Minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit and anastomosis control system

Abstract

The present invention discloses a minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit and anastomosis control system. It includes a puncher, a suturer and an anvil segment holder; the puncher includes a puncher body and an anvil segment, the puncher body includes an inner shaft, a cutting tube and an outer tube arranged in sequence from the inside to the outside, and the end of the inner shaft is threadedly connected with the anvil segment; the suturer includes a main cylinder, an eccentric rotating shaft and a needle storage bin, the eccentric rotating shaft is slidably connected and rotatably connected to the main cylinder; the end of the eccentric rotating shaft is connected to the needle storage bin; a needle insertion position for inserting a straight threaded suture needle is provided in the needle storage bin, and the socket of the needle insertion position faces the main cylinder; a connection structure for threading the anvil segment is provided on the side of the needle storage bin away from the main cylinder. The straight threaded suture needle of the present invention is hidden in the needle storage bin, and enters the aortic cavity together with the suturer, and then the needle storage bin is separated from the main cylinder by rotating, and then the straight threaded suture needle passes through the aortic wall from the inside to the outside in the aortic cavity to complete a needle suture.

Description

Technical Field

[0001] The present invention relates to the technical field of surgical instruments, in particular to anastomosis devices and control systems thereof. Background Art

[0002] Coronary artery bypass surgery (CABG) is an effective means of clinically treating complex coronary artery lesions. In bypass surgery, the anastomosis of the proximal end of the great saphenous vein graft with the ascending aorta is a necessary step in most surgeries. The conventional operation method is: at the site of the ascending aorta where the anastomosis is to be performed, use a side wall clamp to clamp part of the ascending aorta wall to isolate the part of the ascending aorta wall from the main body of the ascending aorta, then make a hole in the part of the ascending aorta wall, and then perform anastomosis between the proximal end of the great saphenous vein graft and the ascending aorta, and remove the side wall clamp after the anastomosis is completed.

[0003] Although this conventional anastomosis method is simple and reliable in terms of anastomosis effect, it requires the side wall clamping of the ascending aorta, which causes extensive damage to the site and the detachment of plaques on it, which in turn causes serious complications such as embolism and infarction of various solid organs. Studies have suggested that the side wall clamping of the ascending aorta is the main risk factor for arterial embolism after coronary artery bypass grafting. Therefore, this anastomosis method urgently needs to be improved, especially in the case of extensive and severe atherosclerosis or calcification of the ascending aorta wall, which is common in clinical practice. In addition, since the placement of the side wall clamp requires a large operating space, the above conventional anastomosis method is not suitable for minimally invasive multi-branch coronary artery bypass grafting (MICS-CABG) with small incisions, deep surgical fields, and small operating spaces, and sometimes even impossible.

[0004] Therefore, there is an urgent need for a new anastomosis assisting device that can avoid sidewall clamping of the ascending aorta and can be reliably operated in a deep surgical field through a small chest wall incision, so as to simplify the operation, shorten the time, and ensure safety, especially to prevent or reduce serious complications such as iatrogenic arterial embolism and even organ infarction, thereby improving the prognosis.

[0005] At present, there are two main auxiliary devices in clinical practice that can perform anastomosis between the ascending aorta and the graft vessel under the condition of normal blood flow in the aorta and avoiding clamping of the side wall of the ascending aorta. They are Enclose II Anastomosis AssistDevice (Vitalitec International, Inc) and Heartstrig III (Guidant CorporationCardiac Surrgery) proximal anastomosis system. Both are expensive imported disposable devices.

[0006] How to use Enclose II:

[0007] When using Enclose II, a purse-string suture should be made on the aorta about 1 cm near the intended anastomosis site (anastomosis) so that the lower clamp of Enclose II can be tightened to stop bleeding when inserted into the aorta in the purse. Rotate the lower knob to open the film attached to the lower clamp, and rotate the upper knob to press the upper clamp against the lower clamp in the aorta, so that the film on the lower clamp isolates the ascending aortic wall at this site from the ascending aortic cavity. Then make an incision and punch a hole on the ascending aortic wall at this site, and then use sutures to connect and knot the proximal end of the graft vessel to the anastomosis on the ascending aorta wall. After the anastomosis is completed, clamp the graft vessel, loosen the lower knob to reset the lower clamp, pull out the lower clamp and tie the purse-string suture to complete the anastomosis of the proximal end of the graft vessel and the ascending aorta.

[0008] How to use Heartstring III:

[0009] The Heartstring III proximal anastomosis system consists of three components: 1. The aortic punch, which is used to punch a hole at the anastomosis site on the ascending aorta; 2. The loading and delivery device, which makes the Heartstring III proximal anastomosis placement fast and easy to operate; 3. The inverted cone seal.

[0010] When using it, you need to use an aortic cutter to first make a hole in the ascending aorta wall where the anastomosis is to be made and control bleeding. Then, pass the delivery device through the anastomosis and go deep into the aortic cavity. Release the inverted cone-shaped seal to make its bottom edge press and buckle around the anastomosis, so that the space between the aortic wall around the anastomosis and the aortic cavity is isolated. After that, use the conventional anastomosis method to complete the continuous or intermittent suturing of the proximal end of the bridge vessel and the ascending aorta anastomosis with a straight suture needle with a line. Before tying the suture, decompose and destroy the inverted cone-shaped seal and remove it from the ascending aorta cavity. At this time, pay attention to compressing the anastomosis to control bleeding. Tighten the suture and tie the knot to complete the anastomosis.

[0011] Both devices create a local blood isolation zone in the lumen of the ascending aorta where anastomosis is to be performed, and then use a straight suture needle with thread to anastomose the ascending aorta wall and the proximal end of the graft vessel in a conventional manner. Although satisfactory suturing can be performed in most cases, these two devices or methods have the following obvious disadvantages and shortcomings:

[0012] 1. In addition to making an anastomosis on the aortic wall, Enclose II also requires a purse-string suture and puncture on the aortic wall near the anastomosis to insert the main part of Enclose II into the ascending aorta. Puncture and perforation at two locations increase the risk of trauma, bleeding, and embolus dislodgement.

[0013] 2. The blood isolation membrane of Enclose II may be punctured by a straight suture needle or a pointed knife, causing heavy bleeding, disuse of Enclose III and anastomosis failure.

[0014] 3. Both Enclose II and Heartstring III will cause a certain degree of bleeding during the suturing process, with the latter causing more bleeding. Carbon dioxide and other gases need to be used to continuously blow away the blood in the surgical field to facilitate exposure of the suture position.

[0015] 4. Both devices expand to a certain extent in the ascending aorta cavity and squeeze the ascending aorta wall, and there is also the possibility of expanding the damage and touching the detached ascending aorta wall plaque.

[0016] In addition to the above-mentioned shortcomings, more importantly, both devices require a larger surgical access and operating space when used. They are more suitable for use in coronary artery bypass surgery with a complete sternum split, but are not suitable for minimally invasive multi-branch coronary artery bypass surgery with a beating heart with only a small chest wall incision.

[0017] In order to overcome the above-mentioned shortcomings, especially to be able to get rid of the side wall clamping of the ascending aorta and to safely and reliably complete the anastomosis operation of the proximal anastomosis of the graft vessel in minimally invasive multi-vessel coronary artery bypass grafting (MICS-CABG) surgery with a small chest wall incision, deep surgical field and poor visual field, the proximal anastomosis instrument kit for grafting vessel in coronary artery bypass grafting described in this case was specially designed and invented to meet the above-mentioned clinical requirements. Summary of the invention

[0018] In view of the problems existing in the prior art, the present invention provides a minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit and an anastomosis control system to solve at least one of the above technical problems.

[0019] In order to achieve the above-mentioned object, the present invention provides a minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit, characterized in that it includes a puncher, a stapler and an anvil segment clamp;

[0020] The punch comprises a punch body and an anvil section for blocking the opening of the aortic wall, wherein the punch body comprises an inner shaft, a cutting tube and an outer tube arranged in sequence from the inside to the outside, the end of the inner shaft is threadedly connected with the anvil section, and the cutting tube slides between the inner shaft and the outer tube;

[0021] The anvil segment holder is used to hold the anvil segment;

[0022] The stapler comprises a main cylinder, an eccentric rotating shaft and a needle storage bin, wherein an eccentric hole for eccentrically setting the eccentric rotating shaft is opened in the main cylinder, the eccentric rotating shaft is slidably connected and rotatably connected to the main cylinder, and the eccentric rotating shaft is connected to the main cylinder through a return spring;

[0023] The end of the eccentric rotating shaft is connected to the needle storage bin;

[0024] The needle storage bin is provided with a needle insertion position for inserting a straight sewing needle with thread, and the insertion opening of the needle insertion position faces the main cylinder;

[0025] The side of the needle storage bin adjacent to the main cylinder is used to press against the main cylinder under the action of the return spring;

[0026] A connection structure for threaded connection with the anvil section is provided on one side of the needle storage bin away from the main cylinder;

[0027] The movement of the eccentric rotating shaft drives the needle storage bin to move, so as to switch between two states: the straight sewing needle with thread at the needle insertion position is exposed outside the main cylinder body and is stored in the main cylinder body. When the straight sewing needle with thread at the needle insertion position is stored in the main cylinder body, the anvil section, the needle storage bin and the main cylinder body are assembled into a straight rod-shaped structure.

[0028] The present invention realizes the blocking of the opening position during the punching process and the suturing process by switching the connection between the anvil section and the puncher and the suturing device, without introducing other opening blocking parts.

[0029] The present invention optimizes the structure of the needle storage bin, so that the straight suture needle with thread is hidden in the needle storage bin and enters the aortic cavity together with the suture device. The needle storage bin is then separated from the main cylinder by rotation, and the straight suture needle with thread is then passed through the aortic wall from the inside to the outside in the aortic cavity to complete a stitch.

[0030] Further preferably, the outer wall of the anvil segment includes a first blocking portion for blocking the opening of the aorta wall and a connecting portion for connecting the anvil segment clamp;

[0031] The outer wall of the needle storage bin includes a second blocking portion for blocking the opening of the aorta wall;

[0032] The outer wall of the main cylinder includes a third blocking portion for blocking the opening of the aorta wall;

[0033] The first blocking portion, the connecting portion, the second blocking portion and the third blocking portion are arranged adjacent to each other in sequence along the axial direction, and the outer diameters of the first blocking portion, the second blocking portion and the third blocking portion match each other;

[0034] The axial movement of the suturing device switches the first sealing part, the second sealing part and the third sealing part to seal the opening of the aorta wall.

[0035] Further preferably, when the punch is used, the anvil section is connected to the punch body;

[0036] When the stapler is in use, the anvil section is connected to the connecting structure of the needle storage bin;

[0037] The eccentric shaft moves axially, driving the distance between the needle storage bin and the main cylinder to expand, and the eccentric shaft rotates circumferentially, thereby positioning the straight sewing needle with thread at the needle insertion position outside the main cylinder, thereby realizing that the straight sewing needle with thread at the needle insertion position is exposed;

[0038] Through the axial movement of the eccentric shaft, the distance between the needle storage bin and the main cylinder is adjusted, and the needle storage bin and the main cylinder are switched to two states: abutting against each other and being away from each other.

[0039] The rotation of the eccentric shaft enables the straight thread-carrying needle to be switched between being located inside the main cylinder and outside the main cylinder.

[0040] Further preferably, the needle storage bin is provided with a shaft connecting portion for connecting the eccentric shaft;

[0041] The rotating shaft connecting portion and the insertion needle are symmetrically arranged on opposite sides of the needle storage bin.

[0042] Further preferably, the tip of the straight sewing needle with thread faces the main cylinder, and the tail end of the straight sewing needle with thread is inserted into the needle insertion position;

[0043] The end surface of the needle storage bin contacting the main cylinder is used as the separation surface;

[0044] The tip of the straight suture needle with thread extends axially upward out of the separation surface of the needle storage bin;

[0045] The straight suture needle with thread comprises a straight needle body, and the tail end of the straight needle body is connected with a suture thread.

[0046] Except for the area where the suture is connected to the straight needle body and is located in the needle storage bin, the rest of the area extends outward from the separation point between the needle storage bin and the main cylinder.

[0047] Further preferably, the needle insertion position includes a slot for inserting the straight suture needle with thread, and an elastic clip for elastically clamping the straight suture needle with thread is installed in the slot.

[0048] Further preferably, the needle storage bin comprises a sleeve, a central fixing member, a first end cover and a second end cover, the left and right ends of the sleeve are sealed by the first end cover and the second end cover, and the central fixing member is sandwiched between the first end cover and the second end cover;

[0049] The first end cover and the central fixing member are both provided with a through hole passing through the eccentric rotating shaft;

[0050] The first end cover is provided with an insertion hole for passing a straight sewing needle with thread;

[0051] The central fixing member is provided with a slot for docking with the jack, and an elastic clip is fixed in the slot;

[0052] The second end cover is provided with the connecting structure.

[0053] Further preferably, the main cylinder is provided with a socket for inserting the straight threaded sewing needle.

[0054] Further preferably, one end of the eccentric shaft is connected to the needle storage bin, the other end of the eccentric shaft is connected to the hand-held handle, the outer sleeve of the eccentric shaft is provided with a return spring with an elastic direction in the axial direction of the eccentric shaft, one end of the return spring in the axial direction is connected to the hand-held handle, and the other end of the return spring in the axial direction is connected to the main cylinder;

[0055] The hand-held handle is provided with a grip extension portion extending radially outward.

[0056] The rotation angle of the eccentric shaft is determined by the extension.

[0057] Further preferably, the main tube body comprises a first tube body and a second tube body connected in sequence, the vertical projection area of ​​the second tube body is within the range of the vertical projection area of ​​the first tube body, and an extension piece extending outward is connected to the connection between the first tube body and the second tube body;

[0058] The extension piece is provided with an inner extension portion extending into the inner cavity of the first tube body, and the inner extension portion abuts against the return spring;

[0059] The central axis of the first tube body coincides with the central axis of the eccentric rotating shaft;

[0060] The eccentric shaft is connected with a hand-held handle rotatably connected to the first tube body, the hand-held handle comprises a shaft portion rotatably connected to the first tube body and a grip extension portion for gripping, the grip extension portion extending radially outward;

[0061] The eccentric rotating shaft is eccentrically arranged in the second tube body.

[0062] Further preferably, the inner shaft, the cutting tube and the outer tube are connected by a positioning pin;

[0063] The inner shaft and the outer tube are provided with positioning holes through which the positioning pin passes.

[0064] The cutting tube is provided with a guide groove for the positioning pin to slide.

[0065] This facilitates the cutting tube to slide between the inner shaft and the outer tube.

[0066] Further preferably, the center of the anvil segment is used for switching the internal threaded hole connecting the connecting structure and the inner shaft;

[0067] An axial end of the anvil section away from the internal threaded hole is provided with an extension portion extending obliquely outward, and the length direction of the extension portion forms an angle greater than 90° and less than 180° with the axial direction of the anvil section;

[0068] The cross-sectional area of ​​the extension portion increases from outside to inside along the length direction.

[0069] It is convenient to guide the anvil segment through the extension part and insert it into the ascending aorta wall punctured by the pointed knife.

[0070] A control system for proximal anastomosis of a minimally invasive coronary artery bypass grafting, characterized in that it comprises a puncher, a stapler and an anvil segment clamp;

[0071] The punch comprises a punch body and an anvil section, wherein the punch body comprises an inner shaft, a cutting tube and an outer tube which are sequentially arranged from the inside to the outside, the end of the inner shaft is threadedly connected with the anvil section, and the cutting tube slides between the inner shaft and the outer tube;

[0072] The anvil segment holder is used to hold the anvil segment;

[0073] The stapler comprises a main cylinder, an eccentric rotating shaft and a needle storage bin, wherein an eccentric hole for eccentrically setting the eccentric rotating shaft is opened in the main cylinder, the eccentric rotating shaft is slidably connected and rotatably connected to the main cylinder, and the eccentric rotating shaft is connected to the main cylinder through a return spring;

[0074] The end of the eccentric rotating shaft is connected to the needle storage bin;

[0075] The needle storage bin is provided with a needle insertion position for inserting a straight sewing needle with thread, and the insertion opening of the needle insertion position faces the main cylinder;

[0076] The side of the needle storage bin adjacent to the main cylinder is used to press against the main cylinder under the action of the return spring;

[0077] A connection structure for threaded connection with the anvil section is provided on one side of the needle storage bin away from the main cylinder;

[0078] With the assistance of the thoracoscope system, the anvil segment clamper clamps the anvil segment, and the anvil segment is separated from the punch body and connected to the stapler.

[0079] Beneficial effects:

[0080] The present invention realizes the integrated design of the puncher and the suture device. Under the premise of normal blood flow in the aorta, the straight suture needle with thread is hidden in the needle storage bin and enters the aorta together with the suture device. Then, the needle storage bin is separated from the main cylinder by rotating, and then the straight suture needle with thread passes through the aortic wall from the inside to the outside in the aorta to complete a one-needle suture.

[0081] The present invention solves the problem of avoiding the need for side wall clamping of the ascending aorta during proximal anastomosis of the graft vessel in coronary artery bypass surgery, thereby avoiding or reducing the resulting thrombus shedding and peripheral artery embolism. In particular, in minimally invasive coronary artery bypass surgery with a small chest wall incision, it can effectively provide a safe and effective solution to the pain points and difficulties of proximal anastomosis of the graft vessel.

[0082] Through this anastomosis instrument kit, the proximal anastomosis of the graft vessel can be completed through a single anastomotic hole on the ascending aorta without clamping the ascending aorta on the side wall, thereby avoiding or reducing the plaque shedding caused by clamping the ascending aorta on the side wall and causing embolism of the distal artery. At the same time, in minimally invasive multi-branch coronary artery bypass grafting with a deeper surgical field and a longer operation distance, the proximal anastomosis of the graft vessel becomes safe, easy and reliable, improving safety while reducing the difficulty of the proximal anastomosis of the graft vessel, which is conducive to the promotion and application of minimally invasive multi-branch coronary artery bypass grafting technology and benefits patients. BRIEF DESCRIPTION OF THE DRAWINGS

[0083] Figure 1 A structural schematic diagram of the present invention;

[0084] Figure 2 is an exploded view of the hole punch of the present invention;

[0085] Figure 3 A schematic diagram of the state change of the hole punch of the present invention;

[0086] Figure 3 A in the figure is a schematic diagram of the structure in the initial state;

[0087] Figure 3 B in the figure is a schematic diagram of the structure in the punching state;

[0088] Figure 4 It is a schematic structural diagram of a straight suture needle with thread of the suture device of the present invention located in the main cylinder;

[0089] Figure 5 It is a schematic structural diagram of a straight suture needle with thread of the suture device of the present invention located outside the main cylinder;

[0090] Figure 6 It is a structural schematic diagram of the needle storage bin of the present invention.

[0091] Figure 7 This is an exploded view of the needle storage bin of the present invention.

[0092] Wherein: 1 is anvil segment, 2 is punch body, 3 is stapler;

[0093] 21 is the inner shaft, 22 is the outer tube, and 23 is the cutting tube;

[0094] 31 is the main cylinder, 32 is the eccentric shaft, 33 is the needle storage bin, 34 is the straight sewing needle with thread, and 35 is the return spring;

[0095] 311 is a first tube body, 312 is an extension piece;

[0096] 321 is a grip extension portion, and 322 is a rotating shaft portion;

[0097] 331 is a first end cover, 332 is a central fixing member, 333 is a second end cover, and 334 is a sleeve. DETAILED DESCRIPTION

[0098] The present invention will be further described below in conjunction with the accompanying drawings.

[0099] See also Figures 1 to 7 , Specific embodiment 1: A minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit, comprising a puncher, a stapler 3 and an anvil segment clamp; the puncher comprises a puncher body 2 and an anvil segment 1 for blocking the opening position of the aortic wall, the puncher body 2 comprises an inner shaft 21, a cutting tube 23 and an outer tube 22 arranged in sequence from the inside to the outside, the end of the inner shaft 21 is threadedly connected with the anvil segment 1, and the cutting tube 23 slides between the inner shaft 21 and the outer tube 22; the anvil segment clamp is used to clamp the anvil segment 1; the stapler 3 comprises a main cylinder 31, an eccentric rotating shaft 32 and a needle storage bin 33, and the main cylinder 31 is provided with a There is an eccentric hole for eccentrically setting an eccentric rotating shaft 32, the eccentric rotating shaft 32 is slidably and rotatably connected to the main cylinder body 31, and the eccentric rotating shaft 32 is connected to the main cylinder body 31 through a reset spring 35; the end of the eccentric rotating shaft 32 is connected to the needle storage bin 33; a needle insertion position for inserting a straight sewing needle 34 with thread is provided in the needle storage bin 33, and the socket of the needle insertion position faces the main cylinder body 31; the side of the needle storage bin 33 adjacent to the main cylinder body 31 is used to resist the main cylinder body 31 under the action of the reset spring 35; the side of the needle storage bin 33 away from the main cylinder body 31 is provided with a connecting structure for threaded connection to the anvil segment 1. The movement of the eccentric rotating shaft drives the needle storage bin 33 to move, and the straight sewing needle 34 with thread at the needle insertion position is switched between two states: exposed outside the main cylinder 31 and stored in the main cylinder 31. When the straight sewing needle 34 with thread at the needle insertion position is stored in the main cylinder 31, the anvil section 1, the needle storage bin 33 and the main cylinder 31 are combined to form a straight rod-shaped structure.

[0100] The present invention switches the connection between the anvil segment 1 and the puncher and the suturing device 3, thereby achieving the blocking of the opening position during the punching process and the suturing process. No other opening blocking parts are required. The present invention changes the traditional puncher structure that cannot be disassembled into a structure in which the anvil segment 1 is detachable, which is easy to disassemble.

[0101] The present invention optimizes the structure of the needle storage bin 33 to facilitate the straight suture needle 34 with thread to be hidden in the needle storage bin 33 and enter the aortic cavity together with the suture device 3. The needle storage bin 33 is then separated from the main cylinder 31 by rotating, and the straight suture needle 34 with thread is then passed through the aortic cavity wall from the inside to the outside in the aortic cavity to complete a stitch.

[0102] The center of the anvil segment 1 is used for switching the connection structure and the internal threaded hole of the inner shaft 21; the axial end of the anvil segment 1 away from the internal threaded hole is provided with an extension portion extending obliquely outward, and the length direction of the extension portion and the axial angle of the anvil segment 1 are greater than 90° and less than 180°; the cross-sectional area of ​​the extension portion increases from the outside to the inside along the length direction. It is convenient to guide the anvil segment 1 through the extension portion to insert into the ascending aorta wall punctured by the pointed knife.

[0103] The outer wall of the anvil segment 1 includes a first blocking portion for blocking the opening position of the aortic wall and a connecting portion for connecting the anvil segment clamp; the outer wall of the needle storage bin 33 includes a second blocking portion for blocking the opening position of the aortic wall; the outer wall of the main cylinder 31 includes a third blocking portion for blocking the opening position of the aortic wall; the first blocking portion, the connecting portion, the second blocking portion and the third blocking portion are arranged adjacent to each other in the axial direction, and the outer diameters of the first blocking portion, the second blocking portion and the third blocking portion match; and the outer diameters of the first blocking portion, the second blocking portion and the third blocking portion match; the axial movement of the suture device 3 switches the first blocking portion, the second blocking portion and the third blocking portion to block the opening position of the aortic wall. The first blocking portion, the second blocking portion and the third blocking portion are all cylindrical structures. The anvil segment clamp includes two mutually hinged clamping arms. A positioning slot is provided on the connecting portion; a positioning protrusion matching the positioning slot is provided on the clamping arm of the anvil segment clamp.

[0104] The axial length of the anvil section 1 can be 8-10 mm. The axial length of the needle storage bin can be 8-10 mm. The outer diameters of the first blocking portion, the second blocking portion and the third blocking portion are 4-5 mm, thereby controlling the size of the operation port.

[0105] The length of the needle body of the straight suture needle is 1-1.8 cm.

[0106] After the puncher punches the hole, the first sealing part seals the opening of the aorta wall.

[0107] When the straight suture needle with thread of the suture device is suturing, the third sealing part seals the opening of the aorta wall.

[0108] When the suture device installs the straight suture needle with thread and the straight suture needle with thread needs to be removed after suturing, the first sealing part or the second sealing part seals the opening position of the aortic wall.

[0109] When the puncher is used, the anvil section 1 is connected to the puncher body 2. When the suture device 3 is used, the anvil section 1 is connected to the connection structure of the needle storage bin 33; the eccentric shaft 32 moves axially, driving the distance between the needle storage bin 33 and the main cylinder 31 to expand, and the eccentric shaft 32 rotates circumferentially, thereby positioning the straight suture needle 34 with thread at the needle insertion position outside the main cylinder 31, so that the straight suture needle 34 with thread at the needle insertion position is exposed; the distance between the needle storage bin 33 and the main cylinder 31 is adjusted by the axial movement of the eccentric shaft 32, and the two states of the needle storage bin 33 and the main cylinder 31 are switched to be against each other and away from each other; the straight suture needle 34 with thread is switched to be located inside the main cylinder 31 and outside the main cylinder 31 by the rotation of the eccentric shaft 32. Figure 4 It is shown that the straight suture needle with thread is located in the main cylinder. Figure 5 The straight suture needle with thread is shown as being outside the main cylinder.

[0110] See also Figure 6 as well as Figure 7 The needle storage bin 33 is provided with a shaft connection portion for connecting the eccentric shaft 32; the shaft connection portion and the insertion needle are symmetrically arranged on the opposite side of the needle storage bin 33. The shaft connection portion is a through hole passing through the eccentric shaft.

[0111] The tip of the straight needle with thread 34 faces the main cylinder 31, and the tail end of the straight needle with thread 34 is inserted into the needle insertion position; the end surface of the needle storage bin 33 that contacts the main cylinder 31 is used as the separation surface; the tip of the straight needle with thread 34 extends axially upward from the separation surface of the needle storage bin 33; the straight needle with thread 34 includes a straight needle body, and the tail end of the straight needle body is connected to the suture. A slot for inserting the straight needle with thread 34 is provided on the main cylinder 31. The suture extends outward from the separation point between the needle storage bin and the main cylinder. The distance between the tip of the straight needle with thread 34 and the separation surface of the needle storage bin 33 is 0.5cm-0.8cm.

[0112] The steps for installing the straight suture needle with thread on the suture instrument are as follows: rotate the eccentric shaft 32 180 degrees to expose the needle insertion position, insert the straight suture needle 34 with thread with the needle tip facing upward into the needle insertion position, press down and rotate the eccentric shaft 32 to align the needle tip with the main cylinder 31, and slowly and automatically elastically reset the eccentric shaft 32 to hide the needle tip partially in the main cylinder 31.

[0113] The needle insertion position includes a slot for inserting the straight sewing needle with thread 34, and an elastic clip for elastically clamping the straight sewing needle with thread 34 is installed in the slot. The needle storage bin includes a sleeve 334, a central fixing member 332, a first end cover 331 and a second end cover 333. The left and right ends of the sleeve 334 are sealed by the first end cover 331 and the second end cover 333. The central fixing member 332 is sandwiched between the first end cover 331 and the second end cover 333; the first end cover 331 and the central fixing member 332 are both provided with a through hole through which the eccentric shaft passes; the first end cover 331 is provided with a socket through which the straight sewing needle with thread passes; the central fixing member 332 is provided with a slot for docking with the socket, and an elastic clip is fixed in the slot; the second end cover 333 is provided with a connecting structure. The central fixing piece is provided with a strip-shaped notch, with two ends of the strip-shaped notch being open in the length direction, the outer side of the strip-shaped opening being connected to the outer wall of the central fixing piece, and the inner side of the strip-shaped opening being connected to the slot. The elastic clip is arranged opposite to the strip-shaped opening.

[0114] See also Figure 4 as well as Figure 5 One end of the eccentric shaft 32 is connected to the needle storage bin 33, and the other end of the eccentric shaft 32 is connected to the hand-held handle. The outer sleeve of the eccentric shaft 32 is provided with a return spring 35 with an elastic direction in the axial direction of the eccentric shaft. One end of the return spring in the axial direction is connected to the hand-held handle, and the other end of the return spring in the axial direction is connected to the main cylinder 31. The hand-held handle is provided with a radially outwardly extending grip extension. The rotation angle of the eccentric shaft 32 is determined by the extension. The main cylinder body includes a first tube body 311 and a second tube body connected in sequence, the vertical projection area of ​​the second tube body is located within the range of the vertical projection area of ​​the first tube body 311, and an extension piece 312 extending outward is connected to the connection between the first tube body 311 and the second tube body; the extension piece is provided with an inner extension part extending to the inner cavity of the first tube body 311, and the inner extension part is against the reset spring 35; the central axis of the first tube body 311 coincides with the central axis of the eccentric shaft; the eccentric shaft 32 is connected with a hand handle connected to the first tube body 311 in rotation, and the hand handle includes a shaft part 322 connected to the first tube body 311 in rotation and a grip extension part 321 for gripping, and the grip extension part 321 extends radially outward; the eccentric shaft 32 is eccentrically arranged in the second tube body. Two guide rings are fixed in the second tube body. A guide hole is provided on the guide ring, and the guide hole is connected to the outer wall of the guide ring. The guide hole is used to pass the eccentric shaft. The central axis of the guide hole is parallel to the central axis of the second tube body, and there is also a gap.

[0115] See also Figure 2 as well as Figure 3The inner shaft 21, the cutting tube 23 and the outer tube 22 are connected by a positioning pin; the inner shaft 21 and the outer tube 22 are provided with positioning holes through which the positioning pin passes, and the cutting tube 23 is provided with a guide groove for the sliding of the positioning pin. This facilitates the sliding of the cutting tube 23 between the inner shaft 21 and the outer tube 22. The guiding direction of the guide groove is to rotate and descend with the central axis of the inner shaft as the rotation center line. The inner shaft includes a supporting portion, a necking portion and an external threaded portion connected in sequence. The outer diameter of the necking portion is smaller than the supporting portion and the external threaded portion, and the external threaded portion is threadedly connected to the anvil segment. The supporting portion is used to slidably connect the cutting tube. The side of the cutting tube 23 adjacent to the anvil segment 1 is an annular cutting blade portion. The inner diameter of the annular cutting blade portion matches the outer diameter of the anvil segment adjacent to the inner shaft side. See Figure 3 In A, in the initial state, the end of the cut tube is exposed outside the neck. Figure 3 In B, when punching, the cutting tube moves, the necking part is received in the cutting tube, and the end of the cutting tube is tangent to the inner axis side of the anvil segment. Before punching, the ascending aorta wall is punctured by 2-3 mm with a pointed knife to form an aortic wall incision, and the head end of the anvil segment 1 is inserted into the aortic cavity through the aortic wall incision. The aortic wall incision is located at the necking part. When punching, the cutting tube moves, and the end of the cutting tube is tangent to the inner axis side of the anvil segment, and the cut annular aortic wall is received between the necking part and the cutting tube.

[0116] The method for using the proximal anastomosis instrument kit for minimally invasive coronary artery bypass grafting includes the following steps:

[0117] Step 1: Use a sharp knife to puncture the ascending aorta wall 2-3 mm at the site where the anastomosis is to be made to form an aortic wall incision;

[0118] Step 2: the head end of the anvil segment 1 is inserted into the aortic cavity through the incision in the aortic wall;

[0119] Step 3: Press down the handle of the puncher to drive the cutting tube 23 to move and complete the perforation of the ascending aorta wall; at this time, leave the anvil segment 1 in the aortic hole and do not pull it out, so that the anvil segment 1 blocks the aortic anastomosis hole;

[0120] Step 4: clamp the connecting portion of the anvil segment 1 with an anvil segment clamp, and the first blocking portion of the anvil segment 1 blocks the aortic anastomosis hole to prevent bleeding;

[0121] Step 5: The anvil segment holder fixes the anvil segment 1, and the punch body 2 is rotated to separate the anvil segment 1 from the punch body 2. At this time, the anvil segment holder still clamps the anvil segment 1 to ensure that the anvil segment 1 is retained in the aortic anastomosis hole;

[0122] Step 6: The storage bin of the stapler 3 is connected to the anvil section 1. At this time, the anvil section 1 and the stapler 3 are assembled.

[0123] Step 7: The eccentric shaft 32 rotates 180° relative to the main cylinder 31 to expose the needle insertion position of the needle storage bin 33, and the tail of the straight suture needle 34 with suture and the suture connected thereto are inserted into the needle insertion position, with the needle tip facing upward;

[0124] Step 8, press down the eccentric shaft 32 to separate the needle storage bin 33 from the main cylinder 31 and rotate the eccentric shaft 32 to load the straight sewing needle 34 with thread into the main cylinder 31;

[0125] Step nine, insert the suture device 3 into the aortic cavity to a depth that reaches the level of the engraved line on the suture device 3 (about 5 mm from the separation surface between the needle storage bin 33 and the main cylinder 31); at this time, the third blocking portion blocks the aortic anastomotic hole;

[0126] Step 10, fix the main cylinder 31 of the suture device 3, press down the eccentric shaft 32 and rotate it 180 degrees and elastically reset the handle, lift the suture device 3 as a whole, so that the straight suture needle 34 with thread passes through the aortic wall from the inside to the outside, and use the needle holder to clamp the straight suture needle 34 with thread and move it out of the aortic wall to complete one suture;

[0127] Step 11, pass the straight suture needle 34 with thread from the outside to the inside through the proximal edge of the bridge vessel, and prepare to put it into the needle storage hole for the next suture;

[0128] Step 12, slightly extend the suture device 3 as a whole into the aortic cavity, and restore the eccentric rotating axis to zero position, so that the suture device 3 as a whole becomes a straight rod;

[0129] Step 13, the suture device 3 is moved outward as a whole, so that the separation surface between the needle storage bin 33 and the main cylinder 31 is exposed to the aortic anastomotic hole, and the second blocking part blocks the aortic anastomotic hole;

[0130] Step 14: The eccentric shaft 32 is rotated 180 degrees to expose the needle insertion position, and the straight threaded needle 34 is placed in the needle insertion position again with the needle tip facing upward, and the eccentric shaft 32 is pressed down and rotated to align the needle tip with the main cylinder 31, and the eccentric shaft 32 is slowly and automatically elastically reset to hide the needle tip part in the main cylinder 31, ready for the next suturing operation;

[0131] Step 15, repeat steps 9 to 14 to complete the entire suturing operation. After suturing is completed, close the distal end of the bridge vessel with a pug clip, tighten the suture, pull out the main body of the suture device 3, and complete the anastomosis operation after tying a knot.

[0132] A control system for proximal anastomosis of a minimally invasive coronary artery bypass grafting surgery includes a puncher, a stapler 3 and an anvil segment clamp; the puncher includes a puncher body 2 and an anvil segment 1, the puncher body 2 includes an inner shaft 21, a cutting tube 23 and an outer tube 22 arranged in sequence from the inside to the outside, the end of the inner shaft 21 is threadedly connected with the anvil segment 1, and the cutting tube 23 slides between the inner shaft 21 and the outer tube 22; the anvil segment clamp is used to clamp the anvil segment 1; the stapler 3 includes a main cylinder body 31, an eccentric rotating shaft 32 and a needle storage bin 33, an eccentric hole for eccentrically setting the eccentric rotating shaft 32 is opened in the main cylinder body 31, and the eccentric rotating shaft 32 is slidably connected to the main cylinder body 31 and The eccentric shaft 32 is connected to the main cylinder 31 through a reset spring 35; the end of the eccentric shaft 32 is connected to the needle storage bin 33; a needle insertion position for inserting a straight suture needle 34 with thread is provided in the needle storage bin 33, and the insertion port of the needle insertion position faces the main cylinder 31; the side of the needle storage bin 33 adjacent to the main cylinder 31 is used to resist the main cylinder 31 under the action of the reset spring 35; the side of the needle storage bin 33 away from the main cylinder 31 is provided with a connecting structure for threaded connection with the anvil segment 1; with the assistance of the thoracoscopic system, the anvil segment clamp clamps the anvil segment to separate the anvil segment from the punch body and connect the anvil segment to the suture device.

[0133] The above are only preferred embodiments of the present invention. It should be pointed out that, for ordinary technicians in this technical field, several improvements and modifications can be made without departing from the principles of the present invention. These improvements and modifications should also be regarded as the scope of protection of the present invention.

Claims

1. A minimally invasive coronary artery bypass grafting proximal anastomosis device kit, characterized in that: Includes a punch, a stapler, and an anvil segment holder; The punch comprises a punch body and an anvil section for blocking the opening of the aortic wall, wherein the punch body comprises an inner shaft, a cutting tube and an outer tube arranged in sequence from the inside to the outside, the end of the inner shaft is threadedly connected with the anvil section, and the cutting tube slides between the inner shaft and the outer tube; The anvil segment holder is used to hold the anvil segment; The stapler comprises a main cylinder, an eccentric rotating shaft and a needle storage bin, wherein an eccentric hole for eccentrically setting the eccentric rotating shaft is opened in the main cylinder, the eccentric rotating shaft is slidably connected and rotatably connected to the main cylinder, and the eccentric rotating shaft is connected to the main cylinder through a return spring; The end of the eccentric rotating shaft is connected to the needle storage bin; The needle storage bin is provided with a needle insertion position for inserting a straight sewing needle with thread, and the insertion opening of the needle insertion position faces the main cylinder; The side of the needle storage bin adjacent to the main cylinder is used to press against the main cylinder under the action of the return spring; A connection structure for threaded connection with the anvil section is provided on one side of the needle storage bin away from the main cylinder; The movement of the eccentric rotating shaft drives the needle storage bin to move, so as to switch between two states: the straight sewing needle with thread at the needle insertion position is exposed outside the main cylinder body and is stored in the main cylinder body. When the straight sewing needle with thread at the needle insertion position is stored in the main cylinder body, the anvil section, the needle storage bin and the main cylinder body are assembled into a straight rod-shaped structure.

2. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The outer wall of the anvil segment comprises a first blocking portion for blocking the opening of the aorta wall and a connecting portion for connecting the anvil segment clamp; The outer wall of the needle storage bin includes a second blocking portion for blocking the opening of the aorta wall; The outer wall of the main cylinder includes a third blocking portion for blocking the opening of the aorta wall; The first blocking portion, the connecting portion, the second blocking portion and the third blocking portion are arranged adjacent to each other in sequence along the axial direction, and the outer diameters of the first blocking portion, the second blocking portion and the third blocking portion match each other; The axial movement of the suturing device switches the first sealing part, the second sealing part and the third sealing part to seal the opening of the aorta wall.

3. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The needle storage bin is provided with a rotating shaft connecting portion for connecting the eccentric rotating shaft; The rotating shaft connecting portion and the insertion needle are symmetrically arranged on opposite sides of the needle storage bin.

4. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The tip of the straight sewing needle with thread faces the main cylinder, and the tail end of the straight sewing needle with thread is inserted into the needle insertion position; The end surface of the needle storage bin contacting the main cylinder is used as the separation surface; The tip of the straight suture needle with thread extends axially upward out of the separation surface of the needle storage bin; The straight suture needle with thread comprises a straight needle body, and the tail end of the straight needle body is connected with a suture thread.

5. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The needle insertion position comprises a slot for inserting the straight suture needle with thread, and an elastic clip for elastically clamping the straight suture needle with thread is installed in the slot.

6. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: One end of the eccentric shaft is connected to the needle storage bin, the other end of the eccentric shaft is connected to the hand-held handle, the outer periphery of the eccentric shaft is provided with the return spring, one end of the return spring in the axial direction is connected to the hand-held handle, and the other end of the return spring in the axial direction is connected to the main cylinder; The hand-held handle is provided with a grip extension portion extending radially outward.

7. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The main tube body comprises a first tube body and a second tube body connected in sequence, the vertical projection area of ​​the second tube body is located within the range of the vertical projection area of ​​the first tube body, and an extension piece extending outward is connected to the connection between the first tube body and the second tube body; The extension piece is provided with an inner extension portion extending into the inner cavity of the first tube body, and the inner extension portion abuts against the return spring; The central axis of the first tube body coincides with the central axis of the eccentric rotating shaft; The eccentric shaft is connected with a hand-held handle rotatably connected to the first tube body, the hand-held handle comprises a shaft portion rotatably connected to the first tube body and a grip extension portion for gripping, the grip extension portion extending radially outward; The eccentric rotating shaft is eccentrically arranged in the second tube body.

8. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The inner shaft, the cutting tube and the outer tube are connected by a positioning pin; The inner shaft and the outer tube are provided with positioning holes through which the positioning pin passes. The cutting tube is provided with a guide groove for the positioning pin to slide.

9. The minimally invasive coronary artery bypass grafting proximal anastomosis instrument kit according to claim 1, characterized in that: The center of the anvil segment is used for switching the internal threaded hole connecting the connecting structure and the inner shaft; An axial end of the anvil section away from the internal threaded hole is provided with an extension portion extending obliquely outward, and the length direction of the extension portion forms an angle greater than 90° and less than 180° with the axial direction of the anvil section; The cross-sectional area of ​​the extension portion increases from outside to inside along the length direction.

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