US20050027308A1 - Methods for performing anastomosis - Google Patents
Methods for performing anastomosis Download PDFInfo
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- US20050027308A1 US20050027308A1 US10/897,523 US89752304A US2005027308A1 US 20050027308 A1 US20050027308 A1 US 20050027308A1 US 89752304 A US89752304 A US 89752304A US 2005027308 A1 US2005027308 A1 US 2005027308A1
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- United States
- Prior art keywords
- ring
- tines
- sleeve
- tine
- anvil
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- Abandoned
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
-
- 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
-
- 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
- A61B2017/1139—Side-to-side connections, e.g. shunt or X-connections
Definitions
- the present invention relates to apparatus and methods for performing anastomosis without hand-suturing.
- CABG coronary artery bypass graft
- the present invention can be used to perform end-to-end anastomosis (in which the open end of a vessel or other organ is attached to (and in fluid communication with) the open end of another vessel or other organ without hand-suturing, end-to-side anastomosis (in which the open end of one vessel or other organ is attached to the side wall of a second organ in fluid communication with an incision or other orifice in the second organ's side wall) without hand-suturing, or side-to-side anastomosis (in which incisions or other orifices in the side walls of two vessels or other organs are aligned in fluid communication with each other and the aligned tissue is attached together) without hand-suturing.
- end-to-end anastomosis in which the open end of a vessel or other organ is attached to (and in fluid communication with) the open end of another vessel or other organ without hand-suturing
- end-to-side anastomosis in which the open end
- the invention is a ring (for use in anastomosis) that is integrally formed from metal, and includes a central ring portion and tines (and typically also docking features or fastener elements) that extend from the ring portion.
- the tines are malleable tines which are movable relative to the ring portion from an initial configuration into a final configuration in which they can grab tissue of an organ (around an incision or other orifice in the organ) and hold such tissue in an everted state.
- each tine has a weak section at which it preferentially folds or buckles when subjected to bending force.
- the ring portion can be rigid or malleable.
- the ring has a tubular central portion.
- the central ring portion is flat (rather than tubular).
- the ring is not integrally formed from metal.
- it is assembled from component parts which are connected together (e.g., by welding), or is made of material (other than metal) which has the required mechanical properties.
- Another aspect of the invention is a method for installing the ring at an incision or other orifice in a vessel (or other organ) with the ring portion extending around the incision or other orifice.
- the tines are advanced against an anvil so that they grab the tissue around the orifice and curl radially (inward or outward) against the anvil (in some embodiments the tines pierce the tissue before they begin to curl; in other embodiments the tines begin to curl before they grab the tissue).
- gray is used herein in a broad sense to denote any operation of grabbing, gripping, grasping, or otherwise capturing the relevant tissue (such that the captured tissue can be moved by moving the thing which captures the tissue), and to denote either “grab and pierce” or “grab without piercing.”
- the anvil is then retracted to fold (or buckle) the tines so that their curled ends move radially outward.
- the tool is used to further fold or bend the tines so that their curled ends move further radially outward.
- the folding (or buckling), curling, and optional bending of the tines everts the tissue near the orifice edges to expose the inside surface of the organ (so that such exposed inside surface can be joined to tissue of another vessel or organ).
- the ring is installed with the ring portion extending around an incision in the side wall of a blood vessel, and the action of curling the tines everts the incised edges of the orifice to expose the inside lining (intima) of the blood vessel.
- the invention is a tool for installing an anastomosis ring in an incision (or other orifice) in a vessel or other organ.
- the tool includes an anvil and a set of concentric, independently movable sleeves around the anvil.
- Each sleeve, and preferably also the anvil can be advanced (in a distal direction) and retracted (in a proximal direction) when desired relative to the other elements of the tool.
- the tool has four independently movable sleeves; in other embodiments it has five independently movable sleeves. It is contemplated that the multiple movements of the various sleeves can be automated and synchronized to some degree such that the installation process requires a minimal number of operator manipulations of the installation tool.
- the distal end of one of the sleeves has two or more circular (or oblong) slots, each for receiving a tubular central ring portion of an anastomosis ring.
- the tool can be used to install a relatively small diameter ring (whose central ring portion fits in an innermost slot) or a relatively large diameter ring (whose central ring portion fits in an outermost slot).
- the outermost sleeve is configured to receive a removable flat member (sometimes referred to herein as a disk).
- the disk has an open center and is oblong or annular, is preferably made of thin metal, and functions during ring installation to provide a surface against which the ring (and tissue engaged therewith) is pressed to deform (fold and/or bend) the ring into its final configuration.
- the disk is released from the installation tool. The tool is then removed from the installed ring, leaving the disk in engagement with the ring and held between the ring and the adjacent tissue.
- the invention is a ring (for use in anastomosis) including a central ring portion (preferably a tubular central ring portion), and tines and fastener elements that extend from the ring portion.
- each tine has a weak section at which it preferentially folds or buckles when subjected to bending force.
- the ring portion can be rigid or malleable.
- the fastener elements can be (or include) malleable elements, spring elements, or both.
- the fastener elements are used to fasten together two precisely aligned anastomosis rings, each installed in an incision (or other orifice) of a different vessel or other organ, and optionally also to align the two rings together.
- the fastener elements of one ring are spring elements having a locking configuration in which they exert spring force on fastener elements of another ring to clamp the two rings together.
- the invention is a method for performing an anastomosis, including the steps of installing an anastomosis ring in an incision (or other orifice) in a vessel or other organ, installing another anastomosis ring in an incision (or other orifice) in another vessel or other organ, precisely aligning the two installed anastomosis rings, and fastening the aligned rings together.
- FIG. 1 is a perspective view of an embodiment of the inventive ring for use in performing anastomosis without hand sutures.
- FIG. 2 is a perspective view of another embodiment of the inventive ring for use in performing anastomosis without hand sutures.
- FIG. 3 is a side elevational view of the ring of FIG. 2
- FIG. 4 is a side cross-sectional view of a portion of the ring of FIG. 1 and a portion of an apparatus for installing it, at an early stage of installation of the ring around an incision in the sidewall of a blood vessel.
- FIG. 5 is a side cross-sectional view of a portion of the ring of FIG. 1 and a portion of an apparatus for installing it, at an intermediate stage of installation of the ring around an incision in the sidewall of a blood vessel.
- FIG. 6 is a side cross-sectional view of a portion of the ring of FIG. 1 and a portion of an apparatus for installing it, at a late stage of installation of the ring around an incision in the sidewall of a blood vessel.
- FIG. 7 is a side cross-sectional view of a portion of the ring of FIG. 1 and a portion of an alternative apparatus for installing it, at an early stage of installation of the ring around an incision in the sidewall of a blood vessel.
- FIG. 8 is a side cross-sectional view of a portion of the ring of FIG. 1 and a portion of the FIG. 7 installation apparatus, at an intermediate stage of installation of the ring around an incision in the sidewall of a blood vessel.
- FIG. 9 is a side cross-sectional view of a portion of the ring of FIG. 1 and a portion of the FIG. 7 installation apparatus, at a late stage of installation of the ring around an incision in the sidewall of a blood vessel.
- FIG. 10 is a perspective view of an embodiment of the inventive anastomosis ring, with its tines ( 61 ) in their initial configuration.
- FIG. 11 is a side cross-sectional view of a portion of ring 60 of FIG. 10 , and of a portion (shown in phantom view) of another ring (identified by reference numeral 260 ) which is a variation on ring 60 .
- FIG. 12 is a side cross-sectional view of portions of rings 60 and 260 of FIG. 11 , after the tines thereof have been curled and formed in accordance with the invention.
- FIG. 13 is a perspective view of the ring of FIG. 10 , with each of its tines 61 in its final configuration.
- FIG. 14 is a side cross-sectional view of a portion of ring 60 (with one tine 61 in the FIG. 13 configuration) installed in tissue of a first vessel at the edge of an incision, and a second vessel (shown in phantom view) aligned with the first vessel.
- FIG. 15 is a perspective view of a portion of a variation on ring 60 of FIG. 10 , with one of its tines ( 61 ′) in its initial configuration.
- FIG. 16 is a side cross-sectional view of a portion of an embodiment ( 80 ) of the inventive ring and a portion of a tool ( 79 ) for installing this ring, in the configuration in which they would be at an early stage (to be referred to as a “first” stage) of installing the ring around an opening of an organ.
- FIG. 17 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a second stage of installing the ring around an opening of an organ.
- FIG. 18 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a third stage of installing the ring around an opening of an organ.
- FIG. 19 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a fourth stage of installing the ring around an opening of an organ.
- FIG. 20 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a fifth stage of installing the ring around an opening of an organ.
- FIG. 21 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a sixth stage of installing the ring around an opening of an organ.
- FIG. 22 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a seventh stage of installing the ring around an opening of an organ.
- FIG. 23 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at an eighth stage of installing the ring around an opening of an organ.
- FIG. 24 is a side cross-sectional view of ring 80 and tool 79 of FIG. 16 , in the configuration in which they would be at a ninth stage of installing the ring around an opening of an organ.
- FIG. 25 is a simplified perspective view of the distal end of tool 79 (of FIG. 16 ), without sleeve 75 , and with ring 80 mounted thereon.
- FIG. 25A is a perspective view of ring 80 around a preferred (fluted) implementation of anvil 70 .
- FIG. 26 is side cross-sectional view of a portion of ring 80 of (of FIGS. 16-25 ) and a portion of another embodiment of the inventive tool ( 90 ) for installing this ring around an opening of an organ.
- FIG. 27 is a detail view of a portion of the apparatus shown in FIG. 26 .
- FIG. 28 is a side cross-sectional view of a portion of ring 80 and a portion of tool 90 , which have been installed (using tool 90 ) around an incision in a blood vessel.
- FIG. 29 is a perspective view of portions of two aligned anastomosis rings (rings 100 and 110 ) having tab fasteners for fastening the rings together.
- FIG. 30 is a perspective view of a portion of a variation on anastomosis ring 100 (of FIG. 29 ) having a tab fastener which is a variation on fastener 101 of FIG. 29 .
- FIG. 31 is a perspective view of portions of two aligned anastomosis rings (rings 130 and 110 ) having tab fasteners, one of which (tab 131 ) is a variation on fastener 101 of FIG. 29 .
- FIG. 32 is a perspective view of portions of two aligned anastomosis rings (rings 140 and 150 ) having a different type of tab fasteners for fastening the rings together, with the fasteners in an open (unlocked) configuration.
- FIG. 33 is a perspective view of the elements shown in FIG. 32 , after these elements have been moved relative to each other into a closed (locked) configuration to fasten the rings together.
- FIG. 34 is a side cross-sectional view of portions of two aligned anastomosis rings (rings 160 and 180 ) having spring fasteners for fastening the rings together.
- FIG. 35 is a perspective view of portions of the aligned anastomosis rings 160 and 180 shown in FIG. 34 .
- FIG. 36 is a perspective view of portions of two aligned anastomosis rings (rings 160 and 170 ) having spring fasteners of another type for fastening the rings together.
- FIG. 37 is a perspective view of a portion of a variation on ring 170 of FIG. 36 .
- FIG. 38 is a perspective view of portions of two aligned anastomosis rings (rings 190 and 200 ) having spring fasteners of another type for fastening the rings together.
- FIG. 39 is a perspective view of portions of two aligned anastomosis rings (rings 190 and 210 ) having tab fasteners for fastening the rings together, with the fasteners in an unlocked position.
- FIG. 40 is a perspective view of portions of aligned rings 190 and 210 of FIG. 39 , with the tab fasteners in a locked position.
- FIG. 41 is a side cross-sectional view of a portion of an embodiment ( 220 ) of the inventive ring and a portion of a tool ( 230 ) for installing this ring, in the configuration in which they would be at an early stage (to be referred to as a “first” stage) of installing the ring around an opening of an organ.
- FIG. 42 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at a second stage of installing the ring around an opening of an organ.
- FIG. 43 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at a third stage of installing the ring around an opening of an organ.
- FIG. 44 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at a fourth stage of installing the ring around an opening of an organ.
- FIG. 45 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at a fifth stage of installing the ring around an opening of an organ.
- FIG. 46 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at a sixth stage of installing the ring around an opening of an organ.
- FIG. 47 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at a seventh stage of installing the ring around an opening of an organ.
- FIG. 48 is a side cross-sectional view of ring 220 and tool 230 of FIG. 41 , in the configuration in which they would be at an eighth stage of installing the ring around an opening of an organ.
- FIG. 49 is a side cross-sectional view of a portion of an embodiment ( 320 ) of the inventive ring and a portion of a preferred embodiment of the inventive tool ( 330 ) for installing the ring, in the configuration in which they would be at an early stage (to be referred to as a “first” stage) of installing the ring around an opening of an organ.
- FIG. 50 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at a second stage of installing the ring around an opening of an organ.
- FIG. 51 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at a third stage of installing the ring around an opening of an organ.
- FIG. 52 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at a fourth stage of installing the ring around an opening of an organ.
- FIG. 53 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at a fifth stage of installing the ring around an opening of an organ.
- FIG. 54 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at a sixth stage of installing the ring around an opening of an organ.
- FIG. 55 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at a seventh stage of installing the ring around an opening of an organ.
- FIG. 56 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at an eighth stage of installing the ring around an opening of an organ.
- FIG. 57 is a side cross-sectional view of ring 320 and tool 330 of FIG. 49 , in the configuration in which they would be at an ninth stage of installing the ring around an opening of an organ.
- FIG. 58 is a perspective view of two of the inventive anastomosis rings ( 380 and 400 ), each installed in an incision in a different blood vessel, and a pair of forceps 420 gripping one of the blood vessels. Rings 380 and 400 are preferred embodiments of the inventive anastomosis rings.
- FIG. 59 is a cross-sectional view of the apparatus and tissue of FIG. 58 , after ring 400 has been lowered onto docking tabs 383 of ring 380 .
- FIG. 60 is a cross-sectional view of the apparatus and tissue of FIG. 59 after rings 380 and 400 have been aligned, while docking tabs 383 are being folded into a locking configuration
- FIG. 61 is a perspective view of ring 380 of FIG. 58 , in its pre-installation configuration.
- malleable element is used herein to denote an element that, when deformed from a first shape into a second shape, will not relax back into the first shape from the second.
- a flexible element can be elastic or malleable (the term “flexible” is used in a broad sense encompassing both the narrower terms “malleable” and “elastic”).
- FIG. 1 is a perspective view of an anastomosis ring 10 , which is an embodiment of the inventive ring for use in performing anastomosis without hand sutures.
- Ring 10 is integrally formed from metal, and includes a central ring portion 11 , and tines 12 and docking features 15 and 16 which extend out from ring portion 11 .
- each of docking features 15 and 16 is implemented so as to add stiffness to ring portion 11 , and to define at least one snap feature (or other fastener) for using in fastening together ring 10 (after it has been installed in a vessel or other organ) with another anastomosis ring.
- Tines 12 are malleable.
- Ring portion 11 can be implemented to be flexible but is preferably rigid. Ring portion 11 is substantially flat in a plane perpendicular to the central axis of ring 10 .
- Each tine 12 is manufactured to be generally flat, and is then bent so as to define a bent edge 13 between ring portion 11 and a distal tine portion which terminates at a sharp distal end. In the initial configuration, the distal tine portions are oriented at least substantially perpendicularly to the plane of ring portion 11 .
- Each tine 12 is preferably tapered, with its width decreasing from its relatively wide proximal end (at portion 11 ) to its sharp distal end.
- Each tine 12 also has a hinge or weak section (sometimes referred to herein as a “weak portion”) at a location that is separated from (but typically near to) edge 13 . Such weak portions are not labeled in FIG. 1 .
- the number of tines is variable and depends on the size of the ring and the size of the tines. The number should be sufficient to ensure that all of the tissue surrounding the orifice is grasped and everted.
- ring 10 (and variations thereon) in an opening (e.g., incision) in a vessel or other organ
- An anvil is inserted through the opening into the organ, and ring 10 is positioned with the sharp tips of tines 12 contacting the tissue surrounding the opening.
- An installation tool is then operated to drive tines 12 against the anvil, causing tines 12 to penetrate through the tissue into contact with the anvil and then begin to curl (or to begin to curl against the anvil and then penetrate the tissue as they continue to curl) so as to engage (and grab) the tissue and optionally also to begin to evert the tissue that surrounds the opening.
- each tine 12 is retracted through ring portion 11 , thereby causing each tine 12 to fold or buckle about its hinge (or weak portion) and thus move into a folded (or buckled) and curled configuration.
- the tines grab the tissue surrounding the opening and thus evert the incised tissue edges as they fold or buckle in response to action of the anvil.
- additional shaping forces are exerted on the tines to move them from their folded (or buckled) and curled configuration into a final configuration. Retraction of the anvil does not significantly deform ring portion 11 although it does deform tines 12 relative to ring portion 11 .
- ring 10 When tines 12 have been deformed into their final configuration and the anvil has retracted out of engagement with ring 10 , ring 10 is fully installed at the opening of the organ with ring portion 11 surrounding the opening (so that fluid can flow through the opening), ring 10 holding tissue around the opening so as to expose its intima, and docking features 15 and 16 exposed so that features 15 and 16 can be aligned with and fastened to docking features of another ring that has been installed at an incision in (or opening of) another organ to produce an anastomosis that joins the two organs.
- FIG. 2 is a perspective view of an anastomosis ring 20 , which is another embodiment of the inventive ring for use in performing anastomosis without hand sutures.
- Ring 20 is integrally formed from metal, and includes a central ring portion 21 , and tines 22 and docking features 25 and 26 which extend out from ring portion 21 .
- Ring 20 differs from above-described ring 10 primarily in that its central ring portion 21 is tubular (in the sense that it surrounds a central axis, has substantially greater length (parallel to the central axis) than width (perpendicular to the central axis), and defines a circular or oblong cross-section in a plane perpendicular to the central axis) rather than flat, and in that tines 22 have slightly different shape than tines 12 . Tines 22 are malleable. Ring portion 21 can be implemented to be flexible but is preferably rigid.
- Docking features 25 and 26 can be identical to above-described docking features 15 and 16 of FIG. 1 . As shown in FIG. 3 , features 25 and 26 are bent upward (at an obtuse angle) relative to ring portion 21 . Alternatively, the docking features can be bent downward (at an acute angle) relative to ring portion 21 , as are alternative docking features 25 A and 26 A shown in phantom view in FIG. 3 .
- an anastomosis to join the organs is accomplished as follows: the two rings are aligned with each other to cause one ring (and the tissue held thereby) to meet the other ring (and the tissue held thereby) such that there is a plane (denoted herein as a “sealing plane”) between the two rings; and the aligned rings are then fastened together.
- each tine 22 of ring 20 is generally flat.
- Each tine 22 has a relatively wide proximal portion between ring portion 11 and shoulder 24 , and a narrower distal portion beyond shoulder 24 .
- Each tine is bent at an edge 23 to define a distal portion (distally beyond edge 23 ) and a proximal portion (between edge 23 and ring portion 11 ).
- Each proximal portion defines a shoulder 24 .
- the width of the distal portion decreases in tapered fashion from edge 23 to a sharp distal end.
- the distal portions of tines 22 are oriented at least substantially perpendicularly to the plane of ring portion 21 .
- each tine 22 curls tightly from its tip to its edge 23 in response to being advanced against an anvil of an installation tool. Later during installation, each tine 22 tends to fold or buckle at shoulder 24 (rather than at other locations along the tine) in response to retraction of the anvil upward (when viewed as in FIG. 2 ) through ring portion 21 , so that shoulder 24 defines a hinge (or weak portion) of tine 22 .
- each tine 22 also has an additional hinge or weak portion (not labeled) at a location which is separated from (but typically near to) shoulder 24 and separated from edge 23 .
- each tine in its pre-installation configuration, has a proximal portion that extends radially inward toward the ring's central axis and a distal portion orientated at least substantially parallel to the ring's central axis (e.g., the embodiments of FIGS. 1 and 2 )
- the distal portion is preferably tapered to its sharp tip to guarantee a tight curl when curling against the anvil of the installation tool during installation.
- the proximal portion need not be tapered (although the proximal portion of each tine of ring 10 is shown to be tapered in FIG. 1 ). In typical implementations, the proximal portion of each tine is not tapered (as in FIG.
- each tine will preferentially fold or buckle at the shoulder (or other hinge or weak portion) of its proximal portion in response to the force exerted by the retracting anvil.
- a shoulder e.g., shoulder 24 of each tine of FIG. 2
- other hinge or weak portion e.g., a hole
- the method for installing ring 20 (and variations thereon) in an opening (e.g., an incision) in a vessel or other organ will be described below in detail, and is basically the same as the method for installing ring 10 .
- An anvil is inserted through the opening into the organ, and ring 20 is positioned with the sharp tips of tines 22 engaging the tissue surrounding the opening.
- An installation tool is then operated to drive tines 22 against the anvil, causing tines 22 to penetrate through the tissue into contact with the anvil and then begin to curl (or to begin to curl against the anvil and then penetrate the tissue as they continue to curl) so as to engage (and grab) the tissue and optionally also to begin to evert the tissue that surrounds the opening.
- each tine 22 is retracted through ring portion 21 , thereby causing each tine 22 to fold or buckle about one or more hinges (or weak portions) thereof and move into a folded (or buckled) and curled configuration.
- the tines grab the tissue surrounding the opening and thus evert the incised tissue edges as they fold or buckle in response to action of the anvil.
- additional shaping forces are exerted on the tines to move them from their folded (or buckled) and curled configuration into a final configuration. Retraction of the anvil does not significantly deform ring portion 21 although it does deform tines 22 relative to ring portion 21 .
- ring 20 When tines 22 have been deformed into their final configuration and the anvil has retracted out of engagement with ring 20 , ring 20 is fully installed at the opening of the organ with ring portion 21 surrounding the opening (so that fluid can flow through the opening), ring 20 holding tissue around the opening so as to expose its intima, and docking features 25 and 26 exposed.
- each embodiment of the inventive ring (including ring 10 or 20 ) are preferably wide and flat so that each has a relatively wide surface oriented parallel to the edge of the opening at which the ring is to be installed. This allows the tines efficiently to exert everting force on the tissue around the opening without tearing or otherwise causing trauma to the tissue, while at the same time the tines can be easily formed in response to exertion of moderate forces thereon (e.g., forces which fold or buckle the tines about their hinges or weak portions).
- moderate forces thereon e.g., forces which fold or buckle the tines about their hinges or weak portions.
- Ring 10 can be installed using an installation tool comprising anvil 30 and independently translatable sleeves 31 and 32 (as shown in FIGS. 4, 5 , and 6 ) at the site of an incision in the side wall of a blood vessel having exterior surface 40 and interior surface (inside lining or “intima”) 41 . Only the right half of the distal portion of each of elements 30 , 31 , and 32 , and the right edge of the incision (whose axis of symmetry extends perpendicular to the plane of FIG. 4 ) are shown in FIGS. 4, 5 , and 6 .
- FIG. 4 shows ring 10 and the installation tool at an early stage of the installation process
- FIG. 5 shows them at a later stage
- FIG. 6 shows them at a still later stage.
- ring 10 When anvil 30 has retracted (upward) into the position shown in FIG. 6 , ring 10 has been installed with ring portion 11 extending around the incision, tines 12 grabbing the tissue around the incision, and tines 12 having been deformed so as to evert the incised edges of the tissue to expose the intima 41 of the blood vessel as shown in FIG. 6 .
- anvil 30 is inserted into the incision.
- Sleeves 31 and 32 are then advanced distally to drive tines 12 of ring 10 into the tissue, so that the tines penetrate the tissue and engage the tine-forming surface 30 A of anvil 30 , and so that the tines begin to curl radially inward (toward the central axis of anvil 30 ) as they advance against anvil surface 30 A.
- sleeves 31 and 32 press ring 10 's flat ring portion 11 in the distal direction against the vessel's exterior surface 40
- anvil 30 is retracted in the proximal direction (toward the top of FIG.
- each tine 12 folds or buckles at its hinge (or weak portion) radially outward (away from the central axis of anvil 30 ) as it continues to grab the tissue, thereby completing the eversion of the incised tissue edges as shown in FIG. 6 .
- sleeve 32 is withdrawn or retracted in the proximal direction, leaving ring 10 installed at the incision with tines 12 holding the incised tissue edges in the desired everted state (for joining to tissue of another vessel or other organ).
- a final step is performed in which an another element (not shown in FIGS. 4-6 ) of the installation tool is advanced into engagement with ring 10 (or the tissue that has been grabbed thereby), or in which anvil 30 is again advanced into the incision and sleeves 31 and 32 are then advanced against anvil 30 , to further bend the tines 12 relative to the rest of ring 10 and thereby further evert the incised tissue edges.
- the optional final step is included in preferred embodiments of the invention.
- ring 10 is installed using a slightly different installation tool that comprises anvil 30 and independently translatable sleeves 51 and 52 (as shown in FIGS. 7, 8 , and 9 ) at the site of an incision in the side wall of a blood vessel having exterior surface 40 and interior surface (“intima”) 41 . Only the right half of the distal portion of each of elements 30 , 51 , and 52 , and the right edge of the incision (whose axis of symmetry extends perpendicular to the plane of FIG. 7 ) are shown in FIGS. 7, 8 , and 9 .
- FIG. 7 shows ring 10 and the installation tool at an early stage of the installation process
- FIG. 8 shows them at a later stage
- FIG. 9 shows them at a still later stage.
- anvil 30 has retracted (upward) into the position shown in FIG. 9
- ring 10 has been installed with ring portion 11 extending around the incision, tines 12 grabbing the tissue around the incision, and tines 12 having been deformed so as to evert the incised edges of the tissue to expose the intima 41 of the blood vessel as shown in FIG. 9 .
- anvil 30 is inserted into the incision.
- sleeves 51 and 52 are advanced distally (relative to anvil 30 ) to drive tines 12 of ring 10 between anvil 30 and the incised tissue edges until the tips of tines 12 engage the tine-forming surface 30 A of anvil 30 , and begin to curl radially outward (away from the central axis of anvil 30 ) as they advance against anvil surface 30 A.
- Sleeves 51 and 52 continue to advance until they reach the position shown in FIG.
- each tine 12 folds or buckles at its hinge (or weak portion) radially outward (away from the central axis of anvil 30 ) while continuing to grab the tissue, thereby everting the incised tissue edges as shown in FIG. 9 .
- sleeve 52 is retracted in the proximal direction or otherwise withdrawn, leaving ring 10 installed at the incision with tines 12 holding the incised tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ).
- a final step is performed in which an another element (not shown in FIGS. 7-9 ) of the installation tool is advanced into engagement with ring 10 (or the tissue that has been grabbed thereby), or in which anvil 30 is again advanced into the incision and sleeves 51 and 52 are then advanced against anvil 30 , to further bend the tines 12 relative to the rest of ring 10 and thereby further evert the incised tissue edges.
- FIGS. 10 and 13 are perspective views of anastomosis ring 60 , which is an embodiment of the inventive anastomosis ring.
- Ring 60 includes ten malleable tines 61 which extend out from cylindrical (tubular) ring portion 65 .
- FIG. 10 shows tines 61 in their initial configuration (the configuration in which they would be when ring 60 is loaded onto an installation tool prior to installation at an incision in an organ).
- FIG. 13 shows each of tines 61 in its final configuration (the configuration in which it would be following installation at an incision in an organ).
- Each tine 61 of ring 60 has a flat cross-section, with two opposed faces and relatively small (narrow) edge surfaces between the faces.
- Each tine 61 has a relatively wide proximal end 64 (from which it extends out from ring portion 65 ) and tapers to a sharp distal end 62 .
- Each tine 61 is preferably made from flat metal, and has a weak portion 63 which is defined by a hole formed (e.g., stamped or etched) therethrough (from one of the opposed faces to the other) at a location between ends 62 and 64 .
- each tine 61 Prior to installation, each tine 61 is pre-formed into an S-shape as shown in FIG.
- each tine is curled radially outward (away from ring 60 's axis of symmetry) so that it grasps tissue, and then the curled tines are folded (or buckled) radially outward about their weak portions to evert the tissue being grasped thereby, until each tine 61 reaches the final configuration shown in FIG. 13 .
- FIGS. 13 As shown in FIGS.
- the folded portion 67 of each tine that is farthest from the ring's tubular portion 65 is at (or very near to) the tine's weak portion 63 .
- the folded portion 67 is preferably slightly raised in the sense that it is slightly above the tine's lowest portion ( 66 ).
- vessel 68 is to be joined (at an anastomosis site) to a second vessel 69 that has been prepared for anastomosis by installation of an anastomosis ring (similar or identical to ring 60 ) around an incision in the second vessel, the folded, raised portions 67 of tines 61 (of ring 60 ) desirably shape the everted, incised tissue edges of vessel 68 .
- portions 67 are raised (relative to portions 66 ) causes ring 60 to present the intima of vessel 68 to the intima of vessel 69 in an orientation that promotes healing together of, and formation of a fluid tight seal between, the joined tissue of vessels 68 and 69 .
- FIG. 15 shows one of tines 61 ′ in its initial configuration (the configuration in which it would be when ring 60 ′ is loaded onto an installation tool prior to installation at an incision in an organ).
- the other tines 61 ′ of ring 60 ′ are omitted from FIG. 15 for clarity.
- Each tine 61 ′ has a flat cross-section, with two opposed faces and relatively small (narrow) edge surfaces between the faces.
- Each tine 61 ′ has a pair of notches 63 ′ in the edge surfaces at a first distance from ring portion 65 ′. These notches define a weak portion of tine 61 ′ at said first distance from ring portion 65 ′.
- Ring 260 differs from ring 60 (of FIGS. 10, 11 , and 12 ) in the following respects.
- each of its tines 61 (which extend out from ring 60 's cylindrical portion 65 ) has a distal portion 61 A that is oriented vertically (when ring 60 is viewed as in FIG. 11 ) and terminates at a sharp tip 62 , a straight proximal portion 61 B oriented at a forty-five degree angle relative to distal portion 61 A, and a horizontally oriented straight portion 61 C between portions 61 A and 61 B.
- Ring 260 (shown in phantom view in FIGS.
- each tine 261 of ring 260 in its pre-installation configuration extends out from ring 260 's cylindrical portion with a distal portion that is oriented vertically (when ring 260 is viewed as in FIG. 11 ), a curved proximal portion R, and a horizontally oriented third portion between the distal portion and the curved proximal portion.
- An important difference between the curved tines 261 of ring 260 and the piecewise linear tines 61 of ring 60 is that, in the ring installation step to be described with reference to FIG.
- tine 261 will bend and rotate farther than tine 61 due to the cam action of surface 76 of sleeve 75 on the smoothly curved tine 261 .
- This additional bending and rotation of tines 261 (to move them from a configuration corresponding to that shown in FIG. 21 to a configuration corresponding to that shown in FIG. 22 ) allows sleeves 72 , 73 , and 74 to more easily form the final bend in each tine 261 as sleeves 72 , 73 , and 74 advance to press tines 261 against surface 76 (during the installation step to be described with reference to FIG. 24 ).
- FIGS. 16-25 we describe a tool 79 for installing ring 80 (partially shown in each of FIGS. 16-25 ), in tissue around an opening in an organ (e.g., an incision in a blood vessel).
- ring 80 can be identical to ring 60 of FIG. 14 .
- each of its tines 80 A (which extend out from ring 80 's cylindrical portion 85 ) has a distal portion 81 that is oriented vertically (when ring 80 is viewed as in FIG. 17 ) and terminates at a sharp tip 82 , a proximal portion 83 oriented at a forty-five degree angle relative to distal portion 81 , and a horizontally oriented third portion 84 between portions 81 and 83 .
- Each tine 80 A of ring 80 will preferentially fold at the junction between angled portion 83 and portion 84 (e.g., in response to forces exerted on ring 80 by retracting anvil 70 during the installation step shown in FIG. 20 , and forces exerted on ring 80 by anvil 70 and sleeves 74 and 75 during the installation step shown in FIG. 24 ).
- Each tine 80 A preferably also has a weak portion (e.g., a hinge) at a location near to (but spaced from) the junction between portions 83 and 84 , so that each tine 80 A preferentially bends at both this junction and the weak portion during the steps described with reference to FIGS. 20 and 24 .
- FIG. 25 is a simplified perspective view of the distal end of tool 79 with ring 80 (in its initial configuration) mounted thereon, showing some of tines 80 A of ring 80 .
- Each tine 80 A has a hole 86 extending through it (at a location along tine portion 84 ), each hole 86 defining a weak portion of the tine.
- FIG. 25A is a perspective view of ring 80 around a preferred (fluted) implementation of anvil 70 .
- Anvil 70 of FIG. 25A has grooves along its sides, and concave, tine-forming portions 70 B of its surface 70 A. Each concave portion 70 B is dimensioned and positioned to receive and form one of the tines of ring 80 .
- Tool 79 which comprises anvil 70 and independently translatable sleeves 71 , 72 , 73 , 74 , and 75 , during installation of an anastomosis ring 80 in an organ (the organ is not shown). Only the right half of the distal portion of each of elements 71 , 72 , 73 , 74 , and 75 , the distal portion of anvil 70 , and the right half of ring 80 , are shown in FIGS. 16-24 .
- Tool 79 also comprises control assembly 79 A (shown only in FIG. 16 ) which is coupled to anvil 70 and sleeve elements 71 - 75 and configured to independently advance and retract appropriate ones of elements 70 - 75 at appropriate times.
- assembly 79 A are manually operated in the sense that a user must manually manipulate at least one element of 79 A to accomplish each advancing or retracting movement of each desired one of elements 70 - 75
- other implementations of assembly 79 A are automatically operated in the sense that they include a trigger, and hardware for implementing a timed sequence of advancing and retracting movements of elements 70 - 75 in response to a single actuation of the trigger.
- Other embodiments of the inventive installation tool (including those described with reference to FIGS. 4-9 and 41 - 57 ) have control assemblies coupled to the tool's anvil and sleeve elements and configured to advance and retract appropriate ones of the anvil and sleeve elements at appropriate times.
- ring 80 is loaded onto tool 79 with tubular portion 85 in circular slot 74 A of sleeve 74 (shown in FIGS. 16 and 17 ), and tines 80 A of ring 80 held between sleeves 71 , 72 , 73 , 74 , and end portion 76 of sleeve 75 as shown in FIG. 16 .
- anvil 70 is inserted into the incision (or other opening) in the organ, and sleeves 71 , 72 , 73 , 74 , and 75 are then advanced (distally) together as a unit to drive tines 80 A between anvil 70 and the tissue edges until the tips of tines 80 A engage the tine-forming surface 70 A of anvil 70 , and begin to curl radially outward (away from the central axis of anvil 70 ) as they advance against anvil surface 70 A.
- Sleeves 71 , 72 , 73 , 74 , and 75 continue to advance until they reach the position shown in FIG.
- FIG. 16 shows one tine 80 A whose tip has been advanced into engagement with surface 70 A (but which has not yet begun to curl), and FIG. 17 shows the same tine after it has been advanced further (by sleeves 71 , 72 , 73 , 74 , and 75 ) and begun to curl radially outward.
- anvil 70 is retracted (toward the top of FIG. 18 ) to further curl the curled distal portion 81 of each tine 80 A relative to the rest of ring 80 into the configuration shown in FIG. 18 , thereby causing portion 81 of each tine to further penetrate and more securely grab the tissue around the opening.
- sleeves 71 and 72 are retracted in the proximal direction (toward the top of FIG. 19 ) while sleeves 73 , 74 , and 75 and anvil 70 remain stationary in engagement with ring 80 .
- anvil 70 is retracted (in the proximal direction) relative to sleeves 73 , 74 , and 75 .
- each tine 80 A folds or buckles at both its weak portion and at the junction (identified by reference numeral 83 A in FIGS. 17 and 25 ) between portions 83 and 84 , so that its curled distal portion 81 moves radially outward (away from the central axis of anvil 70 ) while it continues to grab the tissue, thereby everting the tissue edges.
- each tine 80 A preferably has a weak portion (e.g., a hinge) at a location spaced from the junction ( 83 A) between portions 83 and 84 .
- this weak portion is determined by a hole 86 (shown in and described above with reference to FIG. 25 ) in each tine.
- Each hole 86 is preferably located along the tine such that, when tines 80 A are in their final configuration (shown in FIG. 24 ), the portion ( 87 ) of each tine that is farthest (radially) from the ring's tubular portion 85 does not coincide with the junction 83 A, and such portion 87 coincides with (or is very near to) hole 86 .
- hole 86 extends through portion 84 of each tine 80 A at a location near to, but spaced from junction 83 A between portions 83 and 84 .
- Such separation between hole 86 and junction 83 A (and greater distance between portion 85 and hole 86 than between portion 85 and junction 83 A) is preferred because it reduces trauma to tissue in the following sense during installation of ring 80 in the tissue.
- the installation procedure has not stretched the tissue along portion 83 of each tine (which is not shown in FIG. 24 , but which would be between portion 83 and sleeve portion 76 ).
- the tissue in immediate contact with tip 82 of each tine has undergone significant stretching.
- the degree of stretching which the tissue has undergone is roughly proportional to the tissue's distance (along each tine from tip 82 to portion 87 ) from tip 82 , with tissue nearer to portion 87 (along the tine's axis) having undergone less stretching than tissue farther from portion 87 along the tine's axis.
- tissue nearer to portion 87 along the tine's axis
- the weak portion effectively reduces the amount of stretching undergone by the tissue during ring installation.
- Each tine 80 A preferentially bends at both junction 83 A and at the weak portion (the location of hole 86 ) during the steps described with reference to FIGS. 20 and 24 .
- sleeve 73 is retracted in the proximal direction (as shown in FIG. 21 ), leaving ring 80 (and the tissue gripped thereby) between anvil 70 and sleeves 71 , 72 , 74 , and 75 , with sleeve 74 in a retracted position relative to sleeve 75 .
- sleeve 74 is advanced distally relative to sleeve 75 (into the position shown in FIG. 22 ) to bend and rotate each tine 80 A (relative to the rest of ring 80 ) from the configuration shown in FIG. 21 to that shown in FIG. 22 as a result of force exertion on ring 80 by stationary sleeve 75 and the distal end of advancing sleeve 74 .
- This bending and rotation further everts the tissue edges around the organ opening, causes the tines 80 A to penetrate farther into the tissue, and allows sleeves 72 , 73 , and 74 to more easily form a final bend in each tine 80 A (in the step to be described with reference to FIG. 24 ).
- portion 85 is at least substantially perpendicular to portion 83 of each tine 80 A, and portions 83 and 85 are supported by sleeve 75 .
- sleeve 74 is retracted in the proximal direction relative to portion 76 of sleeve 75 , into the position shown in FIG. 23 .
- sleeves 72 , 73 , and 74 are advanced distally relative to portion 76 of sleeve 75 to press tines 80 A and portion 85 against portion 76 , thereby forming a final bend in each of tines 80 A relative to portion 85 and moving the ring 80 into the final, installed configuration shown in FIG. 24 .
- portions 81 , 82 , and 84 of each tine 80 A are bent radially outward relative to portion 83 and then pushed distally against portion 83 to put ring 80 in the final configuration.
- ring 80 is installed at the opening in the organ with tines 80 A holding the tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ).
- sleeve 75 is (e.g., portions comprising the distal end of sleeve 75 are) spread or dilated (radially outward away from anvil 70 's central axis of symmetry) to decouple tool 79 from the installed ring, and tool 79 is removed from the installed ring.
- flat portion 84 of each tine 80 A conforms with the flat upper surface of portion 76 of sleeve 75 during the step described with reference to FIG. 23 , so that sleeves 72 , 73 , and 74 can efficiently form the final bend in each tine 80 A as sleeves 72 , 73 , and 74 advance to press tines 80 A against surface 76 (during the step described with reference to FIG. 24 ).
- Variations on installation tool 79 can include a sleeve that corresponds functionally to sleeve 75 but has a tine-receiving surface (corresponding to the upper, tine-receiving surface of portion 76 ) that is not flat, but is instead curved to match the curvature of tines of rings to be installed by such tool.
- the weak point of each tine is determined other than by a hole through the tine.
- the weak point can be determined by notches cut into the tine (to reduce the tine's width), a tine portion having reduced thickness, or perforations cut into the tine.
- the ring portion (from which the tines, and optionally also docking features, protrude) is not malleable.
- the ring portion can be rigid or elastic.
- the ring portion is preferably integrally formed from metal, but can alternatively have another structure.
- the ring portion can be assembled from component parts (e.g., metal parts) which are connected together (e.g., by welding), or can be made (entirely or partially) of material other than metal but which has the required mechanical properties (e.g., flexibility and/or moldability).
- installation tool 90 which is another embodiment of the inventive tool for installing ring 80 (or variations on this embodiment of the inventive tined ring) around an opening of an organ (e.g., an incision in a blood vessel).
- Installation tool 90 includes anvil 70 and independently translatable sleeves 71 , 72 , 73 , and 74 which are identical to the corresponding, identically numbered, elements of tool 79 described above with reference to FIGS. 16-25 .
- Tool 90 also includes sleeve 95 and annular disk 96 (which together replace sleeve 75 of above-described tool 79 ), and hardware (not shown) for advancing and retracting elements 70 , 71 , 72 , 73 , 74 , and 95 at desired times.
- the inner radius of annular disk 96 is equal to the inner radius of portion 76 of sleeve 75 of tool 79
- the width of disk 96 (from its inner to outer radius) is such that the overall distance from the inner radius of disk 96 to the outer radius of the distal portion of sleeve 95 is equal to the overall distance from the inner radius of portion 76 of sleeve 75 to the outer radius of sleeve 75 's distal portion.
- Tool 90 can be used to install ring 80 at the site of an incision in the side wall of a blood vessel (shown in FIG. 28 but not FIG. 26 ) having exterior surface 40 and interior surface (inside lining or “intima”) 41 .
- FIG. 26 is a cross-sectional view of the right half only of the distal portion of each of elements 71 , 72 , 73 , 74 , and 95 , and the right half of ring 80 and disk 96 .
- Disk 96 is oblong (with an open center) or annular.
- FIG. 26 shows ring 80 and tool 90 at an early stage of the installation process.
- ring portion 85 is inserted into slot (or groove) 74 A of sleeve 74
- disk 96 is inserted in groove 95 A in sleeve 95 's inner sidewall.
- Each of slot 74 A and groove 95 A is circular or oblong (e.g., each is circular when the tubular central portion of ring 80 is circular and disk 96 is annular).
- Sleeve 95 (or the distal end of sleeve 95 ) can comprise multiple portions which can be moved radially toward each other (to grip the disk 96 ) or radially away from each other (to release the disk 96 ).
- sleeve 95 includes an element which releasably holds disk 96 in groove 95 A.
- disk 96 (or a variation thereon) is removably mounted to a sleeve (sleeve 95 or a variation thereon) by a joining feature other than a groove or notch in the sleeve.
- tool 90 When ring 80 and disk 96 have been loaded onto the distal end of tool 90 , tool 90 is operated to install ring 80 at an incision or other opening in an organ. To accomplish this, tool 90 operates in essentially the same manner as above-described tool 79 would operate to install the same ring, with elements 95 and 96 of tool 90 together corresponding functionally to sleeve 75 of tool 79 , except in that disk 96 remains at the anastomosis site (with the fully installed ring) after sleeve 95 and the other elements of installation tool 90 are removed from the anastomosis site.
- tool 90 can have a simpler design than that of tool 79 , and removal and release of tool 90 following installation of a ring can be easier than removal and release of tool 79 following ring installation.
- the radial distance over which the distal end of sleeve 95 must move (distance “A” in FIG. 27 ) to release disk 96 and to release portion 85 of ring 80 from between sleeves 74 and 95 is much less than the radial distance over which the distal end of sleeve 95 would need to move (distance “B” in FIG.
- sleeve 95 of tool 90 (and sleeve 75 of tool 79 ) are typically made of plastic, but it is practical to implement disk 96 as a metal disk. A metal implementation of disk 96 would typically be stronger than a typical plastic implementation of portion 76 of sleeve 75 .
- Ring portion 85 extends around the incision, tines 80 A have grabbed the tissue around the incision and then been deformed so as to evert the incised edges of the tissue to expose the intima 41 of the blood vessel, and disk 96 is trapped between the vessel's exterior surface 40 and tines 80 A.
- Ring 80 can be implemented with docking features (and optionally also fasteners) that extend out from ring portion 85 .
- disk 96 can be implemented with docking features (and optionally also fasteners) that extend out from disk 96 's outer periphery (for use in aligning ring 80 with, and optionally also attaching ring 80 to, another anastomosis ring).
- ring 80 is preferably implemented without docking features or fasteners to simplify its design.
- the ring is preferably implemented to have one or more fasteners extending out from its central ring portion (the ring portion from which its tines extend). Preferred implementations of such fasteners will next be described with reference to FIGS. 29-40 .
- Each fastener will be described as a feature of an embodiment of a tined anastomosis ring having a tubular central ring portion, although each fastener can be implemented as a feature of an anastomosis ring having a flat central ring portion, or as a feature of an annular ring (e.g., ring 96 of FIG. 28 ) to be installed with any embodiment of the inventive tined anastomosis ring.
- FIG. 29 is a perspective view of portions of two of the inventive anastomosis rings (ring 100 and ring 110 ) which have been aligned together, and respectively include fasteners 101 and 111 which are tabs.
- rings 100 and 110 has a tubular central portion (having the same shape as portion 65 of ring 60 of FIG. 10 ), with tines (not shown) that extend out from such tubular central portion.
- Ring 100 has tabs 101 that extend up from its tubular central portion at locations evenly spaced around the tubular central portion. Only one tab 101 is shown in FIG. 29 .
- Each tab 101 has notches 102 at the junction between tab 101 and ring 100 's tubular central portion.
- Ring 110 has one slotted tab 111 for each tab 101 of ring 100 .
- Each tab 111 has a proximal portion 112 at the junction between tab 111 and ring 110 's tubular central portion, and a distal end defining a slot 113 .
- Each tab 111 is bent into the shape shown in FIG. 29 , so that tab 101 of ring 100 can be advanced upward through slot 113 to align the rings 100 and 110 together.
- rings 100 and 110 have been aligned as shown, they are fastened together by bending each tab 101 radially outward and downward relative to table 111 so that tab 100 folds into an orientation that locks ring 101 together with ring 100 .
- the notches 102 in each tab 101 define a weak point at which tab 101 preferentially folds when it is bent as described.
- Tab 121 (of anastomosis ring 120 ) of FIG. 30 is a variation on tab 101 of FIG. 29 .
- Anastomosis ring 120 has tabs 121 which extend up from its tubular central portion at locations evenly spaced around the tubular central portion, and tines (not shown) that extend down from its tubular central portion. Only one tab 121 is shown in FIG. 30 .
- Tab 121 differs from tab 101 only in that its weak portion (at the junction between tab 121 and ring 120 's tubular central portion) is defined by a slot 122 extending through tab 121 , rather than by notches (e.g., notches 102 of FIG. 29 ) in the tab's sides.
- Tab 131 (of anastomosis ring 130 ) of FIG. 31 is another variation on tab 101 of FIG. 29 .
- Anastomosis ring 130 has tabs 131 which extend up from its tubular central portion at locations evenly spaced around the tubular central portion, and tines (not shown) that extend down from its tubular central portion. Only one tab 131 is shown in FIG. 31 .
- Tab 131 differs from tab 101 in that its weak portion 131 A (which can be a thin portion of tab 131 ) is oriented vertically, and in that it has a notch 132 at the junction between tab 131 and ring 130 's tubular central portion.
- each tab 131 is bent or folded at its weak portion 131 A.
- the weak portion of tab 101 is defined by a set of notches (e.g., notches 102 of FIG. 29 ) in the tab's sides.
- FIGS. 32 and 33 are perspective views of portions of two aligned anastomosis rings (rings 140 and 150 ) having a different type of tab fasteners for fastening the rings together.
- Ring 140 has tabs 141 which extend out from around its tubular central portion
- ring 150 has tabs 151 which extend out is from around its tubular central portion. Only one tab 141 and one tab 151 are shown in each of FIGS. 32 and 33 .
- each tab 141 has a flange 142 that circumferentially overlaps an edge 152 of one of tabs 151 .
- Tabs 141 and preferably also tabs 151 are made of spring metal (or are otherwise biased to remain in their originally manufactured orientations relative to the rest of the ring from which they protrude).
- each tab 141 is bent below the adjacent tab 151 (assuming that the rings are oriented with tabs 141 initially above tabs 151 ), with flange 142 bending relative to the rest of tab 141 to allow it to pass edge 152 of tab 151 .
- tabs 141 and 151 have the relative positions shown in FIG. 33 , with spring force exerted by each tab 141 on tab 151 holding the rings together and tabs 151 preventing tabs 141 from springing back into their original position (i.e., the original position shown in FIG. 32 ).
- FIG. 34 is a side cross-sectional view of portions of two aligned anastomosis rings (rings 160 and 180 ) having spring fasteners for fastening the rings together.
- Each spring fastener comprises elements 163 and 181 .
- Fastener elements 163 are made of spring metal, are generally U-shaped, and each has a body which extends out at an acute angle from an edge (the bottom edge in FIG. 34 ) of ring 160 's tubular central portion, with the body of each element 163 being attached at a proximal end portion 162 to the tubular central portion of ring 160 .
- Each element 163 has two tabs 161 , which extend out at an obtuse angle with respect to the body of element 163 (as shown in FIG. 34 ).
- element 163 in its FIG. 34 configuration
- element 163 will spring back to the configuration shown in FIG. 34 .
- Each fastener element 181 is made from malleable material, and has two wings 182 .
- Each wing 182 is pre-formed to extend in a plane oriented at a ninety-degree angle relative to the rest of the element 181 of which it is a part.
- each element 181 extends vertically (or substantially vertically) upward away from ring 180 's tubular central portion (as shown in FIG. 34 ).
- a surgeon aligns ring 180 with ring 160 by positioning the tubular central portion of ring 180 (which has a slightly larger diameter than does the tubular central portion of ring 160 ) around the tubular central portion of ring 160 so that the rings have a common axis of symmetry (which we shall refer to as being “vertical” to simplify the description) and so that an element 181 of ring 180 extends between the tabs 161 of each element 163 of ring 160 (in the relative orientation shown in FIG. 35 ).
- tabs 161 of one element 163 are temporarily displaced toward the tabs 161 of another element 163 (on another side, typically the opposite side, of ring 160 's tubular central portion), thus bending each of the elements 163 about its end portion 162 toward the ring 160 's tubular central portion, and then the opposed tabs 161 spring back (relax) away from each until each element 163 exerts spring force radially outward against the tubular central portion of ring 180 .
- elements 163 are not elastic.
- wings 182 of each element 181 are spread apart by folding each wing 182 (outward in the directions of arrows A in FIG. 35 , about a vertical axis) over an adjacent one of horizontally oriented tabs 161 .
- the forces between fastener element 163 (including tabs 161 ) and wings 182 fasten together the aligned rings 160 and 180 .
- the tabs 161 on both sides of element 181 provide circumferential support to prevent rotation of ring 160 relative to ring 180 about their common axis.
- fastener element 181 of FIG. 35 A variation on fastener element 181 of FIG. 35 will next be described with reference to FIG. 36 .
- the fastener elements of FIG. 36 implement an embodiment of the inventive tined anastomosis ring fastener.
- ring 160 is identical to ring 160 of FIGS. 34 and 35 , but ring 170 differs from ring 180 (of FIGS. 34 and 35 ) in that it has fastener elements 171 which are shaped differently than fastener elements 181 of FIG. 35 .
- Each fastener element 171 has a spring portion 173 , and a body 172 which ends at free edge 174 .
- each element 171 When ring 170 is oriented with a vertical axis of symmetry, the spring portion 173 of each element 171 extends at least substantially vertically upward away from the upper edge of ring 170 's tubular central portion (as shown in FIG. 36 ). At least the spring portion 173 of each element 171 is made of spring metal (or portion 173 is otherwise biased so that element 171 tends to remain in its originally manufactured orientation).
- a surgeon aligns ring 170 coaxially with ring 160 by positioning the tubular central portion of ring 170 (which has diameter slightly larger than does the tubular central portion of ring 160 ) around the tubular central portion of ring 160 so that the rings have a common axis of symmetry (which we shall refer to as being “vertical” to simplify the description) and so that an element 171 of ring 170 extends between the tabs 161 of each element 163 of ring 160 (in the relative orientation shown in FIG. 36 ).
- tabs 161 of one element 163 when the rings are aligned, tabs 161 of one element 163 (on one side of ring 160 's tubular central portion) are temporarily displaced toward tabs 161 of another element 163 (on another side, typically the opposite side, of ring 160 's tubular central portion), thus bending each of the elements 163 about its end portion 162 toward the ring 160 's tubular central portion, and then the opposed tabs 161 spring back (relax) away from each other until each element 163 exerts spring force radially outward against the tubular central portion of ring 170 .
- elements 163 are not elastic.
- edge 174 When edge 174 has moved vertically above the upper edge of ring 160 's tubular central portion, spring portion 173 springs back (radially inward) into its at least substantially vertical orientation (as shown in FIG. 36 ). When this has been accomplished, the forces between edge 174 and ring 160 's tubular central portion and between fastener element 163 (including tabs 161 ) and ring 170 fasten together the aligned rings 160 and 170 .
- FIG. 37 is a perspective view of a portion of tined anastomosis rings 170 ′ and 160 ′, each embodying the invention.
- Ring 170 ′ has a tubular central portion and a number of spring fastener elements 171 ′.
- Each element 171 ′ is made of spring metal (or is otherwise biased to remain in its originally manufactured orientation relative to the rest of ring 170 ′) and has a shape which is a variation on that of above-described spring fastener element 171 .
- elements 171 ′ are integrally formed with the rest of ring 170 ′.
- Each fastener element 171 ′ has a spring portion 173 ′ (which corresponds functionally to spring portion 173 of element 171 ), and a body having two tabs 174 ′.
- Ring 160 ′ (of FIG. 37 ) is identical to ring 160 (of FIG. 36 ) except in that its fastener elements 163 ′ have straight circumferential support tabs 161 ′ that are oriented vertically; not bent circumferential support tabs with vertical portions and horizontally extending ends (e.g., bent circumferential support tabs 161 of ring 160 ).
- FIG. 38 is a perspective view of portions of two aligned anastomosis rings (rings 190 and 200 ).
- rings 190 and 200 are a tined ring having a tubular central portion and fastener elements for fastening the rings together.
- the fastener elements of ring 190 are tabs 191 which extend out from ring 190 's tubular central portion.
- Each tab 191 has a proximal end portion 192 at ring 190 's tubular central portion and a distal end portion 193 that extends radially outside of ring 190 's tubular central portion as shown in FIG. 38 .
- the fastener elements of ring 200 are tabs 201 which extend radially outward from ring 200 's tubular central portion.
- Each tab 201 has two parallel wings 202 which extend vertically from tab 201 's central portion (when tab 201 's central portion is oriented in a horizontal plane), and each wing 202 has a malleable end portion 203 as shown in FIG. 38 .
- a surgeon (or a surgeon-operated instrument) lowers ring 190 into alignment with ring 200 by positioning the tubular central portion of ring 190 (which has a slightly smaller diameter than does the tubular central portion of ring 200 ) within the tubular central portion of ring 200 so that the rings have a common axis of symmetry and each tab 191 fits between the wings 202 of a different one of tabs 201 .
- each fastener When the rings have been so aligned with each other, each fastener is moved into its locking configuration (to fasten together the aligned rings 190 and 200 ) by bending together the end portions 203 of wings 202 so that each tab 191 is held between a pair of bent-together end portions 203 and the rest of tab 201 .
- FIGS. 39 and 40 Another type of fastener that can be used to hold together a pair of aligned anastomosis rings will be described with reference to FIGS. 39 and 40 .
- the embodiments of FIGS. 39 and 40 are variations on the snap fit fastener embodiment of FIG. 36 .
- ring 210 is a tined anastomosis ring having a tubular central portion and fastener elements for fastening ring 210 together with ring 190 .
- Ring 190 (of FIGS. 39 and 40 ) is identical to ring 190 of FIG. 38 , except in that tabs 191 of FIGS. 39 and 40 have their distal portions 193 extending vertically upward (rather than radially outward as in FIG.
- each tab 191 prior to locking of ring 190 to another ring (i.e., ring 210 ), and tabs 191 of FIGS. 39 and 40 are malleable while tabs 191 of FIG. 38 can but need not be malleable.
- the folded-over geometry of each tab 191 (with a proximal end portion 192 extending in a first vertical direction away from a first one of the top or bottom edge of ring 190 's tubular central portion to a folded portion, and extending in the opposite vertical direction beyond the fold) is needed where there is no room to add features to other one of the top or bottom edge of the tubular central portion (such as where the ring's tines extend out from said other one of the top or bottom edge of the tubular central portion).
- the fastener elements of ring 210 are slotted tabs 211 which extend generally vertically upward from the upper edge of ring 210 's tubular central portion as shown in FIG. 39 .
- Each tab 211 has a slot 212 extending therethrough.
- One edge 213 of each slot 212 is formed so that it extends radially inward (relative to the opposite edge of slot 212 ) such that slot 212 is shaped to receive the distal end 193 of tab 191 when tab 191 is advanced vertically upward to bring ring 190 into alignment with ring 210 (as shown in FIG. 39 ).
- Tabs 191 and 211 are malleable.
- tabs 211 it is desirable to design tabs 211 to have the minimum possible vertical length, since if they are too long they may get in the way of one of the blood vessels joined at the anastomosis site. It is typically preferable to use fastener elements of the type to be described with reference to FIGS. 58-61 (rather than those of FIG. 39 ) since the fasteners of FIG. 58-61 have lower vertical profile (than do those of FIG. 39 ) after two aligned rings are fastened together by folding the tabs 383 , and since the FIG. 39 fasteners may provide less circumferential positioning support (especially where the rings' central portions are circular rather than oblong) than do the fasteners of FIGS. 58-61 .
- a surgeon raises ring 190 into alignment with ring 210 by positioning the tubular central portion of ring 190 (which has a slightly smaller diameter than does the tubular central portion of ring 210 ) within the tubular central portion of ring 210 so that the rings have a common axis of symmetry and each tab 191 fits into slot 212 of a different one of tabs 211 as shown in FIG. 39 .
- each fastener When the rings have been so aligned with each other, each fastener is moved into its locking configuration (to fasten together the aligned rings 190 and 210 ) by bending each pair of aligned tabs 211 and 191 radially outward (into the position shown in FIG. 40 ).
- Installation tool 230 of FIGS. 41-48 comprises anvil 70 (which is identical to anvil 70 of FIGS. 16-24 ) and independently translatable sleeves 231 , 232 , 233 , 234 , and 235 (whose distal surfaces are shaped slightly differently than sleeves 71 , 72 , 73 , 74 , and 75 of FIGS. 16-24 , as shown).
- FIGS. 41-48 show the configuration of tool 230 during each of eight different steps of installing tined anastomosis ring 220 in an organ (the organ is not shown). Ring 220 is identical to ring 80 of FIGS.
- the ring 220 is initially loaded onto tool 230 with tubular portion 221 in slot 234 A of sleeve 234 (as shown in FIG. 41 ), and the tines of ring 220 held between sleeves 231 , 232 , and 234 , and the end portion 236 of sleeve 235 (as shown in FIG. 41 ). Then, anvil 70 is inserted into the incision (or other opening) in the organ.
- Sleeve 234 of tool 230 differs from sleeve 74 of tool 79 in that sleeve 234 has two concentric slots 234 A and 234 B, each of which is circular or oblong, for receiving a tubular central portion (of a tined anastomosis ring) having a different diameter (largest radial dimension).
- Sleeve 74 has only one slot 74 A.
- sleeves 231 , 232 , 233 , 234 , and 235 are advanced distally together as a unit to drive the tines of ring 220 between anvil 70 and the tissue edges, until the tines' tips engage the tine-forming surface 70 A of anvil 70 and begin to curl radially outward (away from the central axis of anvil 70 ) as they advance against anvil surface 70 A.
- Sleeves 231 , 232 , 233 , 234 , and 235 continue to advance until they reach the position shown in FIG.
- FIG. 42 in which they have pressed a horizontal portion of each tine (assuming that ring 220 is oriented with a vertical axis of symmetry as shown in FIG. 42 ) against the organ's exterior surface and caused the distal portion of each tine to bend (against stationary surface 70 A of anvil 70 ) relative to the rest of ring 220 until the tip of each tine has penetrated (and grabbed) the tissue around the opening.
- the distal end of sleeve 233 is angled to match the slope of the angled proximal portion of each tine (of ring 220 in its FIG. 41 configuration).
- FIG. 42 shows one tine in the position it would have after its tip has penetrated the tissue and its distal portion has curled radially outward to grab the tissue.
- sleeves 231 and 232 are retracted in the proximal direction (toward the top of FIG. 43 ) while sleeves 233 , 234 , and 235 and anvil 70 remain stationary in engagement with ring 220 .
- anvil 70 is retracted (in the proximal direction) relative to sleeves 233 , 234 , and 235 .
- Each tine preferably has a weak portion (e.g., a hinge) at a location spaced from the junction ( 222 ) between the tine's horizontal and angled portions.
- this weak portion is determined by a hole in each tine.
- Each hole is preferably located along the tine such that, when the tines are in their final configuration (shown in FIG. 48 ), the portion of each tine that is farthest (radially) from the ring's tubular portion 221 does not coincide with the junction 222 , and such portion coincides with (or is very near to) the hole.
- Each tine preferentially bends at both junction 222 and at its weak portion during the steps described with reference to FIGS. 44, 47 , and 48 .
- sleeve 233 is retracted in the proximal direction (as shown in FIG. 45 ), leaving ring 220 (and the tissue gripped thereby) between anvil 70 and sleeves 234 and 235 , with sleeve 234 in a retracted position relative to sleeve 235 .
- sleeve 234 is advanced distally relative to sleeve 235 (into the position shown in FIG. 46 ) to bend and rotate each tine (relative the rest of ring 220 ) from the configuration shown in FIG. 45 to that shown in FIG. 46 as a result of force exertion on ring 220 by stationary sleeve 235 and the distal end of advancing sleeve 234 .
- This bending and rotation further everts the tissue edges around the organ opening, causes the tines to penetrate farther into the tissue, and allows sleeves 232 and 233 to more easily form a final bend in each tine (in the step to be described with reference to FIGS. 47 and 48 ).
- sleeves 232 and 233 are advanced distally relative to portion 236 of sleeve 235 (as shown in FIG. 47 ) to press the tines against portion 236 (while sleeve 234 holds tubular portion 221 against portion 236 ), thereby further bending the tines relative to tubular portion 221 .
- Sleeve 233 then continues to advance until a final bend has been formed in each tine relative to portion 221 , and the ring 220 has been bent into the final, installed configuration shown in FIG. 48 . Specifically, the curled distal portion of each tine is bent radially outward relative to the proximal portion of each tine (by sleeves 232 and 233 , as shown in FIG.
- ring 220 is installed at the opening in the organ with its tines holding the tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ).
- sleeve 235 is (e.g., portions comprising the distal end of sleeve 235 are) spread or dilated (radially outward away from anvil 70 's central axis of symmetry) to decouple tool 230 from the installed ring, and tool 230 is removed from the installed ring.
- FIGS. 49-57 Another alternative embodiment of a tool for installing one of the inventive anastomosis rings will next be described with reference to FIGS. 49-57 .
- Installation tool 330 of FIGS. 49-57 comprises anvil 70 (which is identical to anvil 70 of FIGS. 16-24 ) and four independently translatable sleeves 331 , 332 , 333 , and 334 (which are shaped slightly differently than the five sleeves 231 , 232 , 233 , 234 , and 235 of FIGS. 41-48 , as shown).
- FIGS. 49-57 illustrate the configuration of tool 330 during each of nine different steps of installing tined anastomosis ring 320 in incision 341 of blood vessel 340 .
- 49-57 is a preferred embodiment of the inventive anastomosis ring installation tool, and it implements (during operation) a preferred embodiment of the inventive method for installing an anastomosis ring in an incision in a blood vessel (or another orifice of another type of organ).
- Ring 320 is similar to ring 80 of FIGS. 16-24 , but its tines (each comprising a distal portion 323 and a proximal portion 322 ) are formed so that when ring 320 is loaded onto tool 330 with its tubular central portion 321 oriented with a vertical axis of symmetry, proximal portions 322 are horizontal and distal portions 323 are vertical. Only the right half of the distal portion of each of elements 331 , 332 , 333 , and 334 , and the right half of ring 320 are shown in FIGS. 49-57 .
- the ring 320 is first loaded onto tool 330 with tubular portion 321 in slot 333 B of sleeve 333 (as shown in FIG. 49 ), and the tines of ring 320 held between sleeves 332 and 333 and the end portion 335 of sleeve 334 (as shown in FIG. 49 ). Then, anvil 70 is inserted into the incision 341 .
- Sleeve 333 of tool 330 differs from sleeve 74 of tool 79 in that sleeve 333 has two concentric slots 333 A and 333 B, each of which is circular or oblong, for receiving a tubular central portion (of a tined anastomosis ring) having a different diameter.
- an anastomosis-ring having a smaller diameter tubular central portion (a tubular central portion having smaller diameter than that of tubular portion 321 ) can be loaded onto tool 330 with its smaller diameter tubular central portion in slot 333 A.
- sleeves 331 , 332 , 333 , and 334 are advanced distally together as a unit to drive the tines of ring 320 between anvil 70 and the incised tissue edges, until the tines' tips engage the tine-forming surface 70 A of anvil 70 and begin to curl radially outward (away from the central axis of anvil 70 ) as they advance against anvil surface 70 A.
- Sleeves 331 , 332 , 333 , and 334 continue to advance until they reach the position shown in FIG.
- sleeve 331 is retracted in the proximal direction (toward the top of FIG. 51 ) while sleeves 332 , 333 , and 334 and anvil 70 remain stationary in engagement with ring 320 .
- anvil 70 is retracted (in the proximal direction) relative to sleeves 332 , 333 , and 334 into the position shown in FIG. 52 .
- each tine preferably has a weak portion (e.g., a hinge) at a location spaced from location 326 . In one implementation, this weak portion is determined by a hole in each tine.
- Each hole is preferably located along the tine such that, when the tines are in their final configuration (shown in FIG. 57 ), the portion of each tine that is farthest (radially) from the ring's tubular portion 321 coincides with (or is very near to) the hole; not with location 326 .
- Each tine preferentially bends at both location 326 and at its weak portion 327 during the steps described with reference to FIGS. 52 and 54 - 57 .
- sleeve 332 is retracted in the proximal direction (into the position shown in FIG. 53 ), leaving ring 320 held between sleeves 333 and 334 .
- sleeve 331 and anvil 70 are advanced distally relative to sleeve 332 until curved distal end surface 331 A of sleeve 331 engages the tines of ring 320 (as shown in FIG. 54 ).
- Sleeve 331 then continues to advance so that the tines ride along surface 331 A so as to rotate the curled distal portion 323 of each tine radially outward into the configuration shown in FIG. 54 . This moves the everted tissue adjacent to the tines radially outward, and further everts the everted tissue.
- sleeve 332 is advanced distally relative to sleeves 331 and 333 (and anvil 70 ) until sleeve 332 's distal end engages the curled distal portion 323 of each tine.
- Sleeve 332 then continues to advance so as to rotate each curled distal portion 323 further radially outward into the configuration shown in FIG. 55 , while surface 331 A engages the intima of the everted tissue (to prevent radially inward movement of the everted tissue). This further everts the everted tissue and allows sleeve 332 to more easily form a final bend in each tine (in the step to be described with reference to FIG. 57 ).
- anvil 70 and sleeve 331 are retracted in the proximal direction into the position shown in FIG. 56 , without exerting force on ring 320 or the everted tissue.
- sleeve 332 is advanced in the distal direction (relative to sleeves 333 and 334 ) to bend and rotate each tine (relative the rest of ring 320 ) from the configuration shown in FIG. 56 to that shown in FIG. 57 , by pressing curled distal portion 323 of each tine (and the tissue adjacent thereto) against portion 335 of sleeve 334 .
- This final bending and rotation further everts the tissue edges around incision 341 .
- ring 320 With ring 320 so installed in the incision 341 in its final configuration, its tines hold the incised tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ).
- sleeve 334 is (e.g., portions comprising the distal end of sleeve 334 are) spread or dilated (radially outward away from anvil 70 's central axis of symmetry) to decouple tool 330 from the installed ring, and tool 330 is removed from the installed ring.
- Tool 330 is simpler than above-described tool 230 in that it has only four advanceable and retractable sleeves ( 331 , 332 , 333 , and 334 ), whereas tool 230 has five such sleeves (sleeves 231 , 232 , 233 , 234 , and 235 ).
- Anastomosis ring 380 of FIGS. 58-61 is installed around an incision in the side wall of blood vessel 378 , with curled tines 381 of ring 380 holding the incised tissue edges of vessel 380 with their intima 378 A exposed for anastomosis with vessel 379 .
- Four docking tabs (or “fingers”) 383 extend out from ring 380 's tubular central portion (parallel to the central longitudinal axis of ring 380 , which is generally vertical in FIG. 58 ).
- There is a hole 384 at the base of each tab 383 defining a weak portion at which tab 383 will preferentially bend in response to exertion of radially outward bending force on its distal end 383 A.
- FIG. 61 shows ring 380 in its pre-installation configuration.
- each tine 381 of ring 380 in the pre-installation configuration has a proximal portion which extends radially inward (perpendicular to ring 380 's central axis of symmetry) toward the center of ring 380 's tubular portion, and a distal (tip) portion extending perpendicular to such proximal portion.
- the “flat” tine geometry of ring 380 of FIG. 61 (the term “flat” denotes that the proximal portions of tines 381 are all coplanar, in a plane perpendicular to the ring's central axis of symmetry) is preferred over the “angled” tine geometry of ring 60 of FIG. 10 (in which the tines have proximal portions which extend at a 45 degree angle relative to the ring's central axis of symmetry, e.g., ring 60 's central axis of symmetry).
- Anastomosis ring 400 is installed around an incision in the side wall of blood vessel 379 , with curled tines 401 of ring 400 holding the incised tissue edges of vessel 379 with their intima (not visible in FIG. 58 ) exposed for anastomosis with vessel 378 .
- vessel 379 is gripped by flat end forceps (or “graspers”) 420 , and moved toward tabs 383 of ring 380 so that tabs 383 enter the space 403 between the everted tissue of vessel 379 and the tubular central portion of ring 400 .
- FIG. 59 shows ring 400 being aligned with ring 380 , with tabs 383 of ring 380 extending upward through ring 400 's tubular central portion.
- Forceps 420 are lowering vessel 379 and ring 400 along tabs 383 toward the tubular central portion of ring 380 , which in turn rests on vessel 378 and the tissue 377 which surrounds vessel 378 .
- two arms of forceps 420 are squeezing together opposite side walls of vessel 379 .
- the tubular central portion of ring 400 has greater diameter than that of ring 380 , so that the two rings can be aligned together with their tubular central portions aligned vertically (as shown in FIG. 60 , in which the tubular central portion of ring 380 is not visible since it is within that of ring 400 )
- forceps 420 release vessel 379 .
- Two arms of forceps 420 (which can be the same arms as were used to align the rings, but which preferably are another pair of arms of an implementation of forceps 420 having two pairs of arms) are then moved into engagement with the tabs 383 (e.g., slightly separated arms of forceps 420 are moved into engagement with one pair of opposed tabs 383 , and then the other pair of opposed tabs 383 ).
- the tab-manipulating arms of forceps 420 are moved downward (when viewed as in FIG. 60 ) to exert bending force on tabs 383 to bend them radially outward into the locking configuration shown in FIG. 60 .
- tabs 383 extend generally horizontally outward, away from the common central axis of symmetry of rings 380 and 400 , to lock rings 380 and 400 firmly together against tissue 377 with the exposed intima of vessel 378 sealed against the exposed intima of vessel 379 .
Abstract
Description
- The present invention relates to apparatus and methods for performing anastomosis without hand-suturing.
- In the United States, many coronary artery bypass graft (CABG) procedures are performed on patients annually. Each of these procedures may include one or more graft vessels which are hand sutured. Until recently, coronary artery bypass procedures have been performed with the patient on cardiopulmonary bypass while the heart is stopped with cardioplegia and the surgery is performed on an exposed, stationary heart. Interest in developing a minimally invasive CABG procedure is increasing.
- A few pioneering surgeons are now performing minimally invasive procedures in which a coronary artery bypass is performed through a small incision in the chest wall, sometimes on a beating heart, i.e., without heart-lung bypass and cardioplegia.
- Until recently all bypass graft procedures have been performed by hand suturing the tiny vessels together with extremely fine sutures under magnification. There is a need (which is addressed by the present invention) for methods and apparatus useful for performing anastomosis during CABG surgery on a beating heart, without hand-suturing.
- The present invention can be used to perform end-to-end anastomosis (in which the open end of a vessel or other organ is attached to (and in fluid communication with) the open end of another vessel or other organ without hand-suturing, end-to-side anastomosis (in which the open end of one vessel or other organ is attached to the side wall of a second organ in fluid communication with an incision or other orifice in the second organ's side wall) without hand-suturing, or side-to-side anastomosis (in which incisions or other orifices in the side walls of two vessels or other organs are aligned in fluid communication with each other and the aligned tissue is attached together) without hand-suturing.
- In a class of embodiments, the invention is a ring (for use in anastomosis) that is integrally formed from metal, and includes a central ring portion and tines (and typically also docking features or fastener elements) that extend from the ring portion. In some preferred embodiments, the tines are malleable tines which are movable relative to the ring portion from an initial configuration into a final configuration in which they can grab tissue of an organ (around an incision or other orifice in the organ) and hold such tissue in an everted state. In some preferred embodiments, each tine has a weak section at which it preferentially folds or buckles when subjected to bending force. The ring portion can be rigid or malleable. In preferred embodiments, the ring has a tubular central portion. In other embodiments, the central ring portion is flat (rather than tubular). In some embodiments, the ring is not integrally formed from metal. For example, in some variations, it is assembled from component parts which are connected together (e.g., by welding), or is made of material (other than metal) which has the required mechanical properties.
- Another aspect of the invention is a method for installing the ring at an incision or other orifice in a vessel (or other organ) with the ring portion extending around the incision or other orifice. In such method, the tines are advanced against an anvil so that they grab the tissue around the orifice and curl radially (inward or outward) against the anvil (in some embodiments the tines pierce the tissue before they begin to curl; in other embodiments the tines begin to curl before they grab the tissue).
- The term “grab” is used herein in a broad sense to denote any operation of grabbing, gripping, grasping, or otherwise capturing the relevant tissue (such that the captured tissue can be moved by moving the thing which captures the tissue), and to denote either “grab and pierce” or “grab without piercing.”
- The anvil is then retracted to fold (or buckle) the tines so that their curled ends move radially outward. In an optional final step (which is included in preferred embodiments), the tool is used to further fold or bend the tines so that their curled ends move further radially outward. The folding (or buckling), curling, and optional bending of the tines everts the tissue near the orifice edges to expose the inside surface of the organ (so that such exposed inside surface can be joined to tissue of another vessel or organ). In typical use, the ring is installed with the ring portion extending around an incision in the side wall of a blood vessel, and the action of curling the tines everts the incised edges of the orifice to expose the inside lining (intima) of the blood vessel.
- In other embodiments, the invention is a tool for installing an anastomosis ring in an incision (or other orifice) in a vessel or other organ. The tool includes an anvil and a set of concentric, independently movable sleeves around the anvil. Each sleeve, and preferably also the anvil, can be advanced (in a distal direction) and retracted (in a proximal direction) when desired relative to the other elements of the tool. In some preferred embodiments the tool has four independently movable sleeves; in other embodiments it has five independently movable sleeves. It is contemplated that the multiple movements of the various sleeves can be automated and synchronized to some degree such that the installation process requires a minimal number of operator manipulations of the installation tool.
- Preferably, the distal end of one of the sleeves has two or more circular (or oblong) slots, each for receiving a tubular central ring portion of an anastomosis ring. Thus, the tool can be used to install a relatively small diameter ring (whose central ring portion fits in an innermost slot) or a relatively large diameter ring (whose central ring portion fits in an outermost slot).
- In some preferred embodiments, the outermost sleeve is configured to receive a removable flat member (sometimes referred to herein as a disk). The disk has an open center and is oblong or annular, is preferably made of thin metal, and functions during ring installation to provide a surface against which the ring (and tissue engaged therewith) is pressed to deform (fold and/or bend) the ring into its final configuration. When the ring is installed in its final configuration, the disk is released from the installation tool. The tool is then removed from the installed ring, leaving the disk in engagement with the ring and held between the ring and the adjacent tissue.
- In other embodiments, the invention is a ring (for use in anastomosis) including a central ring portion (preferably a tubular central ring portion), and tines and fastener elements that extend from the ring portion. Preferably, each tine has a weak section at which it preferentially folds or buckles when subjected to bending force. The ring portion can be rigid or malleable. The fastener elements can be (or include) malleable elements, spring elements, or both. The fastener elements are used to fasten together two precisely aligned anastomosis rings, each installed in an incision (or other orifice) of a different vessel or other organ, and optionally also to align the two rings together. In preferred embodiments, the fastener elements of one ring are spring elements having a locking configuration in which they exert spring force on fastener elements of another ring to clamp the two rings together.
- In other embodiments, the invention is a method for performing an anastomosis, including the steps of installing an anastomosis ring in an incision (or other orifice) in a vessel or other organ, installing another anastomosis ring in an incision (or other orifice) in another vessel or other organ, precisely aligning the two installed anastomosis rings, and fastening the aligned rings together.
-
FIG. 1 is a perspective view of an embodiment of the inventive ring for use in performing anastomosis without hand sutures. -
FIG. 2 is a perspective view of another embodiment of the inventive ring for use in performing anastomosis without hand sutures. -
FIG. 3 is a side elevational view of the ring ofFIG. 2 -
FIG. 4 is a side cross-sectional view of a portion of the ring ofFIG. 1 and a portion of an apparatus for installing it, at an early stage of installation of the ring around an incision in the sidewall of a blood vessel. -
FIG. 5 is a side cross-sectional view of a portion of the ring ofFIG. 1 and a portion of an apparatus for installing it, at an intermediate stage of installation of the ring around an incision in the sidewall of a blood vessel. -
FIG. 6 is a side cross-sectional view of a portion of the ring ofFIG. 1 and a portion of an apparatus for installing it, at a late stage of installation of the ring around an incision in the sidewall of a blood vessel. -
FIG. 7 is a side cross-sectional view of a portion of the ring ofFIG. 1 and a portion of an alternative apparatus for installing it, at an early stage of installation of the ring around an incision in the sidewall of a blood vessel. -
FIG. 8 is a side cross-sectional view of a portion of the ring ofFIG. 1 and a portion of theFIG. 7 installation apparatus, at an intermediate stage of installation of the ring around an incision in the sidewall of a blood vessel. -
FIG. 9 is a side cross-sectional view of a portion of the ring ofFIG. 1 and a portion of theFIG. 7 installation apparatus, at a late stage of installation of the ring around an incision in the sidewall of a blood vessel. -
FIG. 10 is a perspective view of an embodiment of the inventive anastomosis ring, with its tines (61) in their initial configuration. -
FIG. 11 is a side cross-sectional view of a portion ofring 60 ofFIG. 10 , and of a portion (shown in phantom view) of another ring (identified by reference numeral 260) which is a variation onring 60. -
FIG. 12 is a side cross-sectional view of portions ofrings FIG. 11 , after the tines thereof have been curled and formed in accordance with the invention. -
FIG. 13 is a perspective view of the ring ofFIG. 10 , with each of itstines 61 in its final configuration. -
FIG. 14 is a side cross-sectional view of a portion of ring 60 (with onetine 61 in theFIG. 13 configuration) installed in tissue of a first vessel at the edge of an incision, and a second vessel (shown in phantom view) aligned with the first vessel. -
FIG. 15 is a perspective view of a portion of a variation onring 60 ofFIG. 10 , with one of its tines (61′) in its initial configuration. -
FIG. 16 is a side cross-sectional view of a portion of an embodiment (80) of the inventive ring and a portion of a tool (79) for installing this ring, in the configuration in which they would be at an early stage (to be referred to as a “first” stage) of installing the ring around an opening of an organ. -
FIG. 17 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a second stage of installing the ring around an opening of an organ. -
FIG. 18 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a third stage of installing the ring around an opening of an organ. -
FIG. 19 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a fourth stage of installing the ring around an opening of an organ. -
FIG. 20 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a fifth stage of installing the ring around an opening of an organ. -
FIG. 21 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a sixth stage of installing the ring around an opening of an organ. -
FIG. 22 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a seventh stage of installing the ring around an opening of an organ. -
FIG. 23 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at an eighth stage of installing the ring around an opening of an organ. -
FIG. 24 is a side cross-sectional view ofring 80 andtool 79 ofFIG. 16 , in the configuration in which they would be at a ninth stage of installing the ring around an opening of an organ. -
FIG. 25 is a simplified perspective view of the distal end of tool 79 (ofFIG. 16 ), withoutsleeve 75, and withring 80 mounted thereon. -
FIG. 25A is a perspective view ofring 80 around a preferred (fluted) implementation ofanvil 70. -
FIG. 26 is side cross-sectional view of a portion ofring 80 of (ofFIGS. 16-25 ) and a portion of another embodiment of the inventive tool (90) for installing this ring around an opening of an organ. -
FIG. 27 is a detail view of a portion of the apparatus shown inFIG. 26 . -
FIG. 28 is a side cross-sectional view of a portion ofring 80 and a portion oftool 90, which have been installed (using tool 90) around an incision in a blood vessel. -
FIG. 29 is a perspective view of portions of two aligned anastomosis rings (rings 100 and 110) having tab fasteners for fastening the rings together. -
FIG. 30 is a perspective view of a portion of a variation on anastomosis ring 100 (ofFIG. 29 ) having a tab fastener which is a variation onfastener 101 ofFIG. 29 . -
FIG. 31 is a perspective view of portions of two aligned anastomosis rings (rings 130 and 110) having tab fasteners, one of which (tab 131) is a variation onfastener 101 ofFIG. 29 . -
FIG. 32 is a perspective view of portions of two aligned anastomosis rings (rings 140 and 150) having a different type of tab fasteners for fastening the rings together, with the fasteners in an open (unlocked) configuration. -
FIG. 33 is a perspective view of the elements shown inFIG. 32 , after these elements have been moved relative to each other into a closed (locked) configuration to fasten the rings together. -
FIG. 34 is a side cross-sectional view of portions of two aligned anastomosis rings (rings 160 and 180) having spring fasteners for fastening the rings together. -
FIG. 35 is a perspective view of portions of the aligned anastomosis rings 160 and 180 shown inFIG. 34 . -
FIG. 36 is a perspective view of portions of two aligned anastomosis rings (rings 160 and 170) having spring fasteners of another type for fastening the rings together. -
FIG. 37 is a perspective view of a portion of a variation onring 170 ofFIG. 36 . -
FIG. 38 is a perspective view of portions of two aligned anastomosis rings (rings 190 and 200) having spring fasteners of another type for fastening the rings together. -
FIG. 39 is a perspective view of portions of two aligned anastomosis rings (rings 190 and 210) having tab fasteners for fastening the rings together, with the fasteners in an unlocked position. -
FIG. 40 is a perspective view of portions of alignedrings FIG. 39 , with the tab fasteners in a locked position. -
FIG. 41 is a side cross-sectional view of a portion of an embodiment (220) of the inventive ring and a portion of a tool (230) for installing this ring, in the configuration in which they would be at an early stage (to be referred to as a “first” stage) of installing the ring around an opening of an organ. -
FIG. 42 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at a second stage of installing the ring around an opening of an organ. -
FIG. 43 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at a third stage of installing the ring around an opening of an organ. -
FIG. 44 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at a fourth stage of installing the ring around an opening of an organ. -
FIG. 45 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at a fifth stage of installing the ring around an opening of an organ. -
FIG. 46 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at a sixth stage of installing the ring around an opening of an organ. -
FIG. 47 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at a seventh stage of installing the ring around an opening of an organ. -
FIG. 48 is a side cross-sectional view ofring 220 andtool 230 ofFIG. 41 , in the configuration in which they would be at an eighth stage of installing the ring around an opening of an organ. -
FIG. 49 is a side cross-sectional view of a portion of an embodiment (320) of the inventive ring and a portion of a preferred embodiment of the inventive tool (330) for installing the ring, in the configuration in which they would be at an early stage (to be referred to as a “first” stage) of installing the ring around an opening of an organ. -
FIG. 50 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at a second stage of installing the ring around an opening of an organ. -
FIG. 51 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at a third stage of installing the ring around an opening of an organ. -
FIG. 52 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at a fourth stage of installing the ring around an opening of an organ. -
FIG. 53 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at a fifth stage of installing the ring around an opening of an organ. -
FIG. 54 is a side cross-sectional view ofring 320 andtool 330 of FIG. 49, in the configuration in which they would be at a sixth stage of installing the ring around an opening of an organ. -
FIG. 55 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at a seventh stage of installing the ring around an opening of an organ. -
FIG. 56 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at an eighth stage of installing the ring around an opening of an organ. -
FIG. 57 is a side cross-sectional view ofring 320 andtool 330 ofFIG. 49 , in the configuration in which they would be at an ninth stage of installing the ring around an opening of an organ. -
FIG. 58 is a perspective view of two of the inventive anastomosis rings (380 and 400), each installed in an incision in a different blood vessel, and a pair offorceps 420 gripping one of the blood vessels.Rings -
FIG. 59 is a cross-sectional view of the apparatus and tissue ofFIG. 58 , afterring 400 has been lowered ontodocking tabs 383 ofring 380. -
FIG. 60 is a cross-sectional view of the apparatus and tissue ofFIG. 59 afterrings tabs 383 are being folded into a locking configuration -
FIG. 61 is a perspective view ofring 380 ofFIG. 58 , in its pre-installation configuration. - The expression “malleable” element is used herein to denote an element that, when deformed from a first shape into a second shape, will not relax back into the first shape from the second. A flexible element can be elastic or malleable (the term “flexible” is used in a broad sense encompassing both the narrower terms “malleable” and “elastic”).
-
FIG. 1 is a perspective view of ananastomosis ring 10, which is an embodiment of the inventive ring for use in performing anastomosis without hand sutures.Ring 10 is integrally formed from metal, and includes acentral ring portion 11, andtines 12 and docking features 15 and 16 which extend out fromring portion 11. Preferably, each of docking features 15 and 16 is implemented so as to add stiffness to ringportion 11, and to define at least one snap feature (or other fastener) for using in fastening together ring 10 (after it has been installed in a vessel or other organ) with another anastomosis ring.Tines 12 are malleable.Ring portion 11 can be implemented to be flexible but is preferably rigid.Ring portion 11 is substantially flat in a plane perpendicular to the central axis ofring 10. - Each
tine 12 is manufactured to be generally flat, and is then bent so as to define abent edge 13 betweenring portion 11 and a distal tine portion which terminates at a sharp distal end. In the initial configuration, the distal tine portions are oriented at least substantially perpendicularly to the plane ofring portion 11. Eachtine 12 is preferably tapered, with its width decreasing from its relatively wide proximal end (at portion 11) to its sharp distal end. Eachtine 12 also has a hinge or weak section (sometimes referred to herein as a “weak portion”) at a location that is separated from (but typically near to)edge 13. Such weak portions are not labeled inFIG. 1 . The number of tines is variable and depends on the size of the ring and the size of the tines. The number should be sufficient to ensure that all of the tissue surrounding the orifice is grasped and everted. - The method for installing ring 10 (and variations thereon) in an opening (e.g., incision) in a vessel or other organ will be described below in detail, but is generally as follows. An anvil is inserted through the opening into the organ, and
ring 10 is positioned with the sharp tips oftines 12 contacting the tissue surrounding the opening. An installation tool is then operated to drivetines 12 against the anvil, causingtines 12 to penetrate through the tissue into contact with the anvil and then begin to curl (or to begin to curl against the anvil and then penetrate the tissue as they continue to curl) so as to engage (and grab) the tissue and optionally also to begin to evert the tissue that surrounds the opening. Then, the anvil is retracted throughring portion 11, thereby causing eachtine 12 to fold or buckle about its hinge (or weak portion) and thus move into a folded (or buckled) and curled configuration. The tines grab the tissue surrounding the opening and thus evert the incised tissue edges as they fold or buckle in response to action of the anvil. In some cases, additional shaping forces are exerted on the tines to move them from their folded (or buckled) and curled configuration into a final configuration. Retraction of the anvil does not significantly deformring portion 11 although it does deformtines 12 relative to ringportion 11. Whentines 12 have been deformed into their final configuration and the anvil has retracted out of engagement withring 10,ring 10 is fully installed at the opening of the organ withring portion 11 surrounding the opening (so that fluid can flow through the opening),ring 10 holding tissue around the opening so as to expose its intima, and docking features 15 and 16 exposed so that features 15 and 16 can be aligned with and fastened to docking features of another ring that has been installed at an incision in (or opening of) another organ to produce an anastomosis that joins the two organs. -
FIG. 2 is a perspective view of ananastomosis ring 20, which is another embodiment of the inventive ring for use in performing anastomosis without hand sutures.Ring 20 is integrally formed from metal, and includes acentral ring portion 21, andtines 22 and docking features 25 and 26 which extend out fromring portion 21.Ring 20 differs from above-describedring 10 primarily in that itscentral ring portion 21 is tubular (in the sense that it surrounds a central axis, has substantially greater length (parallel to the central axis) than width (perpendicular to the central axis), and defines a circular or oblong cross-section in a plane perpendicular to the central axis) rather than flat, and in that tines 22 have slightly different shape thantines 12.Tines 22 are malleable.Ring portion 21 can be implemented to be flexible but is preferably rigid. - Docking features 25 and 26 can be identical to above-described docking features 15 and 16 of
FIG. 1 . As shown inFIG. 3 , features 25 and 26 are bent upward (at an obtuse angle) relative to ringportion 21. Alternatively, the docking features can be bent downward (at an acute angle) relative to ringportion 21, as are alternative docking features 25A and 26A shown in phantom view inFIG. 3 . - When two rings 20 (or 10) have been installed, each in an opening of a different organ, an anastomosis to join the organs is accomplished as follows: the two rings are aligned with each other to cause one ring (and the tissue held thereby) to meet the other ring (and the tissue held thereby) such that there is a plane (denoted herein as a “sealing plane”) between the two rings; and the aligned rings are then fastened together.
- With reference to
FIG. 2 , eachtine 22 ofring 20 is generally flat. Eachtine 22 has a relatively wide proximal portion betweenring portion 11 andshoulder 24, and a narrower distal portion beyondshoulder 24. Each tine is bent at anedge 23 to define a distal portion (distally beyond edge 23) and a proximal portion (betweenedge 23 and ring portion 11). Each proximal portion defines ashoulder 24. The width of the distal portion decreases in tapered fashion fromedge 23 to a sharp distal end. The distal portions of tines 22 (distal to bent edges 23) are oriented at least substantially perpendicularly to the plane ofring portion 21. During installation, eachtine 22 curls tightly from its tip to itsedge 23 in response to being advanced against an anvil of an installation tool. Later during installation, eachtine 22 tends to fold or buckle at shoulder 24 (rather than at other locations along the tine) in response to retraction of the anvil upward (when viewed as inFIG. 2 ) throughring portion 21, so thatshoulder 24 defines a hinge (or weak portion) oftine 22. In some implementations, eachtine 22 also has an additional hinge or weak portion (not labeled) at a location which is separated from (but typically near to)shoulder 24 and separated fromedge 23. - More generally, in embodiments of the inventive ring in which each tine (in its pre-installation configuration) has a proximal portion that extends radially inward toward the ring's central axis and a distal portion orientated at least substantially parallel to the ring's central axis (e.g., the embodiments of
FIGS. 1 and 2 ), the distal portion is preferably tapered to its sharp tip to guarantee a tight curl when curling against the anvil of the installation tool during installation. The proximal portion need not be tapered (although the proximal portion of each tine ofring 10 is shown to be tapered inFIG. 1 ). In typical implementations, the proximal portion of each tine is not tapered (as inFIG. 1 ) and instead defines a shoulder (e.g.,shoulder 24 of each tine ofFIG. 2 ) or other hinge or weak portion (e.g., a hole), so that when the anvil of the installation tool is retracted (so as to fold or buckle the tines radially outward and thereby evert tissue being grabbed by the tines), each tine will preferentially fold or buckle at the shoulder (or other hinge or weak portion) of its proximal portion in response to the force exerted by the retracting anvil. - The method for installing ring 20 (and variations thereon) in an opening (e.g., an incision) in a vessel or other organ will be described below in detail, and is basically the same as the method for installing
ring 10. An anvil is inserted through the opening into the organ, andring 20 is positioned with the sharp tips oftines 22 engaging the tissue surrounding the opening. An installation tool is then operated to drivetines 22 against the anvil, causingtines 22 to penetrate through the tissue into contact with the anvil and then begin to curl (or to begin to curl against the anvil and then penetrate the tissue as they continue to curl) so as to engage (and grab) the tissue and optionally also to begin to evert the tissue that surrounds the opening. Then, the anvil is retracted throughring portion 21, thereby causing eachtine 22 to fold or buckle about one or more hinges (or weak portions) thereof and move into a folded (or buckled) and curled configuration. The tines grab the tissue surrounding the opening and thus evert the incised tissue edges as they fold or buckle in response to action of the anvil. In some cases, additional shaping forces are exerted on the tines to move them from their folded (or buckled) and curled configuration into a final configuration. Retraction of the anvil does not significantly deformring portion 21 although it does deformtines 22 relative to ringportion 21. Whentines 22 have been deformed into their final configuration and the anvil has retracted out of engagement withring 20,ring 20 is fully installed at the opening of the organ withring portion 21 surrounding the opening (so that fluid can flow through the opening),ring 20 holding tissue around the opening so as to expose its intima, and docking features 25 and 26 exposed. - The tines of each embodiment of the inventive ring (including
ring 10 or 20) are preferably wide and flat so that each has a relatively wide surface oriented parallel to the edge of the opening at which the ring is to be installed. This allows the tines efficiently to exert everting force on the tissue around the opening without tearing or otherwise causing trauma to the tissue, while at the same time the tines can be easily formed in response to exertion of moderate forces thereon (e.g., forces which fold or buckle the tines about their hinges or weak portions). -
Ring 10 can be installed using an installationtool comprising anvil 30 and independentlytranslatable sleeves 31 and 32 (as shown inFIGS. 4, 5 , and 6) at the site of an incision in the side wall of a blood vessel havingexterior surface 40 and interior surface (inside lining or “intima”) 41. Only the right half of the distal portion of each ofelements FIG. 4 ) are shown inFIGS. 4, 5 , and 6.FIG. 4 showsring 10 and the installation tool at an early stage of the installation process,FIG. 5 shows them at a later stage, andFIG. 6 shows them at a still later stage. Whenanvil 30 has retracted (upward) into the position shown inFIG. 6 ,ring 10 has been installed withring portion 11 extending around the incision,tines 12 grabbing the tissue around the incision, andtines 12 having been deformed so as to evert the incised edges of the tissue to expose theintima 41 of the blood vessel as shown inFIG. 6 . - More specifically, as shown in
FIG. 4 ,anvil 30 is inserted into the incision.Sleeves tines 12 ofring 10 into the tissue, so that the tines penetrate the tissue and engage the tine-formingsurface 30A ofanvil 30, and so that the tines begin to curl radially inward (toward the central axis of anvil 30) as they advance againstanvil surface 30A. Then, as shown inFIG. 5 , whilesleeves press ring 10'sflat ring portion 11 in the distal direction against the vessel'sexterior surface 40,anvil 30 is retracted in the proximal direction (toward the top ofFIG. 5 ) to causesurface 30A to begin to bend the distal portion of eachtine 12 toward the top ofFIG. 5 relative to the rest ofring 10. Since thetines 12 extend through the tissue, the tines grab the tissue as they bend, and the bending of the tines causes the incised tissue edges to begin to evert. Then, as shown inFIG. 6 ,sleeve 31 is retracted in the proximal direction whileanvil 30 continues to retract in the proximal direction. In response to the force exerted ontines 12 by retracting anvil 30 (whensleeve 31 has retracted proximally), eachtine 12 folds or buckles at its hinge (or weak portion) radially outward (away from the central axis of anvil 30) as it continues to grab the tissue, thereby completing the eversion of the incised tissue edges as shown inFIG. 6 . After such folding or buckling oftines 12,sleeve 32 is withdrawn or retracted in the proximal direction, leavingring 10 installed at the incision withtines 12 holding the incised tissue edges in the desired everted state (for joining to tissue of another vessel or other organ). Optionally, a final step is performed in which an another element (not shown inFIGS. 4-6 ) of the installation tool is advanced into engagement with ring 10 (or the tissue that has been grabbed thereby), or in whichanvil 30 is again advanced into the incision andsleeves anvil 30, to further bend thetines 12 relative to the rest ofring 10 and thereby further evert the incised tissue edges. The optional final step is included in preferred embodiments of the invention. - Preferably (and as an alternative to the procedure described with reference to
FIGS. 4-6 ),ring 10 is installed using a slightly different installation tool that comprisesanvil 30 and independentlytranslatable sleeves 51 and 52 (as shown inFIGS. 7, 8 , and 9) at the site of an incision in the side wall of a blood vessel havingexterior surface 40 and interior surface (“intima”) 41. Only the right half of the distal portion of each ofelements FIG. 7 ) are shown inFIGS. 7, 8 , and 9.FIG. 7 showsring 10 and the installation tool at an early stage of the installation process,FIG. 8 shows them at a later stage, andFIG. 9 shows them at a still later stage. Whenanvil 30 has retracted (upward) into the position shown inFIG. 9 ,ring 10 has been installed withring portion 11 extending around the incision,tines 12 grabbing the tissue around the incision, andtines 12 having been deformed so as to evert the incised edges of the tissue to expose theintima 41 of the blood vessel as shown inFIG. 9 . - More specifically, as shown in
FIG. 7 ,anvil 30 is inserted into the incision. Then,sleeves tines 12 ofring 10 betweenanvil 30 and the incised tissue edges until the tips oftines 12 engage the tine-formingsurface 30A ofanvil 30, and begin to curl radially outward (away from the central axis of anvil 30) as they advance againstanvil surface 30A.Sleeves FIG. 8 , in which they have pressedring 10'sflat ring portion 11 in the distal direction against the vessel'sexterior surface 40, and caused the distal portion of eachtine 12 to bend (againststationary surface 30A of anvil 30) relative to the rest ofring 10 until the tip of each tine has penetrated (and grabbed) the tissue around the incision. Then, as shown inFIG. 9 ,sleeve 51 andanvil 30 are retracted (in the proximal direction) whilesleeve 52 remains extended in engagement withring 10. In response to the force exerted on tines 12 (and the incised tissue edges that have been grabbed by tines 12) by retractinganvil 30, eachtine 12 folds or buckles at its hinge (or weak portion) radially outward (away from the central axis of anvil 30) while continuing to grab the tissue, thereby everting the incised tissue edges as shown inFIG. 9 . After such folding or buckling oftines 12,sleeve 52 is retracted in the proximal direction or otherwise withdrawn, leavingring 10 installed at the incision withtines 12 holding the incised tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ). Optionally, a final step is performed in which an another element (not shown inFIGS. 7-9 ) of the installation tool is advanced into engagement with ring 10 (or the tissue that has been grabbed thereby), or in whichanvil 30 is again advanced into the incision andsleeves anvil 30, to further bend thetines 12 relative to the rest ofring 10 and thereby further evert the incised tissue edges. -
FIGS. 10 and 13 are perspective views ofanastomosis ring 60, which is an embodiment of the inventive anastomosis ring.Ring 60 includes tenmalleable tines 61 which extend out from cylindrical (tubular)ring portion 65.FIG. 10 shows tines 61 in their initial configuration (the configuration in which they would be whenring 60 is loaded onto an installation tool prior to installation at an incision in an organ).FIG. 13 shows each oftines 61 in its final configuration (the configuration in which it would be following installation at an incision in an organ). - Each
tine 61 ofring 60 has a flat cross-section, with two opposed faces and relatively small (narrow) edge surfaces between the faces. Eachtine 61 has a relatively wide proximal end 64 (from which it extends out from ring portion 65) and tapers to a sharpdistal end 62. Eachtine 61 is preferably made from flat metal, and has aweak portion 63 which is defined by a hole formed (e.g., stamped or etched) therethrough (from one of the opposed faces to the other) at a location between ends 62 and 64. Prior to installation, eachtine 61 is pre-formed into an S-shape as shown inFIG. 10 , so that the tines' distal portions are oriented in a distal direction (so that the tines' distal portions are generally parallel to each other and to the axis of symmetry of ring 60). During the installation process, a distal portion of each tine is curled radially outward (away fromring 60's axis of symmetry) so that it grasps tissue, and then the curled tines are folded (or buckled) radially outward about their weak portions to evert the tissue being grasped thereby, until eachtine 61 reaches the final configuration shown inFIG. 13 . As shown inFIGS. 13 and 14 , whentines 61 are in their final configuration, the foldedportion 67 of each tine that is farthest from the ring'stubular portion 65 is at (or very near to) the tine'sweak portion 63. Assuming that the central axis oftubular portion 65 is oriented vertically, the foldedportion 67 is preferably slightly raised in the sense that it is slightly above the tine's lowest portion (66). Whenring 60 has been installed around an incision in a vessel 68 (withtines 61 in the configuration shown inFIG. 14 so as to evert the incised tissue edges), andvessel 68 is to be joined (at an anastomosis site) to asecond vessel 69 that has been prepared for anastomosis by installation of an anastomosis ring (similar or identical to ring 60) around an incision in the second vessel, the folded, raisedportions 67 of tines 61 (of ring 60) desirably shape the everted, incised tissue edges ofvessel 68. Specifically, the fact thatportions 67 are raised (relative to portions 66) causesring 60 to present the intima ofvessel 68 to the intima ofvessel 69 in an orientation that promotes healing together of, and formation of a fluid tight seal between, the joined tissue ofvessels - A variation on
ring 60 will be described with reference toFIG. 15 . This ring, identified byreference numeral 60′, has a tubularcentral ring portion 65′ and tenmalleable tines 61′ which extend out from the tubular ring portion.FIG. 15 shows one oftines 61′ in its initial configuration (the configuration in which it would be whenring 60′ is loaded onto an installation tool prior to installation at an incision in an organ). Theother tines 61′ ofring 60′ are omitted fromFIG. 15 for clarity. Eachtine 61′ has a flat cross-section, with two opposed faces and relatively small (narrow) edge surfaces between the faces. Eachtine 61′ has a pair ofnotches 63′ in the edge surfaces at a first distance fromring portion 65′. These notches define a weak portion oftine 61′ at said first distance fromring portion 65′. - Ring 260 (shown in phantom view in
FIGS. 11 and 12 ) differs from ring 60 (ofFIGS. 10, 11 , and 12) in the following respects. Inring 60's pre-installation configuration, each of its tines 61 (which extend out fromring 60's cylindrical portion 65) has adistal portion 61A that is oriented vertically (whenring 60 is viewed as inFIG. 11 ) and terminates at asharp tip 62, a straightproximal portion 61B oriented at a forty-five degree angle relative todistal portion 61A, and a horizontally orientedstraight portion 61C betweenportions FIGS. 11 and 12 ) has a central cylindrical portion which is identical tocylindrical portion 65 ofring 60. However, eachtine 261 ofring 260 in its pre-installation configuration extends out fromring 260's cylindrical portion with a distal portion that is oriented vertically (whenring 260 is viewed as inFIG. 11 ), a curved proximal portion R, and a horizontally oriented third portion between the distal portion and the curved proximal portion. An important difference between thecurved tines 261 ofring 260 and the piecewiselinear tines 61 ofring 60 is that, in the ring installation step to be described with reference toFIG. 22 ,tine 261 will bend and rotate farther thantine 61 due to the cam action ofsurface 76 ofsleeve 75 on the smoothlycurved tine 261. This additional bending and rotation of tines 261 (to move them from a configuration corresponding to that shown inFIG. 21 to a configuration corresponding to that shown inFIG. 22 ) allowssleeves tine 261 assleeves tines 261 against surface 76 (during the installation step to be described with reference toFIG. 24 ). - Next, with reference to
FIGS. 16-25 , we describe atool 79 for installing ring 80 (partially shown in each ofFIGS. 16-25 ), in tissue around an opening in an organ (e.g., an incision in a blood vessel). With respect to all embodiments of tools for installing the inventive rings disclosed herein, it is contemplated that the multiple movements of the various sleeves can be automated and synchronized to some degree such that the installation process requires a minimal number of operator manipulations of the installation tool.Ring 80 can be identical to ring 60 ofFIG. 14 . Inring 80's pre-installation configuration, each of itstines 80A (which extend out fromring 80's cylindrical portion 85) has adistal portion 81 that is oriented vertically (whenring 80 is viewed as inFIG. 17 ) and terminates at asharp tip 82, aproximal portion 83 oriented at a forty-five degree angle relative todistal portion 81, and a horizontally orientedthird portion 84 betweenportions - Each
tine 80A ofring 80 will preferentially fold at the junction betweenangled portion 83 and portion 84 (e.g., in response to forces exerted onring 80 by retractinganvil 70 during the installation step shown inFIG. 20 , and forces exerted onring 80 byanvil 70 andsleeves FIG. 24 ). Eachtine 80A preferably also has a weak portion (e.g., a hinge) at a location near to (but spaced from) the junction betweenportions tine 80A preferentially bends at both this junction and the weak portion during the steps described with reference toFIGS. 20 and 24 .FIG. 25 is a simplified perspective view of the distal end oftool 79 with ring 80 (in its initial configuration) mounted thereon, showing some oftines 80A ofring 80. Eachtine 80A has ahole 86 extending through it (at a location along tine portion 84), eachhole 86 defining a weak portion of the tine. -
FIG. 25A is a perspective view ofring 80 around a preferred (fluted) implementation ofanvil 70.Anvil 70 ofFIG. 25A has grooves along its sides, and concave, tine-formingportions 70B of itssurface 70A. Eachconcave portion 70B is dimensioned and positioned to receive and form one of the tines ofring 80. - With reference to
FIGS. 16-24 we next describe operation ofinstallation tool 79 which comprisesanvil 70 and independentlytranslatable sleeves anastomosis ring 80 in an organ (the organ is not shown). Only the right half of the distal portion of each ofelements anvil 70, and the right half ofring 80, are shown inFIGS. 16-24 .Tool 79 also comprisescontrol assembly 79A (shown only inFIG. 16 ) which is coupled toanvil 70 and sleeve elements 71-75 and configured to independently advance and retract appropriate ones of elements 70-75 at appropriate times. It is contemplated that some implementations ofassembly 79A are manually operated in the sense that a user must manually manipulate at least one element of 79A to accomplish each advancing or retracting movement of each desired one of elements 70-75, and that other implementations ofassembly 79A are automatically operated in the sense that they include a trigger, and hardware for implementing a timed sequence of advancing and retracting movements of elements 70-75 in response to a single actuation of the trigger. Other embodiments of the inventive installation tool (including those described with reference toFIGS. 4-9 and 41-57) have control assemblies coupled to the tool's anvil and sleeve elements and configured to advance and retract appropriate ones of the anvil and sleeve elements at appropriate times. - Initially,
ring 80 is loaded ontotool 79 withtubular portion 85 incircular slot 74A of sleeve 74 (shown inFIGS. 16 and 17 ), andtines 80A ofring 80 held betweensleeves end portion 76 ofsleeve 75 as shown inFIG. 16 . Then,anvil 70 is inserted into the incision (or other opening) in the organ, andsleeves tines 80A betweenanvil 70 and the tissue edges until the tips oftines 80A engage the tine-formingsurface 70A ofanvil 70, and begin to curl radially outward (away from the central axis of anvil 70) as they advance againstanvil surface 70A.Sleeves FIG. 17 , in which they have pressedportion 84 of eachtine 80A against the organ's exterior surface and causeddistal portion 81 of eachtine 80A to bend (againststationary surface 70A of anvil 70) relative to the rest ofring 80 until thetip 82 of each tine has penetrated (and grabbed) the tissue around the opening. The distal end ofsleeve 73 is angled to match the slope of each oftine portions 83 ofring 80 in itsFIG. 16 configuration.FIG. 16 shows onetine 80A whose tip has been advanced into engagement withsurface 70A (but which has not yet begun to curl), andFIG. 17 shows the same tine after it has been advanced further (bysleeves - Then, while sleeves 71-75 remain stationary,
anvil 70 is retracted (toward the top ofFIG. 18 ) to further curl the curleddistal portion 81 of eachtine 80A relative to the rest ofring 80 into the configuration shown inFIG. 18 , thereby causingportion 81 of each tine to further penetrate and more securely grab the tissue around the opening. - Then, as shown in
FIG. 19 ,sleeves FIG. 19 ) whilesleeves anvil 70 remain stationary in engagement withring 80. - Then, as shown in
FIG. 20 ,anvil 70 is retracted (in the proximal direction) relative tosleeves anvil 70 ontines 80A (and the tissue edges that have been grabbed bytines 80A), eachtine 80A folds or buckles at both its weak portion and at the junction (identified byreference numeral 83A inFIGS. 17 and 25 ) betweenportions distal portion 81 moves radially outward (away from the central axis of anvil 70) while it continues to grab the tissue, thereby everting the tissue edges. As noted, eachtine 80A preferably has a weak portion (e.g., a hinge) at a location spaced from the junction (83A) betweenportions FIG. 25 ) in each tine. Eachhole 86 is preferably located along the tine such that, whentines 80A are in their final configuration (shown inFIG. 24 ), the portion (87) of each tine that is farthest (radially) from the ring'stubular portion 85 does not coincide with thejunction 83A, andsuch portion 87 coincides with (or is very near to)hole 86. In this preferred implementation,hole 86 extends throughportion 84 of eachtine 80A at a location near to, but spaced fromjunction 83A betweenportions hole 86 andjunction 83A (and greater distance betweenportion 85 andhole 86 than betweenportion 85 andjunction 83A) is preferred because it reduces trauma to tissue in the following sense during installation ofring 80 in the tissue. Whenring 80 has been installed in the tissue in its final configuration (shown inFIG. 24 ), the installation procedure has not stretched the tissue alongportion 83 of each tine (which is not shown inFIG. 24 , but which would be betweenportion 83 and sleeve portion 76). In contrast, the tissue in immediate contact withtip 82 of each tine has undergone significant stretching. The degree of stretching which the tissue has undergone is roughly proportional to the tissue's distance (along each tine fromtip 82 to portion 87) fromtip 82, with tissue nearer to portion 87 (along the tine's axis) having undergone less stretching than tissue farther fromportion 87 along the tine's axis. Thus, since the preferred location of the tine's weak portion effectively movesportion 87 closer (along the tine's axis) to tip 82 than it would be if the weak portion were not present (or if the weak portion had coincided withjunction 83A), the weak portion effectively reduces the amount of stretching undergone by the tissue during ring installation. - Each
tine 80A preferentially bends at bothjunction 83A and at the weak portion (the location of hole 86) during the steps described with reference toFIGS. 20 and 24 . - After the folding or buckling of
tines 80A described with reference toFIG. 20 ,sleeve 73 is retracted in the proximal direction (as shown inFIG. 21 ), leaving ring 80 (and the tissue gripped thereby) betweenanvil 70 andsleeves sleeve 74 in a retracted position relative tosleeve 75. - Then,
sleeve 74 is advanced distally relative to sleeve 75 (into the position shown inFIG. 22 ) to bend and rotate eachtine 80A (relative to the rest of ring 80) from the configuration shown inFIG. 21 to that shown inFIG. 22 as a result of force exertion onring 80 bystationary sleeve 75 and the distal end of advancingsleeve 74. This bending and rotation further everts the tissue edges around the organ opening, causes thetines 80A to penetrate farther into the tissue, and allowssleeves tine 80A (in the step to be described with reference toFIG. 24 ). Whenring 80 has been formed into the configuration shown inFIG. 22 ,portion 85 is at least substantially perpendicular toportion 83 of eachtine 80A, andportions sleeve 75. - After
ring 80 has been placed in the configuration shown inFIG. 22 ,sleeve 74 is retracted in the proximal direction relative toportion 76 ofsleeve 75, into the position shown inFIG. 23 . - Then,
sleeves portion 76 ofsleeve 75 to presstines 80A andportion 85 againstportion 76, thereby forming a final bend in each oftines 80A relative toportion 85 and moving thering 80 into the final, installed configuration shown inFIG. 24 . Specifically,portions tine 80A are bent radially outward relative toportion 83 and then pushed distally againstportion 83 to putring 80 in the final configuration. In this final configuration,ring 80 is installed at the opening in the organ withtines 80A holding the tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ). - After installation of
ring 80,sleeve 75 is (e.g., portions comprising the distal end ofsleeve 75 are) spread or dilated (radially outward away fromanvil 70's central axis of symmetry) to decoupletool 79 from the installed ring, andtool 79 is removed from the installed ring. - In tool 79 (described with reference to
FIGS. 16-24 ),flat portion 84 of eachtine 80A conforms with the flat upper surface ofportion 76 ofsleeve 75 during the step described with reference toFIG. 23 , so thatsleeves tine 80A assleeves tines 80A against surface 76 (during the step described with reference toFIG. 24 ). Variations on installation tool 79 (e.g., those used to install rings having curved tines, such as ring 60) can include a sleeve that corresponds functionally tosleeve 75 but has a tine-receiving surface (corresponding to the upper, tine-receiving surface of portion 76) that is not flat, but is instead curved to match the curvature of tines of rings to be installed by such tool. - In variations on the described embodiments of the inventive tined anastomosis ring, the weak point of each tine is determined other than by a hole through the tine. For example, the weak point can be determined by notches cut into the tine (to reduce the tine's width), a tine portion having reduced thickness, or perforations cut into the tine.
- In variations on the described embodiments of the inventive tined ring, the ring portion (from which the tines, and optionally also docking features, protrude) is not malleable. For example, the ring portion can be rigid or elastic. The ring portion is preferably integrally formed from metal, but can alternatively have another structure. For example, the ring portion can be assembled from component parts (e.g., metal parts) which are connected together (e.g., by welding), or can be made (entirely or partially) of material other than metal but which has the required mechanical properties (e.g., flexibility and/or moldability).
- Next, with reference to
FIGS. 26-28 , we describeinstallation tool 90 which is another embodiment of the inventive tool for installing ring 80 (or variations on this embodiment of the inventive tined ring) around an opening of an organ (e.g., an incision in a blood vessel).Installation tool 90 includesanvil 70 and independentlytranslatable sleeves tool 79 described above with reference toFIGS. 16-25 .Tool 90 also includessleeve 95 and annular disk 96 (which together replacesleeve 75 of above-described tool 79), and hardware (not shown) for advancing and retractingelements annular disk 96 is equal to the inner radius ofportion 76 ofsleeve 75 oftool 79, and the width of disk 96 (from its inner to outer radius) is such that the overall distance from the inner radius ofdisk 96 to the outer radius of the distal portion ofsleeve 95 is equal to the overall distance from the inner radius ofportion 76 ofsleeve 75 to the outer radius ofsleeve 75's distal portion. -
Tool 90 can be used to installring 80 at the site of an incision in the side wall of a blood vessel (shown inFIG. 28 but notFIG. 26 ) havingexterior surface 40 and interior surface (inside lining or “intima”) 41.FIG. 26 is a cross-sectional view of the right half only of the distal portion of each ofelements ring 80 anddisk 96.Disk 96 is oblong (with an open center) or annular. -
FIG. 26 shows ring 80 andtool 90 at an early stage of the installation process. To loadring 80 anddisk 96 attool 90's distal end,ring portion 85 is inserted into slot (or groove) 74A ofsleeve 74, anddisk 96 is inserted ingroove 95A insleeve 95's inner sidewall. Each ofslot 74A andgroove 95A is circular or oblong (e.g., each is circular when the tubular central portion ofring 80 is circular anddisk 96 is annular). Sleeve 95 (or the distal end of sleeve 95) can comprise multiple portions which can be moved radially toward each other (to grip the disk 96) or radially away from each other (to release the disk 96). Theportions comprising sleeve 95's distal end are spread or dilated radially outward (away from each other and away from the central axis of symmetry of anvil 70) to allow insertion ofdisk 96 in (or removal ofdisk 96 from)groove 95A, or contracted radially inward (toward the central axis of anvil 70) so thatdisk 96 is gripped betweensleeve 95 andtines 80A ofring 80. In alternative embodiments of the invention,sleeve 95 includes an element which releasably holdsdisk 96 ingroove 95A. In other alternative embodiments, disk 96 (or a variation thereon) is removably mounted to a sleeve (sleeve 95 or a variation thereon) by a joining feature other than a groove or notch in the sleeve. - When
ring 80 anddisk 96 have been loaded onto the distal end oftool 90,tool 90 is operated to installring 80 at an incision or other opening in an organ. To accomplish this,tool 90 operates in essentially the same manner as above-describedtool 79 would operate to install the same ring, withelements tool 90 together corresponding functionally tosleeve 75 oftool 79, except in thatdisk 96 remains at the anastomosis site (with the fully installed ring) aftersleeve 95 and the other elements ofinstallation tool 90 are removed from the anastomosis site. - For the following reason,
tool 90 can have a simpler design than that oftool 79, and removal and release oftool 90 following installation of a ring can be easier than removal and release oftool 79 following ring installation. The radial distance over which the distal end ofsleeve 95 must move (distance “A” inFIG. 27 ) to releasedisk 96 and to releaseportion 85 ofring 80 from betweensleeves sleeve 95 would need to move (distance “B” inFIG. 27 ) to releaseportion 85 fromelements disk 96 were integrally formed with (or permanently attached to)sleeve 95, assuming that the overall distance from the inner radius ofdisk 96 to the outer radius ofsleeve 95 is equal to the overall distance from the inner radius ofportion 76 ofsleeve 75 to the outer radius of the distal end ofsleeve 75. - Also,
sleeve 95 of tool 90 (andsleeve 75 of tool 79) are typically made of plastic, but it is practical to implementdisk 96 as a metal disk. A metal implementation ofdisk 96 would typically be stronger than a typical plastic implementation ofportion 76 ofsleeve 75. - When
tool 90 has completed the installation ofring 80 at an incision in a blood vessel (as shown inFIG. 28 ),ring portion 85 extends around the incision,tines 80A have grabbed the tissue around the incision and then been deformed so as to evert the incised edges of the tissue to expose theintima 41 of the blood vessel, anddisk 96 is trapped between the vessel'sexterior surface 40 andtines 80A.Ring 80 can be implemented with docking features (and optionally also fasteners) that extend out fromring portion 85. Alternatively,disk 96 can be implemented with docking features (and optionally also fasteners) that extend out fromdisk 96's outer periphery (for use in aligningring 80 with, and optionally also attachingring 80 to, another anastomosis ring). In the latter case,ring 80 is preferably implemented without docking features or fasteners to simplify its design. - When only the inventive tined anastomosis ring (and not also an additional element such as
annular disk 96 ofFIG. 28 ) is to be installed, the ring is preferably implemented to have one or more fasteners extending out from its central ring portion (the ring portion from which its tines extend). Preferred implementations of such fasteners will next be described with reference toFIGS. 29-40 . Each fastener will be described as a feature of an embodiment of a tined anastomosis ring having a tubular central ring portion, although each fastener can be implemented as a feature of an anastomosis ring having a flat central ring portion, or as a feature of an annular ring (e.g.,ring 96 ofFIG. 28 ) to be installed with any embodiment of the inventive tined anastomosis ring. -
FIG. 29 is a perspective view of portions of two of the inventive anastomosis rings (ring 100 and ring 110) which have been aligned together, and respectively includefasteners rings portion 65 ofring 60 ofFIG. 10 ), with tines (not shown) that extend out from such tubular central portion.Ring 100 hastabs 101 that extend up from its tubular central portion at locations evenly spaced around the tubular central portion. Only onetab 101 is shown inFIG. 29 . Eachtab 101 hasnotches 102 at the junction betweentab 101 and ring 100's tubular central portion. -
Ring 110 has one slottedtab 111 for eachtab 101 ofring 100. Eachtab 111 has aproximal portion 112 at the junction betweentab 111 and ring 110's tubular central portion, and a distal end defining aslot 113. Eachtab 111 is bent into the shape shown inFIG. 29 , so thattab 101 ofring 100 can be advanced upward throughslot 113 to align therings tab 101 radially outward and downward relative to table 111 so thattab 100 folds into an orientation that locksring 101 together withring 100. Thenotches 102 in eachtab 101 define a weak point at whichtab 101 preferentially folds when it is bent as described. - Tab 121 (of anastomosis ring 120) of
FIG. 30 is a variation ontab 101 ofFIG. 29 .Anastomosis ring 120 hastabs 121 which extend up from its tubular central portion at locations evenly spaced around the tubular central portion, and tines (not shown) that extend down from its tubular central portion. Only onetab 121 is shown inFIG. 30 .Tab 121 differs fromtab 101 only in that its weak portion (at the junction betweentab 121 and ring 120's tubular central portion) is defined by aslot 122 extending throughtab 121, rather than by notches (e.g.,notches 102 ofFIG. 29 ) in the tab's sides. - Tab 131 (of anastomosis ring 130) of
FIG. 31 is another variation ontab 101 ofFIG. 29 .Anastomosis ring 130 hastabs 131 which extend up from its tubular central portion at locations evenly spaced around the tubular central portion, and tines (not shown) that extend down from its tubular central portion. Only onetab 131 is shown inFIG. 31 .Tab 131 differs fromtab 101 in that itsweak portion 131A (which can be a thin portion of tab 131) is oriented vertically, and in that it has anotch 132 at the junction betweentab 131 and ring 130's tubular central portion. To fastenring 130 to ring 110, eachtab 131 is bent or folded at itsweak portion 131A. In contrast, the weak portion oftab 101 is defined by a set of notches (e.g.,notches 102 ofFIG. 29 ) in the tab's sides. -
FIGS. 32 and 33 are perspective views of portions of two aligned anastomosis rings (rings 140 and 150) having a different type of tab fasteners for fastening the rings together.Ring 140 hastabs 141 which extend out from around its tubular central portion, andring 150 hastabs 151 which extend out is from around its tubular central portion. Only onetab 141 and onetab 151 are shown in each ofFIGS. 32 and 33 . When rings 140 and 150 are aligned, eachtab 141 has aflange 142 that circumferentially overlaps anedge 152 of one oftabs 151.Tabs 141 and preferably alsotabs 151 are made of spring metal (or are otherwise biased to remain in their originally manufactured orientations relative to the rest of the ring from which they protrude). To fastenring 140 to ring 150, eachtab 141 is bent below the adjacent tab 151 (assuming that the rings are oriented withtabs 141 initially above tabs 151), withflange 142 bending relative to the rest oftab 141 to allow it to passedge 152 oftab 151. After such relative movement,tabs FIG. 33 , with spring force exerted by eachtab 141 ontab 151 holding the rings together andtabs 151 preventingtabs 141 from springing back into their original position (i.e., the original position shown inFIG. 32 ). - Next, with reference to
FIGS. 34 and 35 , we describe another type of fastener which can be included as part of the inventive anastomosis ring.FIG. 34 is a side cross-sectional view of portions of two aligned anastomosis rings (rings 160 and 180) having spring fasteners for fastening the rings together. Each spring fastener compriseselements Fastener elements 163 are made of spring metal, are generally U-shaped, and each has a body which extends out at an acute angle from an edge (the bottom edge inFIG. 34 ) ofring 160's tubular central portion, with the body of eachelement 163 being attached at aproximal end portion 162 to the tubular central portion ofring 160. Eachelement 163 has twotabs 161, which extend out at an obtuse angle with respect to the body of element 163 (as shown inFIG. 34 ). When element 163 (in itsFIG. 34 configuration) is rotated (counterclockwise inFIG. 34 ) aboutend portion 162 relative to ring 160's tubular central portion,element 163 will spring back to the configuration shown inFIG. 34 . Eachfastener element 181 is made from malleable material, and has twowings 182. Eachwing 182 is pre-formed to extend in a plane oriented at a ninety-degree angle relative to the rest of theelement 181 of which it is a part. Whenring 180 is oriented with a vertical axis of symmetry, eachelement 181 extends vertically (or substantially vertically) upward away fromring 180's tubular central portion (as shown inFIG. 34 ). - To fasten
ring 160 to ring 180, a surgeon (or a surgeon-operated instrument) alignsring 180 withring 160 by positioning the tubular central portion of ring 180 (which has a slightly larger diameter than does the tubular central portion of ring 160) around the tubular central portion ofring 160 so that the rings have a common axis of symmetry (which we shall refer to as being “vertical” to simplify the description) and so that anelement 181 ofring 180 extends between thetabs 161 of eachelement 163 of ring 160 (in the relative orientation shown inFIG. 35 ). In some implementations of the rings, as the rings are aligned,tabs 161 of one element 163 (on one side ofring 160's tubular central portion) are temporarily displaced toward thetabs 161 of another element 163 (on another side, typically the opposite side, ofring 160's tubular central portion), thus bending each of theelements 163 about itsend portion 162 toward thering 160's tubular central portion, and then theopposed tabs 161 spring back (relax) away from each until eachelement 163 exerts spring force radially outward against the tubular central portion ofring 180. In other implementations of the rings,elements 163 are not elastic. After the rings are aligned,wings 182 of eachelement 181 are spread apart by folding each wing 182 (outward in the directions of arrows A inFIG. 35 , about a vertical axis) over an adjacent one of horizontally orientedtabs 161. When this has been accomplished, the forces between fastener element 163 (including tabs 161) andwings 182 fasten together the aligned rings 160 and 180. In the final configuration, thetabs 161 on both sides ofelement 181 provide circumferential support to prevent rotation ofring 160 relative to ring 180 about their common axis. - A variation on
fastener element 181 ofFIG. 35 will next be described with reference toFIG. 36 . The fastener elements ofFIG. 36 implement an embodiment of the inventive tined anastomosis ring fastener. InFIG. 36 ,ring 160 is identical to ring 160 ofFIGS. 34 and 35 , butring 170 differs from ring 180 (ofFIGS. 34 and 35 ) in that it hasfastener elements 171 which are shaped differently thanfastener elements 181 ofFIG. 35 . Eachfastener element 171 has aspring portion 173, and a body 172 which ends atfree edge 174. Whenring 170 is oriented with a vertical axis of symmetry, thespring portion 173 of eachelement 171 extends at least substantially vertically upward away from the upper edge ofring 170's tubular central portion (as shown inFIG. 36 ). At least thespring portion 173 of eachelement 171 is made of spring metal (orportion 173 is otherwise biased so thatelement 171 tends to remain in its originally manufactured orientation). To fastenring 160 to ring 170, a surgeon (or a surgeon-operated instrument) alignsring 170 coaxially withring 160 by positioning the tubular central portion of ring 170 (which has diameter slightly larger than does the tubular central portion of ring 160) around the tubular central portion ofring 160 so that the rings have a common axis of symmetry (which we shall refer to as being “vertical” to simplify the description) and so that anelement 171 ofring 170 extends between thetabs 161 of eachelement 163 of ring 160 (in the relative orientation shown inFIG. 36 ). Then, asring 170 is moved vertically upward into horizontal alignment withring 160, the central sloping portion of body 172 (betweenwings 176 of body 172) slides overelement 163 and/or the tubular central portion ofring 160, whilespring portion 173 is displaced radially outward relative to ring 170's tubular central portion to allow the thickest portion ofelement 171 to pass overring 160's tubular central portion. In some implementations of the rings, when the rings are aligned,tabs 161 of one element 163 (on one side ofring 160's tubular central portion) are temporarily displaced towardtabs 161 of another element 163 (on another side, typically the opposite side, ofring 160's tubular central portion), thus bending each of theelements 163 about itsend portion 162 toward thering 160's tubular central portion, and then theopposed tabs 161 spring back (relax) away from each other until eachelement 163 exerts spring force radially outward against the tubular central portion ofring 170. In other implementations of the rings,elements 163 are not elastic. Whenedge 174 has moved vertically above the upper edge ofring 160's tubular central portion,spring portion 173 springs back (radially inward) into its at least substantially vertical orientation (as shown inFIG. 36 ). When this has been accomplished, the forces betweenedge 174 and ring 160's tubular central portion and between fastener element 163 (including tabs 161) andring 170 fasten together the aligned rings 160 and 170. - Variations on the
FIG. 36 embodiment employ fastener elements which are differently shaped thanelements FIG. 36 . For example,FIG. 37 is a perspective view of a portion of tined anastomosis rings 170′ and 160′, each embodying the invention.Ring 170′ has a tubular central portion and a number ofspring fastener elements 171′. Eachelement 171′ is made of spring metal (or is otherwise biased to remain in its originally manufactured orientation relative to the rest ofring 170′) and has a shape which is a variation on that of above-describedspring fastener element 171. Preferably,elements 171′ are integrally formed with the rest ofring 170′. Eachfastener element 171′ has aspring portion 173′ (which corresponds functionally tospring portion 173 of element 171), and a body having twotabs 174′.Ring 160′ (ofFIG. 37 ) is identical to ring 160 (ofFIG. 36 ) except in that itsfastener elements 163′ have straightcircumferential support tabs 161′ that are oriented vertically; not bent circumferential support tabs with vertical portions and horizontally extending ends (e.g., bentcircumferential support tabs 161 of ring 160). Whenring 170′ has been aligned withring 160′,elements 163′ andelements 171′ spring into a locked configuration in which they fasten together the aligned rings 160 and 170′. When rings 160′ and 170′ are aligned and fastened together,tabs 174′ of eachelement 171′ are between thetabs 161′ of the corresponding one ofelements 163′, with the bottom surfaces oftabs 174′ exerting downward force on the upper edge of the portion ofelement 163′ betweentabs 161′ and on the upper edge of the tubular central portion ofring 170′. - Another type of fastener that can be used to hold together a pair of aligned anastomosis rings will be described with reference to
FIG. 38 .FIG. 38 is a perspective view of portions of two aligned anastomosis rings (rings 190 and 200). Each ofrings ring 190 aretabs 191 which extend out fromring 190's tubular central portion. Eachtab 191 has aproximal end portion 192 atring 190's tubular central portion and adistal end portion 193 that extends radially outside ofring 190's tubular central portion as shown inFIG. 38 . The fastener elements ofring 200 aretabs 201 which extend radially outward fromring 200's tubular central portion. Eachtab 201 has twoparallel wings 202 which extend vertically fromtab 201's central portion (whentab 201's central portion is oriented in a horizontal plane), and eachwing 202 has amalleable end portion 203 as shown inFIG. 38 . - To fasten
ring 190 to ring 200, a surgeon (or a surgeon-operated instrument) lowersring 190 into alignment withring 200 by positioning the tubular central portion of ring 190 (which has a slightly smaller diameter than does the tubular central portion of ring 200) within the tubular central portion ofring 200 so that the rings have a common axis of symmetry and eachtab 191 fits between thewings 202 of a different one oftabs 201. When the rings have been so aligned with each other, each fastener is moved into its locking configuration (to fasten together the aligned rings 190 and 200) by bending together theend portions 203 ofwings 202 so that eachtab 191 is held between a pair of bent-togetherend portions 203 and the rest oftab 201. - Another type of fastener that can be used to hold together a pair of aligned anastomosis rings will be described with reference to
FIGS. 39 and 40 . The embodiments ofFIGS. 39 and 40 are variations on the snap fit fastener embodiment ofFIG. 36 . In each ofFIGS. 39 and 40 ,ring 210 is a tined anastomosis ring having a tubular central portion and fastener elements forfastening ring 210 together withring 190. Ring 190 (ofFIGS. 39 and 40 ) is identical to ring 190 ofFIG. 38 , except in thattabs 191 ofFIGS. 39 and 40 have theirdistal portions 193 extending vertically upward (rather than radially outward as inFIG. 38 ) prior to locking ofring 190 to another ring (i.e., ring 210), andtabs 191 ofFIGS. 39 and 40 are malleable whiletabs 191 ofFIG. 38 can but need not be malleable. Note that the folded-over geometry of each tab 191 (with aproximal end portion 192 extending in a first vertical direction away from a first one of the top or bottom edge ofring 190's tubular central portion to a folded portion, and extending in the opposite vertical direction beyond the fold) is needed where there is no room to add features to other one of the top or bottom edge of the tubular central portion (such as where the ring's tines extend out from said other one of the top or bottom edge of the tubular central portion). The fastener elements ofring 210 are slottedtabs 211 which extend generally vertically upward from the upper edge ofring 210's tubular central portion as shown inFIG. 39 . Eachtab 211 has aslot 212 extending therethrough. Oneedge 213 of eachslot 212 is formed so that it extends radially inward (relative to the opposite edge of slot 212) such thatslot 212 is shaped to receive thedistal end 193 oftab 191 whentab 191 is advanced vertically upward to bringring 190 into alignment with ring 210 (as shown inFIG. 39 ).Tabs 191 and 211 (of the embodiment ofFIGS. 39 and 40 ) are malleable. It is desirable to designtabs 211 to have the minimum possible vertical length, since if they are too long they may get in the way of one of the blood vessels joined at the anastomosis site. It is typically preferable to use fastener elements of the type to be described with reference toFIGS. 58-61 (rather than those ofFIG. 39 ) since the fasteners ofFIG. 58-61 have lower vertical profile (than do those ofFIG. 39 ) after two aligned rings are fastened together by folding thetabs 383, and since theFIG. 39 fasteners may provide less circumferential positioning support (especially where the rings' central portions are circular rather than oblong) than do the fasteners ofFIGS. 58-61 . - To fasten
ring 190 to ring 210, a surgeon (or a surgeon-operated instrument) raisesring 190 into alignment withring 210 by positioning the tubular central portion of ring 190 (which has a slightly smaller diameter than does the tubular central portion of ring 210) within the tubular central portion ofring 210 so that the rings have a common axis of symmetry and eachtab 191 fits intoslot 212 of a different one oftabs 211 as shown inFIG. 39 . When the rings have been so aligned with each other, each fastener is moved into its locking configuration (to fasten together the aligned rings 190 and 210) by bending each pair of alignedtabs FIG. 40 ). - Next, an alternative embodiment of a tool for installing the anastomosis ring of the invention will be described with reference to
FIGS. 41-48 .Installation tool 230 ofFIGS. 41-48 comprises anvil 70 (which is identical toanvil 70 ofFIGS. 16-24 ) and independentlytranslatable sleeves sleeves FIGS. 16-24 , as shown).FIGS. 41-48 show the configuration oftool 230 during each of eight different steps of installingtined anastomosis ring 220 in an organ (the organ is not shown).Ring 220 is identical to ring 80 ofFIGS. 16-24 , except in that its tines are longer relative to the height of its tubularcentral portion 221 than are the tines ofring 80 relative to the height of tubularcentral portion 85 ofring 80. Only the right half of the distal portion of each ofelements ring 220 are shown inFIGS. 41-48 . - To install
ring 220, thering 220 is initially loaded ontotool 230 withtubular portion 221 inslot 234A of sleeve 234 (as shown inFIG. 41 ), and the tines ofring 220 held betweensleeves end portion 236 of sleeve 235 (as shown inFIG. 41 ). Then,anvil 70 is inserted into the incision (or other opening) in the organ.Sleeve 234 oftool 230 differs fromsleeve 74 oftool 79 in thatsleeve 234 has twoconcentric slots Sleeve 74 has only oneslot 74A. Thus, an anastomosis ring whose tubular central portion has a larger diameter than that ofring 220 can be loaded onto and installed bytool 230. - After
ring 220 has been loaded andanvil 70 has been inserted into the opening in the organ,sleeves ring 220 betweenanvil 70 and the tissue edges, until the tines' tips engage the tine-formingsurface 70A ofanvil 70 and begin to curl radially outward (away from the central axis of anvil 70) as they advance againstanvil surface 70A.Sleeves FIG. 42 , in which they have pressed a horizontal portion of each tine (assuming thatring 220 is oriented with a vertical axis of symmetry as shown inFIG. 42 ) against the organ's exterior surface and caused the distal portion of each tine to bend (againststationary surface 70A of anvil 70) relative to the rest ofring 220 until the tip of each tine has penetrated (and grabbed) the tissue around the opening. The distal end ofsleeve 233 is angled to match the slope of the angled proximal portion of each tine (ofring 220 in itsFIG. 41 configuration).FIG. 42 shows one tine in the position it would have after its tip has penetrated the tissue and its distal portion has curled radially outward to grab the tissue. - Then, as shown in
FIG. 43 ,sleeves FIG. 43 ) whilesleeves anvil 70 remain stationary in engagement withring 220. - Then, as shown in
FIG. 44 ,anvil 70 is retracted (in the proximal direction) relative tosleeves anvil 70 on the tines of ring 220 (and the tissue edges that have been grabbed by the tines), each tine folds or buckles at both its weak portion (atlocation 223 shown inFIG. 44 ) and at the junction (identified byreference numeral 222 inFIGS. 43 and 44 ) between its horizontal and angled portions, so that its curleddistal portion 224 moves radially outward (away from the central axis of anvil 70) while it continues to grab the tissue, thereby everting the tissue edges. Each tine preferably has a weak portion (e.g., a hinge) at a location spaced from the junction (222) between the tine's horizontal and angled portions. In one implementation, this weak portion is determined by a hole in each tine. Each hole is preferably located along the tine such that, when the tines are in their final configuration (shown inFIG. 48 ), the portion of each tine that is farthest (radially) from the ring'stubular portion 221 does not coincide with thejunction 222, and such portion coincides with (or is very near to) the hole. - Each tine preferentially bends at both
junction 222 and at its weak portion during the steps described with reference toFIGS. 44, 47 , and 48. - After the folding or buckling of the tines described with reference to
FIG. 44 ,sleeve 233 is retracted in the proximal direction (as shown inFIG. 45 ), leaving ring 220 (and the tissue gripped thereby) betweenanvil 70 andsleeves sleeve 234 in a retracted position relative tosleeve 235. - Then,
sleeve 234 is advanced distally relative to sleeve 235 (into the position shown inFIG. 46 ) to bend and rotate each tine (relative the rest of ring 220) from the configuration shown inFIG. 45 to that shown inFIG. 46 as a result of force exertion onring 220 bystationary sleeve 235 and the distal end of advancingsleeve 234. This bending and rotation further everts the tissue edges around the organ opening, causes the tines to penetrate farther into the tissue, and allowssleeves FIGS. 47 and 48 ). - After
ring 220 has been placed in the configuration shown inFIG. 46 ,sleeves portion 236 of sleeve 235 (as shown inFIG. 47 ) to press the tines against portion 236 (whilesleeve 234 holdstubular portion 221 against portion 236), thereby further bending the tines relative totubular portion 221.Sleeve 233 then continues to advance until a final bend has been formed in each tine relative toportion 221, and thering 220 has been bent into the final, installed configuration shown inFIG. 48 . Specifically, the curled distal portion of each tine is bent radially outward relative to the proximal portion of each tine (bysleeves FIG. 47 ) and then pushed (bysleeve 233, as shown inFIG. 48 ) distally against the proximal portion to putring 220 in the final configuration. In this final configuration,ring 220 is installed at the opening in the organ with its tines holding the tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ). - After installation of
ring 220,sleeve 235 is (e.g., portions comprising the distal end ofsleeve 235 are) spread or dilated (radially outward away fromanvil 70's central axis of symmetry) to decoupletool 230 from the installed ring, andtool 230 is removed from the installed ring. - Another alternative embodiment of a tool for installing one of the inventive anastomosis rings will next be described with reference to
FIGS. 49-57 .Installation tool 330 ofFIGS. 49-57 comprises anvil 70 (which is identical toanvil 70 ofFIGS. 16-24 ) and four independentlytranslatable sleeves sleeves FIGS. 41-48 , as shown).FIGS. 49-57 illustrate the configuration oftool 330 during each of nine different steps of installingtined anastomosis ring 320 inincision 341 ofblood vessel 340.Tool 330 ofFIGS. 49-57 is a preferred embodiment of the inventive anastomosis ring installation tool, and it implements (during operation) a preferred embodiment of the inventive method for installing an anastomosis ring in an incision in a blood vessel (or another orifice of another type of organ). -
Ring 320 is similar to ring 80 ofFIGS. 16-24 , but its tines (each comprising adistal portion 323 and a proximal portion 322) are formed so that whenring 320 is loaded ontotool 330 with its tubularcentral portion 321 oriented with a vertical axis of symmetry,proximal portions 322 are horizontal anddistal portions 323 are vertical. Only the right half of the distal portion of each ofelements ring 320 are shown inFIGS. 49-57 . - To install
ring 320, thering 320 is first loaded ontotool 330 withtubular portion 321 inslot 333B of sleeve 333 (as shown inFIG. 49 ), and the tines ofring 320 held betweensleeves end portion 335 of sleeve 334 (as shown inFIG. 49 ). Then,anvil 70 is inserted into theincision 341.Sleeve 333 oftool 330 differs fromsleeve 74 oftool 79 in thatsleeve 333 has twoconcentric slots tool 330 with its smaller diameter tubular central portion inslot 333A. - After
ring 320 has been loaded andanvil 70 has been inserted intoincision 341,sleeves ring 320 betweenanvil 70 and the incised tissue edges, until the tines' tips engage the tine-formingsurface 70A ofanvil 70 and begin to curl radially outward (away from the central axis of anvil 70) as they advance againstanvil surface 70A.Sleeves FIG. 50 , in which they have pressed part of thehorizontal portion 322 of each tine against the exterior surface ofvessel 340 and caused thedistal portion 323 of each tine to curl (againststationary surface 70A of anvil 70) relative to the rest ofring 220 until the tip of each tine has penetrated (and grabbed) the tissue around theincision 341. - Then, as shown in
FIG. 51 ,sleeve 331 is retracted in the proximal direction (toward the top ofFIG. 51 ) whilesleeves anvil 70 remain stationary in engagement withring 320. - Then,
anvil 70 is retracted (in the proximal direction) relative tosleeves FIG. 52 . In response to the force exerted byanvil 70 onring 320's tines (and the edges oftissue 340 that have been grabbed by the tines), each tine folds or buckles at both its weak portion (atlocation 327 shown inFIG. 52 ) and at the location along its length (identified byreference numeral 326 inFIG. 52 ) adjacent to the radially inner edge ofsleeve 332's distal end portion, so that the curleddistal portion 323 moves radially outward (away fromanvil 70's central longitudinal axis) while it continues to grab the tissue, thereby everting the tissue edges. The radially inner surface ofsleeve 332 has a recessedportion 332A to provide clearance fordistal portion 323 asdistal portion 323 moves radially outward. Each tine preferably has a weak portion (e.g., a hinge) at a location spaced fromlocation 326. In one implementation, this weak portion is determined by a hole in each tine. Each hole is preferably located along the tine such that, when the tines are in their final configuration (shown inFIG. 57 ), the portion of each tine that is farthest (radially) from the ring'stubular portion 321 coincides with (or is very near to) the hole; not withlocation 326. - Each tine preferentially bends at both
location 326 and at itsweak portion 327 during the steps described with reference toFIGS. 52 and 54 -57. - After the folding or buckling of the tines described with reference to
FIG. 52 ,sleeve 332 is retracted in the proximal direction (into the position shown inFIG. 53 ), leavingring 320 held betweensleeves - Then,
sleeve 331 andanvil 70 are advanced distally relative tosleeve 332 until curveddistal end surface 331A ofsleeve 331 engages the tines of ring 320 (as shown inFIG. 54 ).Sleeve 331 then continues to advance so that the tines ride alongsurface 331A so as to rotate the curleddistal portion 323 of each tine radially outward into the configuration shown inFIG. 54 . This moves the everted tissue adjacent to the tines radially outward, and further everts the everted tissue. - Then,
sleeve 332 is advanced distally relative tosleeves 331 and 333 (and anvil 70) untilsleeve 332's distal end engages the curleddistal portion 323 of each tine.Sleeve 332 then continues to advance so as to rotate each curleddistal portion 323 further radially outward into the configuration shown inFIG. 55 , whilesurface 331A engages the intima of the everted tissue (to prevent radially inward movement of the everted tissue). This further everts the everted tissue and allowssleeve 332 to more easily form a final bend in each tine (in the step to be described with reference toFIG. 57 ). - Then,
anvil 70 andsleeve 331 are retracted in the proximal direction into the position shown inFIG. 56 , without exerting force onring 320 or the everted tissue. - Then,
sleeve 332 is advanced in the distal direction (relative tosleeves 333 and 334) to bend and rotate each tine (relative the rest of ring 320) from the configuration shown inFIG. 56 to that shown inFIG. 57 , by pressing curleddistal portion 323 of each tine (and the tissue adjacent thereto) againstportion 335 ofsleeve 334. This final bending and rotation further everts the tissue edges aroundincision 341. Withring 320 so installed in theincision 341 in its final configuration, its tines hold the incised tissue edges in the desired everted state (so that the everted tissue can be joined to tissue of another vessel or other organ). - After installation of
ring 320,sleeve 334 is (e.g., portions comprising the distal end ofsleeve 334 are) spread or dilated (radially outward away fromanvil 70's central axis of symmetry) to decoupletool 330 from the installed ring, andtool 330 is removed from the installed ring. -
Tool 330 is simpler than above-describedtool 230 in that it has only four advanceable and retractable sleeves (331, 332, 333, and 334), whereastool 230 has five such sleeves (sleeves - A preferred embodiment of the invention will be described with reference to
FIGS. 58, 59 , 60, and 61.Anastomosis ring 380 ofFIGS. 58-61 is installed around an incision in the side wall ofblood vessel 378, with curledtines 381 ofring 380 holding the incised tissue edges ofvessel 380 with theirintima 378A exposed for anastomosis withvessel 379. Four docking tabs (or “fingers”) 383 extend out fromring 380's tubular central portion (parallel to the central longitudinal axis ofring 380, which is generally vertical inFIG. 58 ). There is ahole 384 at the base of eachtab 383, defining a weak portion at whichtab 383 will preferentially bend in response to exertion of radially outward bending force on itsdistal end 383A. -
FIG. 61 shows ring 380 in its pre-installation configuration. Note that eachtine 381 ofring 380 in the pre-installation configuration has a proximal portion which extends radially inward (perpendicular to ring 380's central axis of symmetry) toward the center ofring 380's tubular portion, and a distal (tip) portion extending perpendicular to such proximal portion. The “flat” tine geometry ofring 380 ofFIG. 61 (the term “flat” denotes that the proximal portions oftines 381 are all coplanar, in a plane perpendicular to the ring's central axis of symmetry) is preferred over the “angled” tine geometry ofring 60 ofFIG. 10 (in which the tines have proximal portions which extend at a 45 degree angle relative to the ring's central axis of symmetry, e.g., ring 60's central axis of symmetry). -
Anastomosis ring 400 is installed around an incision in the side wall ofblood vessel 379, with curledtines 401 ofring 400 holding the incised tissue edges ofvessel 379 with their intima (not visible inFIG. 58 ) exposed for anastomosis withvessel 378. In order to align the tubular central portion ofring 380 with the tubular central portion ofring 400,vessel 379 is gripped by flat end forceps (or “graspers”) 420, and moved towardtabs 383 ofring 380 so thattabs 383 enter thespace 403 between the everted tissue ofvessel 379 and the tubular central portion ofring 400. -
FIG. 59 shows ring 400 being aligned withring 380, withtabs 383 ofring 380 extending upward throughring 400's tubular central portion.Forceps 420 are loweringvessel 379 andring 400 alongtabs 383 toward the tubular central portion ofring 380, which in turn rests onvessel 378 and thetissue 377 which surroundsvessel 378. InFIG. 59 , two arms offorceps 420 are squeezing together opposite side walls ofvessel 379. As apparent fromFIG. 59 , the tubular central portion ofring 400 has greater diameter than that ofring 380, so that the two rings can be aligned together with their tubular central portions aligned vertically (as shown inFIG. 60 , in which the tubular central portion ofring 380 is not visible since it is within that of ring 400) - After
rings FIG. 60 ,forceps 420release vessel 379. Two arms of forceps 420 (which can be the same arms as were used to align the rings, but which preferably are another pair of arms of an implementation offorceps 420 having two pairs of arms) are then moved into engagement with the tabs 383 (e.g., slightly separated arms offorceps 420 are moved into engagement with one pair ofopposed tabs 383, and then the other pair of opposed tabs 383). The tab-manipulating arms offorceps 420 are moved downward (when viewed as inFIG. 60 ) to exert bending force ontabs 383 to bend them radially outward into the locking configuration shown inFIG. 60 . In the locking configuration,tabs 383 extend generally horizontally outward, away from the common central axis of symmetry ofrings rings tissue 377 with the exposed intima ofvessel 378 sealed against the exposed intima ofvessel 379. - It is understood that while certain forms of the present invention have been illustrated and described herein, the invention is not to be limited to the specific forms or arrangements of parts described and shown or the specific methods described.
Claims (73)
Priority Applications (1)
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US10/897,523 US20050027308A1 (en) | 2001-02-27 | 2004-07-23 | Methods for performing anastomosis |
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US10/897,523 US20050027308A1 (en) | 2001-02-27 | 2004-07-23 | Methods for performing anastomosis |
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US10/864,621 Abandoned US20050021060A1 (en) | 2001-02-27 | 2004-06-09 | Device, tools and methods for performing anastomosis |
US10/897,523 Abandoned US20050027308A1 (en) | 2001-02-27 | 2004-07-23 | Methods for performing anastomosis |
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US10/864,621 Abandoned US20050021060A1 (en) | 2001-02-27 | 2004-06-09 | Device, tools and methods for performing anastomosis |
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EP (1) | EP1414363A4 (en) |
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US20100256465A1 (en) * | 2009-03-02 | 2010-10-07 | Seventh Sense Biosystems, Inc. | Devices and techniques associated with diagnostics, therapies, and other applications, including skin-associated applications |
US20110105952A1 (en) * | 2009-10-30 | 2011-05-05 | Seventh Sense Biosystems, Inc. | Relatively small devices applied to the skin, modular systems, and methods of use thereof |
US20110105872A1 (en) * | 2009-10-30 | 2011-05-05 | Seventh Sense Biosystems, Inc. | Systems and methods for application to skin and control of actuation, delivery, and/or perception thereof |
US20110105951A1 (en) * | 2009-10-30 | 2011-05-05 | Seventh Sense Biosystems, Inc. | Systems and methods for treating, sanitizing, and/or shielding the skin or devices applied to the skin |
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US20110172508A1 (en) * | 2010-01-13 | 2011-07-14 | Seventh Sense Biosystems, Inc. | Sampling device interfaces |
US20110172510A1 (en) * | 2010-01-13 | 2011-07-14 | Seventh Sense Biosystems, Inc. | Rapid delivery and/or withdrawal of fluids |
US20110181410A1 (en) * | 2010-01-28 | 2011-07-28 | Seventh Sense Biosystems, Inc. | Monitoring or feedback systems and methods |
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US8561795B2 (en) | 2010-07-16 | 2013-10-22 | Seventh Sense Biosystems, Inc. | Low-pressure packaging for fluid devices |
US20130345514A1 (en) * | 2012-06-22 | 2013-12-26 | Empire Technology Development Llc | Proprioceptive endoscope and virtual dynamic tomography |
US8808202B2 (en) | 2010-11-09 | 2014-08-19 | Seventh Sense Biosystems, Inc. | Systems and interfaces for blood sampling |
US8821412B2 (en) | 2009-03-02 | 2014-09-02 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving fluids |
US9033898B2 (en) | 2010-06-23 | 2015-05-19 | Seventh Sense Biosystems, Inc. | Sampling devices and methods involving relatively little pain |
US9119578B2 (en) | 2011-04-29 | 2015-09-01 | Seventh Sense Biosystems, Inc. | Plasma or serum production and removal of fluids under reduced pressure |
US9295417B2 (en) | 2011-04-29 | 2016-03-29 | Seventh Sense Biosystems, Inc. | Systems and methods for collecting fluid from a subject |
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US10543310B2 (en) | 2011-12-19 | 2020-01-28 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving material with respect to a subject surface |
US11177029B2 (en) | 2010-08-13 | 2021-11-16 | Yourbio Health, Inc. | Systems and techniques for monitoring subjects |
US11653928B2 (en) | 2018-03-28 | 2023-05-23 | Datascope Corp. | Device for atrial appendage exclusion |
US11751876B2 (en) | 2019-05-07 | 2023-09-12 | Easyflomicro Inc. | Apparatuses for anastomosis of tubular vessels and related methods |
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---|---|---|---|---|
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Citations (90)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3166072A (en) * | 1962-10-22 | 1965-01-19 | Jr John T Sullivan | Barbed clips |
US3657744A (en) * | 1970-05-08 | 1972-04-25 | Univ Minnesota | Method for fixing prosthetic implants in a living body |
US3938528A (en) * | 1973-05-11 | 1976-02-17 | Investors In Ventures, Inc. | Implanting and splicing articles and methods for living beings |
US4366819A (en) * | 1980-11-17 | 1983-01-04 | Kaster Robert L | Anastomotic fitting |
US4368736A (en) * | 1980-11-17 | 1983-01-18 | Kaster Robert L | Anastomotic fitting |
US4423592A (en) * | 1980-11-28 | 1984-01-03 | Aviation Electric Ltd. | Fuel control system for gas turbine engine |
US4503568A (en) * | 1981-11-25 | 1985-03-12 | New England Deaconess Hospital | Small diameter vascular bypass and method |
US4577631A (en) * | 1984-11-16 | 1986-03-25 | Kreamer Jeffry W | Aneurysm repair apparatus and method |
US4657019A (en) * | 1984-04-10 | 1987-04-14 | Idea Research Investment Fund, Inc. | Anastomosis devices and kits |
US4721109A (en) * | 1986-04-08 | 1988-01-26 | Healey Maureen A | Temporary anastomotic device |
US4892098A (en) * | 1985-06-26 | 1990-01-09 | Sauer Jude S | Tubular tissue welding device without moving parts |
US4899744A (en) * | 1988-12-15 | 1990-02-13 | Tatsuo Fujitsuka | Apparatus for anastomosing digestive tract |
US4907591A (en) * | 1988-03-29 | 1990-03-13 | Pfizer Hospital Products Group, Inc. | Surgical instrument for establishing compression anastomosis |
US4917087A (en) * | 1984-04-10 | 1990-04-17 | Walsh Manufacturing (Mississuaga) Limited | Anastomosis devices, kits and method |
US4917091A (en) * | 1982-06-24 | 1990-04-17 | Unilink Ab | Annular fastening means |
US4917090A (en) * | 1982-06-24 | 1990-04-17 | Unilink, Inc. | Method for performing an anastomosis |
US4997439A (en) * | 1989-01-26 | 1991-03-05 | Chen Fusen H | Surgical closure or anastomotic device |
US5005749A (en) * | 1988-07-01 | 1991-04-09 | United States Surgical Corp. | Anastomosis surgical stapling instrument |
US5078735A (en) * | 1990-06-18 | 1992-01-07 | Mobin Uddin Kazi | Prosthetic grafting method for bypass surgery |
US5089006A (en) * | 1989-11-29 | 1992-02-18 | Stiles Frank B | Biological duct liner and installation catheter |
US5089008A (en) * | 1989-01-26 | 1992-02-18 | Chen Fusen H | Surgical closure means for anastomotic device |
US5104025A (en) * | 1990-09-28 | 1992-04-14 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
US5178634A (en) * | 1989-03-31 | 1993-01-12 | Wilson Ramos Martinez | Aortic valved tubes for human implants |
US5188638A (en) * | 1992-02-06 | 1993-02-23 | Tzakis Andreas G | Apparatus and method for preforming anastomosis fastener securement of hollow organs |
US5192289A (en) * | 1989-03-09 | 1993-03-09 | Avatar Design And Development, Inc. | Anastomosis stent and stent selection system |
US5193731A (en) * | 1988-07-01 | 1993-03-16 | United States Surgical Corporation | Anastomosis surgical stapling instrument |
US5205459A (en) * | 1991-08-23 | 1993-04-27 | Ethicon, Inc. | Surgical anastomosis stapling instrument |
US5290298A (en) * | 1990-05-07 | 1994-03-01 | United States Surgical Corporation | Fragmentable anastomotic device |
US5304220A (en) * | 1991-07-03 | 1994-04-19 | Maginot Thomas J | Method and apparatus for implanting a graft prosthesis in the body of a patient |
US5392979A (en) * | 1987-05-26 | 1995-02-28 | United States Surgical Corporation | Surgical stapler apparatus |
US5395030A (en) * | 1992-06-04 | 1995-03-07 | Olympus Optical Co., Ltd. | Surgical device for stapling and fastening body tissues |
US5395311A (en) * | 1990-05-14 | 1995-03-07 | Andrews; Winston A. | Atherectomy catheter |
US5403333A (en) * | 1990-08-28 | 1995-04-04 | Robert L. Kaster | Side-to-end vascular anastomotic staple apparatus |
US5486187A (en) * | 1994-01-04 | 1996-01-23 | Schenck; Robert R. | Anastomosis device and method |
US5501689A (en) * | 1994-02-03 | 1996-03-26 | United States Surgical Corporation | Plaque stapler |
US5503635A (en) * | 1993-11-12 | 1996-04-02 | United States Surgical Corporation | Apparatus and method for performing compressional anastomoses |
US5707362A (en) * | 1992-04-15 | 1998-01-13 | Yoon; Inbae | Penetrating instrument having an expandable anchoring portion for triggering protrusion of a safety member and/or retraction of a penetrating member |
US5707380A (en) * | 1996-07-23 | 1998-01-13 | United States Surgical Corporation | Anastomosis instrument and method |
US5709693A (en) * | 1996-02-20 | 1998-01-20 | Cardiothoracic System, Inc. | Stitcher |
US5709335A (en) * | 1994-06-17 | 1998-01-20 | Heartport, Inc. | Surgical stapling instrument and method thereof |
US5725544A (en) * | 1993-12-23 | 1998-03-10 | Oticon A/S | Method and instrument for establishing the receiving site of a coronary artery bypass graft |
US5725553A (en) * | 1996-02-29 | 1998-03-10 | Moenning; Stephen P. | Apparatus and method for protecting a port site opening in the wall of a body cavity |
US5732872A (en) * | 1994-06-17 | 1998-03-31 | Heartport, Inc. | Surgical stapling instrument |
US5741274A (en) * | 1995-12-22 | 1998-04-21 | Cardio Vascular Concepts, Inc. | Method and apparatus for laparoscopically reinforcing vascular stent-grafts |
US5855583A (en) * | 1996-02-20 | 1999-01-05 | Computer Motion, Inc. | Method and apparatus for performing minimally invasive cardiac procedures |
US5868763A (en) * | 1996-09-16 | 1999-02-09 | Guidant Corporation | Means and methods for performing an anastomosis |
US5875782A (en) * | 1996-11-14 | 1999-03-02 | Cardiothoracic Systems, Inc. | Methods and devices for minimally invasive coronary artery revascularization on a beating heart without cardiopulmonary bypass |
US5878193A (en) * | 1992-08-10 | 1999-03-02 | Computer Motion, Inc. | Automated endoscope system for optimal positioning |
US5879371A (en) * | 1997-01-09 | 1999-03-09 | Elective Vascular Interventions, Inc. | Ferruled loop surgical fasteners, instruments, and methods for minimally invasive vascular and endoscopic surgery |
US5881943A (en) * | 1994-06-17 | 1999-03-16 | Heartport, Inc. | Surgical anastomosis apparatus and method thereof |
US5893369A (en) * | 1997-02-24 | 1999-04-13 | Lemole; Gerald M. | Procedure for bypassing an occlusion in a blood vessel |
US6013190A (en) * | 1998-01-21 | 2000-01-11 | Vascular Science Inc. | Catheters with integrated lumen and methods of their manufacture and use |
US6015416A (en) * | 1998-02-26 | 2000-01-18 | Ethicon Endo-Surgery, Inc. | Surgical anastomosis instrument |
US6022367A (en) * | 1997-06-18 | 2000-02-08 | United States Surgical | Surgical apparatus for forming a hole in a blood vessel |
US6024748A (en) * | 1996-07-23 | 2000-02-15 | United States Surgical Corporation | Singleshot anastomosis instrument with detachable loading unit and method |
US6030392A (en) * | 1995-01-18 | 2000-02-29 | Motorola, Inc. | Connector for hollow anatomical structures and methods of use |
US6030395A (en) * | 1997-05-22 | 2000-02-29 | Kensey Nash Corporation | Anastomosis connection system |
US6030370A (en) * | 1997-02-05 | 2000-02-29 | Aesculap Ag And Co. Kg | Surgical instrument |
US6036702A (en) * | 1997-04-23 | 2000-03-14 | Vascular Science Inc. | Medical grafting connectors and fasteners |
US6036699A (en) * | 1992-12-10 | 2000-03-14 | Perclose, Inc. | Device and method for suturing tissue |
US6036700A (en) * | 1998-07-14 | 2000-03-14 | Ethicon Endo-Surgery, Inc. | Surgical anastomosis instrument |
US6036704A (en) * | 1999-05-13 | 2000-03-14 | Yoon; Inbae | Anastomosis apparatus and method for anastomosing an anatomical tubular structure |
US6036703A (en) * | 1998-02-06 | 2000-03-14 | Ethicon Endo-Surgery Inc. | Method and apparatus for establishing anastomotic passageways |
US6050472A (en) * | 1996-04-26 | 2000-04-18 | Olympus Optical Co., Ltd. | Surgical anastomosis stapler |
US6053390A (en) * | 1992-05-19 | 2000-04-25 | United States Surgical | Anvil for surgical stapler |
US6168623B1 (en) * | 1998-08-31 | 2001-01-02 | Cardiothoracic Systems, Inc. | Deformable conduits and methods for shunting bodily fluid during surgery |
US6167889B1 (en) * | 1995-04-10 | 2001-01-02 | Cardiothoracic Systems, Inc. | Method for coronary artery bypass |
US6171321B1 (en) * | 1995-02-24 | 2001-01-09 | Heartport, Inc. | Devices and methods for performing a vascular anastomosis |
US6176864B1 (en) * | 1998-03-09 | 2001-01-23 | Corvascular, Inc. | Anastomosis device and method |
US6179849B1 (en) * | 1999-06-10 | 2001-01-30 | Vascular Innovations, Inc. | Sutureless closure for connecting a bypass graft to a target vessel |
US6183486B1 (en) * | 1995-02-24 | 2001-02-06 | Heartport, Inc. | Device and method for minimizing heart displacements during a beating heart surgical procedure |
US6187020B1 (en) * | 1998-04-17 | 2001-02-13 | Laboratoire Perouse Implant | Connecting device for anastomosis, device for fitting fasteners and implant including them |
US6186942B1 (en) * | 1997-04-23 | 2001-02-13 | St. Jude Medical Cardiovascular Group, Inc. | Medical grafting methods and apparatus |
US6190590B1 (en) * | 1996-02-28 | 2001-02-20 | Impra, Inc. | Apparatus and method for making flanged graft for end-to-side anastomosis |
US6190396B1 (en) * | 1999-09-14 | 2001-02-20 | Perclose, Inc. | Device and method for deploying and organizing sutures for anastomotic and other attachments |
US6193129B1 (en) * | 2000-01-24 | 2001-02-27 | Ethicon Endo-Surgery, Inc. | Cutting blade for a surgical anastomosis stapling instrument |
US6193734B1 (en) * | 1998-01-23 | 2001-02-27 | Heartport, Inc. | System for performing vascular anastomoses |
US6206912B1 (en) * | 1996-11-07 | 2001-03-27 | St. Jude Medical Anastomotic Technology Group Inc. | Medical grafting methods and apparatus |
US20020032462A1 (en) * | 1998-06-10 | 2002-03-14 | Russell A. Houser | Thermal securing anastomosis systems |
US6508822B1 (en) * | 1998-11-06 | 2003-01-21 | St. Jude Medical Atg, Inc. | Medical graft assembly |
US6508252B1 (en) * | 1998-11-06 | 2003-01-21 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US6511491B2 (en) * | 1999-03-09 | 2003-01-28 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US6517558B2 (en) * | 1999-01-15 | 2003-02-11 | Ventrica, Inc. | Methods and devices for forming vascular anastomoses |
US6524322B1 (en) * | 1998-10-23 | 2003-02-25 | Eric Berreklouw | Anastomosis device |
US6530932B1 (en) * | 2000-08-30 | 2003-03-11 | Ethicon Endo-Surgery, Inc. | Anastomosis device having improved tissue presentation |
US6533812B2 (en) * | 1998-11-06 | 2003-03-18 | St. Jude Medical Atg, Inc. | Medical anastomosis apparatus |
US6537288B2 (en) * | 1999-05-18 | 2003-03-25 | Cardica, Inc. | Implantable medical device such as an anastomosis device |
US20030074012A1 (en) * | 2000-10-10 | 2003-04-17 | Coalescent Surgical, Inc. | Minimally invasive annuloplasty procedure and apparatus |
US20030078603A1 (en) * | 1999-03-01 | 2003-04-24 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US20040002721A1 (en) * | 1999-09-01 | 2004-01-01 | Podmore Jonathan L. | Method and apparatus for performing end-to-end and end-to-side anastomosis with eversion of tissue edges |
Family Cites Families (80)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2453056A (en) * | 1947-03-12 | 1948-11-02 | Zack William Edwin | Surgical anastomosis apparatus and method |
US3155095A (en) | 1961-02-07 | 1964-11-03 | Adolph M Brown | Anastomosis method and means |
US3258012A (en) | 1961-06-30 | 1966-06-28 | Risaburo Aoki | Method for blood vessel connection |
US3254650A (en) | 1962-03-19 | 1966-06-07 | Michael B Collito | Surgical anastomosis methods and devices |
US3254651A (en) * | 1962-09-12 | 1966-06-07 | Babies Hospital | Surgical anastomosis methods and devices |
AT255638B (en) | 1966-03-08 | 1967-07-10 | Rainer Dr Gottlob | Device for anastomosing vessels |
US3519187A (en) * | 1966-12-06 | 1970-07-07 | Nickolai Nickolajevich Kapitan | Instrument for suturing vessels |
US3606888A (en) | 1969-06-30 | 1971-09-21 | Jack E Wilkinson | Stapling apparatus for anastomosis of hollow viscera |
US3683926A (en) | 1970-07-09 | 1972-08-15 | Dainippon Pharmaceutical Co | Tube for connecting blood vessels |
US3774615A (en) | 1971-02-08 | 1973-11-27 | Ceskoslovenska Akademie Ved | Device for connecting or joining the ends of interrupted tubular organs in surgical operations without stitching |
US3974835A (en) | 1972-11-30 | 1976-08-17 | Hardy Jr Thomas G | Anastomotic apparatus and method |
CH557672A (en) | 1973-07-04 | 1975-01-15 | Vnii Khirurgicheskoi Apparatur | SURGICAL DEVICE WITH MEANS FOR REPLACING VOLLUS ORGANS. |
GB1478142A (en) | 1974-06-15 | 1977-06-29 | Vnii Khirurg Apparatury I Inst | Surgical staples for use in suturing |
SE397769B (en) | 1974-11-04 | 1977-11-21 | Gambro Ab | INITIATIVE ELEMENTS FOR USE IN VEHICLE SURGERY AND METHODS OF PRODUCING SUCCESSFUL |
US4118806A (en) * | 1976-02-04 | 1978-10-10 | Thermo Electron Corporation | Prosthetic blood vessel |
US4055186A (en) | 1976-02-11 | 1977-10-25 | Leveen Harry H | Anastomosis button |
DE2657255A1 (en) | 1976-12-17 | 1978-06-29 | P H Dr Schomacher | DEVICE FOR CLOSING SEPARATED BODY BARRELS |
US4603693A (en) * | 1977-05-26 | 1986-08-05 | United States Surgical Corporation | Instrument for circular surgical stapling of hollow body organs and disposable cartridge therefor |
DE2822603A1 (en) | 1978-05-24 | 1979-11-29 | Kay Dr Thierfelder | Tissue fault closing instrument - has skin fixed to scissor type supports expanded radially catheter in probe |
US4214586A (en) | 1978-11-30 | 1980-07-29 | Ethicon, Inc. | Anastomotic coupling device |
US4217664A (en) * | 1979-02-02 | 1980-08-19 | Faso Joseph M | Prosthesis and method for creating a stoma |
US4214587A (en) | 1979-02-12 | 1980-07-29 | Sakura Chester Y Jr | Anastomosis device and method |
SU1088712A1 (en) * | 1979-11-14 | 1984-04-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Apparatus for circular suture of blood vessels |
US4352358A (en) * | 1979-12-28 | 1982-10-05 | Angelchik Jean P | Apparatus for effecting anastomotic procedures |
US4345600A (en) | 1980-08-04 | 1982-08-24 | Senco Products, Inc. | Purse-stringer |
US4979954A (en) | 1981-10-21 | 1990-12-25 | Owen Gwathmey | Staple suturing method |
US4624255A (en) * | 1982-02-18 | 1986-11-25 | Schenck Robert R | Apparatus for anastomosing living vessels |
US4474181A (en) | 1982-02-18 | 1984-10-02 | Schenck Robert R | Method and apparatus for anastomosing small blood vessels |
US4676245A (en) | 1983-02-09 | 1987-06-30 | Mamoru Fukuda | Interlocking surgical staple assembly |
US4523592A (en) | 1983-04-25 | 1985-06-18 | Rollin K. Daniel P.S.C. | Anastomotic coupling means capable of end-to-end and end-to-side anastomosis |
US4607637A (en) * | 1983-07-22 | 1986-08-26 | Anders Berggren | Surgical instrument for performing anastomosis with the aid of ring-like fastening elements and the fastening elements for performing anastomosis |
US4589416A (en) * | 1983-10-04 | 1986-05-20 | United States Surgical Corporation | Surgical fastener retainer member assembly |
US4787386A (en) | 1984-04-10 | 1988-11-29 | Idea Research Investment Fund, Inc. | Anastomosis devices, and kits |
US4873975A (en) | 1984-04-10 | 1989-10-17 | Walsh Manufacturing (Mississauga) Limited | Anastomosis device and method |
US4777096A (en) | 1984-12-14 | 1988-10-11 | Ethicon, Inc. | Sheet containing a plurality of surgical needles |
US4587202A (en) | 1984-12-14 | 1986-05-06 | Ethicon, Inc. | Photoetching process for making surgical needles |
US4593693A (en) * | 1985-04-26 | 1986-06-10 | Schenck Robert R | Methods and apparatus for anastomosing living vessels |
CN85106639B (en) | 1985-09-03 | 1988-08-03 | 第三军医大学野战外科研究所 | Instrument for blood vessel anastomosis |
US4681110A (en) | 1985-12-02 | 1987-07-21 | Wiktor Dominik M | Catheter arrangement having a blood vessel liner, and method of using it |
US4872874A (en) | 1987-05-29 | 1989-10-10 | Taheri Syde A | Method and apparatus for transarterial aortic graft insertion and implantation |
SU1616624A1 (en) | 1987-07-14 | 1990-12-30 | Предприятие П/Я А-3697 | Surgical suturing apparatus |
US4950283A (en) | 1988-12-29 | 1990-08-21 | John Lezdey | Surgical clip |
US4930502A (en) | 1989-01-26 | 1990-06-05 | Chen Fusen H | Anastomosis device |
US5123908A (en) | 1989-01-26 | 1992-06-23 | Chen Fusen H | Anastomotic device |
US5336233A (en) | 1989-01-26 | 1994-08-09 | Chen Fusen H | Anastomotic device |
US5250057A (en) | 1989-01-26 | 1993-10-05 | Chen Fusen H | Anastomotic device |
US4930674A (en) | 1989-02-24 | 1990-06-05 | Abiomed, Inc. | Surgical stapler |
US5057401A (en) | 1990-03-07 | 1991-10-15 | Ethicon, Inc. | Process for making a device with a three-dimensionally tapered point |
US5035702A (en) | 1990-06-18 | 1991-07-30 | Taheri Syde A | Method and apparatus for providing an anastomosis |
US5037428A (en) | 1990-06-21 | 1991-08-06 | Applied Medical Technology, Inc. | Vessel approximation and alignment device |
US5234447A (en) | 1990-08-28 | 1993-08-10 | Robert L. Kaster | Side-to-end vascular anastomotic staple apparatus |
US5250058A (en) * | 1991-01-17 | 1993-10-05 | Ethicon, Inc. | Absorbable anastomosic fastener means |
WO1993000868A1 (en) * | 1991-07-04 | 1993-01-21 | Earl Ronald Owen | Tubular surgical implant |
US5263973A (en) | 1991-08-30 | 1993-11-23 | Cook Melvin S | Surgical stapling method |
AU669338B2 (en) | 1991-10-25 | 1996-06-06 | Cook Incorporated | Expandable transluminal graft prosthesis for repair of aneurysm and method for implanting |
US5316023A (en) | 1992-01-08 | 1994-05-31 | Expandable Grafts Partnership | Method for bilateral intra-aortic bypass |
US5346501A (en) | 1993-02-05 | 1994-09-13 | Ethicon, Inc. | Laparoscopic absorbable anastomosic fastener and means for applying |
FR2702647B1 (en) | 1993-03-18 | 1995-05-05 | Baudet Jacques | Process of micro-anastomosis of blood vessels and automatic clamp for its implementation. |
JPH09501074A (en) * | 1993-05-20 | 1997-02-04 | ソマネテイツクス コーポレイシヨン | Improved electro-optical sensor for spectrophotometric medical devices |
CA2125258C (en) | 1993-08-05 | 1998-12-22 | Dinah B Quiachon | Multicapsule intraluminal grafting system and method |
US5562690A (en) | 1993-11-12 | 1996-10-08 | United States Surgical Corporation | Apparatus and method for performing compressional anastomoses |
US5609627A (en) | 1994-02-09 | 1997-03-11 | Boston Scientific Technology, Inc. | Method for delivering a bifurcated endoluminal prosthesis |
US5653743A (en) | 1994-09-09 | 1997-08-05 | Martin; Eric C. | Hypogastric artery bifurcation graft and method of implantation |
US6254618B1 (en) * | 1995-01-18 | 2001-07-03 | Pepi Dakov | Connector for hollow anatomical organs |
US5695504A (en) | 1995-02-24 | 1997-12-09 | Heartport, Inc. | Devices and methods for performing a vascular anastomosis |
US5976159A (en) | 1995-02-24 | 1999-11-02 | Heartport, Inc. | Surgical clips and methods for tissue approximation |
US6068637A (en) | 1995-10-03 | 2000-05-30 | Cedar Sinai Medical Center | Method and devices for performing vascular anastomosis |
US5792180A (en) | 1996-01-23 | 1998-08-11 | United States Surgical Corporation | High bend strength surgical needles and surgical incision members and methods of producing same by double sided photoetching |
US5762811A (en) | 1996-01-24 | 1998-06-09 | United States Surgical Corporation | One-sided photoetching process for needle fabrication |
US5693454A (en) | 1996-01-24 | 1997-12-02 | United States Surgical Corporation | Two-sided photoetching process for needle fabrication |
AU5162598A (en) | 1996-11-07 | 1998-05-29 | Vascular Science Inc. | Tubular medical graft connectors |
US5752966A (en) | 1997-03-07 | 1998-05-19 | Chang; David W. | Exovascular anastomotic device |
DE29713335U1 (en) | 1997-07-26 | 1997-10-16 | Quatchadze Georg Dr Med | Surgical instrument for connecting two hollow organs |
NL1007349C2 (en) | 1997-10-24 | 1999-04-27 | Suyker Wilhelmus Joseph Leonardus | System for the mechanical production of anastomoses between hollow structures; as well as device and applicator for use therewith. |
US7063711B1 (en) * | 1998-05-29 | 2006-06-20 | By-Pass, Inc. | Vascular surgery |
US6461320B1 (en) * | 1998-08-12 | 2002-10-08 | Cardica, Inc. | Method and system for attaching a graft to a blood vessel |
US6551334B2 (en) * | 1999-04-16 | 2003-04-22 | Integrated Vascular Interventional Technologies, Lc | Externally directed anastomosis systems and externally positioned anastomosis fenestra cutting apparatus |
US6569173B1 (en) * | 1999-12-14 | 2003-05-27 | Integrated Vascular Interventional Technologies, L.C. | Compression plate anastomosis apparatus |
US6428550B1 (en) * | 1999-05-18 | 2002-08-06 | Cardica, Inc. | Sutureless closure and deployment system for connecting blood vessels |
US6503259B2 (en) * | 2000-12-27 | 2003-01-07 | Ethicon, Inc. | Expandable anastomotic device |
-
2001
- 2001-02-27 US US09/794,670 patent/US6890338B1/en not_active Expired - Fee Related
-
2002
- 2002-02-11 EP EP02756494A patent/EP1414363A4/en active Pending
- 2002-02-11 WO PCT/US2002/022521 patent/WO2002098316A2/en not_active Application Discontinuation
- 2002-02-11 AU AU2002322500A patent/AU2002322500A1/en not_active Abandoned
-
2004
- 2004-06-09 US US10/864,621 patent/US20050021060A1/en not_active Abandoned
- 2004-07-23 US US10/897,523 patent/US20050027308A1/en not_active Abandoned
Patent Citations (99)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3166072A (en) * | 1962-10-22 | 1965-01-19 | Jr John T Sullivan | Barbed clips |
US3657744A (en) * | 1970-05-08 | 1972-04-25 | Univ Minnesota | Method for fixing prosthetic implants in a living body |
US3938528A (en) * | 1973-05-11 | 1976-02-17 | Investors In Ventures, Inc. | Implanting and splicing articles and methods for living beings |
US4366819A (en) * | 1980-11-17 | 1983-01-04 | Kaster Robert L | Anastomotic fitting |
US4368736A (en) * | 1980-11-17 | 1983-01-18 | Kaster Robert L | Anastomotic fitting |
US4423592A (en) * | 1980-11-28 | 1984-01-03 | Aviation Electric Ltd. | Fuel control system for gas turbine engine |
US4503568A (en) * | 1981-11-25 | 1985-03-12 | New England Deaconess Hospital | Small diameter vascular bypass and method |
US4917090A (en) * | 1982-06-24 | 1990-04-17 | Unilink, Inc. | Method for performing an anastomosis |
US4917091A (en) * | 1982-06-24 | 1990-04-17 | Unilink Ab | Annular fastening means |
US4917087A (en) * | 1984-04-10 | 1990-04-17 | Walsh Manufacturing (Mississuaga) Limited | Anastomosis devices, kits and method |
US4657019A (en) * | 1984-04-10 | 1987-04-14 | Idea Research Investment Fund, Inc. | Anastomosis devices and kits |
US4577631A (en) * | 1984-11-16 | 1986-03-25 | Kreamer Jeffry W | Aneurysm repair apparatus and method |
US4892098A (en) * | 1985-06-26 | 1990-01-09 | Sauer Jude S | Tubular tissue welding device without moving parts |
US4721109A (en) * | 1986-04-08 | 1988-01-26 | Healey Maureen A | Temporary anastomotic device |
US5392979A (en) * | 1987-05-26 | 1995-02-28 | United States Surgical Corporation | Surgical stapler apparatus |
US4907591A (en) * | 1988-03-29 | 1990-03-13 | Pfizer Hospital Products Group, Inc. | Surgical instrument for establishing compression anastomosis |
US5005749A (en) * | 1988-07-01 | 1991-04-09 | United States Surgical Corp. | Anastomosis surgical stapling instrument |
US5193731A (en) * | 1988-07-01 | 1993-03-16 | United States Surgical Corporation | Anastomosis surgical stapling instrument |
US4899744A (en) * | 1988-12-15 | 1990-02-13 | Tatsuo Fujitsuka | Apparatus for anastomosing digestive tract |
US5089008A (en) * | 1989-01-26 | 1992-02-18 | Chen Fusen H | Surgical closure means for anastomotic device |
US4997439A (en) * | 1989-01-26 | 1991-03-05 | Chen Fusen H | Surgical closure or anastomotic device |
US5192289A (en) * | 1989-03-09 | 1993-03-09 | Avatar Design And Development, Inc. | Anastomosis stent and stent selection system |
US5178634A (en) * | 1989-03-31 | 1993-01-12 | Wilson Ramos Martinez | Aortic valved tubes for human implants |
US5089006A (en) * | 1989-11-29 | 1992-02-18 | Stiles Frank B | Biological duct liner and installation catheter |
US5290298A (en) * | 1990-05-07 | 1994-03-01 | United States Surgical Corporation | Fragmentable anastomotic device |
US5395311A (en) * | 1990-05-14 | 1995-03-07 | Andrews; Winston A. | Atherectomy catheter |
US5078735A (en) * | 1990-06-18 | 1992-01-07 | Mobin Uddin Kazi | Prosthetic grafting method for bypass surgery |
US5403333A (en) * | 1990-08-28 | 1995-04-04 | Robert L. Kaster | Side-to-end vascular anastomotic staple apparatus |
US5104025A (en) * | 1990-09-28 | 1992-04-14 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
US5304220A (en) * | 1991-07-03 | 1994-04-19 | Maginot Thomas J | Method and apparatus for implanting a graft prosthesis in the body of a patient |
US5285945A (en) * | 1991-08-23 | 1994-02-15 | Ethicon, Inc. | Surgical anastomosis stapling instrument |
US5275322A (en) * | 1991-08-23 | 1994-01-04 | Ethicon, Inc. | Surgical anastomosis stapling instrument |
US5205459A (en) * | 1991-08-23 | 1993-04-27 | Ethicon, Inc. | Surgical anastomosis stapling instrument |
US5292053A (en) * | 1991-08-23 | 1994-03-08 | Ethicon, Inc. | Surgical anastomosis stapling instrument |
US5188638A (en) * | 1992-02-06 | 1993-02-23 | Tzakis Andreas G | Apparatus and method for preforming anastomosis fastener securement of hollow organs |
US5707362A (en) * | 1992-04-15 | 1998-01-13 | Yoon; Inbae | Penetrating instrument having an expandable anchoring portion for triggering protrusion of a safety member and/or retraction of a penetrating member |
US6053390A (en) * | 1992-05-19 | 2000-04-25 | United States Surgical | Anvil for surgical stapler |
US5395030A (en) * | 1992-06-04 | 1995-03-07 | Olympus Optical Co., Ltd. | Surgical device for stapling and fastening body tissues |
US5878193A (en) * | 1992-08-10 | 1999-03-02 | Computer Motion, Inc. | Automated endoscope system for optimal positioning |
US6036699A (en) * | 1992-12-10 | 2000-03-14 | Perclose, Inc. | Device and method for suturing tissue |
US5503635A (en) * | 1993-11-12 | 1996-04-02 | United States Surgical Corporation | Apparatus and method for performing compressional anastomoses |
US5725544A (en) * | 1993-12-23 | 1998-03-10 | Oticon A/S | Method and instrument for establishing the receiving site of a coronary artery bypass graft |
US5486187A (en) * | 1994-01-04 | 1996-01-23 | Schenck; Robert R. | Anastomosis device and method |
US5501689A (en) * | 1994-02-03 | 1996-03-26 | United States Surgical Corporation | Plaque stapler |
US5709335A (en) * | 1994-06-17 | 1998-01-20 | Heartport, Inc. | Surgical stapling instrument and method thereof |
US5732872A (en) * | 1994-06-17 | 1998-03-31 | Heartport, Inc. | Surgical stapling instrument |
US6176413B1 (en) * | 1994-06-17 | 2001-01-23 | Heartport, Inc. | Surgical anastomosis apparatus and method thereof |
US5881943A (en) * | 1994-06-17 | 1999-03-16 | Heartport, Inc. | Surgical anastomosis apparatus and method thereof |
US6030392A (en) * | 1995-01-18 | 2000-02-29 | Motorola, Inc. | Connector for hollow anatomical structures and methods of use |
US6371965B2 (en) * | 1995-02-24 | 2002-04-16 | Gifford, Iii Hanson S. | Devices and methods for performing a vascular anastomosis |
US6183486B1 (en) * | 1995-02-24 | 2001-02-06 | Heartport, Inc. | Device and method for minimizing heart displacements during a beating heart surgical procedure |
US6171321B1 (en) * | 1995-02-24 | 2001-01-09 | Heartport, Inc. | Devices and methods for performing a vascular anastomosis |
US6167889B1 (en) * | 1995-04-10 | 2001-01-02 | Cardiothoracic Systems, Inc. | Method for coronary artery bypass |
US5741274A (en) * | 1995-12-22 | 1998-04-21 | Cardio Vascular Concepts, Inc. | Method and apparatus for laparoscopically reinforcing vascular stent-grafts |
US5709693A (en) * | 1996-02-20 | 1998-01-20 | Cardiothoracic System, Inc. | Stitcher |
US5855583A (en) * | 1996-02-20 | 1999-01-05 | Computer Motion, Inc. | Method and apparatus for performing minimally invasive cardiac procedures |
US6190590B1 (en) * | 1996-02-28 | 2001-02-20 | Impra, Inc. | Apparatus and method for making flanged graft for end-to-side anastomosis |
US5725553A (en) * | 1996-02-29 | 1998-03-10 | Moenning; Stephen P. | Apparatus and method for protecting a port site opening in the wall of a body cavity |
US6050472A (en) * | 1996-04-26 | 2000-04-18 | Olympus Optical Co., Ltd. | Surgical anastomosis stapler |
US6024748A (en) * | 1996-07-23 | 2000-02-15 | United States Surgical Corporation | Singleshot anastomosis instrument with detachable loading unit and method |
US5707380A (en) * | 1996-07-23 | 1998-01-13 | United States Surgical Corporation | Anastomosis instrument and method |
US5868763A (en) * | 1996-09-16 | 1999-02-09 | Guidant Corporation | Means and methods for performing an anastomosis |
US6190397B1 (en) * | 1996-09-16 | 2001-02-20 | Origin Medsystems, Inc. | Means and method for performing an anastomosis |
US6206912B1 (en) * | 1996-11-07 | 2001-03-27 | St. Jude Medical Anastomotic Technology Group Inc. | Medical grafting methods and apparatus |
US5875782A (en) * | 1996-11-14 | 1999-03-02 | Cardiothoracic Systems, Inc. | Methods and devices for minimally invasive coronary artery revascularization on a beating heart without cardiopulmonary bypass |
US5879371A (en) * | 1997-01-09 | 1999-03-09 | Elective Vascular Interventions, Inc. | Ferruled loop surgical fasteners, instruments, and methods for minimally invasive vascular and endoscopic surgery |
US6030370A (en) * | 1997-02-05 | 2000-02-29 | Aesculap Ag And Co. Kg | Surgical instrument |
US5893369A (en) * | 1997-02-24 | 1999-04-13 | Lemole; Gerald M. | Procedure for bypassing an occlusion in a blood vessel |
US6514196B1 (en) * | 1997-04-23 | 2003-02-04 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US6036702A (en) * | 1997-04-23 | 2000-03-14 | Vascular Science Inc. | Medical grafting connectors and fasteners |
US6186942B1 (en) * | 1997-04-23 | 2001-02-13 | St. Jude Medical Cardiovascular Group, Inc. | Medical grafting methods and apparatus |
US6030395A (en) * | 1997-05-22 | 2000-02-29 | Kensey Nash Corporation | Anastomosis connection system |
US6022367A (en) * | 1997-06-18 | 2000-02-08 | United States Surgical | Surgical apparatus for forming a hole in a blood vessel |
US6013190A (en) * | 1998-01-21 | 2000-01-11 | Vascular Science Inc. | Catheters with integrated lumen and methods of their manufacture and use |
US6193734B1 (en) * | 1998-01-23 | 2001-02-27 | Heartport, Inc. | System for performing vascular anastomoses |
US6036703A (en) * | 1998-02-06 | 2000-03-14 | Ethicon Endo-Surgery Inc. | Method and apparatus for establishing anastomotic passageways |
US6187019B1 (en) * | 1998-02-26 | 2001-02-13 | Ethicon Endo-Surgery, Inc. | Surgical anastomosis instrument |
US6015416A (en) * | 1998-02-26 | 2000-01-18 | Ethicon Endo-Surgery, Inc. | Surgical anastomosis instrument |
US6176864B1 (en) * | 1998-03-09 | 2001-01-23 | Corvascular, Inc. | Anastomosis device and method |
US6187020B1 (en) * | 1998-04-17 | 2001-02-13 | Laboratoire Perouse Implant | Connecting device for anastomosis, device for fitting fasteners and implant including them |
US20020032462A1 (en) * | 1998-06-10 | 2002-03-14 | Russell A. Houser | Thermal securing anastomosis systems |
US6036700A (en) * | 1998-07-14 | 2000-03-14 | Ethicon Endo-Surgery, Inc. | Surgical anastomosis instrument |
US6168623B1 (en) * | 1998-08-31 | 2001-01-02 | Cardiothoracic Systems, Inc. | Deformable conduits and methods for shunting bodily fluid during surgery |
US6524322B1 (en) * | 1998-10-23 | 2003-02-25 | Eric Berreklouw | Anastomosis device |
US6533812B2 (en) * | 1998-11-06 | 2003-03-18 | St. Jude Medical Atg, Inc. | Medical anastomosis apparatus |
US6508822B1 (en) * | 1998-11-06 | 2003-01-21 | St. Jude Medical Atg, Inc. | Medical graft assembly |
US6508252B1 (en) * | 1998-11-06 | 2003-01-21 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US6517558B2 (en) * | 1999-01-15 | 2003-02-11 | Ventrica, Inc. | Methods and devices for forming vascular anastomoses |
US20030078603A1 (en) * | 1999-03-01 | 2003-04-24 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6511491B2 (en) * | 1999-03-09 | 2003-01-28 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US6036704A (en) * | 1999-05-13 | 2000-03-14 | Yoon; Inbae | Anastomosis apparatus and method for anastomosing an anatomical tubular structure |
US6537288B2 (en) * | 1999-05-18 | 2003-03-25 | Cardica, Inc. | Implantable medical device such as an anastomosis device |
US6179849B1 (en) * | 1999-06-10 | 2001-01-30 | Vascular Innovations, Inc. | Sutureless closure for connecting a bypass graft to a target vessel |
US6537287B1 (en) * | 1999-06-10 | 2003-03-25 | Cardica, Inc. | Sutureless closure for connecting a bypass graft to a target vessel |
US20040002721A1 (en) * | 1999-09-01 | 2004-01-01 | Podmore Jonathan L. | Method and apparatus for performing end-to-end and end-to-side anastomosis with eversion of tissue edges |
US6190396B1 (en) * | 1999-09-14 | 2001-02-20 | Perclose, Inc. | Device and method for deploying and organizing sutures for anastomotic and other attachments |
US6193129B1 (en) * | 2000-01-24 | 2001-02-27 | Ethicon Endo-Surgery, Inc. | Cutting blade for a surgical anastomosis stapling instrument |
US6530932B1 (en) * | 2000-08-30 | 2003-03-11 | Ethicon Endo-Surgery, Inc. | Anastomosis device having improved tissue presentation |
US20030074012A1 (en) * | 2000-10-10 | 2003-04-17 | Coalescent Surgical, Inc. | Minimally invasive annuloplasty procedure and apparatus |
Cited By (38)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9375218B2 (en) | 2006-05-03 | 2016-06-28 | Datascope Corp. | Systems and methods of tissue closure |
US11369374B2 (en) | 2006-05-03 | 2022-06-28 | Datascope Corp. | Systems and methods of tissue closure |
US10595861B2 (en) | 2006-05-03 | 2020-03-24 | Datascope Corp. | Systems and methods of tissue closure |
US9113836B2 (en) | 2009-03-02 | 2015-08-25 | Seventh Sense Biosystems, Inc. | Devices and techniques associated with diagnostics, therapies, and other applications, including skin-associated applications |
US20100256465A1 (en) * | 2009-03-02 | 2010-10-07 | Seventh Sense Biosystems, Inc. | Devices and techniques associated with diagnostics, therapies, and other applications, including skin-associated applications |
US20100256524A1 (en) * | 2009-03-02 | 2010-10-07 | Seventh Sense Biosystems, Inc. | Techniques and devices associated with blood sampling |
US10939860B2 (en) | 2009-03-02 | 2021-03-09 | Seventh Sense Biosystems, Inc. | Techniques and devices associated with blood sampling |
US10799166B2 (en) | 2009-03-02 | 2020-10-13 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving fluids |
US9775551B2 (en) | 2009-03-02 | 2017-10-03 | Seventh Sense Biosystems, Inc. | Devices and techniques associated with diagnostics, therapies, and other applications, including skin-associated applications |
US9730624B2 (en) | 2009-03-02 | 2017-08-15 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving fluids |
US8821412B2 (en) | 2009-03-02 | 2014-09-02 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving fluids |
US20110105872A1 (en) * | 2009-10-30 | 2011-05-05 | Seventh Sense Biosystems, Inc. | Systems and methods for application to skin and control of actuation, delivery, and/or perception thereof |
US20110105952A1 (en) * | 2009-10-30 | 2011-05-05 | Seventh Sense Biosystems, Inc. | Relatively small devices applied to the skin, modular systems, and methods of use thereof |
US20110105951A1 (en) * | 2009-10-30 | 2011-05-05 | Seventh Sense Biosystems, Inc. | Systems and methods for treating, sanitizing, and/or shielding the skin or devices applied to the skin |
US20110125058A1 (en) * | 2009-11-24 | 2011-05-26 | Seven Sense Biosystems, Inc. | Patient-enacted sampling technique |
US20110172508A1 (en) * | 2010-01-13 | 2011-07-14 | Seventh Sense Biosystems, Inc. | Sampling device interfaces |
US20110172510A1 (en) * | 2010-01-13 | 2011-07-14 | Seventh Sense Biosystems, Inc. | Rapid delivery and/or withdrawal of fluids |
US9041541B2 (en) | 2010-01-28 | 2015-05-26 | Seventh Sense Biosystems, Inc. | Monitoring or feedback systems and methods |
US20110181410A1 (en) * | 2010-01-28 | 2011-07-28 | Seventh Sense Biosystems, Inc. | Monitoring or feedback systems and methods |
US9033898B2 (en) | 2010-06-23 | 2015-05-19 | Seventh Sense Biosystems, Inc. | Sampling devices and methods involving relatively little pain |
US8561795B2 (en) | 2010-07-16 | 2013-10-22 | Seventh Sense Biosystems, Inc. | Low-pressure packaging for fluid devices |
WO2012018486A3 (en) * | 2010-07-26 | 2012-04-12 | Seventh Sense Biosystems, Inc. | Rapid delivery and/or receiving of fluids |
US11202895B2 (en) | 2010-07-26 | 2021-12-21 | Yourbio Health, Inc. | Rapid delivery and/or receiving of fluids |
WO2012018486A2 (en) * | 2010-07-26 | 2012-02-09 | Seventh Sense Biosystems, Inc. | Rapid delivery and/or receiving of fluids |
US11177029B2 (en) | 2010-08-13 | 2021-11-16 | Yourbio Health, Inc. | Systems and techniques for monitoring subjects |
US8808202B2 (en) | 2010-11-09 | 2014-08-19 | Seventh Sense Biosystems, Inc. | Systems and interfaces for blood sampling |
US11253179B2 (en) | 2011-04-29 | 2022-02-22 | Yourbio Health, Inc. | Systems and methods for collection and/or manipulation of blood spots or other bodily fluids |
US10188335B2 (en) | 2011-04-29 | 2019-01-29 | Seventh Sense Biosystems, Inc. | Plasma or serum production and removal of fluids under reduced pressure |
US9119578B2 (en) | 2011-04-29 | 2015-09-01 | Seventh Sense Biosystems, Inc. | Plasma or serum production and removal of fluids under reduced pressure |
US10835163B2 (en) | 2011-04-29 | 2020-11-17 | Seventh Sense Biosystems, Inc. | Systems and methods for collecting fluid from a subject |
US9295417B2 (en) | 2011-04-29 | 2016-03-29 | Seventh Sense Biosystems, Inc. | Systems and methods for collecting fluid from a subject |
US8827971B2 (en) | 2011-04-29 | 2014-09-09 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving fluids |
US10543310B2 (en) | 2011-12-19 | 2020-01-28 | Seventh Sense Biosystems, Inc. | Delivering and/or receiving material with respect to a subject surface |
US20130345514A1 (en) * | 2012-06-22 | 2013-12-26 | Empire Technology Development Llc | Proprioceptive endoscope and virtual dynamic tomography |
US11564689B2 (en) | 2013-11-19 | 2023-01-31 | Datascope Corp. | Fastener applicator with interlock |
US10485545B2 (en) | 2013-11-19 | 2019-11-26 | Datascope Corp. | Fastener applicator with interlock |
US11653928B2 (en) | 2018-03-28 | 2023-05-23 | Datascope Corp. | Device for atrial appendage exclusion |
US11751876B2 (en) | 2019-05-07 | 2023-09-12 | Easyflomicro Inc. | Apparatuses for anastomosis of tubular vessels and related methods |
Also Published As
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US20050021060A1 (en) | 2005-01-27 |
EP1414363A2 (en) | 2004-05-06 |
WO2002098316A2 (en) | 2002-12-12 |
EP1414363A4 (en) | 2008-07-23 |
WO2002098316A3 (en) | 2003-12-31 |
AU2002322500A1 (en) | 2002-12-16 |
US6890338B1 (en) | 2005-05-10 |
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