CN103189003A - Forceps comprising a trocar tip - Google Patents

Abstract

The present invention relates to a forceps comprising an elongate body, a grip region at end of the elongate body, the grip region comprising a lever, a grasping assembly at the opposite end of the elongate body, the grasping assembly comprising a moveable grasper and a trocar, and an actuating mechanism coupling the lever to the grasping assembly for effecting movement of the grasper relative to the elongate body. The present invention also relates to a kit of parts comprising a forceps of the invention and additional components. The invention further relates to a method of forming an anastomosis between two surfaces and a method of forming a stoma trephine in a subject using the kit of parts of the invention. The present invention also relates to the use of the forceps and the kit or parts of the invention in such methods.

Description

The pliers that comprises trocar tip

Technical field

The present invention relates to comprise the operating forceps at trocar tip.

Background technology

Pliers is usually in operation process, and pliers can manipulation of tissue, and does not need the surgeon with hands straightforward manipulation tissue.Pliers also can carry out the tissue manipulation that other instrument can not be done.

Pliers is applicable to the best specific function of serving usually.The type of pliers known in the art comprises artery clamp, mosquito forceps, dressing forceps, sliver pincers, obstetric forceps, pipe wrench and tissue forceps.In some surgical technics, pliers not only is used for manipulation of tissue, also is used for other operating theater instruments of operation.Pliers also is used in and clamps tissue in the operation process, and for example tremulous pulse does not cause damage to catch sewing needle, to assist the childbirth baby, perhaps also can be used for laparoscopic surgery.The pliers that is used for laparoscopic surgery comprises those that WO2006/075153 describes, and the full content of the document is introduced this literary composition by reference.

Traditional pliers uses hinge usually at the one end or in the centre.Pliers can be for nonlocking or locking.Non-locking pincers are also referred to as thumb forceps, and can be endways or the centre hinge.Hinge non-locking pincers endways comprise the content that WO2007/121238 describes, and the content of the document is incorporated herein by reference.Locking pliers has hinge in the centre usually.Some type pliers are having hinge (prehension end is the end that described pliers contacts with the tissue of being handled or operating theater instruments) near prehension end.

Part for the pliers of catching tissue, operating theater instruments or other material generally includes two flat blunt blades, and described blade can be caught object, and does not cause damage.Perhaps the prehension end of described pliers can be adapted to its concrete application, for example carries out biopsy.The example of such pliers comprises those pliers described in the WO2008/101497, and its content is incorporated herein by reference.

The trocar is a kind of be used to puncturing tissue, sharp-pointed operating theater instruments.The trocar often is used in combination with sleeve pipe (pipe), in this way opening is introduced tissue or organ, for example opening is introduced vein, is used for intravenously administrable.The trocar also can be used for discharging the pressure of organizing inner accumulated.

The trocar can be used for being used in combination with other operating theater instruments.For example, WO2009/137761 has described a kind of trocar, the puncture tip that is positioned at the described trocar of distal portions and proximal part is inserted the nail anvil part of operation anastomat, for example circular anastomosis art anastomat device (circular anastomosis stapler apparatus).

The end to end anastomosis operation anastomat is used for biological tissue is linked together, for example after the excision.These anastomats are used in to be removed after the ill part, and two intestinal are connected again.The first of intestinal is connected to nail anvil.Subsequently described nail anvil is docked at the anastomat part of described anastomat device, and orientates as when starting described anastomat, by a row or multi-row seam nail that arranges in a circumferential direction two intestinal are reconnected.

Anastomat also can be used for making the formation of mouth.Making mouthful is artificial opening between two hollow organs or hollow organ and the health outside, and this artificial open construction is passed through for making body fluid and waste product.

The example of operation anastomat comprises to be described among WO2004/089255 and the US4576167.

But because nail anvil is usually located at patient's abdominal part, it may be difficult on the described anastomat that nail anvil is docked to.This makes the operation of nail anvil become problem, and particularly in laparoscopic technique, it enters the inlet point minimum of patient body.As a result, need several otch usually, to enter the relevant portion of patient's anatomical structure.In addition, need usually to use several different devices, to guarantee that nail anvil is docked on the described anastomat, when attempting to be docked at nail anvil on the anastomat, inevitably the patient is damaged.Because butt joint usually occurs in patient's body, the surgeon can not see that nail anvil is docked on the described anastomat.

Therefore, still need a kind of operation device in this area, this operation device can be operated other operation device, and for example the operation anastomat nail anvil reduces the injury that surrounding tissue is produced simultaneously, and the quantity that reduces the operation device that need use simultaneously.

Summary of the invention

The present invention has developed a kind of pliers that comprises trocar tip.Described trocar tip can be used for piercing tissue, and described pliers can be used for fetching the nail anvil of described surgical stapling apparatus subsequently.Particularly, described pliers can be used for inserting the nail anvil of operation circular anastomosis apparatus, and is used for fetching the nail anvil of preparing to be docked on the anastomat from the patient.

Therefore, the present invention relates to a kind of pliers, comprising:

(a) elongated main body;

(b) be positioned at the grasping section of described elongated main body end, described grasping section comprises bar;

(c) be positioned at the grabbing assembly of the opposite end of described elongated main body, described grabbing assembly comprises grasper and the trocar movably; And

(d) actuator, described actuator is connected to described grabbing assembly with described grasping section, and described grasper is moved with respect to described elongated main body.

The invention still further relates to the kit that comprises pliers of the present invention and surgical stapling apparatus.

The invention still further relates to and utilize kit of the present invention in the patient, to form the method for anastomotic stoma.

The invention still further relates to the method for utilizing kit of the present invention in the patient, to form to make choma to bore.

The invention still further relates in anastomotic stoma or when making choma and bore forming, the purposes of described pliers of the present invention.

The invention still further relates in anastomotic stoma or when making choma and bore forming, the purposes of described kit of the present invention.

Description of drawings

Fig. 1 is the perspective view of described suitable pliers of the present invention.

Fig. 2 is the side view of suitable pliers of the present invention.

Fig. 3 is the perspective view at the rear portion of suitable pliers of the present invention.

Fig. 4 is the close shot side view of the grasping section of suitable pliers of the present invention.

Fig. 5 is the cutaway view of the side of the of the present invention described suitable pliers of displaying internal mechanism.

Fig. 6 is the close shot cutaway view of the grasping section of suitable pliers of the present invention.

Fig. 7 is at the grasping section of described suitable pliers of the present invention and the close shot cutaway view of the intersection point between the described elongate body.

Fig. 8 is the close shot side view of the grasping section of suitable pliers of the present invention, and wherein said grabbing assembly also has breach, to hold the tooth of described movably grasper.

Fig. 9 is the close shot side view of the grasping section of described suitable pliers of the present invention, and wherein said grabbing assembly comprises that also breach and described pliers are closed.The tooth of described movably grasper be contained in described breach in.

Figure 10 has showed the anastomat device that comprises anastomat and nail anvil.Described pliers of the present invention can be used for inserting described nail anvil.

Figure 11 has showed straight nail anvil, is used for being docked to described anastomat.

Figure 12 has showed the nail anvil that is docked to fully in the described anastomat.

Figure 13 has showed nail anvil as shown in figure 11, but nail anvil has rotated 90 °.

Figure 14 has showed the nail anvil of the described anastomat of retraction.Tissue or tissue to be sewed up will be placed on the interface 250 of described nail anvil head 220 and stitching devices 150.

Figure 15 has showed that described anastomat is along the cutaway view of the line A-A among Figure 14.

Figure 16 has showed making the position that choma bore to form and has excised columniform abdominal skin and subcutaneous tissue 400, until sheath of rectus abdominis 410.

Figure 17 has showed the sheath of rectus abdominis of opening with cross recess 410.

Figure 18 has showed and utilizes retractor (Lan Shi drag hook) that otch is stayed open.

Figure 19 has showed and utilizes pliers 2 of the present invention to fetch nail anvil 200 in body cavity.

Figure 20 has showed and utilizes pliers 2 of the present invention to take out described pin anvil shaft external.

Figure 21 has showed that the operation anastomat 100 in the external member of the present invention with reinforcing network 138 is applied on the nail anvil butt joint pin 130, and the nail anvil that 200 alignment of described nail anvil prepare to engage docks pin.Utilize clamp 370 firm described nail anvils.

Figure 22 has showed the described nail anvil 200 and the anastomat 100 that engage fully, and in the described anastomat of described nail anvil retraction.

Figure 23 has showed that after starting described anastomat seam nail 440 rows define and make choma brill 450, sew up the loose edge 139 of described net 138 subsequently.

Figure 24 has showed that the choma of making by new establishment bores one section intestinal 342 of 450 taking-ups.

Figure 25 has showed that the nail anvil 245 that comprises network channel 221 is docked to the nail anvil butt joint pin 130 of operation anastomat.

Figure 26 has showed aspirator accessory 227, and the operation anastomat 100 that is connected to aspirator 225.

Figure 27 has showed when being connected to aspirator, by one section intestinal 345 of nail anvil 245 operations.

Figure 28 has showed the nail anvil of anastomat device 200 had been connected to the appropriate location of one section intestinal 340 by purse string suture before being about to carry out docking operation.Utilize the described nail anvil of clamp 370 operations.

Figure 29 a and 29b have showed that pliers of the present invention 2 is used for after piercing through, and the intestinal through creating at far-end rectum stump 350 cuts and fixes, fetches and haul out pin anvil shaft 240.Described grasper 40 utilizes the tooth that aligns with breach 242 to firmly grasp described pin anvil shaft.

Figure 30 a and 30b showed by far-end stump 350 and fetched described pin anvil shaft 240 fully, and expose fully external, in order at interior anus or the described pin anvil shaft of external butt joint and nail anvil butt joint pin 130.Utilize clamp 370 to stablize nail anvil.

Figure 31 a and 31b have showed nail anvil 200 and the anastomat 100 of butt joint fully.Can see nail anvil butt joint indicant 132 by the watch window on the pin anvil shaft.

The specific embodiment

Referring to figs. 1 to 3, a first aspect of the present invention provides a kind of pliers 2, comprising:

(a) elongated main body 10;

(b) be positioned at the grasping section 60 of described elongate body one end, described grasping section comprises bar 70;

(c) be positioned at the grabbing assembly 20 of the opposite end of described elongated main body, described grabbing assembly comprises grasper 40 and the trocar 30 movably; And

(d) actuator, described actuator make described bar be connected to described grabbing assembly, and described grasper is moved with respect to described elongated main body.

Described elongated main body can have any length of the special-purpose of described pliers.In certain embodiments, the length of described elongated main body is 5 to 50cm, and preferred 10 to 30cm.In certain embodiments, described elongated main body is straight, but as required, described elongated main body also can be crooked or bending.If described elongated main body is crooked, described grabbing assembly and/or the trocar can be set to continue the bending of described elongated main body.

The cross section of described elongated main body is cylindrical or substantial cylindrical.This comprises circular and oval cross section, and suitable polygon cross section, for example triangle, square, pentagon, hexagon, heptagon, octagon, nonagon, decagon etc.

Described grasping section 60 also can be described as grabbing assembly, is intended for the part of the pliers of being held by the user.Selectively, described grasping section comprises breach or groove 63, the coefficient of friction that described breach or groove 63 increase between user's hands and the described pliers, thereby the easier pliers that grips.Therefore, described breach or groove 63 also can reduce the risk that described pliers accident falls.Described grasping section 60 can be connected to described elongated main body, and is perhaps integrally formed with described elongated main body.

In a preferred embodiment, described grasping section comprises bar 70 and handle 62, as shown in Figure 1.In described bar 70 and the handle 62 one, perhaps the two can comprise breach or groove 63, holds with a firm grip helping.Preferably, described bar and handle are configured such that user's starting bar, simultaneously by the handle described pliers of holding with a firm grip.The startup of described pliers relates to described bar with respect to the pivoting action of handle.

Described handle can be integrally formed with described elongated main body, thereby can think the extension of described elongated main body.In certain embodiments, described handle is roughly parallel to described elongated main body, can align coaxially with described elongated main body.Perhaps, described handle with respect to described elongated main body shape at an angle, for example 0 ° to 90 °, perhaps 0 ° to 45 °, perhaps 10 ° to 45 °.

Described bar has open position and make position.Fig. 1 and 2 has showed the described bar that is shown in an open position.As shown in Figure 2, the door bolt 74 of the pivot that described bar can be by forming bar is connected to handle.Perhaps, the similar door bolt of the pivot that described bar can be by forming bar is connected to described elongated main body.In order to make described bar closed fully with respect to described handle, described bar selectively comprises relative planar side roughly 68 and 72 with described handle, and as shown in Figure 3, thereby when described bar was closed, described two planar side were close mutually, finally are pressed together.The opposite face of each described bar and handle is bent usually, thinks that the user provides the grasping section that meets human engineering.

Described grasping section selectively comprises elastic biasing device 64, and it remains on open position with bar.Described elastic biasing device is also referred to as elastic biasing means.Described elastic biasing device can be the known any suitable elastic biasing devices of those of ordinary skills, and spring for example, or as shown in Figure 3 for example is connected to the flexible member of an end of the planar side of described handle 68 by bolt 67.The opposite end of described flexible member is pressed on the opposite planar 72 of described bar 70, is shown in an open position to force bar.

In certain embodiments, described flexible member comprises flange 65, and this flange 65 compresses the plane 72 of described bar 70.In another embodiment, the plane 72 of described bar 70 can comprise passage 66, and this passage 66 holds flange 65 as shown in Figure 3, and when the described pliers of user's closure, this passage guides described flexible member to move along the plane 72 of described bar 70.

With reference to figure 4, the grabbing assembly 20 of pliers 2 of the present invention comprises the trocar 30 and grasper 40 movably.In a preferred embodiment, described grabbing assembly 20 and described elongated main body co-axially align or roughly co-axially align.In another embodiment, the described trocar and described elongated main body co-axially align or roughly co-axially align.Usually, the alignment of described grabbing assembly 20 or the trocar 30 makes the part of described grabbing assembly and described elongated main body insert the patient.For example, the described trocar and described elongated main body each can have the longitudinal axis that is parallel to each other.Described two longitudinal axis can be coaxial, and perhaps they can be offset each other.If they are offset each other, the distance of their skews is preferably diameter or the width that is equal to or less than described elongated main body, more preferably is equal to or less than the diameter of described elongated main body or half of width.

In one embodiment, described elongated main body has two relative parallel edges that limit its width.The described trocar also has two relative parallel edges that limit its width.An edge parallel aligned of edge of the described trocar and described elongated main body.As shown in Figure 4.Such alignment, and coaxial or roughly the coaxial described pliers that is aligned to narrow profile is provided, make it to insert easily tissue.

The width of the described trocar or diameter preferably are equal to or less than diameter or the width of described elongated main body.

The described trocar can be any suitable shape for piercing tissue or other material.For example, the described trocar is generally sharp-pointed, and can be conical.Perhaps, the described trocar can comprise the sharp tip that is made of some planar side, for example 3 or 4 tapers that the limit forms.In certain embodiments, the described trocar comprises having tapering point or most advanced and sophisticated elongated part, as shown in Figure 4.Grabbing assembly as shown in Figure 4 comprises the trocar that has with the elongated portion of epiconus part one.The described trocar makes described pliers piercing tissue and other material.By this way, described pliers of the present invention can insert patient or tissue, and does not need other otch.

Described grasper 40 can be connected to the described assembly 20 that grasps by fastening 44 with a bolt or latch, and this door bolt 44 forms pivot, and described grasper 40 is around this pivoting action, as shown in Figure 4.Perhaps, described grasper can be connected to described elongated main body 10 by the similar door bolt that forms pivot, and perhaps described grasper can be connected to described assembly or the elongated main body of grasping by hinge or the connecting device of other type.Therefore, described grasper has the open and close position corresponding with the open and close position of described bar 70, and described movably grasper also can be called the hinge grasper.The closure of described grasper comprises that described grasper is with respect to the pivoting action of described elongated main body.In some embodiments of the invention, the cross section of described grasper is crooked, thereby the bending of described grasper and the described trocar is crooked complementary.When described grasper was positioned at make position, this provided smooth profile, to reduce when the pliers of described trocar end of the present invention inserts patient or tissue or other material, produced damage.

In interchangeable embodiment, the open and close position of described bar 70 closure and the open position with described grasper 40 respectively is corresponding.

In a preferred embodiment, described movably grasper comprises axle 41 and one or more tooth 42, described tooth perpendicular to or to be approximately perpendicular to the axle 41 of described grasper 40 outstanding, as shown in Figure 4.Described tooth helps promptly to organize or use the operating theater instruments of described pliers 2.Described tooth can be arranged at the end (this end is relative with an end that is connected to described grabbing assembly or the trocar) of described axle 41 or they can be along described length setting.

In preferred embodiment, described grabbing assembly comprises the one or more breach 22 that are positioned on the described trocar 30, and described breach is used for holding the tooth 42 of described movably grasper 40, as shown in Figure 8.Therefore, described breach 22 aligns with described tooth 42, thereby when described movably grasper 40 was in the close position, described tooth held as described in the breach, as shown in Figure 9.Described breach makes the existence of described tooth can not influence the profile at described trocar tip.This helps to guarantee can undamagedly enter tissue when described pliers of the present invention inserts the patient or organizes.

In another embodiment of the present invention, described tooth can be crooked, thereby they are conducive to the surface of the described trocar.The better cooperation that this provides between described grasper and the described trocar, and the narrower profile of described trocar end pliers is provided.Can be crooked except described tooth, the axle of described grasper also can be crooked, with the profile at the described trocar of further improvement tip.

In an embodiment of the present invention, described actuator makes described bar be connected with described grabbing assembly, is used for making the pivoting action of described bar and described movably grasper synchronous with respect to the movement of elongated main body.

With reference to figure 5 to 7, in certain embodiments, the actuator of described pliers 2 can be rod 80, described excellent 80 and described elongated main body 10 parallel aligned or parallel alignment.Described actuator or rod mechanically make described bar 70 be connected with described grasper 40, thereby when the user started described bar, described grasper moved to make position.The closure of described grasper relates to described grasper with respect to the pivoting action of described elongated main body.When described grasper was fully closed, described grasper alignd with described elongated main body almost parallel.In certain embodiments, when described grasper is fully closed, described bar also with described handle and/or elongated main body parallel alignment.

In a preferred embodiment, described elongated main body is hollow, and described actuator partly or entirely be included in described elongated body interior.For example, if described actuator comprises rod, described rod can be contained in described elongated body interior.As shown in Figure 5.

In one embodiment of the invention, described actuator also can comprise connecting device 90, and described connecting device connects closed bar and the rod that is retracted to described elongate articles.Withdrawal relates to described rod to the motion of described grasping section.Stretch out and relate to described rod to the motion of described grabbing assembly.

As shown in Figure 7, described connecting device comprises plate 92, and described plate 92 is by fastening 94 ends that are connected to described bar with a bolt or latch.Described door bolt makes described plate carry out pivoting action with respect to bar.The opposite end of described plate 92 is connected to flap 99 by fastening 98 with a bolt or latch.Described door bolt 98 makes described plate 92 do pivoting action with respect to flap 99.Described flap 99 is connected to described rod, thereby the withdrawal of described flap 99 causes described excellent 80 withdrawal.In this embodiment, described connecting device comprises described plate 92, described door bolt 94, described door bolt 98 and described flap 99.Described handle also can comprise the groove 96 on the plane 68 that is positioned at described handle 62, and described groove 96 holds all or part of link 90.

In this embodiment, described elongate articles 10 is hollow, and when described bar was closed, described plate 92 was around pivot 94 and 98 motions.Described flap 99 is retracted in the described groove 96, and this makes described excellent 80 with respect to described elongate articles 10 withdrawals.In certain embodiments, if there is described elastic biasing device 64(in the closure of described bar 70) compressed or crooked.If described elastic biasing device is flexible member as shown in Figure 7, described flange 65 is directed along the passage 66 of described bar 70.Therefore described flexible member moves towards the plane 68 of described handle 62.

In one embodiment, on the described grabbing assembly of the other end of described pliers, as shown in Figure 6, described excellent 80 are connected to described movably grasper 40 by fastening 82 with a bolt or latch.When described excellent 40 during with respect to 10 withdrawals of described elongate articles, described grasper is around its pivot 44 rotations, and described grasper moves to make position.Apply power by the direction of motion at described pliers, axle 41 and the selectable tooth 42 of described grasper move to the described trocar 30, can grasping tissue or other operation device.

When the user was released on the described handle applied pressure, described elastic biasing device made described bar be back to open position.Described plate 92 rotates around its pivot 94 and 98.This makes described folded sheet 99, mechanism 90 extend along described groove 96, and therefore, described excellent 80 extend towards described grabbing assembly 20 along described elongate articles 10.When described excellent 80 when described grabbing assembly 20 extends, described movably grasper 40 rotates around the pivot that it is positioned at 44 places, and described movably grasper 40 is back to open position.

Can prepare described pliers by any suitable material well known by persons skilled in the art.For example, described anastomat can comprise plastics (for example polyamide, polystyrene, polrvinyl chloride, polypropylene, polyurethane, Merlon or polyether-ether-ketone), metal (rustless steel or titanium) or pottery.Described pliers can be by these mixtures of material preparations.

Tissue by the most advanced and sophisticated pliers puncture of the trocar is generally biological tissue, for example intestinal or intestinal wall, esophageal wall, posterior rectus sheath, far-end rectum stump or peritoneum.Other tissue comprises the outside organization of health, for example skin or general organ.

A second aspect of the present invention provides the kit that comprises pliers of the present invention and anastomat device.

Anastomat device as shown in figure 10 comprises:

(a) have the anastomat 100 of near-end 120, far-end 140 and the longitudinal axis 180, described anastomat also comprises

(i) trigger 112;

(ii) nail anvil docks pin 130, and described nail anvil butt joint pin 130 aligns with the longitudinal axis 180 parallel (almost parallel) of described anastomat 100; And

(iii) stitching devices (stapling means) 150, described nail anvil butt joint pin 130 and stitching devices 150 are positioned at the far-end 140 of described anastomat 100;

(b) dismountable nail anvil 200 comprises nail anvil head 220 and pin anvil shaft 240;

Wherein, described pin anvil shaft 240 is suitable for receiving described nail anvil butt joint pin 130, and operates described trigger 112, and described stitching devices 150 is started, and the trocar of wherein said pliers is used for inserting described pin anvil shaft.

" closely " of described anastomat and " far " end refers to when operating described anastomat device, from the user, and the relative distance at the two ends of described anastomat.Near-end is from the nearest end of user, generally includes grasping section and be used for to start the trigger of described stitching devices.Far-end is the user further away from each other, but the patient of the described stitching devices of more close application, thus described stitching devices and nail anvil butt joint pin are usually located at far-end.

Usually, the longitudinal axis extends between near-end and far-end, and roughly passes the center of described anastomat.

Circle and those skilled in the art's other structure that expect easily, that provide suitable seam nail to arrange roughly is provided " circle ".For example, as shown in figure 15, the cross section of described stitching devices can be circular, thereby the seam nail (staple) that can provide circular to arrange also can use ellipsoidal structure.Usually, the cross section of described nail anvil head, described pin anvil shaft, described nail anvil butt joint pin and described stitching devices all is roughly circle, but also can be that the seam that can provide suitable is followed closely other structure of arranging.

Described anastomat has elongated main body usually, is preferably the substantial cylindrical main body.Preferably shape is set to make it to insert suitable tissue and organ.

The main body of described anastomat comprises trigger 112 and stitching devices 150.Preferably, the main body of described anastomat is for roughly straight and be not bent.According to dissection and the organ of using described anastomat device, this is useful.Be straight or roughly among some embodiment of straight (with respect to bending) at described anastomat, because become to have still less vibrations and motion in operating process, this also provides better controls described anastomat, and this influence anastomotic stoma or makes the quality of choma brill.For example, compare with the situation of anastomat bending, can more easily make described anastomat keep parallel with rectal wall.

In certain embodiments, described anastomat comprises grasping section 110, is used for when using described anastomat, by user's grasping.Thereby described grasping section is positioned the near-end 120(of described anastomat usually can be sewed up in the somewhere of distance users), but also can be arranged at other position of anastomat.

Described anastomat device can be used for various operations to be used, for example anastomotic stoma, make mouthful or make the formation that choma bores.These can be in for example gastrointestinal (GI), or between gastrointestinal tract and health outside, but be used for any pipe more at large, or have the organ of inner chamber.Therefore described anastomat device is suitable for as surgical stapling, perhaps at some more specifically among the embodiment, as the intracavity anastomat.In addition, consider the seam nail that provides circular to arrange in certain embodiments, described device can be called the circular anastomosis apparatus.

Common described anastomat device is disposable, falls processed after the use.In a preferred embodiment, described anastomat device is aseptic.

In certain embodiments, the length of described pin anvil shaft is 4,5,6,7,8,9 to 10cm.In certain embodiments, the length of described pin anvil shaft is at least 4,5,6,7,8,9 to 10cm.In some preferred embodiments, the length of described pin anvil shaft is 4 to 50cm, is preferably 4 to 25cm, 4 to 20cm, and 4 to 15cm, and 4 to 12cm, 4 to 10cm, and 5 to 50cm, and 5 to 25cm, 5 to 20cm, and 5 to 15cm, and 5 to 12cm, 5 to 10cm, and 6 to 50cm, and 6 to 25cm, 6 to 20cm, and 6 to 15cm, and 6 to 12cm or 6 to 10cm.

In some embodiments of the present invention, the overall active length of described anastomat is reduced to 250 to 400mm from the industrial standard of 420mm, and preferred 300 to 350mm, and more preferably 310 to 340mm, and more preferably 320 to 330mm, or 325mm.The overall work length of the minimizing of described anastomat provides better, more stable and more meet the platform of ergonomics, with in operation with start in the process of anastomat device and strengthen the user to the control of described anastomat device.

In certain embodiments, for example the length at described pin anvil shaft is at least among the embodiment of 4cm, compares with the nail anvil of prior art, and the nail anvil of described anastomat device is elongated, and compared with prior art, this elongated pin anvil shaft has several advantages.

For example, the existence of longer pin anvil shaft makes and in addition, can carry out interior anus or external docking operation by the described nail anvil of the easier operation of user.

Described elongated axle also makes the surgeon at anal or the described nail anvil of external extracting, the surgeon is caught in vivo, and pin anvil shaft is moved to interior anus or external position.Use short pin anvil shaft, nail anvil is with in docking of described anastomat occurs in patient's body, so the surgeon is very difficult nail anvil is docked pin inserts on the described pin anvil shaft, and is difficult to see whether described nail anvil docks at connecing with described nail anvil fully.Elongated pin anvil shaft makes described axle move into interior anus or external position.

Therefore, described elongated pin anvil shaft makes where the surgeon is clearer sees described nail anvil, docks on the pin to help that it is docked to described nail anvil.Described elongated axle also makes the surgeon see that from external described nail anvil engages with described anastomat fully.Therefore, compared with prior art, described elongated axle provides visual advantage.In the anastomat with short axle, described pin anvil shaft is organized to be covered or surrounds, and this makes and be difficult to the described pin anvil shaft in location, perhaps is difficult to catch axle that it is moved to correct position.But, by prolonging the pin anvil shaft of described anastomat, can address this problem.

In addition, seen by the surgeon because described nail anvil is easier, guarantee to make described pin anvil shaft to be docked to described nail anvil butt joint pin fully for the surgeon is also easier.Anastomat with short pin anvil shaft only depends on " clickly the sound " that can hear and guarantees butt joint.On the contrary, described anastomat can also guarantee for butt joint provides vision herein.Therefore, described anastomat provides extra safety for the patient.

Anus or extrapersonal space in described elongated pin anvil shaft can enter by body interior are to be docked to described anastomat.The length of described prolongation is only limited by the change of the inside power transmission shaft of described anastomat, and this inside power transmission shaft is convenient to the motion of nail anvil butt joint pin (shrink or stretch) the described anastomat of turnover of described nail anvil butt joint pin and joint.

Can similarly change the length of described nail anvil butt joint pin, to adapt to the different length of described pin anvil shaft.Usually, described nail anvil butt joint pin extends to described anastomat, thereby when from as shown in figure 10 the described anastomat of unilateral observation, can see that described nail anvil docks the part of pin.Described nail anvil butt joint needle set has the diameter littler than described pin anvil shaft, makes described nail anvil butt joint pin insert described nail anvil butt joint pin.Particularly, the diameter of described nail anvil butt joint pin is equal to or less than the inner chamber 241 of described pin anvil shaft 240, as shown in figure 11.In a preferred embodiment, described nail anvil butt joint pin or roughly co-axially align (for example during equaling distance that nail anvil dock the width of pin or diameter, perhaps make seam nail with suitable spacing be distributed in described nail anvil dock pin on every side any distance) coaxial with the longitudinal axis of described anastomat.

Described nail anvil butt joint pin can be crooked, and perhaps it can be trocar tip.The most advanced and sophisticated nail anvil butt joint of trocar pin for example as shown in figure 10, has the advantage that can puncture tissue.For example, when between the rectum stump of one section intestinal and rectum lower end, creating anastomotic stoma, can utilize stitching thread or seam nail to make described rectum stump closure, and the most advanced and sophisticated nail anvil butt joint of described trocar pin can be used for piercing through rectum apical stitch line and dock with nail anvil.This guarantees that described anastomat is fit to the location, so that the seam that distributes nail passes the far-end stump simultaneously and to link colon on the nail anvil with mode such as purse string suture.

The seam nail that stitching devices distributes can be set to provide circular arrangement roughly.The arrangement of seam nail is called as stitching thread.Can locate described seam nail, make them along the circumferential arrangement of described circular seams zygonema.Perhaps, they can be arranged along the radius of circular seams zygonema, perhaps and this circular radius and certain angle between circumference.May there be many row's seam nails, for example 2,3,4 or 5 row's seam nails.In certain embodiments, described stitching devices has optional two rows, three rows or the concentric seam of more rows nail and is installed in the seam nail housing along circumference.

Described trigger 112 can be the form of bar for example, as shown in figure 10.In this embodiment, start trigger, the mechanical transfer by power or energy starts described stitching devices.Perhaps, described trigger can be a button, and stitching devices is started automatically, for example, and by using electronic intraware.

The grasping section of anastomat and trigger preferably are set to when the user holds described anastomat with a firm grip by grasping section, and the user can start described trigger simultaneously.For example, as shown in figure 10, described trigger (being bar in the embodiment shown in fig. 10) can be connected to the mid portion of described anastomat, and described grasping section can be to the proximal extension of described anastomat.

In certain embodiments, the far-end of described anastomat also comprises a constriction device 114, as shown in figure 10.The user can rotate this constriction device makes nail anvil butt joint pin (and nail anvil, if nail anvil and nail anvil butt joint pin engage) reversibly be recovered in the stapler main body along the longitudinal axis of anastomat.If nail anvil docks pin and engages with described nail anvil, this will make the nearly described stitching devices of anvil head rest move.Figure 14 has showed the nail anvil 200 that engages with anastomat 100 fully, and this nail anvil 200 is fully retracted described anastomat.The assembly of described stitching devices be configured such that tissue limitations to be stitched together in or be fixed between described nail anvil head and the described stitching devices.Tissue to be stitched together is limited in 250 places, interface of described nail anvil 200 and stitching devices 150.When using this device in operation, because one deck or a few layer tissue be between two assemblies at 250 places, interface of described nail anvil head and stitching devices, therefore described nail anvil head does not directly contact usually each other with stitching devices.

By rotating described constriction device in the opposite direction, described nail anvil butt joint pin (and nail anvil, if nail anvil and nail anvil butt joint pin have engaged) can be shifted out in described anastomat.Perhaps, the user can pull out described nail anvil from described nail anvil butt joint pin simply.

In a preferred embodiment, only at the rotation constriction device, the nail anvil head is moved on near stitching devices and tissue limitations to be stitched together after between described anvil head and the stitching devices, just start described trigger.

Described constriction device can reach the described nail anvil butt joint of guiding pin enters described anastomat along the longitudinal axis purpose by the device of any appropriate, the device of described any appropriate is for for example being positioned at the rod of described stapler main body, and this rod directly or by a connected components is connected to described nail anvil butt joint pin with described constriction device.Described rod can have screw thread, causes rotation thereby can not dock pin to nail anvil when described nail anvil butt joint pin shunk into anastomat.Other contracting mechanism is apparent for those skilled in the art.

Described constriction device can comprise that it is easier to make the user rotate constriction device from the groove of the outward extending flange of constriction device and/or incision constriction device.Constriction device 114 as shown in figure 10 comprises makes the user rotate the easier groove of constriction device.

Start described anastomat trigger, thereby start described stitching devices.In certain embodiments, described device is set in use, thereby a surface to be sewed up is connected to described nail anvil by described nail anvil head.Another surface to be sewed up is orientated the feasible described stitching devices that starts as with respect to described stitching devices, to connect two surfaces and seam nail.Preferably, surface to be sewed up is remained on 250 places, interface of described nail anvil head and stitching devices.

In certain embodiments, lack constriction device, start described trigger described nail anvil butt joint pin (and nail anvil, if nail anvil and nail anvil butt joint pin have engaged) is moved to the near-end of described anastomat, thereby start described stitching devices.

In some embodiments of the invention, described nail anvil head transverse plane the cross section be roughly circle, and its diameter is according to the difference of the tissue that will sew up and difference.For example, the diameter of nail anvil head can be for 10 to 50mm, and more preferably 20 to 35mm.In certain embodiments, the diameter of nail anvil head is 21,25,28 or 32mm.

In certain embodiments, described nail anvil has color mark, for the user provides instant visual information about the diameter of described nail anvil head.Usually, the diameter of described nail anvil head is corresponding with the diameter of described stitching devices, thereby when described nail anvil butt joint pin was withdrawn described anastomat, described nail anvil head alignd with described stitching devices.Described anastomat also can have corresponding color mark, for the user provides diameter information about anastomat.The diameter of described stitching devices can be for 10 to 50mm, and preferred 20 to 35mm.In certain embodiments, the diameter of described stitching devices is 21,25,28 or 32mm.

In one embodiment of the invention, described anastomat also comprises a safety catch (116), as shown in figure 10.This safety catch can be moved by the user, and reversibly engages.When described safety catch engaged, it prevented that described toucher from being started by the user.Therefore, described safety catch can prevent that anastomat from being started because of carelessness.When described safety arrestment breaks away from, can start described toucher fully, thereby start described stitching devices.

Described stitching devices comprises the seam nail groove that anastomat housing, circle or cylindrical blade, a row circumferentially arrange around described circular shear blade outer surface, and driving blade.But the longitudinal axis of described circular shear blade and the described anastomat of driving blade almost parallel moves.The diameter of described stitching devices typically refers to the diameter of described anastomat housing.

When using described anastomat device, described seam nail groove is provided with the seam nail.The seam nail that is used for described anastomat device comprises deformable continuous sheet metal or plastic sheet usually.Crooked described continuous sheet metal or plastic sheet are to form titled with reaching substantially perpendicular to two of this hat sharp or sharp keen lower limbs.Described lower limb pierces through material to be sewed up.The length of these lower limbs has determined the height of seam nail, and according to the difference of thickness of tissue to be sewed up and difference.For example, the length of the lower limb height of cottar (determine) comprises 2,3,4,4.2,5,6,7,8,9,10,15,20,25,30,35,40 and 50mm, preferably, and between 2 to 30mm or between 3 to 20mm or between 4 to 15mm.When described seam nail is installed on the described anastomat, described lower limb points to the far-end of anastomat.

The length of described hat also can be different, and for example, its length can be 2,3,3.8,4,5,6,7,8,9,10,11,12,13,14 or 15mm.Preferably, the length of described hat is 3 to 15mm or 3 to 10mm.The length of described hat has determined between described lower limb distance each other.

Described seam nail can be made by any suitable material, for example other metal or the plastics of titanium, titanium alloy (as Nitinol, because it is the alloy of titanium and nickel, being also referred to as Nitinol), rustless steel or suitable operation purposes.Perhaps, also can use biodegradable seam nail, for example, mainly the seam of being made by the polylactic acid prescription is followed closely.

Before use, described seam nail is initially " U " shape or similar shape usually, for example rectangle or square, and wherein said seam nail forms rectangle or foursquare three limits (for example, described lower limb is set to be approximately perpendicular to described hat usually).

When the user starts the trigger 112 of described anastomat 100, described circular shear blade and seam nail will stretch out from the anastomat housing.By promoting driving blade at far-end, described seam nail is discharged along the longitudinal axis of described anastomat, and pass random layer tissue or the material at 250 places, interface that are positioned at described nail anvil head and described stitching devices, thereby the seam nail is stretched out.The lower limb of described seam nail pierces through material to be sewed up or tissue.In case described seam nail has pierced through material, described lower limb is pressed to the nail anvil head and is made that the seam nail is inside or outwardly-bent, and makes the seam nail remain on the appropriate location.Described lower limb can bend to parallel or be roughly parallel to the degree of described hat.When described lower limb curves inwardly, will form typical " B " shape, identical with many seam nails that once used.By the extruding nail anvil, the distortion of described seam nail forms flat, and tissue or material layer are kept together by flat seam nail.

When starting described stitching devices, described circular shear blade or trepan will advance along the longitudinal axis, to excise the tissue that engages with described anastomat.Therefore, annular or discoid tissue will be excised by described anastomat.After removing, described anastomat device will set up a continuous inner chamber between tissue surface or the part waiting to be stitched together.For example, this can be so that one section intestinal when being connected to or reconnecting other end intestinal to the rectum stump, keeps the hollow cavity that Excreta can be passed through.Perhaps, described circular shear blade can be created one and make mouth between inner chamber (as perineum chamber or gastrointestinal tract inner chamber) and health outside.The diameter of described circular shear blade is followed closely the diameter that groove is arranged less than driving blade and seam, thereby only can be cut with interior portion of tissue at stitching thread.Stitching thread is intactly stayed, so that two surfaces are kept together.

US4576167 and US5758814 have further described the stitching devices that is used for described anastomat device, and its content is incorporated herein by reference.

In one embodiment, described pin anvil shaft can comprise one or more circumferential notch 242, as Figure 11 and shown in Figure 13.These breach make and are booked in that intra-operative is easier, and provide more flexible and more continuous movement between user and nail anvil.Therefore these breach help part as grasping.Described pin anvil shaft can comprise one or several breach, for example 2,3,4,5,6,7,8,9,10 or more breach, and so that above-mentioned advantage to be provided.For example, described pin anvil shaft can comprise 1 to 2,1 to 3,1 to 4,1 to 5,1 to 6,1 to 7,1 to 8,1 to 9 or 1 to 10 breach.Described breach can extend fully along the circumference of described pin anvil shaft, for example forms annular groove, and perhaps they may be limited on the part of described pin anvil shaft circumference, shown in Figure 11 and 13.Described breach can occur in pairs, and they do not center on the whole circumferential extension of described pin anvil shaft like this, and is arranged on the opposite side of described pin anvil shaft.A pin anvil shaft can comprise 1,2,3,4,5,6,7,8,9 or 10 pair, or 1 to 2 pair, 1 to 3 pair, 1 to 4 pair, 1 to 5 pair relative breach.

In another embodiment, as shown in figure 11, described pin anvil shaft 240 can comprise watch window 246.Described nail anvil butt joint pin 130 also can comprise a butt joint indicant 132, thereby when described nail anvil 200 is docked to described nail anvil butt joint pin 130 fully, can sees by described watch window 246 and dock indicant 132.Figure 12 has showed the joint fully of described nail anvil and described nail anvil butt joint pin, and can see butt joint indicant 132 by watch window 246.

Described watch window provides the information of nail anvil and described anastomat degree of engagement for the user.Described watch window and butt joint indicant are orientated as described nail anvil are engaged fully with described anastomat, and only have to see described butt joint indicant by described watch window this moment.Because anus and external butt joint in the existence of the axle of elongation is convenient to, the combination of this watch window, butt joint indicant and elongated pin anvil shaft compared with prior art has more advantage, therefore when using described anastomat device, surgeon or other user can see described watch window and dock indicant.

Described butt joint indicant can be the labelling that visually is different from the other parts of described nail anvil butt joint pin.For example, described butt joint indicant can be a section of dyeing (as redness) of nail anvil butt joint pin, engages fully with described anastomat with the described nail anvil of quick visual confirmation.Described butt joint indicant can dock the whole circumference extension of pin along described nail anvil, thereby no matter the relative direction of rotation of described nail anvil and nail anvil butt joint pin how, still can be seen described butt joint indicant by described watch window.Described butt joint indicant is positioned on the described nail anvil butt joint pin, only makes that when described nail anvil was docked on the described nail anvil butt joint pin fully, described nail anvil indicant ability was alignd with described watch window.

Described pin anvil shaft 240 can comprise a watch window (as Figure 11 and shown in Figure 13, in Figure 13, described nail anvil has rotated 90 °, therefore can't see watch window).Perhaps, described pin anvil shaft can comprise a plurality of watch windows, for example, 2,3,4,5,6,7,8,9 or 10, or more, and this makes can see the butt joint indicant when described pin anvil shaft docks with nail anvil when pin engages fully.Therefore, described pin anvil shaft can comprise 1 to 2,1 to 3,1 to 4,1 to 5,1 to 6,1 to 7,1 to 8,1 to 9 or 1 to 10 watch window.Perhaps, described pin anvil shaft can comprise the part of being made by transparent or semitransparent material, and this part makes when described pin anvil shaft docks with nail anvil can see the butt joint indicant when pin engages fully.Therefore " watch window " of citation comprises the transparent or semitransparent part of described pin anvil shaft, as hole or the opening of the reality on described pin anvil shaft one side.

In one embodiment, because described nail anvil butt joint pin inserts in the described pin anvil shaft, therefore described nail anvil butt joint pin also comprises a retention device 134, when described nail anvil docks pin and docks fully with nail anvil nail anvil reversibly is fixed on the appropriate location.Therefore described pin anvil shaft comprises be used to the inner chamber 241 that holds described nail anvil butt joint pin.Figure 11 has showed that nail anvil 200 arranges be used to being docked to described nail anvil butt joint pin 130.Figure 25 is the cutaway view that described nail anvil butt joint pin 130 inserts the inner chamber 241 of described pin anvil shaft 240.

Described retention device can show as narrow and wide portion of the described nail anvil butt joint pin that matches with the narrow portion of described pin anvil shaft inner chamber.The inner chamber of described pin anvil shaft docks the shape complementarity of pin with described nail anvil, thereby when described nail anvil docks pin with described nail anvil and engages fully, narrow alignment of pin docked in described nail anvil in the narrow portion of the inner chamber of described pin anvil shaft, thereby makes described nail anvil be fixed in the appropriate location movably.

As shown in figure 11, described retention device can comprise the outer barrier device 248 that is positioned on the described pin anvil shaft and the inside retention device 134 that is positioned on the nail anvil butt joint pin.Described outer barrier device can be the part of pin anvil shaft, and in the time will being applied to described outer barrier device from the radially outer power in described pin anvil shaft center, described outer barrier device can oppositely extend beyond the circumference of described pin anvil shaft.Described outer barrier device is also corresponding with narrow of described pin anvil shaft inner chamber.For example, when described inner retention device 134 comprises narrow of described nail anvil butt joint pin and wide (as shown in figure 11), and the butt joint of this nail anvil is when being connected to described pin anvil shaft, and the narrow portion of the inner chamber 241 of described pin anvil shaft 240 makes the outer barrier device 248 of pin anvil shaft 240 pushed outwards.When narrow of the inner chamber 241 that described inner retention device 134 is pushed through the described pin anvil shaft 240 that is present in described outer barrier device 248 places, described outer barrier device 248 returns its initial position consistent with the both sides of described pin anvil shaft 240.The narrow portion of the diameter of pin 130 is docked corresponding to the described nail anvil that is positioned at described inner retention device 134 in the narrow portion that is positioned at described pin anvil shaft 240 inner chambers 241 of described outer barrier device 248, thereby makes described nail anvil movably be fixed in suitable position.

Described retention device is called as the click spring docking mechanism sometimes.Other retention device is apparent for those skilled in the art.

Except described nail anvil reversibly is fixed on the appropriate location, the existence of described retention device also has additional advantage, can send audible sound when described nail anvil engages with anastomat, for the audition that the user provides nail anvil and described anastomat to engage is fully confirmed.

Described retention device makes that also nail anvil can not come off from anastomat when operation anastomat device.Therefore, described retention device has improved the safety of described anastomat.

Preferably, described nail anvil head has circular cross-section at transverse plane.Described nail anvil head comprises two apparent surfaces 222 and 224.One the center of described pin anvil shaft from described two surfaces stretches out, and vertical or be approximately perpendicular to the plane on the surface of extending the butt joint pin.Therefore described pin anvil shaft is connected to the first end of described nail anvil, is one with the nail anvil head perhaps.In certain embodiments, described nail anvil head comprises smooth surface, and wherein said pin anvil shaft extends from this surface.Its facing surfaces is arc, taper shape or conical butt.The shape of common described nail anvil head is modelled as, by intestinal cutting operation (entering intestinal by operative incision) or the own channel operation nail anvil by for example stomach, intestinal, esophagus or other cavity organ the time, for nail anvil provides Non-Invasive top.

Perhaps, one among the apparent surface 222 or 224 can be concave surface, and another is convex surface, and these two apparent surfaces are complimentary to one another, and the thickness of described nail anvil head is by these two apparent surfaces' distance decision.In this embodiment, described pin anvil shaft extends from the center of concave surface 222.Usually, at least part of concave surface is flat, and when described pin anvil shaft docked the pin joint with nail anvil, it was perpendicular to the longitudinal axis of anastomat.

The nail anvil head surface 222 that extends described pin anvil shaft comprises a plurality of breach or pit usually, and when described nail anvil docked in pin joint and the nail anvil butt joint pin withdrawal anastomat with nail anvil, it alignd with the seam nail groove of stitching devices 150.When these breach started described stitching devices, the seam nail was inside or outwardly-bent.Therefore, in case seam nail lower limb passes tissue to be sewed up and when inside or outwardly-bent by nail anvil, described seam nail is fixed in position, and two tissues are fixed together (for example, when creating anastomotic stoma or make the choma of sewing up when mouthful creating of making and bore two cavity organs in creating).The breach on described nail anvil head 222 surfaces can form by modes such as mechanical compaction or engravings.

In one embodiment of the invention, except being used for holding the inner chamber 241 of described nail anvil butt joint pin, described pin anvil shaft also comprises hollow channel 221, as shown in figure 25.Described hollow channel can extend from the inner chamber 241 of described pin anvil shaft 240, pass the whole thickness of described nail anvil head 220, ends at the hole 223 on the surface 224 of described nail anvil head 220.Described pin anvil shaft can comprise a plurality of such passages, and each passage ends at each hole on the nail anvil head surface 224 respectively.Perhaps, described nail anvil 245 can comprise a hollow channel 221 in pin anvil shaft, and this hollow channel is told a plurality of passages or network channel in described nail anvil head, and each passage ends at the hole on the surface 224 of described nail anvil head.Figure 25 has showed the nail anvil 245 of this embodiment of the invention, and wherein, described nail anvil comprises hollow channel 221, and it tells a plurality of passages, and each passage ends at the hole 223 on the surface 224 of described nail anvil head 220.

When nail anvil 245 was connected on the aspirator 225, these passages made air to be inhaled into by the nail anvil head.When apply when suction by described nail anvil, will organize by described passage utilization suction reversibly to be connected to described nail anvil head, described nail anvil can be used for handling biological tissue or other material.This suction produces vacuum, is convenient to reversibly be adsorbed to described nail anvil head with organizing.When tissue place in place or can be used by pliers or other surgical device or surgical finger the time, removable should suction.

Described aspirator can have accessory 227, is used for making it to engage with pin anvil shaft with the identical mode of nail anvil butt joint pin.Described nail anvil 245 can comprise sealing gasket 229, and it provides hermetic seal at described aspirator and nail anvil interchannel.Described sealing gasket can place the place of a passage of a plurality of passages remittance works in the described nail anvil head, and perhaps when this aspirator engaged with nail anvil, it also can place the terminal of described pin anvil shaft below aspirator accessory.

Alternatively, described nail anvil butt joint pin 130 also can be equipped with one or more hollow channels 136, as shown in figure 25.Should make air pass through described nail anvil butt joint pin by a middle mouthful passage, then be inhaled into by the passage 221 on the described nail anvil head 220 or hole 223.Therefore, when described nail anvil docked the pin joint with described nail anvil, described anastomat can be connected to described aspirator, even and when described nail anvil engages with anastomat, also can manipulation of tissue.As shown in figure 26.Anastomat 100 is connected to aspirator 225, and this aspirator 225 aspirates air by the central passage 136 in the described nail anvil butt joint pin 130 through described nail anvil butt joint pin 130.

Preferably, have among the embodiment of one or more passages at the nail anvil head, described aspirator is controlled, and therefore being applied to structural aspiration can change, thereby prevents the damage (to the non-damage operation of tissue) to tissue.The operation of tissue is included in the various surgical operations movement and excision to organ in tissue and the human body, for example, the non-damage of the establishment midgut of making mouthful in stitching is fixed and put back to, and is particularly external when making mouthful with formation when intestinal is exposed, and guarantees the correct orientation of intestinal.Figure 27 has showed the operation to one section intestinal.

In one embodiment, described anastomat device also comprises the quantifier that is positioned on the described stapler main body, and this quantifier has been retracted into information how far in the anastomat for the user provides described nail anvil butt joint pin.When the user rotated constriction device, the distance of the described anastomat of retraction was mobile up and down according to described nail anvil butt joint pin for described quantifier.Described quantifier can comprise certain upper limit and lower limit.Be lower than this lower limit, then described nail anvil butt joint pin not have enough withdrawals and fixes in place so that seam is followed closely to be bent by the breach in the nail anvil head.Surpass this upper limit, then the withdrawal of described nail anvil butt joint pin too much is positioned at nail anvil head and stitching devices two tissues at the interface thereby may damage.

In a preferred embodiment, described quantifier is positioned at the far-end of described anastomat, thereby when the user held described anastomat, user's hands can not block this quantifier.

Described anastomat and stapler main body can be made by any suitable material known to those skilled in the art.For example, described anastomat can comprise plastics (as polyamide, polystyrene, polrvinyl chloride, polypropylene, polyurethane, Merlon or polyether-ether-ketone), metal (as rustless steel or titanium) or pottery.Described nail anvil also can be made by these materials.

The trocar of described pliers 2 is used for inserting in the pin anvil shaft 240 of described anastomat device.Described grabbing assembly is preferred for the described pin anvil shaft of grasping, can not increase the width of (or significantly increasing) described grabbing assembly simultaneously when described grabbing assembly engages with pin anvil shaft.Described movably grasper can be configured such that when described grabbing assembly engages with pin anvil shaft described movably grasper is parallel to described elongate body.

When the trocar 30 of described pliers 2 was used for inserting described pin anvil shaft 240, described pliers 2 was useful with the combination of anastomat device.For example, when inserting the described trocar 30 in the described pin anvil shaft 240, the bar 70 of described pliers 2 and/or grasper 40 keep and open position.Start described bar subsequently, so that described bar and grasper 40 are moved to make position.Described grasper 40 is firmly grasped nail anvil 200 by described pin anvil shaft 240 afterwards, therefore can move described nail anvil safely by described pliers 2.Described pliers 2 of the present invention is showed in Figure 19,20,29a and 29b with reversible being connected of anastomat nail anvil.

If have tooth 42 at described grasper 40, this helps the described nail anvil 200 of grasping.Particularly, the tooth 42 of described grasper 40 and 242 alignment of the breach of described pin anvil shaft 240, thus described tooth 42 is contained in the breach 242 of described pin anvil shaft 240.This makes and uses described pliers of the present invention can more safely firmly grasp described nail anvil.In addition, the width of described grabbing assembly does not increase after grasping described nail anvil or obviously increases.Can find out that described tooth 42 aligns with the breach of described pin anvil shaft 240, keeps narrow side from Figure 20 and 29a.

The existence at the trocar tip 30 on the described pliers 2 allows surgeon's piercing tissue.Therefore, described pliers 2 can be used for fetching and is contained in patient's body or intraorganic nail anvil, and does not need extra otch.Therefore, described pliers 2 can be used for laparoscopic surgery.

Described pliers 2 and elongated pin anvil shaft in conjunction with particularly useful external because it exposes described axle in operation process, this is for for example advantageous particularly when in the ultralow excision of establishment of anal verge 1 to 10cm place or anastomotic stoma.The external surgeon of making that exposes of described pin anvil shaft guarantees that nail anvil is docked to nail anvil butt joint pin fully.

In certain embodiments, external member of the present invention also comprises reinforcing network or reinforcement material.When described anastomat device in use, described net can place between the two layers of tissue to be stitched together.Perhaps, described net can put on the top of tissue to be sewed up or below.Because the seam of using nail passes the layer of tissue and described net, the choma of making that described net or other material are used for enhancing anastomotic stoma or formation bores.Described net also can improve the sealing between the two layers of tissue, to assist preventing that any material from leaking to body cavity from the inner chamber of organ.Net can also help prevent the adverse consequences of operation, for example pour hernie parastomiale.

Described net can be made by any suitable material, for example synthetic or biomaterial.When operation, before starting described stitching devices, described device is positioned on nail anvil butt joint pin or the pin anvil shaft.

Usually, described net is wideer than the width of described nail anvil head and stitching devices.This guarantees that described seam nail engages with described net.Described net can be any suitable structure, and is for example circular, square, avette etc.If described net is circular, the diameter of so described net is wideer than the diameter of described nail anvil and/or described stitching devices usually.Usually, the size of described net is set to cover anastomotic stoma or makes the whole girth that choma bores.

The synthetic material that is applicable to described net comprises polypropylene, polyester and politef (PTFE, for example compress, expansion or electrospinning).Polypropylene has stability, tenacity, inertia and good handling.Polypropylene net is made of the polypropylene fibre that is arranged in the net with different size aperture.The PTFE netting gear has slickness, flexibility, tenacity and growing into property of favorable tissue.

Biological net comprises the pericardium that takes off from cattle, pig and horse etc. on one's body, and other organ that comprises dermal tissue.

In some embodiments of the invention, described external member also can comprise preventer.The material that it is suitable that described preventer has plastics or metal or other is made, and is intended between the nail anvil butt joint pin of the nail anvil that places described stitching devices and have joint at transport process.By preventing that described stitching devices from pushing described nail anvil head, thereby protect described anastomat device to be without prejudice.Described preventer can also prevent that described stitching devices from being started because of carelessness, for example, in certain embodiments, has only that the sufficiently long distance of anastomat could start described stitching devices when nail anvil butt joint pin shrinks into.

Described preventer can be columniform, and preferably, described preventer comprises centre bore, and can be connected to described nail anvil butt joint pin, thereby makes nail anvil butt joint pin pass the centre bore of described preventer.Described preventer can also comprise a passage from the preventer outer to the preventer centre bore, even make when described nail anvil engages, described preventer still can be placed on the described nail anvil butt joint pin or from described nail anvil butt joint pin and remove.

In another embodiment of the present invention, described external member also comprises clamp 370, and it comprises two at one end by the interconnective elongate articles of active joint (for example hinge or pivot), and the other end of described elongate articles is crooked.The sweep of described elongate articles can be at 45 to 135 ° of angles (for example, 90 °) with the unbending part of described elongate articles.The shape of described elongate articles is mutually symmetrical usually.The curved end of described elongate articles comprises one or more crooked grooves, and wherein, the groove on relative elongate articles is in alignment with each other.This alignment makes and leaves the hole at clamp that when this clamp of user's closure each hole is by the recess defining of aliging on the relative elongate articles.Described groove is used for holding the pin anvil shaft of anastomat device, reversibly fixes described nail anvil when described jaws close.Preferably, described clamp is clamped described pin anvil shaft by the breach 242 that is positioned on the pin anvil shaft of the present invention.More preferably, the curved portions degree of described elongate articles can be firmly grasped described nail anvil so that be parallel to the longitudinal axis of described anastomat.The flexibility of described elongate articles is 90 ° to 10 ° angles, preferred 30 ° to 60 ° for the vertical part with respect to described elongate articles.

When operating nail anvil in the surgical operation, suitable clamp provides greater flexibility for the surgeon.Described clamp can be used in steps such as above-mentioned joint and location.Figure 25 and 26 has showed the clamp 370 of operation nail anvil.

In some embodiments of the invention, described kit also comprises operation instructions.In certain embodiments, described external member is sterilization.Described external member can be disposable.

According to a third aspect of the invention we, also provide the method that between two surfaces, forms anastomotic stoma of utilizing kit of the present invention, comprising:

First surface to be sewed up is connected on the nail anvil 200 of described anastomat device;

Utilize described pliers 2 to pierce through second surface to be sewed up;

Firmly grasp described nail anvil 200 with described pliers 2;

Described nail anvil butt joint pin 130 is engaged to described pin anvil shaft 240;

Locate described anastomat 100, so that described stitching devices 150 is engaged to second surface to be sewed up; And

Start described trigger 112, to connect described first and second surfaces and seam nail.

In one embodiment of the invention, the method for formation anastomotic stoma also comprises the step of regaining pin anvil shaft by the stitching thread of second surface.This method also can comprise the operation constriction device, to be engaged to described nail anvil butt joint pin at described nail anvil after, described nail anvil butt joint pin is retracted to described anastomat.Described nail anvil can be connected to described first surface (for example part of rectum or intestinal) by purse string suture or other any suitable method well known by persons skilled in the art.

In the embodiment that uses purse string suture, first tissue is centered around around the described nail anvil by purse string suture, so the nail anvil head is wrapped the into inner chamber of first tissue.Described pin anvil shaft passes purse string suture and exposes in order to being docked to described nail anvil butt joint pin.Make this sutural material and comprise polydioxanone (PDS), polyglycolic acid, polylactic acid, nylon and polypropylene.

The step that pierces through second surface is usually included in the center of circular seams zygonema (or the stitching thread of other suitable shape, according to the arrangement of the seam nail that uses) and pierces through second surface.Described stitching thread refers to after starting described stitching devices, the ideal position of described seam nail.

In order to sew up second surface, described method also comprises the hole that utilizes on stitching thread or the closed second surface of seam nail, and the step that pierces through second surface with described pliers.For example, when between one section intestinal and far-end rectum stump, creating anastomotic stoma, before piercing through with pliers, can utilize the closed or excision far-end rectum stump of stitching thread or seam nail.Perhaps, can make otch at second surface, make nail anvil promptly and by otch be removed by described pliers.Because otch or acanthopore are less than the diameter of described nail anvil head, so this guarantees that described two surfaces (a section intestinal and far-end rectum stump) correctly are positioned the interface between described nail anvil head and the stitching devices, so that when starting described stitching devices, described seam nail passes two surfaces.

Can utilize described pliers to operate described pin anvil shaft.Described pliers is used for fetching described pin anvil shaft through the stitching thread of second surface, thereby with the stitching thread of first surface guiding to second surface.

In case described pin anvil shaft is retrieved through the stitching thread of second surface, described nail anvil can be docked to described anastomat.The selectable operation of described constriction device (as required), and start described trigger.Thereby start described stitching devices, described two surfaces are fixed together with the seam nail.The circular shear blade of described stitching devices is also guaranteed between the inner chamber on first and second surfaces, or continuous inner chamber between the tissue, and can end to end anastomosis.This inner chamber can be enteric cavity, and this depends on the position of anastomotic stoma.

Reinforcing network can be arranged on pin anvil shaft or the nail anvil butt joint pin, thereby described net also is seamed to anastomotic stoma.Described net can be positioned between two surfaces to be sewed up or the tissue.Perhaps, described net can be present in above the surface to be sewed up or below.In certain embodiments, can use one or more nets, for example can use 2,3,4,5 or more.

If the use net, the circular shear blade of described anastomat device will cut described net, to guarantee the continuous inner chamber between two surfaces.Need to sew up the outward flange of described net, so that described net is completely fixed to correct position.

The step of locating described anastomat can comprise that the interface 250 of utilization between described nail anvil head and described stitching devices engages described first and second surfaces.Described first and second surfaces are restricted to or between the surface 222 and described stitching devices 150 of described nail anvil head, thereby when starting described stitching devices by startup trigger 112, the lower limb of described seam nail pierces through described surface, and with the seam nail two surfaces is fixed.Described circular shear blade is set up continuous inner chamber along advancing of the longitudinal axis between two surfaces or tissue.

Figure 28 to 31 has described the purposes that near the enteral of described surgical stapling apparatus anal verge created anastomotic stoma.

Figure 28 has showed the placement that is about to carry out the extension nail anvil of described anastomat before the docking operation.Described nail anvil places the near-end enteral by purse string suture (purse string attachment), the nail anvil clamp 370 that this near-end intestinal is reequiped especially is pulled to the perineum chamber, and the setting angle of this clamp 370 is customized to the longitudinal axis that allows to be parallel to described anastomat and clamps described pin anvil shaft.By firmly grasping described pin anvil shaft along a breach 242 of described pin anvil shaft location.Perhaps, can use the pliers of standard.Described pin anvil shaft is positioned on the remaining far-end rectum stump 350, and this position is in advance by linear stitching devices or stitching thread excision.

Figure 29 a and 29b have showed that described pliers of the present invention passes far-end apical stitch line, and firmly grasp the nail anvil of described anastomat device, thereby fix, fetch and draw described pin anvil shaft through the intestinal otch that is positioned at the far-end stump.Described pliers 2 of the present invention makes and tissue is not being caused under the situation of additional injuries, pierces through far-end apical stitch line.In addition, the profile of described pliers makes and tissue is not being caused under the prerequisite of further damage, takes out described nail anvil by far-end apical stitch line.The tooth of described movably grasper is positioned to align with the breach of described pin anvil shaft, providing safer connection between described pliers and described nail anvil, even when pliers engages with pin anvil shaft simultaneously, also keeps the narrow profile at the trocar tip of described pliers.

Figure 30 a and 30b showed by far-end stump intestinal cut take out described nail anvil fully and expose external in order to pin anvil shaft and anastomat in interior anus or external butt joint.Reorientate described nail anvil clamp 370 to clamp described nail anvil, with firm and promotion butt joint.Whether Figure 30 a and 30b have clearly showed butt joint indicant on the described nail anvil butt joint pin and the watch window on the described pin anvil shaft, can see described butt joint indicant by this window, finish to confirm butt joint.

Figure 31 a and 31b have showed nail anvil and the nail anvil butt joint pin of butt joint fully, can know by watch window and see the butt joint indicant.By starting described trigger, closed described anastomat device, thus two tissues are linked together, anus entered into the anal orifice and rectal intestine stump in seam nail body shell was passed like this, noted simultaneously sphincter mechanism and anal orifice and rectal intestine stump 350 are put in order passing through of segment length.When described nail anvil and anastomat housing appropriate location, start described anastomat device, to create anastomotic stoma.

Traditional butt joint occurs on the level of described seam nail housing.But the anastomat with elongated pin anvil shaft makes the extension that nail anvil butt joint pin-pin anvil shaft assembly is can be almost unlimited, and to be used for anatomical variation, for example obese patient, and other operation for example wishes the fat-reducing surgical operation at external connection seam pin anvil shaft assembly.

According to a forth aspect of the invention, provide a kind of method, this method is utilized described kit of the present invention to form or create the experimenter on one's body and is made the choma brill, comprising:

In the tissue of making mouthful to be formed, form otch;

The nail anvil 200 of described anastomat device is inserted in patient's body;

Firmly grasp described pin anvil shaft 240 with pliers 2;

Make described pin anvil shaft 240 be docked to the nail anvil butt joint pin 130 of described anastomat 100; And

Start described trigger 112, in tissue to be sewed up, to distribute a series of seam nails.

Form or create the method for making mouth and also can comprise the step of using pliers to fetch described pin anvil shaft by otch.Described pliers is used for operating described pin anvil shaft, and fetches described pin anvil shaft through the structural stitching thread of making the choma brill to be formed.Described nail anvil head can be connected to organ or portion of tissue, for example one section intestinal or skin, and described like this nail anvil head is comprised in the inner chamber of organ, and pin anvil shaft is outstanding from this tissue.Then, the pin joint is docked in described pin anvil shaft preparation with nail anvil.Therefore, method of the present invention can comprise the step of utilizing the mode of purse string suture for example described nail anvil to be connected to organ or tissue by described nail anvil head.

In another embodiment of the present invention, described method can comprise that one or more reinforcing networks are applied to described nail anvil docks pin or pin anvil shaft.

For the method for described formation anastomotic stoma, described net can be with any order setting, thus this net can be positioned at above the tissue to be sewed up or below, perhaps when a plurality of organized layers need be stitched together, this net can be placed in these organized layers.If the use net, the annular blade of described anastomat device will cut this net, to guarantee to form to make between inner and this organ outside of organ that choma bores continuous inner chamber be arranged.Need to sew up the outer rim of described net, in order to it is completely fixed in place.

In another embodiment of the present invention, form the step that the method for making the choma brill may further include the constriction device of operation anastomat, dock pin to regain nail anvil, and nail anvil is engaged to described anastomat.

Operation or location nail anvil may relate to the use of pliers 2 and/or clamp 370 in operation.

Start described stitching devices by starting described trigger 112, to distribute described seam nail and with the fixation of tissue at the interface between described nail anvil head and stitching devices together.Will be at internal cavity (for example abdominal cavity) and external formation trepan along the annular blade that the longitudinal axis advances.The distortion that distributes the seam nail by organized layer is fixed together, thereby fixing trepan periphery.

Figure 16 to 24 has described described pliers of the present invention and has made mouth in establishment and change purposes in the brill.

In open surgery, form and make mouthful (or make choma and bore), cylindric to sheath of rectus abdominis 410 one of excision from abdominal skin and subcutaneous tissue 400 earlier usually, as shown in figure 16.Then described sheath 410 is opened a cross recess, rectus abdominis m. by separately (Figure 17), selectable makes it stay open (seeing Figure 18) with retractor along its single.Introduce the nail anvil 200 of suitable size then by the abdominal part of opening.The diameter of described anastomat and nail anvil depends on the diameter that finally passes the intestinal of making the choma brill.

Then, insert described pliers 2 of the present invention by the stomach wall trepan, until penetrating posterior rectus sheath and peritoneum (Figure 19).Described pliers is enough sharp, to pierce through the layer that it need pass through.Described pliers is used for firmly grasping described pin anvil shaft and taking out described pin anvil shaft through otch, and is external by trepan described pin anvil shaft is exposed, and is exposed to abdominal wall (Figure 20).The tooth of described movably grasper is positioned the breach alignment of described pin anvil shaft, so that more stable connection to be provided between described pliers and nail anvil, even when engaging with pin anvil shaft simultaneously, keeps the narrow profile at the trocar tip of described pliers.

Described clamp 370 selectively body external be used to firmly grasping described pin anvil shaft, make it keep stable, and finally assist described pin anvil shaft to dock the joint (Figure 21) of pin with the nail anvil of described stitching devices.Reinforcing network 138 selectively is designed to circle, and its diameter is more than or equal to the diameter of described nail anvil, and selectively, when this reinforcing network prepared, the heart can be created a small gap therein.Can be used for making described net to be inserted into described nail anvil butt joint pin 130 after the described online breach, as shown in figure 21.

Described pin anvil shaft is by clamp 370 grippings and dock pin 130 with the nail anvil of described anastomat and engage.In case lock successfully, the operation constriction device surrounds described reinforcing network, and is positioned at posterior rectus sheath and peritoneum (Figure 22) between nail anvil head and stitching devices.Then, before removing described anastomat 100, start trigger with the startup stitching devices, and take away reinforcing network, posterior rectus sheath and the peritoneum of plate-like, stay the stitching trepan 450 of the accurate reinforcement of being defined by stitching thread 440.Then, the edge 139 of this net 138 is alternatively by being interrupted the 0PDS(polydioxanone) stitching thread or seam nail are seamed to preceding sheath of rectus abdominis, thus this net lies low to protheca, and along the described trepan 450 that passes meat fiber separately (Figure 23) is set fully.

Pull out colon or ileum by described trepan then, form in common mode and make a mouthful (Figure 24; Prior art is described the formation of making mouth, for example, and Keighley, M.R.B.﹠amp; Williams, N.S., " Surgery of the Anus Rectum and Colon ", and 3rd Ed., Saunders Ltd., 2008:Chapter5, pp.175-278).

The inventor has developed the technology that comprises reinforcing network, and it is called as SMART (sew up net and make a mouthful reinforcement technique).The research that comprised net in the past is used for open surgery, and this Netcom crosses the abdomen route and is positioned under the peritoneum.Though this technology is simple relatively, it has significantly increased the operating time, and is difficult to carry out laparoscopic surgery.Use pliers of the present invention and anastomat device can implement the SMART technology quickly and easily, and net is placed in the correct layer of stomach wall, to prevent adhesion.This technology can repeat, and can easily carry out in open surgery and laparoscopic surgery.Described anastomat allows to create makes the choma brill, reinforces the described choma made from net simultaneously and bores.It can be used for forming almost various types of mouths of making, and comprises generating in ileostomy and the colostomy making mouth.Because trocar tip can be used for piercing tissue, and make under the prerequisite that choma bores (excessively stretch make choma bore may cause pour hernie parastomiale) excessively not stretching, regain described anastomat nail anvil, so described pliers can be easily and is operated described anastomat nail anvil rapidly, particularly in laparoscopic technique.

Described method of the present invention can be used any pliers of kit of the present invention.For example, described nail anvil can comprise one or more hollow channels, and this passage extends to the whole thickness that passes described nail anvil head from described pin anvil shaft.This makes described nail anvil or anastomat be connected to aspirator.Described device can be created vacuum by the place, hole on the surface of described nail anvil head subsequently, and in operation process manipulation of tissue.

Use has nail anvil 245 and the aforesaid aspirator of one or more hollow channels, shown in Figure 25 to 27, helps to guarantee that the intestinal of formation being made mouth easily is removed by trepan, or correct guiding.Owing to entering the limited of abdominal cavity, therefore make in the interruption-forming at peritoneoscope in such operation, this operation is difficult especially.

Described anastomat and pliers can be used for opening, endoscope and laparoscopic surgery and method, although pliers of the present invention 2 is specially adapted to laparoscopic surgery.This anastomotic stoma or make choma and bore and to be formed in any ideal surfaced or biological tissue that the patient can sew up.Suitable biological tissue comprises organ walls, entoderm, ectoderm, mesoderm, digestive tract, small intestinal, large intestine, duodenum, jejunum, ileum, caecum, colon, rectum, connective tissue, muscular tissue, epithelial tissue, stomach, esophagus, trachea, peritoneum, sheath of rectus abdominis, far-end rectum stump, endothelium, enteral skin, skin and stomach wall.Anastomotic stoma or make choma and bore and between two or more above-mentioned biological tissues, to form.For anastomotic stoma, two organize and have the inner chamber that can be combined together to form anastomotic stoma usually.For example, anastomotic stoma can be between two sections intestinal of patient, or form between intestinal and the far-end rectum stump.Such anastomotic stoma is commonly referred to the end to end anastomosis mouth.Make choma bore can patient's abdominal part or any want to form make the place that choma bores and form.

Surface to be sewed up or tissue comprise biological tissue, for example intestinal or intestinal wall, esophageal wall, posterior rectus sheath, far-end rectum stump or peritoneum.Other tissue comprises health outside organization, for example when the skin of creating when making mouthful, or general organ.To be sewed up organizing also can refer to surface to be sewed up or material.

Described method can be carried out in patient's (mankind or non-human patients) body.Described method also can be the in vitro method that carries out at tissue samples.

Described method relates to pliers of the present invention, and this pliers can be used for any suitable surgical stapling apparatus.For example, described pliers can with Chex ^TMUse of the crooked disposable use intracavity anastomat of CS-28 (can obtain from Frankenman International Limited).

If described method is used nail anvil 245, this nail anvil comprises one or more hollow channels, this passage extends to the whole thickness of described nail anvil head from described pin anvil shaft, and described method can also comprise by described nail anvil and apply suction, with operation surface to be sewed up or the step of tissue.Operation tissue or surface to be sewed up makes it by suitable location by this way, the formation that is beneficial to anastomotic stoma or makes mouth.

According to a fifth aspect of the invention, provide described pliers of the present invention in anastomotic stoma or make choma the purposes when boring formation.

According to a sixth aspect of the invention, provide kit of the present invention in anastomotic stoma or make choma the purposes when boring formation.

Of the present invention second and the characteristic of follow-up aspect all be to make suitable modification with reference to a first aspect of the present invention.

Embodiment

With reference to following example, present invention will be further described carries out, and these examples are for illustration purpose, rather than in order to limit the scope of the invention.

The low Low Level anterior resection of rectum on anterior perineum plane (APPEAR technology)

Register 14 patients, wherein, 7 is tumor, and 5 is ulcerative colitis, and 2 is traumatic rectal injury.Before art and average postoperative 2 years, the patient is assessed.

Among 14 patients 9 have experienced ileostomy and have reversed and experience at least one year follow up a case by regular visits to, and one of them patient waits for closure.Owing to make a mouthful perineum fistula, four patients do not consider that as yet ileostomy reverses.3 among 14 patients have the handicapped record of transience, but diseases of urinary system do not take place.

When being that tumor or trauma patient carry out the APPEAR operation, the average Wexner incontinence scoring of postoperative patient is 5(scope 0-8, and n=6), average stool is 3(scope 1-8/ days).All cancers are all excised no local recurrence fully.For patients of ulcerative colitis is carried out restorative proctocolectomy APPEAR, Wexner incontinence scoring is 2(scope 0-6, and n=3), on average every day, stool was 3(scope 1-5).SF-36 scoring (weighing 36 brief investigation questionnaires of quality of life) does not obviously change before the art behind closure of ileostomy, and after perineum was dissected, the anal orifice and rectal intestine physiological test did not change.

Therefore, but this APPEAR operation provides a kind of selecting technology for realizing low Low Level Operation of Remaining Musculus Sphincter anastomotic stoma, and this is impossible for traditional operation.This is a kind of promising new operation, even present situation also might reduce the permanent needs of making mouth.In technology such as for example APPEAR, use anastomat device of the present invention, allow nail anvil and anastomat and interior anus or external the joint, make the surgeon can be more clearly visible the position of nail anvil, help it is docked in the nail anvil butt joint pin.Described elongated axle makes that also the surgeon can be at the external joint fully of seeing described nail anvil and anastomat.

Sew up net and make a mouthful reinforcement technique (SMART)

The other hernia of colonic diversion (PH) has very high sickness rate.Three randomized controlled trials show that reinforcing network can significantly reduce its sickness rate.But this technology is very consuming time, be difficult to carry out in laparoscopic surgery, and the craft of dependence trepan is flexible.SMART solves these problems.

SMART uses anastomat device described herein, creates accurate trepan in posterior rectus sheath and peritoneum, simultaneously net circumferentially is fixed to trepan under peritoneum.Stretching is minimum.9 of randomized controlled trial (M:F2:7,55 years old mean age, scope 24-77 year) PH high-risk patients, SMART(7 open surgery, 2 laparoscopic surgeries are carried out in taboo).

The disease that operation back (30 days) is not relevant with making mouth is sent out.It is satisfactory that all make mouth function in 48 hours.Occur the intestinal obstruction irrelevant with making interruption-forming after a patient leaves hospital, the provisional mouthful pain and swelling of making takes place in another patient after the cardiopulmonary resuscitation success.In 13 weeks (2-14) of following up a case by regular visits to, do not find the other hernia of colonic diversion.

SMART be a kind of new simple, in open surgery and laparoscopic surgery, accurately create to reinforce and make the method that choma bores, it has reduced the sickness rate of colon pour hernie parastomiale.Described pliers of the present invention is used for SMART or APPEAR technology, to help to operate described nail anvil, as mentioned above.

Claims (26)

1. pliers comprises:

(a) elongated main body;

(b) be positioned at the grasping section of described main body end, described grasping section comprises bar;

(c) be positioned at the grabbing assembly of the opposite end of described main body, described grabbing assembly comprises movably grasper and the trocar; And

(d) actuator, described actuator is connected to described grabbing assembly with described bar, to cause that described grasper is with respect to the motion of described elongated main body.

2. pliers according to claim 1 is characterized in that, described actuator comprises the rod of the main body that is roughly parallel to described pliers, and makes described bar be connected to described grasper.

3. pliers according to claim 1 and 2 is characterized in that, described elongated main body is hollow.

4. pliers according to claim 2 is characterized in that, described elongated main body is hollow, and described rod is contained in the described elongated main body.

5. according to any described pliers of claim in front, it is characterized in that described movably grasper is connected to described pliers by the door bolt that forms pivot.

6. according to any described pliers of claim in front, it is characterized in that described movably grasper comprises one or more teeth.

7. according to any described pliers of claim in front, it is characterized in that the described trocar comprises one or more breach, when described grasper was closed, described breach alignd with the tooth of hinge type grasper or hinge type grasper.

8. according to any described pliers of claim in front, it is characterized in that described grasping section also comprises the elastic biasing device.

9. according to any described pliers of claim in front, it is characterized in that the described trocar is suitable for being inserted in the nail anvil of operation circular anastomosis device.

10. a kit comprises any described pliers of claim in front and anastomat device, and described anastomat device comprises:

(a) have the anastomat of near-end, far-end and the longitudinal axis, described anastomat also comprises

(i) trigger;

(ii) nail anvil docks pin, and described nail anvil butt joint pin is roughly parallel with the longitudinal axis of described anastomat; And

(iii) stitching devices, described nail anvil butt joint pin and stitching devices are positioned at the described far-end of described anastomat;

(b) dismountable nail anvil comprises nail anvil head and pin anvil shaft;

It is characterized in that described pin anvil shaft is used for receiving described nail anvil butt joint pin, and operates described trigger, and described stitching devices is started, the trocar of wherein said pliers is used for being inserted into described pin anvil shaft.

11. kit according to claim 10 is characterized in that, the length of described pin anvil shaft is 4 to 20cm.

12. according to claim 10 or 11 described kits, it is characterized in that the grasper of described pliers comprises tooth, described pin anvil shaft comprises breach, wherein said tooth is used for and described breach engagement.

13. according to any described kit in the claim 10 to 12, it is characterized in that, also comprise preventer.

14. according to any described kit in the claim 10 to 13, it is characterized in that, also comprise net.

15., it is characterized in that the trocar of described pliers is used for inserting the pin anvil shaft of described anastomat device according to any described kit in the claim 10 to 14.

16. utilize the kit described in any in the claim 10 to 15 between two surfaces, to form the method for anastomotic stoma, comprising:

First surface to be sewed up is connected to the nail anvil of described anastomat device;

Pierce through second surface to be sewed up with described pliers;

Firmly grasp described nail anvil with described pliers;

Described nail anvil butt joint pin is engaged with described pin anvil shaft;

Locate described anastomat, described stitching devices is engaged with second surface to be sewed up; And

Start described trigger, with the seam nail described first and second surfaces are linked together.

17. method according to claim 16 is characterized in that, also comprises the step of operating constriction device, is retracted in the described anastomat with the nail anvil with described nail anvil butt joint pin and joint.

18., it is characterized in that described first surface that will be to be sewed up by purse string suture is connected to described nail anvil according to claim 16 or 17 described methods.

19. according to any described method in the claim 16 to 18, it is characterized in that, also comprise net is applied to described nail anvil butt joint pin or pin anvil shaft.

Any described kit forms the method for making the choma brill in the claim 10 to 15 in patient's body 20. utilize, and comprising:

In the tissue of making mouthful to be formed, form otch;

The nail anvil of described anastomat device is inserted in patient's body;

Firmly grasp described pin anvil shaft with pliers;

Described pin anvil shaft is docked on the nail anvil butt joint pin of described anastomat; And

Start described trigger, so that a series of seam nails are dispensed in the tissue to be sewed up.

21. method according to claim 20 is characterized in that, also comprises the step of utilizing described pliers to fetch described pin anvil shaft by otch.

22. according to claim 20 or 21 described methods, it is characterized in that, also comprise net is applied on described nail anvil butt joint pin or the pin anvil shaft.

23. according to any described method in the claim 20 to 22, it is characterized in that, also comprise the operation constriction device, be retracted to step in the described anastomat with the nail anvil with described nail anvil butt joint pin and joint.

24. according to any described method in the claim 16 to 23, it is characterized in that, described nail anvil comprises one or more hollow channels, described passage from pin anvil shaft, extend through the whole thickness of nail anvil head, described method also comprises the step of aspirating by described nail anvil.

25. any described pliers is in anastomotic stoma or make the purposes of choma in bore forming in the claim 1 to 9.

26. any described kit is in anastomotic stoma or make the purposes of choma in bore forming in the claim 10 to 15.

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