Externally positioned anvil apparatus for cutting anastomosis

• US 6,626,921 B2
• Filed: 10/31/2001
• Issued: 09/30/2003
• Est. Priority Date: 04/16/1999
• Status: Expired due to Fees

• Current Assignee: DF Vital Holdings, LLC
• Original Assignee: Integrated Vascular Interventional Technologies LC (Integrated Vascular Interventional Technologies)
• Inventors: Burnett, Bruce M., Barrus, Michael C., Blatter, Duane D., Goodrich, Kenneth C., Tullius, Nemo J.
• Primary Examiner(s): Woo, Julian W.
• Application Number:
  US10/003,956
• Publication Number:
  US 20020038127A1
• Time in Patent Office: 699 Days
• Field of Search: 606/153, 606/159, 606/170, 606/180, 606/184, 600/567
• US Class Current: 606/153
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• 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 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 2017/0641 having at least three legs as part of one single body
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections
• CPC Class Codes: A61B 2017/1157 applying the staples radially

Abstract

The present invention is directed to a cutting apparatus for cutting an opening in a vessel for subsequent anastomosis. The cutting apparatus includes an anvil, an anvil pull and a cutter. The anvil is inserted through a small incision at the anastomosis site and brought into contact with the interior wall of a vessel so that the anvil distends the wall of the vessel. The cutter is then urged against the portion of the vessel wall that is distended by the anvil to form an opening in the vessel wall.

Claims

1. An anastomosis system comprising:

an externally positioned anvil apparatus including anvil means for engaging an interior surface of a wall of a first vessel at an anastomosis site, and anvil pull means for holding an engaging end of the anvil means against the interior surface of the wall of the first vessel, the anvil pull means extending from the engaging end of the anvil means, wherein the engaging end is convex; and

an external anastomosis operator including

engaging means for engaging the anvil pull means once the anvil means has been inserted though the wall of the first vessel at an insertion opening that has been selected as an anastomosis site and positioned in a lumen of the first vessel with the anvil pull means extending through the insertion opening of the first vessel to enable the engaging means to hold the anvil pull means;

cutting means for forming a first vessel opening in the wall of the first vessel at the anastomosis site through engagement with the anvil means of the anvil apparatus as the engaging means holds the anvil pull means after receiving the anvil pull means through the cutting means, the cutting means having a cutting perimeter that defines the shape of the first vessel opening;

wherein the engaging end of the anvil means has a greater cross-sectional area than a cross-sectional area defined by the cutting perimeter of the cutting means such that portions of the engaging end of the anvil means extend beyond the cutting perimeter when the cutting means engages the anvil means and forms the first vessel opening, and

wherein the engaging end of the anvil means is adapted to engage an area of the interior surface of the wall of the first vessel which is greater than the cross-sectional area defined by the cutting means.

2. An anastomosis systems as claimed in claim 1 wherein the engaging end of the anvil means is a spherical engaging end, and wherein the cutting means includes a cutting tube that terminates at cutting knife with a circular cutting edge such that the first vessel opening is formed as the circular cutting edge presses against the spherical engaging end.

3. An anastomosis system as claimed in claim 1, wherein the cutting means includes a cutting tube that terminates at cutting knife with a noncircular cutting edge and wherein the engaging end of the anvil means has a shape corresponding to that of the cutting edge such that the first vessel opening is formed as the noncircular cutting edge presses against the engaging end.

4. An anastomosis system as claimed in claim 1, wherein the anvil means is an expandable anvil having an initial collapsed position for insertion into the insertion opening and an expanded position, wherein the engaging end has a greater cross-sectional area than the cross-sectional area defined by cutting perimeter of the cutting means when in the expanded position.

5. An anastomosis system as claimed in claim 4, wherein the expandable anvil is mechanically deployable.

6. An anastomosis system as claimed in claim 4, wherein the expandable anvil is chemically deployable.

7. An anastomosis system as claimed in claim 1, wherein the anvil means is rigid.

8. An anastomosis system as claimed in claim 1, wherein the anvil means is solid.

9. An anastomosis system as claimed in claim 1, further comprising spring biasing means for providing tension against the cutting means as the cutting means engages the anvil means of the intraluminally directed anvil apparatus.

10. An anastomosis system as claimed in claim 9, wherein the spring biasing means provides an amount of tension that enables the cutting means to form the first vessel opening after the wall of the first vessel has been distended by the action of the anvil means being pulled into the openings of a compression plate apparatus such that forming the first vessel opening results in at least partial eversion of the portion of the first vessel defining the first vessel opening.

11. An anastomosis system as claimed in claim 1, further comprising means for joining a portion of the first vessel that defines the first vessel opening to a portion of a second vessel that defines a second vessel opening.

12. An anastomosis system as claimed in claim 1, further comprising a compression plate apparatus including a first compression plate having a first compression plate opening configured for alignment with the first vessel opening and a second compression plate having a second compression plate opening configured for alignment with a second vessel opening of a second vessel, the openings being sized to permit the anvil means to pass through the openings and out of the compression plate apparatus after the compression plates have been brought together to enable a portion of the first vessel defining the first vessel opening and a portion of the second vessel defining the second vessel opening to be joined such that the first vessel and the second vessel are anastomosed together.

13. An anastomosis system comprising:

an externally positioned anvil apparatus including an anvil pull extending from an engaging end of an anvil, wherein the engaging end is convex; and

an external anastomosis operator including

an anvil pull engager adapted to hold the anvil pull extending from the anvil of the externally positioned anvil apparatus once the anvil has been inserted though a wall of the first vessel at an insertion opening that has been selected as an anastomosis site and positioned in a lumen of the first vessel with the anvil pull extending through the insertion opening of the first vessel; and

a cutting device that is adapted to engage the anvil of the externally positioned anvil apparatus once the engager has received the anvil pull through the cutting device in order to form an opening in the wall of the first vessel at the anastomosis site, wherein the engager and the cutting device are adapted to enable the anvil pull to be moved through the cutting device,

the cutting device including a cutting tube that terminates at a cutting knife with a cutting edge that defines the shape of the first vessel opening such that the first vessel opening has a perimeter that corresponds with the perimeter of the cutting edge,

wherein the cross-sectional area defined by the perimeter of the cutting edge of the cutting knife is smaller than a cross-sectional area of the engaging end such that portions of the engaging end of the anvil extend beyond the cutting edge when the cutting device engages the anvil and forms the first vessel opening, and

wherein the cross-sectional area of the engaging end of the anvil combined with the shape of the engaging end enables the cutting edge to cut against the engaging end at any position in which the cutting edge is initially set against the engaging end.

14. A cutting apparatus comprising:

anvil means for engaging an interior surface of a wall of a first vessel at an anastomosis site, and anvil pull means for holding an engaging end of the anvil means against the interior surface of the wall of the first vessel, the anvil pull means extending from an engaging end of the anvil means; and

cutting means for forming a first vessel opening in the wall of the first vessel at the anastomosis site through engagement with the anvil means;

wherein the cutting means includes a cutting tube that terminates at a cutting knife with a cutting edge that defines the shape of the first vessel opening,

wherein the anvil pull means extends within the cutting tube to enable the anvil pull means and the cutting means to be moved relative to each other,

wherein the engaging end has a surface with a convex configuration, and

wherein the cross-sectional area defined by the perimeter of the cutting edge of the cutting knife is smaller than a cross-sectional area of the engaging end such that portions of the engaging end of the anvil means extend beyond the cutting edge when the cutting means engages the anvil means and forms the first vessel opening.

15. A cutting apparatus as claimed in claim 14, wherein the engaging end of the anvil means is a spherical engaging end, and wherein the cutting edge is circular such that the first vessel opening is formed as the circular cutting edge presses against the spherical engaging end.

16. A cutting apparatus as claimed in claim 14, wherein the cutting edge is noncircular and wherein the convex shape of the engaging end of the anvil means corresponds to that of the cutting edge such that the first vessel opening is formed as the noncircular cutting edge presses against the engaging end.

17. A cutting apparatus as claimed in claim 14, wherein the anvil means is an expandable anvil having an initial collapsed position for insertion into the first vessel and an expanded position, wherein the engaging end has a greater cross-sectional area when in the expanded position than the cross-sectional area defined by cutting perimeter of the cutting means.

18. A cutting apparatus as claimed in claim 17, wherein the expandable anvil is mechanically deployable.

19. A cutting apparatus as claimed in claim 17, wherein the expandable anvil is chemically deployable.

20. A cutting apparatus as claimed in claim 14, wherein the anvil means is rigid.

21. A cutting apparatus as claimed in claim 14, wherein the anvil means is solid.

22. A cutting apparatus comprising:

an anvil adapted to engage the interior surface of a first vessel at an anastomosis site, and an anvil pull extending from an engaging end of the anvil that is adapted to hold the engaging end of the anvil against the interior of the first vessel;

a cutting device that is adapted to engage the anvil and form a first vessel opening in the wall of the first vessel at the anastomosis site, the cutting device including a cutting tube that terminates at a cutting knife with a cutting edge that defines the shape of the first vessel opening,

wherein the anvil pull extends within the cutting tube to enable the anvil pull and the cutting device to be moved relative to each other,

wherein the engaging end has a surface with a convex configuration, and

wherein the cross-sectional area defined by the perimeter of the cutting edge of the cutting knife is smaller than a cross-sectional area of the engaging end such that portions of the engaging end of the anvil extend beyond the cutting edge when the cutting device engages the anvil and forms the first vessel opening.

23. A cutting apparatus as claimed in claim 22, wherein the engaging end of the anvil is spherical, and wherein the cutting edge is circular such that the first vessel opening is formed as the circular cutting edge presses against the spherical engaging end.

24. A cutting apparatus as claimed in claim 22, wherein the cutting edge is noncircular and wherein the convex shape of the engaging end of the anvil corresponds to that of the cutting edge such that the first vessel opening is formed as the noncircular cutting edge presses against the engaging end.

25. A cutting apparatus as claimed in claim 22, wherein the anvil is an expandable anvil such that the anvil has an initial collapsed position for insertion into the first vessel and an expanded position, wherein the engaging end has a greater cross-sectional area when in the expanded position than the cross-sectional area defined by cutting edge.

26. A cutting apparatus as claimed in claim 25, wherein the expandable anvil is mechanically deployable.

27. A cutting apparatus as claimed in claim 25, wherein the expandable anvil is chemically deployable.

28. A cutting apparatus as claimed in claim 22, wherein the anvil is rigid.

29. A cutting apparatus as claimed in claim 22, wherein the anvil is solid.

30. A cutting apparatus comprising:

a rigid anvil adapted to engage the interior surface of a first vessel at an anastomosis site, and an anvil pull extending from an engaging end of the anvil that is adapted to hold the engaging end of the anvil against the interior of the first vessel;

a cutting device that is adapted to engage the anvil and form a first vessel opening in the wall of the first vessel at the anastomosis site, the cutting device including a cutting tube that terminates at a cutting knife with a cutting edge that defines the shape of the first vessel opening,

wherein the anvil pull extends within the cutting tube to enable the anvil pull and the cutting device to be moved relative to each other,

wherein the engaging end has a surface with a convex configuration,

wherein the cross-sectional area defined by the perimeter of the cutting edge of the cutting knife is smaller than a cross-sectional area of the engaging end such that portions of the engaging end of the anvil extend beyond the cutting edge when the cutting device engages the anvil and forms the first vessel opening.