Device and method for connecting tubular structures

Abstract

To provide a device and method for performing anastomosis.SOLUTION: The device includes a ring that has a plurality of pins extending from various locations on the ring. During a procedure, the pins are passed through portions of tissue and the ring is everted or radially flipped inside out to connect the tissues together.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] (Related Applications) This application claims priority to U.S. Provisional Application No. 62 / 659,075, entitled "Apparatus and Method for Connecting Tubular Structures," filed April 17, 2018, which is incorporated by reference in its entirety. [Background technology]

[0002] Many different medical procedures require a surgical connection between two cavities or passageways, such as blood vessels, ducts, artificial tubes, intestines, or portions of the urinary tract. This connection is often called an anastomosis.

[0003] Typically, anastomosis procedures are performed by hand suturing, mechanical connections, biological adhesives, or a combination thereof. Connection techniques often depend on the type of passage / cavity being connected (e.g., blood vessels or intestines), the angle of the connection (e.g., end-to-end connection or lateral, end-to-side connection), the size of the passage (e.g., less than 1 mm to more than 25 mm in diameter), and whether different types of structures are being connected (e.g., the bladder and urethra).

[0004] Hand-sewn sutures tend to be used most frequently due to their suitability regardless of the type, size, or connection angle of the structures to be connected. Sutures can also be easily removed during the procedure if initially connected in an undesirable manner. However, suturing often requires a significant amount of execution time during the procedure. Furthermore, proper surgical suturing technique to perform the anastomosis requires a significant amount of training for the surgeon and often requires a trained assistant during the procedure. Sometimes sutured anastomoses can also be complicated with strictures.

[0005] Staples or other mechanical closure devices are often desirable because they can quickly connect two structures during a procedure. However, they typically require relatively large and complex devices, which can limit what types of closure sizes and structures can be connected. Similarly, biological adhesives are desirable because they can quickly connect two tissue structures, but often do not dissolve easily if the initial connection is not desirable.

[0006] In this regard, there is a need for an anastomosis closure device that can rapidly connect two structures to one another, provides a reversible connection, is more reliable than sutures, can be easily deployed, and can be used with biological structures of a wide range of shapes / sizes. Summary of the Invention

[0007] The present invention relates generally to devices and methods for performing anastomosis. In one embodiment according to the invention, the device comprises a ring with multiple pins extending from various locations on the ring. During the procedure, the pins are passed through portions of tissue and the ring is everted, or everted radially inside out, to join the tissue together.

[0008] In one embodiment, the device includes a ring formed from a plurality of alternating curves or waves. In one embodiment, the ring is shaped to allow eversion or outward rotation. In one embodiment, the device comprises a plurality of alternating curved pins. In another embodiment, the device comprises a plurality of relatively short pins. In another embodiment, the device comprises a plurality of relatively long pins. [Brief description of the drawings]

[0009] These and other aspects, features and advantages of which embodiments of the invention are possible will be apparent and elucidated from the following description of embodiments of the invention, which proceeds with reference to the accompanying drawings.

[0010] [Figure 1]FIG. 1 is a perspective view of a tubular connector device according to the present invention.

[0011] [Diagram 2] FIG. 2 is a side view of a tubular connector device according to the present invention.

[0012] [Diagram 3] FIG. 3 is a side view of a tubular connector device according to the present invention.

[0013] [Figure 4] FIG. 4 is a top view of a tubular connector device according to the present invention.

[0014] [Diagram 5] FIG. 5 shows the device of FIG. 1 in an inverted state.

[0015] [Figure 6] FIG. 6 shows the device of FIG. 1 in an inverted state.

[0016] [Figure 7] FIG. 7 shows the device of FIG. 1 in an inverted state.

[0017] [Figure 8] FIG. 8 shows the device of FIG. 1 in an inverted state.

[0018] [Figure 9] FIG. 9 shows the device of FIG. 1 in an inverted state.

[0019] [Figure 10] FIG. 10 shows the device of FIG. 1 in an inverted state.

[0020] [Figure 11] FIG. 11 shows the device of FIG. 1 in an inverted state.

[0021] [Figure 12] FIG. 12 shows the device of FIG. 1 in an inverted state.

[0022] [Figure 13] FIG. 13 shows the device of FIG. 1 connecting two tubular structures.

[0023] [Figure 14] FIG. 14 shows the device of FIG. 1 connecting two tubular structures.

[0024] [Figure 15] FIG. 15 shows the device of FIG. 1 connecting two tubular structures.

[0025] [Figure 16] FIG. 16 shows the device of FIG. 1 connecting two tubular structures.

[0026] [Figure 17] FIG. 17 shows the device of FIG. 1 connecting two tubular structures.

[0027] [Figure 18] FIG. 18 shows the device of FIG. 1 connecting two tubular structures.

[0028] [Figure 19] FIG. 19 shows the device of FIG. 1 connecting two tubular structures.

[0029] [Figure 20] FIG. 20 shows the device of FIG. 1 connecting two tubular structures.

[0030] [Figure 21] FIG. 21 shows a perspective view of a tubular connection device according to the present invention.

[0031] [Figure 22] FIG. 22 shows a perspective view of a tubular connection device according to the present invention.

[0032] [Figure 23] FIG. 23 shows a perspective view of a tubular connection device according to the present invention.

[0033] [Figure 24] FIG. 24 shows a perspective view of a tubular connection device according to the present invention.

[0034] [Diagram 25] FIG. 25 shows a deployment device for a tubular connection device according to the present invention.

[0035] [Figure 26] FIG. 26 shows a deployment device for a tubular connection device according to the present invention.

[0036] [Figure 27] FIG. 27 shows a deployment device for a tubular connection device according to the present invention.

[0037] [Figure 28] FIG. 28 shows a deployment device for a tubular connection device according to the present invention.

[0038] [Figure 29] FIG. 29 shows a deployment device for a tubular connection device according to the present invention.

[0039] [Diagram 30] FIG. 30 shows a deployment device for a tubular connection device according to the present invention.

[0040] [Diagram 31] FIG. 31 shows a deployment device for a tubular connection device according to the present invention.

[0041] [Diagram 32] FIG. 32 shows a deployment device for a tubular connection device according to the present invention.

[0042] [Diagram 33] FIG. 33 shows a deployment device for a tubular connection device according to the present invention.

[0043] [Diagram 34]FIG. 34 shows a deployment device for a tubular connection device according to the present invention.

[0044] [Diagram 35] FIG. 35 shows a deployment device for a tubular connection device according to the present invention.

[0045] [Diagram 36] FIG. 36 shows a deployment device for a tubular connection device according to the present invention.

[0046] [Figure 37] FIG. 37 shows a deployment device for a tubular connection device according to the present invention.

[0047] [Figure 38] FIG. 38 shows a deployment device for a tubular connection device according to the present invention.

[0048] [Figure 39] FIG. 39 shows a perspective view of a tubular connection device according to the present invention.

[0049] [Diagram 40] FIG. 40 shows a perspective view of a tubular connection device according to the present invention.

[0050] [Diagram 41] FIG. 41 shows a deployment device for a tubular connection device according to the present invention.

[0051] [Diagram 42] FIG. 42 shows a perspective view of a tubular connection device according to the present invention.

[0052] [Diagram 43] FIG. 43 shows a perspective view of a tubular connection device according to the present invention.

[0053] [Diagram 44] FIG. 44 shows a perspective view of a tubular connection device according to the present invention.

[0054] [Diagram 45] FIG. 45 shows a perspective view of a tubular connection device according to the present invention.

[0055] [Figure 46] FIG. 46 illustrates the use of a deployment device for a tubular connection device according to the present invention.

[0056] [Figure 47] FIG. 47 illustrates the use of a deployment device for a tubular connection device according to the present invention.

[0057] [Figure 48] FIG. 48 shows a deployment device for a tubular connection device according to the present invention.

[0058] [Figure 49] FIG. 49 shows a deployment device for a tubular connection device according to the present invention.

[0059] [Figure 50] FIG. 50 shows a deployment device for a tubular connection device according to the present invention.

[0060] [Figure 51] FIG. 51 shows a deployment device for a tubular connection device according to the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0061] Hereinafter, specific embodiments of the present invention will be described with reference to the drawings. However, the present invention can be implemented in many different forms and should not be construed as being limited to the embodiments described herein. Rather, these embodiments are provided so that this disclosure will be complete and will fully convey the scope of the present invention to those skilled in the art, and the terms used in the detailed description of the embodiments shown in the accompanying drawings are not intended to limit the present invention. In the drawings, like numbers refer to like elements.

[0062] The present invention generally relates to devices for performing anastomoses. Although this specification primarily describes the use of the present invention to connect blood vessels, ducts, intestines, and urinary tracts, it should be understood that the present invention can be used with any biological structure having a passageway and / or cavity. The devices of the present invention are described as transitioning from a normal shape, an initial shape, and / or an inverted shape to an everted shape. It should be understood that an everted shape can mean that the device has been turned inside out or rotated about its circumference relative to its initial shape. In some instances, the rotation may be greater than, less than, or about 180 degrees, and the device may be at least partially everted from the inside out relative to its initial shape. Although eversion (e.g., rotation radially outward around itself) is described herein, in some embodiments, a similar result may be achieved by inversion, especially if only relatively small pins are used.

[0063] 1-4 illustrate one embodiment of an anastomosis device 100 for connecting biological structures in accordance with the present invention. The device 100 includes a ring 102 having multiple pins 104, 106 extending from various locations on the ring 102. During a procedure, the pins 104, 106 are used to pass through and initially connect sections of tissue. The ring 102 is then everted, or flipped radially inside out, to compress the tissues together, as described further below.

[0064] In this embodiment, the ring 102 is comprised of a wire or elongated structure formed into a number of corrugations having peaks 102A and valleys 102B. These corrugations facilitate the expansion and contraction of portions of the ring 102 during the eversion process. Preferably, the peaks 102A and valleys 102B have a curved or rounded shape, but other shapes that can evert are possible, such as square / rectangular waves, "zig-zag" struts, or woven mesh structures. The ring 102 is connected to form a continuous circular wave structure, but may also be formed as a discontinuous C-shape. Additionally, while each wave of the ring 102 is shown to be uniform in size, some waves may be larger than others. For example, the ring 102 may have alternating large and small waves. Although the term "ring" is used, this should be understood to mean circular / tubular shapes, square shapes, triangular shapes, hexagons, octagons, and similar multi-sided shapes.

[0065] The ring 102 and pins 104, 106 may be constructed from one or more wires having any shape (e.g., round, flat, or asymmetric). Preferably, the wire is constructed from a shape memory metal (e.g., Nitinol), although other metals or polymers are possible. In one embodiment, the wire is constructed from a bioabsorbable material. In another embodiment, the device 100 is laser cut from a ring of material. In another embodiment, the ring can be constructed from a flexible material such as silicone and the pins 104, 106 can be constructed from a rigid material.

[0066] If the device is constructed from a shape memory material, the device can be constructed to have a memorized shape (e.g., a heat-set shape) that facilitates its everting. Upon reaching a certain temperature, such as body temperature, the shape memory material also reaches its transition temperature, thereby allowing it to twist into the everted shape.

[0067] The device 100 includes both elongated pins 104 and shortening pins 106, which are connected at the valleys 102B and are arranged in an alternating manner. The elongated pins 104 preferably have a shape that curves radially inward, upward, and then radially outward relative to the device 100. In one example, the elongated pins 104 extend above the crests 102A of the waves, but can alternatively extend to approximately the same height as the crests 102A or even somewhat below the crests 102A. The elongated pins 104 form an upward curve within a range of about 90 degrees and 180 degrees, preferably about 150 degrees. The shortening pins 106 preferably have a shape that extends radially inward and upward relative to the device 100. The shortening pins 106 form an upward curve within a range of about 30 degrees and 90 degrees, preferably about 60 degrees. Both pins 104 and 106 preferably have a pointed distal end shaped to easily penetrate tissue. A barb or similar shape on the distal end is possible, but a uniform, tapered shape is preferred so that the pin can be removed from the tissue for repositioning if necessary.

[0068] With reference to Figures 5-8, the device 100 can be everted during the anastomosis procedure. Note that Figures 9-12 also show eversion of a tubular structure. This eversion step can be performed manually or using a deployment tool, as described later in this specification. Figure 5 shows the device 100 in an initial or normal shape, with the pins 104, 106 facing radially inward and upward relative to the viewer of the figure. In Figure 6, the peaks 102A of the ring 102 have been moved radially outward and downward, rotating the distal end of the pin 104 towards an upward position and rotating the distal end of the pin 106 towards a radially outward position.

[0069] In Figure 7, peaks 102A of ring 102 and the distal end of pin 104 continue to rotate to a downwardly angled position. The distal end of pin 106 also continues to rotate to an outward radial position. Finally, in Figure 8, device 100 is fully everted, or inside out. In this everted configuration, valleys 102B and peaks 102A are inverted in height, pin 106 is angled radially outward from ring 102, and pin 104 is angled radially outward and downward from ring 102.

[0070] Figures 13-20 illustrate this eversion process in conjunction with securing two vessel ends during an anastomosis procedure. Beginning with Figure 9, optional retaining band 108 is placed over first vessel 10A, followed by device 100. Device 100 is oriented so that peak 102A is positioned closest to the end of vessel 10A.

[0071] 14, the elongated pin 104 is inserted through the tissue surrounding the opening of the first blood vessel 10A. The peaks 102A may be radially compressed to some extent to help properly orient the elongated pin 104 through the tissue. When the peaks 102A are again radially expanded, the smaller pin 106 is also directed through the tissue surrounding the opening of the first blood vessel 10A.

[0072] 15, the distal end of the elongated pin 104 is placed within the opening of the second blood vessel 10B. Once inside, the peaks 102A of the ring 102 are rotated or pulled radially away from the second blood vessel 10B, causing the elongated pin 104 to penetrate the tissue of the second blood vessel 10B, as seen in FIG.

[0073] Referring to Fig. 17, as the waves of the ring 102 rotate further towards the outside of the first vessel 10A, the smaller pins 106 also pass through the tissue of the second vessel 10B. As shown in Fig. 18, once eversion is complete, the waves of the ring 102 are disposed circumferentially around the outside of the first vessel 10A, the smaller pins 104 are angled radially outward, and the elongated pins 104 extend away from the second vessel 10B. If a retaining band 108 is used, it can be slid over the waves of the ring to help maintain the everted shape of the device 100, as shown in Fig. 19. Fig. 20 shows a cross-sectional view of the device 100 in the everted shape.

[0074] 21 and 22 show another embodiment of a device 110 that is generally similar to the device 100 described above. However, the device 110 includes only a number of smaller pins 106 extending from the valleys 102B of the corrugations of the ring 102. The device 110 is shown in a fully everted shape such that the pins 106 are disposed radially outward and curve upward. Unlike the device 100 described above, the device 110 may require eversion in a narrower range depending on its use. For example, the corrugations of the ring 102 may evert or transition from about 0 degrees (i.e., a generally flat shape) to about 45 degrees (a generally concave shape). The use of smaller, more curved pins 106 and eversion in a more limited range may be useful in connecting the end of one tubular structure to a side opening of another tubular structure, as described later in this specification. The ring may be asymmetric or elliptical to allow for an elongated connection between tubular structures. In another embodiment, the device 110 may remain in a fixed shape without eversion, but the ring 102 provides sufficient flexibility so that the pins 106 can be individually bent to engage tissue, one at a time.

[0075] 23 and 24 show another embodiment of a device 120 that is generally similar to the previously described device 100. However, device 120 includes only longer pins 104 extending from each of its valleys 102B, and device 120 is otherwise everted in a manner similar to that described for device 100. The use of only long pins 104 is particularly useful when connecting a tubular structure to a cavity such as the bladder, as described later in this specification.

[0076] Figures 25-29 show another embodiment of a device 130 that is generally similar to device 120 described above, but has a tilted elliptical shape. As best shown in Figure 26, the ring 102 forms a generally elliptical shape when viewed from above or below, and as best shown in Figure 27, the waves of the ring are "tilted" or angled in a non-perpendicular direction relative to the overall plane of the ring 102. This elliptical, angled shape can be useful when connecting two structures that intersect at a non-perpendicular angle to one another.

[0077] 30-32 show another embodiment of device 140 that is generally similar to the previous embodiments herein, but instead of a corrugated ring, device 140 includes a ring 142 made of a flexible material such as silicone, rubber, latex, or other elastomeric material. Pins 104 may be made of a more rigid material such as metal or polymer and may be mechanically engaged with ring 142 or connected to ring 142 using a variety of techniques such as being connected via adhesive. FIG. 30 shows device 140 in a normal or inverted shape with pins 104 curved radially inward, FIG. 31 shows device 140 in a partially everted shape with pins 104 directed radially outward from the center of device 140, and FIG. 32 shows device 140 in a fully everted shape with pins 104 curved radially outward from device 140. In this regard, device 140 may be used similarly to any of the other embodiments herein.

[0078] In one exemplary delivery method, the device of the present invention can be deployed with the same instruments used to perform sutured anastomosis. For example, a surgeon can use these instruments to advance pins into tissue and then apply outward radial pressure to the ring 102 to evert it.

[0079] In another embodiment of the delivery method, a deployment device can be used to deploy the device of the present invention. For example, FIG. 33 shows a deployment device 130, comprising elongated members 134, each connected to an engagement portion 132 configured to engage with a peak 102A of the ring 102. In one example, the engagement portion 132 is a rigid sleeve sized and shaped to fit over a portion of the peak 102A. Alternatively, other engagement mechanisms such as hooks or clamps are possible. Once engaged, the elongated members 134 can be rotated (e.g., by a handle) to evert the device 100. Another deployment device can be used to hold the device in a particular shape or state of eversion or eversion.

[0080] In another example delivery method, a deployment device 140 can be used to deploy device 100 from a compressed configuration, as shown in FIG 34. Deployment device 140 can include a tubular portion 142 within which device 100 is compressed, and an elongated portion 144 attached proximally to tubular portion 142. Optionally, an additional device can be used to advance device 100 from tubular portion 142 at a desired location, as shown in FIG 35.

[0081] 36-38 show another example of a delivery / deployment device 145 and a method of use thereof. The device comprises two elongated arm members 146 and 147, each having a distal end that engages with a ring of the device 100. For example, the distal ends of the arms 146 / 147 may form grooves or right angle fingers that removably engage with the ring of the device 100. Unlike the device 130, which engages the device 130 with its arms 134 in a vertical orientation, the device 145 allows the arms 146 / 147 to engage with the device 100 from a parallel or longitudinal orientation. Preferably, one arm 146 is engageable with a more proximal location on the device 100 (e.g., a valley of the ring) and the other arm 147 is engageable with a more distal location on the device 100 (e.g., a peak of the ring), thereby allowing a user to evert the device 100 by pushing one arm and pulling the other arm.

[0082] 13-20 show how to attach the two ends of two tubular structures with the device 100, although connections between structures of different shapes are possible. For example, FIGS. 39 and 40 show that the end of a first blood vessel 10A is connected to the side opening of a second blood vessel 10B by the device 110. First, the peaks 102A of the ring 102 of the device 110 are positioned so that the device 110 is in a generally flat position, thereby allowing the end of the smaller pin 106 to be tilted somewhat downward or in a direction aligned with the longitudinal axis of the blood vessel 10A. The outside of the tissue around the end of the opening of the blood vessel 10A is placed over the end of the pin 106 so that the pin 106 penetrates the tissue. Next, the end of the pin 106 and the end of the first blood vessel 10A are placed into the opening of the second blood vessel 10B, and finally, the ring 102 is rotated toward the first blood vessel 10A so that the pin 106 also penetrates the tissue surrounding the opening of the second blood vessel 10B, as seen in FIG. 40.

[0083] A similar procedure can be performed with an elliptical / angled device 130 as shown in Figure 41. Additionally, the device 130 is first rotated to place its angled ring 102 between a first vessel 10A that intersects a second vessel 10B at a non-orthogonal angle. The remaining steps are similar to those previously described for the previous embodiment.

[0084] Figures 42 and 43 show a device 100 used to connect an end of a first blood vessel 10A to a side opening of a second blood vessel 10B. The connection method is similar to the method described in Figures 9 to 15.

[0085] 44 and 45 show the device 120 used to connect the bladder 14 to the urethra 12. The connection process proceeds similarly to that described in FIGS. 9-15, except that the device 120 is first placed over the urethra 12 and connected to the urethra, and then passed through the opening of the bladder 14 such that eversion of the ring 102 causes the pins 104 to penetrate the bladder tissue. Additionally, the device 120 may be relatively thicker and have somewhat longer pins than the previously described embodiments. Additionally, the device 120 may be delivered through the urethra during the procedure.

[0086] Although the devices herein are described as the primary mechanism for connecting two structures within a patient, they can also be used to prepare one or more ends of a structure for connection via a different mechanism. Figure 46 shows two devices 100 being used on a first vessel 10A and a second vessel 10B to evert the tissue at their respective ends. This allows them to be better or more easily connected via another connection mechanism such as sutures, mechanical connections (e.g., staples), or adhesives. Figure 47 shows a particular connection technique in which sutures 20 are woven between / around the pins of both devices (optionally through the tissue).

[0087] While the previous embodiments have been described as everting or everting inside out to various degrees, in another device and method according to the invention, only the portions of the device are intended to bend individually during the procedure. For example, Figs. 48 and 49 show a device 160 generally similar to the device described above, with only the smaller pins 106 located in the valleys 102B of the ring 102. Unlike the method described above, the device 160 is delivered into the patient in what was previously described as an everting configuration, so that the pins 106 are curved radially outward. Instead of everting or everting the device 160, each "wave" of the ring 102 is bent inward (see Fig. 48) to allow one of the pins 106 to penetrate the desired tissue location, and then released (see Fig. 49). This bending can be performed to connect tissue from two different structures, such as the tubular structures 10A and 10B of Figs. 50 and 51.

[0088] It should be understood that the diameter and height of the device of the present invention may have different sizes depending on the type of structure being connected. For example, when used to connect blood vessels, the diameter of the device may be within the range of 0.2 mm and 45 mm, and its height may be within the range of 0.2 mm and 45 mm. In another example, when used to connect the bladder and the urethra, the diameter of the device may be within the range of 5 mm and 25 mm, and its height may be within the range of 5 mm and 25 mm. In another example, when used to connect a portion of the bile duct, fallopian tube, or ureter, the diameter of the device may be within the range of 3 mm and 12 mm, and its height may be within the range of 3 mm and 15 mm.

[0089] Although the present invention has been described with respect to specific embodiments and applications, those skilled in the art may, in light of this teaching, generate additional embodiments and modifications without departing from the spirit or beyond the scope of the claimed invention. It is therefore to be understood that the drawings and descriptions herein are presented as examples to facilitate understanding of the invention, and should not be construed as limiting the scope of the invention. [Explanation of symbols]

[0090] 12 Urethra 14 Bladder 20 Sutures 100 Anastomosis device 102 Ring 104, 106 pins 108 Retaining Band 10A 1st blood vessel 10B 2nd blood vessel 102A Mountain 102B Valley 140 Deployment device 142 Tubular part 144 Long and thin 145 Delivery / Deployment Device 146, 147 Arm

Claims

1. 1. A device for connecting interior spaces of two biological structures within a patient, comprising: Rings and a plurality of pins connected to the ring; The apparatus is configured such that the plurality of pins are everted from a first shape having a first orientation to a second shape having a second orientation.

2. The device of claim 1 , wherein the ring comprises a wire forming a plurality of waves.

3. The apparatus of claim 2 , wherein the plurality of waves are formed from a plurality of alternating curves within the wire.

4. The apparatus of claim 2 , wherein each of the plurality of waves is rectangular.

5. The apparatus of claim 1 , wherein the plurality of pins further comprises a first plurality of pins having a first length and a second plurality of pins having a second length.

4. The device of claim 1 , wherein the pins are curved radially inward when the device is in the first shape and curved radially outward when the device is in the second shape.

5. The device of claim 1 , wherein the ring is diametrically circular or elliptical.

6. The device of claim 1 , wherein the ring is either fully closed or an open "C" shape.

7. The device of claim 1 , wherein the ring is made of an elastomeric material.

8. 10. The device of claim 1, further comprising a delivery tool having a sleeve sized to engage a portion of the ring and twist the ring to evertate between the first and second shapes.

9. The device of claim 1 , further comprising a delivery tool having a tubular structure sized to radially compress the device.

10. 2. The apparatus of claim 1, wherein the ring includes wire forming a plurality of waves having alternating peaks and valleys in the first shape, each of the plurality of pins being connected to one of the valleys.

11. The apparatus of claim 10 , wherein all of the pins are curved radially inward in the first shape and extend beyond the peaks of the ring.

12. The apparatus of claim 10 , wherein all of the pins are curved radially inward in the first shape and terminate at a height lower than the peak of the ring.

13. 11. The apparatus of claim 10, wherein the pins are all curved radially inward in the first shape, and the pins include alternating pins that terminate at a height lower than the peaks of the ring and pins that extend beyond the peaks of the ring.

14. 1. A method of connecting two biological pathways in a patient, comprising: inserting a pin of the connection device into tissue adjacent the first opening of the first biological structure; inserting a pin of the connection device into tissue adjacent the second opening of the second biological structure; The method includes everting the ring of the connector to redirect the pin, thereby compressing tissue adjacent the first and second openings together.

15. The method of claim 14, wherein the two biological structures are two tubular structures.

16. The method of claim 14 , wherein the two biological structures include a tubular structure and a non-tubular cavity.

17. 15. The method of claim 14, wherein one or more of the two biological structures is a blood vessel, a segment of an intestinal tract, a segment of a duct, a segment of a urinary tract, or a segment of an artificial tube.

18. 15. The method of claim 14, wherein everting the ring further comprises manipulating a delivery tool to engage the device and twist a portion of the device to evert the device.

Images