Microsurgery anastomosis tool

A microsurgery tool for use in anastomosis of small vessels has a thin shaft with a pair of forwardly projecting tines defining a throat for receiving the pointed end of a suture needle. The microsurgery tool is inserted between confronting ends of vessels into engagement with the inner wall of one vessel for receiving a suture needle point passing through the outer wall of the vessel and thereafter is withdrawn from the space between the vessels to engage the outer surface of the other vessel where it receives the pointed end of the same suture needle passing through the inner wall of the other vessel.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention relates to a microsurgery tool to be used in anastomosis of 
small vessels, e.g., veins and arteries. 
2. Description of the Prior Art 
Microsurgery procedures require anastomosis of small vessels, e.g., veins 
and arteries, which may have a diameter of 0.4-1.5 millimeters. When open 
ends of such small vessels are to be joined (anastomosis) the recommended 
procedure is to provide 6 to 8 sutures for a vein-to-vein connection and 7 
to 9 sutures for an artery-to-artery connection. Typical sutures are 0.3 
to 0.4 millimeters wide. Because of the size of the vessels and sutures, 
these procedures are carried out with use of a microscope and are referred 
to as microsurgery techniques. 
Overwhelmingly, such anatomosis procedures employ a clamping device which 
secures the cut ends of the vessel in alignment. See U.S. Pat. No. 
4,553,542. A normal procedure employs microsurgery forceps which are 
inserted through the open end into one of the vessels and allowed to 
spring open whereby the vessel end region is dilated to facilitate 
puncture of that vessel with a suture needle. The forceps are withdrawn 
and inserted through the open end of the other vessel for dilation and the 
suture needle point punctures the dilated vessel surface. The suture 
needle is extracted from both vessels and the trailing suture is tied. 
This sequence is repeated numerous times for each vessel. The initial 
sutures are usually spaced diametrically apart on the vessels and can be 
applied without significant difficulty. Subsequent sutures however are 
quite difficult with the microsurgery forceps technique because of the 
small size of the vessels. Typically, anastomosis of a single vessel using 
the microsurgery forceps techinques may require about one hour of surgical 
time. The success of overall surgical procedures frequently depends upon 
the success of blood vessel anastomosis procedures. An alternative 
existing procedure employs a ring device which is mounted annularly from 
the anastomosis site as described in U.s. Pat. No. 4,474,181. This 
procedure dilates the ends of the vessels and maintains the anastomosis 
suture connection in a dilated condition by connecting each suture to the 
annular ring. Each suture is normally applied with the microsurgery 
forcepts techniques when a ring device is used. 
STATEMENT OF THE PRESENT INVENTION 
A microsurgery tool is provided which functions in cooperation with a 
suture needle in small vessel anastomosis. The microsurgery tool has a 
thin shaft with a pair of forwardly extending tines defining a throat. The 
microsurgery tool is inserted into one of the two vessels and interiorally 
supports the vessel wall. A surgical needle point is inserted through the 
outer wall of the vessel into the throat of the microsurgery tool and is 
directed by the tool through the vessel open end. Thereupon the 
microsurgery tool is withdrawn and placed on the other vessel outer wall 
and the suture needle point punctures the inner wall of the other vessel 
and appears in the throat of the microsurgery tool. Thereafter the 
microsurgery tool is withdrawn, the suture needle is extracted through 
both vessels and the trailing suture is tied. The procedure is repeated as 
many times as required to provide a satisfactory anastomosis.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
The microsurgery tool of this invention can be illustrated in one 
embodiment in FIG. 6 which shows the microsurgery tool 10 having a thin 
shaft 11 and a pair of tines 12, 13 extending forwardly from the shaft 
defining a throat 14 therebetween. The confronting surfaces 15, 16 of the 
tines 12, 13 are sloping surfaces which intersect along a line which is 
angularly presented with respect to the central longitudinal axis of the 
shaft. The confronting surfaces 15, 16 thereby provide a scoop-like 
configuration to the throat 14. The microsurgery tool 10 is secured to 
holding means 17 illustrated schematically in FIG. 6. The main body 
portion of the microsurgery tool 11 is illustrated as a multi-flat 
surfaced rod in FIG. 6. In a preferred embodiment, the main body portion 
of the microsurgery tool 11 is a cylindrical rod or a tapered cylinder 
rod. The thin shaft preferably is from 1 to 4 millimeters in diameter and 
about 10 to 30 millimeters long. The tines 12, 13 project for about 1 to 3 
millimeters, providing a throat opening about 1 to 2 millimeters deep. 
The microsurgery tool, in a preferred embodiment, has an arcuate distal end 
20 as illustrated in FIG. 7. The tool is secured to a handle member 21 
which resembles a pencil and is of such size and shape to permit handling 
by an operating surgeon. The side walls of the handle member 21 may be 
circular in cross-section, or preferably, may define an equilateral figure 
such as a hexagon, octagon. 
The operation of the present microsurgery tool will be described in 
relation to FIGS. 1 through 5 inclusive. 
In those drawings, a left vessel 30 is secured by a clamping member 31 in 
abutment with a right vessel 32 which is secured by a clamping member 33. 
The open ends 34, 35 of the vessels 30, 32 respectively are confined in 
abutment by means of the clamping members 31, 33. Typical clamping members 
are shown in U.S. Pat. No. 4,553,542. 
A normal vein or artery has a diameter of 0.4 to 1.5 millimeters. 
In order to initiate the anastomosis method, two sutures 36, 37 are 
provided in the vessels 30, 31 in accordance with normal prior art 
procedures, preferably by employing microsurgery forceps to dilate end 
vessel end opening 34, 35 respectively. These two sutures 36, 37 are 
spaced apart on the periphery of the open ends 34, 35 and retain the 
vessels 30, 32 to permit completion of the anastomosis. The microsurgery 
tool 11 is introduced between the open ends 34, 35 of the vessels 30, 32 
and the tines 12, 13 are inserted into the right-hand vessel 32 beneath 
its open end 35. The upper surface of the microsurgery tool 11 engages the 
inner wall of the right-hand vessel 32. Penetration of the tines 12, 13 
into the right-hand vessel is about 1.0 millimeters. The throat 14 of the 
tool 11 is maintained partly outside the cut end 35. Approximately 0.5 
millimeter of the throat 14 is outside the right-hand vessel and is 
visible to the operator. An arcuate suture needle 40 with a trailing 
suture 41 is introduced to the site with its point penetrating the outer 
wall of the vessel 32 in the region of the throat 14. The scoop-like shape 
of the throat 14 receives the point of the arucate suture needle 40 
directing the point out from the open end 35 of the vessel 32. 
The microsurgery tool 11 is then withdrawn from the opening between the 
open ends 34, 35 and is positioned as shown in FIG. 2 with its bottom 
surface engaged with the outer wall of the left hand vessel 30. The 
arcuate suture needle 40 punctures the inner wall of the vessel 30 beneath 
the throat 14 and penetrates the vessel wall upwardly, guided by the 
scoop-like shape of the throat 14. Thereafter the microsurgery tool 11 is 
withdrawn from the site and the arcuate suture needle 40 is extracted 
through the suture openings in the vessels 30, 32 with the trailing suture 
41 being drawn into a position where the suture ends (FIG. 3) can be tied 
to form a suture 42 as shown in FIG. 4. Thereafter the microsurgery tool 
11 is introduced into the opening between the open ends 34, 35 and 
contacts the inner wall of the right-hand vessel 32. The microsurgery tool 
11 is used in combination with an arcuate suture needle 40' which is 
secured to a trailing suture 41' and the process described in FIGS. 1, 2, 
3 is repeated to produce an additional suture 43 as shown in FIG. 5. 
When the anastomosis is complete, uniform sutures (36, 37, 42, 43, 44, are 
shown in FIG. 5) along with other sutures (not seen in FIG. 5) will 
present the number of sutures required to complete the anastomosis. 
The preferred embodiment of the microsurgery tool 10 includes an arcuate 
distal end 20 (FIG. 7). The microsurgery tool 10 can be formed with a 
straight shaft 11 as shown in FIG. 6. 
The thin shaft 11 preferably is formed from surgical steel although 
appropriate inert plastic substances can be employed for convenience and 
to reduce expenses. It may be preferred to provide a set of the 
microsurgery tools of differing dimensions as might be required to 
complete a particular anastomosis procedure. The set might include 
individual tools or interchangeable shafts 11 for standard suture needles. 
Typical needles in blood vessel anastomosis procedures are No. 10 (100 
microns thickness) and No. 11 (75 microns thickness). The throat 14 of the 
microsurgery tool 10 should be large enough to receive the cooperating 
suture needles. The tools 10 can be recovered, sterilized and reused. The 
shafts 11 may be permanently secured in holding elements such as the 
handle 21 of FIG. 7 or the shafts may be detachably secured to a holding 
element by pressfit or positive mechanical connection. 
In the improved method of this invention, anastomosis procedures are 
accelerated and are completed without excessive deformation of the 
vessels. Because of the close tolerances in the anastomosis procedure for 
small vessels, the microsurgery tool achieves a positive penetration of a 
suture needle in both vessels which are being connected. 
The procedure is illustrated in the drawings for a butt-to-butt connection 
of two vessels. It should be understood that essentially the same 
procedure can be carried out with an end-to-side anastomosis of the type 
which is well known in the art and which is illustrated, for example, in 
the aforementioned U.S. Pat. No. 4,474,181. 
The present microsurgery tool as well as the anastomosis procedure can 
employ the anastomosis ring described in U.S. Pat. Nos. 4,474,181 and 
4,553,542.