Tissue retention spool for intraluminal anastomotic surgical stapling instrument and methods

• US 4,592,354 A
• Filed: 10/11/1983
• Issued: 06/03/1986
• Est. Priority Date: 10/11/1983
• Status: Expired due to Term

• Current Assignee: Ethicon Incorporated (Johnson & Johnson)
• Original Assignee: Senmed Incorporated
• Inventors: Rothfuss, Robert G.
• Primary Examiner(s): Chamblee, Hugh R.
• Application Number:
  US06/540,895
• Time in Patent Office: 966 Days
• Field of Search: 128/305, 128/334 R, 128/334 C
• US Class Current: 227/179.1
• CPC Class Codes: A61B 17/115 Staplers for performing anastomosis in a single operation
• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 2017/1142 Purse-string sutures

Abstract

A tissue retention spool is disposed on the anvil actuating rod of an intraluminal anastomotic surgical stapling instrument. Tubular tissue is gathered and held on the spool by a suture tie, thus eliminating the previously required purse-stringing procedure. The spool and rod are constructed to initially resist relative sliding motion as the spool is withdrawn into the staple carrier/cylindrical scalpel area prior to setting of staples and internal tissue excision. The combined spool and instrument serve to hold tubular tissue in an erect, closed condition, facilitating the use of closed surgical techniques, without purse-stringing, in limited access areas such as lower colon resections. Alternative spools and methods are included.

Claims

1. In an intraluminal anastomotic surgical stapling instrument having a staple cartridge, a cylindrical scalpel within said cartridge, and a staple anvil mounted on a shiftable rod disposed within and extending from said staple cartridge in operable condition, said anvil being shiftable toward said staple cartridge for bringing ends of a transected tubular tissue structure together for stapling, the improvement comprising:

tissue retention means mounted on said rod and accessible between said staple cartridge and said anvil for holding an end of a tubular tissue structure prior to and during an anastomotic procedure and wherein said tissue retention means is frictionally mounted on said rod and is yieldably slidable therealong between a first position disposed between said staple anvil and said staple cartridge for attachment of a closed tubular tissue structure thereto and a second position within said staple cartridge.

2. The improvement of claim 1, wherein said tissue retention means comprises a spool frictionally mounted on said rod against axial movement therealong and is yieldable for movement along said rod and within said cylindrical scalpel when said anvil is shifted toward said staple cartridge.

3. The improvement of claim 2, wherein said spool has an internal bore defined by a resilient surface for frictional, yieldable engagement with said rod.

4. The improvement of claim 2, wherein said spool has an internal bore receiving said rod, and within said bore elongated, axially extending, radially inwardly projecting projections frictionally engaging said rod.

5. The improvement of claim 4, wherein ends of said axially extending projections are tapered away from said rod.

6. A tissue retention spool for an intraluminal anastomotic surgical stapling instrument, said spool having at least one flanged end extending radially outward of said spool, a cylindrical tissue retention surface including a plurality of radial tissue engaging projection means for holding said tissue against sliding thereon, said spool having an internal bore for slidably receiving a rod of said instrument, said bore comprising means for yieldably gripping said rod and wherein said yieldable gripping means comprises a plurality of axially extending, inwardly projecting lugs for engaging said rod.

7. A tissue retention spool as in claim 6, wherein ends of said lugs are tapered.

8. A tissue retention spool as in claim 6, wherein saids yieldable gripping means comprises a resilient material for frictionally gripping said rod.

9. In a method for surgical anastomosing of transected tubular tissue by stapling, including the steps of inserting the distal end of a stapling instrument into said tubular tissue, said instrument having a cylindrical staple cartridge, cylindrical scalpel therein, and a staple anvil mounted on a rod shiftable toward said cartridge, securing an end of said tissue over said cartridge, excising said tubular tissue, securing a transected end of said tubular tissue over said anvil and about said rod, shifting said anvil toward said staple cartridge, stapling said disjoined tubular tissue together, excising ends of said tubular tissue internally of said staples, and removing said instrument from said tubular tissue with at least one excised end of a tubular tissue retained on said rod, the improvement comprising the additional steps of:

after inserting the instrument, tying said tubular tissue to a spool slidably mounted on said rod;

cutting said tubular tissue distally above said spool, while retaining a proximal end of said tissue on said spool;

shifting said spool within said cylindrical scalpel when said anvil is shifted toward said staple cartridge, said spool sliding on said rod once said spool is positioned; and

retaining a least one annular portion of a cut off end of said tubular tissue on said spool when said instrument is removed.

10. In a method for attaching rectal tissue to an intraluminal anastomotic surgical stapling instrument prior to surgically resecting the lower colon wherein a rectal stump having a free upper end is joined to the lower end of a transected bowel, the steps of:

securing rectal tissue to an intraluminal anastomotic surgical stapling instrument having a staple cartridge and an anvil mounted on a rod extending from said staple cartridge, by externally wrapping a flexible means around said tissue, drawing it onto a tissue retention spool disposed between said cartridge and said anvil, and tying said flexible means to secure said tissue to said spool.

11. In a method for producing a rectal stump supported on an intraluminal anastomotic surgical stapling instrument prior to resecting the lower colon wherein a rectal stump having a free upper end is joined to the lower end of a transected bowel, the steps of:

securing rectal tissue to an intraluminal anastomotic surgical stapling instrument having a staple cartridge and an anvil mounted on a rod extending from said staple cartridge, by externally wrapping a flexible means around said tissue, drawing it onto a tissue retention spool disposed between said cartridge and said anvil, tying said flexible means to secure said tissue to said spool, and cutting off said rectal tissue above said spool, thus producing a rectal stump having a closed upper end secured to said instrument around said spool between said cartridge and said anvil.

12. In a method for resecting the lower colon wherein a rectal stump having a free upper end is joined to the lower end of a transected bowel, the steps of:

securing rectal tissue to an intraluminal anastomotic surgical stapling instrument having a staple cartridge and an anvil mounted on a rod extending from said staple cartridge, by externally wrapping a flexible means around said tissue, drawing it onto a tissue retention spool disposed between said cartridge and said anvil, and tying said flexible means to secure said tissue to said spool;

cutting off said tissue above said spool, thus producing a rectal stump having a closed upper end secured to said instrument around said spool between said cartridge and said anvil;

securing a transected upper end of the bowel over said anvil and about said rod;

extending a cylindrical scalpel over said spool;

excising an end of said rectal stump and an end of said transected bowel when said stump and bowel are stapled together above said ends, said excised ends being disposed internally of said staples; and

withdrawing said cut off ends from said rectal stump when said instrument is removed.