CA1038718A - Surgical suturing instrument - Google Patents
Surgical suturing instrumentInfo
- Publication number
- CA1038718A CA1038718A CA200,117A CA200117A CA1038718A CA 1038718 A CA1038718 A CA 1038718A CA 200117 A CA200117 A CA 200117A CA 1038718 A CA1038718 A CA 1038718A
- Authority
- CA
- Canada
- Prior art keywords
- staple
- slot
- frame
- head
- supporting
- 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.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
Abstract
ABSTRACT OF THE DISCLOSURE
The surgical instrument for suturing organs and tissues with metal staples comprises the supporting body with the longitudinal slot and the flat frame. The frame has the supporting jaw provided with the flat spot facing the slot.
The flat spot of the supporting jaw has a number of depressions for the staple legs to bend. The slot accommodates the staple body with the head into which the staple magazine is inserted, and the staple ejector. The slot in the supporting body opens in the direction perpendicular to the plane of the supporting body frame, whereby a possibility is provided for the staple body with the staple ejector to insert into and extract from the slot in said direction.
The surgical instrument for suturing organs and tissues with metal staples comprises the supporting body with the longitudinal slot and the flat frame. The frame has the supporting jaw provided with the flat spot facing the slot.
The flat spot of the supporting jaw has a number of depressions for the staple legs to bend. The slot accommodates the staple body with the head into which the staple magazine is inserted, and the staple ejector. The slot in the supporting body opens in the direction perpendicular to the plane of the supporting body frame, whereby a possibility is provided for the staple body with the staple ejector to insert into and extract from the slot in said direction.
Description
~3E;7~.~
~ he present invention relates to medical equipment and has particular reference to surgical suturing instruments~ The d:isclosed instrunent can find application in oncological practice fox suturing the walls of the pharynx upon laryngectomy for cancer, as well as or suturing organs and tissues of the thor- ;
acic and abdominal cavities, e.g., for suturing pulmonary tissues. ~-Known in the art is a surgical suturing instrument, comprising the supporting body with the slot and the hook-shaped frame (cf. USSR Inventor's Certificate No. 125,523, issued October 5, 1959 to A. A. Strekopytov, N. S. Gorkin and ~. D.
Garin, and the assignee is NAUCHNO-ISSLEDOVATELSKY INSTITUT
EXPERIMENTALNOI KHIRURGIC~ESKOI APPARATU~Y I I~STRUME~TO~. The frame has a supporting jaw arranged transversely wlth respect -to the slot and having an oblong flat area provided with depres-sions for staple legs to bend. The slot in the supporting body ' pens in the direction parallel to the plane of the supporting .
body ~rame. Said slot accommodates the staple body with the `~
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head into which the staple magazine is inserted, said staple body 20 ~ being free to travel length-wise said slot. The staple ejector ~ -is housed in the staple body with a possibility of longitudinal `~ `
. .
traverse~ Owing to the fact that the slot in the supporting ~
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body is arranged with ltS open end towards the direction parallel to the plane of the eupporting body frame,~ the staple body can be inserted into the slot and removed therefrom only in said direc~
tion.
The staple body can assume the working position with -respect to the supporting body, wherein the gaps between the `''t~
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supportin~ jaw a~d the staple ~agazine correspond to the ~ :
-thickness o~ the tissues being sutured, as well as the ini~
tial position, wherein the staple body is inserted into ..
the slot o~ the sup~)Qrtin~ bod~ or wi-thdrawn therefrvmO '~o i~sert the ~taple bo~y i~to the slot o~ the supporti~ bo~y in the i~itial positio~ o~ the former there needs more room .
i~ the direction o~ the plane o~ the ~rame. ,~
q`he ~taple body a~d the staple ejector are provided with correspo~ding actua-tors to be traversed with respect: to !,.`~' ' '' ~ ~ the supporti~ body towards the ~upporti~g jaw~
: The ætaple magazi~e has open-end slots to accommodate `. .
~: ~ m~tal staples therei~. ~he slots are arran~ed in a strict ..
.... ....
: ~ ~ correæponde~ce with the depressio~s i~ the~rame supporti~g~
jaw. The st~ple ejector haæ~drlvl~ projectlons axran~ed correspo~dln~Iy to the magazi~e slots~O ~hen the~:ejector moves t~war~s the frame supporti~ jaw its driving projeGbions~
enber the ma~azl~e slots~to eject;the~staples~the~e~rom~
o prevent the tiseu~ or or~an bein~ sutured:~rom slipplng~o~f the l~st~ume~t, the staple head i~ provi~ed i` :~
wi~th a~fork limiter~
Durin~ 6uturi~g wath the use~of the abo~e-discussed ;in~ru~e~t the~tissue or organ bei~g sutured is placed i~
between the ~lat~area o~ the~supportlng aa~ and th~ wor~in~
e~d~o~ the~staple ma~azine ~aoing said flat area. Into such ,.................................................................. .
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a position the tissue or or~an bein~ ~utured mayb.~ establi~
shed b~ bein~ troduced throu~h the side opening o~ the ..
hook-shaped ~rame. '~hen the tissue or or~an under suturin~
is ~ixed in position by the ~ork limi-ter9 whereupon the .
sur~eon exerts upon the ac~uator o~ the staple body, thus approximatin~ the ma~azine to the supportin~ jaw of the supportin~ body till the position, wherei~ the ~ecessa~y suturin~ ~ap is establlshed in betwee~ the flat area of the ~ ;;:~;
supportin~ jaw a~d the workin~ of the ma~azineO Next the `
tissues are sutured by exertin~ upo~ the staple ejector actuator,:wi~h the result that the ejeotor proaections pass through the ma~azine slots and drive the staples out there~
romO The~taple:le~s pierce ~he~tissues bein~ sutured and ;`.
th~ust agalnst the depressions i~ the flat~area of the suppor~
tln~ iaw~to bend and thus suture the tissues.~'~he tissu~ to be~ excised~:ls~out out, the ma~azlne ~s wi~hdrawn~rom the supporti~g Jaw~and the ins~trume~t 1~ removed f~om the ope~
rative wound~
Eowever,~the~know~ i~strument iB inco~venient or imprac~
tica~le~:to~be~applied~bo su-ture~applioatio~ ln~ha~d of-acoess .
plaoes~or under spec1flC cond1blo~s:~wh~re the:~space ~or ma~i~ulations l~volved i~ ~ett~n~the~lnstrument into the æuturin~ positlon is limited, e~pecially in the pla~e o~`the ~rame. This di~advanta~e i~ du~ to the oonetruction of the . . ... . .
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support:in~ body of the instr~ent, wherein the supporting ~: :
jaw of the ~upporti~ bo~y and the staple rna~azine can be : .
approxi~ated to ~he tissues bein~ sutured ~nly throu~h the side openin~ o~ the hook-shaped ~rame of the supporti~g body. ~'or the supportin~ jaw a~d the staple ma~azine to .set into the suturi~g positio~ usi~g said technlque~ both of : : them are to be moved with respect to the tissues under sutu~
rin~ by the length equal to the width o~ the supportin~ body frame. I~ thls addi-tio~al space i~ the ope~ative wound.
proves to be i~sufficlent the .sur~eon ha~s to per~o~m compli~
cated manipulations with the ins~rument aimed at the avoida~ce:~
of a~y inju~y~thab is liable to be lnflicted upon both~the tlssues bein~ sutured a~d the su:rrounding tissuesu :~
o ~cite~ a~ example~ in:-the:Gase of la~ ;ectom;y ~or ;canoer ~y~resorting~:to~the:~known~instrumen~, ~he~frame-s~ppor~
tlng aa~ and~the staple magaslne Ga~be brought~under the ;~
tumor~:to be~excls~e~ to the~place.:of suture~appll~oation to the~
pha~ynx~only~ rom the chln~-or:~the breast which are loGated much superior~to:the~plaoe of;~suture applloationO Moreover,~
his~i~volves~::some~compl1~cated~tis~sue-1~juri~g~ma~ipulatlons~
.in~a:~a~ro~ space confined ~etween ~he tumor:resected o~ -the side::o~ ~he chl~;a~d;in the re~ion o~:the trachea,:~a~d~the~remaini~
or~ans and ~isæues~o~ the pat1en-t's hea~ and:neck.
Another disadvantage i~herent in the known instrume~-t resides in lar~e cross-æectional dimensions of the frame ele-, : , ~ : .... " ~:
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ments necessaIy ~or imparti~ reasonable ri~idity -to the co~s-truction o~ the i~strume~t which has to sustai~ consi~
.
derable loads resultin~ f`~Qm staple defo~atio~ during ~utu~
ring process~ which ~eature restricts the field of applica~
tion of the instrument. '~hus, the application o~ the instru :.
ments involves xelatively wide portiorls of` the tissues being sutured, that are required ~ox bein~ ~orced in betwee~
the frame supportin~ jaw and the staple ma~azine which increases the dista~ce ~om the line o~ staples of the suture ... -~
!;' . ~' to the plane of cut of the tissues an~ results in more rou~h .
suture scar; besi~es, lar~er space area is re~uired betwee~ .;
the -tissues ~or the supporti~g jaw a~d the side web of the .
supporti~ body ~rame to i~trodllce. I~ some cases such favou~
rable conditio~s ca~ot be provided and the apparatus proves .~
to be i~applicable. ~ ~ ;
~ o e~empllfy this statementi, i~ the cas~ of' lary~ectomy for cancer too lar~e cross-sectional ~mensions o~ the sid0 web o~ ~he ~rame interfere with its positioni~ the i~ci~
.sio~ made in ~tihe~ tissues in the region of the chin o.~` the ;~
trachea, too large a width of the s~pportin~ jaw makes it `~
le~s practicable to place the jaw uponi the sou~d but res-tric~
:
;: ted in width portions of the pha~y~x and results in a reduced lumen of the sutured pha~y~
~ ;
A nece~sity of reducin~ the cross-sectional dimensions of the frame elements of the supportin~ body makes it impo~
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ssible to use the known instrument for approaching the su-pporting jaw and the magazine to the pharynx portions being sutured using another application technique more reasonable for the operation under discussion. Thus, ~or instance, the known instrument could be approached, in principle, to the ~ `
place of suture application from above (with respect to the patient in recumbent position) rather than from the chin or the breast so as to pass the conglomerate of the tumor tissues through the gap between the supporting jaw and the magazine in the direction perpendicular to the plane of the frame.
However, this cannot be carried out with the known instrument, since the distance from the supporting jaw to ~-~ , .
the magazine is much less than the size of the conglomerated -tumor tissues, on which account the latter cannot be passed through the gap between the supporting jaw and the magazine, , ~
while any increase of said gap is inadmissible since it will necessitate an increase in the length of the side weh o~ the ,,~
supporting body hook and result in a reduced rigidity of the supporting body and, consequently, in an inferior quality 20 of sutures established by metal staples. ~o maintain an `
adequate rigidity of the instrument in this case it is of ~ ~ `
necessity to increase the cross-sectional dimensions of the hook web which renders the known instrument still less applicable for the purpose.
': :
' ' . ' , ~; , ~31~
It i9 an object of the pxesent invention to provide a surgical suturing instrument which is capable of applying sutures in hard-of-access places or under specific conditions where there is but restricted room for manipulations indis-pensable for setting the instrument into suturing position.
It is another object of the present invention to~pro-vide a surgical instrument which is capable of being approached to the tissues under suturing without any injury inflicted ~ -thereupon.
It is still more object of the present invention to provide a surgical instrument capable of applying a suture of `
an upgraded quality.
It is yet still more object of the present invention to ; ;~
provide a surgical instrument capable of attaining an . ~ .
increased lumen of tubular organs when applying a longitu-: ,. ~; -. , :' dinal lateral suture to the wall thereof. ~
. ,. : ~ -Said objects are accomplished due to the fact that in a surgical suturing instrument, comprising a supporting body with a slot and a flat frame having a supporting jaw arranged :: .
transversely with respect to the slot and provided with a flat spot facing the slot and carrying depressions for staple legs to bend, a staple body mounted in said slot of the supporting body with a possibility of longitudinal traversing -and incorporating a head, a staple magazine accommodated ` ~
,'~
.
, " . , i~ the staple body head, a staple ejector associated with the staple bo~y with a possibility o~ lonr~itudi~al traver.si~
and actuators of` the staple body and of the staple ejector~
accordi~g to the i~ention ~aid slot i~ -the supportin~ body ope~s in the direction perpendic~lar to the pla~e o~ the supportin~ body ~rame so as to provide a possi~ility ~or the ;, staple bod~ with the ejector to i~sert into a~d extract from the slot i~ said direction. . ;~ ~.
~, ~ ,. . .
It i~ desirable that the frame of khe suppGrtin~ body be made closed and have two webs parallel to tke slot and ser~ing~
as guldes ~or the head o~ the stap~e body, said webs bein pro~ided~wLth recesses located~i;n thelr rear por~ions~(wlth .
respe~t to the supportin~ ja~ Which recesses are comme~
:surable~ len~th w~th the head of the staple body a~d are adapted to~pro~ide a possibillty~ for the staple bo~ wi~h -~the~ejeotor to l~sert into the slot o~ the suppor~in~ body and;~wlthdraw~there~rom when:m ;t.he rea ~ ost position with respect; to the supporti~ jaw, ; The~head o~the staple bo~y~may have-two side ~alls pe~ endicular to the plane~o~ the ~rame a~d provided~with lon~itudinal slots adapted to lnteract with the webs of the~
frame so as to ~ui~e the ~s~aple~ bod;
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" ', ~:""''' '" ' " ' " ''' ' '' ' ' " '' ~' ' '., ,, :. ' . ' Side projections of the longitudinal slots of the staple body are expedient to be di~ferent in length in such a manner that the height of the projections arranged towards the bottom of the slot in the supporting body be less than the depth of the recesses in the frame webs, while the height of the projections arranged towards the open slot end be in excess of the depth of said recesses. ~ -~
It is also desirable that one of the walls of the -staple body head that are arranged in parallel with the plane of the frame, be made detachable.
The wall of the staple body head that faces the slot ~ -~
in the supporting body may have a notch open towards the detachable wall of the staple body head. A`~
The proposed surgical suturing instrument unlike the ~nown one enables application of mechanical sutures to tissues located in narrow deep cavities where there is less room for manoeuvring with the instrument in the plane of the frame and an inconvenient access to the place of suture `
application. Movel constructional arrangement of the :. .~., ,,:
20 instrument, whereby the supporting body is joined with the ~' remainder part of the instrument in the direction perpendi-cular to the plane of the frame makes it possible to rule out more room in the plane of the frame for the supporting body to assemble with t'ne remainder part of the instrument.
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~3~
Under conditions of restricted space in the operative wound for manoeuvring with the instrument and poor observabili~
ty of the place of suturing, the above said novel feature of the instrument enables a new technique of approaching the supporting ~aw of the supporting body and the magazine to the tissues under suturing to be applied, said techni~ue avo.iding any in~ury -to the tissues under suturiny or the surrounding tissues, which technique consists in that appro~
ached to the place of suture application is the supporting body alone, separated from the remainder part of the instru-ment, whereupon the staple body is inserted into the slot of the supporting body along$~de with the other components without their displacement with respect to the supporting `~
body in the plane of the frame.
The proposed embodiment of the slot in the supporting body that enables the use of the aforesaid instrument appli~
. cation technique, makes practicable t~e embodiment of the supporting body frame as a closed structure which adds much to the constructional rigidity of the instrument as a whole, thereby ensuring a considerable reduction of the cross-sec~
tional area of the supporting body frame elements (~ver :~
three times as compared.to the known instrument). This, in `.
turn, provides a possibility of atraumatic introduction of the frame elements into a much narrower gap in between the tissues in the operative wound, involves less width of tis~
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~L~3879LI~
sues necessary for setting the instrument into suturing position, increases the elasticity of the sutures applied and, with the width of the strip of tissues remaining the same, an increase in the lumen of the tube formed by suture appli~
cation to the margins of the strip of tissues~ All the afore~
said improves the quality of sutures applied by the present instrurnent.
The aforelisted advantages of the proposed instrurnent over the known one are of especially great importance in, say, suturing of the pharynx involved in the process of laryngectomy for cancer and extends much the indications for -the instrument application in case of suturing of the p ~ nx.
The construction of the instrument enables the conglomerated i~
tumor tissues to pass through the frame opening in the direction perpendicular to the plane of the frame of the supporting body detached from the rernainder part of the instrument without inflicting any injury upon the pharynx and the surrounding tissues, whereupon the remainder part of the - instrument is joined with the supporting body without dis~
pla~ing the staple body towards the chin or the breast, i.e., without dislodging the supporting bo~y in the plane of the frame. This makes the method of mechanical suturing of the ~ ~
pharynx in laryngectomy extensively applicable. ~ ~;
As compared to the routine method of manual suturing of the walls of the pharynx in laryngectorrLy, following the exci- ~ ~;
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sion Qf the tumor to be removed, application of the propose~
instrument reduces abruptly the dan~er o~ ecting the -operative wo~d and the phary~x with -the co~tents of the tumor, since first the walls of` the pharynx are sutured and the lume~ o~ the ablated portion is blocked with the use of a special clamp arld only after this the tumor being :
removed is excised to~ekher with the clamp alon~ -the instru~
ment a~d severed from the sutured phar~nx. Applicatio~ o~
the proposed inst~ment improves .rege~eratio~ conditions o~
: ~ the tissues that are as a ~ule sutured after ha~in~ been subjected to beam therapy, cuts down cons1derably the time of~sut~re applic~tio~ to the~phaIynx and:reduces postoperative;
~ Gomplicatlon~
; :ln~what ~ollows the i~ve~tl~o~is iIlustrated:in a spe~
olflc~exempla~y~embodiment~:thereo~:a~d the acoompa~ ing :drawl~s;, where IG.: 1 is:a~schematic partiall~ cutaway vlew~of a sur~
iGal suturlng~l~nstrument~ acoordi~ to the i~uentio~
IG.:2~is~a portion o~ the~supportin~ bo~ accordin~ to~
the~ ve~tion;
LG.~3~1s~a section~;take~al~ the line IlI-III in : ~IG. 4 is~a section taken along the li~e IV-IV i~
~IG. 3; ` ~ :~
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FIG. 5 is the head of the staple body while in the initial position with respect to the supporting body frame, according to the invention, FIG. 6 is the head of the staple bod~ with a detach~
able wall, according to the invention;
FIG. 7 is a section taken along the line VII~VII in ~ ,-FIG. 1, FIG. 8 is a section taken along the line VIII-VIII in FIG. 5~
FIG. 9 is a view along the arrow A of FIG. 3 with the detachable wall of the staple body head out of position; and FIG. 10 is a perspective view of the surgical suturing instrument in its working position.
Reference being now directed to the accompanying draw- ~ ;
ings, the surgical suturing instrument comprises a supporting ,~
body (FIGS. 1, 2) with a slot 2 and a flat frame 3~ The frame 3 ,~ . .
has a supporting jaw 4 arranged transversely with respect to the slot 2 and provided with a flat spot 5 (FIG. 1) facing the slot 2. me flat spot 5 of the supportiny jaw 4 carries depres~
~ sions for staples (not shown) to bend.; Mounted in the slot 2 of the supporting body 1 with a possibility of longitudinal traversing is a staple body 6 with a head 7 which accommodates ,, a replaceable magazine 8 (FIGS. 1, 3) with open-end slots for staples. Interconnected with the staple body 6 with a possibility of longitudinal traverse is a staple e]ector (FIG~ 3) provided , , ;, .
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with driving projections lO. The depressions in the supporting jaw 4, their respective slots in the magazine 8 and the staple driving projections lO are arranged in the proposed specific embodiment of the instrument, in two rows and serve largely for establishing oblong sutures. In a general case the number of rows may be any. , The staple body 6 has a tailpiece 11 with a male thread 12 to which is fitted a nut 13, and with a threaded hole 14 into which a screw 15 is fitted. The nut 13 is in effect .
an actuator of the staple body 6 and has an annular groove .,, .~ '.
16 to interact with the supporting body l. The screw 15 is in essence an actuator of the ejector 9 and has at its end an annular groove 17 with which is engaged a fork 18 tFIG. 4) provided on the ejector 9. At its other end the screw 15 (FIG-. 2) has a hole l9 with longitudinal slots (not shown) : .
into which hole a detachable handle 20 is fitted, having : . -.:. ~ ~: :
projections 21 for interaction with the walls of the longitudinal slots of the hole l9,during rotation of the handle 20. When manipulating the instrument the detachable ~;
-handle 20 can be removed to preclude an inadvertent turn of the screw 15 of the ejector 9 and premature ejection o~
the staples from the magazine 8.
The slot 2 ~FIG. l~in the supporting body l with its ;`~
open end faces the direction perpendicular the plane of the ',': ~:
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a8 frame 3 of the supporting body 1 so as to provide a possi~
bility for the staple bod~ 6 with the ejector 9 (FIG. 3) to insert into the slot 2 and extract therefrom in said direction. A bottom 22 (FIG. 2) of the slot 2 of the supporting body 1 is parallel to the plane of the frame 3.
In the proposed specific embodiment of the instrument the frame 3 of the supporting body 1 is made closed. It is worth noting, however, that in a general case the frame may be shaped otherwise, e.g., as a hook.
Provision of the closed frame of the supporting body -~
is expedient in view of a necessity to impart maximum rigidity , . ~: . .. ..
to the construction of the instrument~
The frame 3 of the supporting body 1 comprises two ~ ;
webs 23 parallel to the slot 2 and adapted to serve as guides for the head 7 (FIG. 1) of the staple body~6. ~'he rear portions of the webs 23 (with respect to the supporting jaw 4) are ;~
provided with recesses 24 (FIGS 1, 5) which are commensurable in length with the head 7 of the staple body 6 and are to provide a possibility for the staple body 6 to insert into the slot 2 of the supporting body 1 and with~raw therefrom when in the rearmost position with respect to the supporting ;~
jaw 4 of the frame 3 as illustrated in FI~. 5. ,~
The head 7 of the staple body 6 has two side walls 25 (FIG. 6) perpendicular to ~he plane of the frame 3 ~nd pro-~ . ' : - ~
~ l6 - ~ ~
~ 8 ~ ~; 4, vided with lon~itudinal 26 to interact with the webs Z3 (~IG. 5~ of the ~rame 3. 'l'he slots 26 (FIG~ 6) keep the head 7 o~ the staple body a~ainst transvarsal displacement with respect to the supportin~ jaw (~lGo 5) 0~ the frame 3 9 this . ~ :
~ei~ due to the ~'act -that ~ide projections 27 and 28 (~G.7) of'-the slots 26 in the head 7 o~ the staple bod~ straddie the ~rame webs 2~
; ~ In its tail portion the staple body 6 (~IG. 1) compri~es projection~ 29 which en~a~e ~rooves ~O o~ the side walls o~
the slot 2 in the supportin~ body 1 and, alo~side with ;.
the pIo3e~tions 27~and 28 (FIGg 7) of -the head 7 o~;the ~ ,J
staple~body~ ntercon~ect the staple~body 6 (FIG~ 1) with :: the supportin~body 1 when bhe ~o~mer:~is;l~its ~orward working position with respect to~the~supporting~jaw 4 4 the ~ram~e~
ha~ks to~the~act~:that~the~x ~ e 3 of' the su~porting ;;: bod~1 ls made~;closed, whereas the slots 26 (~IG. 5j on bhe slde~walls o~;the head 7 of` the staple ~ody~are mtercoDnec-t~ed:~with~the webs 23~o~the ~ram~e 3j hi~h ri~idlby of the nstrumeDt~as~a~ whole~is: attained~rhich :ensuresstabili~o~
the~mutual arr~ngeme~; o~ bhe ma~;azlne 8 (~IGo 1) and~ t~e:~
sup~portlng~ jaw:~4 under maximum load~ UpOIl the~ instrument aor~
respondin~ to bhe mome~t o~ staple deformatlon~ ~his enables the oross-$~ctlonal area of the f'rame elements to be reduoed ~ ,: -~ :
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several times as compared to the k~ow~ surgical inst.rum0nt~
of the same type, with the retai~ed stability o~ the staple ~ :~
de~oI~nation process and hi~h-quality suture~ obtained. ;~ ;
r~he hei~ht of -the pIojectio~s 27 a~d 28 (FIGS 5, 8) arran~ed towards the bottom 22 (~IG. 4) of -the slot 2 of ;~:~
-the supportin body 1 is less than the depth of the receæses 24 (~lGS 5, 8) in the webs 23, while the height of the projections 28 arra~ed towards the ope~ end o~ the slot 2 (~IG. 5) exoeeds the depth o~ the recesses 24~ This makes it possible to fit the head 7 of the staple body o~to the webs 23 of the ~rame 3 of the supportin~ body 1~ hen ,1 ,;
as~embli~ the i~strume~-t, ~nd to avoid getti~g~o~ the entire head 7 oP the staple body inbo the clear openin~ o~
the ~rame ~ a whereb~ the i~strume~t assembly is rendered con~e~ie~ a~d a~ misassembly:is excludedO
A wa11 71 (FIGS~ 6-8) of tbe head 7 o~ the staple body, ` :
arran~ed::i~ parallel wi-th the plane o~ the ~rame, is ma~e~
detachable a~d is ~itted 1nto longitudina1 slots 32 made on~the 1ns1de surfaces of`:the si~e walls ~5 till it thrusts .
a~a1~st the magazLne 8~(FIG. 3). ~ wall 33 (FIG.~6) of the `~
head 7 of the staple body,;~aci~ the~sIot 2 (~IG~ 1~ o~ the ~ ~ -supportin~ bod~ 1a hais a ~otch ~4 (FIG~ 6) whlch ope~s towards the detachable wall 31 of the head 7. '~hereb~ Gon~e nie~ce i~ assem~ly o~ the ejector 9 (~IG. 2) a~d the staple ~ .. , ~", .:
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body 6 is attai~ed. The ejector 9 (~IG. ~ passes through the '~
notch 34 (l-1~IGo 6) in the wall 3~, whose head 3S and the ~
magazine 8 are located between the side walls 25 of the ~ ::
head 7 o~ the staple boc~ and are locked in position in the head 7 ~y means o~ the detachable wall 31 (~'IG. 6) ~ r~he ~:
wall 31 provides also co~venience in replacin~ the ma~azi~e 8 (F~G.9) for which pu~pose said wall is drawn out to relea ~ ,. ..
se the ma~azine 8 a~d extract i-t from -the head 7 o~ -the staple bo~ o ~lake the wall 31 (~`IG. 6) convenient to be drawn out, depressions ~6 are provided on the outside sur~ace thereof. With the wall 31 remo~ed, khe head 7 o~the staple bo~y~is exposed on the side o~ its broadest surface,~
while the i~slde space conflned between the sl~e walls 25 is o~ a relatlvely small depth whioh provides ~avourable conditions~for~Glea~in~ the heacl 7 o~ the staple body.
Transverse~6rooves 37 are:made on the i~slde surfaces of the side walls 25 o~ the head:7 o~ the staple bod~ to ~:
wh1ch ~rooves~;p~oaections 38~ 1G. 9) o~ the magazlne 8 are~
tted~Por loc~ the latter i~ the staple boc~y i~ the direction o~;the~axis of the slot~2 (~IG. 1) in the upportlng body~
Now let~ us consider the:operatlon of the 1nstrument with xeference to the operation of larynaectomy ~or cancer.
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'I'he supportin~ w ~ o~ the ~rame 3 of the su~portin~
body 1 which has been ~etached f'rom the rest of the instru- ~
ment, is approximated to the sou~d portions o~ the wall of ~ :
the pha~ynx that are to be sutured~ having passed t~ough the clear openi~ o~ the frame ~ the comglomerate o~ tumor tlssues prepared ~or resectiont alon~side with the larynx. : :
'~he ~rame 3 o~ the supporti~ body 1 in this case is ~
approa hed to the tumor from above ~ith respect, t~ the patient i~ the recumbent position in such a way that the side webs Z3 of the frame 3 are introduced i~to the inci~
sions i~ the tissues in the area of' the root o~ the ton~ue and the trachea~ while the slot 2 in the ~pporting body 1 .
is posltioned thexeabove~ ~he~ the head 7 (~IG~ 5) o~ the . ~.
taple:bod~ 6~is i~troduced lnto~the~enlar~ed portion of the .
opem ng oP the ~r~me~3 of the~supportin6 bo~y-1 tiIl the p~ojectio~s 28 get in contac~ with the side webs 23 of the ~rame 3,~whereupon the staple bo ~ 6 is inserted into the~
long1tudinaL~slot 2 of th~ supportine body 1.
Upo~ brl~gin~ the pe-tal o~::tke epi~lottis ou-t o~ the zone.
co~fi~ed betwee~the suppor-tin6 jaw 4 ana the maga~ine 8, both.
of~them axe~brough~ toge-thar till obtainin~ the suturi~ ~ap b~:rotatin~ the ~ut 1~ (~IGS. 1:, 3) o~ the actuator o~ the staple body 6, with the xeault that the prodecbions 27 and 28 (FIG8. 1, 7) o~ the æide walls o~ the head 7 ~traddle the :~
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side webs 23 of the frame 3 and reliably fix the magazine 8 ;
in working position with respect to th~ supporting jaw 4.
The walls of the pharynx are sutured by rotating the handle 20 (FIG. 3) of the screw 15 of the actuator of the ejector 9, the movement of which results in that the driving projections 10 enter the respective slots in the magazine 8 and eject the staples therefrom. Upon suturing, a special clamp is placed under the tumor to be resected till the contact with the instrument, and the tissues between the ~;
clamp jaws and th~ instrument are severed with a scalpel. ~ext the magazine 8 is withdrawn from the supporting jaw ~ of the frame 3 of the supporting body 1 by rotating the nut 13 in the reverse direction, and the instrument is removed from the operative wound.
In some cases of instrument application in the thoracic or abdominal cavity, e.g~, in suturing pulmonary tissues, the instrument is expedient to be introduced into the opera~
tive wound in an assembled state, as is usually the case when using the known instruments. When the frame of the supporting body of the instrument according to the invention ~, ; is hook-shaped, the application technique of the instrument ;~
in aIl cases li~ted above differs in nothing from the appli-cation of the known instrument. If, on contrary, tbe frame -~of the supporting ~ody of the instruments is made closed, ~
".':;
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~ 2 'I ---the ti~ues under suturirl~; are introduced between the ~ide webs ~3 of the f rame 3 of` khe supporting body 1 (~'IG . 5) a~d : :
the supportin{~; jaw 4 and ~he magazine 8 whe~ r~tracted with respect ~o the ~upp~,rting jaw ~
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~ he present invention relates to medical equipment and has particular reference to surgical suturing instruments~ The d:isclosed instrunent can find application in oncological practice fox suturing the walls of the pharynx upon laryngectomy for cancer, as well as or suturing organs and tissues of the thor- ;
acic and abdominal cavities, e.g., for suturing pulmonary tissues. ~-Known in the art is a surgical suturing instrument, comprising the supporting body with the slot and the hook-shaped frame (cf. USSR Inventor's Certificate No. 125,523, issued October 5, 1959 to A. A. Strekopytov, N. S. Gorkin and ~. D.
Garin, and the assignee is NAUCHNO-ISSLEDOVATELSKY INSTITUT
EXPERIMENTALNOI KHIRURGIC~ESKOI APPARATU~Y I I~STRUME~TO~. The frame has a supporting jaw arranged transversely wlth respect -to the slot and having an oblong flat area provided with depres-sions for staple legs to bend. The slot in the supporting body ' pens in the direction parallel to the plane of the supporting .
body ~rame. Said slot accommodates the staple body with the `~
,. ~ .
head into which the staple magazine is inserted, said staple body 20 ~ being free to travel length-wise said slot. The staple ejector ~ -is housed in the staple body with a possibility of longitudinal `~ `
. .
traverse~ Owing to the fact that the slot in the supporting ~
.: .;
body is arranged with ltS open end towards the direction parallel to the plane of the eupporting body frame,~ the staple body can be inserted into the slot and removed therefrom only in said direc~
tion.
The staple body can assume the working position with -respect to the supporting body, wherein the gaps between the `''t~
~ ,.
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supportin~ jaw a~d the staple ~agazine correspond to the ~ :
-thickness o~ the tissues being sutured, as well as the ini~
tial position, wherein the staple body is inserted into ..
the slot o~ the sup~)Qrtin~ bod~ or wi-thdrawn therefrvmO '~o i~sert the ~taple bo~y i~to the slot o~ the supporti~ bo~y in the i~itial positio~ o~ the former there needs more room .
i~ the direction o~ the plane o~ the ~rame. ,~
q`he ~taple body a~d the staple ejector are provided with correspo~ding actua-tors to be traversed with respect: to !,.`~' ' '' ~ ~ the supporti~ body towards the ~upporti~g jaw~
: The ætaple magazi~e has open-end slots to accommodate `. .
~: ~ m~tal staples therei~. ~he slots are arran~ed in a strict ..
.... ....
: ~ ~ correæponde~ce with the depressio~s i~ the~rame supporti~g~
jaw. The st~ple ejector haæ~drlvl~ projectlons axran~ed correspo~dln~Iy to the magazi~e slots~O ~hen the~:ejector moves t~war~s the frame supporti~ jaw its driving projeGbions~
enber the ma~azl~e slots~to eject;the~staples~the~e~rom~
o prevent the tiseu~ or or~an bein~ sutured:~rom slipplng~o~f the l~st~ume~t, the staple head i~ provi~ed i` :~
wi~th a~fork limiter~
Durin~ 6uturi~g wath the use~of the abo~e-discussed ;in~ru~e~t the~tissue or organ bei~g sutured is placed i~
between the ~lat~area o~ the~supportlng aa~ and th~ wor~in~
e~d~o~ the~staple ma~azine ~aoing said flat area. Into such ,.................................................................. .
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. .
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7~
a position the tissue or or~an bein~ ~utured mayb.~ establi~
shed b~ bein~ troduced throu~h the side opening o~ the ..
hook-shaped ~rame. '~hen the tissue or or~an under suturin~
is ~ixed in position by the ~ork limi-ter9 whereupon the .
sur~eon exerts upon the ac~uator o~ the staple body, thus approximatin~ the ma~azine to the supportin~ jaw of the supportin~ body till the position, wherei~ the ~ecessa~y suturin~ ~ap is establlshed in betwee~ the flat area of the ~ ;;:~;
supportin~ jaw a~d the workin~ of the ma~azineO Next the `
tissues are sutured by exertin~ upo~ the staple ejector actuator,:wi~h the result that the ejeotor proaections pass through the ma~azine slots and drive the staples out there~
romO The~taple:le~s pierce ~he~tissues bein~ sutured and ;`.
th~ust agalnst the depressions i~ the flat~area of the suppor~
tln~ iaw~to bend and thus suture the tissues.~'~he tissu~ to be~ excised~:ls~out out, the ma~azlne ~s wi~hdrawn~rom the supporti~g Jaw~and the ins~trume~t 1~ removed f~om the ope~
rative wound~
Eowever,~the~know~ i~strument iB inco~venient or imprac~
tica~le~:to~be~applied~bo su-ture~applioatio~ ln~ha~d of-acoess .
plaoes~or under spec1flC cond1blo~s:~wh~re the:~space ~or ma~i~ulations l~volved i~ ~ett~n~the~lnstrument into the æuturin~ positlon is limited, e~pecially in the pla~e o~`the ~rame. This di~advanta~e i~ du~ to the oonetruction of the . . ... . .
. .
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.
support:in~ body of the instr~ent, wherein the supporting ~: :
jaw of the ~upporti~ bo~y and the staple rna~azine can be : .
approxi~ated to ~he tissues bein~ sutured ~nly throu~h the side openin~ o~ the hook-shaped ~rame of the supporti~g body. ~'or the supportin~ jaw a~d the staple ma~azine to .set into the suturi~g positio~ usi~g said technlque~ both of : : them are to be moved with respect to the tissues under sutu~
rin~ by the length equal to the width o~ the supportin~ body frame. I~ thls addi-tio~al space i~ the ope~ative wound.
proves to be i~sufficlent the .sur~eon ha~s to per~o~m compli~
cated manipulations with the ins~rument aimed at the avoida~ce:~
of a~y inju~y~thab is liable to be lnflicted upon both~the tlssues bein~ sutured a~d the su:rrounding tissuesu :~
o ~cite~ a~ example~ in:-the:Gase of la~ ;ectom;y ~or ;canoer ~y~resorting~:to~the:~known~instrumen~, ~he~frame-s~ppor~
tlng aa~ and~the staple magaslne Ga~be brought~under the ;~
tumor~:to be~excls~e~ to the~place.:of suture~appll~oation to the~
pha~ynx~only~ rom the chln~-or:~the breast which are loGated much superior~to:the~plaoe of;~suture applloationO Moreover,~
his~i~volves~::some~compl1~cated~tis~sue-1~juri~g~ma~ipulatlons~
.in~a:~a~ro~ space confined ~etween ~he tumor:resected o~ -the side::o~ ~he chl~;a~d;in the re~ion o~:the trachea,:~a~d~the~remaini~
or~ans and ~isæues~o~ the pat1en-t's hea~ and:neck.
Another disadvantage i~herent in the known instrume~-t resides in lar~e cross-æectional dimensions of the frame ele-, : , ~ : .... " ~:
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:1~31~
ments necessaIy ~or imparti~ reasonable ri~idity -to the co~s-truction o~ the i~strume~t which has to sustai~ consi~
.
derable loads resultin~ f`~Qm staple defo~atio~ during ~utu~
ring process~ which ~eature restricts the field of applica~
tion of the instrument. '~hus, the application o~ the instru :.
ments involves xelatively wide portiorls of` the tissues being sutured, that are required ~ox bein~ ~orced in betwee~
the frame supportin~ jaw and the staple ma~azine which increases the dista~ce ~om the line o~ staples of the suture ... -~
!;' . ~' to the plane of cut of the tissues an~ results in more rou~h .
suture scar; besi~es, lar~er space area is re~uired betwee~ .;
the -tissues ~or the supporti~g jaw a~d the side web of the .
supporti~ body ~rame to i~trodllce. I~ some cases such favou~
rable conditio~s ca~ot be provided and the apparatus proves .~
to be i~applicable. ~ ~ ;
~ o e~empllfy this statementi, i~ the cas~ of' lary~ectomy for cancer too lar~e cross-sectional ~mensions o~ the sid0 web o~ ~he ~rame interfere with its positioni~ the i~ci~
.sio~ made in ~tihe~ tissues in the region of the chin o.~` the ;~
trachea, too large a width of the s~pportin~ jaw makes it `~
le~s practicable to place the jaw uponi the sou~d but res-tric~
:
;: ted in width portions of the pha~y~x and results in a reduced lumen of the sutured pha~y~
~ ;
A nece~sity of reducin~ the cross-sectional dimensions of the frame elements of the supportin~ body makes it impo~
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ssible to use the known instrument for approaching the su-pporting jaw and the magazine to the pharynx portions being sutured using another application technique more reasonable for the operation under discussion. Thus, ~or instance, the known instrument could be approached, in principle, to the ~ `
place of suture application from above (with respect to the patient in recumbent position) rather than from the chin or the breast so as to pass the conglomerate of the tumor tissues through the gap between the supporting jaw and the magazine in the direction perpendicular to the plane of the frame.
However, this cannot be carried out with the known instrument, since the distance from the supporting jaw to ~-~ , .
the magazine is much less than the size of the conglomerated -tumor tissues, on which account the latter cannot be passed through the gap between the supporting jaw and the magazine, , ~
while any increase of said gap is inadmissible since it will necessitate an increase in the length of the side weh o~ the ,,~
supporting body hook and result in a reduced rigidity of the supporting body and, consequently, in an inferior quality 20 of sutures established by metal staples. ~o maintain an `
adequate rigidity of the instrument in this case it is of ~ ~ `
necessity to increase the cross-sectional dimensions of the hook web which renders the known instrument still less applicable for the purpose.
': :
' ' . ' , ~; , ~31~
It i9 an object of the pxesent invention to provide a surgical suturing instrument which is capable of applying sutures in hard-of-access places or under specific conditions where there is but restricted room for manipulations indis-pensable for setting the instrument into suturing position.
It is another object of the present invention to~pro-vide a surgical instrument which is capable of being approached to the tissues under suturing without any injury inflicted ~ -thereupon.
It is still more object of the present invention to provide a surgical instrument capable of applying a suture of `
an upgraded quality.
It is yet still more object of the present invention to ; ;~
provide a surgical instrument capable of attaining an . ~ .
increased lumen of tubular organs when applying a longitu-: ,. ~; -. , :' dinal lateral suture to the wall thereof. ~
. ,. : ~ -Said objects are accomplished due to the fact that in a surgical suturing instrument, comprising a supporting body with a slot and a flat frame having a supporting jaw arranged :: .
transversely with respect to the slot and provided with a flat spot facing the slot and carrying depressions for staple legs to bend, a staple body mounted in said slot of the supporting body with a possibility of longitudinal traversing -and incorporating a head, a staple magazine accommodated ` ~
,'~
.
, " . , i~ the staple body head, a staple ejector associated with the staple bo~y with a possibility o~ lonr~itudi~al traver.si~
and actuators of` the staple body and of the staple ejector~
accordi~g to the i~ention ~aid slot i~ -the supportin~ body ope~s in the direction perpendic~lar to the pla~e o~ the supportin~ body ~rame so as to provide a possi~ility ~or the ;, staple bod~ with the ejector to i~sert into a~d extract from the slot i~ said direction. . ;~ ~.
~, ~ ,. . .
It i~ desirable that the frame of khe suppGrtin~ body be made closed and have two webs parallel to tke slot and ser~ing~
as guldes ~or the head o~ the stap~e body, said webs bein pro~ided~wLth recesses located~i;n thelr rear por~ions~(wlth .
respe~t to the supportin~ ja~ Which recesses are comme~
:surable~ len~th w~th the head of the staple body a~d are adapted to~pro~ide a possibillty~ for the staple bo~ wi~h -~the~ejeotor to l~sert into the slot o~ the suppor~in~ body and;~wlthdraw~there~rom when:m ;t.he rea ~ ost position with respect; to the supporti~ jaw, ; The~head o~the staple bo~y~may have-two side ~alls pe~ endicular to the plane~o~ the ~rame a~d provided~with lon~itudinal slots adapted to lnteract with the webs of the~
frame so as to ~ui~e the ~s~aple~ bod;
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" ', ~:""''' '" ' " ' " ''' ' '' ' ' " '' ~' ' '., ,, :. ' . ' Side projections of the longitudinal slots of the staple body are expedient to be di~ferent in length in such a manner that the height of the projections arranged towards the bottom of the slot in the supporting body be less than the depth of the recesses in the frame webs, while the height of the projections arranged towards the open slot end be in excess of the depth of said recesses. ~ -~
It is also desirable that one of the walls of the -staple body head that are arranged in parallel with the plane of the frame, be made detachable.
The wall of the staple body head that faces the slot ~ -~
in the supporting body may have a notch open towards the detachable wall of the staple body head. A`~
The proposed surgical suturing instrument unlike the ~nown one enables application of mechanical sutures to tissues located in narrow deep cavities where there is less room for manoeuvring with the instrument in the plane of the frame and an inconvenient access to the place of suture `
application. Movel constructional arrangement of the :. .~., ,,:
20 instrument, whereby the supporting body is joined with the ~' remainder part of the instrument in the direction perpendi-cular to the plane of the frame makes it possible to rule out more room in the plane of the frame for the supporting body to assemble with t'ne remainder part of the instrument.
.
, '. :: ,: ' , " , .
, ........................ . .
~3~
Under conditions of restricted space in the operative wound for manoeuvring with the instrument and poor observabili~
ty of the place of suturing, the above said novel feature of the instrument enables a new technique of approaching the supporting ~aw of the supporting body and the magazine to the tissues under suturing to be applied, said techni~ue avo.iding any in~ury -to the tissues under suturiny or the surrounding tissues, which technique consists in that appro~
ached to the place of suture application is the supporting body alone, separated from the remainder part of the instru-ment, whereupon the staple body is inserted into the slot of the supporting body along$~de with the other components without their displacement with respect to the supporting `~
body in the plane of the frame.
The proposed embodiment of the slot in the supporting body that enables the use of the aforesaid instrument appli~
. cation technique, makes practicable t~e embodiment of the supporting body frame as a closed structure which adds much to the constructional rigidity of the instrument as a whole, thereby ensuring a considerable reduction of the cross-sec~
tional area of the supporting body frame elements (~ver :~
three times as compared.to the known instrument). This, in `.
turn, provides a possibility of atraumatic introduction of the frame elements into a much narrower gap in between the tissues in the operative wound, involves less width of tis~
~ 10 --,; ............. ..
~ ~:
~L~3879LI~
sues necessary for setting the instrument into suturing position, increases the elasticity of the sutures applied and, with the width of the strip of tissues remaining the same, an increase in the lumen of the tube formed by suture appli~
cation to the margins of the strip of tissues~ All the afore~
said improves the quality of sutures applied by the present instrurnent.
The aforelisted advantages of the proposed instrurnent over the known one are of especially great importance in, say, suturing of the pharynx involved in the process of laryngectomy for cancer and extends much the indications for -the instrument application in case of suturing of the p ~ nx.
The construction of the instrument enables the conglomerated i~
tumor tissues to pass through the frame opening in the direction perpendicular to the plane of the frame of the supporting body detached from the rernainder part of the instrument without inflicting any injury upon the pharynx and the surrounding tissues, whereupon the remainder part of the - instrument is joined with the supporting body without dis~
pla~ing the staple body towards the chin or the breast, i.e., without dislodging the supporting bo~y in the plane of the frame. This makes the method of mechanical suturing of the ~ ~
pharynx in laryngectomy extensively applicable. ~ ~;
As compared to the routine method of manual suturing of the walls of the pharynx in laryngectorrLy, following the exci- ~ ~;
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sion Qf the tumor to be removed, application of the propose~
instrument reduces abruptly the dan~er o~ ecting the -operative wo~d and the phary~x with -the co~tents of the tumor, since first the walls of` the pharynx are sutured and the lume~ o~ the ablated portion is blocked with the use of a special clamp arld only after this the tumor being :
removed is excised to~ekher with the clamp alon~ -the instru~
ment a~d severed from the sutured phar~nx. Applicatio~ o~
the proposed inst~ment improves .rege~eratio~ conditions o~
: ~ the tissues that are as a ~ule sutured after ha~in~ been subjected to beam therapy, cuts down cons1derably the time of~sut~re applic~tio~ to the~phaIynx and:reduces postoperative;
~ Gomplicatlon~
; :ln~what ~ollows the i~ve~tl~o~is iIlustrated:in a spe~
olflc~exempla~y~embodiment~:thereo~:a~d the acoompa~ ing :drawl~s;, where IG.: 1 is:a~schematic partiall~ cutaway vlew~of a sur~
iGal suturlng~l~nstrument~ acoordi~ to the i~uentio~
IG.:2~is~a portion o~ the~supportin~ bo~ accordin~ to~
the~ ve~tion;
LG.~3~1s~a section~;take~al~ the line IlI-III in : ~IG. 4 is~a section taken along the li~e IV-IV i~
~IG. 3; ` ~ :~
: :. : . ..
~.
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FIG. 5 is the head of the staple body while in the initial position with respect to the supporting body frame, according to the invention, FIG. 6 is the head of the staple bod~ with a detach~
able wall, according to the invention;
FIG. 7 is a section taken along the line VII~VII in ~ ,-FIG. 1, FIG. 8 is a section taken along the line VIII-VIII in FIG. 5~
FIG. 9 is a view along the arrow A of FIG. 3 with the detachable wall of the staple body head out of position; and FIG. 10 is a perspective view of the surgical suturing instrument in its working position.
Reference being now directed to the accompanying draw- ~ ;
ings, the surgical suturing instrument comprises a supporting ,~
body (FIGS. 1, 2) with a slot 2 and a flat frame 3~ The frame 3 ,~ . .
has a supporting jaw 4 arranged transversely with respect to the slot 2 and provided with a flat spot 5 (FIG. 1) facing the slot 2. me flat spot 5 of the supportiny jaw 4 carries depres~
~ sions for staples (not shown) to bend.; Mounted in the slot 2 of the supporting body 1 with a possibility of longitudinal traversing is a staple body 6 with a head 7 which accommodates ,, a replaceable magazine 8 (FIGS. 1, 3) with open-end slots for staples. Interconnected with the staple body 6 with a possibility of longitudinal traverse is a staple e]ector (FIG~ 3) provided , , ;, .
" , . . . . . .
,f~
with driving projections lO. The depressions in the supporting jaw 4, their respective slots in the magazine 8 and the staple driving projections lO are arranged in the proposed specific embodiment of the instrument, in two rows and serve largely for establishing oblong sutures. In a general case the number of rows may be any. , The staple body 6 has a tailpiece 11 with a male thread 12 to which is fitted a nut 13, and with a threaded hole 14 into which a screw 15 is fitted. The nut 13 is in effect .
an actuator of the staple body 6 and has an annular groove .,, .~ '.
16 to interact with the supporting body l. The screw 15 is in essence an actuator of the ejector 9 and has at its end an annular groove 17 with which is engaged a fork 18 tFIG. 4) provided on the ejector 9. At its other end the screw 15 (FIG-. 2) has a hole l9 with longitudinal slots (not shown) : .
into which hole a detachable handle 20 is fitted, having : . -.:. ~ ~: :
projections 21 for interaction with the walls of the longitudinal slots of the hole l9,during rotation of the handle 20. When manipulating the instrument the detachable ~;
-handle 20 can be removed to preclude an inadvertent turn of the screw 15 of the ejector 9 and premature ejection o~
the staples from the magazine 8.
The slot 2 ~FIG. l~in the supporting body l with its ;`~
open end faces the direction perpendicular the plane of the ',': ~:
, '' ., , . : .: ., : .
::: , ,., , : :
a8 frame 3 of the supporting body 1 so as to provide a possi~
bility for the staple bod~ 6 with the ejector 9 (FIG. 3) to insert into the slot 2 and extract therefrom in said direction. A bottom 22 (FIG. 2) of the slot 2 of the supporting body 1 is parallel to the plane of the frame 3.
In the proposed specific embodiment of the instrument the frame 3 of the supporting body 1 is made closed. It is worth noting, however, that in a general case the frame may be shaped otherwise, e.g., as a hook.
Provision of the closed frame of the supporting body -~
is expedient in view of a necessity to impart maximum rigidity , . ~: . .. ..
to the construction of the instrument~
The frame 3 of the supporting body 1 comprises two ~ ;
webs 23 parallel to the slot 2 and adapted to serve as guides for the head 7 (FIG. 1) of the staple body~6. ~'he rear portions of the webs 23 (with respect to the supporting jaw 4) are ;~
provided with recesses 24 (FIGS 1, 5) which are commensurable in length with the head 7 of the staple body 6 and are to provide a possibility for the staple body 6 to insert into the slot 2 of the supporting body 1 and with~raw therefrom when in the rearmost position with respect to the supporting ;~
jaw 4 of the frame 3 as illustrated in FI~. 5. ,~
The head 7 of the staple body 6 has two side walls 25 (FIG. 6) perpendicular to ~he plane of the frame 3 ~nd pro-~ . ' : - ~
~ l6 - ~ ~
~ 8 ~ ~; 4, vided with lon~itudinal 26 to interact with the webs Z3 (~IG. 5~ of the ~rame 3. 'l'he slots 26 (FIG~ 6) keep the head 7 o~ the staple body a~ainst transvarsal displacement with respect to the supportin~ jaw (~lGo 5) 0~ the frame 3 9 this . ~ :
~ei~ due to the ~'act -that ~ide projections 27 and 28 (~G.7) of'-the slots 26 in the head 7 o~ the staple bod~ straddie the ~rame webs 2~
; ~ In its tail portion the staple body 6 (~IG. 1) compri~es projection~ 29 which en~a~e ~rooves ~O o~ the side walls o~
the slot 2 in the supportin~ body 1 and, alo~side with ;.
the pIo3e~tions 27~and 28 (FIGg 7) of -the head 7 o~;the ~ ,J
staple~body~ ntercon~ect the staple~body 6 (FIG~ 1) with :: the supportin~body 1 when bhe ~o~mer:~is;l~its ~orward working position with respect to~the~supporting~jaw 4 4 the ~ram~e~
ha~ks to~the~act~:that~the~x ~ e 3 of' the su~porting ;;: bod~1 ls made~;closed, whereas the slots 26 (~IG. 5j on bhe slde~walls o~;the head 7 of` the staple ~ody~are mtercoDnec-t~ed:~with~the webs 23~o~the ~ram~e 3j hi~h ri~idlby of the nstrumeDt~as~a~ whole~is: attained~rhich :ensuresstabili~o~
the~mutual arr~ngeme~; o~ bhe ma~;azlne 8 (~IGo 1) and~ t~e:~
sup~portlng~ jaw:~4 under maximum load~ UpOIl the~ instrument aor~
respondin~ to bhe mome~t o~ staple deformatlon~ ~his enables the oross-$~ctlonal area of the f'rame elements to be reduoed ~ ,: -~ :
,. , . ."
:,j ,~ ~ ,..... ... . . . .
, , , . , ,~ ", ; "; . ,: ' ~ , ,, , , :, , , ,, . , , , , , ,~ . , ~ 17 3~A.~
,~ :
several times as compared to the k~ow~ surgical inst.rum0nt~
of the same type, with the retai~ed stability o~ the staple ~ :~
de~oI~nation process and hi~h-quality suture~ obtained. ;~ ;
r~he hei~ht of -the pIojectio~s 27 a~d 28 (FIGS 5, 8) arran~ed towards the bottom 22 (~IG. 4) of -the slot 2 of ;~:~
-the supportin body 1 is less than the depth of the receæses 24 (~lGS 5, 8) in the webs 23, while the height of the projections 28 arra~ed towards the ope~ end o~ the slot 2 (~IG. 5) exoeeds the depth o~ the recesses 24~ This makes it possible to fit the head 7 of the staple body o~to the webs 23 of the ~rame 3 of the supportin~ body 1~ hen ,1 ,;
as~embli~ the i~strume~-t, ~nd to avoid getti~g~o~ the entire head 7 oP the staple body inbo the clear openin~ o~
the ~rame ~ a whereb~ the i~strume~t assembly is rendered con~e~ie~ a~d a~ misassembly:is excludedO
A wa11 71 (FIGS~ 6-8) of tbe head 7 o~ the staple body, ` :
arran~ed::i~ parallel wi-th the plane o~ the ~rame, is ma~e~
detachable a~d is ~itted 1nto longitudina1 slots 32 made on~the 1ns1de surfaces of`:the si~e walls ~5 till it thrusts .
a~a1~st the magazLne 8~(FIG. 3). ~ wall 33 (FIG.~6) of the `~
head 7 of the staple body,;~aci~ the~sIot 2 (~IG~ 1~ o~ the ~ ~ -supportin~ bod~ 1a hais a ~otch ~4 (FIG~ 6) whlch ope~s towards the detachable wall 31 of the head 7. '~hereb~ Gon~e nie~ce i~ assem~ly o~ the ejector 9 (~IG. 2) a~d the staple ~ .. , ~", .:
, .
.j ~ ' .; . . .
.. ~ , , ~ . . . . ..
.-. ~', :, .' ,,' ': . . ., , . . . , . , .; .
. . .. , : :. .. ..
" "'' '' ' ' '' , , '" ~' : ' ~q~31~
body 6 is attai~ed. The ejector 9 (~IG. ~ passes through the '~
notch 34 (l-1~IGo 6) in the wall 3~, whose head 3S and the ~
magazine 8 are located between the side walls 25 of the ~ ::
head 7 o~ the staple boc~ and are locked in position in the head 7 ~y means o~ the detachable wall 31 (~'IG. 6) ~ r~he ~:
wall 31 provides also co~venience in replacin~ the ma~azi~e 8 (F~G.9) for which pu~pose said wall is drawn out to relea ~ ,. ..
se the ma~azine 8 a~d extract i-t from -the head 7 o~ -the staple bo~ o ~lake the wall 31 (~`IG. 6) convenient to be drawn out, depressions ~6 are provided on the outside sur~ace thereof. With the wall 31 remo~ed, khe head 7 o~the staple bo~y~is exposed on the side o~ its broadest surface,~
while the i~slde space conflned between the sl~e walls 25 is o~ a relatlvely small depth whioh provides ~avourable conditions~for~Glea~in~ the heacl 7 o~ the staple body.
Transverse~6rooves 37 are:made on the i~slde surfaces of the side walls 25 o~ the head:7 o~ the staple bod~ to ~:
wh1ch ~rooves~;p~oaections 38~ 1G. 9) o~ the magazlne 8 are~
tted~Por loc~ the latter i~ the staple boc~y i~ the direction o~;the~axis of the slot~2 (~IG. 1) in the upportlng body~
Now let~ us consider the:operatlon of the 1nstrument with xeference to the operation of larynaectomy ~or cancer.
,.:, ,,. ,. . ~ . . , . , ,, , - - . ~ ,- .
- 19 - ~
. ;" : ,.. .
'I'he supportin~ w ~ o~ the ~rame 3 of the su~portin~
body 1 which has been ~etached f'rom the rest of the instru- ~
ment, is approximated to the sou~d portions o~ the wall of ~ :
the pha~ynx that are to be sutured~ having passed t~ough the clear openi~ o~ the frame ~ the comglomerate o~ tumor tlssues prepared ~or resectiont alon~side with the larynx. : :
'~he ~rame 3 o~ the supporti~ body 1 in this case is ~
approa hed to the tumor from above ~ith respect, t~ the patient i~ the recumbent position in such a way that the side webs Z3 of the frame 3 are introduced i~to the inci~
sions i~ the tissues in the area of' the root o~ the ton~ue and the trachea~ while the slot 2 in the ~pporting body 1 .
is posltioned thexeabove~ ~he~ the head 7 (~IG~ 5) o~ the . ~.
taple:bod~ 6~is i~troduced lnto~the~enlar~ed portion of the .
opem ng oP the ~r~me~3 of the~supportin6 bo~y-1 tiIl the p~ojectio~s 28 get in contac~ with the side webs 23 of the ~rame 3,~whereupon the staple bo ~ 6 is inserted into the~
long1tudinaL~slot 2 of th~ supportine body 1.
Upo~ brl~gin~ the pe-tal o~::tke epi~lottis ou-t o~ the zone.
co~fi~ed betwee~the suppor-tin6 jaw 4 ana the maga~ine 8, both.
of~them axe~brough~ toge-thar till obtainin~ the suturi~ ~ap b~:rotatin~ the ~ut 1~ (~IGS. 1:, 3) o~ the actuator o~ the staple body 6, with the xeault that the prodecbions 27 and 28 (FIG8. 1, 7) o~ the æide walls o~ the head 7 ~traddle the :~
' ' - ' , ~ ' ; ' ' ~ ` ''~ ' .
, .,~ ' ' '~ "'` '' , ' . ' ' ' ' ~ ~. ' ' ' ' ' ' ' i ~ ' ' ' ' ' ' ' ' "' ' ' ' ' ,': ' ' . ' '. ' ' ''~,'.'" ' , ,, , ' . " ' ~3~
side webs 23 of the frame 3 and reliably fix the magazine 8 ;
in working position with respect to th~ supporting jaw 4.
The walls of the pharynx are sutured by rotating the handle 20 (FIG. 3) of the screw 15 of the actuator of the ejector 9, the movement of which results in that the driving projections 10 enter the respective slots in the magazine 8 and eject the staples therefrom. Upon suturing, a special clamp is placed under the tumor to be resected till the contact with the instrument, and the tissues between the ~;
clamp jaws and th~ instrument are severed with a scalpel. ~ext the magazine 8 is withdrawn from the supporting jaw ~ of the frame 3 of the supporting body 1 by rotating the nut 13 in the reverse direction, and the instrument is removed from the operative wound.
In some cases of instrument application in the thoracic or abdominal cavity, e.g~, in suturing pulmonary tissues, the instrument is expedient to be introduced into the opera~
tive wound in an assembled state, as is usually the case when using the known instruments. When the frame of the supporting body of the instrument according to the invention ~, ; is hook-shaped, the application technique of the instrument ;~
in aIl cases li~ted above differs in nothing from the appli-cation of the known instrument. If, on contrary, tbe frame -~of the supporting ~ody of the instruments is made closed, ~
".':;
.... .
~ 2 'I ---the ti~ues under suturirl~; are introduced between the ~ide webs ~3 of the f rame 3 of` khe supporting body 1 (~'IG . 5) a~d : :
the supportin{~; jaw 4 and ~he magazine 8 whe~ r~tracted with respect ~o the ~upp~,rting jaw ~
; ~,, - ::
:- . -., ~ ... .
'''' ~ ~ ' ' " ,' :
' ' ' -'~," ~, '- "~; ' " ', ', ' `,' ~ ~ ~
:'` '~,'', ~ ' ,', "
,. . . . . . .
Claims (8)
1. A surgical instrument for suturing tissues and organs with metal staples, comprising: a supporting body with a longitudinal slot; a flat frame of the supporting body; a supporting jaw of said frame arranged transversely with respect to said slot; a flat spot of said supporting jaw, facing said slot; a flat sport of said supporting jaw, facing said slot and accommodating depressions for the legs of said staples to bend; a staple body mounted in said slot of said supporting body with a possibility of longitu-dinal traverse; a head of said staple body; a magazine for sand staples, placed in said head of the staple body; an ejector of said staples, interconnected with said staple body with a possibility of longitudinal traverse; an actuator of said staple body; an actuator of said staple ejector characterized in that said slot in the supporting body opens in the direction perpendicular to the plane of said frame of the supporting body, whereby a possibility is provided for said supporting body with the staple ejector to insert into and extract from said slot in said direction.
2. A surgical instrument as claimed in Claim 1, compris-ing: said frame of the supporting body mad closed; two webs of said frame parallel to said slot in the supporting body and severing as guides for said head of the staple body; said webs provided with recesses located in their rear portions (with respect to said supporting jaw), said recesses being commensurable in length with said head of the staple body and adapted to provide a possibility for said staple body with the staple ejector to insert into said slot in the supporting body and extract therefrom when in the rearmost position with respect to said supporting jaw.
3. A surgical instrument as claimed in Claim 2, wherein said head of the staple body has two side walls perpendicu-lar to the plane of said frame and provided with longitudi-nal slots adapted to interact with said webs of the frame so as to guide said staple body.
4. A surgical instrument as claimed in Claim 3, wherein side projections which define the side walls of said longitu-dinal slots in said head of the staple body, said projections being different in height so that the height of said side projections arranged towards the bottom of said slot in the supporting body is less than the depth of said recesses in said frame webs while the height of said side projections arranged toward the open end of said slot is in excess of the depth of said recesses.
5. A surgical instrument as claimed in Claim 3, wherein said head of the staple body has a detachable wall arranged in parallel with the plane of said frame.
6. A surgical instrument as claimed in Claim 4, wherein said head of the staple body has a detachable wall arranged in parallel with the plane of said frame.
7. A surgical instrument as claimed in Claim 5, wherein said head of the staple body has a wall arranged perpendicular to the plane of said frame and facing said slot, said wall being provided with a notch open towards said detachable wall of said head of the staple body.
8. A surgical instrument as claimed in Claim 6, wherein said head of the staple body has a wall arranged perpendicular to the plane of said frame and facing said slot, said wall being provided with a notch open towards said detachable wall of said head of the staple body.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| SU1954520A SU506963A1 (en) | 1973-07-26 | 1973-07-26 | Surgical stapler |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1038718A true CA1038718A (en) | 1978-09-19 |
Family
ID=20563127
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA200,117A Expired CA1038718A (en) | 1973-07-26 | 1974-05-16 | Surgical suturing instrument |
Country Status (6)
| Country | Link |
|---|---|
| US (1) | US3949923A (en) |
| CA (1) | CA1038718A (en) |
| CH (1) | CH578863A5 (en) |
| FR (1) | FR2238465B1 (en) |
| GB (1) | GB1459256A (en) |
| SU (1) | SU506963A1 (en) |
Families Citing this family (31)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4378901A (en) * | 1980-05-22 | 1983-04-05 | Akopov Ernest M | Apparatus for applying a staple suture |
| NL8220482A (en) * | 1981-12-22 | 1983-11-01 | Hospital Prod Ltd | SURGICAL CRAM INSTRUMENT. |
| US4527724A (en) * | 1983-06-10 | 1985-07-09 | Senmed, Inc. | Disposable linear surgical stapling instrument |
| US4568009A (en) * | 1984-01-20 | 1986-02-04 | United States Surgical Corporation | Surgical fastener applying apparatus |
| US4508253A (en) * | 1983-10-04 | 1985-04-02 | United States Surgical Corporation | Surgical fastener applying apparatus |
| US4665916A (en) * | 1985-08-09 | 1987-05-19 | United States Surgical Corporation | Surgical stapler apparatus |
| CH670753A5 (en) * | 1985-09-10 | 1989-07-14 | Vnii Ispytatel Med Tech | |
| CA2052176A1 (en) * | 1990-10-05 | 1992-04-06 | Daniel P. Rodak | Controlled closure mechanism |
| WO2003030742A2 (en) * | 2001-10-05 | 2003-04-17 | Tyco Healthcare Group, Lp | Surgical stapling apparatus and method |
| US7334717B2 (en) | 2001-10-05 | 2008-02-26 | Tyco Healthcare Group Lp | Surgical fastener applying apparatus |
| US7407076B2 (en) * | 2000-10-13 | 2008-08-05 | Tyco Healthcare Group Lp | Surgical stapling device |
| JP4316491B2 (en) * | 2002-05-10 | 2009-08-19 | タイコ ヘルスケア グループ エルピー | Wound closure material applicator and stapler |
| US7296722B2 (en) * | 2003-10-17 | 2007-11-20 | Tyco Healthcare Group Lp | Surgical fastener applying apparatus with controlled beam deflection |
| US7204404B2 (en) * | 2003-12-30 | 2007-04-17 | Ethicon Endo-Surgery, Inc. | Slotted pins guiding knife in a curved cutter stapler |
| US7210609B2 (en) * | 2004-07-30 | 2007-05-01 | Tools For Surgery, Llc | Stapling apparatus having a curved anvil and driver |
| US20070208359A1 (en) * | 2006-03-01 | 2007-09-06 | Hoffman Douglas B | Method for stapling tissue |
| DE102008043340A1 (en) * | 2008-10-31 | 2010-05-06 | Zf Friedrichshafen Ag | Method for detecting the position of the magnet armature of an electromagnetic actuator |
| US8328064B2 (en) * | 2009-05-06 | 2012-12-11 | Covidien Lp | Pin locking mechanism for a surgical instrument |
| US8353436B2 (en) | 2009-05-06 | 2013-01-15 | Covidien Lp | Pin locking mechanism for a surgical instrument |
| US8827137B2 (en) * | 2010-03-25 | 2014-09-09 | Covidien Lp | Pin alignment assembly for surgical stapler |
| US10702269B2 (en) | 2014-12-25 | 2020-07-07 | Covidien Lp | Surgical stapling devices |
| US9775611B2 (en) | 2015-01-06 | 2017-10-03 | Covidien Lp | Clam shell surgical stapling loading unit |
| US9855040B2 (en) | 2015-03-04 | 2018-01-02 | Covidien Lp | Surgical stapling loading unit having articulating jaws |
| USD814632S1 (en) | 2016-10-21 | 2018-04-03 | Covidien Lp | Staple cartridge |
| AU2017258826A1 (en) | 2016-12-02 | 2018-06-21 | Covidien Lp | Surgical stapling instrument with curved end effector |
| US10993714B2 (en) | 2017-11-28 | 2021-05-04 | Covidien Lp | Surgical stapling instrument and associated trigger mechanisms |
| US10945730B2 (en) | 2018-06-25 | 2021-03-16 | Covidien Lp | Stapling device with selectively advanceable alignment pin |
| WO2021022407A1 (en) | 2019-08-02 | 2021-02-11 | Covidien Lp | Surgical stapling device with curved tool assembly |
| JP2023509271A (en) | 2019-11-01 | 2023-03-08 | コヴィディエン リミテッド パートナーシップ | Surgical stapling device with knife blade lock |
| EP4076219A4 (en) | 2019-12-18 | 2023-09-06 | Covidien LP | Surgical stapling device with shipping cap |
| US11744584B2 (en) | 2020-06-09 | 2023-09-05 | Covidien Lp | Alignment pin assembly for surgical stapler |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3494533A (en) * | 1966-10-10 | 1970-02-10 | United States Surgical Corp | Surgical stapler for stitching body organs |
| DE1791114B1 (en) * | 1967-09-19 | 1971-12-02 | Vnii Chirurgitscheskoj Apparat | Surgical device for stapling tissues |
| BE758685A (en) * | 1970-10-14 | 1971-05-10 | Vnii Khirurgicheskoi Apparatur | SURGICAL APPARATUS FOR TISSUE SUTURE WITH STAPLES |
-
1973
- 1973-07-26 SU SU1954520A patent/SU506963A1/en active
-
1974
- 1974-05-15 CH CH666774A patent/CH578863A5/xx not_active IP Right Cessation
- 1974-05-16 GB GB2171974A patent/GB1459256A/en not_active Expired
- 1974-05-16 CA CA200,117A patent/CA1038718A/en not_active Expired
- 1974-05-17 FR FR7417321A patent/FR2238465B1/fr not_active Expired
- 1974-06-05 US US05/476,558 patent/US3949923A/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| GB1459256A (en) | 1976-12-22 |
| DE2423465A1 (en) | 1975-02-06 |
| SU506963A1 (en) | 1976-08-25 |
| US3949923A (en) | 1976-04-13 |
| DE2423465B2 (en) | 1976-06-16 |
| FR2238465B1 (en) | 1976-12-24 |
| FR2238465A1 (en) | 1975-02-21 |
| CH578863A5 (en) | 1976-08-31 |
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