SURGICAL INSTRUMENT FOR SUTURING HOLLOW ' ORGANS IN INFANTS ~
This invention relates to surgical instruments for applying circular staple sutures when placing anastomoses on hollow organs and, more specifically, to instruments for placing esophageal anastomoses in newborn infants in cases of atresia.
Known in the present day surgical practice are surgical instruments for placing circular anastomoses between hollow organs (cf. USSR Author‘s Certificates Nos. 195,041 and l4l,589; patents: Great Britain No. 942,122, U.S. No. 3,193,165, Canada No. 736,256, Switzerland No. 407,407, France No. l,349,20l and No. I,46l,464, Italy No. 674,174 and 724,978, Japan No. 456,544, Belgium No. 668,917). Said instruments feature a tubular body carrying a staple portion , said tubular body housing a central stem and a movable hollow rod with a cylindrical knife and a staple ejector, a detachable supporting head with depressions for bending thc staple ends and a circular recess at whose bottom a replaceable plastic washer is located.
Located inside said supporting head, in the course of the instrument operation, are: a stem connecting the supporting head to the staple portion, the cylindrical knife and the tissues being sutured which are fixed between thc end faces of the staple and supporting portions of the instrument.
The aforementioned known instruments are impracticable for suturing the esophagus in newborn infants in the case of atresia thereof, this being due to anatomical peculiarities inherent in newborn infants, mostly on account of the small size of their organs, as well as due to the fineness and delicacy of the tissues thereof.
An instrument designed for suturing the esophagus in newbom infants should have thediameter of its working portions (i.e., the tubular staple portion and the supporting head) not exceeding 6 or 7 mm., since for placing anastomotic sutures, said portions are to be introduced into the inner cavity of those sectors of the esophagus which are to be sutured.
It is evident that the inner space of the supporting head of such a diameter is not sufficient to accommodate all the necessary components for obtaining a high-quality, suture and for making an incision to obtain an anastomotic aperture through which the sutured portions are free to intercommunicate. i
Appertaining to the aforementioned components are: the depressions for bending the staples, said depressions being provided on the end face surface of the abovesaid supporting head; the cylindrical knife capable of cutting an aperture for a free communicating between the sutured portions of the esophagus; the stem connecting the supporting head of the instrument to the staple portion thereof; the circular recess at the bottom of which the replaceable plastic washer is provided, said recess serving to accommodate the esophageal ends being sutured and to excise the surplus tissue to restore a free permeability of the organ involved.
Moreover, to provide a reliable excision of the anastomotic aperture and a minimum traumatic lesion inflicted upon the living tissues, a slitlikeigap or clearance should be provided between the inner surface of said circular recess and thc outer surface of the cylindrical knife, said gap or clearance being in excess of twice the maximum thickness of the esophageal walls being sutured.
A free spaces should be left between the inner surface of the knife and the stern for the lower end ofthe esophagus constricted with a purse string or circumflexional suture to freely sink thereinto. i
Apparently, it is by reason of the difficulties mentioned above that despite the great progress in mechanization of the process of placing sutures during surgical operations and the wide variety of special suturing instruments available, there has not been previously suggested any instrument which is capable of placing anastomoses between the esophagus sections in the case ofits atresia occurring in newborn infants.
It is therefore a primary object of the present invention to develop a small-size surgical instrument for suturing the esophagus in newborn infants in the case ofits atresia.
lt is a specific object of the present invention to provide such a surgical instrument that is capable of quickly and rcliably placing a circumferential anastomotic suture, as well as to provide a guaranteed excision of the surplus tissue to restore the lumen of the sutured esophagus with a minimum traumatic lesion inflicted upon the tissues thereof during the process of placing an an-astomosis.
To accomplish the objects mentioned above, provision is made in the body of the instrument of the invention for an elastic or springy member capable of insuring a constant rate of travel of the staple ejector at various rates of travel of the rod carrying a puncher, whereas the central stem is free to move reciprocally along the body and to rotate around its own axis when extended all the way out of the body. i
With a view to attaining a simple and reliable operation of the instrument, said elastic member is made as a split washer loosely set over the rear portion of the puncher and located inside the instrument body between the end of the rod and the end face of the staple ejector which is likewise set freely on the rear portion of said puncher.
For the purpose of saving space, the cutting device has a puncher associated with the rod and is adapted to interact, during the operation, with thc edge of acylindrical depression or recess provided at the face end of the supporting head which receives the puncher.
According to the invention said puncher is provided with a cylindrical projection for the tissues being sutured which is inserted into said cylindrical depression or recess in thc supporting head. i
In accordance with the present invention, for thc purpose of convenience, the central stem has a cylindrical tailpiece with a knurled or milled surface, whereas tlhe supporting head has flat regions for a reliable holding of said head by a clamping tool. I
An embodiment of the present invention is described hereinbelow by way of example with reference to the appended drawings, wherein:
FIGS. I and 2 are, respectively, a side elevation and a plan view of the surgical instrument for su.turing hollow organs in infants; " .
FIG‘. 3 is a longitudinal section of an operative end portion of the instrument shown in FIGS. l and 2;
FIG. 4 is a section taken on line A-A of FIG. 3;
FIG. 5 is a section taken on line B-B of FIG. I; and
FIG. 6 is a sectional view showing the operation of the instrument according to the invention.
Referring to FIGS. I and 2, the instrument of the invention comprises an oblong tubular body 1, a movable handle 2 articulated with the body at the rear portion thereof and a stationary handle 3 rigidly coupled to the body 1.
Located inside the front portion of the body 1 is a splincd bushing 4 fixed in position so as to form staple slots 5 (FIGS. 3,4) in combination with thc inner surface of the body I.
A tubular rod 6 passes inside tubular body I, said rod carrying at its front end a puncher 7 threaded thereto. The puncher 7 has a rear portion or tailpiece 8 on which is loosely supported a cylindrical-shaped staple ejector 9 and a split spring washer I0. The washer I0 affords the possibility for the puncher 7 to move with respect to the staple ejector 9 over a length corresponding to the range of the suturing gap spacing or, in other words, the provision of the spring washer makes it possible, with the travel of the staple ejector 9 being invariable, for the travel of the rod 6 along with the puncher 7 to vary within a required range.
The front end of the puncher 7 is fashioned as a cylindrical portion I1 which extends beyond the body 1 (FIGS. 1,3).
The rod 6 is movable lengthwise of the instrument body 1 by means of a linkage coupled to the movable handle 2 and including an actuating arm I2 of fork-shape passing through an opening I3 in body 1 so as to straddle the rod 6 on lateral surfaces I4 thereof(FlG. I).