Abstract:
The invention relates to a device for joining hollow organs with an elongated holder and a needle carrier which is positioned at one end of the holder, where the needle seat extends radially, forming an overhang projecting beyond the periphery of the holder, as well as with a plurality of needles which are disposed standing vertically on the projecting overhang of the needle seat, surrounding the holder.

Description:
This application is Continuation-in-Part of application Ser. No. 09/747,628, file May 25, 2001, pending. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention refers to a device and a procedure for joining hollow organs. With devices and procedures of this kind for attaching blood vessels, the suturing process, for example, can be mechanized and consequently speeded up and simplified. This is of great importance in coronary surgery, in particular for performing operations on the beating heart. Furthermore, through the use of devices and procedures of this kind a repeatable and high-quality suturing process can be carried out, so that the risk of the vessels not being leak-free is minimized or, for example, in coronary surgery that the rear wall of the blood vessel in question is also attached. 
     An important area of application for devices and procedures of this kind is the suturing of end-to-side anastomoses in coronary by-pass surgery, i.e. surgically applied unions of hollow organs in which one end of a vessel is sewn laterally to another one. The devices and procedures under the invention can, however, be used for sewing vessels in all other areas of vascular surgery. 
     Today, about 70,000 by-pass operations are performed each year in Germany alone. Anastomoses on the coronary arteries are the most difficult discipline. They require a great deal of skill and experience on the part of the surgeon, because the blood vessels here are extremely small, with an average arterial diameter of 2 mm and an average vascular diameter of 4 mm, and where the diameter of the other transplants, arteria mammaria interna, for example, is often only 2 mm. In particular, there cannot be any leakage or attachment of the rear wall of the vessel. 
     The manual procedure can be divided up into the following operational steps, where the attachment at the anastomosis suture represents the task which can be taken over by mechanical devices and the appropriate procedures. First of all, a thoracotomy and a sternotomy (opening and separation of the chest wall) are performed. Parallel to this, the transplant (e.g. vein) is obtained and prepared for attachment to the artery with a suitable diagonal end cut. In the next step, an incision is made into the artery as a lengthwise opening. Next the openings of the vein and the artery are joined to each other. This can be simplified and improved by means of a mechanical device. Finally, the thorax is closed up again. 
     Under the present art, several types of what are called staplers are currently known, which, like a paper stapler, place a clip instead of a suture. The systems are used primarily for larger vessels or for sealing off open vessels. Leaks in particular are a major problem with end-to-side staplers. Staplers of this kind are known, for example, from U.S. Pat. Nos. 5,732,872, 4,930,674 or 5,285,945. 
     Coupling systems, such as those described in “Review of Facilitated Approaches to Vascular Anastomosis Surgery,” Werker, P. et al., The Society of Thoracic Surgeons, 1997, follow another approach to joining vessels. Coupling systems of this kind are used mostly in the intestine, or to join the blood vessels end-to-end. 
     A third group of procedures for connecting vessels is based on the conventional suturing technique, which has been mechanized. A system of this kind, for example, is the ArthroSew™ Suturing System from U.S. Surgical Dynamics. 
     The disadvantage of all these systems known from the present art is that they often do not provide any possibility for end-to-side anastomosis, or are not suitable for small vessels with a diameter of about 2 mm. In particular, they are often also not suitable for by-pass surgery. 
     SUMMARY OF THE INVENTION 
     Other applications of the present invention will become apparent to those skilled in the art when the following description of the best mode contemplated for practicing the invention is read in conjunction with the accompanying drawings. 
     It is, therefore, the object of the present invention to make available a procedure and a device for closing an opening in a blood vessel or for joining hollow organs, in particular for performing anastomoses, with which two hollow organs can be joined in a way that is simple, safe and of high quality, as well as being repeatable. 
     This task is solved by means of the device in accordance with the invention. 
     With the device according to the invention or the procedure according to the invention, both proximal as well as distal anastomoses can be performed in a coronary artery bypass operation (CABG), as well as anastomoses with the arteria mammaria interna as the transplant. In addition, they can be employed for closing (sewing up) a blood vessel. 
     The fundamental operating principle of the device under the invention and the procedure under the invention is based on simultaneously punching several needles with sutures through a vessel, where there are similar needles at the other end of the suture, which are simultaneously punched through a second vessel. By pulling the ends of the two sutures tight, placing the ends of the sutures in the cradle and tying the ends of the sutures together, the two vessels are then securely attached to each other. 
     This conception of the device and the procedure solves the task of joining hollow organs, specifically performing anastomoses in a simple, safe and repeatable way. The primary field of application is by-pass surgery on the heart with coronary ischemia, but in addition operations on other organs in the case of stenoses, occlusions, strictures and thromboses, for example, in peripheral arteries. 
     In contrast to manual attachment or the conventional procedures, there is no risk of the rear wall of the vessel being attached or the anastomosis suffering from leakage. With the device under the invention and the procedure under the invention, most operations can not only be performed on the asystolic heart, so that any additional traumatization for the patient as the result of the use of the heart-lung machine is avoided. Specifically, the attachment of very small vessels with a diameter of about 2 mm is possible in safety. 
     On the basis of the mechanized suturing process, the quality of the suture is improved, the rear wall is protected, for example, by means of a needle carrier designed as a shoe, and the operation can consequently be carried out in most cases on the beating heart. 
     Under the invention, the device for joining hollow organs has several elements, which are an elongated holder a needle carrier, which is located at one end of the holder, where the needle carrier forming a projecting overhang extends radially beyond the elongated holder, so that a plurality of needles can be disposed in a ring on this projection pointing away from the end of the holder, for example, so that they stand vertical, while their ends are connected to sutures. In this way, the needle carrier is constructed as a shoe, which protects the rear wall of the vessel from the needles when the holder is inserted into the incision in the vessel. The needles can then be splayed out at a predetermined angle and, with the assistance of a needle seat positioned on the outside of the vessel wall, pushed through the vessel wall along the circumference of the incision. 
     If the other side of the sutures is connected with needles in a similar carrier, the second vessel which is to be connected to the first one can be sutured in this way along the periphery of its incision, so that the two openings are joined along their circumference when the sutures are subsequently pulled tight and tied together. With this, both hollow organs are securely joined together with their openings flush and in a sealing manner. 
     The holder can be implemented as a table stand, for example, for the end of a transplant, if the transplant is still unattached, or as a handle for example, for the second end of the transplant or for the mammaria. In addition, the holder can be equipped with an insertion aid for the transplant, for example, the vessel undergoing anastomosis. This insertion aid can be an enlargement of the elongated holder, or be mounted in the elongated holder in such a way that after the transplant is pulled over the holder and the insertion aid, this insertion aid is expanded so that the transplant has a larger circumference. In this way the transplant can be expanded to a circumference which extends beyond the periphery of the array of needles, so that by means of axial movement in the direction of the holder, the needles can be then pushed through the vessel wall of the transplant. 
     Instead of being pulled over an insertion aid, the holder can also be connected to a sleeve, for example, a cylindrical hollow body. The sleeve can be furnished with a suction device. When the transplant is inserted/introduced into the sleeve, its outer wall is pulled against the inner wall of the sleeve by suction and held in position there. 
     In the next step the end of the transplant is cut to shape. To do this, the sleeve can have a cutting surface which is a surface not oriented parallel to the direction of its internal passage, for example perpendicular or diagonally at a predetermined angle. 
     Set off from this cutting surface, the sleeve has adjustable pressure pads along its circumference by means of which the transplant can be squeezed together. Then the transplant has a larger cross section in the area of the cutting surface than in the area of the pressure pads and it narrows down in the transition to the area of the pressure pads, for example, like a funnel. 
     If the diameter of the needle array is selected in such a way that it lies between the diameter of the two cross sections, the needles can be moved in the direction of the transplant in the axial direction of the sleeve, starting from the inside of the transplant, until they push through the wall of the transplant in the funnel-shaped area and they can be located on the outside of the transplant by a needle seat. 
     Since only the outside of the transplant is touching the inside of the sleeve, the endothelial layers on the inside of the transplant cannot be damaged. Consequently, both distal as well as proximal anastomoses can be performed, as well as anastomoses with the mammaria. 
     With respect to the artery also, it can be held by annular suction by means of a suction device before the incision is made. Kept in position like this, the incision is then made inside the suction-held area at a length matching the circumference of the transplant, and then the shoe with the needles is inserted, without the possibility that the arterial walls could collapse into the artery after performing the incision. 
     To protect the needles when they are being inserted, or rather to protect the vessel from the needles, a needle cap can be pulled over the needles and the needle tips, which is removed from the needles immediately before the needles are deployed, or before the needles are pushed through the vessel wall. In this way, the vessel is protected for as long as possible from the sharp-pointed needles and injuries resulting from them. 
     The needles can be extended in the direction of the lateral vessel wall immediately before being pushed through the vessel wall, while a sleeve is inserted between the needles and the elongated holder and the needles are splayed outwards. 
     All the movements of the needle cap or the sleeve, for example, or the two-part seat for pushing the needles through the vessel wall, can be carried out by simply pressing buttons, for example by using a handle which is attached to the holder and has the appropriate controls with mechanical means of movement. 
     Once the two openings of the vessels are sutured and the sutures drawn tight, the needle seats with the needles and the sutures attached to them can be placed in a cradle, where as the result of proper design of the cradle and proper placement of the needle seats, the sutures coming from the transplant or from the artery are correctly sorted out automatically. The matching ends of the sutures can then be tied together correctly. 
     Tying the sutures together can be done, for example, by means of an auxiliary instrument which takes up the parallel sutures in the cradle from the two sides (artery, transplant) and encloses them with clips. The auxiliary instrument can be designed in such a way that several clips can be placed simultaneously, or only one clip is placed at a time. If several clips are placed simultaneously, it is advantageous if the end effector of the auxiliary instrument is designed in such a way that the distance between the clips on the auxiliary instrument is equal to the distance between the sutures in the cradle. 
     As an alternative to the auxiliary instrument, conventional knots can continue to be made or other procedures such as bonding, thermal forming, etc. can continue to be used. In addition, clips made of nitinol, such as those produced by the Coalescent Surgical Co. Inc., can be used to join the sutures coming from the two hollow organs. 
     In addition to straight needles, curved needles are also conceivable. 
     For sewing on a arteria mammaria interna (an artery which is already on the heart and is only being sutured unilaterally), it is conceivable to design the instrument as a minimally invasive surgical instrument and to introduce it into the body through small incisions and to suture without opening the sternum. To do this, the part of the instrument for the artery and the transplant side would be introduced into the body by means of a trocar and handled endoscopically. 
     The handles of the tool can also be designed in such a way that they can be manipulated by a robot. In the first step, the procedure for the transplant could continue to be performed by hand and only the procedure for the artery be carried out by the robot. To do this, a flange, which is attached to a robot flange, would be installed for the artery side instead of the hand grip. The movement of the needle cap, the sleeve and the two-part seat are then controlled electrically, hydraulically or pneumatically or by other drives. 
     The transplant portion can also be handled by a second robot arm for the suturing of the arteria mammaria interna. The handle with the needle carrier and the insertion aid would be flanged to a robot. The two-part seat would need to be pushed up manually or by yet another robot arm and pulled out along with the needles. The needle seat (two-part seat) is then put into the cradle by the robot, and the tightening and tying together is done manually. 
     Other applications of the present invention will become apparent to those skilled in the art when the following description of the best mode contemplated for practicing the invention is read in conjunction with the accompanying drawings. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The description herein makes reference to the accompanying drawings wherein like reference numerals refer to like parts throughout the several views, and wherein: 
     In what follows some examples are given of devices and procedures under the invention. 
     FIGS. 1a-c show an anastomosis being performed; 
     FIGS. 2a-c show a device under the invention; 
     FIG. 3 shows an artery with a needle carrier inserted; 
     FIG. 4 shows a needle carrier inserted with needle cap raised; 
     FIG. 5 shows the arrangement according to FIG. 4 in cross section; 
     FIG. 6 shows a cross section through an artery with a needle carrier inserted, penetrating the vessel wall; 
     FIG. 7 shows an artery with a vessel wall sutured; 
     FIG. 8 shows another device under the invention; 
     FIG. 9 shows the device from FIG. 8 with the vessel expanded; 
     FIG. 10 shows the device according to FIG. 9 with the vein pulled down over it; 
     FIG. 11 shows the device according to FIG. 10 with the needle seat; 
     FIG. 12 shows the device according to FIG. 11 with a sutured vessel wall; 
     FIG. 13 shows the device according to FIG. 12 with the needle seat removed; 
     FIGS. 14a-d show a set under the invention; 
     FIG. 15 shows the schematic of a set under the invention during suturing of a vessel; 
     FIG. 16 shows the set according to FIG. 15 with the needle seats removed;] 
     FIG. 17 shows a needle seat cradle; 
     FIG. 18 shows a section of the needle seat cradle from FIG. 17 with the needle seat in place; 
     FIG. 19 shows the cradle according to FIG. 18 with two needle seats in place; 
     FIG. 20 shows the cradle according to FIG. 19 with needle seats placed one over the other; 
     FIGS. 21a-b show a device for clipping the ends of sutures; 
     FIG. 22 shows another device for clipping sutures; 
     FIGS. 23a-c show an additional device in accordance with the invention; 
     FIGS. 24a-c show an additional set in accordance with the invention; 
     FIG. 25 shows the schematic of the set from FIG. 24 while the blood vessels are being sutured; 
     FIG. 26 shows an additional schematic of the set from 
     FIG. 24 while the blood vessels are being sutured and 
     FIGS. 27a-c show the sequence when suturing the transplant with a device in accordance with FIG.  23 . 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     FIG. 1 shows schematically the attachment of end-to-end anastomoses. FIG. 1A shows an artery  10  and a vein  11 . The vein  11  is a transplant which is to be joined to the artery  10 . Here, as in all the following illustrations, similar components are identified with similar reference numbers. In FIG. 1B an incision  12  has been made in the artery  10 . The end of the vein  11  has been cut on the diagonal so that a suitable opening  13  results, whose diameter approximately matches the diameter of the opening  12 . FIG. 1C shows how the two openings  12  and  13  of artery  10  and vein  11  are joined to each other and sutured, so that now an end-to-end anastomosis has been performed. 
     FIG. 2 shows a device under the invention, which can be used when creating anastomoses shown in FIG.  1 . This device has a handle  1 , at the end of which a shoe  2  is formed as a needle carrier for needles. This shoe  2 , along with the needles disposed vertically on it, is covered by a needle cap  9 . Above the needle cap  9  there is a needle seat  3 , whose function will be explained later. In addition, sections of sutures  4  are shown, which are connected to the ends of the needles. 
     FIG. 2B shows the lower part of the device from FIG. 2C in an enlarged view in a lateral cross section. Again, the shoe  2  can be seen, on which needles  7  are standing vertically in a ring around a holder  20 . These needles  7  are connected to sutures  4  by the ends facing the shoe  2 . Above the points of the needles there is a sleeve  8 , which can be moved along the holder  20  by means of a sleeve linkage  23 . The entire arrangement of needles  7  and sleeve  8  is covered by a needle cap  9 , which can similarly be moved along the holder  20  by means of a linkage  21 , and in its lowered position provides a protective covering for the needles  7  and the sleeve  8 . Above this protective cover  9  there is needle seat  3 , which can similarly be moved along the holder  20  by a suitable mechanism which is not shown here. 
     FIG. 2A now shows in a cross section rotated by 90° to FIG. 2B a needle carrier  2 , which is inserted into an artery  10 . The needle carrier or shoe  2  was inserted into the artery  10  through a suitable incision not shown in the cross section and then, as shown in FIG. 2A, the needle cap  9  was raised. As a result, the needle points are now exposed inside the artery, but the rear wall of the artery is protected from the needles  7  by the shoe  2 . 
     Both the sleeve  8  and the needle cap  9  can be moved up or down by means of their corresponding linkages  23  or  21  through push buttons  5  or  6  on the handle  1 , as shown in FIG.  2 C. 
     FIG. 3 shows the same arrangement as in FIG. 2B, however in an external view of the artery  10 . It can be seen clearly here that the needle seat  3  can be separated into two, where the needle seat  3  can be moved along the holder rod  20  by means of the linkage  22 . 
     FIG. 4 shows a similar view as in FIG. 3, where however the position of the individual parts corresponds to that in FIG. 2A, i.e. the needle cap  9  has been pulled off the shoe  2  out of the opening in the artery  10  by means of its linkage  21 . 
     FIG. 5 shows the next step during the performance of the anastomosis, where the sleeve  8  has been pushed between the needles and the holder linkage  20  by means of its linkage, so that the needles are now standing sideways at an angle and are spread out radially. If the shoe  2  is now pulled up, or the needle seat  3  is pushed down, the tips of the needles  7  are pressed through the wall of the artery  10  along the circumference of the incision and they come to a stop in the needle seat  3 . This is shown in FIG. 6, where following this position, the needle seat  3  can be withdrawn upward or opened, and the two halves of the needle seat  3   a  and  3   b  can be withdrawn laterally. 
     This is shown in FIG. 7, where it is can be seen that the needles are being removed together with the halves of the needle seat  3   a  and  3   b , where they are pulling the sutures, here  4   a  and  4   b , which are attached to them, through the suture holes. 
     Not all the sutures which come from the ends of the needles are shown in FIG. 7 for the sake of clarity. But it must be made quite clear at this point that the end of each needle is provided with its own suture, which runs through the corresponding suture opening into the interior of the artery and then along the holder  20  and out of the incision. 
     With this step, the first half of performing an anastomosis is concluded. Next comes the suturing of the opening of the vessel to be attached, for example, of a vein. 
     FIG. 8 shows a suitable device, where, instead of a handle, a table stand  30  is being used, which has a center rod  31  as well as a needle carrier  32 , in which needles  37  are disposed in a circle around the center rod  31 . These needles  37  are connected at their ends to sutures  34 . It should be noticed that matching the diagonal cut at the opening of the vein, as shown in FIG. 1, the needle carrier is beveled in the same way. 
     FIG. 9 shows the device from FIG. 8, where an installation aid or insertion aid  35 , which is enlarged in one section, is mounted over the central rod  31 . Alternatively, the insertion aid can be designed just to be dilatable, for example, by suitable inflation. 
     FIG. 10 shows another section from a device in accordance with FIGS. 8 and 9, where a vein  11  is now pulled over the insertion aid  35 . The vein is now similarly greatly stretched in the enlarged section of the insertion aid, where the diameter of the vein in the stretched area is greater than the diameter of the needle arrangement with the needles  37 . In FIG. 10 it can also be seen that one half  33   a  of a two-part needle seat is placed on the vein above the enlarged area. 
     In FIG. 11 the needle seat  33  has been fully assembled from its two halves  33   a  and  33   b.    
     In FIG. 12 it can be seen that the needles are now being pushed axially along the center rod  31 , or the vein with the seat  33  is being pushed in the direction of the needles, so that the needle points pierce the vein wall from inside the vein and come to a stop in the seat  33 . 
     FIG. 13 shows how the two parts of the needle seat  33   a  and  33   b  are pulled away upwards from the expanded part of the vein, whereby the sutures  34 , which are attached to the ends of the needles  37 , are pulled through the corresponding suture holes in the vein  11 . This pulls the corresponding sutures through the opening  13  of the vein, so that the two openings  12  or  13  of artery  10  or vein  11  respectively can now be joined to each other. 
     For this, FIGS. 14A and 14B once more show a holder corresponding to FIG. 2 with a handle  1 , and in FIG. 14B the overall arrangement of shoe  2  with needles and sutures  4  and the table stand  30  with needles  37  and sutures  34 . As can be seen, the open ends of the sutures in both arrangements are attached to each other in each case. After the wall of both the artery and the vein have been pierced, the sutures  4  or  34  consequently run from outside the vein through a suture hole in the vein into the interior of the vein, from there into the interior of the artery and out again through a hole pierced in the wall of the artery. 
     FIG. 14C, and in a section from it FIG. 14D, show an alternative to the table stand  30 . Here the needle holder  32  with the needles  37  is attached to a handle  40 , where the handle ends in a tip over which the vein can be pulled in a suitable way. Installation aids or insertion aids, as described above, can be attached here. 
     FIG. 15 shows the drawing in FIG. 14B in enlarged form. The sutures are shown in two examples  4   a ,  4   b  or  34   a ,  34   b  respectively. Otherwise the drawings correspond to the illustrations in FIG. 4 or  12  respectively. 
     FIG. 16 shows the illustration with the divided seat  3   a ,  3   b  or  33   a ,  33   b  respectively pulled back, where again only two sutures  4   a ,  34   a  or  4   b ,  34   b  respectively are shown as examples. Otherwise the illustration in FIG. 16 corresponds to the illustrations from FIG.  7  and FIG.  13 . 
     FIG. 17 shows a cradle  31  for the split needle seat from FIG.  16 . This cradle  41  has slit-like openings  42 , the distance between which matches the distance between the sutures which come from the divided seats  3   a ,  3   b  or  33   a ,  33   b  respectively. 
     FIG. 18 shows how one seat  33   b  is placed into the cradle  41 . 
     The slit-like openings  42  here are designated by the reference numbers  42   a  through  42   e , where only suture  34   b  which is running through slit  42   e , is given a reference number. 
     FIG. 19 shows how one half  3   b  of a needle seat and one half  33   b  of an additional needle seat are placed next to each other in the cradle  41 . 
     In order to tie the ends of the respective sutures together correctly, the seat  33   b  is laid in a suitable way over the seat  3   b  (FIG.  20 ). As a result, the two ends of the same suture, shown for example as  4   b  and  34   b , are automatically located in each of the slits  42 . 
     The ends of the sutures can be clipped together by means of a auxiliary instrument. FIG. 21 shows such an instrument, where the entire instrument  45  with grip  46  and shaft  47  is shown in FIG. 21B, while FIG. 21A brings only the end of the shaft  47 . A clip holder  48 , which can hold up to five clips  49  is positioned at the end of the shaft  47 . With the aid of these clips  49  the specific suture ends can be attached to each other. 
     FIG. 22 shows another auxiliary instrument  45 , which, however, has a clip holder for only one clip  49 . Instead, the instrument  45  from FIG. 22 has a tong-like anvil  50 , so that two ends of the same suture can be clipped together in a simple fashion with this instrument  45 . 
     It must be noted in the case of the procedures under the invention that before the ends of the sutures are clipped together the sutures from the artery side and the transplant side are pulled tight, so that the opening in the vein lies completely and in a sealing manner on the incision in the artery. Then the sutures can be clipped together in this tightly approximated position. 
     As an alternative to an auxiliary instrument, such as the one shown in FIGS. 20 and 21, the ends of the sutures can, of course, be knotted in the conventional manner or other procedures such as adhesive bonding, thermal forming and similar methods can be employed. Clips made of nitinol (Coalescent Surgical Co., Inc.) can also be used. 
     FIG. 23 shows a further embodiment for a device which corresponds to the one from FIG.  8 . This device has a handle  40  to which a base  61  is attached. The base  61  acts as a holder for the needle carrier  32  in which needles  37  are disposed in an annular arrangement. A needle seat  62  is positioned in an axial direction to this annular arrangement  37 , with passages which extend in the axial direction of the individual needles and through which the needles are passed during an axial movement of the needle array  37 . 
     Another needle seat  33 A and  33 B is located adjacent to the seat  62 , into which the needles are introduced with the axial movement. This seat  33  is a divided seat, which can be subsequently separated into two halves  33   a  and  33   b  and removed with the needles  37  sticking in them. 
     Both the seat  62  and the needle seat  33  are formed as hollow bodies with passages extending in the axial direction of the needle array  37 . 
     The seat  62  and the needle seat  33  are attached to the base  61  by means of an external bar-shaped bracket  65 . 
     As can be seen from FIGS. 23B and 23C, the seat  62  and the needle seat  33  are shaped in such a way that the cross-section of their passage can be made narrower. This can be achieved, for example, by creating air cushions. FIG. 23B shows how a transplant  11  is inserted into the passage of the seats  62  and  33 . FIG. 23C shows how, by means of the pressure cushions the seats  33  and  62 , the cross section of the passage and along with it the diameter of the transplant  11  is constricted locally, so that the cross section of the transplant remains unchanged only at the surface of the seat  62 . The transplant narrows down consequently starting from this surface  67  in a funnel shape in the axial direction of the needles  37 . The largest diameter of the passage of the seat  62  is now adjusted so that it is larger than the diameter of the ring of the needle array  37 . The constriction by means of the pressure cushions in the seats  33  and  62  continues down to a diameter that is smaller than the diameter of the needle array  37 . This creates a transition zone for the transplant in which the transplant tapers down in a funnel shape. If the needles are now punched through the transplant in an axial direction, they penetrate the transplant in the expanded area along the edge of the incision  67  and are pushed through the transplant in the funnel-shaped area  70 . 
     It is advantageous if the seat  62  and/or the needle seat  33  are furnished with a device to apply a vacuum to the inner surface of their passage. In this case the transplant  11  can have suction applied on its outside and be held in position in this way. By holding the transplant in position by means of suction applied to the outside, damage to the inside of the transplant, particularly the endothelium, is avoided. 
     FIG. 24 shows the set up of the device for suturing the transplant and the artery. 
     The needles in both devices are connected to each other by means of sutures  34 , where, just as in FIG. 14, only a part of the sutures is shown. For a further explanation, reference is made to the appropriate FIG. 14, where only the device shown there for suturing the transplant has been replaced by the device from FIG. 23 for suturing the transplant. 
     FIG. 25 shows this arrangement of the two devices according to the invention, the ends of whose needles are connected in each instance by sutures  4 A,  34   a  or  4 B,  34   b.    
     FIG. 26 shows the same arrangement after the needles  7  or  37  have been pulled through the artery  10  or the transplant  11 . The needles  7  or  37  are then pushed into the needle seats  3  or  33  respectively and held in position there. The needle seats are now separated into two needle seat halves  3   a ,  3   b  or  33   a  and  33   b  respectively and removed with forceps  69  whose ends are adapted to the seat. Then the needle seats  3   a ,  3   b ,  33   a ,  33   b  can be set down in suitable seat cradles, and by pulling the sutures tight the transplant can be attached to the artery and thus sutured to it. 
     FIG. 27 shows in the subillustrations A through I the exact sequence of suturing the transplant. Here a device in accordance with FIG. 23 is used, where the same reference numerals are used for the same elements. FIG. 27A shows the device immediately prior to the suturing process. FIG. 27B shows how the transplant  11  is introduced into the needle seat  33  and the seat  62 . FIG. 27C shows the transplant being held by suction against the inner walls of the passage of seats  33  and  62 . In step  27 D the transplant is cut off using a knife  66  along the diagonal surface  67  of the seat  62 , so that it already has a diagonal aspect which matches the opening in the artery to which the transplant is to be sutured. In FIG. 27E the transplant  11  is being constricted behind its opening and the cutting surface  67  by means of pressure pads in the seats  33  and  62 . 
     FIG. 27F shows how the needle array  37  is now displaced in an axial direction and thereby the individual needles  37  are pushed through the transplant  11  from the inside to the outside in the funnel-shaped constricted area. 
     FIG. 27G shows how, after the needles have been passed through the transplant, the needle seat  37  is withdrawn in an axial direction over the transplant and is then separated, and the two parts of the seat  33   a  and  33   b  are removed from the transplant. 
     FIG. 27H shows a cradle  41  for the needle seats  33   a  and  33   b , while FIG. 27I shows how the needle seat  33   b  is placed in the cradle in such a way that one suture  34  is deposited in each of the slits  42  of the cradle  41 . 
     The remainder of the process of attachment is performed as described in the previous examples. 
     In a further example, the instruments and devices presented could be designed as minimally invasive surgical instruments, so that it is not necessary to open the chest wall and the instrument is introduced into the body through small incisions, for example using a trocar. 
     In additional examples the handles  1  can also be designed in such a way that they can be manipulated by a robot. In this way, extensive automation of the suturing procedure would be possible. 
     In summary, it can be said that through the device under the invention, or through sets under the invention having two or more of such devices, at least one in each case for the artery side and one for the vein side, it is possible to join hollow organs together in a simple and safe manner. 
     While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiments but, on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims, which scope is to be accorded the broadest interpretation so as to encompass all such modifications and equivalent structures as is permitted under the law.