Said actuating means can usefully be connecting rods, actuated by trigger levers, or wheels, or push buttons, or the like.

Now, exclusively by way of example and in the field of the digestive system treatment, a possible use of the device according to present invention will be described in co-operation with a mechanical circular suturing device. In this field, the aim of the device according to present invention is to tighten, from the outside, e.g. a gut stump around a supporting structure placed into it, such as the axis of a mechanical circular stapler, by means of one of the above clamps or ties. Around the intestine conduit, at the level of the part to be removed, said clamp is formed as a slipknot, the free end of which being then connected to the device according to present invention. By operating a first actuator, the ring of the slipknot is tightened around the intestine conduit tract containing the stapler axis. Once well tightened the slipknot, the extremity of the clamp or tie extending beyond the tightening ring is cut away by means of a blade moved by a second actuator, leaving around the intestine conduit just the part constituting the tightening ring. Then the resection is carried out, and the free stump is connected to the head or the anvil of the suturing device, depending on the interested part of the intestine conduit. The axis of the head is now connected to the axis of the anvil, which is then retracted, to bring close together the stumps, which can thus be easily stapled and cut. Brief description of the figures The device according to present invention will now be described with reference to one of the possible embodiments shown, exclusively by way of example not limiting aims and scope of present invention, in the attached drawings, in which: Figure 1 is a schematic view of the device according to present invention; Figures 2 and 3 represent each a descriptive, partially sectioned view of an extremity (the operative one) of the device according to present invention;

Figures 4 and 5 show two subsequent operating steps of the invention, with reference to the extremity shown in Figures 2 and 3, holding the clamp or tie in place;

Figure 6 is another schematic sectional view of the device, showing means to cut the clamp or tie.

Detailed description of the invention The device according to present invention (Figure 1 ) essentially comprises a body 10 of generically cylindrical hollow shape, a first extremity 11 of which, called handle, bears actuating devices, in this embodiment actuating levers 12 and 13, while the other extremity 14, the operating one, has two openings 14.1 and 14.2 diametrically opposed to each other, only the second of which, the larger one, being shown in Figure 1. Extremity 14 has no sharp corners and can be angled with respect to the remaining of said cylindrical body by an angle of between 10 and 45°.

Referring now to Figure 2, the operating extremity 14 has a first opening 14.1 and a second opening 14.2, larger than the first one, said openings being diametrically opposed to each other. Within said operating extremity 14 two wheels 15 and 16 are housed, each one rotating around its own axis parallel to each other and perpendicular to the transversal axis of the operating extremity. Above said wheels a first hollow body is seated having upper and lower openings, with respect to the drawing plane, said body being able to freely oscillate around an axis 23 parallel to the wheels ones and being connected to a rod 24 at hinge 25. Within said body 20 a second body 21 is housed, free to oscillate around an axis 26 parallel to axis 23, and leaning against a pin 17 (so that its corner 21.1 just protrudes beyond the upper corner 20.1 of body 20) and thrust downwards (with respect to the drawing plane) by an elastic element 22. The reciprocal arrangement of the various parts is better shown in Figure 3, in which body 20 is sectioned; it is clearly shown that body 21 of present embodiment has a generically trapezoidal shape, with corner 21.1 sharply angled, and is so placed as to leave a free space between said corner 21.1 and body 20, when body 21 leans against pin 17. Figure 4 shows a clamp or tie 30 whose free end 32 is first passed through a slotted terminal part 33 of the clamp itself, thus forming a ring 31 , then is also passed through slot 14.1 into hollow body 14 as well as between wheels 15 and 16 and through hollow body 20, between an inner front wall thereof and body 21. Part 33 is so built that only unidirectional movement of the free end 32 is permitted. Pushing to the right (with reference to the figure) rod 24 (Fig. 5), body 20 rotates anti-clockwise around axis 23, thus moving also body 21 which, under the thrust of elastic body 22, is pushed around axis 26 so that corner 21.1 is pressed against upper part 20.1 of body 20; thus clamp 30 is grasped by bodies 20 and 21 , acting as pliers, and dragged upwards (with reference to the figure). Since terminal part 33 is held against operating extremity 14, at the slot 14.1 , ring 31 will be reduced in diameter and will maintain reduced dimensions, due to the particular structure of part 33. Letting rod 24 to go leftward, e.g. by action of a spring (not shown), bodies 20 and 21 rotate clockwise around relevant axes, tending to re-assume the rest position, fully within extremity 14. Clamp or tie 30 is held between wheels 15 and 16, which can rotate in only one direction, thus being compressed above said wheels. Continuing its clockwise movement, body 21 leans against pin 17 and stops, while body 20 keeps rotating. Now, parts 20.1 and 21.1 are separated, thus freeing clamp 30 which can release compression letting its free end 32 to further slip through slot 14.2. The whole device is now back to the rest position shown in Figure 4.

By repeating such movements of rod 24, ring 31 can be tightened with the necessary strength around the tract of gut to be resected. Now, by means of a second actuator 13 (Figure 1 ), a blade 34 (Figure 6) is moved to cut tie 30 at the level of slot 14.1.

The group of bodies 20 and 21 can be replaced by other devices working to the same goal, driven in any opportune way, such as a couple of ratchet wheels each one rotating only in one direction.

Claims

1. Mechanical surgical device useful in suturing stumps of anatomic tubular conduits in animal and in particular human body, characterised by comprising an elongated body (10) of generically circular cross section having two extremities (11) and (14) and bearing at one of its extremities (14) a manipulating mechanism for a plastics clamp or tie (30) formable as slipknot (31), comprising guiding means (16) for said clamp or tie (30), grasping and driving means (20) and (21 ) as well as cutting means (34) thereof, the other extremity (11 ) bearing actuating means (12) and (13), both for grasping and driving the tie (30) and for cutting the same.

2. Device according to claim 1 , in which said grasping and driving means are formed by a couple of bodies (20) and (21 ) able to rotate each one about an own axis, (23) and (26) respectively, and having surfaces apt to engage said tie and to drive the same during said rotation, said axes being parallel to each other.

3. Device according to claim 2, in which said couple of bodies is formed by a first hollow body (20) of generically parallelepiped shape having two openings on facing walls, and housing a second body (21) of said couple, said second body leaning, at rest, on a pin (17) so that a corner (21.1) of said second body just protrudes beyond one of said openings, being thrust downwards by an elastic element (22) integral with said first body (20).

4. Device according to claim 2, in which said couple of bodies is formed by two ratchet wheels each one rotating in only one direction.

5. Device according to claim 1 , in which said actuating means can be linked to mechanical ties (24) and (34) connected respectively to said grasping/driving means (20) and (21 ) and to said cutting means, each tie being driven by its own actuator.