Surgery – Instruments – Sutureless closure
Reexamination Certificate
1999-06-02
2002-09-03
Robert, Eduardo C. (Department: 3732)
Surgery
Instruments
Sutureless closure
C227S176100
Reexamination Certificate
active
06443973
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to an electromechanical device for use with anastomosing, stapling, and resecting surgical tools, and more specifically to a electromechanical device by which surgical instruments such as anatomosing, stapling, and resecting tools may be remotely actuated.
2. Description of the Prior Art
Upon identification of cancerous or other anomalous tissue in the gastrointestinal tract, surgical intervention is often prescribed. The field of cancer surgery, and more specifically, the surgical procedure by which a section of the gastrointestinal tract which includes cancerous or anomalous tissue is resected, includes a number of uniquely designed instruments. In combination with a description of the present instrumentation and their functions, a description of the state of the art in this surgical procedure shall also be provided.
The first question which must be answered when determining how to treat gastrointestinal cancer relates to the specific location of the cancerous tissue. This is very important insofar as the instruments which are provided in the present art have limitations relating to how far they may be inserted into the gastrointestinal tract. If the cancerous tissue is too far up the colon, for example, then the standard instrumentation provided is unuseable, thus requiring special accomodations. These accomodations generally increase the risk of contamination of the surrounding tissues with bowel contents, increase the length of the surgery and the corresponding need for anaesthesia, and eliminate the benefits of precise anastomosing and stapling which comes from utilizing a mechanized device.
More specifically, in the event that the cancerous tissue is located at a position in the colon which is accessible by the present instrumentation, the patient's abdomen is initially opened to expose the bowel. The surgeon then utilizes a linear cutter and stapling device which cuts the tube of the colon on either side of the cancerous tissue, thereby creating two stapled ends of the bowel (a distal end which is directed toward the anus, and the proximal end which is closest to the small intestine). This is done in order to temporarily minimize contamination.
More particularly, referring to
FIG. 1
, the bowel is placed between the scissoring elements
12
,
14
at the tip of the linear stapling instrument
10
. By squeezing the trigger
16
in the handle
18
of the device, the surgeon causes the scissoring elements
12
,
14
to come together. A second trigger (or a secondary action of the same trigger) is then actuated to drive a series of staples
20
through the clamped end of the colon, thereby closing and transecting the ends.
The surgeon then partially opens the proximal end and inserts the removeable anvil portion of an anastomosing and stapling instrument into the exposed proximal end. This step, as well as those of the remainder of the surgical procedure, are related to the functioning of this surgical instrument. More particularly, and with respect to
FIG. 2
, the surgeon begins by taking the instrument
30
and manually turning the dial
32
at the base of the handle
34
which causes the anvil head
36
at the opposite end to advance forward. The surgeon continues to turn the dial
32
until the anvil head
36
advances to its most extreme extended position. This manual turning requires nearly thirty full rotations. Once fully extended, the anvil head of the instrument is decoupled therefrom and is inserted into the partial opening of the proximal end such that the coupling post extends outwardly therethrough. This partial opening of the proximal end is then sutured closed. The extending shaft
38
of the anastomosing and stapling intrument
30
is then inserted and advanced into the lower colon, transanally, until the coupling stem
40
thereof extends through the stapled distal end. The surgeon then joins the coupling ends of the anvil and shaft together and begins to manually rotate the dial in the handle again, this time bringing the anvil head closer to the end
42
of the shaft.
Once the anvil head and shaft are brought close together, after the surgeon has manually rotated the dial another thirty times, a grip-style trigger
44
in the handle is manually actuated. This actuation causes a circular blade
46
to advance axially out from the tip of the shaft, and into contact with the opposing face
48
of the anvil
36
. The blade cuts through the stapled-closed ends of the proximal and distal ends of the colon, thereby also cutting a new pair of ends of the proximal and distal portions of the colon. The tissue which has been severed is held in an interior volume at the end of the shaft.
In lock step with the cutting, the freshly opened ends are joined together by a series of staples
50
which are advanced through holes in the perimeter of the tip of the shaft (being pressed against and closed by the opposing face of the anvil). The coupled shaft and anvil are then withdrawn from the patient.
More particularly with respect to the structural features of the linear stapling instrument
10
of the prior art which is provided in
FIG. 1
, the device comprises a pistol grip-styled structure
18
having an elongate shaft
19
and distal portion
20
. The distal portion includes a pair of scissor-styled gripping elements
12
,
14
which clamp the open ends of the colon closed. In fact only one of the two scisor-styled gripping elements, the upper jaw portion
12
, moves (pivots) relative to overall structure; the other remains fixed. The actuation of this scissoring means (the pivoting of the upper jaw
12
portion) is controlled by means of a grip trigger
16
maintained in the handle. A number of different means have been disclosed for holding the tips of the scissoring arms closed, including snaps, clips, collars, et al.
In addition to the scissoring means, the distal portion also includes a stapling mechanism. The non-moving lower jaw
14
of the scissoring mechanism includes a staple cartridge receiving region and a mechanism for driving the staples
20
up through the clamped end of the colon, against the upper jaw portion, thereby sealing the previously opened end. The scissoring elements may be integrally formed with the shaft, or may be detachable such that various scissoring and stapling elements may be interchangeable.
More particularly with respect to the structural features of the anastomosing and stapling instrument of the prior art which is provided in
FIG. 2
, the device comprises an anvil portion
36
, a staple, blade and reservior portion
42
, a shaft portion
38
, and a handle portion
34
. The anvil portion
36
, which is selectively removeable from the tip of the shaft, is bullet shaped, having a blunt nosed top portion, a flat cutting support surface
48
on the bottom, and a coupling post
41
extending axially from the bottom surface.
The staple, blade, and reservior portion
42
(SBR portion) of the instrument is provided at the distal end of the instrument, and includes a selectively advanceable and retractable coupling stem
40
for selectively receiving thereon the anvil portion. This action of the coupling stem is provided by a screw threaded shaft and worming mechanism mounted in the handle
34
(described more fully below). The SBR portion is cylindrical in shape, forming a housing which has a hollow interior. It is this hollow interior which forms the reservior
47
. The blade
46
is similarly cylindrical, and seats in the inside of the housing, against the inner wall thereof. The blade is selectively advanceable axially outward from the housing, in accordance with actuation of a trigger
44
mechanism of the handle (again, described more fully below). On the axially outward facing surface of the cylindrical wall of the housing are a series of staple ports, through which the staples
50
of the device are discharged. The same actuation which drives the blade forward similarly drives a series of staple drivers forward within the cylindrical
Dann Dorfman Herrell and Skillman, P.C.
Power Medical Interventions, Inc.
Robert Eduardo C.
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