JPS6358581B2 - - Google Patents

Description

Claim 1: A cylindrical body coaxially housing a rod having a mandrel at one end and holding a circular knife, a longitudinal movement mechanism for the rod, and a stem having a thrust head movable in the axial direction with respect to the rod. and a two-member circular anastomosis mechanism, one member having a number of anastomotic elements disposed on the mandrel and moving together during the circular anastomosis, and the other member having a plurality of anastomosis elements disposed on the mandrel and moving together during the circular anastomosis. In a circular colostomy surgical instrument placed in
Said members of the circular anastomosis mechanism 8 arranged on the mandrel 2 include two rings 9, 10 slightly spaced from each other in the rod axis direction and a ring extending between these rings in the rod axis direction and on one of the rings 9. Essentially needles 11 spaced equidistantly around its circumference
and a plurality of anastomotic elements in the form of , the needles being able to move along one ring 9 in the axial direction of the rod to pierce the other ring 10, some of these needles being elastically contractible in the axial direction of the rod. The other member of the circular anastomosis mechanism located on the thrust head 7 has a possible spring member 12 and at least three needles are formed with an annular recess 13 that engages the ring. A ring 14 is separably connected to the thrust head 7 by the circular knife 4 during the anastomosis and is placed opposite the rings 9, 10 in the direction of the rod axis, and the needle pierces the ring 14 during the anastomosis. The annular recess engages the ring and connects the two members of the circular anastomosis mechanism 8 together, and the members connected by the needles have a colon section compressed by the spring member between them. The surgical instrument is removed from the colon through the ring 14 which is left in the colon lumen until complete necrosis and the thrust head 7 is placed on the thrust head after the ring 14 is cut by the circular knife 4. Surgical instrument for use in circular colonic anastomoses, characterized in that it has a diameter slightly smaller than that of the circular knife 4, in order to sometimes allow passage through said head.

2 Ring 14 placed on thrust head 7
The surgical instrument of claim 1, wherein the surgical instrument is made of a biologically inert polymeric material.

3. Claim 2, characterized in that a fluororesin is used as the biologically inert polymeric material.
Surgical instruments as described in Section.

4. with an annular ridge 28 for locking the spool 27 in order to form the colon end for anastomosis;
A spool 27 is provided attachable to the stem 6, said annular ridge being spaced from the thrust head 7 by a distance necessary to pull the purse string suture used for the colonic end tightly over the stem 6. A surgical instrument according to claim 1, characterized in that:

FIELD OF THE INVENTION This invention relates to medical instruments, and more particularly to surgical instruments used to perform circular colonic anastomoses.

BACKGROUND OF THE INVENTION Surgical instruments used for circular colonic anastomoses, according to one prior art technique, include a cylindrical body coaxially housing a rod having a mandrel at one end and holding a circular knife in position. The surgical instrument is further provided with a longitudinal feed mechanism, a stem with a thrust head, and a mechanism for performing a circular anastomosis. The anastomosis mechanism described above consists of two members, one of which is mounted on the mandrel and the other mounted on the thrust head. A gap for the purse string suture is required between these two members, and this gap can be adjusted by a screw and nut combination provided in the stem. The mandrel attachment member of the mechanism for performing circular anastomosis (hereinafter referred to as "circular anastomosis mechanism" for brevity) has a cylindrical bushing, and a splined ring is fixed at an appropriate position on this bushing, and the inner surface of the bushing A staple slot can be formed together with the staple slot. A cylindrical staple ejector is also housed inside the bush. The surface of the frustration head facing the bushing has a plurality of staple recesses equally spaced circumferentially to correspond with the staple slots, the staple recesses forming the staple into a B-shape during suturing. useful for.

When using the above-mentioned known instrument, the actuating element of the instrument is introduced into the lumen of the colon segment to be sutured and the surgical instrument is moved between the two members of the circular anastomosis mechanism by tightening the preliminary purse string suture. Secure the end of the colon segment onto the stem. Both members of the circular anastomosis mechanism are then brought together, whereupon the staple is forced out of the slot by the staple ejector and the circular knife longitudinal displacement mechanism, such that the staple pierces the compressed colon wall with its apical leg. It passes through the recess and is bent into a B-shape, thus tightly braiding the ends of the colon section to be sutured. A circular knife then cuts a round hole inside the colon in the suture area.

After the suturing procedure, the circular knife longitudinal displacement mechanism returns to its initial position with the staple ejector, the bushing is disengaged from the thrust head by rotating the nut of the circular knife longitudinal displacement mechanism, and the instrument is removed from the operated colon segment. .

The above-mentioned known prior art instrument has a set of variable stable pushers, ejectors and knives so that circular staple sutures of different diameters can be made, so that the instrument has different diameters regardless of the depth of the surgical site. It can be applied to the diameter of the colon. However, metal staples left in the colon wall for a long period of time invite the entry of pathogens from the colon lumen into the colonic suture wall, and the pathogens pass through the holes made by the staples. This can cause inflammation and thereby result in cicatricial narrowing of the anastomotic lumen. Additionally, stapled anastomoses are combined with serosal ligation sutures along the entire perimeter of the anastomosis to prevent pathogens and inflammation associated with peritonitis from spreading from the anastomotic area. However, after a long postoperative period, metal staples left in the anastomotic region in long-term contact with the colonic lumen induce cicatricial stenosis. Additionally, in some cases, stapled anastomoses may not reliably stop bleeding.

DISCLOSURE OF THE INVENTION The present invention aims to provide a surgical instrument for use in colonic anastomosis that is equipped with a circular anastomosis mechanism. After that, no foreign matter is left in the anastomotic region, the invasion of pathogenic bacteria from the colon lumen is reliably prevented, bleeding can be sufficiently stopped, the anastomosis can be made simple and reliable, and the surgical time can be shortened.

The above object of the present invention is achieved by the following configuration. That is, a cylinder housing a coaxially extending rod having a mandrel at one end and holding a circular knife in place, a mechanism for longitudinally moving the rod, and a thrust head movable axially relative to the rod. and a two-member circular anastomosis mechanism, one of the two members having a plurality of anastomotic elements disposed on the mandrel and moving together during the circular anastomosis, and the other member comprising: In a surgical instrument for circular colonic anastomosis, which is arranged on a thrust head, according to the invention, the members of the circular anastomosis mechanism arranged on the mandrel are spaced apart slightly from each other in the direction of the rod axis.
and a plurality of anastomotic elements essentially formed as needles spaced equidistantly circumferentially between the rings, some of the needles having spring members. In contrast, the other member of the circular anastomosis mechanism located on the thrust head is a ring that is releasably connected to the thrust head during anastomosis. Both members of the circular anastomosis mechanism are joined by the needle during the anastomosis and remain in place in the colon lumen until the colon segment compressed by the spring member is completely necrotic.

By configuring the circular anastomosis mechanism in this manner, the anastomotic colon portion is firmly joined by an appropriate range of serosa. The compression by the spring element of the part of the colon wall through which the needle is to be passed ensures a reliable hemostasis and prevents the entry of pathogens from the colon lumen between the compressed colon walls and along the needle, thereby preventing the anastomosis area. This minimizes the inflammatory reaction within the anastomosis, and eliminates the need for serosal ligation sutures along the entire circumference of the anastomosis. After the circular anastomosis mechanism is removed from the patient's body, no foreign material remains within the anastomosis region. Thus, the cause of an inflammatory reaction in the anastomosis area will be eliminated. Furthermore, by providing the spring member, the intestinal tissue can be gradually compressed regardless of its thickness and can be subjected to a uniform pressing force over its entire circumference.

A ring provided on the thrust head is made of a biologically inert polymeric material and at least three needles have an annular recess that engages said ring, while the diameter of the thrust head is circular. slightly smaller than the diameter of the knife, so that when removing the instrument from the colon through the ring after the ring has been cut by the circular knife,
It is capable of passing through the above head. This makes perfect sense.

The above configuration allows the two members of the circular anastomosis mechanism to be firmly locked together. Furthermore, the ring is actually a support for the needle, and
Because it is made of polymeric material, it can be cut with a circular knife to completely remove all components of the surgical instrument from within the patient's body.

Fluoropolymers (plastics) are available as biologically inert polymeric materials.

Preferably, with a view to forming a distal end of the colon for an anastomosis, the surgical instrument is provided with a spool that can be mounted on a stem, said stem having an annular ridge for the spool to engage. This annular ridge is separated from the thrust head by a distance necessary to pull the purse string suture tightly against the stem and into the distal colon.

This configuration eliminates the need to place a purse string suture at the distal colon (which in some cases has proven impractical to perform deep in the small pelvis), thereby making the surgical conditions even more sterile. can. Furthermore, when joining both members of the circular anastomosis mechanism together, the colon tissue anchored to the spool is drawn into the circular interior along with the spool, forming a conical space area into which the stem of the surgical instrument is attached. Tissue from the other end of the colon to be fixed is accommodated freely.

Preferably, the surgical instrument has a device for positioning the spool in the colonic lumen. This positioning device has a fixing rod with two fixing elements that are slightly spaced apart from each other and held by a threaded joint. The fixing elements are formed as two truncated cones arranged opposite each other with their smaller faces facing each other. A spool is inserted between the fixing elements on the fixing rod, one of the fixing elements being attached to one end of the fixing rod, and the other fixing element located away from the end of the fixing rod housing the spool. It has an axial hollow area for

By using the device during surgery, it is possible to secure the ligature accurately and in a desired manner on the spool when placing the ligature on the distal end of the colon.

[Brief explanation of the drawing]

For a better understanding of the invention, illustrative embodiments will now be described in detail with reference to the accompanying drawings.

FIG. 1 is a schematic overall view of a surgical instrument used for colonic anastomosis according to the present invention.

FIG. 2 is an enlarged view of the circular anastomosis mechanism, showing the state immediately before anastomosis.

FIG. 3 is a longitudinal cross-sectional view seen from the direction of arrow A in FIG.

FIG. 4 shows the assembly of the fixed rod and spool.

FIG. 5 shows the device for positioning the spool in the rectum as it is introduced into the rectum.

FIG. 6 shows the position of the colon wall after the thread has been pulled tight and tied onto the spool.

FIG. 7 shows a cut rectum.

FIG. 8 shows the rectum with the stem of the surgical instrument introduced into the spool.

BEST MODE FOR CARRYING OUT THE INVENTION The surgical instrument used for circular colonic anastomosis has a cylindrical body 1 (FIG. 1) with a mandrel 2 at one end. Coaxially arranged within the cylinder 1 is a rod 3 with a circular knife 4 provided at a suitable position. The cylinder 1 further has a rod longitudinal displacement mechanism 5 and a stem 6 with a thrust head 7. The thrust head 7 is movable axially relative to the rod 3. The surgical instrument of the present invention includes two
Circular anastomosis mechanism 8 (second
) is provided. One member of this mechanism 8 has two rings 9 and 10 arranged on the mandrel 2 and somewhat spaced from each other. A plurality of anastomotic elements in the form of needles 11 fixed to the ring 9 are provided between the rings 9 and 10 at equal intervals in the circumferential direction. Some of the needles 11 have an axially elastically retractable spring member 12 and at least three needles 11 have an annular recess 13.
The other member of the circular anastomosis mechanism 8 is essentially in the form of a ring 14 placed on the thrust head 7. This ring 14 is made from a biologically inert polymeric material. This allows the ring 14 to be separated from the thrust head 7 by cutting with the knife 4 during the anastomosis. Fluoroplasts (fluoroplasts) can be used as biologically inert polymeric materials. Both members of the circular anastomosis mechanism 8 are joined together by the needle 11 during the circular anastomosis and are left in the colon lumen until the compressed necrotic colon segment is removed. The thrust head 7 is formed as a nut with a diameter slightly smaller than the diameter of the circular knife 4, so that the thrust head 7 can pass freely through the ring 14 after the plastic ring 14 has been cut by the circular knife. and surgical instruments can be removed from the operated colon. It should be noted that the ring 9 is axially movable relative to the knife 4 and the mandrel 2.

The nut 16 (Fig. 1) is attached to the fixing screw 15 (third
(Fig.) is held on the end face of the cylindrical body 1. This nut engages the threaded portion of the stem 17 and moves the stem 17 along the cylinder 1. As a result, both members of the circular anastomosis mechanism 8 (FIG. 1) can be joined or separated.

Mechanism 5 for moving the circular knife 4 in the longitudinal direction
(FIG. 1) has a fixed handle 18 and an articulated handle 19, both of which are attached to an arm 20 of the cylinder 1 at a suitable position. The articulated movable handle 19 is the fixed handle 1
It has a rotary lock 21 which acts counteracting against a stop piece 22 fixed in the proper position of 8. Lock 21
The rotation angle of is limited by the pin 23.

The short actuating arm 24 of the movable handle 19 is configured to enter the interior of the cylinder 1 through the opening 25 and to straddle the flat side of the rod 3. A shoulder 26 is provided within the rod 3 which serves as a stop for the arm 24.

Stem 6 to form the distal colon for anastomosis.
A spool 27 (FIG. 4) is provided which can be attached to. The stem has an annular ridge 28 for the spool 27 to engage, which annular ridge 28 extends from the thrust head 7 a sufficient distance to pull the purse string suture used in the distal colon tightly over the stem 6. separated.

When using the surgical instrument of the present invention, a device 29 (FIG. 5) may be utilized to secure the spool 27 in position within the colonic lumen. This device 29 consists of two fastening elements 31 and 32 which are somewhat spaced from each other and held by a threaded joint.
It has a fixed rod 30 having a diameter. Fixed element 31
and 32 are formed in the shape of a truncated cone and are arranged in opposite directions so that the smaller base faces face each other, and the spool 27 is inserted between them. A fixing element 31 is placed at one end of the fixing rod 30, while a fixing element 32 is located at a distance from said end of the fixing rod 30 and has an axial hollow area 33 for accommodating the spool 27.

The surgical instrument for circular colonic anastomosis of the present invention described herein can be applied to anastomoses by end-to-end and end-to-side joining techniques, as well as to anastomoses of various colon nodes or colostomies. The exemplary anastomosis procedure described below is an end-to-end joining technique.

Spool 27 is removed from the anus using device 29 to secure the severed end of the rectum for a tip-to-end rectostomy to remove the diseased rectal segment. Introduced into the rectum.
After bringing the spool 27 together with the device 29 in front of the affected segment 34, it is necessary to tie the unaffected segment 35 to the spool using thread 36. At this time, the thread is on spool 27
are tied together at flange 37 to form a knot. Next, using the fixing rod 30, fix the fixing element 3.
2 is retracted and the fixation rod with fixation element 32 is then removed from the rectal lumen, after which the rectum is pulled and the rectum is severed at the flange 37 (FIG. 7) of the spool 27. The affected part of the rectum is then removed together with the fixation element 31 housed within this rectum. Stem 6 (FIG. 8) with plastic ring 14 and thrust head 7 is then introduced into the bore of spool 27;
The spool flange 37 is locked onto the annular ridge 28. The cut end of the rectum is thus quickly and easily fixed onto the stem 6 of the surgical instrument. Furthermore, the surgical instrument is introduced into the anus 39 along the stem 6 and the annular ridge 2
8, is precisely fixed in the working position on the stem 6 by the spool 27 and nut 40 (FIG. 1). The distance from the annular ridge 28 to the plastic ring 14 is large enough to freely fix the adjacent segment of the rectum on the thrust head 7 and on the stem 6 behind the plastic ring 14. Natsu 1
6 is rotated to bring both members of the circular anastomosis mechanism 8 into the working position and bring them together. Next, the handle 38 of the lock 21 is rotated to disengage the lock from the stopper piece 22 and moved as far as possible to press the movable handle 19. As a result,
The short actuating arm 24 of the handle presses against the shoulder 26 of the rod 3, so that the rod moves together with the circular knife held on it. The knife 4 connects the ring 9 and the needle 11 fixed thereto with the spring member 1
Move while compressing 2. As a result, needle 11
penetrates the overlapping intestinal wall sections and further penetrates the plastic ring 14.

The circular knife cuts off the excess intestinal wall, which is then removed when the surgical instrument with the thrust head 7 fixed thereto is removed from the anus.
The small pieces of plastic ring 14 cut by circular knife 4 are also removed together with thrust head 7. The needles 11 try to be pushed back by the spring member 12, but because the annular recesses 13 formed in several needles 11 engage with the plastic ring 14,
The needle 11 cannot come out of the plastic ring 14. As a result, a constant pressing force is always applied by the spring member 12 to the remaining positive wall portion narrowed by the rings 10 and 14, so that this intestinal wall portion usually becomes necrotic in about one week to ten days.

The circular anastomosis mechanism 8 remains within the rectal lumen until the necrotic portion of the rectum is eliminated. As mentioned above, the necrotic area is generally naturally removed from the patient's body 7 to 10 days after surgery.