Flexible annular stapler for closed surgery of hollow organs

Abstract

A improved flexible annular stapler for joining annular organs (163, 164) is disclosed. The novel stapler features greater accuracy of operation and better control by the operator, as well as additional functions, such as internal illumination (76) and viewing facility (82), and accommodation of a large number of accessories, such as fibroscopes (90) and catheters. The novel stapler features easy attachability of both stapling jaws (18, 25) and easy detachability of the head (11). The novel features of the flexible stapler, and associated methods performed thereby, are particularly useful for closed surgery.

Description

[0001] The present invention relates to excision of a section of a hollow or tubular soft organ, such as the digestive tube, and rejoining the remaining ends and, more particularly, to methods for performing these operations under conditions of closed surgery, using a flexible annular stapling and cutting instrument. The invention also relates to an improved construction of such an instrument. [0002] Various ailments of the digestive tube, particularly of the esophagus, the stomach, the small intestines and the colon, such as tumors, chronic inflammation or other disorders, often require excision of a portion of the tube, followed by rejoining of the remaining end segments, through anastomosis to reestablish continuity of the tube. In some cases it is necessary to thus join one organ to another; for example, the cut end of the small intestines may be joined to the colon, or the cut end of the duodenum may be joined to the stomach. In some other cases, two organs or two portions of t...

AI Technical Summary

Benefits of technology

[0010] This novel stapler avoids the shortcomings of the conventional one, listed hereabove. In particular, it enables reaching any segment of the digestive tube—either through a natural opening (mouth or anus) or through a single, conveniently located cut. It also enables end-to-side or side-to-side joints.

[0012] The unrealized potentialities are mainly associated with a new possible mode of its employment, a mode that was not contemplated in the French patent but is the subject of the present invention, namely closed surgery. The practice and techniques of closed surgery, such as laparoscopy and thoracoscopy, have made tremendous progress over the past five years and many surgical procedures on internal organs are now carried out in this mode. Whereas in conventional, open, surgery, a relatively large incision is made in the abdominal wall or chest, closed surgery is characterized by insertion of very thin tools through otherwise intact walls—usually with the aid of small tubular ports, called trocars, which also serve to seal the openings during operation. Some of these tools serve for viewing and usually include a video system so that the entire operation is viewed and monitored on a video screen. The main advantages of closed surgery are (a) the much reduced trauma, resulting in fewer complications and much faster recuperation, which, in turn, shortens hospitalization and costs, (b) reduced risk of infection and (c) considerable reduction of scars.

[0016] The present invention successfully addresses the shortcomings of the presently known configurations by providing an improved and more practical flexible annular stapler, which is applicable to a wide variety of procedures and surgical conditions, including closed surgery.

[0017] More specifically, the stapler of the present invention enables accurate alignment of the head to the anvil during stapling, more convenient activation of the stapling operation itself, possibility of introducing into the stapler, or building into it, various auxiliary tools, such as imagers and catheters, and easy attachability and detachability of the head and of the anvil, all of which are particularly advantageous for operation under conditions of closed surgery.

[0018] The present invention discloses a novel construction of a flexible annular stapler with a large number of optional features and attachments. It also discloses novel methods and procedures for using a flexible stapler, in general, and the improved stapler of the present invention in particular, for anastomosis of hollow organs, which methods contribute to more efficient and cleaner operation.

[0025] the hole in the first jaw having a non-circular cross-sectional shape and the end segment having a complementary cross-sectional shape such as to allow easy sliding of the end segment through the hole while keeping their mutual angular orientation about the axis of the hole fixed;

Problems solved by technology

It is not suitable for hard-to-reach or complicated portions of the intestiness, such as those inside the pelvis, nor for the duodenum; operation on the esophagus or the stomach is difficult.

The temporary sewing of the butt ends is difficult and the depth of the resulting flanges is small, thus risking leakage.

This may allow some twist in the cable and consequently some angular misalignment between the staple pins in the head and the grooves in the face of the anvil, which may cause malfunctioning of the stapling action.

Likewise, because of uneven back pull of an intestinal butt, the faces of the two components may not be parallel, or may not be axially aligned prior to the stapling action, which, again, could cause malfunction.

Another shortcoming of the instrument is in the operation of the handle; turning the knob may not be the optimal way to activate the stapling and cutting operation.

Yet another shortcoming is the difficulty with which the head or anvil and are attachable or detachable, making such operations within the body, as would be advantageous in certain procedures, close to impossible.

However, because the only practical instrument now available for anastomosis is the rigid type described hereabove, which has to be operated under open conditions, the surgery ends up being, in part, of the open type (such as laparoscopically assisted surgery) and thus foregoes some of the advantages listed above.

However, such use of a flexible stapler has not yet been attempted nor, to the best of the inventor's knowledge, even been suggested.

Moreover, there are certain aspects of this type of surgery that render direct utilization of the instrument, as disclosed in the French patent, difficult or impractical.

For example, the preliminary circular sewing of the butt ends over the instrument's head or anvil, difficult even during open surgery, is close to impossible.

Also, there is a need for endoscopy during the operation and it may be difficult to insert or manipulate both the endoscope and the flexible stapler simultaneously in the same tube.

A similar difficulty holds for internal ultrasonic examination.

Since, as stated, use of a flexible stapler in closed surgery has not yet been attempted and since, moreover, such an instrument is not yet available, there has been no clinical experience with anastomosis in the digestive tube under conditions of closed surgery and certainly no experience using such an instrument.

Thus, no suitable procedures have so far been developed, which fact keeps the clinicians and patients from benefiting from the tremendous potential advantages of the technology and also hinders potential acceptance by clinicians of the instruments when they become available.

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