US 3317105 A
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y 2, 1967 G. v. ASTAFJEV ETAL 3,317,105
INSTRUMENT FOR PLACING LATERAL INTESTINAL ANASTOMOSES Filed March 25, 1964 2 Sheets-Sheet 1 FIB 4 y 2 1967 G. v. ASTAFJEV ETAL 3,317,105
INSTRUMENT FOR PLACING LATERAL INTESTINAL ANASTOMOSES Filed March 25, 1964 2 Sheets-Sheet 2 United States Patent 3,317,105 INSTRUMENT FOR PLACING LATERAL INTESTINAL ANASTOMOSES Georgy Vasiljevich Astafjev, Anatoly Nikolaevich Ozhglkhin, Anatoly Georgievich Pugachev, and Viktor Vasiljevich Gavryushov, all of Moscow, U.S.S.R., assignors to, Nauchno-Issledovatelsky Institute Experimentaluoi Khirurgicheskoi Apparatury i Instrumentov, Moscow, U.S.S.R.
Filed Mar. 25, 1964, Ser. No. 356,000 Claims. (Cl. 227-76) This invention relates to surgical suturing devices for placing intestinal anastomoses.
The conventional instruments for intestinal anastomoses comprise staple and support bodies provided with working jaws which respectively have slots receiving U-shaped suturing clips and depressions for bending the clip ends when suturing, pushers mounted in the working jaw of the staple body to drive the clips, as well as a movable Wedge mounted on the staple body for moving the pushers, a blade being mounted on the wedge and used for dissecting the organs in the region. r
The conventional instruments allow suturing of only strong tissues whose walls are 1 to 1.5 mm. thick.
The instruments which apply sutures from outside of the organs cannot be used for suturing thin and delicate small-diameter intestines whose walls are 0.2-0.3 mm. thick since such instruments have organ securing devices usually in the form of needles or sharp teeth which are used to hold the tissues while suturing. It is practically impossible to produce securing devices 0.1 to 0.2 mm. long which would adequately secure the intestine walls.
Other instruments effect suturing by introducing the working jaws into the lumens of the intestines being sutured. They allow a side-to-side suturing of intestines, as well as a suturing of the side wall of an intestine to the stomach with a single-row suture using U-shaped clips.
To perform isoperistaltic gut suturing, the working jaws of the instrument are introduced into the gut lumen through punctures in its side walls. Such punctures in the side Walls of small diameter intestines, for instance, in infants, are not permissible due to the fact that, after the jaws have been removed and the punctures sutured, the gut contracts almost as much as that in adults. This results in the gut lumen becoming constricted to such an extent that passage of nutrients can be greatly restricted and even completely blocked.
Another disadvantage of these instruments is their nonhermetic suturing. That is the reason that when operating on a child, lateral intestinal anastomoses are still placed by means of a conventional surgical needle.
This problem has been solved according to the present invention by providing an instrument for mechanically placing isoperistaltic intestinal anastomoses of the sideto-side type without the side Wall of an intestine being preliminarily punctured; the said instrument is provided with a support jaw, a wedge actuating the clip pushers with a blade hinged therein and dissecting the gut walls between the front and rear clip rows during suturing, whilst leaving some portions at the beginning and at the end of a suture nondissected, as well as projecting pins having shaped caps to secure holders thereon.
The instrument is intended for placing intestinal anastomoses in various cases of both congenital and acquired gut impassability in infants (from new-born to older children).
will be evident from the following detailed description with reference to the accompanying drawings in which:
FIG. 1 is a side view of the instrument according to the invention in partial section;
FIG. 2 is a sectional view taken along lines A-A in FIG. 1;
FIG. 3 is a sectional view taken along lines BB in FIG.
FIG. 4 is a sectional view taken along lines CC in FIG. 1;
FIG. 5 is a sectional view taken along lines DD in FIG. 1;
FIG. 6 is a sectional view taken along lines BE in FIG. 1;
FIG. 7 is a sectional view diagrammatically illustrating gut suturing;
FIG. 8 is a top view of the instrument in partial section; and
FIG. 9 is a perspective view showing the technique of introducing the working jaws of the instrument into the lumen of an intestine.
The instrument comprises a stapling body 1 and a support body 2 (FIG. 1). The stapling body 1 has a straight working jaw 3 extending from the body. The support body 2 has a supporting jaw 4 which extends from the body and is reversely bent such that a limb of the jaw is adjacent jaw 3 and has a free end proximate the body 2 and remote from the free end of jaw 3. Thus the free ends of jaws 3, 4- are at opposite ends of the common adjacent region of the jaws.
Bodies '1 and 2 are secured together to resist longitudinal and transverse displacement by engagement of a cross-shaped lug 5 in the handle of body 1 in a respective cross-shaped slot in the handle of the body 2. Additional looking to resist transverse displacement of the bodies 1 and 2 and to properly secure the working jaws 3 and 4 in place is effected by the entry of a projection 6 in the space between lateral flanks 7 (FIG. 3) of the stapling body 1. A projection 8 and a spring-loaded rack 9 are engageable to rigidly fasten the bodies 1 and 2 together.
The jaw 3 has two rows of slots 10 (FIG. 5) which receive U-shaped metal suturing :clips 15 (FIG. 7). The jaw 4 has two parallel rows of depressions 11 located in alignment with slots 10 for bending the clips 15 when suturing. Each slot 10 receives a pusher 12 to drive the clips 15 out of the slots. The pusher are actuated by a so-called wedge 13 having a beveled leading edge (FIG.
Wedge 13 moves along a longitudinal slot 14 of the jaw 3 and a working slot 14 of the jaw 4 and its leading edge actuates the pushers 12 to drive the clips one after another out of the slots 10. Said clips pierce the walls of the intestine ends a, b to be sutured, these walls being preliminarily clamped by the jaws of the instrument. The ends of the clip are then received in the depressions 11 of jaw 4 and are bent into a B-shape. A blade 16 moves with the Wedge 13 and is supported therefrom by hinge c.
As soon as the wedge 13 forces the first two pairs of 'clips out of jaw 3, the blade 16 comes to the end face 17 of a groove 18 (FIG. 8) in the jaw 3, and the blade turns around hinge c and assumes a vertical position. As the wedge 13 moves on, the blade 16 remains vertical and dissects the intestine walls between the rows of sutures, said walls being clamped between the jaws of the instrument. The hinge c is placed at such a longitudinal distance from the leading edge of the wedge as not to allow the blade 16 to cut the intestine walls between the two final pair of clips when they are driven out. This insures that between the first two and the final two pairs of clips the intestine ends remain intact and are not cut.
In operation, the jaw 3 is introduced into the lumen of the intake section a of the intestine (FIG. 9) whereas its off-take section b is put on the jaw 4. The intestine ends are placed on the jaws from opposite ends and suturing can be performed without puncturing the side walls of the intestine and with a uniform direction of the intestines peristaltic movement. After the intestines are put on the jaws 3 and 4 and fastened with holders 19 connected to projecting pins 20 to prevent the intestine ends from slipping off the jaws 3 and 4, the instrument bodies 1 and 2 are locked by the engagement of projection 8 and the rack 9. Now, while holding the instrument in one hand, the other hand is used to move the wedge 13 along with the blade 16 forward as far as it will go. To facilitate this operation, the wedge is fitted with a finger rest d (FIG. 8). The wedge is guided by engagement of a bolt 21 in a slot 22. In its original position, the wedge is locked with a pin 23. The jaw 3 has two lateral sides 25 which are secured thereto with screws 24, said sides 25 being removed when loading the instrument with the clips 15.
The instrument permits mechanical placing of the side-to-side intestinal anastomoses in the shortest possible time. The lumen of the obtained anastomoses is of a suflicient diameter and does not become constricted. The mechanical suturing has adequate strength. An employment of the instrument results in that there is almost no traumatic injury to the anastomosing edges of the intestines which is frequently the case where the intestinal anastomoses is placed manually.
The instrument can be employed for cutting small intestines and megaduodenum of newly-born infants, and for the resection of small intestines both in babies and in older children.
Though the present invention is described in connection with a preferred embodiment, it is evident that variations and modifications can be made by those skilled in the art without departing from the spirit and scope of the invention, as defined in the attached claims.
What is claimed is:
1. A surgical instrument for placing anastomoses comprising a stapling body including a projecting jaw having a free end, said jaw having a longitudinal slot, and a slot for staples on either side of the longitudinal slot, pusher means in the staple slots for ejecting staples, means movable in the longitudinal slot for actuating the pusher means, cutting means mounted on the latter means for dissecting tissue, a supporting body coupled to said stapling body and including a jaw, the latter jaw extending from the supporting body in the same direction as the jaw of the stapling body and being reversely bent to provide a limb adjacent the jaw of the stapling body jaw having a free end adjacent the stapling body and remote from the free end of the jaw of the stapling body, said limb having depressions aligned with said staple slots for bending the ends of staples ejected therefrom.
2. An instrument as claimed in claim 1 wherein said bodies include pins with shaped heads for fixing thereon holders adapted for being secured to the ends of vessels which are placed on the jaws to prevent the vessels from slipping olf the jaws.
3. An instrument as claimed in claim 1 wherein said cutting means comprises a blade hingeably supported from the means which is movable in the longitudinal slot.
4. An instrument as claimed in claim 3 wherein said jaw of the stapling body has a groove extending a portion of the length of the longitudinal slot for accommodating the blade therein in an inoperative position, said blade contacting the jaw of the stapling body at the end of said groove for being pivotally moved to an operative position.
5. An instrument as claimed in claim 4 wherein said means which is movable in the longitudinal slot is a wedge with a beveled leading edge which reaches an end position in which the last of the staples is ejected, said blade being positioned behind the leading edge of the wedge so as not to reach the position of the last staples when the wedge is at said end position.
References Cited by the Examiner FOREIGN PATENTS 927,936 6/1963 Great Britain.
GRANVILLE Y. CUSTER, JR., Primary Examiner.