Luminal anastomotic device and method

• US 20020185517A1
• Filed: 04/02/2002
• Published: 12/12/2002
• Est. Priority Date: 04/02/2001
• Status: Active Grant

• Current Assignee: Blynn L. Shideler, Kevin S. Vresh, Krisanne Shideler, Susan E. Vresh
• Original Assignee: Blynn L. Shideler, Kevin S. Vresh, Krisanne Shideler, Susan E. Vresh
• Inventors: Vresh, Susan E., Vresh, Kevin S., Shideler, Krisanne, Shideler, Blynn L.
• Granted Patent: US 6,769,590 B2
• Time in Patent Office: Days
• US Class Current: 227/176.1
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/115 Staplers for performing anastomosis in a single operation
• CPC Class Codes: A61B 17/1152 applying the staples on the outside of the lumen
• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/1132 End-to-end connections

Abstract

An end to end anastomotic stapling device connects two lumen sections avoiding constricture at the anastomotic ring. An intraluminal end to end anastomotic stapler includes an expanding head and anvil designed to fire an anastomotic ring having an inner diameter at least equal to the nominal inner diameter of the remaining lumen sections. An extraluminal end to end lumen stapler is described attaching the lumen sections with an exterior flange type connection having anastomotic rings with a diameter larger than the inner diameter of the lumen sections whereby the anastomotic site has a diameter at least as great as the adjacent lumen sections.

Claims

1. An anastomotic stapler for end to end anastomosis forming an anastomotic ring having a diameter greater than or equal to the nominal intraluminal diameter of the segments being anastomized.

2. A minimally invasive surgical stapler that will assist in stapler placement, the stapler having a head and anvil portion, wherein a diameter of the stapler head and stapler anvil portion of the stapler is smaller during insertion and retraction than at firing of the stapler.

3. A closed loop end to end anastomotic stapler with the trimming knife formed by individual knife segments and wherein the knife segments may be selected to operate in at least one of individually, a given sequence, and simultaneously.

4. A closed loop end to end anastomotic stapler with a row of staples contained in the head portion wherein the head portion is formed by individual head portion segments with each head portion segment including at least one stapler and wherein the head portion segments may be selected to operate in at least one of individually, a given sequence, and simultaneously.

5. A closed loop end to end anastomotic stapler having a head portion and an anvil portion and further including multiple anvil portion and multiple head portion controls in the surgical stapler, wherein the operator can independently separate anvil portion functions and the operator can control separate head portion functions.

6. The stapler of claim 5, wherein the stapler includes separate controls for expansion/retraction of the anvil portion and for axial movement of the anvil portion.

7. The stapler of claim 5 wherein the stapler includes separate independent controls for expansion/retraction of the head portion and for firing of a knife blade and staples of the head portion.

8. An end to end anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes a row a staples and a circular trimming knife, wherein the stapler further includes a staple and knife firing mechanism that accommodates relative motion of the head portion containing the staples and the stapler body.

9. An end to end anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes a row a staples and a circular trimming knife, and wherein the stapler further includes an alignment mechanism that aligns and locks the anvil portion and the head portion together prior to the firing of the staples or the knife.

10. An end to end anastomotic stapler with a closed loop row a staples and a circular trimming knife, wherein the stapler extends around the outside of the lumen portions being anastomized.

11. A surgical stapler for end to end anastomosis comprising:

an elongated body;

an expanding head at a first end of the body, the expanding head including a plurality of segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments.

12. The surgical stapler of claim 11, further including an annular knife for trimming the anastomized tissue.

13. The surgical stapler of claim 12, wherein the knife is formed of radially moveable knife segments.

16. The anastomotic stapler of claim 15, utilizing staples formed in a pair of offset annular arrays of staples to couple the end of a first lumen section to the end of a second lumen section.

17. The anastomotic stapler of claim 16, comprising:

a head portion including a stapling mechanism; and

an anvil;

wherein both the head and the anvil can be moved from a retracted position having a first diameter to an expanded position having a second larger diameter, and back to a retracted position after firing.

18. The anastomotic stapler of claim 17, wherein the head portion comprises a plurality of wedge-shaped arc segments that move radially and align in the expanded position to form an annular head.

19. The anastomotic stapler of claim 18, wherein each arc segment has a separate, independent firing mechanism.

20. The anastomotic stapler of claim 18, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

21. The anastomotic stapler of claim 18, wherein each arc segment has a separate, independent knife actuating mechanism.

22. The anastomotic stapler of claim 17, wherein the head portion comprises a plurality of arc-shaped segments that move rotationally from an overlapped formation in the retracted position to align in the expanded position forming an annular head.

23. The anastomotic stapler of claim 22, wherein each arc segment has a separate, independent firing mechanism.

24. The anastomotic stapler of claim 22, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

25. The anastomotic stapler of claim 22, wherein each arc segment has a separate, independent knife actuating mechanism.

27. The anastomotic stapler of claim 26, wherein each stapling unit includes two semi-circular sections connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

28. The anastomotic stapler of claim 27, wherein a first semi-circular section is formed as an anvil, and a second semi-circular section comprises a stapling mechanism and a knife portion.

29. The anastomotic stapler of claim 28, wherein the first semi-circular section includes a series of staple receiving slots and a knife receiving groove, said knife receiving groove situated at the radially outer edge of the first semi-circular section, and wherein the second semi-circular section includes the knife portion situated at the radially outer edge thereof.

30. The anastomotic stapler of claim 28, wherein the separate stapling units may be engaged face-to-face such that staples fired from the stapling mechanism of a first stapling unit may be received in the anvil of a second stapling unit upon firing, and staples fired from the stapling mechanism of a second stapling unit may be received in the anvil of the first stapling unit upon firing in the opposite direction.

31. The anastomotic stapler of claim 30, further comprising at least one means for alignment, allowing for alignment of the separate stapling units when engaged face-to-face.

32. The anastomotic stapler of claim 26, wherein said stapler is extraluminal.

33. The anastomotic stapler of claim 26, wherein each stapling unit further comprises a plurality of tissue retraction members spaced around the periphery of each stapling unit.

35. The surgical stapler of claim 34, wherein the head and the anvil are formed of individual segments;

wherein in a retracted position, the segments overlap in a spiral fashion.

37. The stapler according to claim 36, wherein the individual segments of the head and anvil slide past each other in an opposite direction to form an expanded position having a larger diameter than the diameter of the head an anvil in the retracted position.

40. The stapler of claim 39, further including a mechanism for pulling the lumen to be attached across the stapling face of each stapling unit.

41. The stapler of claim 39, further including an alignment mechanism for aligning the two adjacent stapling units prior to firing a ring of staples.

14. A surgical stapler for end to end anastomosis comprising:

an elongated body;

an expanding head at a first end of the body, the expanding head including a plurality of segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments.

15. An anastomotic stapler for end to end anastomosis forming an anastomotic ring having a diameter greater than or equal to the nominal intraluminal diameter of the segments being anastomized.

26. An anastomotic stapler comprising two identical, separate stapling units, wherein each stapling unit includes at least two sections, connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

34. A surgical stapler for end to end anastomosis comprising:

a stapling head; and

an anvil wherein the anvil is adjacent the stapling head, and wherein the head and anvil can be moved from a retracted position having a first relative diameter and an expanded position having a second larger diameter.

36. A surgical stapler for end to end anastomosis comprising:

a stapling head; and

an anvil, wherein the stapling head and anvil are comprised of individual segments formed in overlapping arrangements, wherein said individual segments slide past each other in a spiral fashion to form a retracted position.

38. A surgical stapler for end to end anastomosis wherein the stapling head is expandable.

39. An extraluminal stapler for end to end anastomosis formed of two opposed stapling units;

each unit clamping around a lumen section to be anastomized;

wherein each said stapling unit comprises two halves, and wherein one half of each unit is a stapling unit and the other half is an anvil portion.

42. A tissue grasping and positioning mechanism for positioning a lumen portion to be anastomized across the stapling face of a stapler in end to end anastomosis.

43. A series of tissue grasping clips, each clip formed of a flexible strip of material, the clips being secured around the edge of a lumen portion to be anastomized for grasping and positioning the lumen portion across the stapling face of a surgical sapling unit.

44. A surgical stapler with multiple controllers, each controller for performing separate functions, the stapler including a series of concentric sleeves for housing separate operating mechanisms, each operating mechanism being controlled by a separate controller.

49. The surgical stapler of claim 48, wherein the head portion is moveable radially relative to the body.

50. The surgical stapler of claim 48, wherein the anvil portion is moveable longitudinally of the body and radially relative to the body.

149. The surgical stapler of claim 48, wherein the head portion is moveable radially outwardly and inwardly relative to the body.

150. The surgical stapler of claim 48, wherein the anvil portion is moveable longitudinally of the body and radially outwardly and inwardly relative to the body.

45. A surgical stapler comprising:

a stapling head portion; and

an anvil portion, wherein the head portion and the anvil portion are each formed of a plurality of individual arc segments, wherein each segment of the head portion including a firing mechanism and a knife actuating mechanism for operating independently of the remaining segments.

46. A circular stapler for end to end anastomosis comprising:

a head portion; and

an anvil portion, wherein the head portion and anvil portion are formed of a plurality of individual arc segments wherein each segment on the head portion includes a separate knife portion at a radially inner side thereof, wherein the knife portions combine to form an annular knife for trimming the inner edge of an anastomized lumen, and wherein each knife portion is independently operable.

47. A surgical stapler for end to end anastomosis including pivoting rods for use as moving mechanisms to facilitate movement in performing a variety of functions.

48. A surgical stapler for end to end anastomosis including:

an elongated body;

a head portion; and

an anvil portion, wherein the anvil portion is moveable in multiple directions relative to the body and the head portion is moveable relative to the body.

51. An intraluminal anastomotic stapler for end to end anastomosis forming an anastomotic ring having a diameter greater than or equal to the nominal intraluminal diameter of the segments being anastomized.

52. A minimally invasive surgical stapler for colorectal luminal anastomosis that will assist in transanal stapler placement within the colon, the stapler having an elongated body, a expanding head and an expanding anvil portion, wherein a diameter of the stapler head and stapler anvil portion of the stapler is smaller during insertion and retraction than at firing of the stapler.

53. A closed loop end to end anastomotic stapler with the trimming knife formed by individual knife segments and wherein the knife segments operate independently.

54. A closed loop end to end anastomotic stapler with a row of staples contained in the head portion wherein the head portion is formed by individual head portion segments with each head portion segment including at least one stapler and wherein the head portion segments operate independently.

55. A closed loop end to end anastomotic stapler having an elongated body, a head portion and an anvil portion and further including multiple anvil portion and multiple head portion controls in the surgical stapler extending the length of the body, wherein the operator can independently control separate anvil portion functions from one end of the body and the operator can control separate head portion functions from the one end of the body.

56. The stapler of claim 55, wherein the stapler includes separate controls for expansion/retraction of the anvil portion and for axial movement of the anvil portion.

57. The stapler of claim 55 wherein the stapler includes separate independent controls for expansion/retraction of the head portion and for firing of a knife blade and staples of the head portion.

58. An internal colorectal end to end anastomotic stapler with an elongated body having controls at a distal end therof, a head portion and an anvil portion, wherein the head portion includes a row a staples and a circular trimming knife, wherein the stapler further includes a staple and knife firing mechanism that accommodates relative radial motion of the head portion containing the staples and the stapler body.

59. An interluminal end to end anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes a row a staples and a circular trimming knife, and wherein the stapler further includes an alignment mechanism that aligns and locks the anvil portion and the head portion together prior to the firing of the staples or the knife, wherein the alignment mechanism includes a plurality of locking pins receivable in aligned holes.

60. An external end to end anastomotic stapler with a closed loop row a staples and a circular trimming knife, wherein the stapler extends around the outside of the lumen portions being anastomized and the stapler includes a longitudinal hinge for opening and closing the stapler about the lumen portions.

61. An internal surgical stapler for end to end anastomosis comprising:

an elongated body having controls at a first end thereof;

an expanding head at a opposite end of the body, the expanding head including a plurality of segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding removeably anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments, wherein the expansion of the anvil and head and the firing of the staples is controlled through the controls.

62. The surgical stapler of claim 61, further including an annular knife for trimming the anastomized tissue.

63. The surgical stapler of claim 62, wherein the knife is formed of radially moveable knife segments.

64. An interluminal surgical stapler for end to end anastomosis comprising:

an elongated body with controls at one end thereof;

an expanding head at an opposite end of the body, the expanding head including a plurality of segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments simultaneously.

65. An anastomotic stapler for end to end anastomosis in colorectal surgery for forming an anastomotic ring in the anastomized lumen having a diameter greater than or equal to the nominal intraluminal diameter of the lumen segments being anastomized.

66. The anastomotic stapler of claim 65, utilizing staples formed in a pair of offset annular arrays of staples to couple the end of a first lumen section to the end of a second lumen section.

67. The anastomotic stapler of claim 66, comprising:

a head portion including a stapling mechanism; and

an anvil;

wherein both the head and the anvil can be moved from a retracted position having a first diameter to an expanded position having a second larger diameter, and back to a retracted position after firing.

68. The anastomotic stapler of claim 67, wherein the head portion comprises a plurality of wedge-shaped arc segments that move radially and align in the expanded position to form an annular head.

69. The anastomotic stapler of claim 68, wherein each arc segment has a separate, independent firing mechanism.

70. The anastomotic stapler of claim 68, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

71. The anastomotic stapler of claim 68, wherein each arc segment has a separate, independent knife actuating mechanism.

72. The anastomotic stapler of claim 67, wherein the head portion comprises a plurality of arc-shaped segments that move rotationally from an overlapped formation in the retracted position to align in the expanded position forming an annular head.

73. The anastomotic stapler of claim 72, wherein each arc segment has a separate, independent firing mechanism.

74. The anastomotic stapler of claim 72, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

75. The anastomotic stapler of claim 72, wherein each arc segment has a separate, independent knife actuating mechanism.

76. An external anastomotic stapler comprising two substantially identical, separate stapling units received around the lumen portions and coupled together with an alignment mechanism, wherein each stapling unit includes at least two sections, connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

77. The anastomotic stapler of claim 76, wherein each stapling unit includes two semi-circular sections connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

78. The anastomotic stapler of claim 77, wherein a first semi-circular section is formed as an anvil, and a second semi-circular section comprises a stapling mechanism and a knife portion.

79. The anastomotic stapler of claim 78, wherein the first semi-circular section includes a series of staple receiving slots and a knife receiving groove, said knife receiving groove situated at the radially outer edge of the first semi-circular section, and wherein the second semi-circular section includes the knife portion situated at the radially outer edge thereof.

80. The anastomotic stapler of claim 78, wherein the separate stapling units may be engaged face-to-face such that staples fired from the stapling mechanism of a first stapling unit may be received in the anvil of a second stapling unit upon firing, and staples fired from the stapling mechanism of a second stapling unit may be received in the anvil of the first stapling unit upon firing in the opposite direction.

81. The anastomotic stapler of claim 80, further comprising at least pin forming the alignment and allowing for alignment of the separate stapling units when engaged face-to-face.

82. The anastomotic stapler of claim 76, wherein said stapler may be fired from one end of the device.

83. The anastomotic stapler of claim 76, wherein each stapling unit further comprises a plurality of tissue retraction members spaced around the periphery of each stapling unit.

84. A colorectal surgical stapler for end to end anastomosis comprising:

an expanding stapling head; and

an expanding anvil wherein the anvil is adjacent the stapling head, and wherein the head and anvil can be moved from a retracted position having a first relative diameter and an expanded position having a second larger diameter wherein the head is fired in the expanded position.

85. The surgical stapler of claim 84, wherein the head and the anvil are formed of individual segments;

wherein in a retracted position, the segments overlap in a spiral fashion.

86. An interluminal surgical stapler for end to end anastomosis comprising:

an elongated body having controls at a first end thereof;

an expanding stapling head; and

an expanding anvil, wherein the stapling head and anvil are comprised of individual segments formed in overlapping arrangements, wherein said individual segments slide past each other in a spiral fashion to form a retracted position.

87. The stapler according to claim 86, wherein the individual segments of the head and anvil slide past each other in an opposite direction to form an expanded position having a larger diameter than the diameter of the head an anvil in the retracted position.

88. A colorectal, transanal surgical stapler for end to end anastomosis wherein the stapling head and stapling anvil is expandable.

90. The stapler of claim 89, further including a mechanism for pulling the lumen to be attached across the stapling face of each stapling unit.

91. The stapler of claim 89, further including an alignment mechanism for aligning the two adjacent stapling units prior to firing a ring of staples.

89. An extraluminal intestinal stapler for end to end anastomosis formed of two opposed stapling units;

each unit clamping around a lumen section to be anastomized;

wherein each said stapling unit comprises two halves hinged together, and wherein one half of each unit is a stapling unit and the other half is an anvil portion.

92. A tissue manipulating clamp for grasping and positioning a lumen portion to be anastomized across the stapling face of a stapler in end to end anastomosis.

93. A set of at least three tissue grasping clips, each clip formed of a flexible strip of material, the clips being secured around the entire edge of a lumen portion to be anastomized for grasping and positioning the lumen portion across the stapling face of a surgical sapling unit.

94. An interluminal surgical stapler for end to end anastomosis with multiple controllers, each controller for performing separate functions, the stapler including a series of concentric sleeves for housing separate operating mechanisms, each operating mechanism being controlled by a separate controller.

95. A surgical stapler comprising:

an elongated body with controls at one end thereof;

a stapling head portion attached to the body; and

an anvil portion, wherein the head portion and the anvil portion are each formed of a plurality of individual arc segments, wherein each segment of the head portion including a firing mechanism and a knife actuating mechanism for operating independently of the remaining segments.

96. A circular closed loop interluminal stapler for end to end anastomosis comprising:

a head portion; and

an anvil portion, wherein the head portion and anvil portion are formed of a plurality of individual arc segments wherein each segment on the head portion includes a separate knife portion at a radially inner side thereof that overlap with adjacent knife portions, wherein the knife portions combine to form an annular knife for trimming the inner edge of an anastomized lumen, and wherein each knife portion is independently operable.

97. A surgical stapler for end to end anastomosis including pivoting rods for use as staple firing mechanism.

98. An interluminal surgical stapler for end to end anastomosis including:

an elongated body with controls at a first end thereof;

an expanding head portion; and

an expanding anvil portion, wherein the anvil portion is moveable in multiple directions relative to the body and the head portion is moveable relative to the body which are controled with the controls at the first end of the body.

99. The surgical stapler of claim 98, wherein the head portion is moveable radially relative to the body.

100. The surgical stapler of claim 98, wherein the anvil portion is moveable longitudinally of the body and radially relative to the body.

101. An extraluminal anastomotic stapler for end to end anastomosis forming an anastomotic ring having a diameter greater than or equal to the nominal intraluminal diameter of the segments being anastomized.

102. A minimally invasive vascular surgical stapler that will assist in stapler placement, the stapler having a head and anvil portion, wherein a diameter of the stapler head and stapler anvil portion of the vascular stapler is smaller during insertion and retraction than at firing of the stapler.

103. A closed loop end to end anastomotic stapler with the trimming knife formed by individual knife segments and wherein the knife segments operate in a given sequence.

104. A closed loop end to end anastomotic stapler with a row of staples contained in the head portion wherein the head portion is formed by individual head portion segments with each head portion segment including at least one stapler and wherein the head portion segments may be selected to operate in a given sequence.

105. A closed loop end to end vascular anastomotic stapler having an elongated body, a head portion and an anvil portion and further including multiple anvil portion and multiple head portion controls in the surgical stapler, wherein the operator can independently operate separate anvil portion functions and the operator can control separate head portion functions from controls on the body.

106. The stapler of claim 105, wherein the stapler includes separate controls for expansion/retraction of the anvil portion and for axial movement of the anvil portion.

107. The stapler of claim 105 wherein the stapler includes separate independent controls for expansion/retraction of the head portion and for firing of a knife blade and staples of the head portion.

108. An end to end anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes a row a staples and a circular trimming knife, wherein the stapler further includes a staple and knife firing mechanism that accommodates relative radial motion of the head portion through pivoting head segments of the head segments containing the staples.

109. A vascular end to end anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes an overlapping row a staples and a trimming knife, and wherein the stapler further includes an alignment mechanism that aligns and locks the anvil portion and the head portion together prior to simultaneously firing of the staples and the knife.

110. An extraluminal end to end anastomotic stapler with a closed loop row a staples and a circular trimming knife, wherein the stapler extends around the outside of the lumen portions being anastomized and includes two identical staple units coupled together.

111. A surgical stapler for end to end anastomosis comprising:

an elongated body;

an expanding head at a first end of the body, the expanding head including a plurality of wedge shaped segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of wedge segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments.

112. The surgical stapler of claim 111, further including an annular knife for trimming the anastomized tissue.

113. The surgical stapler of claim 112, wherein the knife is formed of radially moveable knife segments.

116. The anastomotic stapler of claim 115, utilizing staples formed in a pair of offset annular arrays of staples to couple the end of a first lumen section to the end of a second lumen section.

117. The anastomotic stapler of claim 116, comprising:

a head portion including a stapling mechanism; and

an anvil;

wherein both the head and the anvil can be moved from a retracted position having a first diameter to an expanded position having a second larger diameter, and back to a retracted position after firing.

118. The anastomotic stapler of claim 117, wherein the head portion comprises a plurality of wedge-shaped arc segments that move radially and align in the expanded position to form an annular head.

119. The anastomotic stapler of claim 118, wherein each arc segment has a separate, independent firing mechanism.

120. The anastomotic stapler of claim 118, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

121. The anastomotic stapler of claim 118, wherein each arc segment has a separate, independent knife actuating mechanism.

122. The anastomotic stapler of claim 117, wherein the head portion comprises a plurality of arc-shaped segments that move rotationally from an overlapped formation in the retracted position to align in the expanded position forming an annular head.

123. The anastomotic stapler of claim 122, wherein each arc segment has a separate, independent firing mechanism.

124. The anastomotic stapler of claim 122, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

125. The anastomotic stapler of claim 122, wherein each arc segment has a separate, independent knife actuating mechanism.

127. The anastomotic stapler of claim 126, wherein each stapling unit includes two semi-circular sections connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

128. The anastomotic stapler of claim 127, wherein a first semi-circular section is formed as an anvil, and a second semi-circular section comprises a stapling mechanism and a knife portion.

129. The anastomotic stapler of claim 128, wherein the first semi-circular section includes a series of staple receiving slots and a knife receiving groove, said knife receiving groove situated at the radially outer edge of the first semi-circular section, and wherein the second semi-circular section includes the knife portion situated at the radially outer edge thereof.

130. The anastomotic stapler of claim 128, wherein the separate stapling units may be engaged face-to-face such that staples fired from the stapling mechanism of a first stapling unit may be received in the anvil of a second stapling unit upon firing, and staples fired from the stapling mechanism of a second stapling unit may be received in the anvil of the first stapling unit upon firing in the opposite direction.

131. The anastomotic stapler of claim 130, further comprising at least one means for alignment, allowing for alignment of the separate stapling units when engaged face-to-face.

132. The anastomotic stapler of claim 126, wherein said stapler is extraluminal.

133. The anastomotic stapler of claim 126, wherein each stapling unit further comprises a plurality of tissue retraction members spaced around the periphery of each stapling unit.

135. The surgical stapler of claim 134, wherein the head and the anvil are formed of at least four individual segments.

137. The stapler according to claim 136, wherein the individual segments of the head and anvil slide past each other in an opposite direction to form an expanded position having a larger diameter than the diameter of the head an anvil in the retracted position.

140. The stapler of claim 139, further including a mechanism for pulling the lumen to be attached across the stapling face of each stapling unit.

141. The stapler of claim 140, further including an alignment mechanism for aligning the two adjacent stapling units prior to firing a ring of staples.

156. The stapler of claim 155, wherein the stapler includes separate controls for expansion/retraction of the anvil portion and for axial movement of the anvil portion.

157. The stapler of claim 155 wherein the stapler includes separate independent controls for expansion/retraction of the head portion and for firing of a knife blade and staples of the head portion.

162. The surgical stapler of claim 161, further including an annular knife for trimming the anastomized tissue.

163. The surgical stapler of claim 162, wherein the knife is formed of radially moveable knife segments.

166. The anastomotic stapler of claim 165, utilizing staples formed in a pair of offset annular arrays of staples to couple the end of a first lumen section to the end of a second lumen section.

167. The anastomotic stapler of claim 166, comprising:

a head portion including a stapling mechanism and an internal knife; and

an anvil;

wherein both the head and the anvil can be moved from a retracted position having a first diameter to an expanded position having a second larger diameter, and back to a retracted position after firing.

168. The anastomotic stapler of claim 167, wherein the head portion comprises a plurality of wedge-shaped arc segments that move radially and align in the expanded position to form an annular head.

169. The anastomotic stapler of claim 168, wherein each arc segment has a separate, independent firing mechanism.

170. The anastomotic stapler of claim 168, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

171. The anastomotic stapler of claim 168, wherein each arc segment has a separate, independent knife actuating mechanism.

172. The anastomotic stapler of claim 167, wherein the head portion comprises a plurality of arc-shaped segments that move rotationally from an overlapped formation in the retracted position to align in the expanded position forming an annular head.

173. The anastomotic stapler of claim 172, wherein each arc segment has a separate, independent firing mechanism.

174. The anastomotic stapler of claim 172, wherein each arc segment has an arcuate knife portion that will overlap with knife portions of adjacent arc segments when in the expanded position.

175. The anastomotic stapler of claim 172, wherein each arc segment has a separate, independent knife actuating mechanism.

177. The esophageal-gastric anastomotic stapler of claim 176, wherein each stapling unit includes two semi-circular sections connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

178. The anastomotic stapler of claim 177, wherein a first semi-circular section is formed as an anvil, and a second semi-circular section comprises a stapling mechanism and a knife portion.

179. The anastomotic stapler of claim 178, wherein the first semi-circular section includes a series of staple receiving slots and a knife receiving groove, said knife receiving groove situated at the radially outer edge of the first semi-circular section, and wherein the second semi-circular section includes the knife portion situated at the radially outer edge thereof.

180. The anastomotic stapler of claim 178, wherein the separate stapling units may be engaged face-to-face such that staples fired from the stapling mechanism of a first stapling unit may be received in the anvil of a second stapling unit upon firing, and staples fired from the stapling mechanism of a second stapling unit may be received in the anvil of the first stapling unit upon firing in the opposite direction.

181. The anastomotic stapler of claim 180, further comprising at least one means for alignment, allowing for alignment of the separate stapling units when engaged face-to-face.

182. The anastomotic stapler of claim 181, wherein said stapler is extraluminal.

183. The anastomotic stapler of claim 176, wherein each stapling unit further comprises a plurality of tissue retraction members spaced around the periphery of each stapling unit.

185. The esophageal-gastric surgical stapler of claim 184, wherein the head and the anvil are formed of individual segments;

wherein in a retracted position, the segments overlap in a spiral fashion.

187. The stapler according to claim 186, wherein the individual segments of the head and anvil slide past each other in an opposite direction to form an expanded position having a larger diameter than the diameter of the head an anvil in the retracted position.

190. The stapler of claim 189, further including a mechanism for pulling the lumen to be attached across the stapling face of each stapling unit.

191. The stapler of claim 190, further including an alignment mechanism for aligning the two adjacent stapling units prior to firing a ring of staples.

199. The esophageal-gastric surgical stapler of claim 198, wherein the head portion is moveable radially relative to the body.

200. The surgical stapler of claim 199, wherein the anvil portion is moveable longitudinally of the body and radially relative to the body.

114. A surgical stapler for end to end anastomosis comprising:

an elongated body;

an expanding head at a first end of the body, the expanding head including a plurality of wedge shaped segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of wedge shaped segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments.

115. An extraluminal vascular anastomotic stapler for end to end anastomosis forming an anastomotic ring having a diameter greater than or equal to the nominal intraluminal diameter of the vascular segments being anastomized.

126. An external vascular anastomotic stapler comprising two identical, separate stapling units, wherein each stapling unit includes at least two sections, connected longitudinally by a hinge, said hinge extending longitudinally along the length of the vascular stapling unit.

134. A surgical stapler for end to end anastomosis comprising:

a stapling head with individual wedge shaped segments; and

an anvil with individual wedge shaped segments wherein the anvil is adjacent the stapling head, and wherein the head and anvil can be moved from a retracted position having a first relative diameter and an expanded position having a second larger diameter.

136. A surgical stapler for end to end anastomosis comprising:

a stapling head; and

an anvil, wherein the stapling head and anvil are comprised of at least four individual segments formed in overlapping arrangements, wherein said individual segments slide past each other in a spiral fashion to form a retracted position.

138. A surgical stapler for end to end anastomosis wherein the stapling head is expandable and include at least four wedge shaped segments.

139. An extraluminal stapler for end to end anastomosis formed of two opposed stapling units;

each unit clamping around a lumen section to be anastomized;

wherein each said stapling unit comprises two halves, and wherein one half of each unit is a stapling unit and the other half is an anvil portion and at least one half includes a knife blade.

142. A vascular tissue grasping and positioning mechanism for positioning a vascular lumen portion to be anastomized across the stapling face of a stapler in end to end anastomosis.

143. A series of vascular tissue grasping clips, each clip formed of a flexible strip of material, the clips being secured around the edge of a vascular lumen portion to be anastomized for grasping and positioning the lumen portion across the stapling face of a vascular surgical sapling unit.

144. A surgical stapler for end to end anastomosis, the stapler including multiple controllers, each controller for performing separate functions, the stapler including a series of concentric sleeves for housing separate operating mechanisms, each operating mechanism being controlled by a separate controller.

145. A surgical stapler comprising:

a stapling head portion; and

an anvil portion, wherein the head portion and the anvil portion are each formed of a plurality of individual substantially wedge shaped arc segments, wherein each segment of the head portion including a firing mechanism and a knife actuating mechanism for operating independently of the remaining segments.

146. A circular stapler for end to end anastomosis comprising:

a head portion; and

an anvil portion, wherein the head portion and anvil portion are formed of a plurality of individual wedge shaped arc segments wherein each segment on the head portion includes a separate knife portion at a radially inner side thereof, wherein the knife portions overlap and combine to form an annular knife for trimming the inner edge of an anastomized lumen, and wherein each knife portion is independently operable.

147. A surgical stapler for end to end anastomosis including pivoting rods for use as moving mechanisms to facilitate staple firing of individual head portion segments of the head of the stapler.

148. A surgical stapler for end to end anastomosis including:

an elongated body;

a head portion; and

an anvil portion, wherein the anvil portion is moveable in multiple directions relative to the body including radially and axially and the head portion is radially moveable relative to the body.

151. An esophageal-gastric anastomotic stapler for end to end anastomosis of esophageal gastric tissue for forming an anastomotic connection having a diameter greater than or equal to the nominal intraluminal diameter of the esophageal-gastric segments being anastomized.

152. A minimally invasive esophageal-gastric surgical stapler that will assist in stapler placement within the esophageal-gastric tissue being anastomized, the stapler having a head and anvil portion, wherein a diameter of the stapler head and stapler anvil portion of the stapler is smaller during insertion and retraction than at firing of the stapler.

153. A closed loop end to end anastomotic stapler with the trimming knife formed by individual knife overlapping segments and wherein the knife segments operate simultaneously.

154. A closed loop end to end anastomotic stapler with a row of staples contained in the head portion wherein the head portion is formed by individual head portion segments with each head portion segment including at least one stapler and wherein the head portion segments operate simultaneously.

155. A closed loop end to end anastomotic stapler having a head portion and an anvil portion and further including multiple anvil portion and multiple head portion controls in the surgical stapler, wherein the operator can independently control separate anvil portion functions and the operator can control separate head portion functions, wherein one control is for expanding the head of the stapler.

158. An end to end anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes wedge shaped segments and a row a staples and a circular trimming knife, wherein the stapler further includes a staple and knife firing mechanism that accommodates relative motion of the head portion containing the staples and the stapler body.

159. An end to end esophageal-gastric anastomotic stapler with an elongated body, a head portion and an anvil portion, wherein the head portion includes a row a staples and a circular trimming knife, and wherein the esophageal-gastric stapler further includes an alignment mechanism that aligns and locks the anvil portion and the head portion together prior to the firing of the staples or the knife.

160. An end to end anastomotic stapler with a closed loop row a staples and a circular trimming knife, wherein the stapler includes pivotable sections that combine to extends around the outside of the lumen portions being anastomized.

161. A surgical stapler for end to end anastomosis comprising:

an elongated body;

an expanding head at a first end of the body, the expanding head including a plurality of segments pivotably connected together, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of segments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments.

164. A surgical stapler for end to end anastomosis comprising:

an elongated body;

an expanding head at a first end of the body, the expanding head including a plurality of pivotable segments, each segment having at least one staple, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position;

an expanding anvil coupled to the head, the staples being fired against the anvil, the expanding anvil including a plurality of pivotablesegments, wherein the segments move from a first inward retracted position to at least a second position radially outward from the first position; and

a staple firing mechanism for firing the staples of each head segment against the anvil segments.

165. An esophageal-gastric anastomotic stapler for end to end anastomosis forming an anastomotic connection in the esophageal-gastric tissue having a diameter greater than or equal to the nominal intraluminal diameter of the esophageal-gastric segments being anastomized.

176. An esophageal-gastric anastomotic stapler comprising two identical, separate stapling units, wherein each stapling unit includes at least two sections, connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.

184. A esophageal-gastric surgical stapler for end to end anastomosis comprising:

a stapling head; and

an anvil wherein the anvil is adjacent the stapling head, and wherein the head and anvil can be moved from a retracted position having a first relative diameter and an expanded position having a second larger diameter.

186. A surgical stapler for end to end anastomosis comprising:

a stapling head; and

an anvil, wherein the stapling head and anvil are comprised of individual generally identically shaped segments formed in overlapping arrangements, wherein said individual segments slide past each other in a spiral fashion to form a retracted position.

188. A surgical stapler for end to end anastomosis wherein the stapling head is expandable and includes a plurality of pivotable generally identically shaped segments.

189. An extraluminal stapler for end to end anastomosis formed of two opposed generally identical, opposed stapling units;

each unit clamping around a lumen section to be anastomized;

wherein each said stapling unit comprises two halves, and wherein one half of each unit is a stapling unit and the other half is an anvil portion.

192. A esophageal-gastric tissue grasping and positioning mechanism for positioning a esophageal-gastric lumen portion to be anastomized across the stapling face of an esophageal-gastric stapler in end to end anastomosis.

193. A series of identical tissue grasping clips, each clip formed of a flexible strip of material, the clips being secured around the edge of a lumen portion to be anastomized through snap fit connections with the clips providing for grasping and for positioning the lumen portion across the stapling face of a surgical sapling unit.

194. A esophageal-gastric surgical stapler with multiple controllers, each controller for performing separate functions, the esophageal-gastric stapler including a series of concentric sleeves for housing separate operating mechanisms, each operating mechanism being controlled by a separate controller.

195. A surgical stapler comprising:

a stapling head portion; and

an anvil portion, wherein the head portion and the anvil portion are each formed of a plurality of individual pivotable arc segments, wherein each segment of the head portion including a firing mechanism and a knife actuating mechanism for operating independently of the remaining segments.

196. A circular stapler for end to end anastomosis comprising:

a head portion; and

an anvil portion, wherein the head portion and anvil portion are formed of a plurality of individual arc segments wherein each segment on the head portion includes a separate knife portion at a radially inner side thereof, wherein the knife portions overlap and combine to form an annular knife for trimming the inner edge of an anastomized lumen, and wherein each knife portion is independently operable.

197. A esophageal-gastric surgical stapler for end to end anastomosis including pivoting rods for use as staple firing mechanisms to facilitate movement in the head portion.

198. A esophageal-gastric surgical stapler for end to end anastomosis including:

an elongated body;

a head portion; and

an anvil portion, wherein the anvil portion is moveable in multiple directions relative to the body and the head portion is moveable relative to the body.

201. A tissue manipulator for attachment to tissue to be manipulated by a surgeon, the tissue manipulator comprising:

A) an elongated band attachable to the tissue;

B) a tissue attachment mechanism on a first side of the elongated band for attaching the tissue manipulator to the tissue; and

C) at least one manipulator on a second side of the elongated band, whereby the surgeon manipulates the tissue through the at least one manipulator that transfers the manipulation forces to the tissue generally evenly along the elongated band to minimize tissue damage.

202. The tissue manipulator of claim 201, wherein the elongated band is a flexible member adapted to be folded along an axis thereof about the tissue.

203. The tissue manipulator of claim 202, wherein the tissue attachment mechanism includes a plurality of snap fit connections.

204. The tissue manipulator of claim 202, wherein the tissue attachment mechanism includes adhesive on the first side of the elongated band.

205. The tissue manipulator of claim 201, wherein the at least one manipulator includes an eyelet attached to the second side of the elongated band.

206. The tissue manipulator of claim 205, wherein at least two eyelets are attached to said second side of the elongated band

207. The tissue manipulator of claim 201, wherein the elongated band is generally curved to conform to a lumen edge.