Source: http://www.google.com/patents/US4603693?dq=%22simulated+musical+concert+experience%22
Timestamp: 2017-09-24 18:45:36
Document Index: 398225046

Matched Legal Cases: ['art 14', 'art 14', 'art 14', 'art 14', 'art 14', 'art 46', 'art 46', 'art 44', 'art 44', 'art 44', 'art 44', 'art 44', 'art 46', 'art 46', 'art 44', 'art 46', 'art 44', 'art 44', 'art 46', 'arts 242', 'art 46', 'art 46', 'art 46', 'art 46', 'arts 300', 'art 44', 'art 46', 'art 44', 'art 46', 'art 46', 'art 46', 'art 46', 'art 46', 'art 46', 'art 46', 'art 46', 'art 46', 'art 46', 'art 314', 'art 344', 'art 440', 'art 440', 'art 344', 'art 440', 'art 440', 'art 344', 'art 346', 'art 344']

Patent US4603693 - Instrument for circular surgical stapling of hollow body organs and ... - Google Patents
Apparatus for circular surgical stapling of hollow organs comprising an instrument and disposable cartridge assembly. The instrument comprises a housing with a throughbore in which a tube is received for reciprocation by means of a manually operable squeeze handle. A rod reciprocates within the tube...http://www.google.com/patents/US4603693?utm_source=gb-gplus-sharePatent US4603693 - Instrument for circular surgical stapling of hollow body organs and disposable cartridge therefor
Publication number US4603693 A
Application number US 06/328,068
Publication number 06328068, 328068, US 4603693 A, US 4603693A, US-A-4603693, US4603693 A, US4603693A
Patent Citations (17), Referenced by (464), Classifications (6), Legal Events (3)
Instrument for circular surgical stapling of hollow body organs and disposable cartridge therefor
US 4603693 A
1. A two-part disposable surgical stapling cartridge assembly for use with an actuator having first, second, and third relatively movable actuator members for stapling an annular pattern in hollow body organs, comprising:
(1) an anvil-carrying part including (a) a dish-shaped body, (b) an anvil having an annular array of staple-clinching grooves mounted in said dish-shaped body, and (c) first means for removably mounting said dish-shaped body on said first actuator member; and
(2) a staple-carrying part including (a) a staple guide body defining (i) an annular array of staple-holding grooves and (ii) second means for removably mounting said staple-carrying part on said second actuator member, said second means being the sole means associated with said cartridge assembly for retaining said staple-carrying part on said actuator, (b) a staple ejector means movably mounted in and permanently retained by said staple guide body and being contactable by said third actuator member when said staple guide body is mounted on said second actuator member for ejecting staples from said staple-holding grooves in response to actuation of said third actuator member, (c) annular knife means concentric with and inside said annular array of staple-holding grooves, said annular knife means being permanently mounted on said staple ejector means for movement with said staple ejector means for severing said hollow body organs inside the annular array of staples ejected from said staple-holding grooves, and (d) first and second mutually opposed and interfitting detent means respectively defined by said staple guide body and said ejector means for maintaining said staple ejector means and said annular knife means in a predetermined position in said staple guide body prior to mounting said staple-carrying part on said second actuator member and for preventing accidental relative movement of said staple guide body and said staple ejector means of the type which would cause ejection of the staples from said staple-holding grooves, said detent means being disengaged when said staple guide body is mounted on said second actuator member to allow said third actuator member to move said staple ejector means.
2. A two-part disposable surgical stapling cartridge assembly for use with an actuator having first, second, and third actuator members aligned with a first longitudinal axis and relatively movable parallel to said first longitudinal axis for stapling an annular pattern in body tissue, said cartridge assembly comprising:
(1) an anvil-carrying part including (a) a body, (b) an anvil mounted in said body and having an annular array of staple-clinching grooves, and (c) first means for removably mounting said body on a portion of said first actuator member which is located distally along said first longitudinal axis so that said staple-clinching grooves face in the proximal direction along said first longitudinal axis; and
(2) a staple-carrying part having a second longitudinal axis and including (a) staple guide body means having (i) an annular array of staple-holding grooves parallel to said second longitudinal axis and (ii) second means for removably mounting said staple-carrying part on a portion of said second actuator member which is proximal of said distally located portion of said first actuator member so that said first and second longitudinal axes are parallel and so that said staple-holding grooves face in the distal direction along said first longitudinal axis, said second means being the sole means associated with said cartridge assembly for retaining said staple-carrying part on said actuator when the anvil-carrying part is removed from the actuator, and (b) third means permanently retained by said staple guide body means and movable relative to said staple guide body means parallel to said second longitudinal axis, said third means including (i) fourth means for operatively relating said third means to said third actuator member when said staple-carrying part is mounted on said second actuator member so that said third means moves in the distal direction relative to said staple guide body means in response to distal motion of said third actuator member but so that said third means does not move in the proximal direction relative to said staple guide body means in response to proximal motion of said third actuator member, (ii) staple ejector means for ejecting staples from said staple-holding grooves when said third means moves distally relative to said staple guide body means in response to distal motion of said third actuator member, and (iii) annular knife means inside aaid annular array of staple-holding grooves for severing said body tissue inside the annular array of staples ejected from said staple-holding grooves when said third means moves distally relative to said staple guide body means in response to distal motion of said third actuator member.
3. The apparatus defined in claim 2 wherein said fourth means comprises a proximal-facing surface portion of said third means for abutting a distal-facing surface portion of said third actuator member when said staple-carrying part is mounted on said second actuator member, said abutting surface portions being the sole connection between said third means and said third actuator member.
4. The apparatus defined in claim 2 wherein said proximal-facing surface portion is the proximal-most surface of said third means, and wherein said distal-facing surface portion is the distal end of said third actuator member.
5. The apparatus defined in claim 2 wherein said fourth means is only capable of transmitting axial compression force between said abutting surface portions.
This is a continuation of application Ser. No. 138,877, filed Apr. 10, 1980, abandoned, which is a division of application Ser. No. 967,421, filed Dec. 7, 1978, abandoned, which is a continuation-in-part of U.S. patent application Ser. No. 800,965, filed May 26, 1977, abandoned.
To our knowledge, the instruments of the prior art have had only limited experimental use on animals in the United States. Our experience in such use of these instruments has revealed several areas of inadequacy. Specifically, a hazard lies in employing a single circular row of staples. The failure of a single staple to form and close properly can cause a leak in an anastomosis staple line. The consequences of such a leak can be fatal to the patient. There is also a problem associated with the removal of the instrument from the anastomotic circular staple pattern. In the most frequent applications for an instrument of this type, the staple forming elements on one side of the anastomosis, for instance, the anvil assembly, must be removed by passing then through the inner diameter or lumen of the newly formed circular staple line. A solution to the one problem of staple line security creates a characteristic which increases the other problem. That is, the addition of a second inner concentric row of staples for greater security of the staple forming line creates a smaller lumen than would an anastomosis with a single circular row of staples. Therefore subsequent removal of part of the instrument through the lumen becomes more difficult. The prior art does not address this problem. The present invention overcomes this problem by providing the anvil portion with a particular geometry which permits the anvil side of the stapling mechanism to be readily removed through the lumen of the circular stapled anastomosis.
FIG. 9 is a view in top plan partly in section of the staple carrying part of lhe disposable cartridge showing the keying arrangement;
FIG. 46 is a sectional view of the bayonet assembly in the unlocked position as viewed along lines 46--46 of FIG. 43
The handle part 14 is provided at its lower end with a bifuricated member 90, the legs of which are identified by the reference numeral 92. These legs 92 are fashioned as forks 94 which engage the rolers 80. The bifurcated member 90 is designed with an upstanding central projection 96 which fits into a slot 97 defined in the lower part of the handle part 14. Pins 98 projecting through holes formed in projection 96 hold the bifurcated member 90 to the handle part 14. Handle part 14 pivots about pin 16 as shown in FIG. 6, and forks 94 cooperating with rollers 80 cause driver tube 50 to reciprocate in tube 30. A spring 56 received around tube 50 in region 70 biases sleeve 72 against the reciprocation produced by handle part 14. The left end of spring 56 is held against the end of tube 30.
The anvil carrying part 46 is illustrated in FIGS. 16-22, inclusive, and comprises a plastic body portion 210 of cup shape with a central hub 212 defining a bore 214. A stud 216 is received through the bore 214 and is characterized by knob 48 at one end and a screw thread 220 at its other end with a reduced section 222 defined between its ends. The threading 220 matches the internal threading of the bore at the end of rod 52. Clips 224, defined by the portion 210, project into the bore 214 and engage the shoulder defined by the reduced section 222 to hold stud 216 captive in bore 214, but allowing it to rotate freely. The body portion 210 in the vicinity of bore 214 has cutout 226 to accommodate the key 200 at the end of rod 52. Holes 49 provide venting for the anvil carrying part 46. Metal anvil 230, having a closed pattern in the form of two concentric circular arrays of spaced staple clinching grooves 232 and a central hole 233 is mounted onto body portion 210 by "hot staking". Body portion 210 defines a plurality of ribs 234 at least two of which are provided with projections or bosses 236. Anvil 230 defines matching holes 238 and, after mounting, bosses 236 are melted to form rivets 240 to lock anvil 230 on, see particularly FIG. 22. Anvil 230 is also provided with punched-out lips 242 to secure a cutting block 244 of annular configuration that cooperates with knife 168. Cutting block 244 is rubber, soft plastic, or the like. Anvil 230 defines a cutout or keyway 231 as an extension of hole 233 that coacts with key 200 to insure the proper orientation and indexing for grooves 232 of the anvil 230 relative to slots 158 of the staple carrying part 44. Anvil 230 has vent holes 47 which communicate with vent holes 49 in body 210.
In operation, wing nut 60 is rotated to advance rod 52 out from the end of tube 30. A staple carrying part 44 of a disposable cartridge 40 is fitted over rod 52 and tube 30 and attached to tube 30 by sleeve 42. The geometry of these parts is such that key 180 engages the neck of staple carrying part 44 before the threading engages to draw part 44 onto tube 30 to its seated position. During the last turns of sleeve 42, the end of driver tube 50 engages the staple pusher 160 to reverse the detents 190 and 92 from the position shown in FIG. 13 to the position shown in FIG. 10.
Now with reference to FIGS. 22 and 23 the cut end of the hollow organ, through which the instrument is protruding, is fashioned with a drawstring suture and drawn over the staple-carrying part 44 about the rod 52. The other cut end of the hollow organ is pulled over the anvil carrying part 46 and, by means of a drawstring suture, is tied closely about the rod 52. Thus, the two cut ends of the hollow organ will be interposed between the anvil part 46 and the staple carrying part 44. At this time, the wing nut 60 is rotated to cause retraction of the rod 52, whereupon the anvil-carrying part 46 will be brought into close proximity with the staple-carrying part 44. Wing nut 60 is turned until a predetermined space is filled by the tissue interposed between the staple carrying part 44 and the anvil carrying part 46.
Referring to FIG. 21, the action that takes pIace during ejecting of the staple 159 is generally depicted; as the staples 159 are advanced or ejected out from the slots 158, they are contacted by grooves 232 of the anvil 230 and bent or formed into a conventional B-shape, as depicted in FIG. 21. Simultaneously with the advancement of the staple ejector 160, the knife 168, which is carried by the staple pusher 160, is axially advanced toward the anvil carrying part and the knife edge 170 of the knife 168 will intersect with the interposed tissue ends of the trapped hollow organs (shown in phantom in FIG. 22 at 300 and 302). The cutting edge 170 of the knife 168, which is circular in configuration, cuts through the tissues 300 and 302 and into the annular cutting block 244, which is held within the anvil 230 by means of the punched-out parts 242, as previously described. The advancing of driver tube 50 continues until stop 81 engages stop 100 on rod 52, the location of stop 100 being variable relative to cartridge 44 and body 10 in dependence upon tissue thickness. Stop 100, however, remains in constant positional relationship to anvil part 46, therefore driver tube 50 will advance to a predetermined distance relative to anvil part 46. Consequently, the pusher fingers 159 will always bend the staples into the same configuration. There is, as previously explained, a maximum limit to tissue thickness which a specific staple length can accommodate and which exists when wing nut 60 cannot be screwed down enough to expose groove 51. FIG. 22 depicts in phantom the two concentric circular arrays of staples 159 which join together the ends of the holow organ to be joined. The excess portion of the ends of the hollow organ to be joined are severed by the action of knife edge 170. During the closure of cartridge 44 against anvil part 46 to clamp the tissue prior to stapling, the interior space between the cartridge and anvil becomes essentially air and fluid tight. In this confined space are trapped the excess tissue of the hollow body organs which has been gathered around the center rod 52 by purse string sutures, as shown in FIG. 23, and the blood and other fluids associated with this tissue. Air is also trapped in this confined space. The tissue is extremely fluid and behaves like an incompressible fluid. Once sufficient contact has been made to create a seal between anvil part 46, tissue parts 300 and 302, and cartridge part 44, further tightening to clamp the tissue increases the pressure in the closed, confined space.
When the tissue is sufficiently clamped, the instrument is fired to eject and form the staples and to cut the tissue. The movement of parts within the confined space between the cartridge and anvil are best understood with reference to FIG. 10. When pusher tube 50 advances, the entire assembly of the pusher back 161, pusher fingers 162, and knife 168 advances toward the anvil 230 and significantly reduces the volume of the space in which the excess tissue is trapped. Because the tissue is mostly fluid and largely incompressible, this reduction in volume can create high pressures in the enclosed volume. To prevent this undesirable increase in pressure in the confined tissue, we have provided vent holes leading outward from the enclosed space. These are shown in FIGS. 17, 19 and 22. We have found it desirable to make these vent holes as large as feasible. In actual use of the instrument, it is common to find tissue in significant quantity extruded into and through these vent holes. It has been observed that without the vent holes, there is a definite tendency for the tissue to extrude outward between the clamped faces of the cartridge and anvil so as to literally curl outward the cutting edge 170 of circular knife 168. The severed ends 300 and 302 of the hollow organ are retained around center rod 52 between the anvil carrying part 46 and the staple carrying part 44.
The technique for removal of the anvil part 46 from the stapled anastomosis is shown schematically in FIGS. 24(a) through 24(d), and graphically in FIGS. 25 through 32. After the anvil 46 is moved sufficiently away from the cartridge 44 (FIG. 24(a)), the staple anastomosis line is moved to maximum eccentricity with rod 52. Then the staple line is slipped over the edge of anvil 46 at A (FIG. 24(b)) and moved progressively in this manner until the staple line encircles the anvil part across the section C-B in FIG. 25. Next the opposite point of the staple line at B is moved progressively outward toward D (FIG. 24(c)). Next the staple line is slipped over the perimeter of anvil part 46 at D whereupon the anvil is free to be withdrawn from the anastomosis (FIG. 24(d)).
In other words the anvil-carrying part 46 includes two concentric circular arrays of spaced staple clinching grooves 232 in a closed pattern. The rod 52, upon which the anvil carrying part 46 is mounted, intersects a plane 604 defined by the staple clinching grooves, and is typically concentric within the circular arrays of spaced clinching grooves. The intersection of the exterior surface 600 of the rod 52 with the plane 604 defines a closed geometric FIG. 602. FIG. 26, which graphically illustrates a view taken from a plane parallel to the plane 604 defined by the circular arrays of spaced clinching grooves, shows the closed geometric FIG. 602
Again, with reference to FIG. 25, knob 216 is used to secure the anvil-carrying part 46 to the rod 52. The knob 216 intersects the exterior surface 606 of the anvil-carrying part 46. The intersection of the exterior surface 608 of the knob 216 with the exterior surface 606 of the anvil-carrying part 46 defines a closed geometric FIG. 610.
The anvil-carrying part 46 has a geometric shape related to the circumference of the inner one of the pair of concentric circular arrays of staple clinching grooves. In order to explain the relationship, provision is made in FIGS. 25 and 29-32 for a plurality of cutting planes which pass through the anvil-carrying part 46 and include a line 614 tangent to the exterior of the closed geometric FIG. 610. When the cutting plane is rotated about the line of tangency 614, the plane defines sections, illustrated in FIGS. 30 through 32, of the anvil-carrying part 46 all of which have a perimeter P equal to or less than the circumference of the inner one of the pair of concentric circular arrays of staple clinching grooves.
Referring now to FIGS. 36 through 40, the internal arrangement for the body or housing 310 will now be described in detail. As already noted, the cap 362 contains an external thread which threadedly engages with an internal thread suitably formed in the terminal part of the throughbore 311. This threaded engagement is identified generaly by the reference numeral 366. Throughbore 311, at its end proximal to the disposable cartridge mounting, receives the outer tube 330 which extends into the throughbore 311 terminating at the entry to an enlarged region 370 of the bore 311. The body 310 and the tube 330 are rigidly interconnected in the bore 311 by holding pin 361, so that there is no relative motion between them. The driver tube 350 extends coaxially within the sleeve 330 and projects therefrom into the enlarged region 370 whereupon it is fixedly mounted at its end within a pusher hub 372. This hub 372, in turn, is connected by means of threads 376 with a pusher-stop cap 378. The driver tube 350, together with the pusher hub 372 and the cap 378, all move as a unit.
Pivoting of trigger 314 about pin 316 results in a longitudinally-directed force being exerted on the front walls 391 of the hub 372 by yoke portion 390 of the trigger 314. This results in the forward movement of driver tube 350 within outer tube 330. A spring 356 received around tube 350 in region 370 biases hub 372 against the foward movement produced by handle part 314. The left end of spring 356, as viewed in FIG. 39, is held against the end of tube 330
With reference to FIGS. 41 through 59, the staple-carrying part 344 is an assembly comprised of a hollow main body portion or shell 440 having a cylindrical portion and a frusto-conical portion which terminates in a small diameter neck 441. As best seen in FIG. 50, a staple guide member 448 provided with a projection 452 coacting with a slot 450 defined on the main body part 440 for rotational orientation is secured to the main body part 440. The guide member 448 forms a guide face 456 which defines two concentric circular series of spaced staple-receiving slots 458, see FIG. 54. Holes 451 provide venting for the staple-carrying part 344. Received within the main body part 440, as shown in FIGS. 50 and 55 is a staple pusher assembly 460, which fits concentrically within the main body part 440. The rear portion of the staple ejection assembly 460 is defined by a pusher back 453 having a generally frusto-conical shape and containing vent holes 463. The forward portion of the staple pusher 460 is defined by a member 455 which contains two concentric rings of peripherally spaced fingers 462, each one of which is received within a stape receiving sot 458. The member 455 is secured to the pusher 453 by a suitable adhesive at a point 457. The rear end 461 of the staple pusher 453 is adapted to be contacted by the end of driver tube 350. Hence, upon advancing the staple pusher assembly 460 by driver tube 350, the fingers 462 will pass furlher into the staple receiving slots 458, pushing staples contained therein axially outwardly. The staple pusher 460 is reinforced with a plurality of ribs 464 (FIG. 57), at least two of which are provided with suitable plastic projections or bosses 466. With reference to FIGS. 54 and 63 through 65, a knife 468 in the form of an open cup with the rim defining the knife edge 470 is mounted within the staple ejector assembly 460 by means of holes 473 through which the bosses 466 project. In mounting, the bosses 466 are "hot staked" to fasten the knife 468 onto a support ring 467 of the the staple ejector assembly 460 so that advancement of the staple ejector 460 also advances knife 468. The knife 468 has vent holes 461 which communicate with the vent hoes 463 in the pusher 453.
lt is paramount that the anvil 530 be in precise alignment with cartridge part 344 in all respects. In the above construction, the cartridge is aligned and keyed to center rod 352. As will be explained below, the anvil 530 is also aligned and keyed to the same slots 458 and 459 in rod 352. Since rod 352 is the single member connecting cartridge 344 and anvil 530 during the stapling procedure, an alignment path through the least number of parts (in order to obtain a minimum build up of error through accummulated tolerances, clearances, etc.) has been provided.
In this condition, the instrument is inserted into the patient through the hollow organ that is to be stapled. At this time the patient has been prepared such that the hollow organ to be stapled has been cut and there are two cut ends to be joined together by means of the instrument of the present invention. The instrument is inserted through the hollow organ until it projects from one of the cut ends. The wing nut 360 is rotated to extend the rod 352, thereby creating a substantial gap between the anvil carrying part 346 and the staple carrying part 344.
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Cooperative Classification A61B2017/0023, A61B2017/00473, A61B17/1155