Title:
SURGICAL INSTRUMENT FOR SUTURING TISSUES AND ORGANS WITH METAL STAPLES
United States Patent 3795034
Abstract:
A surgical instrument for suturing tissues and organs with metal staples incorporates a supporting body which at one of its ends carries a supporting jaw which has a flat area on which three parallel rows of depressions are provided, adapted for the ends of the staple legs to bend, two of said three rows serving for applying a double-stitch suture to all the layers of the tissue being sutured, the remaining row is for the application of a single-stitch suture to the upper layer of that tissue. Part of the supporting jaw carrying said one row of depressions is made detachable. The instrument has a staple body, having a hollow head into which is inserted a staple magazine, and staple ejectors for the staples to be driven out therefrom, as well as actuators for an independent motion of the staple ejectors and the staple body. The instrument is capable if application of both a double-stitch suture with subsequent invagination thereof and the application of a single-stitch suture, and a single-stitch suture alone.
Inventors:
Strekopytov, Alexei Alexeevich (Moscow, SU)
Strekopytova, Tatyana Andreevna (Moscow, SU)
Androsova, Tamara Pavlovna (Moscow, SU)
Androsov Deceased., Pavel Iosifovich (Moscow, SU)
Strekopytova, Tatyana Andreevna (Moscow, SU)
Androsova, Tamara Pavlovna (Moscow, SU)
Androsov Deceased., Pavel Iosifovich (Moscow, SU)
Application Number:
05/251696
Publication Date:
03/05/1974
Filing Date:
05/09/1972
View Patent Images:
Export Citation:
Primary Class:
Other Classes:
29/213.100, 227/19
International Classes:
A61B17/072; A61B17/068; B23Q7/10
Field of Search:
29/212D,212R,211R,28D
Primary Examiner:
Eager, Thomas H.
Attorney, Agent or Firm:
Holman & Stern
Claims:
What is claimed is
1. A surgical instrument for suturing tissues and organs with metal staples, comprising: an oblong supporting body having at one of its ends a main portion, and a supporting jaw arranged crosswise of said oblong body, said jaw featuring a flat area facing the main portion of the body; three parallel rows of depressions on said flat area of the jaw, adapted for bending the ends of the staple legs, two of said rows of depressions serving for applying a double-stitch suture to all the layers of the tissue being sutured, while the third row is provided for application of a single-stitch suture to layers of the tissue being sutured; said supporting jaw having a detachable portion which carries one row of said depressions adapted for the application of said single-stitch suture, a staple body having an oblong hollow tailpiece slidable along said supporting body and a hollow head open at an end of said tailpiece, said hollow head facing with its open end said flat area of the supporting jaw; a staple magazine adapted to be inserted into said hollow head and provided with three rows of open-ended slots to accommodate metal staples therein, said rows of open ended slots being arranged in strict correspondence with said three parallel rows of depressions located on the flat area of the supporting jaw; a screw-and-nut mechanism associated with said supporting body and said hollow tailpiece of the staple body for the staple body to travel with respect to said supporting body, whereby said staple body approaches said flat area of said supporting jaw to force the tissue being sutured thereagainst; two staple ejectors having elongated stems capable of independently sliding along said tailpiece of the staple body, transverse heads being provided at the ends of said staple ejectors carrying three parallel rows of ejecting projections adapted to engage said slots in the magazine when the staple ejectors are moving; and means to impart independent motion to said staple ejectors with the result that said ejecting projections drive out the staples from the magazine slots.
2. A surgical instrument as claimed in claim 1, wherein the supporting jaw of the supporting body comprises a tapered first jaw portion which is nondetachable from the instrument, said first jaw protion carrying thereon said two rows of depressions, and a second detachable jaw portion which carries said third row of depressions, whereby, the instrument may be used with said detachable jaw detached, so as to facilitate suturing of small-length organs and so as to facilitate introduction of the instrument into less accessible places in a zone of the organ being sutured.
1. A surgical instrument for suturing tissues and organs with metal staples, comprising: an oblong supporting body having at one of its ends a main portion, and a supporting jaw arranged crosswise of said oblong body, said jaw featuring a flat area facing the main portion of the body; three parallel rows of depressions on said flat area of the jaw, adapted for bending the ends of the staple legs, two of said rows of depressions serving for applying a double-stitch suture to all the layers of the tissue being sutured, while the third row is provided for application of a single-stitch suture to layers of the tissue being sutured; said supporting jaw having a detachable portion which carries one row of said depressions adapted for the application of said single-stitch suture, a staple body having an oblong hollow tailpiece slidable along said supporting body and a hollow head open at an end of said tailpiece, said hollow head facing with its open end said flat area of the supporting jaw; a staple magazine adapted to be inserted into said hollow head and provided with three rows of open-ended slots to accommodate metal staples therein, said rows of open ended slots being arranged in strict correspondence with said three parallel rows of depressions located on the flat area of the supporting jaw; a screw-and-nut mechanism associated with said supporting body and said hollow tailpiece of the staple body for the staple body to travel with respect to said supporting body, whereby said staple body approaches said flat area of said supporting jaw to force the tissue being sutured thereagainst; two staple ejectors having elongated stems capable of independently sliding along said tailpiece of the staple body, transverse heads being provided at the ends of said staple ejectors carrying three parallel rows of ejecting projections adapted to engage said slots in the magazine when the staple ejectors are moving; and means to impart independent motion to said staple ejectors with the result that said ejecting projections drive out the staples from the magazine slots.
2. A surgical instrument as claimed in claim 1, wherein the supporting jaw of the supporting body comprises a tapered first jaw portion which is nondetachable from the instrument, said first jaw protion carrying thereon said two rows of depressions, and a second detachable jaw portion which carries said third row of depressions, whereby, the instrument may be used with said detachable jaw detached, so as to facilitate suturing of small-length organs and so as to facilitate introduction of the instrument into less accessible places in a zone of the organ being sutured.
Description:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to medical equipment and is concerned particularly with surgical instruments for suturing tissues and organs. The proposed instrument is applicable for suturing gastric stumps, duodenum, small and large intestines, pulmonary tissues and certain other organs as well.
2. DESCRIPTION OF PRIOR ART
Known in the present state of the surgical art is a surgical instrument for suturing tissues and organs with metal staples (cf., U.S. Pat. No. 3,252,643), having an oblong supporting body carrying at one of its ends a supporting jaw which is arranged crosswise with respect to the main oblong portion of the body and a flat area that faces the main portion of the body. Provision is made on the flat area of the jaw for three parallel rows of depressions for the ends of the staple legs to bend. Two rows of depressions out of said three rows serve to establish a double-stitch suture featuring a staggered arrangement of the staples, whereby the obtained suture is made tight and hemostatic. Said suture is applied across all the layers of the tissue being sutured. One row of said depressions serves to obtain a single-stitch suture which is applied only to upper layers of the tissue being sutured.
Provision is made on flat area of the supporting jaw for projections with holes for the needles to fix the tissue or organ being sutured in the instrument. The oblong portion of the supporting body is made box-shaped to accomodate the staple body thereinside. Provision is made in the tail portion of the supporting body for a through opening for the projection of the staple body to accommodate and a shoulder upon which rests a screw enabling the staple body to travel with respect to the supporting body. The screw is left-hand threaded to be turned into the projection of the staple body.
The staple body is made as an oblong hollow tailpiece or tang carrying at one of its ends a hollow head which is open towards the flat area of the supporting jaw. The staple body is mounted slidably along the supporting body. A change staple magazine is fitted into the hollow head of the staple body, said magazine being provided with three rows of open-end slots adapted to accommodate metal staples, and projections with holes into which the needle is inserted to fix the tissue or organ being sutured in the instrument.
Three rows of open-end slots in the magazine are arranged in strict correspondence with the three rows of depressions provided on the flat area of the supporting jaw. To eject and drive out the staples from the magazine slots and bend them in the depressions of the supporting jaw, two staple ejectors are provided, viz., a double-row ejector and a single-row ejector. Each ejector is made as an elongated stem terminating in a transverse head which carries ejecting projections made in correspondance with the magazine slots.
The staple ejectors are mounted in the oblong hollow tailpiece of the staple body with a possibility of independently sliding therein. Movement of the ejectors results in the ejecting projections engaging the magazine slots to drive the staple out therefrom.
The elongated stems of the staple ejectors terminate in threaded tailpieces or tangs, whereon nuts are screwed with which the ejectors interact with the tailpiece of the staple body.
Motion to each of the ejectors is imparted from a detachable key which interacts with the nut provided on the ejector tang.
The length of stroke of the staple ejectors towards the supporting jaw of the supporting body is limited by a stop made as a fork capable of being inserted into the staple body from above.
The position assumed by said stop in the staple body is so selected that the staple ejectors would stop moving just after the staples have been ejected from the magazine and the ejecting projections prove to be somewhat extended from the magazine slots. Such a restriction of motion of the staple ejectors is necessary to preclude trauma of the tissues being sutured which is likely to be inflicted thereupon by the ejecting projections which, being driven out from the slots of the magazine, might bite into the tissue being sutured.
A restricting fork is detachably fitted into the head of the staple body to prevent the tissue or organ being sutured from slipping off the instrument.
When in use the afore-discussed surgical instrument is so positioned by the surgeon that the supporting jaw is located beneath the tissue or organ being sutured and the whole tissue or organ is arranged between the flat area of the supporting jaw and the working face of the staple magazine fitted in place in the head of the staple body. Then the tissue or organ being sutured is fixed in place from above by the restricting fork; thereupon the surgeon starts rotating the staple body driving nut, thus causing the latter to approach the supporting jaw until it assumes the position, wherein a necessary suturing gap is established in between the flat area of the supporting jaw and the working face of the magazine. Next, needles are introduced into the holes in the projections of the supporting jaw and magazine to prick the surfaces of the tissue or organ being sutured that are crimped in between the afore-said projections, thereby fixing said tissue or said organ to the instrument. The surgeon may proceed to suturing the tissue with a double-stitch suture as soon as all the above-described operations are carried out. To this end, a detachable key is fitted into the nut on the tailpiece of the double-row staple ejector and rotated there to exert the staple ejector forward towards the supporting jaw. This results in the staple ejecting projections passing through the magazine double-row slots to eject the staples therefrom. The staples, having pierced the tissue being sutured, rest against the depressions located on the flat area of the supporting jaw, thus getting bent to assume the B-shape. After that the part of the tissue to be removed is excised by a scalpel exactly along the edge of the instrument. This is followed by the application of a single-stitch suture. To this end, the staple body is retracted from the supporting jaw by 5-6 mm and the previously obtained double-stitch suture is invaginated throughout its length into the interior of the sutured organ. Further, the staple body is brought near the supporting jaw again to clamp the tissue being sutured therebetween. The detachable key having been refitted from the nut of the double-row staple ejector to the nut of the single-row ejector, the latter nut is rotated to exert the single-row ejector towards the supporting jaw. The ejecting plates, while passing through the slots of the magazine, push out the staples therefrom which, having pierced the external sheaths of the organ being sutured, get bent in the depressions of the flat area of the supporting jaw.
Suturation over, the needles fixing the tissue being sutured are removed, the staple body is withdrawn from the supporting jaw and the instrument is taken off from the thus-sutured organ.
Suturing of organs with a double-stitch suture followed by the invagination of the latter and application of a single stitch, suture, is conducive to better healing, and prevents formation of postoperative commissures or fistulas.
However, the afore-described instrument is widely applicable particularly in suturation of the organs of the alimentary tract or canal, wherein the application of a double-tiered invaginated suture is involved, consisting of a double-stitch suture through all the layers of the tissue being sutured and a single-stitch suture applied to the upper layers of said tissue, whereas for suturation of the tissues and organs of the thoracic cavity for instance some other instruments are in more frequent use featuring smaller size of the working members and capable of applying only a double-stitch suture to all the layers of the tissue being sutured. This makes it necessary to have a rather wide range of instruments at disposal, capable of application of a variety of sutures and featuring different sizes of the working members thereof, which however is economically unreasonable.
Moreover, too large a width of the supporting jaw of the instrument renders it inapplicable for suturing small-length organs and hampers its passing through narrow channels or ducts in tissues.
SUMMARY OF THE INVENTION
It is therefore an essential object of the present invention to provide such a surgical instrument for suturing tissues and organs with metal staples whose design would make it suitable for use both on the organs of the abdominal cavity and on those of the thoracic cavity and which would be capable of applying both a double-stitch suture with subsequent invagination thereof by way of a single-stitch suture, and a double-stitch suture penetrating through all the layers of the tissue being sutured, furthermore, the working portion of the surgical instrument being of small size to enable its passage through narrow and profound channels or ducts in tissues and to enable the application of sutures to small-length organs.
Said object is attained due to the fact that in a surgical instrument for suturing tissues and organs with metal staples, comprising an oblong supporting body carrying at one of its ends a supporting jaw arranged crosswise with respect to the main oblong portion of the body and having a flat area facing said main portion of the body, said flat area carries three parallel rows of depressions adapted for the ends of the staple legs to bend, of which two rows serve for the application of a double-stitch suture to all the layers of the tissue being sutured, while one row serves for the application of a single-stitch suture to the upper layers of the tissue being sutured the surgical instrument further comprises a staple body made as an elongated hollow tailpiece terminating in a hollow head which is open towards the flat area of the supporting jaw, said staple body being slidable along the supporting body, a staple magazine adapted to be inserted into said hollow head and provided with three rows of open-end slots for metal staples to be accommodated, said slots being arranged in exact correspondence with the three rows of depressions on the flat area of the supporting jaw; a screw-and-nut mechanism associated with the supporting body and the tailpiece of the staple body is provided for the staple body to move with respect to the supporting body; two staple ejectors having elongated stems mounted with a possibility of independent sliding along the tailpiece of the staple body are provided, said stems terminating in transverse heads which carry staple ejecting projections adapted when the ejectors are moving, to engage the slots of the magazine to drive out staples therefrom, as well as means to impart independent motion to said staple ejectors; further according to the invention, part of the supporting jaw of the supporting body that carries one row of depressions adapted to apply a single-stitch suture to the upper layers of the tissue being sutured, is made detachable.
It is expedient that the non-detachable portion of the supporting jaw of the supporting body that carries two rows of depressions adapted to establish a double-stitch suture, be taper-shaped which makes it suitable for being introduced into hard-of-access places within the zone of the organ being sutured and for suturing small-length organs.
The proposed surgical instrument is suitable to be used both on the organs of the abdominal cavity and on those of the thoracic cavity and is capable of applying both a double-stitch suture with subsequent invagination thereof and suturing the upper tissue layers, and a double-stitch suture alone applied to all the layers of the tissue being sutured.
Besides, the detachable construction of the supporting hook of the proposed instrument allows it to be passed through narrow and profoundly located channels or ducts in tissues and placed under small-length organs to apply a suture thereto.
BRIEF DESCRIPTION OF THE DRAWINGS
An embodiment of the present invention will now be considered in conjunction with the accompanying drawings, wherein:
FIG. 1 is a schematic side elevation, partly in section, of a surgical instrument for suturing tissues and organs with metal staples according to the invention;
FIG. 2 is an enlarged-scale sectional view taken on the line III--III in FIG. 1;
FIG. 3 is a plan view, partly in section, of a surgical instrument for suturing tissues and organs, according to the invention;
FIG. 4 is an enlarged-scale view of a staple magazine, taken substantially along the arrow A in FIG. 1; and
FIG. 5 is an enlarged-scale cross-sectional view of a supporting jaw and a staple magazine when brought together.
DESCRIPTION OF PREFERRED INVENTIVE EMBODIMENTS
Now referring to FIG. 1, the surgical instrument for suturing tissues and organs with metal staples comprises an oblong supporting body 1 having at one of its ends a supporting jaw 2 arranged crosswise with respect to the main oblong portion of the supporting body 1 and having a flat area 3 facing the main portion of the supporting body 1. The flat area 3 carries three parallel rows of depressions 4, 5, 6 (FIG. 2) adapted for the ends of the staple legs to be bent. Two rows of the depressions 4 and 5 out of said three rows serve for application of a double-stitch suture with the staples arranged in a staggered relation, whereby tightness and good hemostatic properties of the performed suture are attained. The suture is applied to all the layers of the tissue being sutured. The row of the depressions 6 serves for establishing a single-stitch suture which is applied only to the upper layers of the tissue being sutured.
Provision is made on the flat area 3 (FIGS. 1, 2) for projections 7 with holes into which is inserted a needle 8 to fix the tissue or organ being sutured in the instrument.
The supporting jaw 2 is made composite and comprises two detachable portions 9 and 10 (FIGS. 2, 3), the portion 9 of the supporting jaw 2 having two rows of the depressions 4 and 5 (FIG. 2) for a double-stitch suture to be applied, whereas the portion 10 of the supporting jaw 2 has one row of the depressions 6 for a single-stitch suture to be applied.
The portion 10 of the supporting jaw 2 carrying the depressions 6 for a single-stitch suture is made detachable.
The non-detachable portion 9 of the supporting jaw 2 is taper-shaped which facilitates its being introduced into hard-of-access places within the zone of the organ being sutured.
Quick assembly and dissembly of the portions 9 and 10 of the supporting jaw 2 is effected by means of locks consisting of two shaped holes 11 and 12 (FIG. 1) provided in the non-detachable portion 9, a shaped pin 13 made fast on the detachable portion 10 (FIG. 2) and adapted to engage the shaped hole 11 in the non-detachable portion 9, and a shaped hole in the detachable portion 10 coaxial with the shaped hole 12 in the non-detachable portion 9, into which two holes a detachable lock is adapted to fit, said lock incorporating a shaped pin 14 and a springy platelet 15 (FIGS. 1, 2).
The central oblong portion of the supporting body 1 (FIGS. 1, 3) is box-shaped to accomodate a staple body 16 therein. The tail portion of the supporting body 1 has a through opening 17 (FIG. 1) to accommodate a projection 18 of the staple body 16, and a shoulder 19 upon which a nut 20 rests, said shoulder enabling the staple body 16 to travel with respect to the supporting body 1. The nut 20 is left-hand threaded and is adapted to be turned into the projection 18 of the staple body 16.
The staple body 16 is made as an elongated hollow tailpiece or tang having a hollow head 21 at one of its ends, said head being open towards the flat area 3 of the supporting jaw 2.
A change staple magazine 22 (FIGS. 1, 4) is fitted into the hollow head 21 of the staple body 16. The magazine 22 is provided with three rows of open-end slots 23, 24, 25 (FIGS. 4, 5) adapted to accommodate metal staples, and with projections 26 with holes into which a needle 27 is inserted to fix the tissue or organ being sutured, with respect to the instrument. The three rows of the open-end slots 23, 24, 25 of the magazine 22 are arranged in an exact correspondence with the three rows of the depressions 4, 5, 6 (FIG. 5) on the flat area 3 of the supporting jaw 2. To eject and drive out the staples from the slots 23, 24, 25 (FIG. 4) of the magazine 22 and bend them in the depressions 4, 5, 6 of the supporting jaw 2, provision is made for two staple ejectors, viz., a double-row ejector 28 (FIG. 3) and a single-row ejector 29. Each of the ejectors 28 and 29 is made as an elongated stem terminating in a transverse head which carries staple ejecting projections 30 made in an exact correspondence with the slots 23, 24, 25 (FIG. 4) of the magazine 22.
The staple ejectors 28, 29 (FIG. 3) are independently slidable in the elongated hollow tailpiece of the staple body 16. With the staple ejectors 28, 29 moving, the ejecting projections 30 engage the slots 23, 24 and 25 (FIG. 4) of the magazine 22 to drive out the staples (not shown) therefrom.
The elongated stems of the staple ejectors 28, 29 (FIG. 3) terminate in threaded shanks 31 and 32 onto which nuts 33 and 34 are screwed, whereby the ejectors 28, 29 get interconnected with the tailpieces of the staple body 16.
Motion to each of the ejectors 28 and 29 is imparted from a detachable key 35 (FIG. 1) adapted to interact with the corresponding nut 33 or 34 on the shank of the ejector 28 or 29.
Advancing of the ejectors 28, 29 (FIG. 3) towards the supporting jaw 2 (FIG. 1) of the supporting body 1 is limited by a stop 36 made as a fork adapted to be fitted into the staple body from above.
The position assumed by the stop 36 in the staple body 16 is so selected that the staple ejectors 28 or 29 (FIG. 3) stop moving just after the staples have been ejected and the ejecting projections 30 get flush with the working face of the magazine 22. Such a restriction of the motion of the ejectors 28, 29 is necessary to preclude trauma of the tissues being sutured that might be inflicted thereupon by the ejecting projections 30 which, having pushed out the staples from the slots of the magazine 22, might bite into the tissue.
A fork limiter 37 (FIG. 1) is detachably fitted into the head of the staple body 16 which prevents the tissue or organ being sutured from slipping off the instrument.
When applying a double-stitch suture with subsequent invagination thereof and application of a single-stitch suture to the upper layers of the tissue being sutured, the surgical instrument for suturing tissues and organs with metal staples operates as follows.
During operation, the instrument is so positioned by the surgeon that the supporting jaw 2 should be located under the tissue of organ being sutured in such a way that the entire tissue or organ is arranged in between the flat area 3 of the supporting jaw 2 and the working face of the staple magazine 22 that looks on the supporting jaw 2, said magazine being fitted in the head 21 of the staple body 16. Then the tissue or organ is fixed from above with the fork limiter 37, whereupon the surgeon starts rotating the nut 20 of the staple body 16 actuator, causing the latter to approach the supporting jaw 2 till such a position, wherein a necessary suturing gap is established in between the flat area 3 of the supporting jaw 2 and the working face of the magazine 22, said gap being checked against the notches provided on the projection 18 of the staple body 16 and on the tailpiece of the supporting body 1.
Next, the needles 8 and 27 are inserted into the holes in the projections 7 and 26 of the supporting jaw 2 and the magazine 22, said needles piercing the surfaces of the tissue or organ being sutured that are corrugated in between the projections 7 and 26, thereby fixing said tissue or said organ to the instrument. Suturing of the tissues with a double-stitch suture may be started as soon as the above-described operations are carried out. To this end a detachable key 35 is fitted into the nut 33 on the shank of the double-row staple ejector 28 and rotated there to exert the ejector 28 forward towards the supporting jaw 2. This results in the ejecting projections 30 passing through the corresponding slots 23, 24 (FIG. 5) of the magazine 22 to eject the staples (not shown) therefrom. The staples, having pierced the tissues being sutured, rest against the depressions 4, 5 located on the flat area 3 of the supporting jaw 2 to be bent into the B-shape. Thereupon, the part of the tissue to be removed is excised by a scalpel exactly along the edge of the instrument. This is followed by the application of a single-stitch suture. To this end, the staple body 16 (FIG. 1) is withdrawn from the supporting jaw 2 by 5-6 mm and the double-stitch suture obtained previously is invaginated throughout its length into the interior of the sutured organ. Further, the staple body 16 is brought closer to the supporting jaw 2 again to clamp the tissue being sutured therebetween. Having refitted the detachable key 35 from the nut 33 of the double-row ejector 28 into the nut 34 (FIG. 3) of the single-row ejector 29 and rotating the key 35 the surgeon causes the single-row ejector 29 to move towards the supporting jaw 2. The ejecting projections 30, while passing through the slots 25 (FIG. 5) of the magazine 22, drive out the staples therefrom which, having pierced the external sheaths of the organ being sutured, get bent in the depressions 6 of the flat area 3 of the supporting jaw 2. To complete the suturing procedure, the fixing needles 8, 27 (FIG. 1) are removed, the staple body is retracted from the supporting jaw 2 and the instrument is taken off the thus-sutured organ.
Suturing of organs with a double-stitch suture followed by the invagination of the latter and application of a single-stitch suture as mentioned earlier, contribute to better healing and prevent the formation of postoperative commissures or fistulas.
In case a double-stitch suture alone is to be applied, the proposed surgical instrument operates as follows.
Before the use of the instrument, the detachable portion 10 (FIG. 3) of the supporting jaw 2 with depressions for a single-stitch suture, is disconnected therefrom with the result that the supporting jaw 2 gets substantially narrower and, consequently, more convenient for being placed underneath small-length organs or for passing it via narrow channels or ducts in tissues.
Then the surgeon positions the instrument in such a way that the portion 9 of the supporting jaw should be located beneath the tissue or organ being sutured and the entire tissue or organ is arranged in between the flat area 3 of the supporting jaw 2 and the working face of the staple magazine 22 fitted into the head 21 (FIG. 1) of the staple body 16. Thereupon, the tissue or organ is fixed from above with the fork limiter 37, and the surgeon starts rotating the nut 20 of the staple body 16 actuator, thus causing said body to approach the supporting jaw 2 until a necessary suturing gap is established in between the flat area 3 of the supporting jaw 2 and the working face of the magazine 22.
This done, the suturing operation may proceed. To this end, the detachable key 35 is fitted into the nut 32 provided on the shank of the double-row staple ejector 28 and rotated to exert the ejector 28 forward towards the supporting jaw 2. As a result the ejecting projections 30 pass through the double-row slots of the magazine 22 and drive out the staples therefrom.
The staples, having pierced the tissues being sutured, rest against the depressions 4, 5 (FIG. 5) located on the flat area 3 of the supporting jaw 2 and get bent to assume the B-shape. After that, any part of the tissue to be removed is excised by a scalpel exactly along the edge of the instrument next the staple body 16 (FIG. 1) along with the magazine 22 is withdrawn from the sutured organ and the instrument is taken off.
1. Field of the Invention
The present invention relates to medical equipment and is concerned particularly with surgical instruments for suturing tissues and organs. The proposed instrument is applicable for suturing gastric stumps, duodenum, small and large intestines, pulmonary tissues and certain other organs as well.
2. DESCRIPTION OF PRIOR ART
Known in the present state of the surgical art is a surgical instrument for suturing tissues and organs with metal staples (cf., U.S. Pat. No. 3,252,643), having an oblong supporting body carrying at one of its ends a supporting jaw which is arranged crosswise with respect to the main oblong portion of the body and a flat area that faces the main portion of the body. Provision is made on the flat area of the jaw for three parallel rows of depressions for the ends of the staple legs to bend. Two rows of depressions out of said three rows serve to establish a double-stitch suture featuring a staggered arrangement of the staples, whereby the obtained suture is made tight and hemostatic. Said suture is applied across all the layers of the tissue being sutured. One row of said depressions serves to obtain a single-stitch suture which is applied only to upper layers of the tissue being sutured.
Provision is made on flat area of the supporting jaw for projections with holes for the needles to fix the tissue or organ being sutured in the instrument. The oblong portion of the supporting body is made box-shaped to accomodate the staple body thereinside. Provision is made in the tail portion of the supporting body for a through opening for the projection of the staple body to accommodate and a shoulder upon which rests a screw enabling the staple body to travel with respect to the supporting body. The screw is left-hand threaded to be turned into the projection of the staple body.
The staple body is made as an oblong hollow tailpiece or tang carrying at one of its ends a hollow head which is open towards the flat area of the supporting jaw. The staple body is mounted slidably along the supporting body. A change staple magazine is fitted into the hollow head of the staple body, said magazine being provided with three rows of open-end slots adapted to accommodate metal staples, and projections with holes into which the needle is inserted to fix the tissue or organ being sutured in the instrument.
Three rows of open-end slots in the magazine are arranged in strict correspondence with the three rows of depressions provided on the flat area of the supporting jaw. To eject and drive out the staples from the magazine slots and bend them in the depressions of the supporting jaw, two staple ejectors are provided, viz., a double-row ejector and a single-row ejector. Each ejector is made as an elongated stem terminating in a transverse head which carries ejecting projections made in correspondance with the magazine slots.
The staple ejectors are mounted in the oblong hollow tailpiece of the staple body with a possibility of independently sliding therein. Movement of the ejectors results in the ejecting projections engaging the magazine slots to drive the staple out therefrom.
The elongated stems of the staple ejectors terminate in threaded tailpieces or tangs, whereon nuts are screwed with which the ejectors interact with the tailpiece of the staple body.
Motion to each of the ejectors is imparted from a detachable key which interacts with the nut provided on the ejector tang.
The length of stroke of the staple ejectors towards the supporting jaw of the supporting body is limited by a stop made as a fork capable of being inserted into the staple body from above.
The position assumed by said stop in the staple body is so selected that the staple ejectors would stop moving just after the staples have been ejected from the magazine and the ejecting projections prove to be somewhat extended from the magazine slots. Such a restriction of motion of the staple ejectors is necessary to preclude trauma of the tissues being sutured which is likely to be inflicted thereupon by the ejecting projections which, being driven out from the slots of the magazine, might bite into the tissue being sutured.
A restricting fork is detachably fitted into the head of the staple body to prevent the tissue or organ being sutured from slipping off the instrument.
When in use the afore-discussed surgical instrument is so positioned by the surgeon that the supporting jaw is located beneath the tissue or organ being sutured and the whole tissue or organ is arranged between the flat area of the supporting jaw and the working face of the staple magazine fitted in place in the head of the staple body. Then the tissue or organ being sutured is fixed in place from above by the restricting fork; thereupon the surgeon starts rotating the staple body driving nut, thus causing the latter to approach the supporting jaw until it assumes the position, wherein a necessary suturing gap is established in between the flat area of the supporting jaw and the working face of the magazine. Next, needles are introduced into the holes in the projections of the supporting jaw and magazine to prick the surfaces of the tissue or organ being sutured that are crimped in between the afore-said projections, thereby fixing said tissue or said organ to the instrument. The surgeon may proceed to suturing the tissue with a double-stitch suture as soon as all the above-described operations are carried out. To this end, a detachable key is fitted into the nut on the tailpiece of the double-row staple ejector and rotated there to exert the staple ejector forward towards the supporting jaw. This results in the staple ejecting projections passing through the magazine double-row slots to eject the staples therefrom. The staples, having pierced the tissue being sutured, rest against the depressions located on the flat area of the supporting jaw, thus getting bent to assume the B-shape. After that the part of the tissue to be removed is excised by a scalpel exactly along the edge of the instrument. This is followed by the application of a single-stitch suture. To this end, the staple body is retracted from the supporting jaw by 5-6 mm and the previously obtained double-stitch suture is invaginated throughout its length into the interior of the sutured organ. Further, the staple body is brought near the supporting jaw again to clamp the tissue being sutured therebetween. The detachable key having been refitted from the nut of the double-row staple ejector to the nut of the single-row ejector, the latter nut is rotated to exert the single-row ejector towards the supporting jaw. The ejecting plates, while passing through the slots of the magazine, push out the staples therefrom which, having pierced the external sheaths of the organ being sutured, get bent in the depressions of the flat area of the supporting jaw.
Suturation over, the needles fixing the tissue being sutured are removed, the staple body is withdrawn from the supporting jaw and the instrument is taken off from the thus-sutured organ.
Suturing of organs with a double-stitch suture followed by the invagination of the latter and application of a single stitch, suture, is conducive to better healing, and prevents formation of postoperative commissures or fistulas.
However, the afore-described instrument is widely applicable particularly in suturation of the organs of the alimentary tract or canal, wherein the application of a double-tiered invaginated suture is involved, consisting of a double-stitch suture through all the layers of the tissue being sutured and a single-stitch suture applied to the upper layers of said tissue, whereas for suturation of the tissues and organs of the thoracic cavity for instance some other instruments are in more frequent use featuring smaller size of the working members and capable of applying only a double-stitch suture to all the layers of the tissue being sutured. This makes it necessary to have a rather wide range of instruments at disposal, capable of application of a variety of sutures and featuring different sizes of the working members thereof, which however is economically unreasonable.
Moreover, too large a width of the supporting jaw of the instrument renders it inapplicable for suturing small-length organs and hampers its passing through narrow channels or ducts in tissues.
SUMMARY OF THE INVENTION
It is therefore an essential object of the present invention to provide such a surgical instrument for suturing tissues and organs with metal staples whose design would make it suitable for use both on the organs of the abdominal cavity and on those of the thoracic cavity and which would be capable of applying both a double-stitch suture with subsequent invagination thereof by way of a single-stitch suture, and a double-stitch suture penetrating through all the layers of the tissue being sutured, furthermore, the working portion of the surgical instrument being of small size to enable its passage through narrow and profound channels or ducts in tissues and to enable the application of sutures to small-length organs.
Said object is attained due to the fact that in a surgical instrument for suturing tissues and organs with metal staples, comprising an oblong supporting body carrying at one of its ends a supporting jaw arranged crosswise with respect to the main oblong portion of the body and having a flat area facing said main portion of the body, said flat area carries three parallel rows of depressions adapted for the ends of the staple legs to bend, of which two rows serve for the application of a double-stitch suture to all the layers of the tissue being sutured, while one row serves for the application of a single-stitch suture to the upper layers of the tissue being sutured the surgical instrument further comprises a staple body made as an elongated hollow tailpiece terminating in a hollow head which is open towards the flat area of the supporting jaw, said staple body being slidable along the supporting body, a staple magazine adapted to be inserted into said hollow head and provided with three rows of open-end slots for metal staples to be accommodated, said slots being arranged in exact correspondence with the three rows of depressions on the flat area of the supporting jaw; a screw-and-nut mechanism associated with the supporting body and the tailpiece of the staple body is provided for the staple body to move with respect to the supporting body; two staple ejectors having elongated stems mounted with a possibility of independent sliding along the tailpiece of the staple body are provided, said stems terminating in transverse heads which carry staple ejecting projections adapted when the ejectors are moving, to engage the slots of the magazine to drive out staples therefrom, as well as means to impart independent motion to said staple ejectors; further according to the invention, part of the supporting jaw of the supporting body that carries one row of depressions adapted to apply a single-stitch suture to the upper layers of the tissue being sutured, is made detachable.
It is expedient that the non-detachable portion of the supporting jaw of the supporting body that carries two rows of depressions adapted to establish a double-stitch suture, be taper-shaped which makes it suitable for being introduced into hard-of-access places within the zone of the organ being sutured and for suturing small-length organs.
The proposed surgical instrument is suitable to be used both on the organs of the abdominal cavity and on those of the thoracic cavity and is capable of applying both a double-stitch suture with subsequent invagination thereof and suturing the upper tissue layers, and a double-stitch suture alone applied to all the layers of the tissue being sutured.
Besides, the detachable construction of the supporting hook of the proposed instrument allows it to be passed through narrow and profoundly located channels or ducts in tissues and placed under small-length organs to apply a suture thereto.
BRIEF DESCRIPTION OF THE DRAWINGS
An embodiment of the present invention will now be considered in conjunction with the accompanying drawings, wherein:
FIG. 1 is a schematic side elevation, partly in section, of a surgical instrument for suturing tissues and organs with metal staples according to the invention;
FIG. 2 is an enlarged-scale sectional view taken on the line III--III in FIG. 1;
FIG. 3 is a plan view, partly in section, of a surgical instrument for suturing tissues and organs, according to the invention;
FIG. 4 is an enlarged-scale view of a staple magazine, taken substantially along the arrow A in FIG. 1; and
FIG. 5 is an enlarged-scale cross-sectional view of a supporting jaw and a staple magazine when brought together.
DESCRIPTION OF PREFERRED INVENTIVE EMBODIMENTS
Now referring to FIG. 1, the surgical instrument for suturing tissues and organs with metal staples comprises an oblong supporting body 1 having at one of its ends a supporting jaw 2 arranged crosswise with respect to the main oblong portion of the supporting body 1 and having a flat area 3 facing the main portion of the supporting body 1. The flat area 3 carries three parallel rows of depressions 4, 5, 6 (FIG. 2) adapted for the ends of the staple legs to be bent. Two rows of the depressions 4 and 5 out of said three rows serve for application of a double-stitch suture with the staples arranged in a staggered relation, whereby tightness and good hemostatic properties of the performed suture are attained. The suture is applied to all the layers of the tissue being sutured. The row of the depressions 6 serves for establishing a single-stitch suture which is applied only to the upper layers of the tissue being sutured.
Provision is made on the flat area 3 (FIGS. 1, 2) for projections 7 with holes into which is inserted a needle 8 to fix the tissue or organ being sutured in the instrument.
The supporting jaw 2 is made composite and comprises two detachable portions 9 and 10 (FIGS. 2, 3), the portion 9 of the supporting jaw 2 having two rows of the depressions 4 and 5 (FIG. 2) for a double-stitch suture to be applied, whereas the portion 10 of the supporting jaw 2 has one row of the depressions 6 for a single-stitch suture to be applied.
The portion 10 of the supporting jaw 2 carrying the depressions 6 for a single-stitch suture is made detachable.
The non-detachable portion 9 of the supporting jaw 2 is taper-shaped which facilitates its being introduced into hard-of-access places within the zone of the organ being sutured.
Quick assembly and dissembly of the portions 9 and 10 of the supporting jaw 2 is effected by means of locks consisting of two shaped holes 11 and 12 (FIG. 1) provided in the non-detachable portion 9, a shaped pin 13 made fast on the detachable portion 10 (FIG. 2) and adapted to engage the shaped hole 11 in the non-detachable portion 9, and a shaped hole in the detachable portion 10 coaxial with the shaped hole 12 in the non-detachable portion 9, into which two holes a detachable lock is adapted to fit, said lock incorporating a shaped pin 14 and a springy platelet 15 (FIGS. 1, 2).
The central oblong portion of the supporting body 1 (FIGS. 1, 3) is box-shaped to accomodate a staple body 16 therein. The tail portion of the supporting body 1 has a through opening 17 (FIG. 1) to accommodate a projection 18 of the staple body 16, and a shoulder 19 upon which a nut 20 rests, said shoulder enabling the staple body 16 to travel with respect to the supporting body 1. The nut 20 is left-hand threaded and is adapted to be turned into the projection 18 of the staple body 16.
The staple body 16 is made as an elongated hollow tailpiece or tang having a hollow head 21 at one of its ends, said head being open towards the flat area 3 of the supporting jaw 2.
A change staple magazine 22 (FIGS. 1, 4) is fitted into the hollow head 21 of the staple body 16. The magazine 22 is provided with three rows of open-end slots 23, 24, 25 (FIGS. 4, 5) adapted to accommodate metal staples, and with projections 26 with holes into which a needle 27 is inserted to fix the tissue or organ being sutured, with respect to the instrument. The three rows of the open-end slots 23, 24, 25 of the magazine 22 are arranged in an exact correspondence with the three rows of the depressions 4, 5, 6 (FIG. 5) on the flat area 3 of the supporting jaw 2. To eject and drive out the staples from the slots 23, 24, 25 (FIG. 4) of the magazine 22 and bend them in the depressions 4, 5, 6 of the supporting jaw 2, provision is made for two staple ejectors, viz., a double-row ejector 28 (FIG. 3) and a single-row ejector 29. Each of the ejectors 28 and 29 is made as an elongated stem terminating in a transverse head which carries staple ejecting projections 30 made in an exact correspondence with the slots 23, 24, 25 (FIG. 4) of the magazine 22.
The staple ejectors 28, 29 (FIG. 3) are independently slidable in the elongated hollow tailpiece of the staple body 16. With the staple ejectors 28, 29 moving, the ejecting projections 30 engage the slots 23, 24 and 25 (FIG. 4) of the magazine 22 to drive out the staples (not shown) therefrom.
The elongated stems of the staple ejectors 28, 29 (FIG. 3) terminate in threaded shanks 31 and 32 onto which nuts 33 and 34 are screwed, whereby the ejectors 28, 29 get interconnected with the tailpieces of the staple body 16.
Motion to each of the ejectors 28 and 29 is imparted from a detachable key 35 (FIG. 1) adapted to interact with the corresponding nut 33 or 34 on the shank of the ejector 28 or 29.
Advancing of the ejectors 28, 29 (FIG. 3) towards the supporting jaw 2 (FIG. 1) of the supporting body 1 is limited by a stop 36 made as a fork adapted to be fitted into the staple body from above.
The position assumed by the stop 36 in the staple body 16 is so selected that the staple ejectors 28 or 29 (FIG. 3) stop moving just after the staples have been ejected and the ejecting projections 30 get flush with the working face of the magazine 22. Such a restriction of the motion of the ejectors 28, 29 is necessary to preclude trauma of the tissues being sutured that might be inflicted thereupon by the ejecting projections 30 which, having pushed out the staples from the slots of the magazine 22, might bite into the tissue.
A fork limiter 37 (FIG. 1) is detachably fitted into the head of the staple body 16 which prevents the tissue or organ being sutured from slipping off the instrument.
When applying a double-stitch suture with subsequent invagination thereof and application of a single-stitch suture to the upper layers of the tissue being sutured, the surgical instrument for suturing tissues and organs with metal staples operates as follows.
During operation, the instrument is so positioned by the surgeon that the supporting jaw 2 should be located under the tissue of organ being sutured in such a way that the entire tissue or organ is arranged in between the flat area 3 of the supporting jaw 2 and the working face of the staple magazine 22 that looks on the supporting jaw 2, said magazine being fitted in the head 21 of the staple body 16. Then the tissue or organ is fixed from above with the fork limiter 37, whereupon the surgeon starts rotating the nut 20 of the staple body 16 actuator, causing the latter to approach the supporting jaw 2 till such a position, wherein a necessary suturing gap is established in between the flat area 3 of the supporting jaw 2 and the working face of the magazine 22, said gap being checked against the notches provided on the projection 18 of the staple body 16 and on the tailpiece of the supporting body 1.
Next, the needles 8 and 27 are inserted into the holes in the projections 7 and 26 of the supporting jaw 2 and the magazine 22, said needles piercing the surfaces of the tissue or organ being sutured that are corrugated in between the projections 7 and 26, thereby fixing said tissue or said organ to the instrument. Suturing of the tissues with a double-stitch suture may be started as soon as the above-described operations are carried out. To this end a detachable key 35 is fitted into the nut 33 on the shank of the double-row staple ejector 28 and rotated there to exert the ejector 28 forward towards the supporting jaw 2. This results in the ejecting projections 30 passing through the corresponding slots 23, 24 (FIG. 5) of the magazine 22 to eject the staples (not shown) therefrom. The staples, having pierced the tissues being sutured, rest against the depressions 4, 5 located on the flat area 3 of the supporting jaw 2 to be bent into the B-shape. Thereupon, the part of the tissue to be removed is excised by a scalpel exactly along the edge of the instrument. This is followed by the application of a single-stitch suture. To this end, the staple body 16 (FIG. 1) is withdrawn from the supporting jaw 2 by 5-6 mm and the double-stitch suture obtained previously is invaginated throughout its length into the interior of the sutured organ. Further, the staple body 16 is brought closer to the supporting jaw 2 again to clamp the tissue being sutured therebetween. Having refitted the detachable key 35 from the nut 33 of the double-row ejector 28 into the nut 34 (FIG. 3) of the single-row ejector 29 and rotating the key 35 the surgeon causes the single-row ejector 29 to move towards the supporting jaw 2. The ejecting projections 30, while passing through the slots 25 (FIG. 5) of the magazine 22, drive out the staples therefrom which, having pierced the external sheaths of the organ being sutured, get bent in the depressions 6 of the flat area 3 of the supporting jaw 2. To complete the suturing procedure, the fixing needles 8, 27 (FIG. 1) are removed, the staple body is retracted from the supporting jaw 2 and the instrument is taken off the thus-sutured organ.
Suturing of organs with a double-stitch suture followed by the invagination of the latter and application of a single-stitch suture as mentioned earlier, contribute to better healing and prevent the formation of postoperative commissures or fistulas.
In case a double-stitch suture alone is to be applied, the proposed surgical instrument operates as follows.
Before the use of the instrument, the detachable portion 10 (FIG. 3) of the supporting jaw 2 with depressions for a single-stitch suture, is disconnected therefrom with the result that the supporting jaw 2 gets substantially narrower and, consequently, more convenient for being placed underneath small-length organs or for passing it via narrow channels or ducts in tissues.
Then the surgeon positions the instrument in such a way that the portion 9 of the supporting jaw should be located beneath the tissue or organ being sutured and the entire tissue or organ is arranged in between the flat area 3 of the supporting jaw 2 and the working face of the staple magazine 22 fitted into the head 21 (FIG. 1) of the staple body 16. Thereupon, the tissue or organ is fixed from above with the fork limiter 37, and the surgeon starts rotating the nut 20 of the staple body 16 actuator, thus causing said body to approach the supporting jaw 2 until a necessary suturing gap is established in between the flat area 3 of the supporting jaw 2 and the working face of the magazine 22.
This done, the suturing operation may proceed. To this end, the detachable key 35 is fitted into the nut 32 provided on the shank of the double-row staple ejector 28 and rotated to exert the ejector 28 forward towards the supporting jaw 2. As a result the ejecting projections 30 pass through the double-row slots of the magazine 22 and drive out the staples therefrom.
The staples, having pierced the tissues being sutured, rest against the depressions 4, 5 (FIG. 5) located on the flat area 3 of the supporting jaw 2 and get bent to assume the B-shape. After that, any part of the tissue to be removed is excised by a scalpel exactly along the edge of the instrument next the staple body 16 (FIG. 1) along with the magazine 22 is withdrawn from the sutured organ and the instrument is taken off.