Resection apparatus

The resection apparatus includes a cutting instrument, e.g., a laser beam, and a unit for suturing the organ being resected, incorporating an oblong die with depressions for staples to bend, an oblong detachable staple body with a staple magazine and a staple ejector. A holder of the staple body has two members and, of which the first member is arranged parallel to the die and is rigidly coupled thereto, whereas the second member is arranged square with the former one, is offset transversely with respect to it and carries a retainer, to lock the staple body in position. Provision is also made in the apparatus for a hold-down frame set on the second member transversely in the plane of movement of the staple body so as encompass, while in one of its positions, the die along the external perimeter thereof for clamping the organ being resected. The first member has guideways for the cutting instrument to set and traverse.

FIELD OF THE INVENTION 
The present invention relates generally to medicine, more specifically to 
surgery and has particular reference to an apparatus for resction of human 
organs, especially those seated in hard to access places. 
BACKGROUND OF THE INVENTION 
Known in the present state of the medical art are instruments for suturing 
human organs with metallic staples, wherein the part of the organ being 
resected is cut off mechanically, i.e., by a knife after suturing (cf., 
e.g., USSR Inventor's Certificate No. 511,939). However, when applying 
such suturing instruments it is extremely difficult to use an electrotome 
or plasma scalpel or a laser beam as the cutting instruments. On the other 
hand, it is common knowledge that mechanical dissection fails to provide 
an aseptic and bloodless incision. 
Another apparatus for staple suturing and dissecting by virtue of a laser 
beam as disclosed in U.S. Pat. No. 4,143,660, is known to comprise a 
staple body and a supporting body, each being separately applied to the 
organ operated upon and joined together by a special locking device, a 
cutting instrument, an optical waveguide for a laser beam or a mechanical 
knife traversable along the staple body. However, such an apparatus cannot 
successfully be applied for resections in hard to access places (such as 
the cardiac portion of the stomach, the small pelvis, thoracic cavity). In 
addition, resection of human organs with the use of the apparatus 
according to said patent requires extensive mobilization of the organ 
operated upon which involves considerable traumatization of the 
surrounding tissues, increased loss of blood and complicated operative 
techniques. 
Another apparatus for suturing the gastric walls with pi-shaped staples and 
resection as described in USSR Inventor's Certificate No. 209,629, 
comprises a cutting instrument and a suturing unit for the organ being 
resected which incorporates an oblong die provided with depressions for 
staples to bend, a staple body with a magazine and a staple ejector, said 
staple being mounted on its holder comprising a member arranged parallel 
to the die and rigidly held thereto, and another member arranged square 
with the first one in the plane of movement of the staple body. 
However, the construction features of said apparatus fail to provide an 
aseptic incision of the tissue operated upon, since the member arranged 
parallel to the die and the other member arranged square with the former 
one are interconnected square with each other so that the former member 
along with the staple body lie in the same plane, that is, in the plane of 
movement of the staple body, which prevents the application of a change 
cutting instrument, in particular a laser beam, whereby an aseptic 
incision cannot be produced. 
SUMMARY OF THE INVENTION 
It is an object of the present invention to provide such a resection 
apparatus that would ensure aseptic operative procedure in hard to access 
places involving minimized amount of traumatized tissues and loss of 
blood. 
It is another object of the present invention to provide such a resection 
apparatus that would ensure a reliable fixing of the organ being resected 
both in the course of suturing and resecting in hard to access places with 
a possibility of merely replacing one cutting instrument by another. 
It is one more object of the pesent invention to provide such a resection 
apparatus that would ensure a possibility of applying a variety of cutting 
instruments in the same apparatus. 
It is still one more object of the present invention to provide a 
possibility of using a laser-beam cutting instrument in the resection 
apparatus involved, so as to ensure full aseptic conditions. 
It is yet still one more object of the present invention to provide a 
possibility of visual monitoring of the cutting process with the use of a 
laser-beam cutting instrument. 
And it is an additional object of the present invention to provide a 
resection apparatus of the character set forth hereinbefore that would 
ensure a lower extent of injury to the surrounding tissues. 
Said and other objects are accomplished due to the fact that in a resection 
apparatus, comprising a cutting instrument and a suturing unit which 
incorporates an oblong die with a number of depressions for staples to 
bend, an oblong staple body with a staple magazine and a staple ejector, 
said staple body being detachably mounted on its holder and having a first 
member arranged parallel to the die and rigidly coupled thereto, and a 
second member arranged square with said first member in the plane of 
movement of the staple body and rigidly fixed to said first member, 
according to the present invention, the second member of the holder is 
offset transversely with respect to the first member so as to lie off the 
plane of movement of the staple body, and carries a retainer to lock the 
staple body in position, and provision is also made for a hold-down frame 
mounted on the second member traversably in the plane of movement of the 
staple body so as to encompass, while in one of its positions, the die 
along the external perimeter thereof, whereas guideways are provided on 
the first member for the cutting instrument to move. 
An advantageous feature of the herein-proposed resection apparatus resides 
in that the transversely offset position of the second member of the 
holder with respect to the first member thereof makes it possible, after 
suturing the organ operated upon, to remove the staple body and replace it 
by any cutting instrument, in particular an optical waveguide of laser 
emission, in order to provide an aseptic resection in a hard to access 
zone of surgical intervention, while the retainer ensures high rate of 
such a replacement. The hold-down frame enables the tissue to be reliably 
fixed to the die after suturing which ensures against any dislodging of 
the sutured organ after removal of the staple body. Thus, a pin-point 
accuracy of cutting is attained which is of special importance when a 
laser-beam cutting instrument is resorted to. In addition, the guideways 
provided in this resection apparatus rule out any deviation of the cutting 
instrument. 
One of the embodiments of the present invention provides for the use of a 
laser-beam cutting instrument known `per se` whose optical waveguide is 
accommodated in a head mounted in guideways, a gap being provided between 
the guideways for the laser beam to pass.

DETAILED DESCRIPTION OF THE INVENTION 
Referring now to the accompanying drawings the resection apparatus 
comprises the following units and components: a staple body 1, a holder 2 
of the staple body 1, a die 3 with depressions 3a, a bracket 4 with a slot 
5, a hold-down frame 6, an optical waveguide 7 of laser emission (not 
shown), whose beam serves as a cutting instrument. The laser is not shown 
for the sake of easy reading of the drawings. Moreover the laser itself is 
irrelevant to the essence of the present invention and there may be used 
as such a laser any one of the currently used lasers capable of providing 
adequate emissive power, e.g., the "Scharplan" laser device. 
The holder 2 comprises a first member 8 arranged parallel to the die 3 and 
coupled rigidly thereto, and a second member 9 rigidly interconnected with 
the first member 8 of the holder 2. The first member 8 and the die 3 are 
made integral with each other so that such an integral piece is 
yoke-shaped. The die 3 carries a number of the depressions 3a for bending 
the staples fed from the staple body 1, and has a slot 10 (FIG. 2) for the 
cutting instrument to pass, as well as another slot 11 to accommodate a 
supporting plastics insert (not shown for the sake of easy reading of the 
drawing) whose shape follows that of the slot 11 and involved in cutting 
the tissue with the knife. The first member 8 of the holder 2 has 
guideways 12 for the optical waveguide 7 to traverse, as well as an 
opening 13 for centre-aligning and guiding the staple body 1. To provide 
more rigidity during the suturing the first member 8 and the die 3 are 
associated by a screw 14 (FIG. 1) which passes through a hole 15 (FIG. 2) 
in the die 3 situated between the rows of depressions. The hole 15 is 
closed by a plate 16 (FIGS. 3, 4) so as to prevent the laser beam from 
injuring the subjacent tissues and organs. 
The second member 9 of the holder 2 has a T-shaped profile, is rigidly 
coupled to the first member 8 of the holder 2 and is offset with respect 
to the first member 8 along its transverse axis for a length required in a 
given particular case for the laser waveguide 7 to set on the guideways 12 
of the first member. 
A handle 17 is provided in the top portion of the second member 9 of the 
holder 2, made integral with said member. A slot 18 is made in the handle 
17 for a rod 19 to pass, said rod entering with its end the slot 5 of the 
bracket 4, whereby the staple body 1 is locked in place on the second 
member 9 of the holder 2. 
The rod 19 is traversable along the slot 18 of the handle 17 under the 
action of a spring 20 which is centred about a stud 21. The slot 18 in the 
handle 17 accommodating the rod 19 and the spring 20 is closed on both 
sides by side members 22. A handhold 23 is for the rod 19 to retract into 
the slot 18 of the handle 17. 
The top portion of the second member 9 of the holder 2 carries the bracket 
4 to fix the staple body 1 in position. The bracket 4 has a slot 24 to 
accommodate a nut 25. The centre of the slot 24 coincides with the centre 
of the opening 13 in the first member 8 and with that of the slot 10 in 
the die 3, whereby the staple body 1 can be centre-aligned with respect to 
the opening 13 in the first member 8 and the die 3. 
The second member 9 carries a link 26 of the hold-down frame 6 which is 
traversable in the plane of movement of the staple body 1 independently of 
the latter by means of the link 26. While in one of its positions (when 
fixing the organ being resected) the hold-down frame 6 is locked by a 
latch 27 actuated by a spring 28. When in this extreme position the 
hold-down 6 encompasses the die 3 along the external perimeter thereof so 
that the edge of the hold-down frame interacts with the tissue of an organ 
29 to fix it on bevelled edges 30 of the die 3, at the same time 
stretching the tissue and forcing it against the die. A flange 31 is 
provided at the top of the link 26 of the hold-down frame 6 for 
conveniently moving the latter. A screw 32 is envisaged for the hold-down 
frame to lock in the topmost position. 
The staple body 1 has a tailpiece 33 and a staple head 34. The top portion 
of the tailpiece 33 of the staple body 1 has a male thread 35 which 
engages the nut 25 for the staple body 1 to travel with respect to the 
bracket 4, as well as a female thread 36 to engage a screw 37 for a staple 
ejector 38 to actuate. 
The staple head 34 has a T-slot 39 adapted to accommodate a change staple 
magazine 40 which is locked on the staple body 1 by a slider 41 actuated 
by a flat spring 42 made fast on the staple body 1 by screws 43. The 
staple head 34 of the staple body 1 enters the opening 13 in the first 
member 8 of the holder 2 and, while traversing, with its lugs 44 rests 
against the top surface of the first member 8, whereby a constant 
clearance between the magazine 40 and the die 3 is defined. 
The ejector 38 has a slot 45 to accommodate a pressure head 46 of the screw 
37, and is provided in its middle portion with a hinge joint 47 necessary 
for disassembling and removing the ejector 38 from the staple body 1. A 
screw 48 passing through a slot 49 in the staple body 1 prevents the hinge 
joint 47 against spontaneous disengaging from the screw 37. The ejector 38 
carries two rows of ejecting plates 50 to drive pi-shaped staples out of 
the magazine 40. 
A change knife 51 is interposed between the ejecting plates 50. 
Changeability of the knife makes it possible to carry out an operation by 
any technique without replacing the ejector 38, e.g., using the knife for 
dissecting the tissues, or without a knife, by applying any other cutting 
instrument, a laser beam in this particular case. 
The laser waveguide 7 comprises a head 52 with a T-shaped endpiece 53 made 
of polytetrafluoroethylene and adapted to engage the guideways 12 of the 
first member 8 of the holder 2, said member being arranged parallel to the 
die 3. 
A tube 54 is held to the head 52 by a thread (not shown), said tube being 
in turn held to a focussing objective 55 of the laser device through a 
thread (not shown). 
Now let us consider a surgical intervention with the use of the laser beam 
as a cutting instrument. In this case the knife 51 must be removed from 
the ejector 38. The apparatus assembled as shown in FIGS. 1 and 3 and a 
required number of the change magazines loaded with staples, are subject 
to sterilization by any conventional method, e.g., in an autoclave. The 
optical waveguide is sterilized separately in 96-percent ethanol. The 
operative procedure is performed as follows. 
The staple body 1 with the bracket 4 is fitted onto the holder 2 and the 
bracket 4 is locked by the rod 19. The hold-down frame 6 is fixed in its 
topmost position. The apparatus is brought behind the organ to be 
resected, whereupon the hold-down frame 6 is let to move down by pressing 
the flange 31, and the organ 29 is fixed to the die 3. Then the staple 
body is actuated by the nut 25 to move down till meeting the top surface 
of the member 8, and the latter is connected to the die 3 by the screw 14. 
While so doing one must observe that the ejector 38 should be in the 
topmost position, whereupon the screw 37 is rotated to move the ejector 38 
all the way down to varying suturing with staples arranged in two parallel 
rows. 
The suturing over the screw 14 is turned out, the retainer 19 is forced out 
and the bracket 4 along with the staple body a is removed from the holder 
2. Then the optical waveguide 7 connected to the laser device (not shown) 
is put on the guideways 12 of the member 8. Once the laser has been fired 
the focussed laser beam is directed by the waveguide to pass in-between 
the rows of staples and get onto the organ being resected. Thus, 
traversing the waveguide 7 along the guideways 12 of the member 8 one can 
perform an aseptic and bloodless resection of the organ operated upon. 
This done the laser is turned out, the hold-down frame 6 is moved all the 
way up and locked by the screw 32, and the apparatus is removed from the 
resected organ. This terminates the operative procedure. 
When mechanical resection of the tissue is resorted to the knife 51 is not 
removed from the ejector 38, and a plastics insert (not shown) is fitted 
into the slot 11 of the die 3. With the ejector 38 moved by the screw 37 
the organ operated upon is resected by the knife 51 and staple-sutured at 
the same time. 
Thus, the proposed resection apparatus enables one to perform an aseptic 
and a traumatic resection of human organs seated in hard to access places 
with the minimized extent of injury to the surrounding tissues and 
practically without bleeding. The application of the apparatus simplifies 
the operative techniques, renders any complications due to infecting the 
operative field less probable, cuts down the operating time, facilitates 
the surgeon's labour and provides better conditions for the surgical 
intervention as a whole. 
It must be noted that the apparatus is applicable not only for resection of 
human organs but also for formation of transplants from the stomach to 
establish a pediculate gastroma. 
Although the present invention has been described with reference to a 
preferred embodiment thereof and to a specific drawing, it should be 
understood to those skilled in the art that various changes and 
modifications may be made within the scope of the claims that follow. 
Thus, there may be provided the provision of staple depressions arranged 
square with the above-described rows on one of the end faces so as to 
obtain a pi-shaped suture, which is especially expedient for formation of 
transplants from the stomach when the apparatus is applied to the stomach 
several times in succession, for instance, in the case of transplant 
formation according to Gavrilin, or for formation of an isoperistaltic 
tube from the greater curvature of the stomach.