Anastomosis apparatus and methods

• US 8,066,724 B2
• Filed: 01/10/2003
• Issued: 11/29/2011
• Est. Priority Date: 09/12/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Golden, Steve, Ho, Liem
• Primary Examiner(s): Nguyen; Tuan
• Application Number:
  US10/340,164
• Publication Number:
  US 20040050393A1
• Time in Patent Office: 3,245 Days
• Field of Search: 606/158, 606/217, 606/219, 606/157, 606/144, 606/148, 606/222, 606186-189, 606149-155
• US Class Current: 606/153
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• 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 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/06009 having additional means for releasably clamping the suture to the needle, e.g. actuating rod slideable within the needle
• CPC Class Codes: A61B 2017/06076 helically or spirally coiled for sutures A61B2017/06171
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0649 Coils or spirals
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1125 Forceps, specially adapted for performing or assisting anastomosis
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections Y-shaped blood vessel prostheses A61F2002/065

Abstract

A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein comprises a support device having a plurality of arms forming spaces therebetween. The support device is adapted to support the first tubular structure within an opening in the second tubular structure to facilitate anastomosing the tubular structures together. The arms can be configured to urge the first tubular structure against the portion of the second tubular structure surrounding the opening to form a seal therebetween. According to one embodiment, a plurality of discrete fasteners are provided to pass through the support device spaces and the first and second tubular structures.

Claims

1. A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein, the system comprising:

a support device having a plurality of arms arranged to form a space between adjacent arms, the arms each terminating at a distal face, the distal faces forming a discontinuous annular surface configured to support the first tubular structure;

a plurality of graft piercing members, each graft piercing member extending from the distal face of one of the plurality of arms and adapted to pierce and hold a portion of the first tubular structure, wherein a maximum width dimension of each of the graft piercing members is less than an annular length of each of the distal faces; and

a plurality of fasteners adapted to pass through the spaces and the first and second tubular structures;

wherein the system is configured such that the first tubular structure can be everted over the support device, the support device passed through the opening in the second tubular structure, the fasteners passed through the spaces and tubular structures to anastomose the first and second structures, and the support device and graft piercing members subsequently removed from the anastomosed first and second tubular structures and the fasteners;

wherein the fasteners comprise surgical clips.

2. The system of claim 1 wherein the support device has a longitudinal axis and the graft piercing members extend parallel to the longitudinal axis.

3. The system of claim 1 wherein the support device is tubular.

4. The system of claim 1 wherein the fasteners comprise self-closing surgical clips.

5. The system of claim 1, wherein the support device has a longitudinal axis and further wherein in a natural state in which the support device is not subjected to an exterior constraining force, the arms extend parallel to the longitudinal axis.

6. A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein, the system comprising:

a support device having a proximal portion and a distal portion, the distal portion comprising a plurality of arms, each having a proximal end coupled to the proximal portion and a distal end, the plurality of arms being arranged to form a space between adjacent arms where the space extends to the distal end of the adjacent arms such that the distal ends of adjacent arms are separated, each arm having a distal face, wherein the distal faces of the arms further being arranged to form a discontinuous annular distal face configured to support an everted portion of the first tubular structure thereover in a plane transverses to a central axis collectively defined by the arms;

a plurality of graft piercing members adapted to pierce and hold the everted portion of the first tubular structure, each graft piercing member extending from the distal face;

a plurality of fasteners adapted to pass through the spaces formed between adjacent arms and the first and second tubular structures;

wherein the system is configured such that the first tubular structure can be everted over the arms of the support device, a portion of the support device passed through the opening in the second tubular structure, the fasteners passed through the spaces and tubular structures to anastomosed the first tubular structure to the second tubular structure, and the support device and graft piercing members subsequently removed from the anastomosed first and second tubular structures and the fasteners;

wherein the arms of the support device are radially adjustable inward and outward when a portion of the support device is passed through the opening in the second tubular structure;

wherein the fasteners comprise clips.

7. The system of claim 6 wherein the support device comprises a tube having a plurality of slots forming the spaces.

8. The system of claim 6 wherein the fasteners comprise self-closing surgical clips.

9. The system of claim 6 wherein the support device has a longitudinal axis and the graft piercing members extend parallel to the longitudinal axis.

10. The system of claim 6, wherein the proximal portion is an elongated tube.

11. A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein, the system comprising:

a support device having a proximal portion and a distal portion, the distal portion comprising a plurality of arms, each having a proximal end coupled to the proximal portion and a distal end, the plurality of arms being arranged to form a space between adjacent arms where the space extends to the distal end of the adjacent arms such that the distal ends of adjacent arms are separated, the arms further being arranged to form a surface configured to support an everted portion of the first tubular structure thereover, wherein the proximal portion includes a tube forming a longitudinal slit through a thickness thereof; and

a plurality of fasteners adapted to pass through the spaces formed between adjacent arms and the first and second tubular structures;

wherein the first tubular structure can be everted over the arms of the support device, the support device passed through the opening in the second tubular structure, and the fasteners passed through the spaces and tubular structures to anastomose the first tubular structure to the second tubular structure;

wherein the fasteners comprise clips; and

wherein the arms are permanently rigidly affixed to the proximal portion such that the arms permanently cannot slide relative to the proximal portion.

12. A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein, the system comprising:

a support device having a proximal portion and a distal portion, the distal portion comprising a plurality of arms, each having a proximal end coupled to the proximal portion and a distal end, the plurality of arms being arranged to form a space between adjacent arms where the space extends to the distal end of the adjacent arms such that the distal ends of adjacent arms are separated, the arms further being arranged to form a surface configured to support an everted portion of the first tubular structure thereover, wherein the proximal portion includes a tube forming a longitudinal slit through a thickness thereof; and

a plurality of fasteners adapted to pass through the spaces formed between adjacent arms and the first and second tubular structures;

wherein the first tubular structure can be everted over the arms of the support device, the support device passed through the opening in the second tubular structure, and the fasteners passed through the spaces and tubular structures to anastomose the first tubular structure to the second tubular structure;

wherein the fasteners comprise clips;

further including a plurality of graft piercing members, each graft piercing member extending from one of the plurality of arms and adapted to pierce and hold a portion of the first tubular structure; and

wherein the support device has a longitudinal axis and each of the graft piercing members terminate at piercing tip opposite the corresponding arm, and further wherein an entirety of an extension of each of the graft piercing members from the respective arm to the corresponding piercing tip is parallel to the longitudinal axis.