WO2011042508A1

WO2011042508A1 - Anastomosis device

Info

Publication number: WO2011042508A1
Application number: PCT/EP2010/065032
Authority: WO
Inventors: Hubertus Feussner; Wilhelm Dirk; Armin Schneider
Original assignee: Technische Universität München
Priority date: 2009-10-07
Filing date: 2010-10-07
Publication date: 2011-04-14
Also published as: DE102009048433A1

Abstract

The present invention relates to a device for an end-to-end anastomosis of two ends (11, 12) of a substantially tubular anatomical or physiological hollow structure (10), wherein the device is substantially tubular for inserting or passing through the hollow structure (10). The hollow structure comprises a first set of fingers (1) for engaging with the first end (11) of the hollow structure, wherein the first set of fingers (1) can be aligned substantially parallel to the tube axis (X) for inserting into the hollow structure. The hollow structure further comprises a second set of fingers (2) for engaging with the second end (12) of the hollow structure, wherein the second set of fingers (2) for inserting into the hollow structure is substantially parallel to the tube axis (X), but can be aligned at least substantially in the opposite direction of the first set of fingers. In particular, the first set of fingers (1) has a radially outwardly directed pre-tension applied thereto, whereby the first set of fingers (1) can automatically engage with the first end (11) of the hollow structure no external forces act on the fingers of the first set (1).

Description

A ASTOMOSING DEVICE

The present invention relates to a device for connecting two hollow organ sections in an end-to-end anastomosis. In particular, the invention relates to a connector, in the form of a clip, for an end-to-end anastomosis, an applicator for attaching the connector of the invention and a system of applicator and connector. BACKGROUND OF THE INVENTION

An end-to-end anastomosis is understood to be an anastomosis in which two anatomical hollow structures (e.g., intestinal tracts) are reconnected (e.g., sewn) at their open ends to form a continuous hollow structure. The problem of end-to-end anastomosis arises in surgery, for example, when segments of the gastrointestinal tritium have to be removed and the remaining stumps reunited to restore continuity of the gastrointestinal passage.

In conventional (open) surgery, reconnection of sections of the gastrointestinal tract is traditionally done with single-button sutures or continuous suture. Various types of mechanical connectors have also been developed to reduce or eliminate the need for sutures. The first serious method to unite intestinal components without seam, goes back to Benjamin Muiphy, the inventor of the so-called Murphy button. Further developments of the Murphy button are described, for example, in U.S. Patents 4,055,186 and 5,141,516.

WO 03/061487 relates to an apparatus for producing anastomoses between hollow organs having an inner sleeve for attachment about the end of the first hollow organ and having an outer sleeve for attachment about the end of the second hollow organ, which over the inverted over the inner sleeve end of the first hollow organ is arranged. wherein the inner and outer sleeve is designed to be divisible, so that they can be removed after the anastomosis has taken place.

For several decades, so-called circular stapling machines (eg CEEA stackers) have been used with suitable localization. For a colon anastomosis is The stapler is inserted into the intestinal lumen through an enterotomy remote from the wound margin. In the other end of the bow a pressure plate is introduced. Around the central mandrel of the stapler now a purse-string suture is placed and tightened in both bowel ends. After closure of the anastomosis, the transverse enterotomy site is finally closed by a suture or a transverse stapler. That is, with such devices, the two Damistümpfe be circularly clamped together in one operation and simultaneously the endoluminal "tissue supernatant" is cut out. This results in a circular restoration of the passage. A similar stapler is described, for example, in WO 87/06448.

However, a disadvantage of such Kiammergeräte is that until recently only rigid instruments were available; the use of these rigid instruments was therefore limited only to reachable anatomical regions

Recently, for higher regions of the gastrointestinal tract (GI tract) also flexible Klammemahigeräte available. They can also be used to reach sections of the GI tract that are not accessible with the rigid devices. However, the use of flexible staplers is still limited for the following reasons: transport to higher portions of the colon or deeper portions of the upper GI tract is difficult because of the lack of visual control. The two intestinal stumps to be united (bowel ends) must be elaborately prepared (purse-string suture) and approximated. In addition, the complex mechanical design is very expensive and not applicable to structures with small volumes or dimensions.

US Pat. No. 6,682,540 discloses a connecting device in the form of a crown, which is mainly used for F.nd-to-side anastomoses. In particular, it is an essential feature of this crown that the tips of the crown are formed as rigid barbs to ensure a secure engagement in the tissue. According to another embodiment, there is also disclosed an end-to-end anastomosis device having barbs on opposite sides. However, due to the rigidly formed barbs when attaching the connecting device, injuries or ruptures of the physiological hollow vessels can easily occur. In addition, the crown can not by a Hollow structure are performed without the hollow structure is damaged. Thus, the crown is preferably suitable for anastomoses of conventional (open) surgery.

It is. It is therefore an object of the present invention to overcome the above-mentioned disadvantages of the prior art and to provide an improved device. In particular, it is an object of the present invention to provide a device by which rapid, but also safe and durable anastomoses of biological hollow structures can be made. In addition, the device should be as simple and inexpensive as possible.

The object of the present invention is solved by the independent claims and the aspects discussed below. The dependent claims describe further preferred embodiments and modifications of the invention.

SUMMARY OF THE INVENTION

The present invention relates to a device (hereinafter also referred to as a connector) which is suitable. connect two ends of a substantially tubular anatomical or physiological hollow structure. In particular, the present invention relates to a device and a system for. Set circular anastomoses in the gastrointestinal tract

In the following, the term hollow structure or anatomical hollow structure or physiological hollow structure is preferably used for all anatomical or physiological hollow structures of a mammal, in particular a human. The term hollow structure includes, for example, hollow organs such as blood vessels, but also ureters or hollow organs of the digestive tract, etc. Compounds of such hollow organs occur very frequently in surgery, with end-to-end anastomoses in which two ends of two hollow organs are joined together and end -to-side anastomoses, in which the end of a hollow organ is connected laterally to a second hollow organ, is distinguished, in particular the term used in the application of the hollow structure vessels, such as blood vessels, air and esophagus and preferably intestines, in particular the large intestine , Preferably, the inventive connector relates to a device for end-to-end anastomosing of a large bowel. That is to say, the invention preferably relates to Device an endoluminal usable staple for the preparation of circular anastomoses, ie the entire circumference of the hollow structure comprehensive new compounds.

The connector according to the invention or an envelope of the connector according to the invention is substantially formed as a cylindrical tube or sleeve, i. the connector has substantially a cylindrical axis, the cross section perpendicular to the cylinder axis being substantially circular. However, the cross section is not limited to circular cross sections, i. the connector may also have other cross-sectional shapes, for example elliptical cross-sections. In addition, the cross-sectional shape may change under the action of external forces, for example when the connector is in engagement with the anatomical hollow structure. The substantially circular or elliptical cross-sections therefore preferably refer to the shape that the connector assumes without external forces. The substantially circular or elliptical cross-sections have the advantage that the binder can be passed through the hollow structure and thus can be positioned at the point of the hollow organ to be connected. For example, a connector may be passed through the rectum for end-to-end anastomosis of a large intestine to the site through which the large intestine is to be connected. According to the invention it is particularly preferred that injuries are avoided during the passage of the connector through the intestine.

To connect the two ends of the hollow structure to the connector of the present invention, the connector has two sets of fingers, the first set of fingers being for mating with the first end of the hollow structure, and the second set of fingers for mating is provided (adapted) with the second end of the hollow structure.

To facilitate passage through the hollow structure, the two sets of fingers should be aligned substantially parallel to the axis of the cylindrical shape of the connector; ie unintentional engagement with the hollow structure during the passage or introduction into the hollow structure should be avoided, since this could lead to injuries or ruptures. In particular, the entire finger should be in each case from the shaft to the tip of the finger Be substantially parallel to the axis of the connector. In particular, it is particularly advantageous if the ends (tips) of the fingers are oriented not in the radial direction but in the direction of the axis in order to avoid injuries to the hollow structure during insertion; ie the tips point in the axial direction.

However, in order to enable a (targeted) engagement of the fingers in the hollow structure or in the inner wall of the hollow structure, the two sets of fingers are aligned substantially opposite to the axis of the cylindrical shape. The first set of fingers point in the distal direction to engage the distal end of the hollow structure and the second set of fingers are directed in the opposite direction and point in the proximal direction to engage the proximal end of the hollow structure to get. In addition, according to the invention, preferably at least one set of the fingers is subjected to a bias, so that the fingers are at least partially (automatically) directed radially outward when no or only small external forces act on the fingers. According to a preferred embodiment, exactly one set of fingers is biased, whereas the second set of fingers is not biased (radial). In particular, it is preferably advantageous if the first set of fingers is made of a resilient or elastic material. In addition, it is particularly advantageous if the second set of fingers is transferred from the axial orientation to the radial orientation only by application of an external force. For example, this can be achieved using a plastically deformable material. In particular, the terms "plastic" and "elastic" are used in the usual sense in the present application. For example, plastic deformation or plasticity describes the ability of solids to irreversibly withstand under force and maintain that shape after exposure. In contrast, an elastic fabric will resume its original shape.

According to the invention, the connector is introduced into the hollow structure by means of a device (applicator) described below, such that the preloaded set of fingers is aligned substantially parallel to the cylinder axis by the action of an external force. Once this set of fingers is positioned at the appropriate location in the hollow organ, ie the fingers are positioned on the inner wall of one end of the hollow structure, the external force is removed, whereby the fingers automatically orient radially outwardly, so that the fingers come into engagement with the hollow structure or into engagement with the (inner) wall of the holi-structure. Preferably, the fingers bend due to the bias not only radially outward, but also rearward with respect to the original orientation. In. In terms of angles, this means that during the insertion of the connector, the first set of fingers with the cylinder axis preferably forms an angle of 0 ° or an angle between -5 to + 5 °. After removal of the external force, the fingers of the first set preferably bend arcuately in an angular range of 0 ° to 180 °, preferably between 90 ° and 180 °, more preferably between 1.20 ° and. 180 °.

In other words, the connector according to the invention has at least two different states. A first \ "insertion condition \" in which the fingers are aligned substantially parallel to the cylinder axis; and an "engagement state" in which at least one set of the fingers is partially bent in the radial direction to engage the hollow structure. Preferably, the change from the insertion condition to the engagement condition occurs due to an elastic configuration of the fingers, i. the elastic material of the fingers is biased into the engaged state. According to another embodiment, the state change can also be generated by means of force (for example magnetic force), cold, heat or current. For example, fingers of the first and / or the second set may consist of a shape memory alloy and the state change may be effected by heating the connector according to the invention.

The second set of fingers can be constructed the same or similar to the first set of fingers, ie, also be biased. According to another preferred embodiment, the fingers of the second set may also be shaped without a radial bias. To an intervention of the second. To achieve set of fingers with the hollow structure or inner wall of the holi-structure, the fingers of the second set of fingers are mechanically bent radially outward. The preferred angular range after the mechanical (manual) bending of the fingers of the second set should substantially correspond to the angular range of the first fingers to ensure a secure connection of the two ends. According to the invention, it is not mandatory that all fingers of the first or second set are brought into engagement with the hollow structure. For example, individual fingers may be aligned substantially along the inner wall of the hollow structure, whereby a further stabilization in the radial direction of the hollow structure can be achieved. Accordingly, it is not mandatory that all fingers have pointed ends to get into the hollow structure in secure engagement. However, it is preferred that at least one part, preferably all fingers, have pointed ends, possibly with barbs, and penetrate into the wall of the hollow structure or pierce the wall upon engagement with the ends of the hollow structure.

Around. To achieve a secure end-to-end anastomosis, the outer diameter of the connector is preferably matched to the inner diameter of the hollow structure, i. the outer diameter of the tubular envelope of the connector substantially corresponds to the inner diameter of the hollow structure. For example, common outside diameters for an anastomosis of a human are. Large intestine in the range between 20 to 40 mm. Therefore, connectors according to the invention are preferably provided with common diameters of about 25, 28, 31 or 33 mm.

In order to ensure a secure connection, each set of the two finger sets of the connector according to the invention preferably has at least 6 fingers. Preferably, the first and / or the second set of fingers has at least 8 fingers, preferably 10, 12, 14, 16 or more fingers.

Preferably, the first and / or the second set of fingers are formed by means of a highly elastic material, for example made of metal, preferably of stainless metal and more preferably of a shape memory alloy such as a nickel titanium alloy (nitinol) metal. However, the fingers can also be made of other composite formulations, for example of plastic or of a plastic-metal mixture. Alternatively or additionally, individual or all fingers may have a shape memory polymer or be made of a shape memory polymer. Shape-memory polymers are plastics which have a shape memory effect, that is to say they can "remember" their former external shape, despite an intervening heavy deformation.For example, a shape memory polymer can have two components, the first component is an elastic polymer, a kind of "spring element", and the second component is a hardening wax, which can lock the "spring element" in any desired shape.

Preferably, the first set of fingers is made of a material different from the material of which the second set of fingers is made. In another embodiment, the first set of fingers and the second set of fingers are the same material; Preferably, both sets of fingers are made in one piece (integral).

According to a preferred embodiment, the fingers of the first set are directly connected to the fingers of the second set. According to a further preferred embodiment, the fingers of the first and / or the second set may be attached to a structure, preferably common carrier. Preferably, the fingers are seen from the support structure in the. Aligned in essentially opposite directions (towards, proximal and distal). The support structure is preferably substantially annular or oval-shaped. causing the im. Substantially circular or oval cross-section of the connector according to the invention is formed.

In order to place the connector according to the invention specifically for an end-to-end anastomosis and to engage with the two ends of the hollow structure, the present invention also relates to an applicator, in particular in the form of a (introducer) catheter, along the hollow structure can be introduced. The introducer catheter according to the invention is particularly designed for insertion of a connector according to the invention, wherein the introducer catheter has a proximal end for handling and a distal end for insertion into the substantially tubular anatomical or physiological hollow structure. The erfmdungsgemäße catheter has essentially two main components, a substantially tubular inner part whose outer diameter substantially corresponds to the inner diameter of the connector; and a tubular outer part, which is aligned coaxially with the inner part and is displaceable in the axial direction relative to the inner part. Preferably, the inner diameter of the outer part substantially corresponds to the outer diameter of the connector. Preferably, the dimensions of the inner part, the outer part and the connector are chosen so that the Connector between the inner part and Außenenteii positionable and the first and second set of fingers is aligned substantially parallel to the axis of the inner part. That is, preferably, the fingers of the first and second sets of fingers, respectively, are disposed between the inner and outer members, the outer member providing an outer force component directed against the bias of the first and second sets of fingers, respectively. Simply put, incorporating the connector of the present invention between the inner and outer members will cause the preloaded fingers to be substantially cylindrically aligned against their bias, thereby facilitating imports into the anatomical hollow structure.

Preferably, the inner part has a lumen (cavity) through which more

Devices, such as an endoscope, are insertable and are preferably displaceable relative to the inner part or the outer part.

Preferably, at least part of a distal portion of the inner part and / or the outer part is substantially translucent, preferably transparent, whereby the introducer catheter together with the connector is visually inspected to the ends of the hollow structure by means of an endoscope disposed in the lumen of the inner part can.

To prevent unintentional dislodging of the connector with respect to the catheter (applicator), the connector and / or the catheter may include means for releasably securing the connector to the delivery catheter. For example, projections may be provided on a support structure of the connector, which are releasably fixed with a mechanism on the inner or outer part. For example, the catheter could have recesses that can be engaged with the protrusions by relative movement between the catheter and connector. Of course, a reverse configuration is also possible, that is, there are protrusions in the catheter which can be engaged with spouts in the connector. Additionally or alternatively, other releasable connection possibilities between the catheter and the connector are possible, for example a bayonet mechanism. Thus, the connector may be temporarily fixed to the catheter to insert the catheter into the hollow structure along with the connector. Subsequently, the connector can be released from the catheter

O to pull the catheter out of the hollow structure without the hollow structure engaging connector.

In addition, the present invention also relates to a system consisting of an introduction catheter according to the invention and a erfmdungs gladly a connector, which is mounted at least on the inner part.

Finally, the present invention also relates to a method for an end-to-end anastomosis of two ends of a. Substantially tubular anatomical hollow structure having at least one of the following steps. First, a connector according to the invention, which is preferably detachably arranged on or on or in a catheter according to the invention, is provided. The inventive connector is inserted into the hollow structure using the catheter until the first set of fingers lie in the lumen of the end of the distal hollow structure. Thereafter, the outer tube is displaced proximally relative to the inner tube such that the preloaded fingers of the first set flex radially outward and engage the end of the distal hollow structure. Optionally, the inner tube and / or the catheter is further displaced proximally, whereby the end of the distal Hohistruktur the end of the proximal hollow structure is approximated. In particular, such or additional displacement of the inner tube and / or the catheter in the proximal direction can also cause the fingers of the first set to be hooked deeper into the hollow structure. A proximal displacement of the outer tube relative to the inner tube then causes the proximal fingers of the second set to be exposed. Then, the outer tube is displaced in the distal direction relative to the inner tube, whereby the fingers of the second set are bent in the radial direction to engage the end of the proximal hollow structure. Finally, if necessary, the catheter can be detached from the connector and removed.

The invention also includes individual features in the figures, even though they are shown there in connection with other features and / or are not mentioned above or below.

The invention also includes embodiments with any combination of features mentioned or shown above or below various embodiments. BRIEF DESCRIPTION OF THE DRAWINGS

Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the drawings. Show it:

Fig. 1 is a perspective view of an inventive

Connector between two ends of an anatomical

Hollow structure is positioned; and

Figs. 2a - 2d snapshots during the connection of two bowel ends with the aid of a connector according to the Invention and

Delivery catheter.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Figure 1 shows a perspective view of a connector 42 according to the invention arranged between two ends of a gut 10 and intended to connect the two ends 11 and 12 of the intestine. The connector 42 according to the invention is substantially shaped in a rö-shaped manner along the axis X with a first set of fingers 1 aligned in the distal direction to engage the distal end 11 of the intestine. The second set of fingers 2 is oriented opposite the first fingers and points in the proximal direction to engage the proximal end 12 of the intestine. The fingers are shown here as pointed metal pins, which, a safe intervention or piercing of the intestinal walls is achieved. In addition, the two sets of fingers are attached to a common annular support structure 3. In addition, it should be noted that the fingers are shown here for simplicity without bias.

Figures 2a - 2d show snapshots during the connection (anastomosis) of two bowel ends 1 1, 12 with Fiüfe a connector according to the invention and Einführkatheters (applicator). On an inner part 101 of the insertion catheter, a connector according to the invention 42 is mounted, in particular the inner part 101 is shown as an inner tube 101, which is preferably flexible, but at the distal end may have an area which is rigid in order to ensure a secure fit of the to ensure connector according to the invention on the inner tube 101. On the inner tube 101, the connector with two sets of radially arranged fingers in the form of metal pins 1 and 2 is arranged (see FIG. 1), which represent the connector 50 according to the present invention. The first set of metal pins 1 points in the distal direction and the second set of. Metal pins 2 points in the proximal direction. The metal pins 1 and 2 are held in an axially stretched state by an outer part 102 of the embrittlement catheter in the form of an outer tube 102, ie the metal pins 1 and 2 are substantially parallel to the axis X of the inner and outer tubes, respectively. In this state, the connector according to the invention is introduced into the distal intestinal stump 1 to be anastomosed (FIG. 2 a).

Once the metal posts of the connector of the present invention are placed in the lumen of distal stump 11, outer tube 102 is retracted (proximally) relative to inner tube 101 such that the distal ends of metal posts 1 are exposed (Figure 2b). Since the metal pins 1 are subjected to a bias, the metal pins 1 bend radially outward and preferably approximately to approximately 180 °, so that the metal pins 1 pierce the intestinal wall 1 1 from the inside to the outside. The distal end of the intestine 11 is thus fixed to the invention. Connector engaged.

Preferably, the connector 42 of the invention is (releasably) attached to the inner tube, so that by pulling on the inner tube 101 in the proximal direction (see arrows "A" in Fig. 2b), the metal pins 1, which are curved by about 180 °, radially in hook in the circumference of the distal intestinal segment 1 1. Due to the fact that the diameter is considerably increased by the outward curvature of the metal pins 1, the mucous membrane and preferably also the peritoneal coating of the distal intestinal segment 1 1 are pierced by the metal 1.

By pulling the inner tube 101 or the entire catheter, ie by simultaneous pulling on the inner and outer tube 101, 102, the distal intestine segment 1 1 - which is in engagement with the metal pins 1 - the proximal intestine segment. 12, so that the connection (anastomosis) can be performed (see Fig. 2b). In a next step, now only on the outer tube 102 in the proximal direction is pulled (see arrows "B" in Fig. 2c), whereby the proximal tips of the proximal metal pins 2 are exposed.

According to a preferred embodiment, the proximal metal pins 2 may also be biased radially outwardly so that the proximal tips will automatically move outwardly to engage the proximal stump 1.2 as soon as the proximal metal pins 2 are exposed.

According to another preferred Ausfühiomgsform the proximal metal pins 2 are not or only with a very small radially outwardly directed bias applied, so that the proximal metal pins 2 are substantially parallel to the axis of the inner tube 101 aligned, i. E. the metal pins 2 point in the proximal direction.

Now, when the outer tube 102 is advanced again, i. in the distal direction, the proximal tips of the pins 2 are bent over as far as depending on the feed carried out so that they hook into the circumference of the proximal sump 12 (see Fig. 2d). By further bending creates a stable abutment to the distal tips 1, so that both wound edges are sufficiently firmly connected or clamped together.

In a next step, the inner tube 101 of the. invention

Loosened connector 42 so that the connector remains at the junction and the erfmdungsgemäße catheter can be removed. For example, by rotation of the inner tube 101, a locking between the inner tube 101 and the pins 1 or and / or a lock between the inner tube 101 and the support structure 3 can be achieved so that the insertion catheter can be removed.

The invention thus relates to a device for setting circular anastomoses in the gastrointestinal tract. The insertion catheter according to the invention or the application device according to the invention preferably comprises essentially two main components, an inner part and an outer part (inner tube and outer tube), the outer tube having a larger diameter than the inner tube and being displaceable relative to the inner tube. Preferably, one or both parts are made of a flexible material so that they can be planted on commercial endoscopes and the system of the invention via the flexible endoscope in the Holilstruktur (intestinal lumen, colon, esophagus, stomach, vessels, ureters, etc.) are introduced can. Under the endoscope view, the anastomosis is preferably applied, so that at any time a controlled placement of the staples is possible

The invention also includes the exact or exact terms, features, numerical values, or ranges, etc., as above or below, of such terms, features, numerical values, or ranges in the context of terms such as "about, about, substantially," generally, at least, "., ^etc; were named (that is" at least about 3 "is also" 3 "or" substantially radially ^'1 should also or "" include Radić) The term. ". means moreover "and / or".

Claims

Patent claims

A connector (42) for an end-to-end anastomosis of two

Ends (1 1, 12) of a substantially tubular anatomical

Hollow structure (10), wherein the connector for insertion into and / or passage into the hollow structure (10) is substantially tubular and comprises: a first set of fingers (1) for engaging the first end (11) of the hollow structure; the first set of fingers (1) for

Inserting into the hollow structure substantially parallel to the tube axis

(X) is arranged;

a second set of fingers (2) for engagement with the second one

End (12) of the hollow structure; wherein the second set of fingers (2) for insertion into the hollow structure is substantially parallel to the tube axis

(X), but at least substantially opposite to the first set of fingers is arranged and

wherein at least the first set of fingers (1) has a radially outward bias, whereby the first set of fingers (1) automatically engages the first end (1 1) of the hollow structure when no external forces are applied to the fingers (1). 1) of the first sentence act.

The device of claim 1, wherein the fingers of the second set of fingers (2) can be bent in the radial direction from the orientation parallel to the tube axis to engage the second end (12) of the hollow structure (10).

3. Connector (42) according to claim. 1 or 2. wherein the first and / or second set of. Fingers (1, 2) preferably have pointed ends which are aligned parallel to the tube axis and upon engagement with the ends (1 1. 12) of the hollow structure in the wall of the hollow structure (10) penetrate or pierce the wall.

4. Connector (42) according to any one of the preceding claims, wherein

(i) the outer diameter of the tubular form is between 20 to 40 mm, preferably about 25, 28, 31 or 33 mm, and / or

(ii) the first and / or the second set of fingers (1, 2)

at least 6 fingers, preferably 8, 10, 12, 14, 16 or more fingers.

A connector (42) according to any one of the preceding claims, wherein the first and / or the second set of fingers (1, 2) is made of metal, preferably made of stainless metal, and more preferably of a shape memory material, preferably of a shape memory alloy how Nitinol is made.

A connector (42) according to any preceding claim, wherein the first and second sets of fingers (1, 2) are secured to a common, preferably annular support structure (3) and the support structure (3) preferably comprises means. releasably fixing the support structure (3) to an insertion catheter (100).

7. Connector (42) according to one of the preceding claims, wherein

(i) the first set of fingers (1) and the second set of fingers (2) are made of different materials; or

(ii) the first set of fingers (1) and the second set of fingers (2), optionally the support structure (3) according to

Claim 6, from the same material, preferably in one piece.

8. An introducer catheter (1 00) for inserting a connector (42) according to claim 1 to 7, with a proximal end to. Handle and a distal end for insertion into a substantially

tubular anatomical hollow structure (10), wherein the catheter (100) comprises:

a substantially rohrförmi ges inner part (101) whose

Outer diameter substantially the inner diameter of the

Connector (42) corresponds; and

a sleeve-shaped outer part (102), which is aligned coaxially with the inner part and in the axial direction relative to the inner part (101) is displaceable, wherein the inner diameter of the outer part (102) substantially corresponds to the outer diameter of the connector (42). wherein the connector (42) is positionable between the inner part (1101) and the outer part (102) and the first and second set of fingers (1, 2) are aligned substantially parallel to the axis of the inner part (101).

9. introducer catheter (100) according to claim 8, wherein

(I) the inner part (101) has a lumen through which a

Endoscope is inserted and preferably displaced, and / or

(ii) at least part of a distal portion of the inner part (101) and / or of the outer part (102) is substantially translucent, preferably transparent.

10. introducer catheter (100) according to claim 8 or 9, wherein the inner part (101) and / or the outer part (102) has a detachable

Has fixing mechanism that is adapted

(i) temporarily fix the connector (42) to the catheter (100) to place the catheter (100) together with the connector (42) in the

Insert hollow structure (10); and (ii) disengage the connector (42) from the catheter (100) to withdraw the catheter (100) from the hollow structure (10) without the connector (42) in engagement with the hollow structure (10).

1 1. System consisting of one. The introducer catheter (100) of any one of claims 8 to 10 and a connector (42) of any one of claims 1 to 7 mounted on at least the inner member (101).

12. A method for an end-to-end anastomosis of two ends (1 1, 12) of a substantially tubular anatomical

Hollow structure (10) with the steps:

(a) providing a connector (42) for one of

Claims 1 to 7, wherein the connector (42) is releasably disposed on or on or in a catheter (100) according to any one of claims 8 to 10;

(b) inserting the connector (42) into the hollow structure (10) using the catheter (100) until the first set of fingers (1) lie in the lumen of the end of the distal hollow structure (11);

(c) displacing the outer tube (102) proximally relative to the inner tube (101) such that the biased fingers of the first set (1) flex radially outward and engage the end of the distal hollow structure (11);

(d) moving the inner tube (101) or catheter (100) proximally, thereby approximating the end of the distal hollow structure (11) to the end of the proximal hollow structure (12);

(e) displacing the outer tube (102) proximally relative to the inner tube (101), thereby exposing the proximal fingers of the second set (2); and

(f) displacing the outer tube (102) relative to the inner tube (101) in the distal direction whereby the fingers of the second set (2) are bent in the radial direction to engage the end of the proximal hollow structure (12) ,

13. The method of claim 12, wherein between the

Method steps (c) and (d) by moving the inner tube (101) in the proximal direction, the fingers of the first set (1) are hooked deeper into the Hohlst ktur (10).

14. The method of claim 12 or 1 3, wherein after the

Method step (f) of the catheter (100) from the connector (42) is released.