US 2127903 A
Description (Le texte OCR peut contenir des erreurs.)
Aug. 23, 1938. A. BOWEN 2,127,903
TUBE FOR SURGICAL PURPOSES AND METHOD OF PREPARING AND USING THE SAME Filed May 5', 1936 4 Sheets-Sheet l v YINIVENTOR.
A. BOWEN 2,127,903 TUBE FOR SURGICAL PURPOSES AND METHOD OF PREPARING-AND USING THE SAME Aug. 23, 1938.
Filed May 5, 19356 4 Sheets-Sheet 2 INVENTOR.
2497 40? EOW'F/V,
Aug. 23, 1938. A. BOWEN 2,127,903 T UBE FOR SURGICAL PURPOSES AND METHOD OF PREPARING AND usme THE SAME Filed y 5, 1956 4 Sheets-Sheet 5 COMMON 5/4 E j J/ .FJZ, g f
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A. BOWEN Filed May 5, 1956 4 Sheets-Sheet 4 INVENTOR. @7770? EQWf/V,
Patented Aug. 23, I
UNITED STATES PATENT OFFICE TUBE FOB SURGICAL PURPOSES lgl'ETHOD OF PREPARING USING THE Arthur Bowen, Los Angeles, Calif., assignor at Davis & Geek, Inc., Brooklyn, N. Y., a corporation of New York Application May 5, 1936, Serlal No. 17,930
- 10 Claims. (01. 128-334) The present invention relates to a tube of may be put may be readily separated into five absorbable animal material, a method of prepartypes of situations as follows:
ing the same and its use in surgery. 1. End to end, end to side, or side ,to side The principal object of the invention is to proanastomosis;
vide a hollow tube ofabsorbable animal tissue 2. Transplantation of one duct into another:
having requisite rigidity and absorptive properties 3. Structural support for reconstruction or rewlth minimum tendency to cause irritation of pair:
animal. tissue, to devise methods whereby the same 4. Used as an exterior sheath to protect a transmaybe readily prepared and to propose various planted nerve, tendon or the like;
uses and. practical applications thereof for 5. Used for drainage purposes, with or without surgical purposes. wicks.
As long ago as 1774, Leconte advocated wrap- The invention further consistsin the novel conping a section of a goose quill around a wounded structlon, arrangement'and combination of parts, blood vessel holding it in place with a ligature. methods of manufacture and use more fully l tr Later Latteri and Petrinari reported the use of inafter described in the drawings. 15
implanted magnesium tubes and quills of doves In the-drawings: feathers for end to end anastomosisof the severed F 1 s ws 8 completed tube of this n conimon bile duct using-such tubes and quills. t nl Today the use of Murphy buttons for end to and Fig. 2 shows a modified form of tube with de- 2 anastomosis of the severed or strictured intestinal pressions in its end portions; tract is well known. Difiiculties are encountered Fig. 3 shows a collared bobbin; in these situations in that after the parts have Fig. 4 is a modified bobbin or tube with collars, healed, the non-absorbable tubes, or buttons must at'each end; be removed, accomplished usually by dislodgment Fig. 5 shows a spool-shaped tube or bobbin;
and subsequent passage out of the system by the Fig. 6 illustrates a di-conical shaped tube; 25
patient. Fig. 7 shows a completed Y-tube;
The present invention seeks to avoid the Fig. 7a illustrates a completed T-tube; necessity of removal of such tubes by constructing Fig. 8 shows the method of wrapping tapes on them of a material which will be readily absorbed a mandrel in the manufacture of a tube prior to or digested by the body during or subsequent to form pressing where that is desirable:
the repair period. Fig. 9 shows a tube in the process of being To this end, the invention contemplates in -its formed from cords; broadest aspect straight, angular, curved, Y or Fig. 10 shows a tube in the process of being T tubes of absorbable animal tissue such, for inmanufactured from woven strands;
.35 stance, as the submucosa layer of animal in- Fig. 11 is a composite view of a two-part testinal tissue. mandrel for the manuiacture of T-tubes;
The invention further contemplates the manu- Fig. 12 shows the manner of winding a tape on feature of such tubes by forming the animal tissue the T-shaped mandrel of Fig. 11;
into a tube. This may be done by wrapping, Fig. 120. shows the completely wound strip on winding, spinning or forming the tissue over a the T-mandrel; mandrelor core, form pressing the tissue to shape Figs. 13, 14 and 15 progressively illustrate a and subsequently removing the core. For this tube implantation in an end to end anastomosis purpose, the animal tissue may be in the form of using a T-tube. threads, ribbons or a pulp to which a binder such Fig. 16 illustrates a method of imp a as glue has been added so that upon formation straight tube in an end to end anastomosis; 45 of the material into a tube. the material will Fi 1'1 i us es a -tube implantation in a harden in that shape and maintain its form. end to side anastomosis;
\ The invention I further contemplates the use i 18 illustrates t P p r implantaof such tubes as above described in a large numtion oi. the common duct into the duodenum; bar of practical applications and for surgical pur-' Fig. ,19 shows this Operation complete except 50 poses. While-a number oi uses have been set forth for suturing;
herein, it is to be understood that they are men-,- Fig. 20 illustrates a side to side anastomosis;
tioned as illustrative and typical only and are not Fig. 21 illustrates a severed nerve about to have to beconstrued in a limiting sense. its edges approximated; 5 Perhaps the use to which tubes or character ,Figs, 21a, 21b and 210 show the method of is the submucous layer of --animal intestinal recited for that approximating the edges of a severed nerve and its protection by an absorbable tube.
Referring'now with particularity to the drawings, in Fig. 1 there is shown perhaps the most common type of tube or bobbin, to wit: a straight, hollow element of elongated nature, the dimensions of such an article being variable, of course, dependent upon the situation in which it is to be used. The words tube" and bobbin are herein" used interchangeably as their difference relates only to dimensions. A short, stubby tube may be termed a bobbin.
In Fig. 2, a modified form of tube is shown at I having a slightly depressed groove 3 at the end portion thereof. This form is particularly desirable in an end to end anastomosis in that it facilitates ligaturing the incised ends of the duct.
In Fig. 3, a tube is shown at I having a collar 5 at one end which may be desirable in some instances.
In Fig. 4, the tube 4 and 8 at each end.
In Fig. 5, a spool shaped tube! is shown' which involves all of the desirable attributes of the tube of Fig. 2 in that ligaturing is facilitated.
The spool shape of the tube may be further accentuated into the form shown in Fig. 6 where at 8 the tube is diconical in shape, that is, it consists essentially of two frustro-conical configurations with their smaller bases contiguous.
In Figs. 7 and 7a, Y and T shaped tubes are shown respectively.
In manufacturing these shapes, anysuitable absorbable animal material may be utilized which will have or can be made to have desirable rigidity, absorbabiiity and freedom from a tendency to produce tissue irritation. The material must likewise be capable of withstanding heat or chemical sterilization. The best material of which I am aware from which these tubes may be made is provided with collars I tissue.
This material in either the form of threads or wound over a metal or other form to give it the desired shape. For instance in Fig. 8 a ribbon 9 may be spirally wound over a metal form i0, slightly overlapping the convolutions, and the core I! subsequently removed after the ribbon has been permitted to assume a self-sustaining condition.
In Fig. 9, threads ii are spirally wound, woven or spun over the core ill in the same manner as of Fig. 8. It has been foundthat manufacturethe contact of the in this type of threads with each other is suiiicient to cause a coalescence therebetween with the result that an eventually integral construction results.
In Fig. 10, a modified form of weaving is shown over the core III, where these strands may be either in the form of threads or ribbons.
Where T or Y tubes are to be made, it will be desirable to provide a two-part core such, for instance, as is shownin Fig. 11. There one armis shown at i! having a threaded socket II in.
which the leg ll may be screwed. Obviously where a Y tubeis desired instead of a T, the arm I! may assume a V shape. In manufacturing a T tube from the two-part core of Fig. 11, reference is had to. Figs. 12 and 12a using preferably a ribbon material, such for instance, as is shown in Fig. 8. In this instance, the ribbon may be wound on the core beginning at one end of' the arm, spirally around that arm from the end toward the center. At the center, it is crissdown the leg I to the end, back again upon in itself and out to the opposite end of' the arm I2. -Where desired, a second or any number of additional layers may be superimposed in the same manner and beginning at the opposite end of the arm it. when the winding has been completed and the material is self-sustaining, the core may be disconnected by unscrewing the leg I from the arm I! followed by subsequent removal of the latter.
Obviously, absorbable straight, Y or T tubes of anmial tissue may be made also by winding or spinning gut threads or narrow gut ribbons or strips spirally or transversely over a form and held together by a binder of glue or similar substance.
In all cases, it is desirable to form press the material oi the tubes or bobbins to shape, either with or without heat as this materially assists in bringing the tube to 'a self-sustaining condition with smooth surfaces. This action, therefore, eliminates to a great extent the irregularities in the surface oi the articles shown, for instance, in Figs. 8, 9, 10, 12 and 12d.
For the purpose of retarding absorption by animal tissue, the absorbable tubes may. be further treated. The methods which I have devised for the purpose may consists of: (1) immersion of the absorbable tube in a solution of formaldehyde; (2) immersion of the tube in liquid alboline; 3) coating the tube with keratin; (4) coating the tube with paraillne; and (5) coating the tube with resinous material.
Various surgical situations in which the absorbable tubes of animal membrane which I have devisedmay be used will now be recited although it is to be distinctly understood that in the recitation of these practical applications, they are to be taken as typical only and are not to be construed as limiting the invention. The invention, on the contrary, is to be construed broadly as any use to hich the tubes of this invention may be put 1' a surgical standpoint is to be considered, as coming within thepurview of the invention.
1. End to end anastomosis of the severed or strictured common bile duct over an implanted absorbable straight tube of animal membrane or a Y or T-shap'ed tube 01' the same Figs. 13, 14 and 15 progressively illustratesuch an implantation. The two ends of the severed common bile duct are shown at II through which sutures it have been sewn. In Fig. 14, the severed ends I! have been partially approximated and at this point a 1 tube I! of the invention has been inserted in the two ends as shown in Fig. 15. The approximation of the severed ends ll of the duct is then completed further manipulation of the sutures.
2. End to end anastomosis of the hepatic duct to the common Hie duct over an implanted straight tube of absorbable animal tissue or a T-shaped tube of the same. Reference may here be had to Figs. 16 and 17. In Fig. 16, the absorbable straight tube is shown at i inserted into the ends of the common bile duct II and the hepatic duct ll. sutures ll being held by the usual forceps is. The anastomosis is completed in much the 1swan-1e1 lmanner as recited above with reference to Fig. 17 shows an absorbable to the same situation as the hepatic duct II has to the erect T-tube i! applied in Fig. m except that I been anasicmosed direct duodenum II through an lacks-:1 portion curved needles 23 ready ior implantation.
3. Transplantation oi the common bile duct to (a) duodenum, (b) stomach, (c) iejunum, (d) colon, using an implanted straight tube or 1"- shaped tube of absorbable animal tissue for direct implantation or by use of the Coilfey technique.
Fig. 18 illustrates an incision 2| made in theduodenum 20 by means of scalpel 22 and the common duct IS with sutures i6 attached and carrying 19 shows the manner of implantation of the common duct l into the duodenum 2II by means o! a straight absorbable tube I, the suturing being completed subsequently in the usual manner.
4. Tight suture of the common bile duct after exploratory choledochtomy with implantation of an absorbable tube of animalmembrane to (a) facilitate closure, (b) prevent too tight suture and stricture, (c) prevent biliary fistula.
5. The use of-an absorbable tube of animal membrane to bridge a small gap in the ends of the common or hepatic bile duct and as a structural support over which to build and reconstruct the duct with surrounding tissues.
II. Urological surgery 1. Reconstruction of the urethra with anal) j sorbable tube of animal membrane as a support-I ing tunnel. v
- 2. Reconstruction of cut, stenosed, orstrictured vas deferens.
3. Direct end t'o end anastomosis of cut or strictured ureter over the implanted absorbable tube.
The development 01' an'absorbable tube of animal membrane over which to anastomose a cut or.
strictured ureter appears to meet the requirements of (a) simple technique, (b) splintage of" the suture line, .(c) patent lumen with no inter- 1 ference with urinary flow and (d) absorption.
4. Tight suture after ureterotomy, using the implanted absorbable tube to facilitate suturing and to support the lumen of the sutured ureten.
5. Utero-intestinal anastomosis, implanting a sufllcient length of the absorbable tube in the lumen of the transplanted ureter to maintain its pateney during the period of traumatic swelling following "its having been embedded in the wall of the intestine, thereby preventing obstruction of the urinary flow and back pressure in the kidney.
6. Plastic surgery of the urethra, by implanting the absorbable 'tube as a tunnel throughwhich to maintain urinary flow and over which as a structural support to reconstruct the wall of the urethra.
III. Gynecology 1. Plastic reconstruction of a strictured lumen or fimbriated end of the Fallopiantube to. maintain pateney.
2. Reconstruction and maintenance of the inmen of the remaining end of the Fallopian tube after removal of tubal pregnancy, especially in those cases where a previous salp'ingectomy on the lymphatic ducts.
other side has been done or'where there is pathology in the other tube. In this instance, an absorbable tube of suitable diameter is inserted in the uterine endoi the tube and anchored by stay sutures; the absorbable tube being permitted to project beyond the Fallopian tube so as to prevent,
distal tubal mucosa from contracting and narrowing the distal end of the tube.
' IV. Vascular surgery I End to end anastomosis of veins, arteries, and In all previous methods, an attempt was made to splint the suture line and permit the flow of blood; but never has'an absorb- Fig.
able tubular membrane been used within or without the lumen in the suturing of blood vessels.
V. Surgery of salivary ducts Transplantation, drainage, and dilatation of strictured or severed salivary ducts.
v1. Gastro-intestinal surgery 1. Anastomosis of gallbladder to stomach-duodenum or jejunum for the purpose of maintaining patency of the lumen and permitting drainage of bile to the stomach or intestine,
2. To facilitate end to end, end to side, and side to side anastomosis of intestines over an absorbable bobbin. The advantages of the absorbable bobbin of animal tissue for these surgical situations include (a) the bobbin facilitates the placing of sutures, (b) it splints the suture line,
(0) it permits drainage of intestinal contents through a patent lumen, (d) it avoids the necessity of periormingenterostomy for decompression above sutured anastomosis, (e) the bobbin absorbs without the possibility of causing intestinal "obstruction during passage.
8. To maintain the pateney of gastro-enterostomy opening. The technic of gallbladder anastomosis is shown in Fig. 20. In that figure the gallbladder is shown at 24 anastomosed in v a side to side relationship with the stomach 25 by means of a collared absorbable tube 4. Obviously the same type .ofanastomosis may be made between the gallbladder and the duodenum.
VIIfOrtope'dic surgery In tendon suturing,,a sutured tendon may be placed in the lumen of a lubricated absorbable, .tube of animal membrane, which is split longitudinally on one side, to (a) prevent adhesions of the sutured tendon to the surrounding structures,(b) permit the tendon to lie and move in the tunnel of the absorbable tube, and (0) creation of a residual tunnel of surrounding To deposit a sutured nerve within the sheath of the absorbable tube to prevent adhesions.
Reference is here made to Fig. 21. After the ends of the cut or neuromatous nerves 26 are approximated, as in Figs. 21a. and 211), a suitable length and diameter of absorbable tube of animal membrane 21 is cut longitudinally, the edges separated and the sutured nerve placed within the lumen of the absorbable tube and the cut edges of the tube approximated with several interrupted sutures, a; few of these being left long and threaded on a needle and used to anchor the tube in place over the sutured nerve, as shown tube. 1x. Drainage tubes with 'or without wicks The use of the absorbable tubes of animal membrane as drainage tubes, with or without inF'ig. 210. In such cases, a lubricant may be interposed between the implanted organ and the 1 axially located wicks, especially in regions where 15 one would fear the loss of a non-absorbable drain, such, for example, as in brain absesses. Absorbable catgut strands have been used as wicks.
It will be obvious that in all of the above situations an absorbable tube is desirable because not only of its minimum irritating nature to animal tissues but also because it does not need to be subsequently removed from the locus, being gradually digested or absorbed by the body. By
the time the tube has disappeared by reason of the body processes, repair has taken place through growth or healing between the parts as desired. The period of time required for this complete absorption will, of course, be dependent upon previous treatment of the tube to modify its absorptiveness.
While the invention has been shown and described with particular reference to certain speciflc embodiments, it is to be understood that it is not to be limited thereto, but is to be construed broadly, and limited only by the scope of the claims. I claim: v
1. As a complete article of manufacture, a tube of absorbable animal material.
2. As a complete article of manufacture, a Y- tube of absorbable animal material.
3. As a complete article of manufacture, a T- tube of absorbable animal material.
4. A method of manufacturing a tubular article for use in surgical situations which consists in forming animal material over a mandrel to form a tube and when the tube has become selfsustaining, removing the mandrel.
5. The method of claim 4 which includes the step of form pressing the animal material on the mandrel prior to removing the latter.
6. The method of manufacturing a tubular article for use in surgical situations which consists in winding animal material spirally in one direction around a mandrel and then back in a reverse direction spirally to form a tube, and when the tube becomes self-sustaining removing the mandrel.
'7. A method of anastomosis which consists of implanting a tube of absorbable animal material into the parts to be anastomosed and permitting the tube to remain in place until absorbed.
8. A method of lending support to a hollow organ during repair and to maintain the patency of the lumen which consists in implanting therein a tube of absorbable animal material and permitting the tube to remain in place until absorbed.
9. A method of protecting an animal organ during repair which consists of implanting said organ in a tube of absorbable animal material and permitting the tube to remain in place until absorbed.
10. The method of claim 9 in which a lubricant is interposed between the implanted 'organ and the tube.
' ARTHUR BOWEN.