CA1156116A - Intraluminal anastomosis surgical stapling instrument - Google Patents
Intraluminal anastomosis surgical stapling instrumentInfo
- Publication number
- CA1156116A CA1156116A CA000367659A CA367659A CA1156116A CA 1156116 A CA1156116 A CA 1156116A CA 000367659 A CA000367659 A CA 000367659A CA 367659 A CA367659 A CA 367659A CA 1156116 A CA1156116 A CA 1156116A
- Authority
- CA
- Canada
- Prior art keywords
- anvil
- casing
- staple
- surgical staples
- adjusting rod
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
- 230000003872 anastomosis Effects 0.000 title abstract description 18
- 210000000056 organ Anatomy 0.000 claims abstract description 38
- 230000000007 visual effect Effects 0.000 claims abstract description 5
- 238000003491 array Methods 0.000 claims description 21
- 239000000463 material Substances 0.000 claims description 7
- 238000000034 method Methods 0.000 description 10
- 238000004519 manufacturing process Methods 0.000 description 5
- 238000005520 cutting process Methods 0.000 description 4
- 238000013459 approach Methods 0.000 description 3
- 229940090045 cartridge Drugs 0.000 description 3
- 230000036770 blood supply Effects 0.000 description 2
- 230000006835 compression Effects 0.000 description 2
- 238000007906 compression Methods 0.000 description 2
- 230000035876 healing Effects 0.000 description 2
- 230000002093 peripheral effect Effects 0.000 description 2
- 241000283014 Dama Species 0.000 description 1
- IAYPIBMASNFSPL-UHFFFAOYSA-N Ethylene oxide Chemical compound C1CO1 IAYPIBMASNFSPL-UHFFFAOYSA-N 0.000 description 1
- 235000003332 Ilex aquifolium Nutrition 0.000 description 1
- 235000002296 Ilex sandwicensis Nutrition 0.000 description 1
- 235000002294 Ilex volkensiana Nutrition 0.000 description 1
- 238000004026 adhesive bonding Methods 0.000 description 1
- 230000003444 anaesthetic effect Effects 0.000 description 1
- 230000000740 bleeding effect Effects 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 238000013461 design Methods 0.000 description 1
- JNSGIVNNHKGGRU-JYRVWZFOSA-N diethoxyphosphinothioyl (2z)-2-(2-amino-1,3-thiazol-4-yl)-2-methoxyiminoacetate Chemical compound CCOP(=S)(OCC)OC(=O)C(=N/OC)\C1=CSC(N)=N1 JNSGIVNNHKGGRU-JYRVWZFOSA-N 0.000 description 1
- 210000003238 esophagus Anatomy 0.000 description 1
- 210000003811 finger Anatomy 0.000 description 1
- 230000002439 hemostatic effect Effects 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
- 230000000968 intestinal effect Effects 0.000 description 1
- 210000000936 intestine Anatomy 0.000 description 1
- 210000002429 large intestine Anatomy 0.000 description 1
- 238000012423 maintenance Methods 0.000 description 1
- 230000013011 mating Effects 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 230000001338 necrotic effect Effects 0.000 description 1
- 239000002674 ointment Substances 0.000 description 1
- 210000000664 rectum Anatomy 0.000 description 1
- 210000000813 small intestine Anatomy 0.000 description 1
- 229910001220 stainless steel Inorganic materials 0.000 description 1
- 239000010935 stainless steel Substances 0.000 description 1
- 238000010561 standard procedure Methods 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 210000003813 thumb Anatomy 0.000 description 1
- 210000001835 viscera Anatomy 0.000 description 1
- 238000003466 welding Methods 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
Abstract
INTRALUMENAL ANASTOMOSIS SURGICAL
STAPLING INSTRUMENT
ABSTRACT OF THE DISCLOSURE
A disposable surgical stapling instrument for the joining together of tubular body organs such as the organs of the alimentary canal. The instrument comprises an elongated body having a tubular housing portion and a coaxial cylindrical handle portion.
The tubular housing portion supports at its free end a coaxial cylindrical casing containing at least one annular array of surgical staples. An adjusting rod is coaxially and non-rotatively mounted within the instrument body and has a first end extending beyond the staple-containing casing. An anvil, of improved configuration for easier removal from the anastomotic site, is removably mounted by means of an anvil nut on the first end of the adjusting rod facing the staple-containing casing. By means of an adjustment knob at the free end of the instrument body handle portion, the anvil and the adjusting rod are shiftable axially of the instrument body between a position wherein the anvil is adjacent the staple-containing casing and a position wherein the anvil is spaced from the staple-containing casing. The anvil has a plurality of anvil pockets formed therein to clinch the staples over a range of distances between the anvil and the staple casing constituting a working gap. The adjustment rod has a second end mounting an indicator cooperating with the adjustment knob to give both visual and tactile indications that the anvil is spaced from the staple casing within the operating gap. A ring scale is mounted on the adjusting knob enabling accurate setting of the distance between the anvil and the staple casing, within the working gap, according to the thickness of the tissue of the tubular body organs being joined. The instrument is also provided with a lever actuated staple driver and scalpel assembly and a slide safety lockout to prevent undesired actuation of the lever.
STAPLING INSTRUMENT
ABSTRACT OF THE DISCLOSURE
A disposable surgical stapling instrument for the joining together of tubular body organs such as the organs of the alimentary canal. The instrument comprises an elongated body having a tubular housing portion and a coaxial cylindrical handle portion.
The tubular housing portion supports at its free end a coaxial cylindrical casing containing at least one annular array of surgical staples. An adjusting rod is coaxially and non-rotatively mounted within the instrument body and has a first end extending beyond the staple-containing casing. An anvil, of improved configuration for easier removal from the anastomotic site, is removably mounted by means of an anvil nut on the first end of the adjusting rod facing the staple-containing casing. By means of an adjustment knob at the free end of the instrument body handle portion, the anvil and the adjusting rod are shiftable axially of the instrument body between a position wherein the anvil is adjacent the staple-containing casing and a position wherein the anvil is spaced from the staple-containing casing. The anvil has a plurality of anvil pockets formed therein to clinch the staples over a range of distances between the anvil and the staple casing constituting a working gap. The adjustment rod has a second end mounting an indicator cooperating with the adjustment knob to give both visual and tactile indications that the anvil is spaced from the staple casing within the operating gap. A ring scale is mounted on the adjusting knob enabling accurate setting of the distance between the anvil and the staple casing, within the working gap, according to the thickness of the tissue of the tubular body organs being joined. The instrument is also provided with a lever actuated staple driver and scalpel assembly and a slide safety lockout to prevent undesired actuation of the lever.
Description
INTRALUMENAL ANASTOMOSIS SURGICAL
STAPLING INSTRUMENT
ROBERT G. ROTHFUSS
TECHNICAL FIELD
The invention relates to an intralumellal anastomosis surgical stapling instrumellt and more particularly to such an instrument which may readily be made in a single-use, disposable form and which is provided with improved operating gap setting and ïndicating means and an anvil configured both to properly clinch the staples over the full range of the operating gap and for easier removal of the tool from the joined tubular body organs.
BACKGROUND ART
Within the last decade there has been an ever increasing use of surgical staples, in lieu of conventional sutures, in many internal organ and intestinal procedures from the esophagus to the rectum. U.S.
Patents 3,193,165; 3,338,847; 3,552,626, 3,593,903, 3,638,652 and 4,207,898 teach exemplary types of surgical stapling instruments devised by prior art wor~ers for such procedures. The use of surgical staples and such surgical stapling instruments has made many difficult procedures much simpler. Of even greater importance, however, is the fact that the use of surgical staples significantly reduces the time required for such procedures and therefore reduces the length of time for which the patient must be maintained under anesthetic.
U.S. Patents 3,193,165 and 3,388,847 are exemplary ~5~1~6 of permanent-type, reusable lnstruments req~iring tha~
the staples be hand-loaded into a single ring cart-ridge~ Instruments of this type haye several dis-advantages. In general, they are complex in structure, expensive to manufacture, bulky and heavy. They must be constantly maintained; disassembled and cleaned after each use; and sterilized for each procedure.
Staples must be individually hand-loaded into the cartridge for each procedure. The instrument scalpel must be sharpened periodically and special tools are frequently required for assembly, disassembly, main-tenance and replacement of parts.
It is well known that the tubular structures constituting the human alimentary canal, i.e. the esaphogus, small and large intestines, are of varying diameters and wall thicknesses even within the same patient. In order to place a circular anastomosis in the tubular structures of the alimentary canal, instruments of the type described must be introduced into the inner space of the organ being sutured. The diameter of the staple containing portion of the instrument must correspond to the internal diameter of the organ being stapled.
The above noted ~.S. Patent 3,552,626 teaches interchangable staple carrying heads of different diameters. Such an instrument, however, not only suffers from those disadvantages mentioned above, but in addition, the interchangable heads are difficult to install and remove. The minimum size of such heads is limited because of the bulky fittings required for their joinder to the instrument. Furthermore, the instrv~ent is provided with a knurled nose nut which 115~13.6 can dama~e the inside of the intestine during removal of the instrument. The instrument of the above noted copending application can be made ~holly disposa~le or can be a reusable instrument provided with a disposable staple cartridge. As a reusable instrument ~t would suffer from the drawbacks noted above.
Along with the advantages of the use of surgical staples and surgical stapling instruments, there are certain inherent dangers. First of all, it is nec-essary to select the proper staple size for the thick-ness of tissue to be joined. Secondly, even if the proper staple size is selected, the staples must not be formed too tightly or too loosely. If the staples are formed too tightly the blood supply needed for the healing process is cut off and tne tissue becomes necrotic. If the staples are formed too loosely, then hemorrhaging and/or leakage can occur. Thus, both too tightly and too loosely formed staples can cause serious problems and complications.
The present invention is directed to an intra-lumenal anastomosis surgical stapling instrument of extremely simple design. '.~hile the instrument may be ~anufactured in the form of a permanent, reusable instrument, it is particularly adapted to manufacture as a single-use, disposable surgical stapling instruMent.
The instrument is capable of placing an "end-to-end", "end-to-side", "side-to-side" and "side-to-end"
anastomosis. Since the instrumer.t lends itself well to manufacture as a single-use, disposable instrument, it can readily be mae in one or more lengths and with staple-containing casings of different diameters to cover most of the internal diameters encountered in the human alimentary canal.
The instrument of the present inven1ion is light weight and easy to manipulate. While tfie staple-containillg casing can mount a single amlular array of staples, it preferably contains two staggered annular arrays of staples in concentric pattern eliminating the necessity for over-suturing to stop leakage and bleeding.
The instrument of the present invention is provided with improved gap setting means including means for giving both a visual and a tactile indication that the space between the anvil and tfie staple-containing casing is within the "working gap" of the instrument and calibra~ed adjustable vernier means for setting the actual gap, within the "working gap", at a distance appropriate for the thickness of tissues being joined. To this end, the surgical stapling instrument may be used in conjunction with a tissue thickness measuring device of the type, for example, taught in U.S. Patent 4,312,363 issued January 26, 1982, to Robert G. Rothfuss and Edwin L. Stith, Jr.
The instrument may be provided with a slide safety lockout to prevent accidental ejection of the staples. The instrument may further be vented to equali~e pressure on either side of an anastomosis, as will be 1 l 55 ~
described hereillafter.
Finally, prior art instruments of the type described have been characterized by the fact that they are difficult to remove from the anastomotic site after the staples are crimped and the tissue is joined.
The instrument of the present invention is provided with an improved anvil of unique profile for easy removal of the instrument from the anastomotic site.
Heretofore surgical stapling instruments have been devised with anvil means configured to form the surgical staples into a B-shaped configuratioll. This is taught, for example, in U.S. Patents 3,490,675 and 3,494,533. The anvil of the present invention is provided with anvil pockets so configured as to adequately crimp the surgical staples into a B-shape throughout the range of the "working gap" without requiring the use of staples of different leg lengths.
DISCLOSURE OF THE INVENTION
According to one aspect of the invention there is provided a surgical stapling instrument of the type used to join together tubular body organs, said surgical stapling instrument comprising an elongated body having first and second ends, a cylindrical casing affixed coaxially Oll said first end of said body, at least one annular array of surgical staples mounted within said casing, an adjusting rod coaxially mounted within said body and said casing, said adjusting rod having a first end extending beyond said casing, an anvil mounted on said first end of said adjusting rod, said anvil having an anvil surface facing said casing, an adjustment knob mounted at said second end of said body, said adjustmellt knob being hollow, said adjusting rod being operatively comlected to said adjustment knob, said adjusting rod and said anvil being axially shiftable by operation of said adjustment knob between a pOsitioll wllerein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a staple driver and ~3 1~5~
a cylindrical scalpel located within said casing, means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil to drive said staples through said tubular body organs to be joined, to clinch said staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil sur-face and said casing Collstitutillg a working gap of said instrument, said adjusting rod having a second end located within said hollow adjustment knob, indicator means mounted on said second end of said adjusting rod and being so configured as to give both visual and tactile indications that the distance between said anvil surface and said casing is at and within said working gap, a scale in association with one of said adjustment knob and said second end of said body and a cooperating indicator mark on the other of said adjustment knob and said second end of said body enabling final adjustment of said dis-tance between said anvil surface and said casing within said working gap according to the thickness of the tissue of the tubular body organs being joined.
According to another aspect of the invention there is provided an anvil having an anvil surface for use with a surgical stapling instrument of the type employed to join together tubular body organs and of the type having a cylindrical casing containing at least one annular arrayof surgical staples, means to support and shift said anvil between a position wherein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a driver for said surgical staples and a cylindri-cal scalpel located within said casing and means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil surface to drive said surgical staples through the tubular body organs ~to be joined to clinch said surgical staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting :, '`
, . . .
115~11G
6a a working gap of said instrument, said anvi.l being of button-like configura-tion and comprising a body portion of lesser transverse dimension than the diameter of said staple containing casing, near one end said body portion flaring outwardly to form a thin annular flange having a maximum diameter substantially the same as the diameter of said casing, said end of said anvil having said flange comprising said anvil surface.
According to a further aspect of the invention there is provided an anvil having an anvil surface for use with a surgical stapling instrument of the type employed to join together tubular body organs and of the type having a cylindrical casing containing at least one annular array of surgical staples, means to support and shift said anvil between a position wherein said anvil surface is adjacent said casing and a position wherein said~anvil surface is spaced from said casing~ a driver for said surgical staples and a cylindrical scalpel located within said casing and means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil surface to drive said surgical staples through the tubular body organs to be joined, to clinch said surgical staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting a working gap of said instrument, said anvil surface having at least one annular array of pairs of anvil pockets formed therein, the number of anvil pocket pairs being equal to the number of said surgical staples mounted in said casing, each of said surgical staples comprising a U-shaped element having a pair of legs joined by a crown portion, the anvil pockets of each pair bei.ng mirror images of each other and being spaced from each other so ~as to each receive one of the legs of the same surgical staple, the pockets of a pair both comprising elongated depressions each having a first longi-tudinal curved large radius bottom surface portion to be first contacted ~, ~
6b by their respective staple legs to bend said legs toward each other and a second longitudinal curved bottom surface portion of lesser radius to cause said legs to form oppositely directed curves so that said staple achieves a B-shaped configuration, whereby staples of a single leg length will be adequately clinched at any distance between said anvil surface and said casing within said working gap.
_IEF DESCRIPTION OF TIIE DRAWINGS
Figure 1 is a fragmentary side elevational view of the intra-lumenal anastomosis surgical stapling instrument of the present invention.
Figure 2 is a fragmentary longitudinal cross sectional view of the instrument of Figure 1.
~15~
Figure 3 is an end elevational view of the forward end of the staple-containing casing.
Figure 4 is an end elevational view oE the anvil and anvil nut assembly, ~iewed from that end which faces the staple-containing casing.
Figure 5 is an enlarged, fragmentary, longitudinal cross sectional view of the distal end of the instrument illustrating the staple-containing casing and the anvil assembly.
Figure 6 is a fragmentary view illustrating the arrangement of organs on the instrument prior to placing an end-to-end anastomosis.
Figure 7 is a fragmentary cross sectional view of the completed end-to-end anastomosis of Figure 6.
Figure 8 is an elevational view of a surgical staple for use with the instrument of the present invention.
Figure 9 is an elevational view of a staple of the instrument of the present invention formed at its maximum height.
Figure 10 is an elevational view of a surgical staple of the instrument of the present invention formed at its minimum height.
Figure 11 is a fragmentary plan view of a cooper-ating pair of anvil pockets in the anvil of the instru-ment.
Figure 12 is a fragmentary cross sectional view taken along section line 12-12 of Figure 11.
Figure 13 is a fragmentary cross sectional view taken along section line 13-13 of Figure 12.
BEST MODE OF CARRYING OUT THE INVENTION
~eference is first made to Figures 1 and 2 in which like parts have been given like index numerals. The instrument of the present invention is generally indicated at 1 and comprises an elongated body 2 having a tubular housing portion 3 and a coaxial cylindrical handle portion 4 of slightly larger diameter.
1~5~
While the surgical stapling instrument of the present invention can be constructed as a reusable, sterilizable instrument, it lends itself well to manu-facture as a single-use, disposable instrument. For purposes of an exemplary showing it will be described in its disposable form wherein its parts are made of metal and plastic suitable for use in a surgical en-vironment and capable of being sterilized by autoclave, ethylene oxide, irradiation or other standard methods.
The body 2 is made up of two mirror image halves molded of plastic material and firmly welded together by means well known in the art. One of the body halves is shown at 2a in Figure 1, while the other body half is shown at 2b in Figure 2. Aside frcm being mirror images of each other, the body halves are otherwise substantially identical.
At its distal end, the tubular housing portion 3 of body 2 mounts a cylindrical staple-containing casing 5 which will be described hereinafter.
An adjustment rod 6 is mounted within the body 2 and extends axially thereof. ~he distal end of adjustment rod 6 extends beyond casing 5 and has an anvil assembly, generally indicated at 7, affixed thereto. The anvil assembly 7 will be described hereinafter.
At the proximal end of handle portion 4 of body 2 there is rotatively mounted an adjusting knob 8. The adjusting knob 8 is a hollow cylindrical member having a first portion 8a extending beyond the proximal end of handle portion 4. Adjusting knob 8 has a second portion 8b of a lesser outside diameter. The outside diameter of portion 8b is such as to be just nicely received within handle portion 4 and to be rotatable therein. The adjusting knob 8 has a third portion 8c of yet smaller diameter. The portion 8c has a threaded lL 15~1 ~6 g bore 9 extending therethrough.
~ s indicated aboye, adjustment knob 8 i3 rotatiYely mounted within handle portion 4 of body 1. To maintain the adjusting knob 8 in position within handle portion 4, the body halves 2a and 2b are provided with cooperating, annular, interior flanges. The interior flange of body half 2b is illustrated at 10. It will be understood that the body half 2a has a sim~lar, aligned annular lnterior flange (not shown). The annular flange 10 of body half 2b and the cooperating annular flange of body half 2a abut a forward shoulder 11 of adjusting knob 8 formed between its portions 8b and 8c. Similarly, a shoulder 12 formed between adjustment knob portions 8a and 8b abuts the proximal end of handle portion 4. Finally, adjusting knob 8 ls provided with an annular notch 13, while the interior of handle portion 4 is provided with a matching notch 14. A washer 15 is located in notches 13 and 14 to preclude axial shifting of adjusting knob 8.
While not required, for reasons which will become apparent hereinafter, the adjusting knob 8 is prefer-ably molded of clear plastic. Mounted on its exterior adjacent the proximal end of handle portion 4 there is a ring scale 16. The handle portion 4, adjacent ring scale 16 has a index mark 17 formed thereon. The purpose of ring scale 16 and index mark 17 will be described hereinafter.
The rearward or proximal end of adjusting rod 6 is threaded as at 18. The threaded portion 18 of 1 30 adjusting rod 6 is engaged in the threaded bore 9 of adjusting knob 8. Each body half 2a and 2b has formed on its interior surface an elongated channe~ or slot.
115~ 6 The channel or slot in body half 2b is shown in broken lines at 19. The identical slot formed on body half 2a is not shown, but when the body hal~es are joined together, the slot 19 and its counterpart on bo~y half 2a will be diametrically opposed. Adjusting rod 6 has a transverse perforation 20 formed therein. A
pin 21 extends through the transverse perforation and the free ends of the pin 21 are slidably engaged in the slot 19 of body half 2b and the similar slot of body half 2a. As a result, pin 21 precludes rotatlon of adjusting rod 6. It will be evident, however, that as adjusting knob 8 is rotated in one direction, its threaded engagement with adjusting rod 6 will cause the adjusting rod to shift axially of body 1. This, in turn, will cause anvil assembly 7 to shift away from staple-containing casing 5. Rotation of adjusting knob 8 in the opposite direction will cause axial shifting of adjusting rod 6 in the opposite direction with the result that anvil assembly 7 will shift toward staple-containing casing 5.
A cylindrical, hollow driver tube 22 is slidablyand coaxially mounted on adjusting rod 6. Driver tube 22 mounts at its distal end a staple driver and a scalpel to be described hereinafter. Near its proximal end the dri~er tube has an annular array of inwardly extending dimples, one of which is shown at 23. In similar fashion, the driver tube 22 is provided with an annular array of dimples near its distal end, one of which is shown at 24. The driver tube 22 is axially shiftable with respect to the instrument body 1 and the adjusting rod 6, and the arrays of dimples 115~1~6 23 and 24 proYide low friction guide means for the driver tube 22 with respect to the adjusting rod 6.
Affixed to the proximal end of driver tube 22 there is a cylindrical spool 25 having annular flanges 25a and 25b at its ends. Body halves 2a and 2b have downwardly depending extensions 26 (see Figure 1) and 27 (see Figure 2), respectively. A lever 28 is pivotally mounted on a pin 29, the ends of which are mounted in extensions 26 and 27. The upper portion of lever 28 is bifurcated and terminates in a pair of lobes, one of which is shown in Figure 2 at 30. The lobes are adapted to lie to either side of spool 25 between the annular spool flanges 25a and 25b. As a result, when lever 28 is squeezed toward handle portion 4 of body 2, the lobes thereof, cooperating with spool 25, will cause the driver tube 22 to shift axially and forwardly of adjusting rod 26.
At the proximal end of the tubular housing portion 3 of body 2 the body halves 2a and 2b are provided with mating internal annular flanges. The internal annular flange of body half 2b is shown at 31 in Figure 2. The matching annular flange of body half 2a is not shown. The driver tube 22 carries a pair of loosely mounted washers 32 and 33. These washer serve as abutments for the ends of a compression spring 34 mounted on driver tube 22. Washer 32 normally lies in abutment with flange 31 and its counterpart on body half 2a while washer 33 normally abuts the flange 25a of spool 25. In this manner, compression spring 34 serves as a return spring biasing driver tube 22 and lever 28 to their normal unactuated positions as illustrated in Figures 1 and 2.
1~
The instrument 1 is provided with a slide safety lockout 35 to prevent inadvertent actuation of lever 28 and driver tube 22. To this end, body half 2b is provided with a slot 36 just behind the downwardly depending extension 27. The body half 2a is provided with a matchlng slot (not shown). The slide safety lockout 35 is captively and slidably mounted in the slot. The slide safety lockout 35 has a shoulder 37 which engages body half 2b above slot 36. Slide safety lockout 35 will have a similar shoulder (not shown) on it other side to similarly engage body half 2a.
At its rearward end, the slide safety lockout 35 has a portion 38 engagable by the thumb or finger of the surgeon to shift the lockout 35 into and out of its lockout position. At its forward end, the slide safety lockout 35 has a nose portion 39 adapted to engage shoulders formed on the bifurcated portion of lever 28 to prevent actuation of the lever. One such shoulder is shown at 40 in Figure 2. In Figure 2 the slide safety lockout 35 is shown in its lockout position preventing actuation of lever 28. It will be apparent from Figure 2 that the slide safety lock-out 35 can be shifted rearwardly so that its nose 39 no longer engages the lever shoulders (one of which is shown at 40) so that the lever is free to be actuated.
Reference is now made to Figures 2, 3 and 5 wherein like parts have been given like index numerals. The forwardmost end 41 o~ tubular housing portion 3 of body 1 is of reduced diameter. The tubular body portion 3 has an annular flange 42 formed adjacent reduced diameter portion 41 so as to define a shoulder 43.
B
The cylindrical casing 5 comprises a hollow member and has at its rearward end an axial bore 44 adapted to just nicely re~eive the reduced diameter portion 41 of tubular housing portion 3 with the rearward end of casing 5 in abutment against shoulder 43. In addition, to assure that casing 5 is in the correct rotative position (so that the staples located therein are in proper alignment with the anvil pockets on the anvil assembly 7) the reduced diameter portion 41 of tubular housing portion 3 may be provided with a plur-ality of evenly spaced keys (two of which are shown at 45 and 46 while the bore 44 of casing 5 is provided with matching keyways, two of which are shown at 47 and 48. Casing 5 may be molded of plastic material and glued or welded to reduced diameter portion 41 and to flange 42.
Permanently affixed (by gluing, welding or the like) to the inside surface of staple-containing casing 5 there is a staple guide 49. Staple guide 49 may be molded of plastic material.
As is evident from Figure 3, the staple guide 49 has a first annular array of channels 50, each con-taining a staple 51 and a second annular array of channels 52, each containing a staple 53. The second annular array of channels 52 is located within the first annular array of channels 50 and is staggered with respect thereto. Therefore, the instrument is capable of implanting a double sta~gered row of staples in concentric pattern.
The forwardmost end of driver tube 22 has a reduced portion 22a forming a shoulder 54. Mounted on the reduced portion 22a there is a washer 55 and an annular staple driver 56. Staple driver 56 has a first annular array of tines 57 each of which is aligned with and extends into one of the channels 50 of staple guide 49. Similarly, staple driver 56 has a second annular array of tines 58, each of which extends into one of the channels 52 of staple guide 49. It will be evident that when the driver tube 2~
is shifted forwardly by lever 28, the tines 57 and 58 of driver 56 will drive staples 51 and 53 from their respective channels 50 and 52, through the tissue being joined and against anvil assembly 7 to be described hereinafter. A cylindrical scalpel 59 is also mounted on the smaller diameter portion 22a of driver tube 22.
The forwardmost end of the portion 22a is upset, there-by captively mounting washer 55, staple driver 56 andscalpel 59 thereon. The forwardmost annular edge of scalpel 59 has an inside bevel 59a formed thereon to provide a cutting edge. Washer 55 assures that the driver 22 imparts uniform force to staple driver 56 and cylindrical scalpel 59. Furthermore, abutment of washer 55 against the end of forwardmost portion 41 of body 2 determines the normal unactuated positions of driver tube 22 and lever 28.
Reference is now made to Figures 4 and 5 wherein the anvil assembly 7 is most clearly shown. The anvil assembly comprises an anvil 60, and an anvil nut 73.
The anvil 60 is a cylindrical member, the rearward end of which is open and the forward end of which is closed except for an axial perforation 63 therethrough.
As is most clearly seen in Figure 4, perforation 63 is circular in peripheral configuration except for a flat 64, the purpose of which will be descri~ed here-inaf~er. The rearward end of anvil 60 is provided with a thin annular flange 65 which presentSa flat annular surface 66 facing toward staple-containing :l 1 5 ~
casing 5. The outer peripheral edge of flange 65 is rounded as at 67 and the forward surface 68 of flange 65 slopes forwardly and inwardly. As a result, the anvil 60 has a button-like cross section, the importance of which will be evident hereinafter.
The rearward flat surface 66 of anvil flange 65 is provided with a first annular array of pairs of anvil pockets 69a-69b, each pair of pockets adapted to cooperating with the legs of one of the staples 51.
In similar fashion, anvil surface 66 is provided with a second annular array of pairs of anvil pockets 70a-70b, each pair of pockets 70a-70b being adapted to cooperate with the legs of one of the staples 53. As the driver 56 and its tines 57 and 58 drive staples 51 and 53 from channels 50 and 52, through the tissue to be joined and against anvil 60, the pocket pairs 69a-69b and 70a-70b will cause the legs of staples 51 and 53 to be properly crimped, as will be further described hereinafter. A semi-rigid washer 71 is located within anvil 60 to serve as a back-up structure for cylindrical scalpel 59.
The forwardmost end 72 of adjusting rod 6 is of reduced diameter and is externally threaded. The threaded portion 72 has a flat 72a formed thereon which corresponds to the flat 64 of anvil perforation 63.
Thus, when anvil 60 is mounted on portion 72 of adjusting rod 6, cooperation of flats 64 and 72a will assure that anvil pockets 69a-69b and 70a-70b will be properly aligned with the staple containing channels 50 and 52 of staple guide 49. This is true since keys 45 and 46 and keyways 47 and 48 determine the rotative position of staple-containing casing 5 and thus staple guide 49 affixed thereto and pin 21 precludes rotation of adjusting rod 6.
B
Anvil 60 is re~ovably affixed to the threaded por-tion 72 of adjustin~ rod 6 by an anvil nut 73. ~nvil nut 73 may be molded of plastic or the like and is provided with an axial metalllc insert 74. Metallic insert 74 has an axial bore 75 which is internally threaded so as to be engageable on threaded portion 72 of adjusting rod 6. ~hen anvil nut 73 is in place, the anvil 60 will be in abutment with a shoulder 76 on adjusting rod 6 formed by the smaller diameter threaded portion 72.
Anvil nut 73 is preferably frusto-conical in con-figuration to assist in insertion thereof into the tubular body members to be joined. The exterior surface of anvil nut 73 may be provided with a plurality of longitudinally extending grooves or flutes 77 to render it more easily graspable by the surgeon. This will render the anvil nut 73 and anvil 60 more readily removable during certain surgical procedures such as end-to-side and side-to-end anastomosis, as is well known in the art.
The forward end of adjusting rod 6 is provided with an axial bore 78 leading to a lateral or trans-verse bore 79. The bore 75 in metallic insert 74 of anvil nut 73 extends completely through the metallic insert and is coaxial with bore 78. In similar fashion, the forwardmost end of the plastic portion of anvil nut 73 has bore 80 formed therein, coaxial with and communicating with bore 75 of metallic insert 74 and bores 78 and 79 of adjusting rod 6. This series of bores constitutes a Yent passage, the purpose of which will be described hereinafter.
To complete the stucture, the rearwardmost portion 81 of the proximal end of adjusting rod 6 is unthreaded 115~
and mounts ~ cap-like indicator 82. Indicator 82 gives both a tactile and visual indication that the space between anvil 60 and staple-containing casing 5 is within the working or operating gap of the instrument, as will be apparent hereina~ter.
The instrument of the present invention having been described, its use and operation may be set forth as follows. For purposes of an exemplary description, the operation of the instrument will be set forth with respect to a simple end-to-end anastomosis procedure and reference is made to Figures 2, 5 and 6.
At the outset, the anvil 60 is preferably so located that its flat annular surface 66 is in abutment or near abutment with staple-containing casing 5 and staple guide 49. Furthermore, the slide safety lockout 35 should be in its lockout position to prevent inadvertent actuation of lever 28.
In Figure 6 two tubular body organs or lumens 83 and 84 to be joined are illustrated. At the time of the end-to-end anastomosis procedure, the distal end of the instrument is inserted into lumen 83 either through a natural opening in the patient's body, if possible, or through an incision made in the side of lumen 83 remote from the anastomotic site. When casing 5 reaches the position shown with respect to lumen 83 in Figure 6, the adjusting knob 8 is rotated by the surgeon to cause anvil 60 to shift away from casing 5. The end of lumen 83 is then tied ~bout the exposed portion of adjusting rod 6 by means of a simple purse string suture 85, as is shown in Figure 6.
Thereafter, anvil assembly 7 is inserted in lumen 84 and lumen 84 is tied about the exposed portion of adjusting rod 6 by a purse string suture 86, as shown 115~
1~
Once the lu~ens 83 and 84 have been tied to the instrument in the manner shown in Figure 6, the next step is to set the proper gap between casing 5 and surface 66 of anvil 60 in order to join the lumens by means of the surgical staples. Prior to the anastomotic procedure, the surgeon will have measured the thickness of the tissue of lumens 83 and 84 using a tissue thickness measuring instrument of the type set forth in the above mentioned copending application.
The tissue thickness to be joined is, of course, the sum of the tissue thickness of lumen 83 and lumen 84.
With this value in mind, the proper gap between staple-containing casing 5 and the surface 66 of anvil 60 can be set by the surgeon in the following manner.
First of all, adjusting knob 8 is rotated in a direction to cause surface 66 of anvil 60 to approach the distal end of casing 5. Rotation of adjusting knob 8 is continued until the rearward end of indicator 82 becomes substantially coplanar with the rearward end of adiusting knob 8. This can be ascertained both by feel and visually. If adjusting knob 8 is made of clear plastic, the surgeon can readily watch the indicator 82 approach this coplanar position.
The length of adjusting rod 6 is such that when the rearward end of indicator 82 is coplanar with the end of adjusting knob 8, the surgeon can be assured that the maximum spacing between casing 5 and the surface 66 of anvil 60 within the operating gap of the instrument has been achieved. At this point, the surgeon utilizes the ring scale 16 and index mark 17 to set the final gap in accordance with the tissue ~1561-~
'19 thickness ~easurement previously made.
Once the final gap has been achieved, the slide safety lockout 35 is shifted to its rçarward or non-locking position and the surgeon squeezes lever 28 towar~ handle portion 4 of instrument bo~.y 2. The engagement of the lobes (one of which is shown at 30 in Figure 2) of lever 2~ with spoo] 25 will cause driver tube 22 to shift forwardly with respect to adjusting rod 6. This,in turn, will cause driver 56 10 and its tines 57 and 58 to drive staples 51 and 53 from their respective staple guide chanr.els 50 and 52.
The staples will pass through the tissue of lumens 83 and 84 and the legs of each staple will thereupon enter their respective anvil pocket pairs 69a-69b and 70a-70b to be clinched. Since the surgeon is working at a gap within the operating gap of the instrument, adequate clinching of the staples is assured. Washer 54 further assures that the clinching force imparted by driver 56 will be unifor~ with respect to all of the staples 51 and 53.
As will be evident from Figures 2 and 5, the cylindrical scalpel 59 is offset rearwardly with respect to staples 51 and 53. As a xesult, scalpel 59 will not begin to cut through the tissue of lumens ~3 and 84 until sufficient clinching of the staples has been accomplished. The purpose of cylindrical scalpel 59 is to excise that portion of the tissue of lumens S3 and 84 which is tied to adjusting rod 6. The inside bevel 59aprovides a more parallel cut and also forces the excised tissue into the scalpel W~sher 54 also insures that unifor~ force is applied about the cylindrical cutting edge of scalpel 59.
115~
Semi ~igid washer 71, located within anvil 60 acts as a cutting board for cyllndrical scalpel 59, supporting the tissue being cut. The washer is located flush with an~il surface 66 so as to minimize stretch or pull on the tissue being cut.
The stapling and cutting steps having been performed, it is now necessary to remove the instrument from the anastomotic site. In order to do this, adjusting knob 8 is turned in such a direction as to cause anvil 60 to move away from casing 5. This shifting of anvil 60 to open the gap would produce a partial vacuum due to the piston affect causing the joined lumens to collapse into the gap. This is prevented by the vent system comprising bor~s 80, 75, 15 78 and 79, described above with respect to Figure 5.
Once the anvil assembly 7 is remote from casing 5, the instrument can be removed. This removal requires that the anvil assembly 7 pass through the hole left in the joined organs by cylindrical scalpel 59. This hole is smaller than the original internal diameters of the two organs. The above noted button-configuration of anvil 60 allows the stapled anastomosis to be slipped over a portion of flange 65 while the remainder of the stapled anastomosis approaches adjusting rod 6. By circling the anastomosed tissue about the button-shaped flange 65, the anvil assembly 7 can be brought through the anastomotic site without undue strain on ~he tissue or the staple lines. The instrument can thereafter readily be removed from lumen 83 and the anastomGtic procedure is complete. The completed anastomosis i5 illustrated in Figure 7.
As indicated above, the organs of the human alimentary canal are of varylng diameters and wall 115~
thicknesses even in the same patient. It is therefore desirable th~t the instrument of the present inventi~n be made available with staple-containing casings of different external diameters. While not intended to be so limited, it has been found that if the instrument is made available with staple-containing casings having external diameters of 21mm, 25mm, 28mm, and 33mm, most of the internal diameters of the organs of the human alimentary canal will be covered. The instrument may, of course, be made with staple-containing casings 5 of smaller or larger diameters.
The number of staples in the staple-containing casing is dependent upon the external diameter of the casing. Studies have shown that the staples 51 of the outer annular array and the staples 53 of the inner annular should o~erlap slightly, as shown in Figure 3, to insure a hemostatic and leak-free closure. However, if the staples 51 and 53 are placed too close together, the blood supply will be comprised and affect healing.
Furthermore, if the staples 51 and 53 are arranged too close together, there is less elasticity left in the stapled anastomosis and this renders the instrument more difficult to remove from the anastomotic site.
There is also an optimum margin of tissue that must be left between the inner annular array of staples 53 and the cylindrical scalpel 59 since all living tissue retracts when cut.
It will be understood that the instrument 1 of the present invention can be designed with any appropriate operating gap, depending upon its ultimate use. While not intended to be so limited, lt has been found that if the instrument 1 is proyided with a operating gap of from 1 to 3~m, it can be used in con;unction with substantially all of the organs of the human alimentar~
canal. In an exemplary working embodiment of the instrument 1 designed to have a working gap of 1 to 3mm, the ring scale 16 was graduated from 0 to 3mm ln 0.5mm increments. At the point where the mark indicated as 3m~ on ring scale 16 was aligned with index mark 17 on the instrument handle portion 4, the rear surface of indicator 82 was coplanar with the rear end of adjusting knob 8, indicating that the maximum value of the oper-ating gap had been achieved.
The instrument of the present invention can be used with one size of surgical staple throughout its operating gap. Thi~ is made possible by the configur-ation of the anvil pockets 69a-69b and 70a-70b which tend to form the surgical staples 51 and 53 into "B"
shaped configurations. An exemplary surgical staple 51 is illustrated in Figure 8. As indicated above, staples 51 and 53 of the two annular arrays are identical.
In its initial form, staple 51 has an inverted "U" shape with a substantially horizontal crown portion 51a and downwardly depending legs 51b and 51c. The free ends of legs Slb and 51c are cut at a downwardly and inwardly sloping angle so as to form tissue-penetrating points 51d and 51e. As the surgical staple 51 is advance by staple driver 56 through the tissue to be joined and into a pair of anvil pockets 69a and 69b, the legs 51b and 51c will be clinched toward each other in a curved configuration. Figure 9 illustrates the staple of ~igure 8 in its fully formed position at the maxlmum ~alue of the working gap of instrument 1.
115~
Figure 10 illustrates the staple of Figure 8 in its final configuration when form~d at the minimum value of the operating gap of instrument 1. In the exemplary embodiment described above wherein the instrument 1 had an operating gap of 1 to 3mm, it was found that the surgical staples 51 and 53 would perform as indicated in Figures 9 and 10 when provided with a leg length of about 5.5mm, or about 0.216 inches.
Figures 11, 12 and 13 illustrate an exemplary pair of anvil pockets 69a and 69b. It will be understood that all of the pocket pairs 69a-69b are identical and that all of the pocket pairs 70a and 70b are also identical to pocket pairs 69a and 69b.
As is evident from Figures 11 through 13 and Figure 4, the pocket pairs 69a and 69b are formed in the flat rearwardly facing surface 66 of anvil 60.
Anvil pocket 69a and anvil pocket 69b are mirror images of each other, and are otherwise identical.
Taken together, the anvil pockets 69a and 69b are somewhat lo~ger than the staple crown (i.e., the width of the staple) to enable manufacturing with reasonable tolerance. In Figure 12, this is shown by virtue of the fact that the legs 51b and 51c of a staple 51 (Figure 8) are shown in broken lines in their initial positions, just entering pockets 69a and 69b. As will be evident from Figure 13, the sides of pockets 69a and 69b slope inwardly and downwardly to allow for radial tolerance and to urge the staple legs 51b and 51c toward the center of their respective pockets at the deepest portion thereof.
Turning to ~igure 12, the pockets 69a and 69b have first longitudinally extending large radius portions 69c and 69d, respectively. These large radius 115~
portions cooperate with the points 51d and 51e of staple legs 51b and 51c, respectively, to cause them to bend toward each other. Anvil pockets 69a and 69b also have longitudinally extending smaller radius portions 69e and 69f, respectively. As the staple legs 51b and 51c are driven further toward anvil 60, small radius anvil pocket portions 69e and 69f will cause the staple legs 51b and 51c to for~ a radius of curvature of their own. ~he gap setting of instru-ment 1 will determine the ultimate configuration of thestaple 51 between that shown in Figure 9 and that shown in Figure 10, as described above. At all gap settings within the working gap of the instrument, the staple 51 will be formed into a B-shaped configuration.
To enable the instrument 1 of the present invention to utilize surgical staples of a single leg length throughout the working gap of the instrument, the essential elements include the leg length, wire diameter and tensile strength of the surgical staple 51 and the contour of anvil pockets 69a and 69b. In an exemplary working embodiment, the staple 51 was made of stainless steel having a wire diameter of about 0.011 inch, a tensile strength of from about 150,000 to about 160,000 psi and a leg length of about 0.216 inch.
Anvil pockets 69a and 69b had an overall length, including the space therebetween, of about 0.182 inch, each of pockets 69a and 69b having a maximum width of about 0.028 inch and a maximum depth of about 0.015 inch. The large radius portions 69c and 69d had a radius of about 0.081 inchO The smaller radius portions 69e and 69f each had a radius of about 0.035 inch. In this working embodiment, staples 51 were successfully and reliably formed into acceptable B-shapes throughout a working gap of from.l to 3 mm.
~ .odifications may be made in the inverltion without departing from the spirit of it. For example, ring scale 16 could be mounted on the end of instrument body
STAPLING INSTRUMENT
ROBERT G. ROTHFUSS
TECHNICAL FIELD
The invention relates to an intralumellal anastomosis surgical stapling instrumellt and more particularly to such an instrument which may readily be made in a single-use, disposable form and which is provided with improved operating gap setting and ïndicating means and an anvil configured both to properly clinch the staples over the full range of the operating gap and for easier removal of the tool from the joined tubular body organs.
BACKGROUND ART
Within the last decade there has been an ever increasing use of surgical staples, in lieu of conventional sutures, in many internal organ and intestinal procedures from the esophagus to the rectum. U.S.
Patents 3,193,165; 3,338,847; 3,552,626, 3,593,903, 3,638,652 and 4,207,898 teach exemplary types of surgical stapling instruments devised by prior art wor~ers for such procedures. The use of surgical staples and such surgical stapling instruments has made many difficult procedures much simpler. Of even greater importance, however, is the fact that the use of surgical staples significantly reduces the time required for such procedures and therefore reduces the length of time for which the patient must be maintained under anesthetic.
U.S. Patents 3,193,165 and 3,388,847 are exemplary ~5~1~6 of permanent-type, reusable lnstruments req~iring tha~
the staples be hand-loaded into a single ring cart-ridge~ Instruments of this type haye several dis-advantages. In general, they are complex in structure, expensive to manufacture, bulky and heavy. They must be constantly maintained; disassembled and cleaned after each use; and sterilized for each procedure.
Staples must be individually hand-loaded into the cartridge for each procedure. The instrument scalpel must be sharpened periodically and special tools are frequently required for assembly, disassembly, main-tenance and replacement of parts.
It is well known that the tubular structures constituting the human alimentary canal, i.e. the esaphogus, small and large intestines, are of varying diameters and wall thicknesses even within the same patient. In order to place a circular anastomosis in the tubular structures of the alimentary canal, instruments of the type described must be introduced into the inner space of the organ being sutured. The diameter of the staple containing portion of the instrument must correspond to the internal diameter of the organ being stapled.
The above noted ~.S. Patent 3,552,626 teaches interchangable staple carrying heads of different diameters. Such an instrument, however, not only suffers from those disadvantages mentioned above, but in addition, the interchangable heads are difficult to install and remove. The minimum size of such heads is limited because of the bulky fittings required for their joinder to the instrument. Furthermore, the instrv~ent is provided with a knurled nose nut which 115~13.6 can dama~e the inside of the intestine during removal of the instrument. The instrument of the above noted copending application can be made ~holly disposa~le or can be a reusable instrument provided with a disposable staple cartridge. As a reusable instrument ~t would suffer from the drawbacks noted above.
Along with the advantages of the use of surgical staples and surgical stapling instruments, there are certain inherent dangers. First of all, it is nec-essary to select the proper staple size for the thick-ness of tissue to be joined. Secondly, even if the proper staple size is selected, the staples must not be formed too tightly or too loosely. If the staples are formed too tightly the blood supply needed for the healing process is cut off and tne tissue becomes necrotic. If the staples are formed too loosely, then hemorrhaging and/or leakage can occur. Thus, both too tightly and too loosely formed staples can cause serious problems and complications.
The present invention is directed to an intra-lumenal anastomosis surgical stapling instrument of extremely simple design. '.~hile the instrument may be ~anufactured in the form of a permanent, reusable instrument, it is particularly adapted to manufacture as a single-use, disposable surgical stapling instruMent.
The instrument is capable of placing an "end-to-end", "end-to-side", "side-to-side" and "side-to-end"
anastomosis. Since the instrumer.t lends itself well to manufacture as a single-use, disposable instrument, it can readily be mae in one or more lengths and with staple-containing casings of different diameters to cover most of the internal diameters encountered in the human alimentary canal.
The instrument of the present inven1ion is light weight and easy to manipulate. While tfie staple-containillg casing can mount a single amlular array of staples, it preferably contains two staggered annular arrays of staples in concentric pattern eliminating the necessity for over-suturing to stop leakage and bleeding.
The instrument of the present invention is provided with improved gap setting means including means for giving both a visual and a tactile indication that the space between the anvil and tfie staple-containing casing is within the "working gap" of the instrument and calibra~ed adjustable vernier means for setting the actual gap, within the "working gap", at a distance appropriate for the thickness of tissues being joined. To this end, the surgical stapling instrument may be used in conjunction with a tissue thickness measuring device of the type, for example, taught in U.S. Patent 4,312,363 issued January 26, 1982, to Robert G. Rothfuss and Edwin L. Stith, Jr.
The instrument may be provided with a slide safety lockout to prevent accidental ejection of the staples. The instrument may further be vented to equali~e pressure on either side of an anastomosis, as will be 1 l 55 ~
described hereillafter.
Finally, prior art instruments of the type described have been characterized by the fact that they are difficult to remove from the anastomotic site after the staples are crimped and the tissue is joined.
The instrument of the present invention is provided with an improved anvil of unique profile for easy removal of the instrument from the anastomotic site.
Heretofore surgical stapling instruments have been devised with anvil means configured to form the surgical staples into a B-shaped configuratioll. This is taught, for example, in U.S. Patents 3,490,675 and 3,494,533. The anvil of the present invention is provided with anvil pockets so configured as to adequately crimp the surgical staples into a B-shape throughout the range of the "working gap" without requiring the use of staples of different leg lengths.
DISCLOSURE OF THE INVENTION
According to one aspect of the invention there is provided a surgical stapling instrument of the type used to join together tubular body organs, said surgical stapling instrument comprising an elongated body having first and second ends, a cylindrical casing affixed coaxially Oll said first end of said body, at least one annular array of surgical staples mounted within said casing, an adjusting rod coaxially mounted within said body and said casing, said adjusting rod having a first end extending beyond said casing, an anvil mounted on said first end of said adjusting rod, said anvil having an anvil surface facing said casing, an adjustment knob mounted at said second end of said body, said adjustmellt knob being hollow, said adjusting rod being operatively comlected to said adjustment knob, said adjusting rod and said anvil being axially shiftable by operation of said adjustment knob between a pOsitioll wllerein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a staple driver and ~3 1~5~
a cylindrical scalpel located within said casing, means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil to drive said staples through said tubular body organs to be joined, to clinch said staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil sur-face and said casing Collstitutillg a working gap of said instrument, said adjusting rod having a second end located within said hollow adjustment knob, indicator means mounted on said second end of said adjusting rod and being so configured as to give both visual and tactile indications that the distance between said anvil surface and said casing is at and within said working gap, a scale in association with one of said adjustment knob and said second end of said body and a cooperating indicator mark on the other of said adjustment knob and said second end of said body enabling final adjustment of said dis-tance between said anvil surface and said casing within said working gap according to the thickness of the tissue of the tubular body organs being joined.
According to another aspect of the invention there is provided an anvil having an anvil surface for use with a surgical stapling instrument of the type employed to join together tubular body organs and of the type having a cylindrical casing containing at least one annular arrayof surgical staples, means to support and shift said anvil between a position wherein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a driver for said surgical staples and a cylindri-cal scalpel located within said casing and means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil surface to drive said surgical staples through the tubular body organs ~to be joined to clinch said surgical staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting :, '`
, . . .
115~11G
6a a working gap of said instrument, said anvi.l being of button-like configura-tion and comprising a body portion of lesser transverse dimension than the diameter of said staple containing casing, near one end said body portion flaring outwardly to form a thin annular flange having a maximum diameter substantially the same as the diameter of said casing, said end of said anvil having said flange comprising said anvil surface.
According to a further aspect of the invention there is provided an anvil having an anvil surface for use with a surgical stapling instrument of the type employed to join together tubular body organs and of the type having a cylindrical casing containing at least one annular array of surgical staples, means to support and shift said anvil between a position wherein said anvil surface is adjacent said casing and a position wherein said~anvil surface is spaced from said casing~ a driver for said surgical staples and a cylindrical scalpel located within said casing and means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil surface to drive said surgical staples through the tubular body organs to be joined, to clinch said surgical staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting a working gap of said instrument, said anvil surface having at least one annular array of pairs of anvil pockets formed therein, the number of anvil pocket pairs being equal to the number of said surgical staples mounted in said casing, each of said surgical staples comprising a U-shaped element having a pair of legs joined by a crown portion, the anvil pockets of each pair bei.ng mirror images of each other and being spaced from each other so ~as to each receive one of the legs of the same surgical staple, the pockets of a pair both comprising elongated depressions each having a first longi-tudinal curved large radius bottom surface portion to be first contacted ~, ~
6b by their respective staple legs to bend said legs toward each other and a second longitudinal curved bottom surface portion of lesser radius to cause said legs to form oppositely directed curves so that said staple achieves a B-shaped configuration, whereby staples of a single leg length will be adequately clinched at any distance between said anvil surface and said casing within said working gap.
_IEF DESCRIPTION OF TIIE DRAWINGS
Figure 1 is a fragmentary side elevational view of the intra-lumenal anastomosis surgical stapling instrument of the present invention.
Figure 2 is a fragmentary longitudinal cross sectional view of the instrument of Figure 1.
~15~
Figure 3 is an end elevational view of the forward end of the staple-containing casing.
Figure 4 is an end elevational view oE the anvil and anvil nut assembly, ~iewed from that end which faces the staple-containing casing.
Figure 5 is an enlarged, fragmentary, longitudinal cross sectional view of the distal end of the instrument illustrating the staple-containing casing and the anvil assembly.
Figure 6 is a fragmentary view illustrating the arrangement of organs on the instrument prior to placing an end-to-end anastomosis.
Figure 7 is a fragmentary cross sectional view of the completed end-to-end anastomosis of Figure 6.
Figure 8 is an elevational view of a surgical staple for use with the instrument of the present invention.
Figure 9 is an elevational view of a staple of the instrument of the present invention formed at its maximum height.
Figure 10 is an elevational view of a surgical staple of the instrument of the present invention formed at its minimum height.
Figure 11 is a fragmentary plan view of a cooper-ating pair of anvil pockets in the anvil of the instru-ment.
Figure 12 is a fragmentary cross sectional view taken along section line 12-12 of Figure 11.
Figure 13 is a fragmentary cross sectional view taken along section line 13-13 of Figure 12.
BEST MODE OF CARRYING OUT THE INVENTION
~eference is first made to Figures 1 and 2 in which like parts have been given like index numerals. The instrument of the present invention is generally indicated at 1 and comprises an elongated body 2 having a tubular housing portion 3 and a coaxial cylindrical handle portion 4 of slightly larger diameter.
1~5~
While the surgical stapling instrument of the present invention can be constructed as a reusable, sterilizable instrument, it lends itself well to manu-facture as a single-use, disposable instrument. For purposes of an exemplary showing it will be described in its disposable form wherein its parts are made of metal and plastic suitable for use in a surgical en-vironment and capable of being sterilized by autoclave, ethylene oxide, irradiation or other standard methods.
The body 2 is made up of two mirror image halves molded of plastic material and firmly welded together by means well known in the art. One of the body halves is shown at 2a in Figure 1, while the other body half is shown at 2b in Figure 2. Aside frcm being mirror images of each other, the body halves are otherwise substantially identical.
At its distal end, the tubular housing portion 3 of body 2 mounts a cylindrical staple-containing casing 5 which will be described hereinafter.
An adjustment rod 6 is mounted within the body 2 and extends axially thereof. ~he distal end of adjustment rod 6 extends beyond casing 5 and has an anvil assembly, generally indicated at 7, affixed thereto. The anvil assembly 7 will be described hereinafter.
At the proximal end of handle portion 4 of body 2 there is rotatively mounted an adjusting knob 8. The adjusting knob 8 is a hollow cylindrical member having a first portion 8a extending beyond the proximal end of handle portion 4. Adjusting knob 8 has a second portion 8b of a lesser outside diameter. The outside diameter of portion 8b is such as to be just nicely received within handle portion 4 and to be rotatable therein. The adjusting knob 8 has a third portion 8c of yet smaller diameter. The portion 8c has a threaded lL 15~1 ~6 g bore 9 extending therethrough.
~ s indicated aboye, adjustment knob 8 i3 rotatiYely mounted within handle portion 4 of body 1. To maintain the adjusting knob 8 in position within handle portion 4, the body halves 2a and 2b are provided with cooperating, annular, interior flanges. The interior flange of body half 2b is illustrated at 10. It will be understood that the body half 2a has a sim~lar, aligned annular lnterior flange (not shown). The annular flange 10 of body half 2b and the cooperating annular flange of body half 2a abut a forward shoulder 11 of adjusting knob 8 formed between its portions 8b and 8c. Similarly, a shoulder 12 formed between adjustment knob portions 8a and 8b abuts the proximal end of handle portion 4. Finally, adjusting knob 8 ls provided with an annular notch 13, while the interior of handle portion 4 is provided with a matching notch 14. A washer 15 is located in notches 13 and 14 to preclude axial shifting of adjusting knob 8.
While not required, for reasons which will become apparent hereinafter, the adjusting knob 8 is prefer-ably molded of clear plastic. Mounted on its exterior adjacent the proximal end of handle portion 4 there is a ring scale 16. The handle portion 4, adjacent ring scale 16 has a index mark 17 formed thereon. The purpose of ring scale 16 and index mark 17 will be described hereinafter.
The rearward or proximal end of adjusting rod 6 is threaded as at 18. The threaded portion 18 of 1 30 adjusting rod 6 is engaged in the threaded bore 9 of adjusting knob 8. Each body half 2a and 2b has formed on its interior surface an elongated channe~ or slot.
115~ 6 The channel or slot in body half 2b is shown in broken lines at 19. The identical slot formed on body half 2a is not shown, but when the body hal~es are joined together, the slot 19 and its counterpart on bo~y half 2a will be diametrically opposed. Adjusting rod 6 has a transverse perforation 20 formed therein. A
pin 21 extends through the transverse perforation and the free ends of the pin 21 are slidably engaged in the slot 19 of body half 2b and the similar slot of body half 2a. As a result, pin 21 precludes rotatlon of adjusting rod 6. It will be evident, however, that as adjusting knob 8 is rotated in one direction, its threaded engagement with adjusting rod 6 will cause the adjusting rod to shift axially of body 1. This, in turn, will cause anvil assembly 7 to shift away from staple-containing casing 5. Rotation of adjusting knob 8 in the opposite direction will cause axial shifting of adjusting rod 6 in the opposite direction with the result that anvil assembly 7 will shift toward staple-containing casing 5.
A cylindrical, hollow driver tube 22 is slidablyand coaxially mounted on adjusting rod 6. Driver tube 22 mounts at its distal end a staple driver and a scalpel to be described hereinafter. Near its proximal end the dri~er tube has an annular array of inwardly extending dimples, one of which is shown at 23. In similar fashion, the driver tube 22 is provided with an annular array of dimples near its distal end, one of which is shown at 24. The driver tube 22 is axially shiftable with respect to the instrument body 1 and the adjusting rod 6, and the arrays of dimples 115~1~6 23 and 24 proYide low friction guide means for the driver tube 22 with respect to the adjusting rod 6.
Affixed to the proximal end of driver tube 22 there is a cylindrical spool 25 having annular flanges 25a and 25b at its ends. Body halves 2a and 2b have downwardly depending extensions 26 (see Figure 1) and 27 (see Figure 2), respectively. A lever 28 is pivotally mounted on a pin 29, the ends of which are mounted in extensions 26 and 27. The upper portion of lever 28 is bifurcated and terminates in a pair of lobes, one of which is shown in Figure 2 at 30. The lobes are adapted to lie to either side of spool 25 between the annular spool flanges 25a and 25b. As a result, when lever 28 is squeezed toward handle portion 4 of body 2, the lobes thereof, cooperating with spool 25, will cause the driver tube 22 to shift axially and forwardly of adjusting rod 26.
At the proximal end of the tubular housing portion 3 of body 2 the body halves 2a and 2b are provided with mating internal annular flanges. The internal annular flange of body half 2b is shown at 31 in Figure 2. The matching annular flange of body half 2a is not shown. The driver tube 22 carries a pair of loosely mounted washers 32 and 33. These washer serve as abutments for the ends of a compression spring 34 mounted on driver tube 22. Washer 32 normally lies in abutment with flange 31 and its counterpart on body half 2a while washer 33 normally abuts the flange 25a of spool 25. In this manner, compression spring 34 serves as a return spring biasing driver tube 22 and lever 28 to their normal unactuated positions as illustrated in Figures 1 and 2.
1~
The instrument 1 is provided with a slide safety lockout 35 to prevent inadvertent actuation of lever 28 and driver tube 22. To this end, body half 2b is provided with a slot 36 just behind the downwardly depending extension 27. The body half 2a is provided with a matchlng slot (not shown). The slide safety lockout 35 is captively and slidably mounted in the slot. The slide safety lockout 35 has a shoulder 37 which engages body half 2b above slot 36. Slide safety lockout 35 will have a similar shoulder (not shown) on it other side to similarly engage body half 2a.
At its rearward end, the slide safety lockout 35 has a portion 38 engagable by the thumb or finger of the surgeon to shift the lockout 35 into and out of its lockout position. At its forward end, the slide safety lockout 35 has a nose portion 39 adapted to engage shoulders formed on the bifurcated portion of lever 28 to prevent actuation of the lever. One such shoulder is shown at 40 in Figure 2. In Figure 2 the slide safety lockout 35 is shown in its lockout position preventing actuation of lever 28. It will be apparent from Figure 2 that the slide safety lock-out 35 can be shifted rearwardly so that its nose 39 no longer engages the lever shoulders (one of which is shown at 40) so that the lever is free to be actuated.
Reference is now made to Figures 2, 3 and 5 wherein like parts have been given like index numerals. The forwardmost end 41 o~ tubular housing portion 3 of body 1 is of reduced diameter. The tubular body portion 3 has an annular flange 42 formed adjacent reduced diameter portion 41 so as to define a shoulder 43.
B
The cylindrical casing 5 comprises a hollow member and has at its rearward end an axial bore 44 adapted to just nicely re~eive the reduced diameter portion 41 of tubular housing portion 3 with the rearward end of casing 5 in abutment against shoulder 43. In addition, to assure that casing 5 is in the correct rotative position (so that the staples located therein are in proper alignment with the anvil pockets on the anvil assembly 7) the reduced diameter portion 41 of tubular housing portion 3 may be provided with a plur-ality of evenly spaced keys (two of which are shown at 45 and 46 while the bore 44 of casing 5 is provided with matching keyways, two of which are shown at 47 and 48. Casing 5 may be molded of plastic material and glued or welded to reduced diameter portion 41 and to flange 42.
Permanently affixed (by gluing, welding or the like) to the inside surface of staple-containing casing 5 there is a staple guide 49. Staple guide 49 may be molded of plastic material.
As is evident from Figure 3, the staple guide 49 has a first annular array of channels 50, each con-taining a staple 51 and a second annular array of channels 52, each containing a staple 53. The second annular array of channels 52 is located within the first annular array of channels 50 and is staggered with respect thereto. Therefore, the instrument is capable of implanting a double sta~gered row of staples in concentric pattern.
The forwardmost end of driver tube 22 has a reduced portion 22a forming a shoulder 54. Mounted on the reduced portion 22a there is a washer 55 and an annular staple driver 56. Staple driver 56 has a first annular array of tines 57 each of which is aligned with and extends into one of the channels 50 of staple guide 49. Similarly, staple driver 56 has a second annular array of tines 58, each of which extends into one of the channels 52 of staple guide 49. It will be evident that when the driver tube 2~
is shifted forwardly by lever 28, the tines 57 and 58 of driver 56 will drive staples 51 and 53 from their respective channels 50 and 52, through the tissue being joined and against anvil assembly 7 to be described hereinafter. A cylindrical scalpel 59 is also mounted on the smaller diameter portion 22a of driver tube 22.
The forwardmost end of the portion 22a is upset, there-by captively mounting washer 55, staple driver 56 andscalpel 59 thereon. The forwardmost annular edge of scalpel 59 has an inside bevel 59a formed thereon to provide a cutting edge. Washer 55 assures that the driver 22 imparts uniform force to staple driver 56 and cylindrical scalpel 59. Furthermore, abutment of washer 55 against the end of forwardmost portion 41 of body 2 determines the normal unactuated positions of driver tube 22 and lever 28.
Reference is now made to Figures 4 and 5 wherein the anvil assembly 7 is most clearly shown. The anvil assembly comprises an anvil 60, and an anvil nut 73.
The anvil 60 is a cylindrical member, the rearward end of which is open and the forward end of which is closed except for an axial perforation 63 therethrough.
As is most clearly seen in Figure 4, perforation 63 is circular in peripheral configuration except for a flat 64, the purpose of which will be descri~ed here-inaf~er. The rearward end of anvil 60 is provided with a thin annular flange 65 which presentSa flat annular surface 66 facing toward staple-containing :l 1 5 ~
casing 5. The outer peripheral edge of flange 65 is rounded as at 67 and the forward surface 68 of flange 65 slopes forwardly and inwardly. As a result, the anvil 60 has a button-like cross section, the importance of which will be evident hereinafter.
The rearward flat surface 66 of anvil flange 65 is provided with a first annular array of pairs of anvil pockets 69a-69b, each pair of pockets adapted to cooperating with the legs of one of the staples 51.
In similar fashion, anvil surface 66 is provided with a second annular array of pairs of anvil pockets 70a-70b, each pair of pockets 70a-70b being adapted to cooperate with the legs of one of the staples 53. As the driver 56 and its tines 57 and 58 drive staples 51 and 53 from channels 50 and 52, through the tissue to be joined and against anvil 60, the pocket pairs 69a-69b and 70a-70b will cause the legs of staples 51 and 53 to be properly crimped, as will be further described hereinafter. A semi-rigid washer 71 is located within anvil 60 to serve as a back-up structure for cylindrical scalpel 59.
The forwardmost end 72 of adjusting rod 6 is of reduced diameter and is externally threaded. The threaded portion 72 has a flat 72a formed thereon which corresponds to the flat 64 of anvil perforation 63.
Thus, when anvil 60 is mounted on portion 72 of adjusting rod 6, cooperation of flats 64 and 72a will assure that anvil pockets 69a-69b and 70a-70b will be properly aligned with the staple containing channels 50 and 52 of staple guide 49. This is true since keys 45 and 46 and keyways 47 and 48 determine the rotative position of staple-containing casing 5 and thus staple guide 49 affixed thereto and pin 21 precludes rotation of adjusting rod 6.
B
Anvil 60 is re~ovably affixed to the threaded por-tion 72 of adjustin~ rod 6 by an anvil nut 73. ~nvil nut 73 may be molded of plastic or the like and is provided with an axial metalllc insert 74. Metallic insert 74 has an axial bore 75 which is internally threaded so as to be engageable on threaded portion 72 of adjusting rod 6. ~hen anvil nut 73 is in place, the anvil 60 will be in abutment with a shoulder 76 on adjusting rod 6 formed by the smaller diameter threaded portion 72.
Anvil nut 73 is preferably frusto-conical in con-figuration to assist in insertion thereof into the tubular body members to be joined. The exterior surface of anvil nut 73 may be provided with a plurality of longitudinally extending grooves or flutes 77 to render it more easily graspable by the surgeon. This will render the anvil nut 73 and anvil 60 more readily removable during certain surgical procedures such as end-to-side and side-to-end anastomosis, as is well known in the art.
The forward end of adjusting rod 6 is provided with an axial bore 78 leading to a lateral or trans-verse bore 79. The bore 75 in metallic insert 74 of anvil nut 73 extends completely through the metallic insert and is coaxial with bore 78. In similar fashion, the forwardmost end of the plastic portion of anvil nut 73 has bore 80 formed therein, coaxial with and communicating with bore 75 of metallic insert 74 and bores 78 and 79 of adjusting rod 6. This series of bores constitutes a Yent passage, the purpose of which will be described hereinafter.
To complete the stucture, the rearwardmost portion 81 of the proximal end of adjusting rod 6 is unthreaded 115~
and mounts ~ cap-like indicator 82. Indicator 82 gives both a tactile and visual indication that the space between anvil 60 and staple-containing casing 5 is within the working or operating gap of the instrument, as will be apparent hereina~ter.
The instrument of the present invention having been described, its use and operation may be set forth as follows. For purposes of an exemplary description, the operation of the instrument will be set forth with respect to a simple end-to-end anastomosis procedure and reference is made to Figures 2, 5 and 6.
At the outset, the anvil 60 is preferably so located that its flat annular surface 66 is in abutment or near abutment with staple-containing casing 5 and staple guide 49. Furthermore, the slide safety lockout 35 should be in its lockout position to prevent inadvertent actuation of lever 28.
In Figure 6 two tubular body organs or lumens 83 and 84 to be joined are illustrated. At the time of the end-to-end anastomosis procedure, the distal end of the instrument is inserted into lumen 83 either through a natural opening in the patient's body, if possible, or through an incision made in the side of lumen 83 remote from the anastomotic site. When casing 5 reaches the position shown with respect to lumen 83 in Figure 6, the adjusting knob 8 is rotated by the surgeon to cause anvil 60 to shift away from casing 5. The end of lumen 83 is then tied ~bout the exposed portion of adjusting rod 6 by means of a simple purse string suture 85, as is shown in Figure 6.
Thereafter, anvil assembly 7 is inserted in lumen 84 and lumen 84 is tied about the exposed portion of adjusting rod 6 by a purse string suture 86, as shown 115~
1~
Once the lu~ens 83 and 84 have been tied to the instrument in the manner shown in Figure 6, the next step is to set the proper gap between casing 5 and surface 66 of anvil 60 in order to join the lumens by means of the surgical staples. Prior to the anastomotic procedure, the surgeon will have measured the thickness of the tissue of lumens 83 and 84 using a tissue thickness measuring instrument of the type set forth in the above mentioned copending application.
The tissue thickness to be joined is, of course, the sum of the tissue thickness of lumen 83 and lumen 84.
With this value in mind, the proper gap between staple-containing casing 5 and the surface 66 of anvil 60 can be set by the surgeon in the following manner.
First of all, adjusting knob 8 is rotated in a direction to cause surface 66 of anvil 60 to approach the distal end of casing 5. Rotation of adjusting knob 8 is continued until the rearward end of indicator 82 becomes substantially coplanar with the rearward end of adiusting knob 8. This can be ascertained both by feel and visually. If adjusting knob 8 is made of clear plastic, the surgeon can readily watch the indicator 82 approach this coplanar position.
The length of adjusting rod 6 is such that when the rearward end of indicator 82 is coplanar with the end of adjusting knob 8, the surgeon can be assured that the maximum spacing between casing 5 and the surface 66 of anvil 60 within the operating gap of the instrument has been achieved. At this point, the surgeon utilizes the ring scale 16 and index mark 17 to set the final gap in accordance with the tissue ~1561-~
'19 thickness ~easurement previously made.
Once the final gap has been achieved, the slide safety lockout 35 is shifted to its rçarward or non-locking position and the surgeon squeezes lever 28 towar~ handle portion 4 of instrument bo~.y 2. The engagement of the lobes (one of which is shown at 30 in Figure 2) of lever 2~ with spoo] 25 will cause driver tube 22 to shift forwardly with respect to adjusting rod 6. This,in turn, will cause driver 56 10 and its tines 57 and 58 to drive staples 51 and 53 from their respective staple guide chanr.els 50 and 52.
The staples will pass through the tissue of lumens 83 and 84 and the legs of each staple will thereupon enter their respective anvil pocket pairs 69a-69b and 70a-70b to be clinched. Since the surgeon is working at a gap within the operating gap of the instrument, adequate clinching of the staples is assured. Washer 54 further assures that the clinching force imparted by driver 56 will be unifor~ with respect to all of the staples 51 and 53.
As will be evident from Figures 2 and 5, the cylindrical scalpel 59 is offset rearwardly with respect to staples 51 and 53. As a xesult, scalpel 59 will not begin to cut through the tissue of lumens ~3 and 84 until sufficient clinching of the staples has been accomplished. The purpose of cylindrical scalpel 59 is to excise that portion of the tissue of lumens S3 and 84 which is tied to adjusting rod 6. The inside bevel 59aprovides a more parallel cut and also forces the excised tissue into the scalpel W~sher 54 also insures that unifor~ force is applied about the cylindrical cutting edge of scalpel 59.
115~
Semi ~igid washer 71, located within anvil 60 acts as a cutting board for cyllndrical scalpel 59, supporting the tissue being cut. The washer is located flush with an~il surface 66 so as to minimize stretch or pull on the tissue being cut.
The stapling and cutting steps having been performed, it is now necessary to remove the instrument from the anastomotic site. In order to do this, adjusting knob 8 is turned in such a direction as to cause anvil 60 to move away from casing 5. This shifting of anvil 60 to open the gap would produce a partial vacuum due to the piston affect causing the joined lumens to collapse into the gap. This is prevented by the vent system comprising bor~s 80, 75, 15 78 and 79, described above with respect to Figure 5.
Once the anvil assembly 7 is remote from casing 5, the instrument can be removed. This removal requires that the anvil assembly 7 pass through the hole left in the joined organs by cylindrical scalpel 59. This hole is smaller than the original internal diameters of the two organs. The above noted button-configuration of anvil 60 allows the stapled anastomosis to be slipped over a portion of flange 65 while the remainder of the stapled anastomosis approaches adjusting rod 6. By circling the anastomosed tissue about the button-shaped flange 65, the anvil assembly 7 can be brought through the anastomotic site without undue strain on ~he tissue or the staple lines. The instrument can thereafter readily be removed from lumen 83 and the anastomGtic procedure is complete. The completed anastomosis i5 illustrated in Figure 7.
As indicated above, the organs of the human alimentary canal are of varylng diameters and wall 115~
thicknesses even in the same patient. It is therefore desirable th~t the instrument of the present inventi~n be made available with staple-containing casings of different external diameters. While not intended to be so limited, it has been found that if the instrument is made available with staple-containing casings having external diameters of 21mm, 25mm, 28mm, and 33mm, most of the internal diameters of the organs of the human alimentary canal will be covered. The instrument may, of course, be made with staple-containing casings 5 of smaller or larger diameters.
The number of staples in the staple-containing casing is dependent upon the external diameter of the casing. Studies have shown that the staples 51 of the outer annular array and the staples 53 of the inner annular should o~erlap slightly, as shown in Figure 3, to insure a hemostatic and leak-free closure. However, if the staples 51 and 53 are placed too close together, the blood supply will be comprised and affect healing.
Furthermore, if the staples 51 and 53 are arranged too close together, there is less elasticity left in the stapled anastomosis and this renders the instrument more difficult to remove from the anastomotic site.
There is also an optimum margin of tissue that must be left between the inner annular array of staples 53 and the cylindrical scalpel 59 since all living tissue retracts when cut.
It will be understood that the instrument 1 of the present invention can be designed with any appropriate operating gap, depending upon its ultimate use. While not intended to be so limited, lt has been found that if the instrument 1 is proyided with a operating gap of from 1 to 3~m, it can be used in con;unction with substantially all of the organs of the human alimentar~
canal. In an exemplary working embodiment of the instrument 1 designed to have a working gap of 1 to 3mm, the ring scale 16 was graduated from 0 to 3mm ln 0.5mm increments. At the point where the mark indicated as 3m~ on ring scale 16 was aligned with index mark 17 on the instrument handle portion 4, the rear surface of indicator 82 was coplanar with the rear end of adjusting knob 8, indicating that the maximum value of the oper-ating gap had been achieved.
The instrument of the present invention can be used with one size of surgical staple throughout its operating gap. Thi~ is made possible by the configur-ation of the anvil pockets 69a-69b and 70a-70b which tend to form the surgical staples 51 and 53 into "B"
shaped configurations. An exemplary surgical staple 51 is illustrated in Figure 8. As indicated above, staples 51 and 53 of the two annular arrays are identical.
In its initial form, staple 51 has an inverted "U" shape with a substantially horizontal crown portion 51a and downwardly depending legs 51b and 51c. The free ends of legs Slb and 51c are cut at a downwardly and inwardly sloping angle so as to form tissue-penetrating points 51d and 51e. As the surgical staple 51 is advance by staple driver 56 through the tissue to be joined and into a pair of anvil pockets 69a and 69b, the legs 51b and 51c will be clinched toward each other in a curved configuration. Figure 9 illustrates the staple of ~igure 8 in its fully formed position at the maxlmum ~alue of the working gap of instrument 1.
115~
Figure 10 illustrates the staple of Figure 8 in its final configuration when form~d at the minimum value of the operating gap of instrument 1. In the exemplary embodiment described above wherein the instrument 1 had an operating gap of 1 to 3mm, it was found that the surgical staples 51 and 53 would perform as indicated in Figures 9 and 10 when provided with a leg length of about 5.5mm, or about 0.216 inches.
Figures 11, 12 and 13 illustrate an exemplary pair of anvil pockets 69a and 69b. It will be understood that all of the pocket pairs 69a-69b are identical and that all of the pocket pairs 70a and 70b are also identical to pocket pairs 69a and 69b.
As is evident from Figures 11 through 13 and Figure 4, the pocket pairs 69a and 69b are formed in the flat rearwardly facing surface 66 of anvil 60.
Anvil pocket 69a and anvil pocket 69b are mirror images of each other, and are otherwise identical.
Taken together, the anvil pockets 69a and 69b are somewhat lo~ger than the staple crown (i.e., the width of the staple) to enable manufacturing with reasonable tolerance. In Figure 12, this is shown by virtue of the fact that the legs 51b and 51c of a staple 51 (Figure 8) are shown in broken lines in their initial positions, just entering pockets 69a and 69b. As will be evident from Figure 13, the sides of pockets 69a and 69b slope inwardly and downwardly to allow for radial tolerance and to urge the staple legs 51b and 51c toward the center of their respective pockets at the deepest portion thereof.
Turning to ~igure 12, the pockets 69a and 69b have first longitudinally extending large radius portions 69c and 69d, respectively. These large radius 115~
portions cooperate with the points 51d and 51e of staple legs 51b and 51c, respectively, to cause them to bend toward each other. Anvil pockets 69a and 69b also have longitudinally extending smaller radius portions 69e and 69f, respectively. As the staple legs 51b and 51c are driven further toward anvil 60, small radius anvil pocket portions 69e and 69f will cause the staple legs 51b and 51c to for~ a radius of curvature of their own. ~he gap setting of instru-ment 1 will determine the ultimate configuration of thestaple 51 between that shown in Figure 9 and that shown in Figure 10, as described above. At all gap settings within the working gap of the instrument, the staple 51 will be formed into a B-shaped configuration.
To enable the instrument 1 of the present invention to utilize surgical staples of a single leg length throughout the working gap of the instrument, the essential elements include the leg length, wire diameter and tensile strength of the surgical staple 51 and the contour of anvil pockets 69a and 69b. In an exemplary working embodiment, the staple 51 was made of stainless steel having a wire diameter of about 0.011 inch, a tensile strength of from about 150,000 to about 160,000 psi and a leg length of about 0.216 inch.
Anvil pockets 69a and 69b had an overall length, including the space therebetween, of about 0.182 inch, each of pockets 69a and 69b having a maximum width of about 0.028 inch and a maximum depth of about 0.015 inch. The large radius portions 69c and 69d had a radius of about 0.081 inchO The smaller radius portions 69e and 69f each had a radius of about 0.035 inch. In this working embodiment, staples 51 were successfully and reliably formed into acceptable B-shapes throughout a working gap of from.l to 3 mm.
~ .odifications may be made in the inverltion without departing from the spirit of it. For example, ring scale 16 could be mounted on the end of instrument body
2 adjacent adjustment knob ~ and adjustment knob 8 could carry indicator mark 17.
Claims (29)
PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A surgical stapling instrument of the type used to join together tubular body organs, said surgical stapling instrument comprising an elongated body having first and second ends, a cylindrical casing affixed coaxially on said first end of said body, at least one annular array of surgical staples mounted within said casing, an adjusting rod coaxially mounted within said body and said casing, said adjusting rod having a first end extending beyond said casing, an anvil mounted on said first end of said adjusting rod, said anvil having an anvil surface facing said casing, an adjustment knob mounted at said second end of said body, said adjustment knob being hollow, said adjusting rod being operatively connected to said adjustment knob, said adjusting rod and said anvil being axially shiftable by operation of said adjustment knob between a position wherein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a staple driver and a cylindrical scalpel located within said casing, means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil to drive said staples through said tubular body organs to be joined, to clinch said staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting a working gap of said instrument, said adjusting rod having a second end located within said hollow adjustment knob, indicator means mounted on said second end of said .
adjusting rod and being so configured as to give both visual and tactile indications that the distance between said anvil surface and said casing is at and within said working gap, a scale in association with one of said adjustment knob and said second end of said body and a cooperating indicator mark on the other of said adjust-ment knob and said second end of said body enabling final adjustment of said distance between said anvil surface and said casing within said working gap according to the thickness of the tissue of the tubular body organs being joined.
adjusting rod and being so configured as to give both visual and tactile indications that the distance between said anvil surface and said casing is at and within said working gap, a scale in association with one of said adjustment knob and said second end of said body and a cooperating indicator mark on the other of said adjust-ment knob and said second end of said body enabling final adjustment of said distance between said anvil surface and said casing within said working gap according to the thickness of the tissue of the tubular body organs being joined.
2. The structure claimed in claim 1 wherein said means to shift said driver and scalpel comprises a hollow driver tube slidably mounted on said adjusting rod and having first and second ends, said scalpel and said driver being mounted at said first end of said driver tube, a lever pivotally affixed to said instrument body, said lever being operatively connected to said second end of said hollow driver tube, said lever being pivot-able and said driver tube being shiftable thereby from a normal position wherein said scalpel and driver are in their retracted positions to an actuated position wherein said scalpel and said driver are shifted toward said anvil, and resilient means biasing said lever and said driver tube to said normal position.
3. The structure claimed in claim 1 including first and second concentric annular arrays of surgical staples in said casing, said arrays being circumferentially offset with respect to each other.
4. The structure claimed in claim 1 wherein said hollow adjustment knob has an annular rearward end, said indicator means on said second end of said adjusting rod has a rearward surface so located as to be flush with the rearward end of said adjustment knob when said distance between said anvil surface and said casing is at the maximum of said working gap and as to extend rearwardly beyond said rearward end of said adjustment knob when said distance between said anvil surface and said casing is within said working gap.
5. The structure claimed in claim 1 wherein said anvil is removably affixed to said first end of said adjustment rod.
6. The structure claimed in claim 1 wherein said anvil is of button-like configuration comprising a body portion of lesser transverse dimension than the diameter of said staple containing casing, near one end said body portion flares outwardly to form a thin annular flange having a maximum diameter substantially the same as the diameter of said casing, said end of said anvil having said flange comprising said anvil surface.
7. The structure claimed in claim 1 including an axial bore in said adjusting rod extending from said first end of said adjusting rod and terminating in a transverse bore forming an opening in the side of said adjusting rod, said axial bore being of such length that when said tubular body organs are joined by said surgical staples said axial and said transverse bores comprise a vent passage to equalize the pressure on either side of said joinder of said tubular body organs.
8. The structure claimed in claim 1 wherein said anvil surface has at least one annular array of pairs of anvil pockets formed therein, the number of anvil pocket pairs being equal to the number of said surgical staples mounted in said casing, each of said surgical staples comprising a U-shaped element having a pair of legs joined by a crown portion, the anvil pockets of each pair being mirror images of each other and being spaced from each other so as to each receive one of the legs of the same surgical staple, the pockets of a pair both comprising elongated depressions each having a first longitudinal curved large radius bottom surface portion to be first contacted by their respective staple legs to bend said legs toward each other and a second longitudinal curved bottom surface portion of lesser radius to cause said legs to form into oppositely directed curves so that said staple achieves a B-shaped configuration whereby staples of a single leg length will be adequately clinched at any gap setting within said working gap.
9. The structure claimed in claim 2 including releasable lockout means to lock said lever in its normal position.
10. The structure claimed in claim 2 wherein said hollow adjustment knob has an annular rearward end, said indicator means on said second end of said adjusting rod has a rearward surface so located as to be flush with the rearward end of said adjustment knob when said distance between said anvil surface and said casing is at the maximum of said working gap and as to extend rearwardly beyond said rearward end of said adjustment knob when said distance between said anvil surface and said casing is within said working gap.
11. The structure claimed in claim 4 wherein said adjustment knob is transparent, said adjusting rod indicator being visible therethrough.
12. The structure claimed in claim 6 wherein said anvil end having said flange has a central depres-sion formed therein, a washer-like member of semi-rigid material being mounted in said depression and comprising backing means for said cylindrical scalpel.
13. The structure claimed in claim 6 wherein said anvil surface has at least one annular array of pairs of anvil pockets formed therein, the number of anvil pocket pairs being equal to the number of said surgical staples mounted in said casing, each of said surgical staples comprising a U-shaped element having a pair of legs joined by a crown portion, the anvil pockets of each pair being mirror images of each other and being spaced from each other so as to each receive one of the legs of the same surgical staple, the pockets of a pair both comprising elongated depressions each having a first longitudinal curved large radius bottom surface portion to be first contacted by their respective staple legs to bend said legs toward each other and a second longitudinal curved bottom surface portion of lesser radius to cause said legs to form into oppositely directed curves so that said staple achieves a B-shaped configuration whereby staples of a single leg length will be adequately clinched at any gap setting within said working gap.
14. The structure claimed in claim 8 including said first and second concentric annular arrays of surgical staples in said casing, said annular arrays of surgical staples being circumferentially offset with respect to each other, said anvil having first and second concentric annular arrays of pairs of anvil pockets, said annular arrays of anvil pocket pairs being circumferentially offset with respect to each other such that each anvil pocket pair is aligned with one of said surgical staples in said casing.
15. The structure claimed in claim 10 wherein said anvil is of button-like configuration comprising a body portion of lesser transverse dimension than the diameter of said staple containing casing, near one end said body portion flaring outwardly to form a thin annular flange having a maximum diameter substantially the same as the diameter of said casing, said end of said anvil having said flange comprising said anvil surface.
16. The structure claimed in claim 15 wherein said anvil surface has at least one annular array of pairs of anvil pockets formed therein, the number of anvil pocket pairs being equal to the number of said surgical staples mounted in said casing, each of said surgical staples comprising a U-shaped element having a pair of legs joined by a crown portion, the anvil pockets of each pair being mirror images of each other and being spaced from each other so as to each receive one of the legs of the same surgical staple, the pockets of a pair both comprising elongated depressions each having a first longitudinal curved large radius bottom surface portion to be first contacted by their respective staple legs to bend said legs toward each other and a second longitudinal curved bottom surface portion of lesser radius to cause said legs to form into oppositely directed curves so that said staple achieves a U-shaped configuration whereby staples of a single leg length will be adequately clinched at any gap setting within said working gap.
17. The structure claimed in claim 16 including said first and second concentric annular arrays of surgical staples in said casing, said annular arrays of surgical staples being circumferentially offset with respect to each other, said anvil having first and second concentric annular arrays of pairs of anvil pockets, said annular arrays of anvil pocket pairs being circumferentially offset with respect to each other such that each anvil pocket pair is aligned with one of said surgical staples in said casing.
18. The structure claimed in claim 17 including an axial bore in said adjusting rod extending from said first end of said adjusting rod and terminating in a transverse bore forming an opening in the side of said adjusting rod, said axial bore being of such length that when said tubular body organs are joined by said surgical staples said axial and said transverse bores comprise a vent passage to equalize the pressure on either side of said joinder of said tubular body organs.
19. The structure claimed in claim 18 including releasable lockout means to lock said lever in its normal position.
20. The structure claimed in claim 19 wherein said adjustment knob is transparent, said adjusting rod indicator being visible therethrough.
21. An anvil having an anvil surface for use with a surgical stapling instrument of the type employed to join together tubular body organs and of the type having a cylindrical casing containing at least one annular array of surgical staples, means to support and shift said anvil between a position wherein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a driver for said surgical staples and a cylindrical scalpel located within said casing and means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil surface to drive said surgical staples through the tubular body organs to be joined to clinch said surgical staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting a working gap of said instrument, said anvil being of button-like configuration and comprising a body portion of lesser transverse dimension than the diameter of said staple containing casing, near one end said body portion flaring outwardly to form a thin annular flange having a maximum diameter substantially the same as the diameter of said casing, said end of said anvil having said flange comprising said anvil surface.
22. The structure claimed in claim 21 wherein said anvil end having said flange has a central depression formed therein, a washer-like member of semi-rigid material being mounted in said depression and comprising backing means for said cylindrical scalpel.
23. An anvil having an anvil surface for use with a surgical stapling instrument of the type employed to join together tubular body organs and of the type having a cylindrical casing containing at least one annular array of surgical staples, means to support and shift said anvil between a position wherein said anvil surface is adjacent said casing and a position wherein said anvil surface is spaced from said casing, a driver for said surgical staples and a cylindrical scalpel located within said casing and means to shift said staple driver and said scalpel from a retracted position within said casing toward said anvil surface to drive said surgical staples through the tubular body organs to be joined, to clinch said surgical staples against said anvil surface and to sever excess portions of said tubular body organs over a range of distances between said anvil surface and said casing constituting a working gap of said instrument, said anvil surface having at least one annular array of pairs of anvil pockets formed therein, the number of anvil pocket pairs being equal to the number of said surgical staples mounted in said casing, each of said surgical staples comprising a U-shaped element having a pair of legs joined by a crown portion, the anvil pockets of each pair being mirror images of each other and being spaced from each other so as to each receive one of the legs of the same surgical staple, the pockets of a pair both comprising elongated depressions each having a first longitudinal curved large radius bottom surface portion to be first contacted by their respective staple legs to bend said legs toward each other and a second longitudinal curved bottom surface portion of lesser radius to cause said legs to form oppositely directed curves so that said staple achieves a B-shaped configuration, whereby staples of a single leg length will be adequately clinched at any distance between said anvil surface and said casing within said working gap.
24. The structure claimed in claim 23 wherein said anvil is of button-like configuration comprising a body portion of lesser transverse dimension than the diameter of said staple containing casing, near one end said body portion flaring outwardly to form a thin annular flange having a maximum diameter substantially the same as the diameter of said casing, said end of said anvil having said flange comprising said anvil surface.
25. The structure claimed in claim 23 including first and second concentric annular arrays of surgical staples in said casing, said annular arrays of surgical staples being circumferentially offset with respect to each other, said anvil having first and second concentric annular arrays of pairs of anvil pockets, said annular arrays of anvil pocket pairs being circumferentially offset with respect to each other such that each anvil pocket pair is aligned with one of said surgical staples in said casing.
26. The structure claimed in claim 24 wherein said anvil end having said flange has a central depression formed therein, a washer-like member of semi-rigid material being mounted in said depression and comprising backing means for said cylindrical scalpel.
27. The structure claimed in claim 24 including first and second concentric annular arrays of surgical staples in said casing, said annular arrays of surgical staples being circumferentially offset with respect to each other, said anvil having first and second concentric annular arrays of pairs of anvil pockets, said annular arrays of anvil pocket pairs being circumferentially offset with respect to each other such that each anvil pocket pair is aligned with one of said surgical staples in said casing.
28. The structure claimed in claim 27 wherein said anvil end having said flange has a central depression formed therein, a washer-like member of semi-rigid material being mounted in said depression and com-prising backing means for said cylindrical scalpel.
29. The structure claimed in claim 1 including vent means to equalize the pressure on either side of said joinder of said tubular body organs.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US06/124,954 | 1980-02-26 | ||
| US06/124,954 US4319576A (en) | 1980-02-26 | 1980-02-26 | Intralumenal anastomosis surgical stapling instrument |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1156116A true CA1156116A (en) | 1983-11-01 |
Family
ID=22417584
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000367659A Expired CA1156116A (en) | 1980-02-26 | 1980-12-29 | Intraluminal anastomosis surgical stapling instrument |
Country Status (19)
| Country | Link |
|---|---|
| US (1) | US4319576A (en) |
| JP (2) | JPS56121543A (en) |
| AR (1) | AR225654A1 (en) |
| AT (1) | AT393616B (en) |
| AU (1) | AU542542B2 (en) |
| BE (1) | BE887286A (en) |
| BR (1) | BR8101154A (en) |
| CA (1) | CA1156116A (en) |
| DD (1) | DD160036A5 (en) |
| DE (2) | DE3106490C2 (en) |
| ES (1) | ES498160A0 (en) |
| FR (1) | FR2476477B1 (en) |
| GB (2) | GB2070499B (en) |
| HK (1) | HK69886A (en) |
| IT (1) | IT1144115B (en) |
| MX (1) | MX151314A (en) |
| NL (1) | NL187559C (en) |
| SE (2) | SE458739B (en) |
| ZA (1) | ZA807910B (en) |
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- 1981-01-26 JP JP913281A patent/JPS56121543A/en active Granted
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| WO2018118622A3 (en) * | 2016-12-21 | 2018-08-02 | Ethicon Llc | Staple forming pocket arrangements comprising primary sidewalls and pocket sidewalls |
| EP3338661A3 (en) * | 2016-12-21 | 2018-08-29 | Ethicon LLC | Staple forming pocket arrangements |
| WO2018116005A3 (en) * | 2016-12-21 | 2018-11-22 | Ethicon Llc | Staple forming pocket arrangements |
| CN110475519A (en) * | 2016-12-21 | 2019-11-19 | 爱惜康有限责任公司 | Arrangement of nail-forming pit |
| EP3777713A1 (en) * | 2016-12-21 | 2021-02-17 | Ethicon LLC | Staple forming pocket arrangements comprising primary sidewalls and pocket sidewalls |
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