Tubular tissue converter

Abstract

A tubular tissue transformer (TTT) for tubular tissue structures. The tubular tissue transformer has a plurality of blades and a plurality of retainers on each of the plurality of blades. Each retainer retains a tubular tissue structure on a respective blade. A coupling system for coupling tubular tissue structures together and tools and methods for attaching and widening tubular tissue structures are also provided.

Description

Technical Field

[0001] This invention generally relates to tubular tissue converters for tubular tissue structures, as well as related tools and methods. Background Technology

[0002] In surgery, tissue structures can be joined together to form an anastomosis. Traditionally, this involves manually suturing the tissue structures together, a process that can be time-consuming, risky, demanding, and may require extensive training and high precision.

[0003] Devices used to help connect tissue structures use large retaining pins to hold the structures in place, attaching them one at a time. However, some tissue structures may tear if subjected to tension when attached to the retaining pins. This can be particularly problematic for relatively thick-walled or non-flexible tissue structures such as arteries.

[0004] Tissue structures can be everted before joining each other to ensure good contact between the inner surfaces of the structures for healing. In some cases, this can cause excessive deformation of the tissue structure, damaging it and hindering anastomosis. This can be particularly problematic for relatively thick-walled or non-flexible tissue structures, such as arteries. In some cases, it may be difficult to provide the correct surface geometry to maintain good contact between the inner surfaces of the joined tissue structures. Summary of the Invention

[0005] According to an exemplary embodiment, a tubular tissue converter for tubular tissue structures is provided, the tubular tissue converter comprising:

[0006] Multiple blades; and

[0007] Multiple retainers are provided on each of the plurality of blades, each retainer being configured to retain the tubular tissue structure on the respective blade.

[0008] According to another exemplary embodiment, a method for attaching a tubular tissue structure to a tubular tissue converter is provided, the method comprising:

[0009] Press a portion of the tubular tissue structure to hold the tubular tissue structure in multiple positions simultaneously.

[0010] According to another exemplary embodiment, a tubular tissue converter for tubular tissue structures is provided, the tubular tissue converter comprising:

[0011] Multiple blades, the multiple blades being configured to retain the everted portion of the tubular tissue structure; and

[0012] A bushing configured to move between a first position and a second position, and configured to support the outer surface of the everted portion of the tubular tissue structure in the second position.

[0013] According to another exemplary embodiment, a method is provided, comprising:

[0014] Part of the everted tubular tissue structure; and

[0015] The outer surface of the everted portion of the tubular tissue structure is supported on a surface that bends outward from the center away from the everted portion.

[0016] According to another exemplary embodiment, a tool is provided for widening a portion of a tubular tissue structure, the tubular tissue structure being held on the tubular tissue converter around an opening of the tubular tissue converter, the tool comprising:

[0017] A tapered portion, configured to be inserted into the opening to widen the opening, thereby widening the portion of the tubular tissue structure.

[0018] According to another exemplary embodiment, a tool is provided for widening a portion of a tubular tissue structure, the tubular tissue structure being held on the tubular tissue converter around an opening of the tubular tissue converter, the tool comprising:

[0019] An expandable portion, which is used to be inserted into the opening and expand in the opening to widen the opening, thereby widening the portion of the tubular tissue structure.

[0020] According to another exemplary embodiment, a method for widening a portion of a tubular tissue structure is provided, the method comprising:

[0021] The portion of the tubular tissue structure having a first diameter is retained;

[0022] When the portion of the tubular tissue structure is held, the portion of the tubular tissue structure is deformed to a second diameter greater than the first diameter; and

[0023] The portion of the tubular tissue structure having a second diameter is retained.

[0024] According to another exemplary embodiment, a tubular tissue converter for tubular tissue structures is provided, the tubular tissue converter comprising:

[0025] One or more blades, said one or more blades being positioned around the channel of the tubular tissue converter and configured to retain part of the tubular tissue structure; and

[0026] A bushing, the bushing being configured to be at least partially positioned within the channel;

[0027] The bushing is at least partially plastically deformable to radially expand the one or more blades and hold the blades in their radially expanded state.

[0028] According to another exemplary embodiment, a system for connecting tubular tissue structures is provided, the system comprising:

[0029] A first tubular tissue transducer has one or more retainers for retaining a portion of the tubular tissue structure, the one or more retainers being located at the position of one or more retainers around the retained portion of the tubular tissue structure;

[0030] A second tubular tissue converter has one or more retainers for retaining a portion of the tubular tissue structure, the one or more retainers being located at the position of one or more retainers around the retained portion of the tubular tissue structure;

[0031] First connecting device; and

[0032] A second connecting device is configured to be connected to the first connecting device;

[0033] The first and second connecting devices are configured to connect the retaining portion of the tubular structure, and when the retaining portion is connected, maintain a predetermined rotational offset between the one or more retainer positions of the first tubular tissue converter and the one or more retainer positions of the second tubular tissue converter, the rotational offset being an offset about a longitudinal axis passing through the connecting device.

[0034] According to another exemplary embodiment, an attachment tool is provided, including:

[0035] A deformable surface configured to press a portion of a tubular tissue structure against a plurality of retainers of a tubular tissue converter to attach the portion of the tubular tissue structure to the tubular tissue converter.

[0036] The embodiments may be implemented according to any of the dependent claims.

[0037] As is well known, terms such as “comprising,” “including,” and “containing” may have exclusive or inclusive meanings in different jurisdictions. For the purposes of this specification, unless otherwise stated, these terms are intended to have an inclusive meaning, that is, they will be considered to include the listed components that are directly involved in the use, and may also include other unspecified components or elements.

[0038] References to any document in this specification do not constitute an admission that it is prior art that can be effectively combined with other documents, or an admission that it constitutes part of common general knowledge. Attached Figure Description

[0039] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention, wherein:

[0040] Figure 1A It is a perspective view of a tubular tissue converter in a non-expanded, quiescent state, based on an example.

[0041] Figure 1B This is a perspective view of an exemplary alternative to the tubular tissue converter.

[0042] Figure 2A It is in a state of expansion. Figure 1A A perspective view of the tubular tissue converter.

[0043] Figure 2B It is in a state of expansion. Figure 1B A perspective view of the tubular tissue converter.

[0044] Figure 3A yes Figure 1A and Figure 2A An exploded view of the tubular tissue converter.

[0045] Figure 3B yes Figure 1B and Figure 2B An exploded view of the tubular tissue converter.

[0046] Figure 4 It is based on a cross-section of an example tubular tissue converter.

[0047] Figure 5 It is a perspective view of a tubular tissue converter and the tubular tissue structure located in the channel of the tubular tissue converter, based on an example.

[0048] Figure 6 It is a perspective view of a tubular tissue converter and the tubular tissue structure held on the tubular tissue converter, based on an example.

[0049] Figure 7 It is a perspective view of a tubular tissue converter and a tubular tissue structure everted to the tubular tissue converter, based on an example.

[0050] Figure 8A It is a perspective view of an example system for connecting tubular tissue structures.

[0051] Figure 8B This is a perspective view of an exemplary alternative system for connecting tubular tissue structures.

[0052] Figure 9A yes Figure 8A The system decomposition diagram.

[0053] Figure 9B yes Figure 8A An exploded diagram of an exemplary alternative to the system.

[0054] Figure 9C yes Figure 8B The system decomposition diagram.

[0055] Figure 10 It is a perspective view of a tubular tissue converter, a connecting device according to an example, and a tubular tissue structure.

[0056] Figure 11 It is used for connection Figure 8A A perspective view of the tubular tissue system and tubular tissue structures.

[0057] Figure 12 It is a cross-sectional view of a tubular tissue structure inserted into a tubular tissue converter, based on an example.

[0058] Figure 13 It is based on an example in Figure 12 A cross-sectional view of the tool used to operate on the inserted tubular tissue structure.

[0059] Figure 14 This is based on an example of operating on a tubular tissue structure to attach it to a tubular tissue converter. Figure 12 and 13 A cross-sectional view of the tool.

[0060] Figure 15 It is a cross-sectional view of a tubular tissue transducer in a non-expanded, quiescent state and a tubular tissue structure held on the tubular tissue transducer, based on an example.

[0061] Figure 16 It is based on an example of an expanded state. Figure 15 The tubular tissue converter and the everted part on the tubular tissue converter Figure 15 A cross-sectional view of the tubular tissue structure.

[0062] Figure 17 It is a cross-sectional view of a tool operating on a tubular tissue converter and a tubular tissue structure held on the tubular tissue converter, based on an example.

[0063] Figure 18 It is based on an example in Figure 17 The tubular tissue converter is operated on the bushing to deform the bushing. Figure 17 A cross-sectional view of the tool.

[0064] Figure 19 It is a partial cross-sectional view of a system for connecting tubular tissue structures, based on an example.

[0065] Figure 20 It is based on an example Figure 19 A partial cross-sectional view of the system and tubular tissue structure, wherein the tubular tissue converter of the system is engaged with the connecting device of the system.

[0066] Figure 21 It is based on an example Figure 19 and Figure 20 A cross-sectional view of the system and tubular tissue structure, in which the connecting device and the tubular tissue structure are connected together. Detailed Implementation

[0067] This application relates to a tubular tissue transformer (TTT) having blades, bushings, and retainers. Each blade has more than one retainer. Multiple retainers allow tubular tissue structures to attach to more than one retainer simultaneously, rather than requiring them to attach one at a time. This simplifies and accelerates the attachment of tissue structures.

[0068] The bushing is also designed to evert the tissue structure by expanding the blades and to support the outer surface of the everted tissue structure. This provides a large, well-supported surface for the tissue structure to attach to another tissue structure and can reduce damage to the tissue structure during eversion.

[0069] This application also relates to tools and methods for attaching and widening tissue structures, as well as systems for connecting tubular tissue converters and tubular tissue structures together.

[0070] The following terms will be used throughout the instruction manual:

[0071] A tubular tissue transducer (TTT) is a device that alters tissue structure to facilitate anastomosis. It may also optionally maintain, evert, and / or change the diameter of the tissue structure. It may also optionally maintain the integrity of the tissue structure during one or more of these processes. Throughout this specification and claims, reference to a tubular tissue transducer or TTT should be understood to mean such a device.

[0072] Tubular tissue structures are parts of the human or other animal body that are formed of tissue and are typically tubular with an internal lumen. Examples include blood vessels such as veins, arteries, lymphatic vessels, ureters, pancreatic ducts, intestines, and other ducts.

[0073] A blade is part of an object, extends another part of that object, and has a significant width transverse to its length at at least one location along the length direction.

[0074] A bushing is a component positioned near the inner periphery of a channel or opening.

[0075] In the context of tubular tissue structures, eversion means turning outwards, making the inner surface of the tissue structures surrounding the lumen easily accessible. Derived terms such as eversion and everted have the same meaning.

[0076] Circumferential connections between anastomosing tubular tissue structures.

[0077] An exemplary tubular tissue converter (TTT) 1 in Figure 1A , 2A As shown in Figures 3A and 3A, the device 1 has blades 2, each blade 2 having a retainer 3. In this example, the tubular tissue converter 1 also includes a bushing 4. Figure 1A In the first configuration, the blade 2 is in its stationary position and the bushing 4 is in the non-advanced position. Figure 2A The same device 1 in a second configuration is depicted, wherein the blade 2 is in an expanded configuration and the bushing 4 is in an advanced position.

[0078] In this example, each blade 2 has multiple retainers for holding the attached tubular tissue structure. For devices that require attaching the tissue structure individually to each retainer, having more than one retainer per blade 2 might traditionally be considered disadvantageous. However, the retainers on each blade of this tubular tissue converter 1 are designed to simultaneously attach and hold the tissue structure in one step, without requiring separate attachment to each retainer. This reduces the time, skill, and expertise required to attach the tissue structure to the retainers.

[0079] The retainer can be an aspiration port, pin, clip, or other component that can be attached to tissue structures. Figure 1A In the example, the retainer is pin 3, which can be straight or bent outwards. By extending outwards, this means at an angle away from the longitudinal axis 19 passing through the tubular tissue converter 1, an angle roughly aligned with the direction of extension of the blade 2. The retainer can also be a combination of straight pins and bent pins. In some uses, straight pins can be more easily pushed into the tissue structure. In some uses, bent pins can better retain the tissue structure and reduce the likelihood of it detaching from the tubular tissue converter 1. Straight pins can extend at an angle away from the longitudinal axis 19. Combinations of straight pins at different angles can exist.

[0080] In this example, the length of pin 3 is between 0.2 mm and 1.5 mm, for example, between 0.5 mm and 1.2 mm. Different lengths of pin 3 can be suitable for different applications, such as for different tissue structures. For example, shorter pins may be more suitable for attachment to small or thin-walled structures, while longer pins may be better suited for large or thick-walled structures. The tubular tissue converter 1 can have pins of different lengths on each blade 2, which reduces the amount of preparation required for the outer layer (or outer membrane) of the tubular tissue structure before attachment. This also reduces the time required for the connection process.

[0081] A large number of retainers allows the tissue structure to attach at numerous points around the tissue structure, which reduces stress at each attachment point. A large number of attachment points also reduces the strength required to attach to each individual retainer, avoiding the need for relatively destructive retainers such as large pins, which create large pores in the tissue structure and can potentially cause significant damage. It also allows for the use of relatively small, tightly clustered retainers that can simultaneously attach to the tissue structure pressed against them. Different numbers of retainers may be appropriate depending on the nature and size of the tissue structure, the size and type of the retainers, and the number of blades 2. For example, thick-walled or relatively inflexible tissue structures may require more retainers per blade 2, as may be the case for large tissue structures. Similarly, a larger number of retainers may be required when individual retainers are smaller. If the tubular tissue converter 1 has a small number of blades 2, a larger number of retainers may be required per blade 2. In one example, there are 2 to 10 retainers on each blade 2. In one example, there are at least 8 retainers in total on the tubular tissue converter 1. Figure 1A In this example, there are 8 retainers in the form of pins 3 on each blade 2. In this example, there are a total of 32 retainers on the tubular tissue converter 1.

[0082] The retainers can be arranged in one or more rows on each blade 2. This allows for the installation of more retainers on the retaining surface 6 of each blade 2. Figure 1A In the example, each blade 2 has two rows of pins 3; five pins in the outer row and three pins in the inner row. To accommodate more retainers on each blade, the retainers can be arranged close together, for example, with a distance of 0.2 mm to 0.5 mm between adjacent retainers.

[0083] Different numbers of blades are suitable for different applications. More blades allow for a more even distribution of forces on the tissue structure, especially during any expansion or eversion the tissue structure may undergo. Fewer blades may offer easier control for the operator. The number of blades can be at least four or at least five. Figure 1A In the example, the tubular tissue converter 1 has four blades 2. In an alternative example, a single blade may replace multiple blades 2. In this example, the blade may be generally cylindrical or truncated conical with a variable perimeter. The perimeter of such a blade can be changed by deformation, stretching, or winding and unwinding.

[0084] The blade 2 can be positioned around the channel 17 via the tubular tissue converter 1. In use, the tissue structure can be located in the channel 17 and held on the blade 2 around the opening of the channel 17. The channel 17 is sized to accommodate the tissue structure.

[0085] Blade 2 is flexible, allowing it to widen and narrow. A portion of blade 2 can move outward away from the longitudinal axis 19 or inward closer to the longitudinal axis 19. Figure 1A , Figure 2A and Figure 3A In the example, blade 2 extends outward from the ring or base 5. Blade 2 and ring 5 together form a single unit 10. The distal end of blade 2 can move toward and away from axis 19 to expand or contract the opening of channel 17. This can allow for changing the diameter of the opening to aid in attaching tissue structures to tubular tissue converter 1 or to another tissue structure. The outward bending of blade 2 is also useful for everted tissue structures, as will be referenced. Figure 6 and 7 A more detailed description was provided.

[0086] To bend the blades 2 inward, the operator can, for example, clamp the blades 2 with pliers and squeeze them. This allows the diameter of the opening to be reduced, making it easier for tissue structures to attach. To assist this process, the blades 2 can be provided with features that make them easier to clamp. Figure 1A In the example, the tubular tissue converter 1 has a groove 7 formed in the blade 2, which can accommodate the end of the forceps and help prevent the forceps from slipping off the tubular tissue converter 1.

[0087] In having Figure 1A In the alternative examples of the different structures shown, different portions of the blade 2 can expand or narrow. For example, if the tissue structure is contained in the portion located between the ends of the blade 2, the blade 2 can expand or narrow at that portion.

[0088] The blades 2 can be elastically flexible within the typical range of bending they experience during use, so that they return to their original configuration after release.

[0089] exist Figure 3A The exploded view shows the body 10, the retainer (in the form of a pin) 3, and the bushing 4. A hole 8 is provided in the blade 2 to receive the pin 3 in this example. The pin 3 is arranged in a circular pattern, as is the blade 2. The bushing 4 can be seen in more detail in this view.

[0090] The bushing 4 includes a generally cylindrical body 13. At the front portion of the bushing 4 (i.e., the end closest to the distal end of the blade 2), the bushing 4 is formed as a support surface 11. This support surface 11 is configured to support the outer surface of the structural components during use. The support surface 11 may be formed by a widened portion of the bushing 4. As the bushing 4 is advanced from a first, rearward position to a second, forward position, the widened portion may also abut against the inner surface of the blade 2 to drive them outward. The widened portion may also engage with the blade 2 to resist the bushing 4 from moving back from the forward position to the rearward position. For example, the widened portion may extend beyond the end of the blade 2 such that the rear surface of the widened portion contacts the end of the blade 2, thereby resisting it from being pulled back after passing the blade 2. Alternatively, a groove or asymmetrical bevel may be present on the inner surface of the blade 2, and the widened portion engages with the groove or asymmetrical bevel to resist being pulled back from the groove or after passing the steep edge of the bevel.

[0091] The support surface 11 may be formed by a flange extending outward from the body 13 of the bushing 4 at an acute angle to the body 13 of the bushing 4, for example, 90°. Alternatively, the support surface 11 may be formed by an "open" portion that bends outward from the body 13. Because the support surface bends outward away from the center of the supporting portion of the tubular tissue structure, the tubular tissue structure can be supported on the surface in an outwardly curved manner. The support surface 11 may bend outward between 10° and 120°, or between 30° and 90°. The support surface 11 may bend outward with a radius of curvature selected based on the properties of the tissue structure to be supported. If the outward folding is too tight, some tissue structures may suffer unacceptable damage. In such cases, it may be advantageous to select a radius of curvature larger than that which might cause unacceptable damage to the tissue structure. For example, arteries have relatively thick and inelastic walls compared to other tissue structures such as veins, and may be unacceptably damaged if the outward folding is too tight. In some examples, the radius of curvature is greater than 0.2 mm.

[0092] The bushing 4 may also include a flange 12 or other features to prevent it from advancing beyond the second, forward position. The flange 12 may abut against the rear surface of the ring 5 or another portion of the body 10 to prevent the bushing 4 from moving forward beyond the forward position. Alternatively, the bushing 4 may include: a widened portion to form a friction fit with an opening in the body 10 of the tubular tissue converter 1; a bayonet assembly to fit into a complementary assembly in the body 10 of the tubular tissue converter 1; or an adhesive to adhere to the body 10 of the tubular tissue converter 1. If the sleeve 4 includes a widened portion, a bayonet assembly, or an adhesive, this may additionally prevent the bushing 4 from moving out of the second position toward the first position, in addition to or in place of the widened portion forming the support surface 11.

[0093] Bushing 4 may also have a gap 14 in the body 13 to allow for widening of bushing 4, as referenced. Figure 17 and 18 The details are as follows. Despite the presence of gap 14, the cross-section of bushing 4 can be approximately circular. Approximately circular means that bushing 4 forms a complete circle of greater than 50%, greater than 75%, greater than 85%, or preferably greater than 90%, while noting that the circle mentioned in actual implementation may not be a perfect circle.

[0094] Bushing 4 can also cause the blade 2 to bend. In this example, bushing 4 is disposed within channel 17 and configured to move along channel 17. Figure 1A and 2A As shown, bushing 4 can be in the first, rearward position ( Figure 1A ) and second, forward position ( Figure 2A The blades move between ( ). When bushing 4 is in the rearward position, blades 2 do not expand, that is, they are in a "stationary" configuration, as Figure 1A As shown. When the bushing 4 moves to the forward position, the outer edge of the widened portion forming the support surface 11 rests on the inner surface of the blade 2, pushing the blade 2 to form... Figure 2A The bushing 4 has a radially expanding configuration and holds the blades 2 within this configuration. Alternatively, the bushing 4 may have another portion separate from the widened portion forming the support surface 11 to support the blades 2 so that they expand and / or hold them within the expanding configuration.

[0095] The bushing 4 may be at least partially plastically deformable. This allows it to deform when a force is applied and retain its deformed shape after the force is removed. The bushing 4, or a portion thereof, may be formed from a material with appropriate deformation properties, depending on the application. For example, the material may be selected such that it can undergo plastic deformation under typical forces applied by the operator during the widening process (see details). Figure 17 and 18However, it retains its shape (i.e., rigidly) under the typical forces exerted by the leaf blade 2 and the retaining portion of the tissue structure before or after the widening process. A suitable material is a metal, such as stainless steel or surgical steel, titanium alloy, or cobalt-chromium. Another suitable material is a polymer, such as a polytetrafluoroethylene / silicone composite.

[0096] Components of the tubular tissue converter 1 may be transparent to allow the operator to see the tissue structure during use. In particular, one or more of the bushing 4 and / or blades 2 may be transparent.

[0097] In one example, the tubular tissue converter 1 may be provided with a suction port. The suction port, alone or in combination with pin 3, can constitute a retainer. In one example, the suction port is located at the end of pin 3.

[0098] Figure 4 In the example shown, the retainer is a pin 3 with a suction port 29 at its end. The suction port 29 is connected to a low-pressure source via a suction line 9. Figure 4 In this example, the suction line 9 passes through the corresponding pin 3 and blade 2 and is connected to a low-pressure source in the ring 5 region. In this example, the low-pressure source is a syringe 28, which creates a partial vacuum in the suction line 9 when its plunger is withdrawn. Alternatively, the low-pressure source could be a vacuum pump or the like.

[0099] Figures 5 to 7 A tubular tissue converter 1 is depicted for use with the tubular tissue structure 16 in various states.

[0100] exist Figure 5 In this example, the tissue structure 16 is located in the channel. The tissue structure in this example has been cut, and the portion 18 near the cut end extends out of the channel 17 into the area of ​​the retainer, which in this example is a pin 3. In this state, the bushing 4 is not advanced and the blade 2 is in its stationary position.

[0101] exist Figure 6 In the middle, the tissue structure 16 has been attached to the retainer 3 at part 18. For example, in Figure 6 As can be seen, portion 18 is attached to the retainer and held on the device 1 at multiple points arranged in a roughly circular pattern. In this state, the bushing 4 is not advanced and the blades 2 are in their stationary position. In this position, portion 18 of the tissue structure 16 is not fully folded outwards. Depending on the range of motion of the blades 2 and the angle at which they are attached to the tissue structure 16 in the contraction configuration, portion 18 of the tissue structure 16 may be partially folded outwards or not folded outwards at all.

[0102] exist Figure 7 In the middle, bushing 4 has been advanced to the forward position. Blade 2 has expanded outward. Therefore, with Figure 5 and Figure 6 Compared to the previous structure, portion 18 of the tissue structure 16 is turned outwards more. Portion 18 of the tissue structure 16 can be turned outwards up to 90°, approximately 90°, or greater than 90°, and does not need to be completely "inside-out". In one example, portion 18 of the tissue structure 16 is turned outwards at approximately 90°. In some cases, a 90° outward turn may be optimal to expose most of the inner surface area of ​​the tubular tissue structure 16 for attachment to another structure, without needing to turn the tissue structure 16 outwards beyond what is necessary.

[0103] Despite Figure 7 While not visible in the foreground, the support surface of the bushing 4 is located near the end of the blade 2. In this position, the support surface of the bushing 4 contacts the outer surface of the everted portion 18 of the tissue structure 16, supporting it to form a wide, generally circular surface suitable for attaching another tissue structure, thus creating a fit. The end of the blade 2 in this state can also form a support surface for the everted portion of the tissue structure. In this example, the support surface 6 of the blade 2 is located near the support surface 11 of the bushing 4 and forms a small angle with the support surface 11 of the bushing 4, such that the blade 2 and the bushing 4 cooperate to provide a composite support surface. In this configuration, the support surface 6 of the blade 2 can form an angle less than 45°, less than 30°, or less than 15° with the support surface of the bushing 4. In an alternative example, the blade 2 can provide the entire support surface without the action of the bushing 4.

[0104] from Figure 3A As can be seen, the support surface 11 of the bushing 4 essentially covers the entire circle, with only small gaps 14. Even during expansion, these gaps are smaller than the intervals 15 between adjacent blades 2, thus providing more support than the support surface 6 of the blade 2 alone provides. In this way, the support surface 11 of the bushing helps ensure that the area around the flared portion 18 is a large, uniformly supported surface, essentially the entire circumference. "Essentially the entire circumference" means greater than 50%, 75%, 85%, or preferably greater than 90% of the entire circumference. This helps to form a good seal between the two tissue structures when joined to form a fit. Because the support surface 11 of the sleeve 4 bends outward away from the center of the flared portion, the flared portion 18 of the tissue structure 16 is supported such that it also bends outward. The portion 18 is supported in this shape by the support surface 11 in contact with its outer surface. As already noted, this helps to avoid damage to the tissue structure 16.

[0105] Figure 8A A system 20 for connecting tubular tissue structures is shown, which includes a first tubular tissue converter 1, a second tubular tissue converter 1', a first connecting device 21, and a second connecting device 22. Figure 9AAn exploded view of the system is shown, which illustrates the first connecting device, the second connecting device, the first tubular tissue converter 1, and the second tubular tissue converter 1'. Figure 9B An alternative system for exploded views is described. Figure 10 The first connecting device 21 and the first tubular tissue converter 1 are shown in more detail.

[0106] The first tubular tissue converter 1 and the second tubular tissue converter 1' can be referenced. Figure 1A , Figure 2A , Figure 3A and Figures 4 to 7 The described tubular tissue converter, or different tubular tissue converters, are described. Tubular tissue converter 1 and tubular tissue converter 1' each hold a portion of the tubular tissue structure at at least one corresponding holding position 27 surrounding the tissue structure. In one example, tubular tissue converter 1 and tubular tissue converter 1' each hold the tissue structure in more than one holding position 27. Figure 8A In the example, the tubular tissue converters 1' and 1 each have 4 blades 2, and each blade 2 has a holding position 27 corresponding to the area covered by multiple pins 3 and 3'.

[0107] The first connecting device 21 and the second connecting device 22 can be positioned together to juxtapose the everted portions of the tissue structures and are connected together to connect the tissue structures to each other. Connecting devices 21 and 22 ensure that the retaining positions 27 and 27' of the retaining devices are offset from each other when connected. By using the retaining position of the other device to "fill" the gap between the retaining positions of one tubular tissue converter, this helps ensure a good, uniform seal around the connection interface. This also prevents or reduces the possibility of the retainer of one device interfering with the retainer of another device. For example, if the retainer is a pin, a predetermined offset prevents the pins of the tubular tissue converter from contacting each other. If the pins do contact, this may prevent the retaining portions of the tissue structures from being adequately positioned together to form a good seal.

[0108] The coupling devices 21 and 22 include alignment features to ensure that they are coupled to each other only in one of a set of discrete opposing directions about the longitudinal axis 25. In one example, the alignment features are one or more pins and one or more holes for receiving the pins. Pins may be provided on two or only one of the coupling devices. Accordingly, holes may be provided on two or only one of the coupling devices. Figure 8A , 9AIn the example of 9B, the first connecting device 21 has two pins 23, and the second connecting device 22 has two holes 24. In this example, the pins 23 are not evenly spaced around the longitudinal axis 25, i.e., their rotational offset is not 360° / n, where n is the number of pins. This restricts the connecting devices 21, 22 to being connected to each other only in one opposite direction around the longitudinal axis 25. The pins 23 may have features such as teeth or barbs for engaging with the second connecting device 22 at the periphery of the holes 24. The pins 23 or holes 24 may be provided with an adhesive. The pins 23 or holes 24 may taper to provide a friction fit. In one example, the holes 24 are tapered to engage with the pins 23 having a constant cross-section.

[0109] Each connecting device also has one or more alignment features to ensure that it holds each tubular tissue converter 1 in one of a set of discrete relative directions about the longitudinal axis 25. In other words, the tubular tissue converter cannot be held in the connecting device at any angle, but only at an angle that ensures its retainer is offset from the retainer of another tubular tissue converter. This allows the connecting device and each tubular tissue converter 1 to mate about the axis 25 in one or more predetermined compatible directions. Each connecting device may have recesses 26, 26' that receive the corresponding tubular tissue converter 1, 1'. In one example, the inner surface of the recesses 26, 26' may be non-circular, and a portion of the outer surface of each tubular tissue converter 1, 1' may also be non-circular. When the tubular tissue converters 1, 1' are received in the recesses 26, 26', the non-circularity of the devices can prevent them from rotating away from a particular relative direction. Figure 9B In the example, the recesses 26, 26' and the tubular tissue converters 1, 1' are polygonal. Additionally or alternatively, other mating structures may be provided that prevent the tubular tissue converters 1, 1' from rotating away from a specific relative orientation with respect to the connecting devices 21, 22. For example, these mating structures may include a pin in one device and a hole in another device for receiving the pin; a ridge in one device and a groove in another device for receiving the ridge. When such mating structures are provided, the exterior of the recesses 26, 26' and the tubular tissue converters 1, 1' may be circular. In the examples of Figures 8 and 9A, the cross-section of the recesses 26, 26' is approximately circular, but in this example, each recess does not form a complete circle. More specifically, the cross-section of each recess is approximately three-quarters of a circle.

[0110] exist Figure 8A and Figure 9AIn the example, the cross-sections of the connecting devices 21 and 22 are approximately circular, but not completely circular. In this example, they are approximately three-quarters of a circle. This means that the connecting devices 21 and 22 are each open on one side. This allows the connecting devices 21 and 22 to move over the tubular tissue structure from that side to position the tissue structure within the central opening of the connecting devices 21 and 22. This is faster and easier than inserting the cut end of the tissue structure longitudinally through a fully circular opening. The opening also allows the operator to see the interface between the tubular tissue converter 1, the tubular tissue converter 1', and the tissue structure when connecting them.

[0111] Figure 10 A first connecting device 21 is shown, wherein a first tubular tissue converter 1 is located in a recess. The first tubular tissue converter 1 has a tubular tissue structure 16, which is held to the first tubular tissue converter 1 at four holding positions 27 around the holding portion 18.

[0112] Figure 11 A system for connecting a first tubular tissue structure 16 and a second tubular tissue structure 16' in use is shown. The holding position 27 of the first tubular tissue converter 1 is shown offset from the holding position 27' of the second tubular tissue converter 1'. The pin 23 of the first connecting device 21 is shown inserted into the hole 24 of the second connecting device 22. In this configuration, the system 20 forms a connection or mating between the two tubular tissue structures 16, 16'.

[0113] Alternative examples in Figure 1B , 2B As shown in 3B, 8B, and 9C. In this case, the tubular tissue converter device 1 has five blades 2. Figure 3B As shown, each blade 2 has a recess 100 for receiving a hook insert 102. Each hook insert 102 has a plurality of retainers / hooks 3 that can be attached to a tubular structure, similar to Figure 1A Pin 3 in the middle. This embodiment can make device manufacturing and assembly easier and can improve the method of vascular retention. The hook insert 102 can be made of a hard material such as stainless steel, wherein the sharp hook 3 is processed using wire electrical discharge machining (EDM). The sharp hard hook 3 can easily and non-invasively pierce the arterial wall. The base 106 of the hook insert 102 provides a smooth surface for the bushing to abut against as it advances through the tubular tissue converter to bend the blade radially outward. However, the blade 2 into which the hook insert 102 is inserted must remain deformable so that the blade 2 can bend radially outward as the bushing 4 advances forward to evert the vessel. To achieve this, the hook insert 102 is most likely to be manufactured as a separate component capable of being inserted into the recess 100 in a retrograde manner. In other words, these recesses 100 can be inserted by means of... Figure 3AIt works in a similar way to the hole 8 of the receiving pin 3.

[0114] For each hook insert, hook 3 may include 3 hooks. There may be 1 inner hook and 2 outer hooks. Each hook may be tapered and / or outwardly curved. The length of each hook may be 0.5-2.0 mm. The thickness of each hook may be in the range of 0.05-1.00 mm, for example, the thickness may be 0.15 mm.

[0115] The hook insert 102 can be held in place by employing an interference fit mechanism. Alternatively, a lip can be present at the rear end of the hook insert 102, allowing it to engage properly in the recess 100. In another alternative, a low-viscosity adhesive can be used to form a bond between the hook insert 102 and the recess 100. All combinations of the above can also be used.

[0116] The hook insert 102 has a lip 104 on its outer surface to prevent the forceps from slipping off the blade. The forceps are used to properly position the tubular tissue converter 1 onto the blood vessel it can be held. When a soft tubular tissue structure, such as an artery, is attached to the hook 3 of the tubular tissue converter, the user can use fine forceps to pick up the blood vessel and attach it to the hook 3. To help hold the blood vessel and minimize stress on the vessel during this process, the user can bend the blade 2 radially inward to bring the hook 3 closer to the vessel wall by applying compressive force with the forceps. When compressive force is applied, the lip 104 prevents the forceps from unintentionally slipping off the leading edge and damaging the soft tissue structure. The lip acts as a guide... Figure 1A It has the same function as groove 7 in the middle. The height of this lip can be approximately 0.2-1.0 mm.

[0117] In this particular configuration with five blades, if the operator wants to hold the blades from the side of the tubular tissue converter, one clamp tip will be used against the top blade, and the other clamp tip will be used against the two bottom blades. The top blade will be the one undergoing the most inward bending, and the operator will first attach the artery to this set of hooks. The operator will rotate the tubular tissue converter and, as he / she walks in circles, sequentially press each blade, thereby attaching the artery to the retainer on each blade.

[0118] The base 106 of the hook insert 102 extends slightly further radially inward than its corresponding blade 2, such that it is the base 106 that engages with the bushing 4. This surface provides a smoother interface for the radial expansion of the blade as the bushing 4 advances. As mentioned, the hook insert can be made of a rigid material, such as stainless steel, titanium, or hard plastic. Rigidity in this context means in response to the force applied by pushing the bushing 4 to its final position.

[0119] Blade 2 can be molded from deformable plastic. The plastic and rigidity of each blade structure can be designed such that as bushing 4 advances, the blade angle (compared to the longitudinal axis 19) varies between 2-15°, or approximately 9°. Deformable in this context means in response to the force provided by pushing bushing 4 to its final position.

[0120] like Figure 9C As shown, the main feature of this embodiment of the connecting device 21 is a recess 26 for receiving a connecting flange or wing 108 on either side of the tubular tissue converter 1, and a lip 110 on the front clamp 112 of the connecting device 21 to prevent the tubular tissue converter 1 from slipping out of the recess 26. The tubular tissue converters 1 and 1' are attached to and turned outwards at the respective ends of the blood vessel and are clamped in each connecting device 21, 21'. The two connecting devices 21, 21' are then brought close together, rotated and offset (so that the corresponding blades and hooks interlock in the space between the opposing blades), and then permanently connected by a pin 23. Alternatively, each tubular tissue converter may include connecting holes 24, 24', and the connecting pin 23 may directly engage the corresponding tubular tissue converter 1, 1'.

[0121] This type of coupling device 21 allows for improved visibility of the recess 26 into which the tubular tissue converter 1 must be fitted. The coupling wing 108 allows the tubular tissue converter 1 to be inserted from the top (or conversely, the coupling device 21 to be introduced from below), thereby reducing the total movement required to mate the tubular tissue converter 1 with its corresponding coupling device 21. The mating can be achieved using an interference fit or by means of a locking mechanism in the deformable front clamp 112.

[0122] The front clamp 112 secures the connecting wing 108 in place and prevents antegrade movement. This means that the tubular tissue converter 1 will not slip out of the connecting device or move obliquely away from the central axis 25.

[0123] This method also reduces the overall length of the connector (i.e., when the connector is connected by pin 23). This is because the central gap that the tubular tissue converter must first pass through is no longer required before the reverse conversion to fit into the recess 26. Figure 9A As shown.

[0124] Now refer to Figures 12 to 21 Describe various methods that can be executed separately as separate programs, or can be executed together as multiple parts of a program.

[0125] exist Figure 12In this example, a portion 18 of the tubular tissue structure 16 is inserted into a channel in the tubular tissue converter 1 in the direction indicated by arrow 33. In this example, the inserted portion 18 is the cut end of the tissue structure 16. In this example, the tubular tissue converter 1 is a reference... Figures 1A to 8B The tubular tissue converter is described. In such an example, portion 18 of the tissue structure 16 passes through the bushing 4 and is between the blades 2.

[0126] exist Figure 13 In this process, the attachment tool 30 has been brought into contact with a portion 18 of the tissue structure 16 at position 30'. The attachment tool 30 may include a portion, such as a tip 31, that inserts into the opening of the tubular tissue structure 16. The attachment tool 30 has a deformable surface 32 that can simultaneously press the portion 18 of the tissue structure 16 against a plurality of retainers. Before or simultaneously with pressing the portion 18 of the tissue structure 16 against the retainers, the operator may squeeze the blades 2 inward or otherwise retract the blades 2 to bring the ends of each blade 2 closer together. This can make it easier to attach the tissue structure to the tubular tissue converter 1, especially in cases where the tissue structure is narrow or relatively inflexible. In one example, the operator grasps the groove 7 of the tubular tissue converter 1 with pliers and squeezes to retract the blades 2.

[0127] exist Figure 14 In the middle, tool 30 is in position 30', and deformable surface 32 has been removed from... Figure 13 The state shown produces deformation to better contact with and press the portion 18 of the tissue structure 16 onto the retainer. As indicated by arrow 36, tool 30 can also rotate to help attach the portion 18 of the tissue structure 16 around its entire periphery.

[0128] Pressing portion 18 on the retainer allows it to be attached simultaneously to multiple locations, each corresponding to one of the retainers. This eliminates the need to attach the tissue structure to each retainer individually. As shown by arrow 37, the tissue structure is slightly folded outwards onto the retainers and attached to them.

[0129] The tool 30 may include a fluid, such as air, water, or gel, encapsulated by a deformable surface 32. In one example, the fluid-filled area may be squeezed or otherwise compressed by an operator in one area to expand the tool at the region of contact with tissue structure. This can gently press against all or most of the tissue structure surrounding it, thereby facilitating rapid attachment to multiple retainers simultaneously. The deformable surface 32 may be an elastic, flexible surface.

[0130] In an alternative example, the operator can press on the tissue structure without the aid of tool 30, for example, by using their fingers.

[0131] exist Figures 12 to 14 In the example shown, the holding portion 18 of the tissue structure 16 is the portion near the cut end of the tissue structure. In an alternative example, the holding portion could be the area around the slit on the side of the tissue structure. This allows the tubular tissue converter 1 to be used as a side connector for connecting the end and side of a tubular tissue structure.

[0132] exist Figure 15 In the middle, tissue structure 16 is attached to tubular tissue converter 1 at portion 18. Bushing 4 is in the first, rearward position and blade 2 is in a contracted configuration. By pushing bushing 4 in the direction indicated by arrow 38, the operator can advance bushing 4 towards the second, forward position, as... Figure 16 As shown.

[0133] exist Figure 16 In the forward position, the bushing 4 is in the advanced position, and the end of the blade 2 has expanded radially outward, as indicated by arrow 39. This expansion has caused a portion 18 of the tissue structure 16 to fold outward. The folded portion 18 is now supported by the support surface 11 of the bushing 4 in the folded state. The bushing 4 holds the folded portion 18 in its outwardly curved configuration by bringing it into contact with the curved support surface 11 at its outer surface. Thus, the tubular tissue converter 1 can quickly and easily fold a portion of the tissue structure outward by advancing the bushing 4.

[0134] The radius of curvature of the everted portion can be greater than the value that would damage the tissue structure. The radius of curvature can be greater than 0.2 mm.

[0135] In an alternative example, the tubular tissue converter 1 may include another mechanism to expand the blade 2 and evert the portion 18. For example, the tubular tissue converter 1 may include an outer ring that is attached to the blade and slides rearward to pull the blade outward, and then is fixed in place. In another alternative example, the tubular tissue converter 1 may simply retain the tissue structure, and a separate device may be used to evert the tissue structure. In yet another example, it may also rely on the following Figure 17 and Figure 18 The widening method is used to evert the tissue structure.

[0136] exist Figure 17 and Figure 18 The image shows a tool used to widen a portion of a tubular tissue structure. This can be useful when the tissue structure has a smaller diameter than the tissue structures it will be joined to. Figure 17 As shown, a portion 18 of the tissue structure 16 is held around the opening 17 of the tubular tissue converter 1. This portion 18 initially has a first diameter. A widening tool 40 is used to widen the opening 17, which in turn widens the holding portion 18 of the tissue structure 16 to have a second diameter. Figure 17 and Figure 18 In the example, the tapered portion 41 of the widened tool 40 is inserted into the opening 17 in the direction indicated by arrow 43. The tool 40 can be held by the operator at the handle 42.

[0137] like Figure 18 As indicated by arrow 44, the plastically deformed portion of the insertion drive bushing 4 of the tapered portion 41 is radially outward. This drives the blades 2 of the tubular tissue converter 1 outward. The bushing 4 is then able to maintain its shape against the inward forces of the blades and the tissue structure, thus holding the tissue structure in its widened state. The tissue structure can be widened to more closely approximate the width of another tissue structure to which it will be attached. This can help join the tissue structures together. When the tissue structures to be joined have different diameters, the one with the smaller diameter can be widened. When the tissue structures have similar diameters, a widening process may not be necessary.

[0138] Alternatively, different widening tools with expandable portions can be used to widen the opening. Instead of a tapered portion, the expandable portion can be inserted into the opening and expand to widen it. In one example, the tool includes fluid encapsulated by a deformable surface that can expand when the fluid is compressed in another area of ​​the tool. As described above, the expansion of the opening can also be used to evert a portion of the tissue structure by bending the blades outward, thereby everting the holding portion 18 of the tissue structure outward.

[0139] exist Figures 19 to 21 In this process, tubular tissue converters 1 and 1' engage with coupling devices 21 and 22, and tissue structures 16 and 16' are joined together using coupling devices to form an anastomosis.

[0140] exist Figure 19 In this configuration, connecting devices 21 and 22 have passed through the tissue structures 16 and 16' from the sides, while the everted portions of the tissue structures 16 and 16' remain on the tubular tissue converters 1 and 1'. Then, connecting devices 21 and 22 move toward their respective tubular tissue converters 1 and 1' in the directions indicated by arrows 45 and 45'. This causes them to engage with the tubular tissue converters 1 and 1', as... Figure 20 As shown.

[0141] exist Figure 20 In this example, the tubular tissue converters 1 and 1' engage with corresponding connecting devices 21 and 22. The tubular tissue converters 1 and 1' are positioned within the connecting devices 21 and 22 at a predetermined relative angle around the longitudinal axis, as shown in the reference. Figure 8A As detailed above. Then the connecting devices 21, 22 together with the tubular tissue converters 1, 1' move toward each other in the direction indicated by arrows 45 and 45' so that they engage with each other and the everted portions of the tissue structures 16, 16' come into contact with each other.

[0142] exist Figure 21 In the middle, the connecting devices 21 and 22 are connected to each other by pin 23 and hole 24. The outwardly turned portions of the tissue structures 16 and 16' are also connected to each other at the interface 50 by the mutual retention of the connecting devices 21 and 22, without the need for sutures or staples.

[0143] For reference Figure 8A As described in detail, the tubular tissue converters 21 and 22 are joined together by a predetermined rotational offset between the retainers of the tubular tissue converters. See reference... Figure 3A As described in detail, the combined outward-facing portions are supported essentially around their entire perimeter. These features ensure a good seal around the interface 50 and minimal fluid leakage.

[0144] After connecting devices 21, 22 and tissue structures 16, 16', the operator can monitor the newly formed anastomosis for leaks or other signs of poor connection. If these are noticed, the operator can disconnect devices 21, 22 by pulling them apart without removing sutures or staples. This can be a non-destructive process, allowing devices 21, 22 to reconnect after disconnection (and any other corrective actions, such as reattachment), without removing the tubular tissue converters 1, 1' from tissue structures 16, 16' or cutting off the retaining portions of tissue structures 16, 16'.

[0145] The described apparatus, system, and method allow for rapid, safe, and easy attachment of tissue structures to tubular tissue converters, enabling eversion, widening, and connection of tissue structures while reducing the risk of tissue damage, and this can be particularly suitable for arterial connections.

[0146] While the invention has been described by way of the description of embodiments thereof, and while the embodiments have been described in detail, the applicant does not intend to limit or in any way restrict the scope of the appended claims to such detailed description. Other advantages and modifications will readily occur to those skilled in the art. Therefore, the invention, in its broader aspects, is not limited to the specific details, representative devices and methods, and the illustrative examples shown and described. Accordingly, deviations from these details may be made without departing from the spirit or scope of the applicant's overall inventive concept.

Claims

1. A tubular tissue translator (TTT) for a tubular tissue structure, the tubular tissue translator comprising: a plurality of leaves configured to hold an everted portion of the tubular tissue structure at an end of each leaf; a substantially longitudinal channel, the plurality of leaves being resiliently flexible and positioned around an opening of the channel, the leaves flexing radially outward when a sleeve is advanced forward to evert a blood vessel; a sleeve configured to couple between an outer surface of the tubular tissue structure and the plurality of leaves, the sleeve being movable between a first position and a second position, and having one or more support faces configured to support an outer surface of the everted portion of the tubular tissue structure in the second position; wherein the sleeve is longitudinally movable along the channel from the first position to the second position to move the plurality of leaves radially outward relative to the opening of the channel to further evert the tubular tissue structure when held by the plurality of leaves, in the second position, the one or more support faces of the sleeve are closer to the ends of the plurality of leaves than in the first position to support the outer surface of the everted portion of the tubular tissue structure with the ends of the plurality of leaves, and the sleeve is unable to advance beyond the second position.

2. The tubular tissue translator of claim 1, further comprising: a plurality of retainers on or proximate to each of the plurality of leaves, each retainer configured to substantially retain the tubular tissue structure on a respective leaf.

3. The tubular tissue translator of claim 2, wherein the plurality of retainers are pins.

4. The tubular tissue translator of claim 3, wherein one or more of the pins are curved away from a longitudinal axis of the tubular tissue translator.

5. The tubular tissue translator of claim 3, wherein one or more of the pins are straight.

6. The tubular tissue translator of claim 5, wherein one or more of the pins extend at an angle away from a longitudinal axis of the tubular tissue translator.

7. The tubular tissue translator of claim 3, wherein the pins are between 0.2 mm and 1.5 mm.

8. The tubular tissue translator of claim 3, wherein each leaf has between 2 and 10 pins.

9. The tubular tissue translator of claim 3, wherein each pin is positioned between 0.1 mm and 0.5 mm from an adjacent pin.

10. The tubular tissue translator of claim 3, wherein a total number of pins of the tubular tissue translator is at least 8.

11. The tubular tissue translator of claim 3, wherein each leaf has a plurality of rows of pins.

12. The tubular tissue translator of claim 2, wherein one or more of the plurality of retainers each comprise a suction port.

13. The tubular tissue translator of claim 12, wherein the suction port is in communication with a source of low pressure via a suction line that passes through a respective pin.

14. The tubular tissue converter of claim 1, wherein the plurality of leaves comprises at least four leaves.

15. The tubular tissue converter of claim 14, wherein the plurality of leaves comprises at least five leaves.

16. The tubular tissue converter of claim 2, wherein the plurality of retainers comprises a plurality of leaf inserts, each leaf insert comprising one or more hooks to retain the tubular tissue structure on the leaf insert.

17. The tubular tissue converter of claim 16, wherein the bushing is configured to engage a base of each of the plurality of leaf inserts, whereby urging the bushing can push the leaf inserts longitudinally, which in turn moves a portion of each of the plurality of leaves outward.

18. The tubular tissue converter of claim 17, wherein the outward movement is between 2° to 15° compared to a longitudinal axis.

19. The tubular tissue converter of claim 16, wherein the plurality of leaf inserts are rigid and the plurality of leaves are deformable.

20. The tubular tissue converter of claim 1, wherein the bushing is substantially circular in cross-section.

21. The tubular tissue converter of claim 1, wherein each of the one or more support faces is curved outwardly by 30° to 90°.

22. The tubular tissue converter of claim 1, wherein each of the one or more support faces is curved outwardly with a radius of curvature that is greater than a value that would damage the tubular tissue structure.

23. The tubular tissue converter of claim 22, wherein each of the one or more support faces is curved outwardly with a radius of curvature that is greater than 0.2 mm.

24. The tubular tissue converter of claim 1, wherein each of the plurality of leaves has a support face configured to be positioned adjacent an outer surface of an everted portion of the tubular tissue structure.

25. The tubular tissue converter of claim 24, wherein, In the second position, the support face of the leaf is located adjacent to and at a small angle to the support face of the bushing, such that the leaf and the bushing cooperate to provide a composite support face for the tubular tissue structure.

26. The tubular tissue converter of claim 24, wherein, In the second position, the support face of each of the plurality of leaves is located adjacent to and at an included angle to the support face of the bushing that is less than 45°.

27. The tubular tissue converter of claim 1, wherein the bushing is configured to resist movement away from the second position.

28. The tubular tissue converter of claim 1, wherein the bushing is configured to engage the leaf to resist retraction from the second position toward the first position.

29. The tubular tissue converter of claim 1, configured such that the plurality of leaves have a radially contracted configuration when the bushing is in the first position, and the one or more leaves have a radially expanded configuration when the bushing is in the second position.

30. The tubular tissue translator of claim 29, wherein the bushing has an outer surface configured to contact an inner surface of the leaflet in the second position to retain the leaflet in the expanded configuration.

31. The tubular tissue translator of claim 29, wherein in the radially contracted configuration, the leaflets are configured to retain the tubular tissue structure in a less everted state than the radially expanded configuration.

32. The tubular tissue translator of claim 1, wherein one or more of the leaflets or the bushing is transparent.

33. The tubular tissue translator of claim 1, wherein each leaflet includes a groove.

34. The tubular tissue translator of claim 1, further comprising a ring, wherein the ring and the leaflets together form a single unitary body.

35. A system for coupling tubular tissue structures, the system comprising: a tubular tissue translator (TTT) as in claim 1 configured to retain the everted portion of the tubular tissue structure; a second tubular tissue translator (TTT) for a second tubular tissue structure comprising: a plurality of leaflets configured to retain an everted portion of the second tubular tissue structure; a substantially longitudinal channel, the plurality of leaflets being located around an opening of the channel; and a bushing configured to couple between an outer surface of the tubular tissue structure and the plurality of leaflets, the bushing being movable between a first position and a second position, and having one or more support faces configured to support an outer surface of the everted portion of the second tubular tissue structure in the second position; a first coupling device; and a second coupling device coupled to or configured to be coupled to the first coupling device; wherein the first coupling device and the second coupling device are configured to couple the everted and retained portions of the tubular tissue structure to the everted and retained portions of the second tubular tissue structure, and to maintain a predetermined rotational offset between retainers of the plurality of leaflets of the tubular tissue translator and retainers of the plurality of leaflets of the second tubular tissue translator when the retained portions are coupled, the rotational offset being an offset about a longitudinal axis passing through the coupling devices.

36. The system of claim 35, wherein one or both of the first coupling device and the second coupling device includes one or more pins received in corresponding one or more holes defined in the other coupling device.

37. The system of claim 36, wherein the one or more pins are tapered.

38. The system of claim 36, wherein the pins include teeth or barbs for engagement with a respective perimeter of the one or more holes and the other coupling device.

39. The system of claim 36, further comprising an adhesive on the one or more pins.

40. The system of claim 36, wherein the one or more holes are tapered.

41. The system of claim 35, wherein each coupling device has a recess defined inside thereof for receiving a respective tubular tissue converter, wherein an inner surface of the recess and an outer surface of a portion of a respective tubular tissue converter configured to be located in the recess have a non-circular cross-section.

42. The system of claim 35, wherein each tubular tissue converter has one or more coupling wings, and each coupling device has a recess defined inside thereof for receiving a respective coupling wing, and wherein the coupling devices are held together by one or more coupling pins.

43. The system of claim 35, wherein the coupling devices and the tubular tissue converters have mating structures configured to mate at one or more predetermined relative angles about the longitudinal axis.

44. The system of claim 35, wherein one or both of the first coupling device and the second coupling device has a side opening to allow insertion of an uncut portion of a tubular tissue structure.

Images