Patent Document

TECHNICAL FIELD AND BACKGROUND OF THE INVENTION 
     The invention relates to an apparatus for connecting a variety of surgical instruments to an operating control device. 
     Disclosed, for example, by U.S. Pat. No. 4,573,468 is a circular stapling device from which the head unit may be removed as a whole. Connecting the head unit to an operating control part on this stapling device is achieved by a complicated bayonet lock. Furthermore, the clincher insertion head needs to be screwed onto/from this known instrument which is a nuisance and time-consuming. 
     As it reads from U.S. Pat. No. 5,533,361 a head part of the surgical instrument is positively connected by a crimped tube stiffly and non-separably to a shank part of the operating control means. In U.S. Pat. No. 4,606,343 too, it reads that a shank tube of the operating control device and a head part of the surgical instrument are likewise fixedly connected to each other. Replacing any parts of the surgical instrument is thus not provided for. 
     SUMMARY OF THE INVENTION 
     It is thus the object of the invention to configure a variety of surgical instruments so that they can be quickly replaced whilst retaining satisfactory operating control of the element in each case, and that furthermore as many function elements as possible of the various instruments are reusable. 
     In accordance with the invention, for connecting a variety of surgical instruments for both minimally invasive surgery and for application in open surgery a push-button fastener is provided at the proximal end of the instrument to be connected in each case at the distal end of a shank part of an operating control device. Furthermore, for connecting and actuating the function elements of the instrument connected in each case a mandrel assembly is provided at the proximal end of the instrument which is mounted on a receiving part at the distal end of an adjuster mechanism actuatable by the operating control means. 
     In accordance with the invention the mandrel assembly is preferably a tubular pin body slotted at its proximal end, having splined portions which is mounted on a contact pin guided and positioned in the shank part and connected to the adjustmer mechanism of the operating control means. 
     Unlike the complicated need to screw the clincher insertion head onto the circular stapling device as disclosed by U.S. Pat. No. 4,573,468 the head unit is connected by the solution in accordance with the invention via a simple push button fastener to the distal end of the shank part of the operating control means. In addition, connection of the clincher insertion head for instance of a circular stapling device is achieved via a latch fastener. In accordance with the invention a variety of instruments can thus be speedily and intuitively connected to the shank part of an operating control means and, at the same time, salient function elements of the surgical instrument concerned to be connected via a mandrel provided at the distal end of the shank part of the operating control means. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The invention will now be detailed by way of preferred embodiments with reference to the drawings in which: 
     FIG. 1 is a perspective illustration of the three main assemblies of a head unit; 
     FIGS. 2 a  to  2   c  are exploded views each likewise in a perspective illustration of the individual parts of the three main assemblies of the head unit as shown in FIG. 1, i.e. FIG. 2 a  depicting those of the staple cartridge assembly, FIG. 2 b  those of the mandrel assembly and FIG. 2 c  those of the clincher insertion head assembly, 
     FIG. 3 is a section view of the head unit fitted to the shank with the clincher insertion head extended; 
     FIG. 4 is likewise a section view of the head unit fitted to the shank but with the clincher insertion head retracted and stapling implemented; 
     FIG. 5 is a section view through the clincher insertion head along a line  5 — 5  as shown in FIG. 4; 
     FIG. 6 is a magnified perspective illustration of the push button fastener applied to the distal end of a shank part including a button mechanism assigned thereto at the proximal end of the head unit; 
     FIG. 7 is a perspective illustration of a section at the distal end of a contact pin and a mount on a mandrel; 
     FIG. 7 a  is a detail of the contact pin shown greatly magnified; 
     FIG. 8 is an illustration of a modified version of the distal end of a shank part and a proximal end of a head unit adapted thereto; 
     FIGS. 9 a  and  9   b  are partial section views of a scalpel holder and a staple ejector fixedly coupled thereto, i.e. shown retracted in FIG. 9 a  and shown extended in FIG. 9 b;    
     FIGS. 10 a  and  10   b  are partial section views of a first embodiment of the scalpel holder and of a staple ejector connected thereto via a coupling element, i.e. shown retracted in FIG. 10 a  and shown extended in FIG. 10 b;    
     FIGS. 11 a  and  11   b  are partial section views of a second embodiment of the scalpel holder and of a staple ejector connected thereto via a coupling element, i.e. shown retracted in FIG. 11 a  and shown extended in FIG. 11 b;    
     FIGS. 12 a  and  12   b  are partial section views of a third embodiment of the scalpel holder and of a staple ejector connected thereto via a coupling element, i.e. shown retracted in FIG. 12 a  and shown extended in FIG. 12 b;    
     FIGS. 13 a  and  13   b  are partial section views of a fourth embodiment of the scalpel holder and of a staple ejector connected thereto via a coupling element, i.e. shown retracted in FIG. 13 a  and shown extended in FIG. 13 b;    
     FIGS. 14 a  and  14   b  are partial section views of a fifth embodiment of the scalpel holder and of a staple ejector connected thereto via a coupling element, i.e. shown retracted in FIG. 14 a  and shown extended in FIG. 14 b;    
     FIG. 15 a  is a partly perspective illustration and partly section view of an embodiment of a purse string suture applicator; 
     FIG. 15 b  is a magnified section view of a detail of the clincher insertion head of the purse string suture applicator as shown in FIG. 15 a;    
     FIG. 15 c  is likewise a magnified section view of a detail of a staple cartridge with inserted staple; 
     FIG. 15 d  is a perspective illustration of the staple cartridge with inserted suture loop as seen from above; 
     FIG. 15 e  is a section view in part of the purse string suture applicator with the clincher insertion head retracted and stapling implemented; 
     FIG. 15 f  is a section view on a greatly magnified scale of a suture stapled to one bowel end with the scalpel knife extended; 
     FIG. 16 a  is a perspective illustration of a staple cartridge of a linear stapler with extended clincher insertion head as seen from above; 
     FIG. 16 b  is an illustration of the staple cartridge as shown in FIG. 16 a  with the clincher insertion head retracted; 
     FIG. 16 c  is a side view partly sectioned of a first embodiment of a linear stapler with the clincher insertion head extended; 
     FIG. 16 d  is a frontal view partly sectioned of the linear stapler with the clincher insertion head extended; 
     FIG. 16 e  is a perspective illustration of the stapling portion of the linear stapler with the clincher insertion head extended and an adapter connected; 
     FIG. 16 f  is a detail illustration of the stapling portion as shown in FIG. 16 e;    
     FIG. 16 g  is a perspective illustration of a closed stapling portion; 
     FIG. 16 h  is a perspective illustration of a further embodiment of the staple cartridge as seen from above; 
     FIG. 17 a  is a perspective illustration of a second embodiment of a linear stapler with the pusher open; 
     FIG. 17 b  is a side view of the linear stapler as shown in FIG. 17 a  shown partly in section with the pusher open and stapling implemented; 
     FIG. 17 c  is a side view of the linear stapler shown partly in section with the pusher closed and stapling implemented; 
     FIG. 17 d  is a detail illustration of the staple cartridge of the linear stapler as shown in  17   e  shown partly sectioned; 
     FIG. 17 e  is a view of the linear stapler as seen from above with the pusher open; 
     FIG. 17 f  is a perspective illustration of the linear stapler corresponding to that as shown in FIG. 17 e  with the pusher closed and stapling implemented; 
     FIG. 17 g  is a section view taken along the line  17   g — 17   g  as shown in FIG. 17 f;    
     FIG. 18 a  is perspective illustration of an anastomosis ring applicator as viewed overall; 
     FIG. 18 b  is a side view of the anastomosis applicator as shown in FIG. 15 a,  shown partly in section, with an open anastomosis ring; 
     FIG. 18 c  is illustration partly in section of an anastomosis applicator as shown in FIG. 18 b  with the mounted anastomosis ring open and showing the inerted ends of the hollow organ represented schematically, and 
     FIG. 18 d  is an illustration partly in section of the anastomosis applicator corresponding to that as shown in FIG. 18 c  with the anastomosis ring closed. 
    
    
     DETAILED DESCRIPTION 
     Referring now to FIG. 1 there is illustrated how a head unit of circular stapling device is split up into three assemblies, namely a staple cartridge assembly  1 , a mandrel assembly  2  and a clincher insertion head assembly  3 . 
     Referring now to FIG. 2 a  it is evident that the staple cartridge  1  is accommodated in a housing  11  of a head unit of the circular stapling device which is connected via a push button fastener  112  to a shank tube  42  (FIG. 4) of the stapling device. Arranged concentrically in a staple cartridge  17  connected to the housing  11  are U-shaped staples  18  in at least one staple chute  172 , plungers  161  of a staple ejector  16  mounted axially shiftable in the housing  11  being suitably oriented relative to the staple chute(s)  172 . 
     Mounted axially shiftable in the housing  11  of the head unit is likewise a scalpel holder  12  with mounted scalpel  13 . Scalpel holder  12  and staple ejector  16  are connected to each other via coupling elements  15 . By means of a spring  14  supporting the scalpel holder  12  at the raised face  124  against the staple ejector  16  the scalpel holder  12  together with the scalpel  13  is retracted back into the housing  11  after stapling and preferably an excision has been performed. 
     Referring now to FIG. 2 b  it is evident that a pin body  21  of the mandrel  2  has a tubular slotted end  212  which is mountable on a contact pin  43  of a clincher insertion head actuator mechanism  44  (see FIG. 7) of the stapling device, a circumferential groove of the contact pin  43  engaging a circumferential raised face  211  (FIG. 7 a ) of the inner contour of the pin  21 . 
     In adjusting a tissue gap the contact pin  43  with the mandrel  2  is drawn into the interior of the shank tube  42  by means of the clincher insertion head adjusting mechanism  44  of the stapling device, as a result of which the slotted end  212  of the mandrel  2  is located within a barrelled pressure part  41  of the stapling device, thus arresting the connection of the contact pin  43  with the mandrel  2 . 
     Splines  23  and  22  respectively align the mandrel  2  rotatively with reference to the splines  123  of the scalpel holder  12  and the splines  332  of a staple anvil  33  (FIG. 2 c ) respectively, thus assuring that the staple chutes  172  of the cartridge  17  are precisely aligned relative to the staple clinching grooves  331  of the anvil  33  (see FIG. 3, top). 
     At the distal end of the mandrel  2  the clincher insertion head  2  is releasably connected, the smaller inner diameter  322  (FIG. 5) of a latching element  32  thereby engaging a corresponding groove  213  of the mandrel  2  (FIG. 2 b ). To release the connection between the mandrel  2  and the clincher insertion head  3  an operating control button  36  needs to be actuated to overcome the spring force of a spring  35  centered on a spigot  311  of a domed cap  31 . In this arrangement the latching element  32  attached by a nose  321  in the operating control button  36  is displaced so that the larger diameter  323  of the latching element  32  is aligned in the longitudinal axis of the mandrel  2 . 
     The diameter  323  is dimensioned somewhat larger than the outer diameter of the mandrel  2  or of a pilot hole  312  so that the mandrel in this position can be extracted from the clincher insertion head  3 . The clincher insertion head  3  comprises the staple clinching grooves  331  for clinching the staples  18  as well as a ring  34  preferably made of teflon serving as the cutter counterpart for the scalpel  13  so that during the stapling action an axial force is exerted by the barrelled pressure part  41  on the scalpel holder  12 . 
     Referring now to FIG. 6 there is illustrated in perspective a push button fastener  112  provided at the proximal end of the housing  11  of the head unit and comprising push buttons  112  seated pliantly. The push buttons  112  engage corresponding radial holes  420  in a shank tube  42 . 
     Referring now to FIG. 7 there is illustrated in perspective the slotted end  212  of the pin body  21 . As evident from the cartridge detail illustration in FIG. 7 a  a circumferential raised face  211  on the inner contour of the slotted tubular end  212  engages a corresponding groove in the contact pin  43  of a clincher insertion head adjusting mechanism  44  (not shown) of a operating control part. 
     Referring now to FIG. 8 there is illustrated part of the stapling mechanism  45  of the operating control part which translates into a barrelled pressure part  41  by means of which a compressive force is transferred as an axial pressure force into the body of a head unit. 
     Referring now to FIGS. 9 a  and  9   b  there is illustrated a first embodiment identified as variant  1   a  in which scalpel holder V 1   a - 12  and staple ejector V 1   a - 16  are fixedly coupled, i.e. stapling and excision occurring simultaneously. In a stapling action the unit comprising scalpel holder V 1   a - 12  and staple ejector V 1   a - 16  is displaced axially in the housing  11  of the head unit (FIG. 9 b ), resulting in the staples  18  being ejected from their chutes and clinched in the staple clinching grooves  331  of the anvil  33 . At the same time the circular scalpel V 1   a - 13  trims the protruding edge of tissue. 
     In all embodiments as described in the following stapling is done prior to the excision. In the embodiment modified accordingly as shown in FIG. 2 a  to FIG. 4 as well as in FIGS. 10 a  and  10   b,  thus identified as variant V 1   b,  and involving a linear-sensitive coupling action the staple ejector V 1   b - 16  is connected to the scalpel holder V 1   b - 12  by at least one coupling element  15  (FIG. 2 a ). This at least one coupling element  15  is seated in a window  162  of the staple ejector  16  as well as in a recess  1211  of a guiding groove  121  of the scalpel holder  12 . On commencement of stapling staple ejector V 1   b - 16  and scalpel holder V 1   b - 12  are moved in common (FIG.  3 ). 
     After a predetermined stapling travel the configuration of an inner contour  111  of the housing  11  enables the coupling elements  15  to be radially displaced, as a result of which a ramp  151  (FIG. 3) on each coupling element  15  comes up against a raised face  171  in the staple cartridge  17  so that the coupling element  15  is displaced radially outwards until it no longer engages the scalpel holder  12 , thus subsequently resulting in staple ejector  16  and scalpel holder  12  being decoupled, after which the scalpel holder  12  travels alone to implement the excision (see FIG.  4 ). 
     Referring now to FIGS. 10 a  and  10   b  it is evident that in the first embodiment variant V 1   b  the scalpel holder V 1   b - 12  is connected to the staple ejector V 1   b - 16  via at least one tab V 1 - 19  in the form of a flexible finger. This tab V 1   b - 19  engages a corresponding recess V 1   b - 124  of the scalpel holder V 1   b - 12  and transfers the force during the stapling action from the scalpel holder V 1   b - 12  to the staple ejector V 1   b - 16  (see FIG. 10 a ). 
     Once stapling has been implemented, the staple ejector V 1   b - 16  comes up against the staple cartridge: the tabs V 1   b - 19  then being located in a portion of the inner contour  111  of the housing  11  (FIG. 3) in which the tabs V 1   b - 19  can be bent radially outwards. Due to the ramps of the recess V 1   b - 124  the tabs V 1   b - 19  are urged radially outwards, as a result of which the scalpel holder V 1   b - 12  is decoupled from the staple ejector V 1   b - 16 . The scalpel holder V 1   b - 12  then travels by itself and implements the excision (see FIG. 10 b ). 
     Unlike the linear-sensitive coupling as described above the coupling now to be described with reference to the FIGS. 11 a / 11   b,  FIGS. 12 a / 12   b,  FIGS. 13 a / 13   b  and in FIGS. 14 a / 14   b  in the embodiments, identified as variants V 2   a  to V 2   d,  is termed force-sensitive. 
     In these embodiments too, stapling occurs prior to the excision. Staple ejectors V 2   a - 16 , V 2   b - 16 , V 2   c - 16  and V 2   d - 16  as well as scalpel holders V 2   a - 12 , V 2   b - 12 , V 2   c - 12  and V 2   d - 12  respectively are connected to each other via at least one breakaway lock V 2   a - 10 , V 2   b - 10 , V 2   c - 10  and V 2   d - 10  respectively. During the stapling action the staple ejectors V 2   a - 16 , V 2   b - 16 , V 2   c - 16  and V 2   d - 16  and the scalpel holders V 2   a - 12 , V 2   b - 12 , V 2   c - 12  and V 2   d - 12  respectively travel in common. 
     Once the stapling action has been implemented the staple ejector V 2   a - 16 , V 2   b - 16 , V 2   c - 16  and V 2   d - 16  respectively comes up against the staple cartridge, for example V 2   a - 17  as shown in FIG. 11 b.  As soon as the stapling force exceeds the breakaway force of the corresponding breakaway lock V 2   a - 10 , V 2   b - 10 , V 2   c - 10  and V 2   d - 10  respectively the staple ejector V 2   a - 16 , V 2   b - 16 , V 2   c - 16  and V 2   d - 16  and scalpel holder V 2   a - 12 , V 2   b - 12 , V 2   c - 12  and V 2   d - 12  respectively decouple so that the latter subsequently travels by itself and implements the excision. 
     Referring now to FIGS. 11 a  and  11   b  there is illustrated a second embodiment (variant V 2   a ) in which the breakaway lock V 2   a - 10  is achieved as a frangible knockout which breaks as soon as the breakaway force is exceeded so that the scalpel holder V 2   a - 12  and staple ejector V 2   a - 16  are subsequently decoupled. 
     Referring now to FIGS. 12 a  and  12   b  there is illustrated a variant V 2   b  in which the breakaway lock V 2   b - 10  is achieved as a leaf spring latch V 2   b - 10  seated in a recess V 2   b - 124  of the scalpel holder V 2   b - 12 . When the breakaway force is sufficient the leaf spring latch V 2   b - 10  deforms like a bending finger, causing it to snap out of place from the recess V 2   b - 124 , thus resulting in scalpel holder V 2   b - 12  and staple ejector V 2   b - 16  being decoupled from each other. 
     Referring now to FIGS. 13 a  and  13   b  there is illustrated a third embodiment (variant V 2   c ) in which the breakaway lock is a ball spring latch, the ball V 2   c - 10  of which is urged by a spring V 2   c - 11  into a recess V 2   c - 121  in the scalpel holder V 2   c - 12 . Once the breakaway force on stopping of the staple ejector V 2   c - 16  is sufficient the ball V 2   c - 10  snaps out of place from the recess V 2   c - 121 , resulting in the staple ejector V 2   c - 16  being decoupled from the scalpel holder V 2   c - 12 . 
     Referring now to FIGS. 14 a  and  14   b  there is illustrated a fourth embodiment (variant V 2   d ) in which the coupling element features a corrugated inner contour V 2   d - 160  of the staple ejector V 2   d - 16  engaging a corresponding outer contour V 2   d - 121  of the scalpel holder V 2   d - 12 . To decouple the staple ejector V 2   d - 16  from the scalpel holder V 2   d - 12  after the stapling action the breakaway force applied must be sufficient to urge the inner contour V 2   d - 160  of the staple ejector V 2   d - 16  sufficient radially outwards due to the ramp-effect of the outer contour V 2   d - 121  so that the inner contour V 2   d - 160  totally releases from the cuter contour V 2   d - 121 . 
     Referring now to FIGS. 15 a  to  15   f  there is illustrated a further embodiment of the circular stapling device in the form of a purse string suture applicator. A purse string suture applicator does not serve to directly connect two free ends of a hollow organ, it instead serving to prepare this connection and is thus termed an anastomosis preparator with which a suture loop is applied to a free end of a hollow organ by means of staples. 
     A purse string suture applicator is configured and functions similarly to the circular stapling device as described above, except that in the purse string suture applicator the staples are not arranged and oriented, as in the stapling device in two rows circumferentially but in one row radially. The remaining configuration of a purse string suture applicator including the scalpel which may be coupled either fixedly to the staple ejector or connected thereto by means of a decoupling mechanism has already been detained in describing the circular stapler. 
     Likewise, the purse string suture applicator or anastomosis preparator, termed the fifth embodiment (variant V 3 ) in the following comprises the same system connecting the shank tube, the reciprocating driver means as for stapling device described (see V 3 - 112 , V 3 - 212 , V 2 - 22 , V 3 - 23 ). 
     A suture loop V 3 - 4  is inserted in a circumferential groove V 3 - 171  in the staple cartridge V 3 - 17  of an instrument head V 3 - 11  and is guided via side groove V 3 - 113  from the instrument head V 3 - 11  to the handle part. The suture loop V 3 - 4  may already be provided with a knot accommodated in a knot holder V 3 - 174 . 
     One end of the hollow organ is drawn via a domed cap V 3 - 31  of a clincher insertion head V 3 - 3  so that the projecting hollow organ comes into contact near to the mandrel V 3 - 2 . Subsequently the clincher insertion head is caused to approach the base V 3 - 1  of the instrument head V 3 - 11  until the required staple gap is set, the width of which is checked at the handle. 
     Stapling is then implemented in which the suture loop V 3 - 4  is attached to the end of the hollow organ by means of radially oriented staples V 3 - 18  and excision of the projection of the hollow organ done by means of a scalpel V 3 - 13 . On actuation of a plunger V 3 - 16  the staples V 3 - 18  are ejected by staple ejectors V 3 - 161  from the staple chutes V 3 - 172  of a staple cartridge V 3 - 17  and B-clinched in corresponding staple clinching grooves V 3 - 331  of a metal inlay V 3 - 33 . The circular scalpel (annular knife) V 3 - 13  is counterheld in a plastics ring V 3 - 34 . 
     After the stapling action the clincher insertion head V 3 - 3  is again extended from the staple cartridge V 3 - 17  and the hollow organ drawn off with the stapled suture loop. The tissue projection remains on the instrument as a cut-out ring serving to check a correctly implemented loop application. 
     Referring now to to FIGS. 15 a  to  15   f  there is illustrated the embodiment of the purse string suture applicator equipped with gripper arms V 3 - 24  fixedly joined by the mandrel V 3 - 2 . The gripper arms V 3 - 24  are open in the distal position of the clincher insertion head V 3 - 2  (see FIGS. 15 a ,  15   d ) so that a free end of a hollow organ, for example a free bowel end, may be inserted in the gripper arms V 3 - 24 . 
     When the clincher insertion head V 3 - 3  is moved towards the staple cartridge V 3 - 17 , the gripper arms V 3 - 24  close and grip by their ends V 3 - 241  the hollow organ to the groove of the mandrel V 2 - 214 . The tissue gap is then set and subsequently the stapling action and excision implemented during which the suture V 3 - 4  is attached to the end of the hollow organ by the staples V 3 - 18  and excision of the projecting tissue done with the circular scalpel V 13 - 13 . 
     Subsequently the clincher insertion head V 3 - 3  is slightly moved away from the staple cartridge V 3 - 17  so that the bowel is easy removed, the radial staple arrangement thereby proving to be no restriction to the extensibility of the bowel, 
     The clincher insertion head V 3 - 3  can be removed by actuating the operating control button V 3 - 36 . In addition, the gripper arms V 3 - 24  are configured so that its grippers engage corresponding grooves in the scalpel holder  13 , enabling the components to be precisely aligned to each other. 
     A so-called linear stapling device may be configured in a boom-type form either with a double row of staples and a side-cutting scalpel parallel thereto (see FIGS. 16 a  to  16   d ) or with two double rows of staples on both sides of the scalpel (see FIG. 16 h ), or it may be equipped optionally with a fixedly fitted or attachable purse-string suture staple as evident from, for example, FIGS. 16 e  to  16   g . The connections to the operating control part configured as the “handle part” are configured analogously. A linear stapling device serves to undertake closures on hollow organs. 
     Referring now to FIGS. 16 a  to  16   h  there is illustrated a fifth embodiment (variant V 4 ) in which a anvil V 4 - 3  is fixedly connected to the mandrel (V 4 - 2 ) by means of the handle part during coarse and fine adjustment, the mandrel comprising at its distal end slots V 4 - 212 . This connection is non-releasable during a stapling action and can be only be separated with the clincher insertion head V 4 - 3  extended. 
     A staple cartridge V 4 - 17  is fixedly connected to a base part V 4 - 1  (FIG. 16 d ) which is coupled to a shank tube (not shown in FIG. 16) of the handle part via push button fastener V 4 - 112 . An ejector V 4 - 16  is shiftingly mounted in the head unit housing V 4 - 11  and coupled to a pusher (likewise not shown) in the handle part. 
     The ejector V 4 - 16  ejects by plungers V 4 - 161  the staples V 4 - 18  from the staple chutes V 4 - 172  of the staple cartridge V 4 - 17 . The staples V 4 - 18  are B-clinched in corresponding clinching grooves V 4 - 331  in a metal inlay V 4 - 33  (FIG. 16 f ) of the clincher insertion head V 4 - 3  whilst a linear scalpel V 4 - 13  configured optionally fixed or releasably coupled to the ejector V 4 - 16  is guided in the scalpel groove V 4 - 173  to part the hollow organ and to cut into a plastics body V 4 - 34 . 
     Referring now to FIGS. 16 e  to  16   g  there is illustrated a further embodiment of a linear stapler including a linear scalpel and a single-sided double staple suture with which a corrugated clamping of the bowel may be achieved by corresponding purse-string suture staples V 4 - 19  and V 4 - 38  on the other side facing away from the staple side. In this arrangement the hollow organ is located in a corrugated position in the recesses V 4 - 191  and V 4 - 381 . Prior to implementing the staple stitching action a suture V 4 - 4  is guided towards the side of the clincher insertion head and back to the staple cartridge (or vice-versa) via two suture guide grooves V 4 - 192  and V 4 - 382  oriented parallel to the knife. In this way a purse-string suture loop may be directly placed with needle and filament through the tissue. 
     A linear boom-type stapling device is made use of to produce a closure in a hollow organ by a two-row stapling action and the projecting tissue trimmed with a knife. Referring now to FIGS. 17 a  to FIG. 17 g  there is illustrated an embodiment with which a linear double row of staples V 5 - 172  may be placed on one side of the linear scalpel V 5 - 13 . 
     Furthermore, a double row of staples may also be placed on each side of the linear scalpel (see FIG. 16 h ). By means of the linear scalpel a closed hollow organ may be parted by a cut between the two double rows of staples thus resulting in two closed hollow organ stubs. 
     In a further aspect (not shown) of a linear stapler including a linear scalpel and a double row of staples on one side a corrugated clamp of the bowel may be achieved on the other side of the linear scalpel, i.e. facing away from the staple side. Before implementing the stapling stitching action a suture may be applied with the needle guided towards the clincher insertion head and back to the the staple cartridge (or vice-versa) via two suture guide grooves oriented parallel to the knife thus resulting in a purse-string suture stitch being directly placed through the tissue (see FIGS. 16 e  to  16   g ). 
     An alligator-type linear stapling device consists of a fixed base part V 5 - 1  to which the staple cartridge V 5 - 17  is fixedly connected and in which ejector and scalpel holder V 5 - 16  as well as pusher V 5 - 12  are shiftingly mounted with a locating pin. The clincher insertion head V 5 - 3  with the staple clinching grooves V 5 - 331  and a plastics inlay V 5 - 34  serving as the cutting surface area for the annular knife V 5 - 15  is movably mounted in the head unit housing V 5 - 11  via a pin joint V 5 - 313  in a guide V 5 - 114 . 
     Referring now to FIGS. 17 e  and  17   f  there is illustrated an ejector V 5 - 16  guided via staple ejectors V- 161  in staple chutes V 5 - 172  of the staple cartridge V 5 - 17  has ramps V 5 - 163  via which it is actuated by the pusher V 5 - 12  via corresponding ramps V 5 - 126 . Additionally secured to the ejector is a linear scalpel V 5 - 13  which is guided in a groove V 5 - 173  in the cartridge V 5 - 17 , whereby knife and ejector may be actuated partly decoupled from each other. 
     Referring now to FIGS. 17 c  and  17   f  there is illustrated how the anvilV 5 - 31  may be optionally fitted at its distal end with a latching hole V 5 - 333  engaged by a locating pin V 5 - 125  so that the clincher insertion head is not deformed during clinching of the staples V 5 - 18  and cutting, i.e. retains its desired position. 
     The connection to a “handle part and shank tube” is configured the same as in the other head units. The base is fixedly connected via the push button fastener V 5 - 112  but relesably connected to the shank tube. Preventing release during a stapling action is achieved by the snap-action noses of the push button fastener V 5 - 112  being locked in place by a stop to prevent accidental opening. 
     The clincher insertion head V 5 - 31  is driven in a connecting link V 5314  from the mandrel V 5 - 21  via a toggle pin V 5 - 24  which is coupled to the inner pusher medium of the “handle part” via a resilient connector V 5 - 212  and is likewise locked in place to prevent accidental release during the stapling action. The ejector V 5 - 16  is actuated by the pusher with the locating pin V 5 - 12  which is connected to the outer pusher medium of the handle part. 
     Opening and closing the clincher insertion head is thus achieved by actuating a coarse and vernier adjustment on the handle part whilst locking the clincher insertion head in place and implementing stapling is controlled by a toggle handle provided on the handle part. 
     The alligator-type linear stapler is intended for application in minimally invasive surgery since due to its small cross-section there is no problem in introducing it through a trocar. 
     Referring now to FIGS. 18 a  to  18   d  there is illustrated an anastomosis applicator permitting application of an anastomosis ring V 6 - 5  (e.g. a VALTRAC” ring). The anastomosis ring V 6 - 5  is mounted in the open condition (see V 6 - 51  in FIG. 18 b ) on an annular gripper V 6 - 19  and locked in place by means of a clamping device V 6 - 2 . The clamping device V 6 - 2  comprises a conical section V 6 - 25  of a mandrel V 6 - 21  which expands the annular gripper and arrests the anastomosis ring V 6 - 5  relative to a ring mount V 6 - 11  of a base part V 6 - 1 . 
     The instrument is then introduced into the hollow organ stub, for example via side incision, until the distal ring-half protrudes from the previously freely prepared end of the hollow organ provided with a purse-string suture loop. 
     By tightening the purse-string suture in the annular gripper and knotting, the first end of the hollow organ is defined in the gap between the halves of the anastomosis ring. Then, the second free end of the bowel is tightened with the purse-string suture via the distal ring-half and likewise defined on the ring by the suture loop. 
     After this, by actuating the handle part and the resulting movement of an ejector V 6 - 16  the proximal ring-half is moved from the ejector V 6 - 16  onto the distal ring-half until the ring-halves interlock. Subsequently, the mandrel V 6 - 21  is moved over a short distance distally, thus resulting in the closed anastomosis ring (see condition V 6 - 52  as shown in FIG. 18 d ) being released from the mandrel to enable the instrument to be removed from the hollow organ. 
     As in the other head variants the connection to the handle part and shank tube is configured analogously to that of the circular stapler. The mandrel V 6 - 21  is connected to the head adjuster via a resilient connection in the form of a snap-action nose connection V 6 - 212 . The expanding mandrel is part of the base part V 6 - 1  to which also a funnel-clinched ring cover V 6 - 11  is joined in which the ring is circumferentially guided. The base part is connected to the shank tube via snap-action nose connection V 6 - 112 . The ejector V 6 - 16  which closes the anastomosis ring is connected to the middle pusher medium and is actuated by the toggle handle.

Technology Category: 1