Anastomosis device

Abstract

The present invention relates to systems for use in the anastomosis of tubular biological organs within the body, in particular small tubular organs such as blood vessels, bile ducts, lymphatic ducts, nerve ducts, epididymis, etc. The anastomosis system comprises a coupling device with a body, generally within a housing, a coupling assembly attached to the body, several suture units within the coupling assembly, and an actuator formed within the coupling device.

Description

Anastomosis device Technological field This disclosure relates to assemblies and devices for use in the anastomosis of tubular biological organs within the body, in particular, small tubular organs (such as blood vessels, bile duct, lymphatic duct, nerve ducts, epididymis, etc.). Background of the technique The following is a list of references to documents considered relevant as background information on the subject matter currently being disclosed: - WO 2016 / 128961 - US 4,744,362 - US 2006 / 0167485 - US 2004 / 0199185 - US 5,330,503 - US 2005 / 0288697 - US 5,746,757 - US 5,417,699 - US 3,265,069 - WO 2020 / 157753 The acknowledgment of the above references in this document should not be inferred to mean that they are in any way relevant to the patentability of the subject matter of this disclosure. Background In medical practice, various techniques are known for the anastomosis of severed tubular organs, including blood vessels and others. WO 2016 / 128961 discloses, among other things, anastomosis devices for joining two tubular organs that use multiple threads, each thread having needles at both ends, and devices that expedite the suturing procedure for joining the two end portions of the tubular organ together. An anastomosis assembly that also makes use of a plurality of pairs of needles with a connecting thread, the needles being manipulated in a coordinated manner for an effective vessel anastomosis procedure, is disclosed in WO 2020 / 157753. Overview This disclosure provides an anastomosis system for joining two opposite ends of a tubular organ. The two ends may be ends of tubular organs, such as blood vessels or lymphatic vessels, for example, severed during surgery or by accident, one end of a vessel grafted to a matching vessel at a recipient site, etc. Some elements of this disclosure are similar to those described in WO 2020 / 157753 (the "previous disclosure"). The anastomosis system comprises a coupling device with a body, typically within a housing, a coupling assembly connected to the body, a plurality of suture units within the coupling assembly, and an actuator assembly formed within the coupling device. The system is symmetric about a longitudinal plane of symmetry, normal to the coupling axis (defined below); specifically, all elements on one side of the plane of symmetry are mirror images of those on the other side. For ease of description, "first" is used to define the elements on one side of the plane and "second" to define the mirror-image elements on the other side. It should be understood that the use of "first" and "second" is not intended to indicate any hierarchy or sequence. In an anastomosis procedure, multiple sutures are placed between opposing tissue ends, such as arteries or veins, to join them together. For small vessels, this can be a complex and lengthy procedure. The system described herein aims to optimize this procedure. The system of the present invention comprises a coupling assembly, which defines a coupling axis, having a pair of axially symmetrical rope coupling members joined together by an integral, axially extending connecting body. The rope coupling members have opposing axial rope coupling projections configured to engage with the ropes by pulling the rope wall over the outer surface of these projections. Corresponding (and oppositely oriented) pairs of suture needles, the needles of each pair being joined together by a common suture thread, form part of the system and are fitted within the coupling members, with the needle points housed within needle receiving channels defined in the rope coupling members.By axially displacing a needle handling element associated with the rope coupling members, the needle points are drawn out to pierce the walls of the ropes secured to the outer surface of the rope coupling lugs. The needle handling element is typically in the form of a sleeve attached to the outer surface of the rope coupling member. In the following description, the term suture unit will be used to designate a pair of needles that are joined together by a suture thread; and the term needle assembly will be used to designate all the suture needles that are associated with a rope coupling member. The coupling assembly comprises first and second axially symmetric coupling members that define a coupling axis along their length. The first and second axially symmetric coupling members each have two respective opposing axial end-coupling projections. Each of these projections is configured for independent coupling with one of the fabric ends by pulling the end walls onto the outer surface of the projection, thus positioning the end in a sutured state where the end walls cover a portion of the projection's end-engaging feature. Two opposing sets of first and second open channels in the first and second end-coupling members are arranged axially symmetrically around the coupling axis.Each of the channels extends between a rear channel end defined on the rope coupling member and a front channel end defined on the rope attachment portion of the projection, thereby defining a channel axis between them. Each channel is defined between side walls and a bottom wall having a curved front portion and a curved rear portion. The curvatures of the two bottom wall portions, i.e., the front and rear portions, are offset and separated by a pivot point. Each first channel in one set has a corresponding second channel in the opposite second set of channels; the corresponding first and second channels extend along the same channel axis. The coupling assembly also comprises first and second needle handling elements on the first and second rope coupling members, respectively.The rope coupling members are configured as a sliding sleeve on the outer surface of the rope coupling member, each being able to move axially between an outer position more proximal to said rope coupling projection and an inner position more distal to the rope coupling projection. Each of the plurality of suture units comprises a suture thread coupled to two curved suture needles, each curved needle having a pointed front portion and a rear portion coupled to the thread. Each suture needle is housed within one of the channels: one suture needle of each suture unit is housed in one of the first channels and the other suture needle of the unit in one of the second channels. When the needle handling element is in its external position, the front portion of each needle rests against the front lower wall portion of the channel, and the rear end of the needle extends out of the channel.The rear end of the needle is coupled to the needle handling element, so that, when the needle handling element is axially displaced from the outer position to the inner position, the needle pivots around said pivot point to rest against the rear lower wall portion of the channel, thereby pivotally displacing the pointed front portion of the needle out of the channel to pierce the walls of the stem when it is in said suturing state. The actuator assembly is symmetrical with respect to the plane of symmetry, which, as previously stated, is substantially perpendicular to the coupling axis of the coupling assembly. The actuator assembly is supported by the body. The actuator assembly comprises first and second arms, pivotally fixed to the body about their respective first and second pivot axes, which are essentially parallel to the plane of symmetry. Each of the first and second arms is configured to engage, at its distal portion, with the first and second needle handling elements, respectively. Each arm can move independently from an initial state to a tissue piercing state by moving a distal portion of the respective arm toward the plane of symmetry, axially displacing the respective needle handling element from the outer to the inner position.The actuator assembly has first and second actuation elements, each of which can move independently and alternately, generally in the proximal-distal direction, and is associated with the first and second arms, respectively. During this alternating movement, the arms pivot between a rest state and an actuated state, causing the respective needle handling elements to move between the outer and inner positions. In one embodiment, displacement of the actuating element from proximal to distal causes the arms to pivot between the rest state and the actuated state, respectively. The first and second actuating elements may have respective first and second pins that are received and moved alternately within the respective first and second guide slots defined within the body to guide the alternating displacement of the actuating elements. The pins may also be received within the respective first and second arm slots defined within the first and second arms, each arm slot being offset with respect to its respective guide slot, so that the alternating movement of the actuating element induces the pivoting movement of the respective arm. In one embodiment, the system comprises a wheel element attached to the coupling assembly and rotatable about a wheel axle extending essentially parallel to the coupling axle. Rotation of the wheel element causes the coupling assembly to rotate about the coupling axle. According to one embodiment, the wheel element may be connected to the coupling assembly via a closed-loop belt or ring that transfers the rotational motion of the wheel to the coupling assembly. It should be noted, however, that other assemblies, such as a gear system, may be used to connect the wheel to the coupling assembly. According to one embodiment of the present disclosure, the pivot axes are located in the rear portions of the arms. The anastomosis device comprising a wheel element may also comprise first and second wheel-engaging levers, which can pivot independently between a locked and unlocked state about first and second pivot axes, respectively. The wheel-engaging levers of this embodiment have respective first and second projections extending laterally toward the wheel. The wheel may have first and second receptacles configured to receive the respective first and second projections, such that, once received in the receptacles, the wheel is rotatably fixed in a position defined herein as the "zero position." The zero position is useful for ensuring that the two needles of a suture unit, which are linked by a common suture thread, pierce and engage opposite aligned portions of the two tissue strands. When performing an anastomosis procedure, a set of first needles is manipulated to pierce the walls of the respective suture strand. The strand can then be axially rotated by turning the wheel to allow the medical professional to access the other needles around the perimeter of the strands. These needles are then pulled further through the strand walls, pulling the suture thread with them. To ensure that the second set of needles pierce locations opposite to those of the first needles on the opposite strand, the wheel is returned to the zero position. This ensures proper needle alignment (i.e., the needles of each suture unit must be inserted into the tissue aligned with each other to minimize the application of tension or torque on the strands).As will be clarified later, according to some realizations, the manipulation of the needles to pierce the walls of the ropes, in the manner described, can only be achieved when the wheel element is in the zero position. In one embodiment, the wheel-engaging levers pivot between the engaged and disengaged states by displacement of their respective actuating elements. The pivoting movement of the wheel-engaging lever from the unlocked to the locked state is typically against the deflecting force of a push element, which pushes the lever into the unlocked state. The wheel-engaging lever may have a bearing edge, opposite the projection, that rests on the pin. The bearing edge may have a displacement-stopping portion configured such that displacement of the pin in the proximal-to-distal direction induces a pivoting movement of the lever to the locked state; specifically, proximal-to-distal displacement is prevented when the wheel is not in the zero position. The support edge may include a recess distal to the travel-stop portion that allows the wheel-engaging lever to pivot to the unlocked state. The travel-stop portion may be configured such that displacement of the pin in the distal-to-proximal direction induces a pivoting displacement of the lever to the locked state; this pivoting displacement is deactivated when the wheel is not in the zero position. According to one embodiment, the needles are retained within the channels by a retaining element. The retaining element may be a snap ring housed in a defined circumferential groove in the cable coupling projection. The snap ring may have a diameter such that it fits snugly in the circumferential groove and an integral gripping portion for grasping and pulling a portion of the ring out of the groove. The snap ring may also include a notch for cutting the ring. A snap ring of the type described above, with the integral gripping portion and the notch, is also an aspect of the present disclosure. Brief description of the drawings To better understand the subject matter disclosed in this document and to illustrate how it can be put into practice, the following examples will be described, without limitation, by referring to the accompanying drawings, in which: Figure 1 is a perspective view of the anastomosis system according to an embodiment of the present disclosure. Figures 2A and 2B are, respectively, top and bottom perspective views of the system in Figure 1 in an initial state, with the casing removed to facilitate the visualization of the internal elements. Figure 2C is a planar cross-section of the device in Figure 2B. Figures 3A and 3B are respective top perspective and plan views of the system in an intermediate operating state. Figures 3C and 3D are respective bottom perspective and plan views of the system in an intermediate operating state. Figures 4A and 4B are respective top perspective and plan views of the system with one of the needle handling elements in its interior position and the needles in their drilling state. Figures 4C and 4D are respective bottom perspective and plan views of the system with one of the needle handling elements in its interior position and the needles in their drilling state. Figures 5A and 5B are, respectively, top and bottom perspective views, with the lever in the locked state, preventing the wheel from rotating. Figure 5C is a planar cross-section of the device in Figure 5B. Figures 6A and 6B are a side view and a longitudinal cross-sectional view, respectively, of a coupling assembly according to an embodiment of the present disclosure. Figure 6C is an enlarged cross-sectional view of one side of the coupling assembly of Figures 6A-6B. Figures 7A and 7B are cross-sectional views of the needles in a non-piercing and piercing position, respectively. Figure 8 is a perspective view of a retaining element according to an embodiment of this disclosure. Figure 9 is a close-up view of the front portion of the device in Figure 1, in which the thread storage element can be seen more clearly. Detailed description of the achievements In the following description, the terms "upper" and "lower" are used to designate the normal operating state of the system, with the upper side of the device being the one that is oriented towards the professional during use of the system. As can be seen, the embodiments described below are intended to illustrate the general principles of the assembly and devices disclosed herein and are not limited to the details of these embodiments. Some possible modifications may be mentioned when analyzing certain elements. However, modifications may also be possible, as an expert in the field would appreciate, even to elements for which modifications are not specifically discussed herein, all within the general scope of this disclosure. Referring firstly to Figure 1, which shows the anastomosis system according to an embodiment of the present disclosure. System 100 includes a device 102 and a coupling assembly 112. The device 102 has a housing 104 that accommodates the device body 106 (shown in Figure 2A and following). Visible are the upper portion of the wheel element 108 and the first and second drive elements 110A, 110B, whose function will be explained below. Zero markings 107 are visible on the top of the wheel element 108 and, when aligned with markings 109 on the body, provide a visual indication of the zero position, as will be further described below. Referring to Figures 2A-2C, the coupling assembly 112 has some features and general operating principles similar to those described in WO 2020 / 157753. The coupling assembly 112 includes a coupling body 113 with two axial coupling members 114A and 114B defining a coupling shaft 116. Each of the coupling members 114A and 114B has a truncated tapered axial projection for coupling a tube end 118A and 118B, respectively, and is configured for independent coupling with an end of a tubular organ (not shown) by pulling the walls of the end over the outer face of the projections 118A and 118B to a sutured state. The first and second open channel assemblies 120A and 120B are defined on the coupling members and arranged axially symmetrically around the coupling shaft 116. The structure of the coupling assembly 112 is shown in Figures 6A-6C. A plurality of suture units 122 are visible, each suture unit 122 being composed of suture threads 124 linking pairs of first and second curved needles 126A, 126B, respectively. The suture threads are represented schematically and, for ease of illustration, are not shown at their full length. The suture threads can be (and usually are) longer than shown. To prevent tangling before or during use, the threads are stored in a thread storage unit 105, shown in close-up in Figure 9. The first and second needles are arranged respectively in the first and second sets of open channels 120A, 120B. As can be seen in the cross-sectional view of Figures 6B-6C, each open channel 120 extends between a rear end of channel 128 and a front end of channel 130 and defines a channel axis parallel to the coupling axis 116. The needles of a suture unit are housed in corresponding open channels that lie along the same channel axis. Each channel 120 is defined between side walls and a bottom wall, which has a curved front wall portion 132 and a curved rear wall portion 134, the curvatures of portions 132 and 134 being offset and separated by a pivot point 136. The coupling assembly has first and second needle handling elements 140A and 140B, respectively, which are configured as a sleeve on the body 113 and can be axially displaced between an outer position (shown in Figures 6A and 6B) and an inner position closer to the center of the coupling assembly. As illustrated in Figures 7A and 7B, this displacement causes the needle to be extracted in the manner described below. Each needle has a front portion with a point 142 and a rear portion 144, joining the two rear portions of a pair of needles into one suture unit. Each rear portion 144 of the needles 126 is held by the needle handling element 140. The handling elements 140 are mounted on the body 113 of the coupling assembly and each of them can be axially moved inwards from its initial position seen in Figure 7A to a middle portion of the body to the position shown in Figure 7B. When the needle handling element 140 is in its outer position (Figure 7A), the front portion of each needle rests against the front wall portion 132, and the rear portion of the needle back portion 144 extends out of the channel 120, keeping the pointed front portion 142 within the channel. Once the needle handling element 140 moves to the inner position (Figure 7B), the axial displacement pivots the needle 126 around the pivot point 136 so that the needle rests against the back wall portion 134. The pivoting displacement causes the pointed front portion 142 of the needle to emerge from the channel 120 to pierce the walls of the suture in a sutured state. The curvature of the front lower wall portion 132, and also that of the rear lower wall portion 134 of channel 120, and therefore also that of needle 126, is normally circular; that is, it is arched and traces a section of an imaginary curvature (e.g., a circle) defined around a center of curvature (not shown). The lower wall of the front portion of the channel is arched around an imaginary front center of curvature, and the rear portion of the channel is arched around an imaginary rear center of curvature. The rear center of curvature is offset rearward with respect to the front center of curvature. It should be noted that an arched lower wall tracing a section of an imaginary circle is only one example, and the curvature can have other trajectories, e.g., hyperbolic, parabolic, etc. A circumferential groove 148 formed on the outer face of the handling element 140 houses a retaining element 150, which holds the needles within the channels 120 during movement and can be cut and removed after the needles pierce the shaft walls. The retaining element, shown in Figure 8, has a ring portion 152 and an integral gripping portion 154 that allows the healthcare professional to pull it out, and a notch 156 to facilitate cutting the ring. After cutting, the needles are released from the coupling member. Returning to Figures 2A-5C, the device body 106, the elements and their function will now be described. Inside a rear end of the device body 106 is fitted a wheel element 108, which can rotate about an axle 160 fixed to the wheel frame 161, being parallel to the coupling axle 116 and having a circular groove 162 that accommodates a closed-loop band or cable 164 that extends to and is fixed within the groove 166 of the coupling body 113. Thus, by rotating the wheel element 108, the coupling body 113 rotates in the same circular direction, to allow the practitioner access to all needles after they have been pierced through the walls of the cable. Wheel element 108 has a "zero position" mark 107, as will be further explained later; this is the position in which the rotation of the wheel element is stopped by means of wheel-locking levers.To prevent the band 164 from slipping under the applied torque, it is possible to form a transverse hole inside the groove 162 to serve as an anchor for the band or cable: the band / cable 164 is inserted through the hole and then wound around the shaft inside the groove 162, preventing such slippage or engagement. Within the body 106, an actuator assembly, generally designated as 170, is formed. The actuator assembly 170 is symmetrical about a plane of symmetry extending along the longitudinal axis 172 and perpendicular to the coupling axis 116. The actuator assembly 170 has first and second arms 176A, 176B, which have respective front portions 178A, 178B and rear portions 180A, 180B. The arms are pivotally coupled to the body about respective first and second pivots 182A, 182B, which are parallel to the plane of symmetry. The front portions 178A, 178B are configured to couple distally to the respective first and second needle handling elements 140A, 140B.The pivoting movement of the arms from the initial state (shown in Figures 2A-2C) to the tissue piercing state displaces the needle handling elements from the outer to the inner position, thus causing needle extraction. For example, the movement of arm 176A along the arced path 184A causes the needle handling element 140A to displace to extract the needles, as shown in Figures 4A-4D. The drive arrangement 170 also includes drive elements 110A and 110B, having the respective external sliders 188A and 188B (slider 188A has been removed from Figure 2A for clarity) and pins 190A and 190B that can be moved alternately in the general proximal-to-distal direction. Washers 192 secure the pins in position. The first and second guide slots 194A and 194B are defined in the body 113, with the respective pins 190A and 190B received therein; the guide slots thus guide the reciprocating movement of the drive elements. Pins 190A, 190B are also received within the respective first and second arm slots 196A, 196B, which are offset with respect to the respective guide slots 194A, 194B. Consequently, the reciprocating displacement of the drive elements causes the pivoting movement of the respective arms 176A, 176B. The anastomosis device also includes first and second wheel coupling levers 198A, 198B, which also pivot around the respective pivots 182A, 182B. The levers 198A, 198B have end portions 200A, 200B that are coupled together via spring 202, which deflects the levers to a wheel-unlocking state, which will be described below. Levers 198A, 198B have their respective inwardly extending projections 204A, 204B, which extend through openings in the wheel frame 161 into the wheel element 108 and are configured to be received within the respective receptacles 206A, 206B defined in the wheel element 108. The arrangement is such that the projections 204A, 204B can be received in the receptacles 206A, 206B only when the wheel element 108 is in said zero position.Levers 198A, 198B have their respective support edges 208A, 208B, opposite the projections that rest on pins 190A, 190B. The support edges have displacement-stopping portions 210A, 210B (best seen in Figures 3A-3D), configured so that displacement of pin 190 in the proximal-to-distal direction induces the lever to move into the locked state, this movement being deactivated when wheel element 108 is not in the zero position (as seen in Figures 5A-5C). When wheel 108 is in the zero position, this displacement is activated and, once the pins are displaced distally along the proximal-to-distal direction beyond the stop portion 210, the recesses 212A, 212B allow the levers to pivot to the unlocked state, by the thrust force of spring 202, thereby allowing rotation of wheel element 108.This ensures that the needles in coupling assembly 112 are removed only when the wheel is in the zero position, thus guaranteeing axial alignment of the needle on both ends. The sequence shown in Figures 2A-4D illustrates this operating procedure for side "A" of the system, for removing needles 126A from coupling member 114A. A similar sequence occurs when moving the drive elements in the distal to proximal direction, a displacement that is deactivated when the wheel is not in the zero position.

Claims

1. Anastomosis system (100) for joining two ends of a tubular organ, comprising a coupling device (102) with a body (106) and a housing (104), a coupling assembly (112) connected to the body, a plurality of suture units (122) within the coupling assembly, and an actuator assembly formed within the device; the coupling assembly comprising - first and second axial coupling members (114A, 114B) defining a coupling axis, having two respective opposing first and second axial end-coupling projections (118A, 118B), each projection being configured for independent coupling with one of the ends by pulling the end walls over its external surface to a sutured state in which the end walls cover an end-engaging portion thereof, - two opposing first and second open channel assemblies (120A,120B) in said first and second rope coupling members, respectively, arranged axially symmetrically about the coupling axis, each of the channels extending (i) between a rear channel end (128) in the rope coupling member and a front channel end (130) in the rope engagement portion of the projection to define a channel axis, (ii) being defined between side walls and a bottom wall having a curved front wall portion (132) and a curved rear wall portion (134), the curvatures of the two portions being offset and separated by a pivot point (136), and (iii) having a corresponding channel in the opposite assembly extending along the same channel axis, and comprising - first and second needle handling elements (140A, 140B) in the first and second rope coupling members, respectively,each being able to move axially between an outer position more proximal to said rope coupling projection and an inner position; each of the plurality of suture units comprises - a suture thread (124) and two curved suture needles, each having a pointed front portion (142) and a thread-coupled rear portion (144) that is coupled to the thread, - each of the suture needles being housed within one of the channels, one of the suture needles of each unit being housed in a channel of one of said rope coupling members and the other suture needle of the unit being in the corresponding channel in the other of said rope coupling members, - when the needle handling element is in its outer position, the front portion of each needle rests against the front wall portion and the rear end of the needle extends out of the channel,and - the rear end of the needle being coupled to the needle handling element such that, after axial displacement of said element from the outer to the inner position, the needle pivots about said pivot point to rest against the rear wall portion, thereby pivotally displacing the pointed front portion of the needle out of said channel to pierce the walls of the suture when in said suturing state; the actuator assembly - being symmetric about a plane of symmetry substantially perpendicular to the coupling axis of the coupling assembly, - having first and second arms (176A, 176B), pivotally fixed to the body about the respective first and second pivot axes, which are essentially parallel to the plane of symmetry, each configured to couple in its distal portion to the respective first and second needle handling elements,independent, moving each of the arms from an initial state to a tissue piercing state, causing a distal portion of the respective arm to move towards the other to axially displace the respective needle handling element from the outer to the inner position, and wherein the anastomosis system is characterized in that it has first and second drive elements (110A, 110B), each of which can be alternately and independently displaced, generally in the proximal-distal direction, and, respectively, associated with the first and second arms, so that, during said alternate movement, the arms pivot between a rest state and an actuated state, inducing the respective needle handling elements to displace between the outer and inner positions.

2. The anastomosis system of claim 1, wherein the displacement of the drive element (110A,110B) in the proximal-to-distal direction causes the arms to pivot between said rest state and said actuated state, respectively.

3. The anastomosis system of claim 1 or 2, wherein the first and second actuation elements (110A, 110B) have respective first and second pins (190A, 190B) received and alternately moving within respective first and second guide slots (194A, 194B) defined within the body.

4. The anastomosis system of claim 3, wherein the first and second pins are housed within respective first and second arm slots defined within the respective first and second arms, each arm slot being offset with respect to the respective guide slot,whereby the reciprocating motion of the drive element induces the pivoting motion of the respective arm.

5. The anastomosis device of any one of claims 1 to 4, wherein said first and second pivot axes are located in the rear end portions of the arms.

6. The anastomosis system of any one of claims 1 to 5, comprising a wheel element (108) rotatable about a wheel axis essentially parallel to the coupling axis and connected to the coupling assembly such that rotation of the wheel element causes rotation of the coupling assembly about the coupling axis.

7. The anastomosis system of claim 6, wherein the wheel element is connected to the coupling assembly via a closed-loop band or ring (164).

8. The anastomosis device of claim 6 or 7, comprising: first and second wheel engagement levers (198A,198B), which can pivot independently between a locked and unlocked state about their respective first and second pivot axes, and which have respective first and second projections extending laterally toward the wheel, the wheel having first and second receptacles configured to receive the respective first and second projections, such that, once received, the wheel is rotatably fixed in a zero position.

9. The anastomosis device of claim 8, wherein the wheel engagement lever pivots between the engaged and released states by displacement of the actuating element.

10. The anastomosis device of claim 9, wherein the pivoting movement of the wheel engagement lever from the unlocked to the locked state is against the pushing force of a pushing element that pushes said lever to move to the unlocked state.The wheel-engaging lever has a bearing edge, opposite said projection, that rests on said pin, the bearing edge having a displacement-stop portion configured such that displacement of the pin in the proximal-to-distal direction induces a pivoting displacement of the lever to the locked state.

11. The anastomosis device of claim 10, wherein the bearing edge comprises a recess distal to said displacement-stop portion that allows the wheel-engaging lever to pivot to the unlocked state, and the displacement-stop portion is configured such that displacement of the pin in the distal-to-proximal direction induces a pivoting displacement of the lever to the locked state.

12. The anastomosis assembly of any one of claims 1 to 11,comprising a retaining element (150) for retaining suture needles within the channels.

13. The anastomosis assembly of claim 12, wherein the retaining element is an elastic ring housed in a circumferential groove defined in the cable coupling projection.

14. The anastomosis assembly of claim 13, wherein the elastic ring has a diameter such that it can fit snugly in the circumferential groove, and has an integral gripping portion for grasping and extracting a portion of the ring from the circumferential groove.

15. The assembly according to claim 14, wherein the elastic ring comprises a notch for cutting the ring.

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