Title:
Tube for surgical purposes and method of preparing and using the same
United States Patent 2127903


Abstract:
The present invention relates to a tube of r absorbable animal material, a method of prepar- t ing the same and its use in surgery. The principal object of the invention is to provide a hollow tube of absorbable animal tissue having requisite rigidity and absorptive properties with minimum...



Inventors:
Arthur, Bowen
Application Number:
US7793036A
Publication Date:
08/23/1938
Filing Date:
05/05/1936
Assignee:
DAVIS & GECK INC
Primary Class:
Other Classes:
138/118, 139/388, 623/23.64
International Classes:
A61B17/11; A61F2/04
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Description:

The present invention relates to a tube of r absorbable animal material, a method of prepar- t ing the same and its use in surgery.

The principal object of the invention is to provide a hollow tube of absorbable animal tissue having requisite rigidity and absorptive properties with minimum tendency to cause irritation of animal tissue, to devise methods whereby the same may be readily prepared and to propose various uses and practical applications thereof for surgical purposes.

As long ago as 1774, Leconte advocated wrapping a section of a goose quill around a wounded blood vessel holding it in place with a ligature. Later Latteri and Petrinari reported the use of implanted magnesium tubes and quills of doves' feathers for end to end anastomosis of the severed common bile duct using such tubes and quills.

Today the use of Murphy buttons for end to end anastomosis of the severed or strictured intestinal tract is well known. Difficulties are encountered in these situations in that after the parts have healed, the non-absorbable tubes, or buttons must. be removed, accomplished usually by dislodgment and subsequent passage out of the system by the patient.

The present invention seeks to avoid the necessity of removal of such tubes by constructing them of a material which will be readily absorbed or digested by the body during or subsequent to the repair period.

To this end, the invention contemplates in its broadest aspect straight, angular, curved, Y or T tubes of absorbable animal tissue such, for instance, as the submucosa layer of animal intestinal tissue.

The invention further contemplates the manufacture of such tubes by forming the animal tissue into a tube. This may be done by wrapping, winding, spinning or forming the tissue over a mandrel or core, form pressing the tissue to shape and subsequently removing the core. For this purpose, the animal tissue may be in the form of threads, ribbons or a pulp to which a binder such as glue has been added so that upon formation of the material into a tube, the material will harden in that shape and maintain its form.

The invention further contemplates the use of such tubes as above described in a large number of practical applications and for surgical purposes. While a number of uses have been set forth herein, it is to be understood that they are mentioned as illustrative and typical only and are not to be construed in a limiting sense.

Perhaps the use to which tubesi Qf tis character nay be put may be readily separated into five ypes of situations as follows: 1. End to end, end to side, or side .to side inastomosis; 2. Transplantation of one duct into another; 3. Structural support for reconstruction or repair; 4. Used as an exterior sheath to protect a transplanted nerve, tendon or the like; 5. Used for drainage purposes, with or without wicks.

The invention further consists in the novel construction, arrangement and combination of parts, methods of manufacture and use more fully hereinafter described in the drawings. In the drawings: Fig. 1 shows a completed tube of this invention; Fig. 2 shows a modified form of tube with depressions in its end portions; Fg. 3 shows a collared bobbin; Fig. 4 is a modified bobbin or tube with collars at'each end; Fig. 5 shows a spool-shaped tube or bobbin; Fig. 6 illustrates a di-conical shaped tube; Fig. 7 shows a completed Y-tube; Fig. 7a illustrates a completed T-tube; Fig. 8 shows the method of wrapping tapes on a mandrel in the manufacture of a tube prior to form pressing where that is desirable; Fig. 9 shows a tube in the process of being formed from cords; Fig. 10 shows a tube in the process of being manufactured from woven strands; Fig. 11 is a composite view of a two-part mandrel for the manufacture of T-tubes; Fig. 12 shows the manner of winding a tape on the T-shaped mandrel of Fg. 11; Fig. 12a shows the completely wound strip on the T-mandrel; Figs. 13, 14 and 15 progressively illustrate a tube implantation in an end to end anastomosis using a T-tube.

Fig. 16 illustrates a method of implanting a straight tube in an end to end anastomosis; Fig. 17 illustrates a T-tube implantation in an end to side anastomosis; Fig. 18 illustrates the preparation for implantation of the common duct into the duodenum; Fig. .19 shows this operation complete except for suturing; Fig. 20 illustrates a side to side anastomoss; Fg. 21 illustrates a severed nerve about to have Its edges approximated; .igs. 21a, 21b and 21c show the method of 5 approximating the edges of a severed nerve ax its protection by an absorbable tube.

Referring'now with particularity to the drav ngs, in Fig. 1 there is shown perhaps the ma common type of tube or bobbin, to wit: a straigh hollow element of elongated nature, the dimer sions of such an article being variable, of cours dependent upon the situation In which it is I be used. The words "tube" and "bobbin" ai herein used Interchangeably as their differenc relates only to dimensions. A short, stubby tub may be termed a bobbin.

In Fig. 2, a modified form of tube is shown at having a slightly depressed groove 3 at the en portion thereof. This form Is particularly de sirable in an end to end anastomosis in that 1 facilitates ligaturing the incised ends of the duel In Fg. 3, a tube Is shown at 4 having a colla 5 at one end which may be desirable in somi instances.

In Fig. 4, the tube 4 s provided with collars I and' 6 at each end.

In Pig. 5, a spool shaped tube 7 is shown whicl involves all of the desirable attributes of th< tube of Fg. 2 in that ligaturing is facilitated The spool shape of the tube may be furthe, accentuated into the form shown In Fig. 6 wherE at 8 the tube is diconical In shape, that is, 1< consists essentially of two frustro-conical configurations with their smaller bases contiguous In Fgs. 7 and 7a, Y and T shaped tubes are shown respectively.

In manufacturing these shapes, any suitable absorbable animal material may be utilized which will have or can be made to have desirable rigidity, absorbability 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 the submucous layer of animal intestinal tissue.

This material in either the form of threads or ribbons may then be wound over a metal or other form to give t the desred shape. For instance in Fig. 8 a ribbon 9 may be spirally wound over a metal form 10, slightly overlapping the convolutions, and the core 10 subsequently removed after the ribbon has been permitted to assume a self-sustaining condition.

In Fig. 9, threads I I are spirally wound, woven or spun over the core 10 in the same manner as recited for that of Fig. 8. It has been found that in this type of manufacture the contact of the threads with each other is sufficient to cause a coalescence therebetween with the result that an eventually integral construction results.

In Mg. 10, a modified form of weaving is shown over the core 10, 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 shown in Fg. 11. There one arm is shown at 12 having a threaded socket II in which the leg 14 may be screwed. Obviously where a Y tube is desired Instead of a T, the arm 2 may assume a V shape. In manufacturing a T tube from the two-part core of ig. 11, reference Is had to Figs. 12 and 12a using preferably a ribbon material, such for instance, as Is shown in ig. 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 criss-crossed 78 down the leg 14 to the end, back again upon id itself and out to the opposite end of the arm 12.

Where desired, a second or any number of addir- tional layers may be superimposed in the same st manner and beginning at the opposite end of the t, arm 12. When the winding has been completed i- and the material is self-sustaining, the core may e, be disconnected by unscrewing the leg 14 from ;o the arm 12 followed by subsequent removal of re the latter.

:e Obviously, absorbable straight, Y or T tubes e of anmial tissue may be made also by winding or spinning gut threads or narrow gut ribbons or 2 strips spirally or transversely over a form and d held together by a binder of glue or similar - substance.

t In all cases, it is desirable to form press the Smaterial of the tubes or bobbins to shape, either r With or without heat as this materially assists in bringing the tube to a self-sustaining condition with smooth surfaces. This action, there- 20 Sfore, eliminates to a great extent the irregularities in the surface of the articles shown, for Instance, h in Figs. 8, 9, 10, 12 and 12a.

S For the purpose of retarding absorption by animal tissue, the absorbable tubes hay be furr ther treated. The methods which I have devised Sfor the purpose may consists of: (1) immersion Sof 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 parafne; and (5) coating the tube with resinous material.

Various surgical situations In which the absorbable tubes of animal membrane which I have devised may be used will now be recited although 3 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 contrasy, is to be construed broadly as any use to which the tubes of this 40 invention may be put from a surgical standpoint is to be considered as coming within the purview of the Invention.

I. Surgery of the bilary tract 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-shaped tube of the same . Figs. 13, 14 and 15 progresilvely illustrate such an impaintation. The two ends of the severed common bile duct are shown at II through which sutures II have been sewn. In Fig. 14, the severed ends 15 have been partially approximated and at this oint a T tube II of the invention has been Inserted in the two ends -as shown in Fg. 15. The approximation of the severed ends II of the duct is then completed by further manipulation of the sutures.

2. End to end anastomosis of the hepatic duct to the common bile duct over an implanted straight tube of aborbable 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 I8, sutures II being held by the usual forceps fl. The anastomosis Is completed in much the same manner as recited above with reference to Fig. 15. Pg. 17 shows an absorbable T-tube 1T applied to the same situation as In Fig. i3 except that the hepatic duct It has been anas icti ed direct to the duodenum 1S through an l'i::-- portion thereof. 3. Transplantation of the common bile duct to (a) duodenum, (b) stomach, (c) jejunum, (d) colon, using an implanted straight tube or Tshaped tube of absorbable animal tissue for direct implantation or by use of the Coffey technique.

Fig. 18 illustrates an incision 21 made in the duodenum 20 by means of scalpel 22 and the common duct 15 with sutures 16 attached and carrying curved needles 23 ready for implantation. Fig. o 19 shows the manner of implantation of the common duct 15 into the duodenum 20 by means of astraight 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 animal membrane 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 o01 me uremra with au wusorbable tube of animal membrane as a supporting tunnel.

2. Reconstruction of cut, stenosed, or strictured 30 vas deferens.

3. Direct end to end anastomosis of cut or strictured ureter over the implanted absorbable tube.

The development of 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 Interference with urinary flow and (d) absorption.

4. Tight suture after ureterotomy, using the 40 implanted absorbable tube to facilitate suturing and to support the lumen of the sutured ureter..

5. Utero-intestinal anastomosis, implanting a sufficient length of the absorbable tube in the lumen of the transplanted ureter to maintain its 45 patency 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 M the absorbable tube as a tunnel through which to maintain urinary flow and over which as a structural support to reconstruct the wall of the urethra.

III. Gynecology 55 1. Plastic reconstruction of a strictured lumen or fimbriated end of the Fallopian tube to maintain patency.

2. Reconstruction and maintenance of the lumen of the remaining end of the Fallopian tube 60 after removal of tubal pregnancy, especially in those cases where a previous salpingectomy on the 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 65 the uterine end of 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.

70 IV. Vascular surgery End to end anastomosis of veins, arteries, and lymphatic ducts. In all previous methods, an attempt was made to splint the suture line and 75 permit the flow of blood; but never has an absorbable 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 5 strictured or severed salivary ducts.

VI. Gastro-intestinal surgery 1. Anastomosis of gallbladder to stomach, duodenum or jejunum for the purpose of maintaining 10 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, (c) it permits drainage of intestinal contents through a patent jmunen, (d) it avoids the necessity of performing-enterostomy for decompression above sutured anastomosis, (e) the bobbin absorbs without the possibility of causing intestinal obstruction during passage.

3. To' maintain the patency of gastro-enter- 23 ostomy opening. The technic of gallbladder anastomosis is shown in Fig. 20. In that figure the gallbladder is shown at 24 anastomosed in a side to side relationship with the stomach by means of a collared absorbable tube 4. Obvi- 30 ously the same type of anastomosis may be made between the gallbladder and the duodenum.

VII. Ortopedic surgery 1. In tendon suturing, a sutured tendon may 35 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 (c) creation of a residual tunnel of surrounding tissue after the absorbable tube of animal tissue has been absorbed.

2. In tendon transplantation, a sufficient length of the absorbable tube of animal membrane of suitable caliber is split longitudinally on one side, the edges separated and the tendon placed within the tube. A few interrupted sutures are placed to approximate the cut edges of the absorbable tube, 50 several of these sutures being left long to be used to anchor the tube to the surrounding tissues by suturing.

VIII. Neuro-surgery To deposit a sutured nerve within the sheath 55 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 21b, a suitable length and diameter of absorbable tube of animal 60 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 o5 and threaded on a needle and used to anchor the tube in place over the sutured nerve, as shown in Fig. 21c. In such cases, a lubricant may be interposed between the implanted organ and the tube. 70 IX. Drainage tubes with or without wicks The use of the absorbable tubes of animal membrane as drainage tubes, with or without axially located wicks, especially in regions where Is L·~~ __~_LL-- ~-LCI- Il~~ki 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 tue 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 specific embodiments, it is to be understood that 29 it is not to be limited thereto, but is to be construed broadly, and limited only by the scope of the claims.

I claim: 1. As a complete article of manufacture, a tube ",i of absorbable animal material.

2. As a complete article of manufacture, a Ytube of absorbable animal material.

3. As a complete article of manufacture, a Ttube 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.