[go: up one dir, main page]

WO2011146816A1 - Dispositif d'anastomose et procédé associé - Google Patents

Dispositif d'anastomose et procédé associé Download PDF

Info

Publication number
WO2011146816A1
WO2011146816A1 PCT/US2011/037304 US2011037304W WO2011146816A1 WO 2011146816 A1 WO2011146816 A1 WO 2011146816A1 US 2011037304 W US2011037304 W US 2011037304W WO 2011146816 A1 WO2011146816 A1 WO 2011146816A1
Authority
WO
WIPO (PCT)
Prior art keywords
tubular
vessel
distal
holding member
stapling
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2011/037304
Other languages
English (en)
Inventor
Abdulrhman Elnaggar
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Columbia University in the City of New York
Original Assignee
Columbia University in the City of New York
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Columbia University in the City of New York filed Critical Columbia University in the City of New York
Publication of WO2011146816A1 publication Critical patent/WO2011146816A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A61B17/1152—Staplers for performing anastomosis, e.g. in a single operation applying the staples on the outside of the lumen
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00491—Surgical glue applicators
    • A61B2017/00504—Tissue welding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1103—Approximator
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1125—Forceps, specially adapted for performing or assisting anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132—End-to-end connections

Definitions

  • This application discloses a novel anastomosis device. More particularly, this application discloses an anastomosis system comprising vessel holding members and a stapler, which is particularly useful in end-to-end anastomosis of the portal vein in deceased donor liver organ transplant surgery.
  • Organ transplant surgery such as a liver transplant
  • Organ transplant surgery is reasonably common in the United States and throughout the world. Time is critical in organ transplant surgery, where there are many blood vessels from the transplant organ that must be attached to the patient's blood vessels. For blood to reach the organ with oxygen and nutrients and to preserve the function of the transplant, blood vessels must be attached quickly and effectively.
  • anastomosis comprises two vessel holding members and a stapling device that can attach blood vessels in a reproducible, almost automated manner.
  • the vessel holding members each hold the respective ends of two blood vessels, and then the stapler staples the ends to one another. The results of this procedure are consistent and reproducible regardless of the operator. This technology is useful in any surgical procedure where the ends of two blood vessels or two tubular organs must be joined together.
  • the vessel holding members each comprise a tubular vessel holding member having a radially extending flange-like structure at one end.
  • the flange-like structures are regular or irregular in shape, preferably with projections that will secure a vessel.
  • the stapling device comprises a tool capable of stapling in a circular or semi-circular pattern, to provide a leak-proof joint or connection between two vessels or tubular organs.
  • the stapler is based upon a forceps structure where the proximal end of the forceps structure comprises a handle or grip and the distal end of the forceps structure comprises facing surfaces that can be positioned around vessel segments, such as opposing semi-circular members that clamp or close together.
  • the semi-circular members have two parallel sections so that each pair of semi-circular or circular members can fit on either side of two flange members.
  • one or both of the facing surfaces of the distal end of the forceps comprise arcuate blade segments that form circular or semi-circular blades. These blades cut excess vessel tissue and, optionally, flange material, to provide a smooth surface.
  • the end of a vessel from an organ or the end of a tubular organ is inserted into the open end of a first vessel holding member through the first vessel holding member and out the other end having a first flange member.
  • the open end of the vessel or tubular organ is then stretched or everted so that the exterior surface and wall of the vessel or tubular organ are stretched over and engage the first flange member of the first vessel holding member.
  • the corresponding vessel or tubular organ from the patient is threaded through a second vessel holding member and the open end of that vessel or tubular organ is stretched or everted over the flange of that vessel holding member.
  • the two flange members then are abutted together, and a stapling device operates to staple the flanges together. If one or both of the facing surfaces of the distal end of the stapling device have blades, then excess vessel or tubular organ tissue will be removed at the same time that the flange members are stapled together.
  • the flanges can be circular or irregular, preferably with points to hold the everted vessel tissue.
  • the outer surface of the flanges may comprise one or more barbs to engage vessel tissue.
  • the stapling device has a mechanism so that the semi-circular stapling sections come together to form essentially a complete circle and the staples are propelled from one or both sides of the semi-circular stapler members to engage the flanges and tissue.
  • the staples form almost all or all of a ring to prevent fluid leakage.
  • the distal end of the stapling device will be removable so that the distal end can be replaced with another distal end for stapling another vessel.
  • the flange members could be fastened together with chemical, mechanical, or electrothermal means that is quick and efficient.
  • a system for anastomosis of two vessels or tubular organs comprises: a first vessel holding member capable of holding an end of a first vessel or tubular organ; a second vessel holding member capable of holding an end of a second vessel or tubular organ; and a stapling device or tool for stapling together the ends of the first and second vessels or tubular organs.
  • each vessel holding member is tubular.
  • each vessel holding member has a radially extending flange-like structure at one end.
  • the flange-like structure is regular or irregular.
  • the flange-like structure has points to secure tissue.
  • the points are barbs.
  • the stapling device or tool has one or more stapling sections that form essentially a complete circle.
  • the stapling device or tool comprises arcuate blade segments.
  • system comprises:
  • each tubular vessel holding member having a proximal end, a distal end having a radially extending flange structure, and a lumen; and a stapling device or tool having a proximal end and a distal end, wherein the distal end comprises a circular or semi-circular structure capable of stapling in a circular or semi-circular pattern.
  • a method for anastomosis of two vessels or tubular organs comprises: advancing a distal portion of a first vessel or tubular organ through the lumen of a first tubular vessel holding member having a proximal end, a distal end having a radially extending flange member, and a lumen; everting the distal portion of the first vessel or tubular organ over the distal flange member of the first tubular vessel holding member; advancing a distal portion of a second vessel or tubular organ through the lumen of a second tubular vessel holding member having a proximal end, a distal end having a radially extending flange member, and a lumen; everting the distal portion of the second vessel or tubular organ over the distal flange member of the second tubular vessel holding member; positioning the distal flange member of the first tubular vessel holding member adjacent to the distal flange member of the second tubular vessel holding member; and stap
  • Figure 1 is a lateral view of an embodiment of a vessel holding member according to the invention
  • Figure 2 is a head-on view of the embodiment of the invention shown in Figure 1 ;
  • Figure 3 is a cross-sectional view of the vessel holding member shown in Figures 1 and 2;
  • Figure 4 is an oblique view of an embodiment of a stapling device according to the invention.
  • Figure 5 is a partly cross-sectional view of the distal section of the stapling device shown in Figure 4;
  • Figures 6 and 7 are each a partial cross-sectional view of a segment of the distal section shown in Figure 5;
  • Figure 8 is an oblique view of a stapling system according to the invention.
  • a vessel holding member 2 comprises a tubular structure 4 with a proximal opening 6 and a distal opening 8 and having a lumen 10 therethrough.
  • a flange member 12 is integral with or attached to vessel holding member 2.
  • Flange member 12 can be regular or irregular in shape, preferably having two or more projections or barbs 14.
  • flange member 12 is attached to structure 4 at attachment points 16.
  • FIG. 3 A cross-sectional view of the vessel holding member 2 in Figures 1 and 2 is shown in Figure 3.
  • the distal portion 18 of a vessel 20 has been advanced into proximal opening 6 and through lumen 10 and everted over flange member 12.
  • a stapler tool or device 22 shown in Figure 4 comprises a proximal portion 24, a fulcrum 26, and a distal portion 28.
  • Proximal portion 24 comprises two proximal members 30, each of which has a finger grip 32.
  • a releasable locking mechanism 36 can lock proximal members 30 together.
  • Distal portion 28 comprises a distal stapling system 38 attached to distal members 42.
  • Distal stapling system 38 comprises two members 44, each having a rigid bottom piece 46 and a movable upper piece 48. Each upper piece 48 is in communication with, and is controlled by, a control member 50 at proximal portion 24. Preferably movable upper piece 48 is hinged to distal member 42 at hinge 62.
  • Rigid bottom piece 46 and upper piece 48 comprise staples 56 that are arranged closely together in circular or substantially circular fashion. The release of staples 56 is controlled by a trigger mechanism 52 at proximal potion 24. Staples 56 are fired into flange members 12 to secure the vessel ends together
  • stapler system 38 may comprise two or more arcuate blade members to form circularly arranged blades 60 in addition to the staples 56. Blades 60 are intended to trim excess vessel tissue and any portion of the flange members 12 that might be pointed or jagged.
  • Rigid bottom piece 46 and upper piece 48 engage each other at points 64 and 66.
  • the engaging surfaces are preferably reciprocally shaped to have a tight fit at points 64 and 66.
  • Examples of reciprocally shaped surfaces 68 and 70, and 72 and 74, are set forth in the sections shown in Figures 6 and 7, respectively.
  • Other examples of reciprocal shapes include curved or saw-tooth configurations.
  • portal vein segments 80 and 82 are positioned within vessel holding members 86 and 88, respectively.
  • the respective distal ends 90 and 92 of portal vein segments 80 and 82 have been everted over flange members 94 and 96, respectively.
  • the stapling device 100 comprises distal sections 102 and 104 that have facing stapling surfaces 108 and 1 10, respectively. Stapling surfaces 108 and 1 10 have arcuate blades or blade segments (not shown).
  • proximal grips 1 14 and 1 16 of stapling device 100 are squeezed together by the operator (not shown), distal sections 102 and 104 move toward each other in the direction of arrows 120 and 122, respectively, so that portal vein segment distal ends 90 and 92 abut.
  • Activation of button or switch 124 by the operator causes stapling surfaces 108 and 1 10 to propel staples (not shown) to staple flange members 94 and 96 together and to trim portal vein segment tissue to form a smooth surface.
  • vessel connector members 2 comprise physiologically acceptable materials such as nitinol or stainless steel.
  • the tubular portion of each vessel holding member could comprise a solid or perforated material, such as a stent.
  • Flange members are preferably solid or rigid surfaces that withstand the stress of the material everted thereover. The flanges must be designed to maintain shape but still accept staples or other securing devices.
  • Vessel holding members 2 could be from about 0.5 mm to about 3.0 mm in wall thickness and from about 1.0 cm to about 10.0 cm in length, with an inner diameter of from about 3.0 mm to about 30 mm.
  • Flange members 12 could have a thickness of from about 0.8 mm to about 1.6 mm and a length, that is, the distance from the distal opening of the vessel holding member to the outer edge or a point of the flange, of from about 0.5 cm to about 2.0 cm.
  • the vessel holding members will be about the same size in a given application.
  • the length and/or inner diameter of two opposing vessel holding members could differ dependent upon the vessels being mated, although the respective flange members must be identical or substantially similar in shape and/or size so that the surfaces will mate and that the secured interlocking junction will be secure.
  • a method for anastomosis of two vessels comprises: advancing a distal portion of a first vessel through the lumen of a first tubular vessel holding member having a proximal end, a distal end having a radially extending flange member, and a lumen; everting the distal portion of the first vessel over the distal flange member of the first tubular vessel holding member; advancing a distal portion of a second vessel through the lumen of a second tubular vessel holding member having a proximal end, a distal end having a radially extending flange member, and a lumen; everting the distal portion of the second vessel over the distal flange member of the second tubular vessel holding member; positioning the distal flange member of the first tubular vessel holding member adjacent to the distal flange member of the second tubular vessel holding member; and stapling the distal flange members together, wherein the first vessel through the lumen of a first tubular vessel holding member having a
  • the stapling device can be configured so that distal portions of the device bring the vessel holding members together immediately prior to the stapling step. Also, it is within the scope of the invention that simultaneous with, or immediately thereafter, the stapling step, the stapling tool will trim excess vessel tissue and cut off or smooth out any sharp or jagged portions of the flange members. [00045] It is also within the scope of the invention that the distal portion or portions of the stapling tool can be replaced.
  • the distal portion of the stapling tool can be quickly replaced with a new staple pack so that the surgeon can perform another anastomosis. This can be repeated for each subsequent anastomosis performed.
  • the salient point is that rest of the stapling tool can be re-used for this patient, thus minimizing expenses.
  • the rest of the stapling tool could be sterilized for use in another patient.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention porte sur un système d'anastomose qui comporte deux éléments de retenue de vaisseau tubulaire, chaque élément de retenue de vaisseau tubulaire ayant une extrémité proximale, une extrémité distale ayant une structure de bride s'étendant radialement, une lumière et un outil à agrafer. L'outil à agrafer présente une extrémité proximale et une extrémité distale, l'extrémité distale comportant une structure circulaire ou semi-circulaire pouvant agrafer en un motif circulaire ou semi-circulaire. Dans un procédé d'utilisation du système pour faire une anastomose entre deux vaisseaux ou organes tubulaires, une partie distale d'un premier vaisseau ou organe tubulaire est avancée à travers la lumière d'un premier élément de retenue de vaisseau tubulaire, la partie distale du premier vaisseau ou organe tubulaire est retournée sur l'élément de bride distale du premier élément de retenue de vaisseau tubulaire, et une partie distale d'un second vaisseau ou organe tubulaire est avancée à travers la lumière d'un second élément de retenue de vaisseau tubulaire.
PCT/US2011/037304 2010-05-20 2011-05-20 Dispositif d'anastomose et procédé associé Ceased WO2011146816A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US34673310P 2010-05-20 2010-05-20
US61/346,733 2010-05-20
US34792910P 2010-05-25 2010-05-25
US61/347,929 2010-05-25

Publications (1)

Publication Number Publication Date
WO2011146816A1 true WO2011146816A1 (fr) 2011-11-24

Family

ID=44992073

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2011/037304 Ceased WO2011146816A1 (fr) 2010-05-20 2011-05-20 Dispositif d'anastomose et procédé associé

Country Status (1)

Country Link
WO (1) WO2011146816A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2020078264A1 (fr) * 2018-10-17 2020-04-23 张海红 Anastomose à petite lumière et son procédé d'utilisation
EP3917409B1 (fr) * 2019-01-31 2025-03-12 Lydus Medical Ltd. Dispositif d'anastomose

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4752024A (en) * 1986-10-17 1988-06-21 Green David T Surgical fastener and surgical stapling apparatus
US20020185517A1 (en) * 2001-04-02 2002-12-12 Vresh Susan E. Luminal anastomotic device and method
US20030222117A1 (en) * 2002-05-31 2003-12-04 Orban Joseph P. End-to-end anastomosis instrument and method for performing same

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4752024A (en) * 1986-10-17 1988-06-21 Green David T Surgical fastener and surgical stapling apparatus
US20020185517A1 (en) * 2001-04-02 2002-12-12 Vresh Susan E. Luminal anastomotic device and method
US20030222117A1 (en) * 2002-05-31 2003-12-04 Orban Joseph P. End-to-end anastomosis instrument and method for performing same

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2020078264A1 (fr) * 2018-10-17 2020-04-23 张海红 Anastomose à petite lumière et son procédé d'utilisation
EP3917409B1 (fr) * 2019-01-31 2025-03-12 Lydus Medical Ltd. Dispositif d'anastomose

Similar Documents

Publication Publication Date Title
US10278703B2 (en) Temporary fixation tools for use with circular anastomotic staplers
EP0554990B1 (fr) Appareil pour l'anastommose
CN103156659B (zh) 包括通过凸起联接的支撑件的手术吻合装置
CA2801749C (fr) Agrafeuse circulaire avec diametre de lumiere accru
US9010609B2 (en) Circular stapler including buttress
EP2135564B1 (fr) Appareil d'agrafage chirurgical contenant un matériau de traitement des plaies
US20110184443A1 (en) Stapling apparatus for performing anastomosis on hollow organs
US20070246505A1 (en) Surgical buttress assemblies and methods of uses thereof
EP2489311A2 (fr) Enclume inclinable pour agrafeuse chirurgicale annulaire
US9532780B2 (en) EEA anvil snap ring activator
EP2039303A2 (fr) Aide d'insertion adapté pour l'interférence
KR101024344B1 (ko) 의료용 문합장치
EP3386401B1 (fr) Ensemble enclume et système d'administration
WO2011146816A1 (fr) Dispositif d'anastomose et procédé associé
CA2804386C (fr) Appareil d'agrafage pour la realisation d'une anastomose sur des organes creux
EP2777519A1 (fr) Appareil d'application d'attache chirurgicale avec sections de poignées détachables
CA2787917C (fr) Appareil d'agrafage pour realiser une anastomose sur des organes creux
CN112656486B (zh) 夹持装置、包皮吻合及环切器械
WO2013036893A9 (fr) Agrafeuse chirurgicale pour anastomose aortique

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 11784307

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 11784307

Country of ref document: EP

Kind code of ref document: A1