WO1993022974A1

WO1993022974A1 - Variable diameter circular stapler for surgical stitching of hollow organs

Info

Publication number: WO1993022974A1
Application number: PCT/FR1993/000476
Authority: WO
Inventors: Charam Khosrovaninejad; Shéhérazade GIRAUD
Original assignee: Charam Khosrovaninejad; Giraud Sheherazade
Priority date: 1992-05-19
Filing date: 1993-05-17
Publication date: 1993-11-25
Also published as: FR2691352A1

Abstract

Surgical apparatus for circular stitching of human organs. The invention concerns a generally circular apparatus, its diameter capable of being varied to suit organs to be stitched without it being necessary to change the apparatus or the staple holder. The apparatus consists of movable staple and knife holder units (6) disposed in a circle, and moving anvil holder units (24) disposed in a circle. Bars (9 and 24) serve to assemble said units and displace them in relation to the supporting planes constitued by compartments (7 and 23). The apparatus has a central removable axis (3) which links the compartments (7 and 23) to each other, and displaces movable units (6 and 24) by means of conical elements (4 and 35). The conjugated displacement of the latter during rotation of the central axis (3) moves the variable diameter circles opposite the moving units (6 and 24). Said units are in close contact with conical elements (4 and 35) through flat elements (5) and (32). The variation of the diameter of the cones opposite the movable units (6 and 24) is thereby directly transmitted to the latter, which results in their conjugated displacement externally or internally of the device according to the rotational direction given to the central axis (3).

Description

Circular stapler with variable diameter for surgical suturing of hollow organs using staples.

The present invention relates to an instrument for circular surgical suturing using staples of hollow organs of the human body and more particularly for end-to-end, end-to-end, side-to-side, and side-to-end anastomoses.

Currently, many instruments are known for making a circular anastomosis using staples, they are advantageous for certain organs such as the colon and the esophagus. These instruments have a prefixed diameter to best adapt to the diameter of hollow organs to be sutured. It is impossible to use diameters intermediate to the prefixed diameters without changing the instrument or without changing the magazine containing the staples. In other words, we are sometimes forced to use an instrument whose diameter is not perfectly suited to that of the hollow organs to be sutured and in this case the circular suture may stenosis.

The present instrument makes it possible to modify the diameter of the stapler at will during its application and this continuously, it can be adapted exactly to the diameter of the organ to be sutured. It eliminates the constraints imposed by the discontinuous variation in the diameter of the instruments currently used and the risk of anastomotic stenosis. Finally, it improves the comfort of the surgeon by choosing a single instrument, as a corollary it eliminates the risk of additionally linked to the use of an unsuitable and therefore unused instrument.

The present instrument makes it possible to continuously vary its diameter by the simultaneous and coordinated movement of the staple-holding units and the anvil-holding units housed in the distal part of the instrument called "the stapler head". The detailed description of the 'instrument will be better appreciated through the drawings among which: fig. 1bis represents an overall view of the device in the open position, FIG. 1 is a front section of the distal part of FIG. 1bis according to A-A 'fig. 2 is a detailed view of FIG. 1 showing the assemblies of the mobile units and the mechanism of the central axis FIG. 3 is a detailed view of a staple-knife holder functional unit of FIG. 2 fig. 4 is a perspective view of the internal face of a staple-knife unit showing the spatula which is used to move the latter, FIG. 5 is a view of FIG. 4 further showing the device which allows the movement of the staple-knife holder plate FIG. 6 is the top view of FIG. 5 fig. 7 is a detailed view of the staple-knife holder plate FIG. 8 is a sectional view of the anvil holder unit and the staple-holder plate for knife FIG. 9 is a cross-sectional view of the central axis of FIG. 2 according to A-A 'fig. 10 is a view from the bottom of the anvil holder unit of FIG. 8

REPLACEMENT SHEET fig. 11 is a detailed view of the device of the central axis of FIGS. 1 and 2 and which induces the change of caliber of the stapler

The instrument includes a main body 64 having a rear handle 65. At the front end of the body is a tube 66 which extends forward. On the free end of the tube is the most distal part of the apparatus called "the stapler head" and which includes the staple-knife units and the anvil-holder units. We will be interested in the description of the "stapler head", because it is what brings the essential of the novelty.

The head of the new device has a circular section and is schematically constituted (fig. 1): 1- of a segment 1 comprising units 6 staple-knife holders arranged in a circular fashion. 2- a segment 2 comprising units 24 anvil holders arranged in a circular manner. 3- a removable central axis 3 which secures the 2 segments 1 and 2 and which also includes the devices 4 and 35 which will allow the continuous variation of the diameter of the stapler head. 4- spatulas 5 and 32 disposed respectively between said devices and units 6 and 24. At the outset it should be noted that the variation in the diameter of this stapler is obtained by the simultaneous displacement and conjugation of units 6 and 24 arranged so circular.

Segment 1 is of circular section. It consists (fig. 1 and 2) of 2 separate parts, one of which 7 is fixed and unique, the other located in front of the first is formed by a variable number of separate units 6 arranged in a circular fashion and which are movable relative to part 7. The center of part 7 is hollowed out in a circular manner to allow passage to the central axis 3. Each unit 6 can slide freely on the corresponding segment of the 7 in a plane perpendicular to the longitudinal axis of the stapler. This sliding is made stable thanks to bars 8 and 9 (fig. 2) penetrating respectively into cubicles 10 and 11 which are hollowed out respectively in the 7 and the units 6. These bars will increase the bearing surfaces between the units 6 and part 7. When the units 6 have slipped out of part 7, the bearing surfaces between the 2 will remain parallel if a force was exerted on the front part of the units 6. The bars 8 which are integral with the units 6 are located on the outer slope of these and enter the cubicles 10 from outside to inside. The bars 9 which are integral with the part 7 are arranged on the internal slope of the latter and penetrate the boxes 11 from inside to outside.

Check unit 6 is functionally autonomous. It consists of: 1- a compartment 12 (fig. 2 and 3) which contains staples located in stalls 16 and the plate 13 which supports pushers 14 and the knife 15. The knife 15 is housed along the internal edge of the plate 13. When the plate is mobilized towards the front of the unit 6, in its course it drives the pushers 14 and the knife 15. Thus the staples are ejected into the viscera to perform the anastomosis and the knife 15 cuts the fabrics remaining inside the staples. 2- a spatula 5 (fig. 2 and 4) which is applied against the device 4 of the central axis and which transmits the movements of the said device to the unit 6. 3- of a body 17 ( fig.2) which contains cubicles 11 for barrettes 9. On the external face of the body 17 are arranged barrettes 8 which will be placed in cubicles 10.

SHEET OF EMP THIS ENT The plate 13 is movable in the compartment 12 (fig. 3). The movement is applied along the longitudinal axis of the device thanks to a hollow cylinder 18, the distal segment of which forms a circular disc 19 (fig. 3 and 5). The center 20 of this disc is open to allow passage to the central axis 3 of the stapler. Thus the disc 19 is located in front of the spatula 5 (fig. 5), the latter is made a passage in the cylinder 18 through the window 53. The disc 19 and the plate 13 are connected (fig. 3, 7 ) thanks to small bars 21 which are fixed along the internal edge of the plate 13. These small bars are located in small boxes 22 contained in the disc 19 where they can move in the same direction as the unit 6 during movements of the latter. this. Thus, the plate 13 can be propelled forward regardless of the distance from the unit 6 relative to the central axis of the stapler.

The segment 2 is also made up (fig. 2) of 2 parts with circular section, one of which 23 is fixed and constitutes the most distal part of the stapler. The other located behind the 23 is formed by a set of anvil holding units 24 arranged in a circular manner, which are movable relative to the part 23. The units 24 move in a plane perpendicular to the axis longitudinal of the stapler. Their sliding on the part 23 is made stable thanks to bars. Bars 25 integral with the units 24 are arranged on the outer edge of these and go to bed from outside inside, in cubicles 26 hollowed out in the fixed part 23. Bars 27 integral with the fixed part 23 are arranged at the edge internal of it and will lie from inside to outside in cubicles 28 dug in the units 24. These bars will increase the bearing surfaces between the units 24 and the part 23. When the units 24 have slipped out of part 23, the bearing surfaces between the 2 will remain parallel if a force is exerted on the rear face of the units 24.

Each unit 24 is functionally autonomous. It consists of: 1- a compartment 29 (fig. 8) anvil holder which contains rows of flattening staples 34. A partition 30 located at its internal edge which faces it and thus delimits with it a space 31 where the knife 15 is placed at the end of its stroke during the propulsion of the plate 13. 2- of a spatula 32 which is integral with it by its external end (ftg. 2) and which will transmit the movements of the device 35 of the central axis 3 3- of bars 25 and cubicles 28 (fig. 2).

The central axis 3 of the stapler (fig. 2) has a crucial role because it is it which will allow the movement of units 6 and 24 (fig. 2) in a plane peφendicular to the axis of the device and therefore to increase or decrease the diameter of the stapler head. On the other hand, it will fasten segments 1 and 2 together when needed. Finally it will make it possible to adjust the distance which separates segment 1 from segment 2. We will describe in detail its different constituents.

The axis 3 is composed (fig. 2) of a cylinder 36 which carries grooves 37 projecting at each of its ends. This cylinder is extended at each end by a cylinder 38 of diameter smaller than the cylinder 36. The cylinders 36 and 38 fit together by a mechanism which allows the free rotation of one relative to the other. The cylinder 38 which is located in front of the cylinder 36 is reversibly fixed in a cylindrical compartment of complementary diameter 39. The latter is integral with the fixed part 23

REMP ACE SHEET AND of segment 2 (fig. 1). The cylinder 38 which is located at the rear end of the cylinder 36 is in turn reversibly fixed in the cylinder 40 of complementary diameter. The latter is extended behind the cylinder 38 and its wall is filtered on its surface 41. The threading 41 is contained in a cylinder 63 of complementary threading. The rotation of the latter causes the displacement of the cylinder 40 backwards or forwards. This movement will make it possible to adjust the distance which separates the units 24 from the units 6. The cylinder 36 retains freedom of rotation about its longitudinal axis and remains removable. The rotation of the cylinder 36 is obtained by means of the cylinder 42, the front end of which has grooves 43 which protrude in its lumen. These will lean against other grooves 44 arranged on the surface of the rear end of the cylinder 36. The rotation of the cylinder 42 will thus cause the rotation of the cylinder 36 thanks to the backing of the grooves 2 cylinders.

The central axis 3 includes the devices 4 and 35 (fig. 2), the actuation of which enables the moving units 6 and 24 to be moved. The device 4 is formed by a cone 44, the outer surface 48 of which is filtered (fig. .2, 11). Its base is extended by a cylinder 45 (fig. 11) whose lumen is hollowed out by grooves 47 and its outer surface 49 is filtered. A hole of complementary caliber to the cylinder 36 is dug in the center of the assembly formed by the cone 44 and the cylinder 45 to allow passage to the cylinder 36 whose grooves 37 come to lean against those of the cylinder 45 (FIG. 9). The cylinder 45 is located in a fixed cylinder 50 (FIGS. 2 and 9) which is integral with the segment 1 and whose diameter is greater and complementary to the cylinder 45 and its internal surface 51 is filtered. The rotation of the cylinder 36 around its longitudinal axis (fig. 9) causes that of the cylinder 45 around the same axis. The rotation of the cylinder 45 in the cylinder 50 (fig. 2 and 9) will cause its translation in the longitudinal direction in the direction of the threading. Thus, when the cylinder 36 is put into rotation, the cone 44 is driven in a rotational movement around its longitudinal axis, and in a translational movement along the same axis.

The innermost end 52 of the spatula 5 is applied against the anterior end of the cone 44 (fig. 2). It has the shape of a curve segment (fig. 4). Its internal face 54 is filtered in a complementary manner to that of the cone 44. Its angle of inclination α relative to the axis of the spatula 5 is equal to that between the wall of the cone 44 against which it is applied and the top of it (fig. 2). The rotation of the cone 44 and its forward movement will bring circles of increasing size into contact with the spatula 5. The increase in the diameter of the circle which is in contact with the internal end of the spatula 5 can only be done at the expense of the latter by pushing it outwards. Com ^*** each spatula 5 is integral with a unit 6, it follows a displacement thereof towards the outside, and from there an increase in the diameter of segment 1 at its mobile units 6 (fig 1). The amplitude of this movement is variable according to the difference which exists between the diameter of the top and the base of the cone 44.

The rotation of the cylinder 36 is transmitted to the device 35 through a hollow cylinder 55 of greater diameter (FIG. 2). The device 35 is composed of a cone 33 whose surface is filtered and whose base located towards the front of the device is extended by a cylinder 56. The external surface 57 of this cylinder is filtered while on its internal surface 58 protrude from the grooves 59. The center of the device

35 leaves the passage to the cylinder 36 whose grooves 37 come to lean against those of the cylinder 56. This

REPLACEMENT SHEET the latter is placed in a cylinder 60 (integral with the fixed part 23 of segment 2) whose diameter is wider and whose internal surface 61 is filtered in a complementary manner. The rotation of the cylinder 36 will cause the rotation of the cylinder 56 thanks to the backing of their grooves 37 and 59. The rotation of the cylinder 56 in the cylinder 60 will cause the first in a translational movement along its longitudinal axis. The device 35 will therefore be driven in a rotational and translational movement around and along its longitudinal axis. Thus the rotation of the cylinder 36 induces a movement of rotation and translation of the devices 4 and 35 around and along the longitudinal axis of the device and this in a combined manner. According to the direction of the threading of their different constituents, the devices 4 and 35 will be animated by a conjugate movement and converging towards one another.

The internal end 62 of the spatula 32 has the shape of an arc of a circle (FIG. 2). Its internal surface is filtered in addition to that of the latter. It is inclined at an angle β which is equal to that formed by the side of the cone against which it is applied and the top of it. The end 62 of the spatula 32 is applied against the outer wall of the top of the cone 33. The translation and rotation of the device 35 takes place in a direction which will bring circles with increasing diameters of the cone 33 into contact with the end 62 of the spatula 32 which is therefore gradually pushed out. The amplitude of this movement is a function of the difference which exists between the dimensions of the top and the base of the cone 33. Each spatula 32 is integral with unit 24. Thus the activation of the device 35 will cause the progressive displacement of the units 24 arranged in a circle and from there an increase in the diameter of segment 2 at its mobile units 24 (fig. 1).

FEU-LLË ®ε REPLACEMENT

Claims

1- Apparatus for connecting hollow members by staples in a circular pattern, characterized in that its distal part called "the stapler head" comprises a segment 1 consisting of mobile autonomous units staple-knives 6, arranged in circle, and a fixed compartment 7 relative to which these mobile units move, a segment 2 consisting of mobile autonomous anvil holding units 24 arranged in a circle whose surfaces come into contact with the clips to close them and a fixed compartment 23 relative to which the mobile units 24 move, means for mounting and holding the staple-knife unit 6 to the fixed compartment 7 as well as means for holding the anvil unit 24 to the fixed compartment 23, a central axis 3 formed by a part of a cylinder 36 whose rotation allows the simultaneous and coordinated rotation and translation of the devices 4 and 35 inducing continuous modifications of the diameter of the stapler, and on the other hand a cylinder 40 reversibly fixed to the cylinder 36 and the translation of which causes the displacement of the segments 1 and 2 towards one another from a spaced-apart position for placing in place of the organs to be stapled up to a closed position for the ejection and the folding of the staples, the spatulas 5 integral with the mobile units 6 and whose ends 52 are applied against the surface of the device 4, they transmit directly to the mobile units 6 any modification of the diameter of the central axis 3 by moving them towards the outside or towards the inside of the stapler during the translation of the device 4, and of the spatulas 32 integral with the mobile units 24 and whose ends 62 apply against the surface of the device 35, they transmit directly to the mobile units 24 any change in the diameter of the central axis 3 by moving them outwards or inwards during the translation of the device 3 5.

- Apparatus according to claim 1, characterized in that it comprises cylinders 50 and 60, so that the devices 4 and 35 move in translation, simultaneously and of the same amplitude along the central axis 3.

- Apparatus according to claim 1 or 2 characterized in that the autonomous mobile units 6 staple-knife holders contain on the one hand staples and on the other hand a plate 13 supporting the pushers 14 and the knife 15 respectively serving l ejection of staples and section of stapled bodies.

- Apparatus according to claim 3, characterized in that the plate 13 is extended towards the central axis of the stapler by bars 21 and, it is movable in a compartment 12 thanks to a cylinder 18 whose distal segment forms a circular disc 19 and this, whatever the distance separating the unit 6 from the central axis 3 of the stapler.

REPLACEMENT SHEET