CA2234148C - Method and anastomotic instrument for use when performing an end-to-side anastomosis - Google Patents
Method and anastomotic instrument for use when performing an end-to-side anastomosis Download PDFInfo
- Publication number
- CA2234148C CA2234148C CA002234148A CA2234148A CA2234148C CA 2234148 C CA2234148 C CA 2234148C CA 002234148 A CA002234148 A CA 002234148A CA 2234148 A CA2234148 A CA 2234148A CA 2234148 C CA2234148 C CA 2234148C
- Authority
- CA
- Canada
- Prior art keywords
- anvil
- elongate member
- stapling
- instrument
- anastomotic instrument
- 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 - Fee Related
Links
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
- A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
-
- 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
- A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
Abstract
When performing an end-to-side anastomosis connecting the end (10) of a firs t vessel (9) to the edge region (12) around an opening in the side wall of a second vessel (11), an instrument (1) is used having a circumferential stapling anvil (3) secured to an anvil tube (2) accommodating the first vess el (9), the end of which is everted about the anvil (3) with the intima of the end region (10) facing the intima of the edge region (12), when the instrume nt (1) with the first vessel (9) in place has been inserted into the opening in the second vessel (11). Then, a clamping tube (5) is advanced towards the anvil (3), clamping the end (10) and edge region (12) together against the anvil (3). In the next step, a number of stapling plungers (6) carrying staples (7) are advanced towards the anvil (3), the latter having staple- bending surfaces (4), thus stapling the two vessels together in a manner not shown. Finally, the clamping tube (5) and the stapling plungers (6) are withdrawn, and the whole instrument removed from the anastomosis.
Description
METHOD AND ANASTOMOTIC INSTRUMENT FOR USE W~-IEN PERFORMING
AN END'-TO-SIDE ANASTOMOSIS
TECHNICAL FIELD
The present invention relates to a method of the kind set forth in the preamble of claim 1.
BACKGROUND ART
A method of this kind is disclosed in the international application having the publication No. WO 95/17128. In this previously known method, the means used for inter-connecting the two vessels consisted of an open springy brace carrying spikes and being capable of being bent elastically so as to make its free ends cross each other, said :pikes forming angles with the brace gradually diminishing from acute angles at the free ends to substantially right angles mid-way between them. When released from the anastomotic instrument holding the brace in the elastically bent condition, it would bring the spikes into engagement with the regions to be joined so as to penetrate the latter and so to speak nail them together.
Extra-clinical trials have, however, shown that one can not always be certain that all the spikes have penetrated through the parts concerned of the two vessels to be joined, this probably being due to the limited elastic force .available from the springy brace.
DISCLOSURE OF THE INVENTION
It is the object of the present invention to provide a method of the kind referred to above, with which it is possible to achieve a more reliable connection between the two vessels forming the anastomosis, and this object is achieved by proceeding as set forth in the characteriz-ing clause of claim 1. With this arrangement, the parts concerned of the two vessels to be joined are connected to each other through a stapling operation based on the same principles as other surgical stapling devices and - inc:identally - ordinary office staplers.
As already indicated above, the use of stapling devices in surgical work is not unknown, but until now only in situations, in which it is possible to move the organ or organs to be operated upon from their normal position in Z5 the patient's body, such as in the abdominal cavity, to a position - not infrequently outside the patient's body - in which the anvil member, against which the staples are bent (corresponding to the lower part of an office stapler), can be placed on the side of the joint concerned facing away from the stapling plungers (corresponding to the p7_unger in the top part of an office stapler). Thus, the present invention is the first to offer what could be called "in-situ stapling". To make this possible, the present invention prescribes the use of an anastomosis instrument capable of performing the following four functions:
a cruidincr function, i.e. guiding the instrument carrying the first vessel into the opening having been formed in the side of the second vessel, :30 - an arranging function, i.a. urging the edge of the opening to the second vessel into a shape and position corresponding to the shape and position of t:he end region of the first vessel preparatory to - a stapling function, in which the parts of the two vessels having been brought into contact through the arranging function are positively joined by a stapling operation, and - a removal function, in which the instrument after S completion of the stapling operation is removed from the joint formed by being luxated out of the pocket formed on the everted end of the first vessel, said pocket then unfolding simultaneously with a slight withdrawal of the first vessel.
At this point it should be emphasized that, using a preferred embodiment of the instrument, in which there is a rigid mechanical connection between the anvil member and the part of the instrument adapted to be gripped manually by the operating surgeon, both the guiding function and the arranging function referred to above may be carried out with the best possible "feel", as the surgeon will be able- to sense manually any objects encountered by the anvil member, including - of course - the second vessel and the anastomotic opening formed therein.
All the functions described above may be carried out without removing the organs concerned through any significant distance away from their normal functional position in the body, making the method according to the invention eminently suitable for coronary by-pass operations. Thus, the expression "in-situ stapling" would appear justified.
The present invention also relates to an anastomotic instrument for carrying out the method according to the invention.
-3a-According to the invention, there is provided an anastomotic instrument, characterized by:
a) a first elongate member, to one end of which is rigidly secured a circumferential anvil member in such a manner, that said first vessel may be placed within said first elongate member with its end region everted about said anvil member with the terminal part of said end region facing towards the opposite end of said first elongate member, b) staple-bending recesses provided in said anvil member and facing towards said opposite end, c) a second elongate member longitudinally moveable relative to said first elongate member and adapted to be moved toward said anvil member so as to make it possible to clamp together therebetween said end region on said first vessel and an edge region on said second vessel, and d) stapling plungers longitudinally moveable relative to said first and second elongate members and adapted to insert staples penetratingly through said clamped end and edge regions into engagement with said stapling-bending recesses so as to bend permanently said staples into a shape, in which they hold said end and edge regions together.
AN END'-TO-SIDE ANASTOMOSIS
TECHNICAL FIELD
The present invention relates to a method of the kind set forth in the preamble of claim 1.
BACKGROUND ART
A method of this kind is disclosed in the international application having the publication No. WO 95/17128. In this previously known method, the means used for inter-connecting the two vessels consisted of an open springy brace carrying spikes and being capable of being bent elastically so as to make its free ends cross each other, said :pikes forming angles with the brace gradually diminishing from acute angles at the free ends to substantially right angles mid-way between them. When released from the anastomotic instrument holding the brace in the elastically bent condition, it would bring the spikes into engagement with the regions to be joined so as to penetrate the latter and so to speak nail them together.
Extra-clinical trials have, however, shown that one can not always be certain that all the spikes have penetrated through the parts concerned of the two vessels to be joined, this probably being due to the limited elastic force .available from the springy brace.
DISCLOSURE OF THE INVENTION
It is the object of the present invention to provide a method of the kind referred to above, with which it is possible to achieve a more reliable connection between the two vessels forming the anastomosis, and this object is achieved by proceeding as set forth in the characteriz-ing clause of claim 1. With this arrangement, the parts concerned of the two vessels to be joined are connected to each other through a stapling operation based on the same principles as other surgical stapling devices and - inc:identally - ordinary office staplers.
As already indicated above, the use of stapling devices in surgical work is not unknown, but until now only in situations, in which it is possible to move the organ or organs to be operated upon from their normal position in Z5 the patient's body, such as in the abdominal cavity, to a position - not infrequently outside the patient's body - in which the anvil member, against which the staples are bent (corresponding to the lower part of an office stapler), can be placed on the side of the joint concerned facing away from the stapling plungers (corresponding to the p7_unger in the top part of an office stapler). Thus, the present invention is the first to offer what could be called "in-situ stapling". To make this possible, the present invention prescribes the use of an anastomosis instrument capable of performing the following four functions:
a cruidincr function, i.e. guiding the instrument carrying the first vessel into the opening having been formed in the side of the second vessel, :30 - an arranging function, i.a. urging the edge of the opening to the second vessel into a shape and position corresponding to the shape and position of t:he end region of the first vessel preparatory to - a stapling function, in which the parts of the two vessels having been brought into contact through the arranging function are positively joined by a stapling operation, and - a removal function, in which the instrument after S completion of the stapling operation is removed from the joint formed by being luxated out of the pocket formed on the everted end of the first vessel, said pocket then unfolding simultaneously with a slight withdrawal of the first vessel.
At this point it should be emphasized that, using a preferred embodiment of the instrument, in which there is a rigid mechanical connection between the anvil member and the part of the instrument adapted to be gripped manually by the operating surgeon, both the guiding function and the arranging function referred to above may be carried out with the best possible "feel", as the surgeon will be able- to sense manually any objects encountered by the anvil member, including - of course - the second vessel and the anastomotic opening formed therein.
All the functions described above may be carried out without removing the organs concerned through any significant distance away from their normal functional position in the body, making the method according to the invention eminently suitable for coronary by-pass operations. Thus, the expression "in-situ stapling" would appear justified.
The present invention also relates to an anastomotic instrument for carrying out the method according to the invention.
-3a-According to the invention, there is provided an anastomotic instrument, characterized by:
a) a first elongate member, to one end of which is rigidly secured a circumferential anvil member in such a manner, that said first vessel may be placed within said first elongate member with its end region everted about said anvil member with the terminal part of said end region facing towards the opposite end of said first elongate member, b) staple-bending recesses provided in said anvil member and facing towards said opposite end, c) a second elongate member longitudinally moveable relative to said first elongate member and adapted to be moved toward said anvil member so as to make it possible to clamp together therebetween said end region on said first vessel and an edge region on said second vessel, and d) stapling plungers longitudinally moveable relative to said first and second elongate members and adapted to insert staples penetratingly through said clamped end and edge regions into engagement with said stapling-bending recesses so as to bend permanently said staples into a shape, in which they hold said end and edge regions together.
Advantageoous embodiments of the anastomotic instrument according to the invention, the effects of which - beyond what is self-evident - are explained in the following detailed part of the present description.
A method is disclosed in EP-A-X54,990, Fig. 8, where an end-to-side anastomosis 14 - 15' is performed.
Fig. 8 of this document shows an end-14-to-side-15' ana-stomosis, but here suture 21 is used instead of clamping by moving parts, and a separate instrument 32 is used for the stapling action, i.e. not parts moving longitu-dinally in or around anvel 10.
Thus, it will be evident that the method and apparatus as described in EP-A-554,990 do not anticipate the method and apparatus of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
In the following detailed part of the present description, the invention will be explained in more detail with reference to the exemplary embodiments of an anastomotic instrument according to the invention shown in the drawings, in which Figures 1-8 show the process of performing an end-to side anastomosis using an anastomotic instrument according to the invention, in Figures 1-7 being drawn in a highly simplified manner for ease of understanding, Figures 9-12 in perspective and with certain parts cut away show a practical embodiment of an anastomotic instru-- 4a -merit with the various possible relative positions of the relatively movable parts, and Figure 13 at a highly enlarged scale shows a part of the instrument shown in Figure 1 with modified clamping surfaces.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
As mentioned above, the embodiment shown in Figures 1-8 of the anastomosis instrument according to the present invention constitutes a simplified version with the primary purpose of explaining the invention; this does ~Myl~ ~D SaF_rs not, however, preclude the possibility of using this embodiment in actual practice.
Thus, Figure 1 shows an anastomosis instrument 1 5 consi:~ting of three main components that are movable relat:ive to each other in the longitudinal direction, i.e. :in the direction shown as the vertical direction in Figures 1:
- an anvil tube 2, - a clamping tube 5, and - a sect of stapling plungers 6.
On it~~ lower end, the anvil tube 2 carries an anvil 3 , the upper side of which is provided with a number of staple-bending recesses 4 adapted to cooperate with and bend an equal number of staples 7, in the situation shown in Figure 1 being temporarily held lightly in an equal number of staple-holding recesses 8 formed in the lower ends of the st=apling plungers 6.
Figure 2 shows the situation, in which the instrument is made ready for use by the operating surgeon. As mentioned initially, the anastomosis instrument according to the present invention is primarily developed for use when performing coronary bypass operations, and to this end, a bypass vessel 9 - that may be a vein taken from some other part of the patient's body - has been inserted in the anvil tube with its lower end evened about the anvil 3 and with its end region 10 covering the staple-bending :30 reces ses 4 in the upper surface of the anvil 3. At this point it should be noted that the bypass vessel 9 may have a considerably larger circumference than the inside of the anvil tube 2, consequently lying more or less folded in the longitudinal direction in the latter, for which reason the action of everting its end region 10 about. the anvil 3 does not necessarily entail undue stretching of the bypass vessel 9.
Figure 3 shows the instrument having been made ready as shown in Figure 2 inserted in an opening in a coronary artery 11, said opening having an edge region 12 which, due to the elasticity of the tissue of the coronary artery 11, will embrace the anvil tube 2 in a location close to the anvil 3. The opening in the coronary artery 11 may e.g. have been formed according to the method described in the international application with publication No. WO
95/17127 with the title "Method and instrument for establishing the receiving side of a coronary artery bypass graft".
As soon as the operating surgeon in the situation shown in Figure 3 has ascertained that the edge region 12 embraces the anvil tube 2 closely on all sides, he or she will proceed to the situation shown in Figure 4, in which the clamping tube 5 has been moved towards the anvil 3 so as to clamp the edge region 12 on the coronary artery 11 and the end region 10 on the bypass vessel 9 firmly together in readiness for the next step shown in Figure 5, in which the stapling plungers 6 have been moved downwardly so as to cause the staples 7 to penetrate the edge region 12 and the end region 10 and engage the staple-bending recesses 4, by which they will be bent in a tangential direction in a similar manner as is known from both surgical staplers and ordinary office staplers.
In the situation shown in Figure 6, the clamping tube 5 together with the stapling plungers 6 have been moved outwardly and away from the staples 7, the staple-holding WO 97/1b122 PCT/DK95/00430 recesses 8 due to their light holding action having let go of the staples 7, the latter also having been anchored in the end region 10 by their bent ends.
Figure 7 shows the situation, in which the operation of removing the anastomosis instrument 1 from the coronary artery 11 and its anastomosis with the bypass vessel 9 has begun. As will be seen from Figures 6 and 7, the circumferential pocket formed by the eversion of the lower end of the bypass vessel 9 will now open and allow the anvil 3 to be removed by luxation, Figure 8 showing the situation after such removal, resulting in a finished anastomosis of the intima-to-intima type considered most desirable for this type of operation.
The three main components of the anastomosis instrument 1 referred to above, i.e. the anvil tube 2, the clamping tube 5 and the set of stapling plungers 6, will, of course, have to be connected to some kind of operating members to enable the operating surgeon and his or her assistants to carry out the steps shown in Figures 1-8.
Theoretically, these operating members could consist of three tubes (not shown), viz.
- a relatively long holding tube in continuation of the anvil tube 2, - a somewhat shorter clamping tube in continuation of the clamping tube 5, and - an even shorter stapling tube, to which the stapling plungers 6 are connected.
As is well-known, however, coronary bypass operations, especially according to the method of the international application referred to above, should be carried out as rapidly as possible, and for this reason, the "theoretical" embodiment shown in Figures 1-7 is too cumbersome to work with to ensure a sufficiently rapid operating procedure. As mentioned above, Figures 9-12 illustrate an embodiment of an anastomosis instrument according to the present invention, that is highly suitable for creating' an end-to-side anastomosis in a very ;short time .
Due to the construction of the instrument shown in Figures 9-12 :it is not possible to make an easily understandable drawing in the nature of the simple drawings of Figures 1-7. F~'or this reason, the "active" parts of the instrument have been shown in perspective, and with the exception of the anvil and its supporting columns, with one half removESd along a longitudinal sectional plane, so that the remaining half can be seen partly from the inside, partly from the outside. In Figures 9-12, those of the components functionally corresponding to components shown in Figures 1-7 have been given the same reference numbers with :100 added, whereas components not having "opposite numbers" in Figures 1-7 have been given the reference numbers of the components, with which they are most closely associated, with the addition of a capital letter.
As shown in Figure 9, the anastomosis instrument 101 comprises a number of parts functionally corresponding to parts of the instrument shown in Figures 1-7, viz.:
- an anvil tube 102, - an anvil 103, - a clamping tube 105, and :30 - a set of stapling plungers 106.
Although the basic functions of these parts are the same as the basic functions of the corresponding parts in the embodiment of Figures 1-7, the arrangement differs somewhat from that of the latter, as will be evident from t:he following.
In contrast to the anvil tube 2 of Figure 1, the anvil tube 102 of Figure 9 extends on the outside of the instrument and is terminated by an end wall 102A, to which the anvil 103 is secured at a distance by means of two columns, viz . an upstream column 103A and a downstream column 103B. The expressions "upstream" and "downstream"
l0 refer to the direction of blood flow in the artery, in which the instrument 101 is intended to be used in creating an end-to-side anastomosis.
To make it possible to insert the bypass vessel (not shown) corresponding to the bypass vessel 9 shown in Figures 1-8, all transversely oriented components have suitax>le openings, of which the forwardmost opening 103C
is formed in the anvil 103, the latter being provided with staple-bending recesses 104 having the same function as the: staple-bending recesses 4 shown in Figure 1.
As will be seen from Figures 9-12, the various components are not rotationally symmetrical about the longitudinal axis of the instrument, as the anvil 103 has been made "boat-shaped" to make it easier to insert it in the opening in the artery and to make it easier for the edges of the opening to fit in with the upper side of the anvil 103 with the stapling recesses 104.
Due to the arrangement of the anvil tube 102 as the outermost component terminated by the end wall 102A, it is not. possible in this embodiment to let the clamping tube :L05 extend in its full circumferential width all the way towards the upper face of the anvil 103. For this reason, the clamping tube 105 is terminated by an end wall 105A, from which a set of clamping columns 105B
extend in the forward (downward) direction through suitable openings in the anvil tube end wall 102A.
The stapling plungers 106 are guided in the longitudinal direction in suitable guides in the clamping columns 1058, and their rearmost (uppermost) ends are secured to a stapling plunger carrier 106A, itself secured to and 10 terminating a stapling tube 1068, through which the force for actuating the stapling plungers 106 may be transmitted from a suitable operating device. Figures 9-12 show neither staples corresponding to the staples 7 of Figure 1 nor staple-holding recesses corresponding to the staple-holding recesses 8 shown in Figure 1, but it will be understood that the forwardmost (lowermost) ends of the stapling plungers 106 will be provided with suitable staple-holding recesses capable of holding staples in such a position, that when the stapling plungers 106 are advanced towards the anvil 103, the staples will be bent by the staple-bending recesses 104 in the usual manner.
The relative positions of the various parts as shown in Figure 9 correspond to those shown in Figures 1-3, i.e.
there is a sufficient distance between the rearward (upper) face of the anvil 103 and the forward (downward) ends of the clamping columns 1058 to accomodate the everted end region of the bypass vessel corresponding to the end region 10 shown in Figure 2, as well as the edge region of the coronary artery concerned corresponding to the edge region 12 of the coronary artery 11 shown in Figure 3.
The situation shown in Figure 10 corresponds to that shown in Figure 4, i.e. the clamping columns 105B have been advanced towards the anvil 103, in Figure 10 leaving a gap symbolizing the presence of the end region of the bypass vessel and the edge region of the coronary artery (all not shown). The movement of the clamping columns 1058 has, of course, been effected by advancing the clamping tube 105 to the same extent. To prevent said end and edge regions being crushed in the clamping operation, suitable stops (not shown) are adapted to stop the movement of the clamping columns 105B towards the anvil 103 so as to leave a gap just sufficient to hold them firmly together. To improve the grip, the clamping surfaces may be provided with elastically flexible fins or fingers 13 as shown in Figure 13. This Figure shows how this concept could be applied to the embodiment shown in Figures 1-7, it being - of course -equally applicable to that shown in Figures 9-12.
The relative positions shown in Figure 11 correspond to those shown in Figure 5, i.e. the stapling plungers 106 have now been advanced, guided by the clamping columns 105B so as to bring the staples (not shown) into engage-ment with the staple-bending recesses 104, thus joining the end region of the bypass vessel to the edge region of the coronary artery (a11 not shown).
The relative positions shown in Figure 12 correspond to those shown in Figures 6 and 7 and with the exception that in Figure 12, the stapling plungers 106 have not only been withdrawn from the staples joining the two vessels, but have in fact been removed completely from the instrument to make it possible to insert a new set of staples, that may be of the disposable or semi-disposable type.
,._.
A. ~ ,,l~;w ~4=, ;~
:,1~~
y With the arrangement shown in Figures 9-12, the operating surgeon may literally have a firm grip on the situation by holding the outermost component, i.e. the anvil tube 102, which is rigidly connected to the anvil 103 through the columns 103A and 103B, so that he or she will be able to move the anvil 103 with the everted end of the bypass vessel into the opening in the coronary artery by direct manual control, and - not least - by "direct mechanical feedback", as the rigid mechanical interconnec-tion between the anvil 103 and the anvil tube 102 enables the surgeon to "feel" whatever object is encountered by the anvil. Advantageously, the rearward (upper) part (not shown) of the instrument may comprise suitable operating devices and/or mechanisms for moving the clamping tube 105 and the stapling plungers 106 relatively to the anvil tube 102 and hence relatively to the anvil 103. Due to the extremely limited time available for performing coronary bypass operations, these operating devices and/or mechanisms should be designed to enable the operating surgeon to initiate the requisite movements rapidly and with a minimum of effort.
Thus, the operating devices and/or mechanisms could be arranged to function under the control of a single operating member, such as a push-button on the rear (upper) end of the instrument adapted to be operated by the surgeon's thumb, in the following manner:
- firstly, when the operating member is moved in a first direction, e.g. a push-button is depressed, the clamping columns 105B will be advanced to their forwardmost (lower) position, in which they clamp the end region of the bypass vessel and the edge region of the opening in the artery together until said stop is reached, and then the stapling plungers 106 will immediately be A~.~~l'1~~~ s~'~'~
A method is disclosed in EP-A-X54,990, Fig. 8, where an end-to-side anastomosis 14 - 15' is performed.
Fig. 8 of this document shows an end-14-to-side-15' ana-stomosis, but here suture 21 is used instead of clamping by moving parts, and a separate instrument 32 is used for the stapling action, i.e. not parts moving longitu-dinally in or around anvel 10.
Thus, it will be evident that the method and apparatus as described in EP-A-554,990 do not anticipate the method and apparatus of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
In the following detailed part of the present description, the invention will be explained in more detail with reference to the exemplary embodiments of an anastomotic instrument according to the invention shown in the drawings, in which Figures 1-8 show the process of performing an end-to side anastomosis using an anastomotic instrument according to the invention, in Figures 1-7 being drawn in a highly simplified manner for ease of understanding, Figures 9-12 in perspective and with certain parts cut away show a practical embodiment of an anastomotic instru-- 4a -merit with the various possible relative positions of the relatively movable parts, and Figure 13 at a highly enlarged scale shows a part of the instrument shown in Figure 1 with modified clamping surfaces.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
As mentioned above, the embodiment shown in Figures 1-8 of the anastomosis instrument according to the present invention constitutes a simplified version with the primary purpose of explaining the invention; this does ~Myl~ ~D SaF_rs not, however, preclude the possibility of using this embodiment in actual practice.
Thus, Figure 1 shows an anastomosis instrument 1 5 consi:~ting of three main components that are movable relat:ive to each other in the longitudinal direction, i.e. :in the direction shown as the vertical direction in Figures 1:
- an anvil tube 2, - a clamping tube 5, and - a sect of stapling plungers 6.
On it~~ lower end, the anvil tube 2 carries an anvil 3 , the upper side of which is provided with a number of staple-bending recesses 4 adapted to cooperate with and bend an equal number of staples 7, in the situation shown in Figure 1 being temporarily held lightly in an equal number of staple-holding recesses 8 formed in the lower ends of the st=apling plungers 6.
Figure 2 shows the situation, in which the instrument is made ready for use by the operating surgeon. As mentioned initially, the anastomosis instrument according to the present invention is primarily developed for use when performing coronary bypass operations, and to this end, a bypass vessel 9 - that may be a vein taken from some other part of the patient's body - has been inserted in the anvil tube with its lower end evened about the anvil 3 and with its end region 10 covering the staple-bending :30 reces ses 4 in the upper surface of the anvil 3. At this point it should be noted that the bypass vessel 9 may have a considerably larger circumference than the inside of the anvil tube 2, consequently lying more or less folded in the longitudinal direction in the latter, for which reason the action of everting its end region 10 about. the anvil 3 does not necessarily entail undue stretching of the bypass vessel 9.
Figure 3 shows the instrument having been made ready as shown in Figure 2 inserted in an opening in a coronary artery 11, said opening having an edge region 12 which, due to the elasticity of the tissue of the coronary artery 11, will embrace the anvil tube 2 in a location close to the anvil 3. The opening in the coronary artery 11 may e.g. have been formed according to the method described in the international application with publication No. WO
95/17127 with the title "Method and instrument for establishing the receiving side of a coronary artery bypass graft".
As soon as the operating surgeon in the situation shown in Figure 3 has ascertained that the edge region 12 embraces the anvil tube 2 closely on all sides, he or she will proceed to the situation shown in Figure 4, in which the clamping tube 5 has been moved towards the anvil 3 so as to clamp the edge region 12 on the coronary artery 11 and the end region 10 on the bypass vessel 9 firmly together in readiness for the next step shown in Figure 5, in which the stapling plungers 6 have been moved downwardly so as to cause the staples 7 to penetrate the edge region 12 and the end region 10 and engage the staple-bending recesses 4, by which they will be bent in a tangential direction in a similar manner as is known from both surgical staplers and ordinary office staplers.
In the situation shown in Figure 6, the clamping tube 5 together with the stapling plungers 6 have been moved outwardly and away from the staples 7, the staple-holding WO 97/1b122 PCT/DK95/00430 recesses 8 due to their light holding action having let go of the staples 7, the latter also having been anchored in the end region 10 by their bent ends.
Figure 7 shows the situation, in which the operation of removing the anastomosis instrument 1 from the coronary artery 11 and its anastomosis with the bypass vessel 9 has begun. As will be seen from Figures 6 and 7, the circumferential pocket formed by the eversion of the lower end of the bypass vessel 9 will now open and allow the anvil 3 to be removed by luxation, Figure 8 showing the situation after such removal, resulting in a finished anastomosis of the intima-to-intima type considered most desirable for this type of operation.
The three main components of the anastomosis instrument 1 referred to above, i.e. the anvil tube 2, the clamping tube 5 and the set of stapling plungers 6, will, of course, have to be connected to some kind of operating members to enable the operating surgeon and his or her assistants to carry out the steps shown in Figures 1-8.
Theoretically, these operating members could consist of three tubes (not shown), viz.
- a relatively long holding tube in continuation of the anvil tube 2, - a somewhat shorter clamping tube in continuation of the clamping tube 5, and - an even shorter stapling tube, to which the stapling plungers 6 are connected.
As is well-known, however, coronary bypass operations, especially according to the method of the international application referred to above, should be carried out as rapidly as possible, and for this reason, the "theoretical" embodiment shown in Figures 1-7 is too cumbersome to work with to ensure a sufficiently rapid operating procedure. As mentioned above, Figures 9-12 illustrate an embodiment of an anastomosis instrument according to the present invention, that is highly suitable for creating' an end-to-side anastomosis in a very ;short time .
Due to the construction of the instrument shown in Figures 9-12 :it is not possible to make an easily understandable drawing in the nature of the simple drawings of Figures 1-7. F~'or this reason, the "active" parts of the instrument have been shown in perspective, and with the exception of the anvil and its supporting columns, with one half removESd along a longitudinal sectional plane, so that the remaining half can be seen partly from the inside, partly from the outside. In Figures 9-12, those of the components functionally corresponding to components shown in Figures 1-7 have been given the same reference numbers with :100 added, whereas components not having "opposite numbers" in Figures 1-7 have been given the reference numbers of the components, with which they are most closely associated, with the addition of a capital letter.
As shown in Figure 9, the anastomosis instrument 101 comprises a number of parts functionally corresponding to parts of the instrument shown in Figures 1-7, viz.:
- an anvil tube 102, - an anvil 103, - a clamping tube 105, and :30 - a set of stapling plungers 106.
Although the basic functions of these parts are the same as the basic functions of the corresponding parts in the embodiment of Figures 1-7, the arrangement differs somewhat from that of the latter, as will be evident from t:he following.
In contrast to the anvil tube 2 of Figure 1, the anvil tube 102 of Figure 9 extends on the outside of the instrument and is terminated by an end wall 102A, to which the anvil 103 is secured at a distance by means of two columns, viz . an upstream column 103A and a downstream column 103B. The expressions "upstream" and "downstream"
l0 refer to the direction of blood flow in the artery, in which the instrument 101 is intended to be used in creating an end-to-side anastomosis.
To make it possible to insert the bypass vessel (not shown) corresponding to the bypass vessel 9 shown in Figures 1-8, all transversely oriented components have suitax>le openings, of which the forwardmost opening 103C
is formed in the anvil 103, the latter being provided with staple-bending recesses 104 having the same function as the: staple-bending recesses 4 shown in Figure 1.
As will be seen from Figures 9-12, the various components are not rotationally symmetrical about the longitudinal axis of the instrument, as the anvil 103 has been made "boat-shaped" to make it easier to insert it in the opening in the artery and to make it easier for the edges of the opening to fit in with the upper side of the anvil 103 with the stapling recesses 104.
Due to the arrangement of the anvil tube 102 as the outermost component terminated by the end wall 102A, it is not. possible in this embodiment to let the clamping tube :L05 extend in its full circumferential width all the way towards the upper face of the anvil 103. For this reason, the clamping tube 105 is terminated by an end wall 105A, from which a set of clamping columns 105B
extend in the forward (downward) direction through suitable openings in the anvil tube end wall 102A.
The stapling plungers 106 are guided in the longitudinal direction in suitable guides in the clamping columns 1058, and their rearmost (uppermost) ends are secured to a stapling plunger carrier 106A, itself secured to and 10 terminating a stapling tube 1068, through which the force for actuating the stapling plungers 106 may be transmitted from a suitable operating device. Figures 9-12 show neither staples corresponding to the staples 7 of Figure 1 nor staple-holding recesses corresponding to the staple-holding recesses 8 shown in Figure 1, but it will be understood that the forwardmost (lowermost) ends of the stapling plungers 106 will be provided with suitable staple-holding recesses capable of holding staples in such a position, that when the stapling plungers 106 are advanced towards the anvil 103, the staples will be bent by the staple-bending recesses 104 in the usual manner.
The relative positions of the various parts as shown in Figure 9 correspond to those shown in Figures 1-3, i.e.
there is a sufficient distance between the rearward (upper) face of the anvil 103 and the forward (downward) ends of the clamping columns 1058 to accomodate the everted end region of the bypass vessel corresponding to the end region 10 shown in Figure 2, as well as the edge region of the coronary artery concerned corresponding to the edge region 12 of the coronary artery 11 shown in Figure 3.
The situation shown in Figure 10 corresponds to that shown in Figure 4, i.e. the clamping columns 105B have been advanced towards the anvil 103, in Figure 10 leaving a gap symbolizing the presence of the end region of the bypass vessel and the edge region of the coronary artery (all not shown). The movement of the clamping columns 1058 has, of course, been effected by advancing the clamping tube 105 to the same extent. To prevent said end and edge regions being crushed in the clamping operation, suitable stops (not shown) are adapted to stop the movement of the clamping columns 105B towards the anvil 103 so as to leave a gap just sufficient to hold them firmly together. To improve the grip, the clamping surfaces may be provided with elastically flexible fins or fingers 13 as shown in Figure 13. This Figure shows how this concept could be applied to the embodiment shown in Figures 1-7, it being - of course -equally applicable to that shown in Figures 9-12.
The relative positions shown in Figure 11 correspond to those shown in Figure 5, i.e. the stapling plungers 106 have now been advanced, guided by the clamping columns 105B so as to bring the staples (not shown) into engage-ment with the staple-bending recesses 104, thus joining the end region of the bypass vessel to the edge region of the coronary artery (a11 not shown).
The relative positions shown in Figure 12 correspond to those shown in Figures 6 and 7 and with the exception that in Figure 12, the stapling plungers 106 have not only been withdrawn from the staples joining the two vessels, but have in fact been removed completely from the instrument to make it possible to insert a new set of staples, that may be of the disposable or semi-disposable type.
,._.
A. ~ ,,l~;w ~4=, ;~
:,1~~
y With the arrangement shown in Figures 9-12, the operating surgeon may literally have a firm grip on the situation by holding the outermost component, i.e. the anvil tube 102, which is rigidly connected to the anvil 103 through the columns 103A and 103B, so that he or she will be able to move the anvil 103 with the everted end of the bypass vessel into the opening in the coronary artery by direct manual control, and - not least - by "direct mechanical feedback", as the rigid mechanical interconnec-tion between the anvil 103 and the anvil tube 102 enables the surgeon to "feel" whatever object is encountered by the anvil. Advantageously, the rearward (upper) part (not shown) of the instrument may comprise suitable operating devices and/or mechanisms for moving the clamping tube 105 and the stapling plungers 106 relatively to the anvil tube 102 and hence relatively to the anvil 103. Due to the extremely limited time available for performing coronary bypass operations, these operating devices and/or mechanisms should be designed to enable the operating surgeon to initiate the requisite movements rapidly and with a minimum of effort.
Thus, the operating devices and/or mechanisms could be arranged to function under the control of a single operating member, such as a push-button on the rear (upper) end of the instrument adapted to be operated by the surgeon's thumb, in the following manner:
- firstly, when the operating member is moved in a first direction, e.g. a push-button is depressed, the clamping columns 105B will be advanced to their forwardmost (lower) position, in which they clamp the end region of the bypass vessel and the edge region of the opening in the artery together until said stop is reached, and then the stapling plungers 106 will immediately be A~.~~l'1~~~ s~'~'~
actuated to staple the two regions together, after which both the clamping columns 105B and the stapling plungers 106 are withdrawn, e.g. by releasing said push-button, and - secondly, immediately upon the operating member moving in the opposite directian, e.g. when the push-button has been released, the mechanism is re-set in readiness for a movement in the first direction, after which the instrument can be removed as described above with reference to Figure 7.
It should be possible for a technician skilled in the art of designing and making surgical instruments comprising operating mechanisms to design and construct an operating device or mechanism capable of operating in the manner described above, for which reason these parts have not been described or shown in detail.
It should be possible for a technician skilled in the art of designing and making surgical instruments comprising operating mechanisms to design and construct an operating device or mechanism capable of operating in the manner described above, for which reason these parts have not been described or shown in detail.
List of Parts 1 anastomosis instrument 2 anvil tube 3 anvil 4 staple-bending recess 5 clamping tube 6 stapling plunger 7 staple 8 staple-holding recess :10 9 bypass vessel end region 11 coronary artery 12 edge region 13 fin or finger 101 anastomosis instrument 102 anvil tube 102A (anvil tube) end wall 103 anvil 103A (anvil) upstream column 103B (anvil) downstream column 103C (anvil) opening 104 staple-bending recess 105 clamping tube 105A (clamping tube) end wall 105B clamping column (and stapling-plunger guide) 106 stapling plunger 106A stapling plunger carrier 106B stapling tube
Claims (11)
1. Anastomotic instrument (1; 101), characterized by:
a) a first elongate member (2; 102), to one end of which is rigidly secured a circumferential anvil member (3; 103) in such a manner, that said first vessel (9) may be placed within said first elongate member (2; 102) with its end region (10) everted about said anvil member (3; 103) with the terminal part of said end region facing towards the opposite end of said first elongate member (2;
102), b) staple-bending recesses (4; 104) provided in said anvil member (3; 103) and facing towards said opposite end, c) a second elongate member (5; 105; 105A; 105B) longitudinally moveable relative to said first elongate member (2; 102) and adapted to be moved toward said anvil member (3; 103) so as to make it possible to clamp together therebetween said end region (10) on said first vessel (9) and an edge region (12) on said second vessel (11), and d) stapling plungers (6; 106) longitudinally moveable relative to said first (2; 102) and second (5; 105, 105A, 105B) elongate members and adapted to insert staples (7) penetratingly through said clamped end (10) and edge (12) regions into engagement with said stapling-bending recesses (4; 104) so as to bend permanently said staples (7) into a shape, in which they hold said end (10) and edge (12) regions together.
a) a first elongate member (2; 102), to one end of which is rigidly secured a circumferential anvil member (3; 103) in such a manner, that said first vessel (9) may be placed within said first elongate member (2; 102) with its end region (10) everted about said anvil member (3; 103) with the terminal part of said end region facing towards the opposite end of said first elongate member (2;
102), b) staple-bending recesses (4; 104) provided in said anvil member (3; 103) and facing towards said opposite end, c) a second elongate member (5; 105; 105A; 105B) longitudinally moveable relative to said first elongate member (2; 102) and adapted to be moved toward said anvil member (3; 103) so as to make it possible to clamp together therebetween said end region (10) on said first vessel (9) and an edge region (12) on said second vessel (11), and d) stapling plungers (6; 106) longitudinally moveable relative to said first (2; 102) and second (5; 105, 105A, 105B) elongate members and adapted to insert staples (7) penetratingly through said clamped end (10) and edge (12) regions into engagement with said stapling-bending recesses (4; 104) so as to bend permanently said staples (7) into a shape, in which they hold said end (10) and edge (12) regions together.
2. Anastomotic instrument (101) according to claim 1, characterized in that the external surface of said first elongate member (102) constitutes at least a part of the external surface of said instrument (101), so as to make it possible to hold the latter by manually gripping the former.
3. Anastomotic instrument according to claim 2, characterized in that said first elongate member (102) is rigidly connected to said anvil member (103) through an end wall (102A) rigidly secured to or integral with the end of said first elongate member (102) and at least one connecting member (103A, 103B) rigidly secured to said end wall (102A) and said anvil member (103).
4. Anastomotic instrument according to claim 3, characterized in that said second elongate member (105, 105A, 1058) comprises:
a) a rearward part (105) longitudinally moveable in said first elongate member (102), b) an intermediate part (105A) rigidly secured to or integral with said rearward part (105) and c) a plurality of forward clamping columns, each at the end (105B) being rigidly secured to said intermediate part (105A), extending through said end wall (102A) and each on the opposite end having a clamping surface facing said anvil member (103).
a) a rearward part (105) longitudinally moveable in said first elongate member (102), b) an intermediate part (105A) rigidly secured to or integral with said rearward part (105) and c) a plurality of forward clamping columns, each at the end (105B) being rigidly secured to said intermediate part (105A), extending through said end wall (102A) and each on the opposite end having a clamping surface facing said anvil member (103).
5. Anastomotic instrument according to any one of claims 1-4, characterized in that each said stapling plunger (106) with a rear end is rigidly secured to a stapling plunger carrier (106A) rigidly secured to a third elongate member (106B) longitudinally moveable in said rearward part (105) of said second elongate member (105, 105A, 105B) and with the remainder extending moveably through said intermediate part (105A) and said clamping columns (105B).
6. Anastomotic instrument (1; 101) according to any one of claims 1-5, characterized by such an arrangement that said second elongate member (5; 105, 105A, 105B) can only be advanced relative to said first elongate member (2; 102) and said anvil member (3; 103) to an extent leaving a gap slightly smaller than the combined thickness of said end region (10) and said edge region (12), said movement being limited e.g. by a suitable stop member.
7. Anastomotic instrument according to claim 7, characterized by a mechanism adapted to move said second elongate member (105, 105A, 105B) and said stapling plungers (106) relative to said first elongate member (102) and said anvil member (103) in dependence on the movement of a single operating member moveable in a first direction and then returnable in the opposite direction in the following manner:
a) when said operating member is moved in said first direction, said elongate member (105, 105A, 105B) is advanced to said limiting position leaving said gap immediately upon which said stapling plungers (106) are actuated to join said end region (10) to said edge region (12), immediately upon which both said elongate member (105, 105A, 105B) and said stapling plungers (106) are withdrawn to leave a large gap between said clamping plungers (105B) and said anvil member (103) allowing the instrument (101) to be removed from the joint, and b) when said operating member is moved in said second direction, the mechanism is re-set in readiness for a new movement in said first direction.
a) when said operating member is moved in said first direction, said elongate member (105, 105A, 105B) is advanced to said limiting position leaving said gap immediately upon which said stapling plungers (106) are actuated to join said end region (10) to said edge region (12), immediately upon which both said elongate member (105, 105A, 105B) and said stapling plungers (106) are withdrawn to leave a large gap between said clamping plungers (105B) and said anvil member (103) allowing the instrument (101) to be removed from the joint, and b) when said operating member is moved in said second direction, the mechanism is re-set in readiness for a new movement in said first direction.
8. Anastomotic instrument (101) according to claim 7, characterized by means, such as a spring, adapted to move said operating member in said second direction, as soon as the force moving it in said first direction is removed.
9. Anastomotic instrument (1; 101) according to any one of claims 1-8, characterized in that at least one of the mutually cooperating clamping surfaces on said anvil member (3; 103) and the said second elongate member (5;
105, 105A, 105B) are modified to improve the gripping effect on the tissue parts (10, 12) to be joined.
105, 105A, 105B) are modified to improve the gripping effect on the tissue parts (10, 12) to be joined.
10. Anastomotic instrument according to claim 9, characterized in that said mutually cooperating clamping surfaces are roughened or embossed with a grip-improving pattern.
11. Anastomotic instrument according to claim 9, characterized in that said mutually cooperating clamping surfaces are provided with elastically flexible fins or fingers (13) in the relaxed state extending obliquely inwardly (Figure 13).
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/DK1995/000430 WO1997016122A1 (en) | 1995-10-31 | 1995-10-31 | Method and anastomotic instrument for use when performing an end-to-side anastomosis |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2234148A1 CA2234148A1 (en) | 1997-05-09 |
CA2234148C true CA2234148C (en) | 2002-01-08 |
Family
ID=8155380
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002234148A Expired - Fee Related CA2234148C (en) | 1995-10-31 | 1995-10-31 | Method and anastomotic instrument for use when performing an end-to-side anastomosis |
Country Status (12)
Country | Link |
---|---|
US (1) | US5993468A (en) |
EP (1) | EP0859572B1 (en) |
JP (1) | JP3207436B2 (en) |
KR (1) | KR100269077B1 (en) |
AT (1) | ATE188862T1 (en) |
AU (1) | AU701033B2 (en) |
CA (1) | CA2234148C (en) |
DE (1) | DE69514694T2 (en) |
DK (1) | DK0859572T3 (en) |
ES (1) | ES2145303T3 (en) |
NO (1) | NO981922L (en) |
WO (1) | WO1997016122A1 (en) |
Families Citing this family (279)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6440146B2 (en) | 1996-07-23 | 2002-08-27 | United States Surgical Corporation | Anastomosis instrument and method |
US6293955B1 (en) | 1996-09-20 | 2001-09-25 | Converge Medical, Inc. | Percutaneous bypass graft and securing system |
US6036702A (en) * | 1997-04-23 | 2000-03-14 | Vascular Science Inc. | Medical grafting connectors and fasteners |
AU721415B2 (en) | 1996-11-08 | 2000-07-06 | Converge Medical, Inc. | Percutaneous bypass graft and securing system |
US5993464A (en) | 1998-01-23 | 1999-11-30 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US6066144A (en) * | 1997-10-07 | 2000-05-23 | Ethicon Endo-Surgery, Inc. | Surgical anastomosis method |
US6726704B1 (en) | 1998-05-29 | 2004-04-27 | By-Pass, Inc. | Advanced closure device |
WO2001041623A2 (en) * | 1999-05-30 | 2001-06-14 | By-Pass, Inc. | Anastomotic devices and methods |
US6641593B1 (en) | 1998-06-03 | 2003-11-04 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6613059B2 (en) | 1999-03-01 | 2003-09-02 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6945980B2 (en) | 1998-06-03 | 2005-09-20 | Medtronic, Inc. | Multiple loop tissue connector apparatus and methods |
WO2000015144A1 (en) | 1998-06-10 | 2000-03-23 | Advanced Bypass Technologies, Inc. | Aortic aneurysm treatment systems |
US6261304B1 (en) | 1998-09-10 | 2001-07-17 | Percardia, Inc. | Delivery methods for left ventricular conduit |
US6203553B1 (en) * | 1999-09-08 | 2001-03-20 | United States Surgical | Stapling apparatus and method for heart valve replacement |
US6146393A (en) * | 1998-12-18 | 2000-11-14 | Wakabayashi; Akio | External tubular stapling device for anastomosing a vascular graft to an anastomosing sheath |
US8118822B2 (en) | 1999-03-01 | 2012-02-21 | Medtronic, Inc. | Bridge clip tissue connector apparatus and methods |
US6695859B1 (en) | 1999-04-05 | 2004-02-24 | Coalescent Surgical, Inc. | Apparatus and methods for anastomosis |
US6623494B1 (en) | 1999-04-16 | 2003-09-23 | Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) | Methods and systems for intraluminally directed vascular anastomosis |
US7981126B2 (en) | 1999-04-16 | 2011-07-19 | Vital Access Corporation | Locking compression plate anastomosis apparatus |
WO2000072764A1 (en) * | 1999-05-28 | 2000-12-07 | The Board Of Trustees Of The Leland Stanford Junior University | Anastomosis system and methods for use |
US6253768B1 (en) | 1999-08-04 | 2001-07-03 | Percardia, Inc. | Vascular graft bypass |
US6494889B1 (en) | 1999-09-01 | 2002-12-17 | Converge Medical, Inc. | Additional sutureless anastomosis embodiments |
US6702828B2 (en) * | 1999-09-01 | 2004-03-09 | Converge Medical, Inc. | Anastomosis system |
US20020173809A1 (en) * | 1999-09-01 | 2002-11-21 | Fleischman Sidney D. | Sutureless anastomosis system deployment concepts |
US8529583B1 (en) | 1999-09-03 | 2013-09-10 | Medtronic, Inc. | Surgical clip removal apparatus |
US6605053B1 (en) | 1999-09-10 | 2003-08-12 | Percardia, Inc. | Conduit designs and related methods for optimal flow control |
US6926730B1 (en) | 2000-10-10 | 2005-08-09 | Medtronic, Inc. | Minimally invasive valve repair procedure and apparatus |
US20040068278A1 (en) * | 1999-12-06 | 2004-04-08 | Converge Medical Inc. | Anastomosis systems |
US6461364B1 (en) | 2000-01-05 | 2002-10-08 | Integrated Vascular Systems, Inc. | Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use |
US9579091B2 (en) | 2000-01-05 | 2017-02-28 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
US6391048B1 (en) | 2000-01-05 | 2002-05-21 | Integrated Vascular Systems, Inc. | Integrated vascular device with puncture site closure component and sealant and methods of use |
US6942674B2 (en) | 2000-01-05 | 2005-09-13 | Integrated Vascular Systems, Inc. | Apparatus and methods for delivering a closure device |
US7842068B2 (en) | 2000-12-07 | 2010-11-30 | Integrated Vascular Systems, Inc. | Apparatus and methods for providing tactile feedback while delivering a closure device |
US8758400B2 (en) | 2000-01-05 | 2014-06-24 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
CA2397121C (en) | 2000-01-18 | 2009-04-07 | Tyco Healthcare Group Lp | Anastomosis instrument and method for performing same |
US6916327B2 (en) * | 2000-03-07 | 2005-07-12 | Metacardia, Inc. | Device for creating an anastomosis, including penetration structure and eversion structure |
US6551332B1 (en) | 2000-03-31 | 2003-04-22 | Coalescent Surgical, Inc. | Multiple bias surgical fastener |
AU2001288006A1 (en) | 2000-09-08 | 2002-03-22 | Thomas Anthony | Device for locating a puncture hole in a liquid-carrying vessel |
US6626918B1 (en) | 2000-10-06 | 2003-09-30 | Medical Technology Group | Apparatus and methods for positioning a vascular sheath |
US6746459B2 (en) | 2000-10-19 | 2004-06-08 | Terumo Kabushiki Kaisha | End-to-side blood vessel anastomosis method and instruments therefor |
US6695867B2 (en) | 2002-02-21 | 2004-02-24 | Integrated Vascular Systems, Inc. | Plunger apparatus and methods for delivering a closure device |
US7806904B2 (en) | 2000-12-07 | 2010-10-05 | Integrated Vascular Systems, Inc. | Closure device |
US8690910B2 (en) | 2000-12-07 | 2014-04-08 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US7211101B2 (en) | 2000-12-07 | 2007-05-01 | Abbott Vascular Devices | Methods for manufacturing a clip and clip |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US7905900B2 (en) | 2003-01-30 | 2011-03-15 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
JP4130584B2 (en) | 2001-01-24 | 2008-08-06 | タイコ ヘルスケア グループ リミテッド パートナーシップ | Anastomosis instrument and method for performing anastomosis |
US6945444B2 (en) | 2001-04-03 | 2005-09-20 | Tyco Healthcare Group, Lp | Surgical stapling device for performing circular anastomoses |
KR20020091523A (en) * | 2001-05-31 | 2002-12-06 | (주)에이치비메디컬스 | Vascular anastomosis device |
IES20010547A2 (en) | 2001-06-07 | 2002-12-11 | Christy Cummins | Surgical Staple |
US6626920B2 (en) | 2001-07-05 | 2003-09-30 | Converge Medical, Inc. | Distal anastomosis system |
US20030229365A1 (en) * | 2002-06-10 | 2003-12-11 | Whayne James G. | Angled vascular anastomosis system |
US6858035B2 (en) | 2001-07-05 | 2005-02-22 | Converge Medical, Inc. | Distal anastomosis system |
US6972023B2 (en) * | 2001-07-05 | 2005-12-06 | Converge Medical, Inc. | Distal anastomosis system |
US20060064119A9 (en) * | 2001-07-05 | 2006-03-23 | Converge Medical, Inc. | Vascular anastomosis systems |
US20070060952A1 (en) | 2005-09-02 | 2007-03-15 | Roby Mark S | Surgical stapling device with coated knife blade |
WO2003030745A1 (en) * | 2001-10-05 | 2003-04-17 | Tyco Healthcare Group Lp | Tilt top anvil for a surgical fastener device |
US6981979B2 (en) * | 2001-12-14 | 2006-01-03 | Enrico Nicolo | Surgical anastomotic devices |
US6769594B2 (en) | 2002-05-31 | 2004-08-03 | Tyco Healthcare Group, Lp | End-to-end anastomosis instrument and method for performing same |
JP4508866B2 (en) | 2002-06-04 | 2010-07-21 | アボット ヴァスキュラー デヴァイシス | Vascular closure clip and delivery device |
ES2364043T3 (en) | 2002-07-31 | 2011-08-23 | Tyco Healthcare Group Lp | TOOL COATING ELEMENT AND COATING DEPLOYMENT DEVICE. |
US8066724B2 (en) | 2002-09-12 | 2011-11-29 | Medtronic, Inc. | Anastomosis apparatus and methods |
CA2501049C (en) | 2002-10-04 | 2012-01-03 | Tyco Healthcare Group Lp | Surgical stapling device |
US8105345B2 (en) | 2002-10-04 | 2012-01-31 | Medtronic, Inc. | Anastomosis apparatus and methods |
US7108710B2 (en) | 2002-11-26 | 2006-09-19 | Abbott Laboratories | Multi-element biased suture clip |
JP2006509595A (en) * | 2002-12-16 | 2006-03-23 | エドリッチ・ヴァスキュラー・ディヴァイシズ,インコーポレイテッド | Multiple stapling instruments for narrow vessels |
US8398656B2 (en) | 2003-01-30 | 2013-03-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8821534B2 (en) | 2010-12-06 | 2014-09-02 | Integrated Vascular Systems, Inc. | Clip applier having improved hemostasis and methods of use |
US8202293B2 (en) | 2003-01-30 | 2012-06-19 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US7857828B2 (en) | 2003-01-30 | 2010-12-28 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US8758398B2 (en) | 2006-09-08 | 2014-06-24 | Integrated Vascular Systems, Inc. | Apparatus and method for delivering a closure element |
US8905937B2 (en) | 2009-02-26 | 2014-12-09 | Integrated Vascular Systems, Inc. | Methods and apparatus for locating a surface of a body lumen |
US7168604B2 (en) | 2003-06-20 | 2007-01-30 | Tyco Healthcare Group Lp | Surgical stapling device |
US7794471B1 (en) * | 2003-06-26 | 2010-09-14 | Cardica, Inc. | Compliant anastomosis system |
US7182769B2 (en) | 2003-07-25 | 2007-02-27 | Medtronic, Inc. | Sealing clip, delivery systems, and methods |
US20050043749A1 (en) * | 2003-08-22 | 2005-02-24 | Coalescent Surgical, Inc. | Eversion apparatus and methods |
US8394114B2 (en) | 2003-09-26 | 2013-03-12 | Medtronic, Inc. | Surgical connection apparatus and methods |
JP4604040B2 (en) | 2003-10-17 | 2010-12-22 | タイコ ヘルスケア グループ リミテッド パートナーシップ | Surgical stapling device |
US7879047B2 (en) | 2003-12-10 | 2011-02-01 | Medtronic, Inc. | Surgical connection apparatus and methods |
AU2005226643B2 (en) | 2004-03-19 | 2010-07-22 | Covidien Lp | Anvil assembly with improved cut ring |
US8181840B2 (en) | 2004-03-19 | 2012-05-22 | Tyco Healthcare Group Lp | Tissue tensioner assembly and approximation mechanism for surgical stapling device |
IES20040368A2 (en) | 2004-05-25 | 2005-11-30 | James E Coleman | Surgical stapler |
US8926633B2 (en) | 2005-06-24 | 2015-01-06 | Abbott Laboratories | Apparatus and method for delivering a closure element |
US8313497B2 (en) | 2005-07-01 | 2012-11-20 | Abbott Laboratories | Clip applier and methods of use |
US9456811B2 (en) | 2005-08-24 | 2016-10-04 | Abbott Vascular Inc. | Vascular closure methods and apparatuses |
US8920442B2 (en) | 2005-08-24 | 2014-12-30 | Abbott Vascular Inc. | Vascular opening edge eversion methods and apparatuses |
US20070060895A1 (en) | 2005-08-24 | 2007-03-15 | Sibbitt Wilmer L Jr | Vascular closure methods and apparatuses |
US8808310B2 (en) | 2006-04-20 | 2014-08-19 | Integrated Vascular Systems, Inc. | Resettable clip applier and reset tools |
US8540132B2 (en) | 2006-05-16 | 2013-09-24 | Covidien Lp | Tilt anvil assembly |
USD611144S1 (en) | 2006-06-28 | 2010-03-02 | Abbott Laboratories | Apparatus for delivering a closure element |
US8556930B2 (en) | 2006-06-28 | 2013-10-15 | Abbott Laboratories | Vessel closure device |
DE602007012771D1 (en) | 2007-03-07 | 2011-04-07 | Covidien Ag | CLAMP DEVICE FOR MUCOSEKTOMY |
US8226681B2 (en) | 2007-06-25 | 2012-07-24 | Abbott Laboratories | Methods, devices, and apparatus for managing access through tissue |
US8893947B2 (en) | 2007-12-17 | 2014-11-25 | Abbott Laboratories | Clip applier and methods of use |
US20090157101A1 (en) | 2007-12-17 | 2009-06-18 | Abbott Laboratories | Tissue closure system and methods of use |
US7841502B2 (en) | 2007-12-18 | 2010-11-30 | Abbott Laboratories | Modular clip applier |
US8011554B2 (en) | 2008-01-09 | 2011-09-06 | Tyco Healthcare Group, Lp | Raised boss for staple guide |
US8177836B2 (en) | 2008-03-10 | 2012-05-15 | Medtronic, Inc. | Apparatus and methods for minimally invasive valve repair |
US9282965B2 (en) | 2008-05-16 | 2016-03-15 | Abbott Laboratories | Apparatus and methods for engaging tissue |
US8181838B2 (en) | 2008-09-10 | 2012-05-22 | Tyco Healthcare Group Lp | Surgical stapling device |
US8398676B2 (en) | 2008-10-30 | 2013-03-19 | Abbott Vascular Inc. | Closure device |
US8231042B2 (en) | 2008-11-06 | 2012-07-31 | Tyco Healthcare Group Lp | Surgical stapler |
US8323312B2 (en) | 2008-12-22 | 2012-12-04 | Abbott Laboratories | Closure device |
US8858594B2 (en) | 2008-12-22 | 2014-10-14 | Abbott Laboratories | Curved closure device |
US9414820B2 (en) | 2009-01-09 | 2016-08-16 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US9486191B2 (en) | 2009-01-09 | 2016-11-08 | Abbott Vascular, Inc. | Closure devices |
US20100179589A1 (en) | 2009-01-09 | 2010-07-15 | Abbott Vascular Inc. | Rapidly eroding anchor |
US9173644B2 (en) | 2009-01-09 | 2015-11-03 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US9089311B2 (en) | 2009-01-09 | 2015-07-28 | Abbott Vascular Inc. | Vessel closure devices and methods |
US8281974B2 (en) | 2009-01-14 | 2012-10-09 | Tyco Healthcare, Group LP | Surgical stapler with suture locator |
US20100185234A1 (en) | 2009-01-16 | 2010-07-22 | Abbott Vascular Inc. | Closure devices, systems, and methods |
US8453913B2 (en) | 2009-02-06 | 2013-06-04 | Covidien Lp | Anvil for surgical stapler |
KR101069603B1 (en) * | 2009-02-17 | 2011-10-05 | (주)트리플씨메디칼 | End-to-Side TUBULAR ANASTOMOSIS DEVICE |
US8518060B2 (en) | 2009-04-09 | 2013-08-27 | Medtronic, Inc. | Medical clip with radial tines, system and method of using same |
US8668704B2 (en) | 2009-04-24 | 2014-03-11 | Medtronic, Inc. | Medical clip with tines, system and method of using same |
US8146790B2 (en) | 2009-07-11 | 2012-04-03 | Tyco Healthcare Group Lp | Surgical instrument with safety mechanism |
US8328062B2 (en) | 2009-07-21 | 2012-12-11 | Covidien Lp | Surgical instrument with curvilinear tissue-contacting surfaces |
US8267301B2 (en) | 2009-08-19 | 2012-09-18 | Tyco Healthcare Group Lp | Surgical stapler |
US20110054492A1 (en) | 2009-08-26 | 2011-03-03 | Abbott Laboratories | Medical device for repairing a fistula |
US8430292B2 (en) | 2009-10-28 | 2013-04-30 | Covidien Lp | Surgical fastening apparatus |
US8322590B2 (en) | 2009-10-28 | 2012-12-04 | Covidien Lp | Surgical stapling instrument |
US8413872B2 (en) | 2009-10-28 | 2013-04-09 | Covidien Lp | Surgical fastening apparatus |
US8303624B2 (en) | 2010-03-15 | 2012-11-06 | Abbott Cardiovascular Systems, Inc. | Bioabsorbable plug |
US8758399B2 (en) | 2010-08-02 | 2014-06-24 | Abbott Cardiovascular Systems, Inc. | Expandable bioabsorbable plug apparatus and method |
US8603116B2 (en) | 2010-08-04 | 2013-12-10 | Abbott Cardiovascular Systems, Inc. | Closure device with long tines |
US8617184B2 (en) | 2011-02-15 | 2013-12-31 | Abbott Cardiovascular Systems, Inc. | Vessel closure system |
US9149276B2 (en) | 2011-03-21 | 2015-10-06 | Abbott Cardiovascular Systems, Inc. | Clip and deployment apparatus for tissue closure |
US8708212B2 (en) | 2011-10-18 | 2014-04-29 | Covidien Lp | Tilt top anvil with torsion spring |
US9016547B2 (en) | 2011-10-26 | 2015-04-28 | Covidien Lp | EEA tilt top anvil with ratchet/locking mechanism |
US9332976B2 (en) | 2011-11-30 | 2016-05-10 | Abbott Cardiovascular Systems, Inc. | Tissue closure device |
US9010605B2 (en) | 2012-01-12 | 2015-04-21 | Covidien Lp | Sliding sleeve for circular stapling instrument reloads |
US9022274B2 (en) | 2012-02-15 | 2015-05-05 | Covidien Lp | Circular stapler with increased lumen diameter |
US9351734B2 (en) | 2012-06-19 | 2016-05-31 | Covidien Lp | Spring loaded anvil retainer |
US10213205B2 (en) | 2012-07-06 | 2019-02-26 | Covidien Lp | T-slot tilt anvil for circular stapling instrument |
US9675359B2 (en) | 2012-10-10 | 2017-06-13 | Covidien Lp | Surgical instrument with preload assembly |
US9572572B2 (en) | 2012-11-09 | 2017-02-21 | Covidien Lp | Circular stapler mechanical lockout |
US9364209B2 (en) | 2012-12-21 | 2016-06-14 | Abbott Cardiovascular Systems, Inc. | Articulating suturing device |
US9351724B2 (en) | 2013-01-11 | 2016-05-31 | Covidien Lp | Circular stapling instrument |
US9592056B2 (en) | 2013-03-14 | 2017-03-14 | Covidien Lp | Powered stapling apparatus |
CN104042292A (en) | 2013-03-15 | 2014-09-17 | 柯惠Lp公司 | Surgical anastomosis device comprising assemblies capable of being repeatedly utilized |
US9532780B2 (en) | 2013-06-12 | 2017-01-03 | Covidien Lp | EEA anvil snap ring activator |
US9668740B2 (en) | 2013-06-14 | 2017-06-06 | Covidien Lp | Anvil assembly with sliding sleeve |
US10271843B2 (en) | 2013-06-17 | 2019-04-30 | Covidien Lp | Surgical instrument with lockout mechanism |
US9750503B2 (en) | 2013-07-11 | 2017-09-05 | Covidien Lp | Methods and devices for performing a surgical anastomosis |
US9693773B2 (en) | 2013-09-11 | 2017-07-04 | Covidien Lp | Anvil assembly with sliding sleeve |
US9517070B2 (en) | 2013-11-13 | 2016-12-13 | Covidien Lp | Anvil assembly and delivery system |
US9554802B2 (en) | 2013-11-13 | 2017-01-31 | Covidien Lp | Anvil assembly with frangible retaining member |
US9913643B2 (en) | 2014-05-09 | 2018-03-13 | Covidien Lp | Interlock assemblies for replaceable loading unit |
EP3154448B1 (en) | 2014-06-12 | 2019-08-28 | Covidien LP | Surgical stapling apparatus |
US9861367B2 (en) | 2014-06-24 | 2018-01-09 | Covidien Lp | Anvil assembly delivery systems |
US9867619B2 (en) | 2014-06-24 | 2018-01-16 | Covidien Lp | System for delivering an anvil assembly to a surgical site |
US10405864B2 (en) | 2014-07-04 | 2019-09-10 | Covidien Lp | Loading unit with shipping member for surgical stapling device |
US9757133B2 (en) | 2014-07-09 | 2017-09-12 | Covidien Lp | Methods and devices for performing a surgical anastomosis |
US10898196B2 (en) | 2014-11-21 | 2021-01-26 | Covidien Lp | Cleaning apparatus for surgical instruments |
US10085744B2 (en) | 2014-12-08 | 2018-10-02 | Covidien Lp | Loading unit attachment band for surgical stapling instrument |
US9855045B2 (en) | 2014-12-09 | 2018-01-02 | Covidien Lp | Anvil assembly delivery system |
WO2016090600A1 (en) | 2014-12-11 | 2016-06-16 | Covidien Lp | Stapler with auto-matic lockout mechanism |
US10499916B2 (en) | 2014-12-11 | 2019-12-10 | Covidien Lp | Surgical stapling loading unit |
CN106999189B (en) | 2014-12-17 | 2020-05-26 | 柯惠有限合伙公司 | Surgical stapling device with firing indicator |
US10022126B2 (en) | 2015-01-07 | 2018-07-17 | Covidien Lp | Loading unit locking collar |
US10039549B2 (en) | 2015-01-07 | 2018-08-07 | Covidien Lp | Loading unit retention clip for surgical stapling instrument |
US10117656B2 (en) | 2015-01-07 | 2018-11-06 | Covidien Lp | Loading unit locking collar |
WO2016127433A1 (en) | 2015-02-15 | 2016-08-18 | Covidien Lp | Surgical stapling device with firing indicator of unitary construction |
US10881408B2 (en) | 2015-04-22 | 2021-01-05 | Covidien Lp | Interlock assembly for replaceable loading units |
US10426480B2 (en) | 2015-04-29 | 2019-10-01 | Covidien Lp | Cutting ring assembly with rigid cutting member |
US9987001B2 (en) | 2015-06-12 | 2018-06-05 | Covidien Lp | Surgical anastomosis apparatus |
US10111668B2 (en) | 2015-07-02 | 2018-10-30 | Covidien Lp | Anvil assembly with snap backup ring |
US9974536B2 (en) | 2015-07-02 | 2018-05-22 | Covidien Lp | Anvil assemblies and delivery systems |
US10117655B2 (en) | 2015-07-22 | 2018-11-06 | Covidien Lp | Loading unit locking band for surgical stapling instrument |
US10085756B2 (en) | 2015-07-24 | 2018-10-02 | Covidien Lp | Anvil assembly and anvil assembly delivery system |
US10117675B2 (en) | 2015-07-28 | 2018-11-06 | Covidien Lp | Trocar tip protector |
US9980730B2 (en) | 2015-09-21 | 2018-05-29 | Covidien Lp | Loading unit locking collar with rotational actuated release |
US10111684B2 (en) | 2015-09-25 | 2018-10-30 | Covidien Lp | Adapter assembly including a removable trocar assembly |
US10542992B2 (en) | 2015-10-19 | 2020-01-28 | Covidien Lp | Loading unit with stretchable bushing |
WO2017066918A1 (en) | 2015-10-20 | 2017-04-27 | Covidien Lp | Circular stapler with tissue gap indicator assembly |
US10842495B2 (en) | 2015-10-21 | 2020-11-24 | Covidien Lp | Annular knife for a surgical stapler |
US10512466B2 (en) | 2015-11-05 | 2019-12-24 | Covidien Lp | Adapter assembly for surgical device |
CN108289683B (en) | 2015-11-13 | 2021-06-25 | 柯惠有限合伙公司 | Circular stapler with audible indicator mechanism |
ES2821891T3 (en) | 2015-12-07 | 2021-04-28 | Covidien Lp | Anvil Assembly and Delivery System |
US10390835B2 (en) | 2015-12-10 | 2019-08-27 | Covidien Lp | Surgical fastener apparatus with linear position sensor |
US10524797B2 (en) | 2016-01-13 | 2020-01-07 | Covidien Lp | Adapter assembly including a removable trocar assembly |
EP3410957B1 (en) | 2016-02-04 | 2020-06-03 | Covidien LP | Circular stapler with visual indicator mechanism |
US10398439B2 (en) | 2016-02-10 | 2019-09-03 | Covidien Lp | Adapter, extension, and connector assemblies for surgical devices |
US10603042B2 (en) | 2016-02-10 | 2020-03-31 | Covidien Lp | Flexible circular stapler |
EP3422986B1 (en) | 2016-03-04 | 2023-12-27 | Covidien LP | Robotic surgical assemblies |
US10595871B2 (en) | 2016-05-10 | 2020-03-24 | Covidien Lp | Insertion instrument, adapter assemblies and protector assemblies for a flexible circular stapler |
US11141162B2 (en) | 2016-07-08 | 2021-10-12 | Covidien Lp | Loading unit locking collar with linearly actuated release |
US11452522B2 (en) | 2016-08-15 | 2022-09-27 | Covidien Lp | Circular stapling device with articulating anvil retainer assembly |
US10426470B2 (en) | 2016-11-04 | 2019-10-01 | Covidien Lp | Stapling device with releasable knife carrier |
US10499922B2 (en) | 2016-11-04 | 2019-12-10 | Covidien Lp | Stapling device with self-releasing knife carrier pusher |
US11241232B2 (en) | 2017-01-24 | 2022-02-08 | Covidien Lp | Surgical stapling device with resettable anvil assembly |
WO2018140066A1 (en) | 2017-01-25 | 2018-08-02 | Covidien Lp | Circular stapling device and method of use |
US10542993B2 (en) | 2017-02-24 | 2020-01-28 | Covidien Lp | Anvil assembly of circular stapling device including alignment splines |
EP3592252B1 (en) | 2017-03-09 | 2023-10-25 | Covidien LP | End effector assembly for circular stapler apparatus |
US11382629B2 (en) | 2017-03-09 | 2022-07-12 | Covidien Lp | Surgical stapling device with audible indicator mechanism |
US11071549B2 (en) | 2017-03-23 | 2021-07-27 | Covidien Lp | Circular stapling device with alignment splines |
US10342534B2 (en) | 2017-03-23 | 2019-07-09 | Covidien Lp | Surgical stapling device with releasable knife carrier |
US10881409B2 (en) | 2017-05-02 | 2021-01-05 | Covidien Lp | Rotation assembly for a surgical device |
US11596400B2 (en) | 2017-06-09 | 2023-03-07 | Covidien Lp | Handheld electromechanical surgical system |
US11045199B2 (en) | 2017-06-09 | 2021-06-29 | Covidien Lp | Handheld electromechanical surgical system |
US10932784B2 (en) | 2017-06-09 | 2021-03-02 | Covidien Lp | Handheld electromechanical surgical system |
US10987107B2 (en) | 2017-07-05 | 2021-04-27 | Covidien Lp | Surgical stapling device |
WO2019023841A1 (en) | 2017-07-31 | 2019-02-07 | Dow Silicones Corporation | Process and apparatus to make liquid silicone rubber compositions |
US11090054B2 (en) | 2017-08-07 | 2021-08-17 | Covidien Lp | Stapling device with resettable tilt anvil assembly |
US10828026B2 (en) | 2017-08-08 | 2020-11-10 | Covidien Lp | Tiltable anvil assembly |
US10695069B2 (en) | 2017-08-23 | 2020-06-30 | Covidien Lp | Circular stapling device with offset spline tip |
US11234703B2 (en) | 2017-09-01 | 2022-02-01 | Covidien Lp | Circular stapling device with position ribs |
US11324507B2 (en) | 2017-11-03 | 2022-05-10 | Covidien Lp | Device and method for attachment of a stomal sleeve |
US11497501B2 (en) | 2018-03-26 | 2022-11-15 | Covidien Lp | Circular stapling device with A-frame splines |
US11006960B2 (en) | 2018-03-28 | 2021-05-18 | Covidien Lp | Surgical anvil assemblies for surgical stapling instruments |
US10952734B2 (en) | 2018-04-23 | 2021-03-23 | Covidien Lp | Stapling device with cut ring biasing member |
US11197676B2 (en) | 2018-06-28 | 2021-12-14 | Covidien Lp | Tie-down method for anvil assembly delivery system |
US11241234B2 (en) | 2018-08-14 | 2022-02-08 | Covidien Lp | Anvil assembly with self-retaining backup member |
US11564691B2 (en) | 2018-08-24 | 2023-01-31 | Covidien Lp | Powered circular stapling device |
US10973544B2 (en) | 2018-10-02 | 2021-04-13 | Covidien Lp | Retaining mechanism for trocar assembly |
US11141163B2 (en) | 2018-10-04 | 2021-10-12 | Covidien Lp | Circular stapling device with anvil rotation locking structure |
US11065005B2 (en) | 2018-11-07 | 2021-07-20 | Covidien Lp | Reload assembly for a circular stapling device |
US11147561B2 (en) | 2018-11-28 | 2021-10-19 | Covidien Lp | Reload assembly for a circular stapling device |
US11389263B2 (en) | 2018-12-13 | 2022-07-19 | Covidien Lp | Lockout mechanisms for surgical instruments |
US11166728B2 (en) | 2019-02-08 | 2021-11-09 | Covidien Lp | Reload assembly for a circular stapling device |
US11529144B2 (en) | 2019-02-22 | 2022-12-20 | Covidien Lp | Encapsulated plug assembly for electromechanical surgical devices |
US11547411B2 (en) | 2019-02-22 | 2023-01-10 | Covidien Lp | Anastomosis wound protector |
US11337701B2 (en) | 2019-03-01 | 2022-05-24 | Covidien Lp | Devices and methods for assembling adapter assemblies |
US11331782B2 (en) | 2019-03-01 | 2022-05-17 | Covidien Lp | Reload assembly for a circular stapling device |
US11457921B2 (en) | 2019-03-26 | 2022-10-04 | Covidien Lp | Anvil assembly for surgical stapling instrument |
US11534164B2 (en) | 2019-04-05 | 2022-12-27 | Covidien Lp | Strain gauge stabilization in a surgical device |
US11596410B2 (en) | 2019-04-05 | 2023-03-07 | Covidien Lp | Surgical stapling device |
US11317945B2 (en) | 2019-04-16 | 2022-05-03 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11344330B2 (en) | 2019-04-16 | 2022-05-31 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11660116B2 (en) | 2019-04-16 | 2023-05-30 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11419631B2 (en) | 2019-04-16 | 2022-08-23 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11839378B2 (en) | 2019-04-19 | 2023-12-12 | Covidien Lp | Circular stapling instruments |
US11399838B2 (en) | 2019-04-22 | 2022-08-02 | Covidien Lp | Reload assembly for circular stapling devices |
US11246599B2 (en) | 2019-04-25 | 2022-02-15 | Covidien Lp | End effector for circular stapling instrument |
JP2022543958A (en) | 2019-05-31 | 2022-10-17 | コヴィディエン リミテッド パートナーシップ | circular stapling device |
US11690624B2 (en) | 2019-06-21 | 2023-07-04 | Covidien Lp | Reload assembly injection molded strain gauge |
US11446035B2 (en) | 2019-06-24 | 2022-09-20 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11123101B2 (en) | 2019-07-05 | 2021-09-21 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11357509B2 (en) | 2019-07-11 | 2022-06-14 | Covidien Lp | Reload assembly for a circular stapling device |
US11192227B2 (en) | 2019-07-16 | 2021-12-07 | Covidien Lp | Reload assembly for circular stapling devices |
US11253255B2 (en) | 2019-07-26 | 2022-02-22 | Covidien Lp | Knife lockout wedge |
US11464510B2 (en) | 2019-07-26 | 2022-10-11 | Covidien Lp | Reload assembly with knife carrier lockout |
US11399825B2 (en) | 2019-10-28 | 2022-08-02 | Covidien Lp | Reload assembly with knife carrier lockout |
US11553918B2 (en) | 2019-12-16 | 2023-01-17 | Covidien Lp | Reload assembly with knife carrier lockout |
US11730481B2 (en) | 2020-01-06 | 2023-08-22 | Covidien Lp | Assemblies for retaining a trocar assembly |
US11517317B2 (en) | 2020-01-06 | 2022-12-06 | Covidien Lp | Trocar release assemblies for a surgical stapler |
US11911038B2 (en) | 2020-01-13 | 2024-02-27 | Covidien Lp | Cut optimization for excessive tissue conditions |
US11523828B2 (en) | 2020-01-28 | 2022-12-13 | Covidien Lp | Sealed reload assembly for stapling device |
US11622767B2 (en) | 2020-02-19 | 2023-04-11 | Covidien Lp | Sealed trocar assembly for stapling device |
US11547438B2 (en) | 2020-02-24 | 2023-01-10 | Covidien Lp | Tip protector for ensuring trocar insertion |
US11382630B2 (en) | 2020-02-25 | 2022-07-12 | Covidien Lp | Surgical stapling device with two part knife assembly |
US11779343B2 (en) | 2020-02-26 | 2023-10-10 | Covidien Lp | Staple reload assembly with releasable knife |
US11298152B2 (en) | 2020-02-28 | 2022-04-12 | Covidien Lp | Trocar retaining mechanism including band support |
US11272998B2 (en) | 2020-03-04 | 2022-03-15 | Covidien Lp | Strain gage fixation in tension |
US11350939B2 (en) | 2020-03-24 | 2022-06-07 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11426169B2 (en) | 2020-03-24 | 2022-08-30 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11426170B2 (en) | 2020-03-24 | 2022-08-30 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11653925B2 (en) | 2020-05-21 | 2023-05-23 | Covidien Lp | Tissue relaxation monitoring for optimized tissue stapling |
US11547405B2 (en) | 2020-05-22 | 2023-01-10 | Covidien Lp | Surgical stapling device |
US11553921B2 (en) | 2020-07-15 | 2023-01-17 | Covidien Lp | Surgical stapling device with flexible shaft |
US11547412B2 (en) | 2020-07-22 | 2023-01-10 | Covidien Lp | Surgical instruments and methods of assembly |
US11877744B2 (en) | 2020-08-14 | 2024-01-23 | Covidien Lp | Low-cost powered stapler with end stop selection |
US11627966B2 (en) | 2020-08-26 | 2023-04-18 | Covidien Lp | Surgical stapling device |
US11801054B2 (en) | 2020-09-22 | 2023-10-31 | Covidien Lp | Surgical stapler with oval tool assembly |
US11712509B2 (en) | 2020-10-02 | 2023-08-01 | Covidien Lp | Seal assembly for circular stapling instrument |
US11627967B2 (en) | 2020-11-23 | 2023-04-18 | Covidien Lp | Trans-anastomotic insertion device |
US11877750B2 (en) | 2021-01-21 | 2024-01-23 | Covidien Lp | Surgical stapler with powered and manual functions |
US11786241B2 (en) | 2021-02-16 | 2023-10-17 | Covidien Lp | Surgical stapling device including a hydraulic staple formation mechanism |
US11553920B2 (en) | 2021-05-03 | 2023-01-17 | Covidien Lp | Trocar retainer assembly for surgical stapler |
US11490894B1 (en) | 2021-05-12 | 2022-11-08 | Covidien Lp | Surgical device with grease filter |
US11642131B2 (en) | 2021-05-17 | 2023-05-09 | Covidien Lp | Devices and methods for shortening a rectal stump during a lower anterior resection procedure |
US11612400B2 (en) | 2021-05-24 | 2023-03-28 | Covidien Lp | Trocar assembly with bearing assembly for load sharing |
US11819208B2 (en) | 2021-08-05 | 2023-11-21 | Covidien Lp | Handheld electromechanical surgical device with strain gauge drift detection |
US11737759B2 (en) | 2021-08-05 | 2023-08-29 | Covidien Lp | Surgical stapling device accommodating prolapsed tissue |
US11744592B2 (en) | 2021-08-05 | 2023-09-05 | Covidien Lp | Handheld electromechanical stapler with tissue thickness detection |
US20230047471A1 (en) * | 2021-08-13 | 2023-02-16 | Cilag Gmbh International | Staple forming features for circular surgical stapler |
US11911039B2 (en) | 2021-08-13 | 2024-02-27 | Cilag Gmbh International | Circular surgical stapler having staples with expandable crowns |
US11883028B2 (en) | 2021-09-08 | 2024-01-30 | Covidien Lp | Systems and methods for post-operative anastomotic leak detection |
US11717299B2 (en) | 2021-10-12 | 2023-08-08 | Covidien Lp | Surgical stapling device with probiotics |
Family Cites Families (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4576167A (en) * | 1981-09-03 | 1986-03-18 | United States Surgical Corporation | Surgical stapler apparatus with curved shaft |
US4776506A (en) * | 1986-11-13 | 1988-10-11 | United States Surgical Corporation | Surgical stapler apparatus |
US5119983A (en) * | 1987-05-26 | 1992-06-09 | United States Surgical Corporation | Surgical stapler apparatus |
US5366462A (en) * | 1990-08-28 | 1994-11-22 | Robert L. Kaster | Method of side-to-end vascular anastomotic stapling |
US5234447A (en) * | 1990-08-28 | 1993-08-10 | Robert L. Kaster | Side-to-end vascular anastomotic staple apparatus |
US5188638A (en) * | 1992-02-06 | 1993-02-23 | Tzakis Andreas G | Apparatus and method for preforming anastomosis fastener securement of hollow organs |
DK145593A (en) * | 1993-12-23 | 1995-06-24 | Joergen A Rygaard | Surgical double instrument for performing connection mlm. arteries (end-to-side anastomosis) |
-
1995
- 1995-10-31 AT AT95935866T patent/ATE188862T1/en not_active IP Right Cessation
- 1995-10-31 DE DE69514694T patent/DE69514694T2/en not_active Expired - Fee Related
- 1995-10-31 JP JP51699597A patent/JP3207436B2/en not_active Expired - Fee Related
- 1995-10-31 EP EP95935866A patent/EP0859572B1/en not_active Expired - Lifetime
- 1995-10-31 CA CA002234148A patent/CA2234148C/en not_active Expired - Fee Related
- 1995-10-31 WO PCT/DK1995/000430 patent/WO1997016122A1/en active IP Right Grant
- 1995-10-31 AU AU38017/95A patent/AU701033B2/en not_active Ceased
- 1995-10-31 US US09/065,042 patent/US5993468A/en not_active Expired - Fee Related
- 1995-10-31 KR KR1019980703130A patent/KR100269077B1/en not_active IP Right Cessation
- 1995-10-31 DK DK95935866T patent/DK0859572T3/en active
- 1995-10-31 ES ES95935866T patent/ES2145303T3/en not_active Expired - Lifetime
-
1998
- 1998-04-28 NO NO981922A patent/NO981922L/en not_active Application Discontinuation
Also Published As
Publication number | Publication date |
---|---|
JPH11502753A (en) | 1999-03-09 |
AU701033B2 (en) | 1999-01-21 |
CA2234148A1 (en) | 1997-05-09 |
AU3801795A (en) | 1997-05-22 |
US5993468A (en) | 1999-11-30 |
ATE188862T1 (en) | 2000-02-15 |
DE69514694D1 (en) | 2000-02-24 |
DE69514694T2 (en) | 2000-07-27 |
WO1997016122A1 (en) | 1997-05-09 |
DK0859572T3 (en) | 2000-06-26 |
EP0859572B1 (en) | 2000-01-19 |
NO981922L (en) | 1998-06-30 |
ES2145303T3 (en) | 2000-07-01 |
JP3207436B2 (en) | 2001-09-10 |
EP0859572A1 (en) | 1998-08-26 |
KR19990067179A (en) | 1999-08-16 |
KR100269077B1 (en) | 2000-11-01 |
NO981922D0 (en) | 1998-04-28 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2234148C (en) | Method and anastomotic instrument for use when performing an end-to-side anastomosis | |
CA2244221C (en) | Method and anastomotic instrument for use when performing an end-to-side anastomosis | |
JP3207440B2 (en) | Anastomotic device for use when performing end-to-end anastomosis | |
US6811555B1 (en) | Method and apparatus for performing anastomosis with eversion of tissue edges and joining of exposed intima of the everted tissue | |
US4930674A (en) | Surgical stapler | |
US7347864B2 (en) | Method for end-to-end anastomosis | |
JP4159805B2 (en) | Pushing mechanism for closing method | |
US5314436A (en) | Method and apparatus for performing end-to-end anastomoses | |
US7343920B2 (en) | Connective tissue repair system | |
US4703887A (en) | Collapsible purse string aid for use with intraluminal stapling device | |
JP2647259B2 (en) | Method and apparatus for performing dorsal vein ligation | |
JP4320061B2 (en) | Endoscope control device | |
AU764573B2 (en) | A needle holder to assist in suturing | |
WO2001015607A1 (en) | Method and apparatus for performing anastomosis | |
KR102241687B1 (en) | Device to assist inserting of circular stapler | |
WO2023238142A1 (en) | A device for manually performing anastomosis |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request | ||
MKLA | Lapsed |