Surgical instrument for extracting an anastomotic ring device

• US 7,758,589 B2
• Filed: 05/03/2005
• Issued: 07/20/2010
• Est. Priority Date: 05/03/2005
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Freeman, Lynetta, Ortiz, Mark S.
• Primary Examiner(s): Manahan; Todd E
• Assistant Examiner(s): DOWE, KATHERINE MARIE
• Application Number:
  US11/120,826
• Publication Number:
  US 20060253134A1
• Time in Patent Office: 1,904 Days
• Field of Search: 606/108, 606/153, 606/138, 606/113, 606/127, 606/206, 600/104, 600214-217
• US Class Current: 606/108
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 2017/0408 Rivets other bone rivets A61B17/68; rivets for connecting prosthetic parts A61F2002/30433, A61F2220/0041

Abstract

A surgical instrument comprises a handle and an elongate shaft, and is operable to remove an anastomotic ring device from a patient. The elongate shaft houses a plurality of ring engaging fingers. Each of the fingers comprises sheath housing a wire having a hook at its distal end. Each hook may be advanced beyond the distal end of a respective sheath to engage petals on an anastomotic ring device. Subsequent proximal retraction of the hooks secures the anastomotic ring device to the ring engaging fingers. With the anastomotic ring device secured to the ring engaging fingers, the fingers may be drawn together to collapse the anastomotic ring device from an actuated, hollow rivet-shaped configuration to an unactuated, cylindrically-shaped configuration. The surgical instrument may then contain the collapsed anastomotic ring device, thereby facilitating removal of the anastomotic ring device from the patient.

Claims

1. A method of extracting an anastomotic ring device from an expanded position to a collapsed position using an instrument comprising:

a handle;

a hollow elongate sleeve having a proximal end and a distal end defining a longitudinal axis, wherein the elongate sleeve is slidably attached to the handle; and

a plurality of ring-engaging members each having a proximal end integrally attached to the handle and a distal end, wherein a first portion of each ring engaging member is housed within the hollow of the elongate sleeve, wherein the distal ends of the ring-engaging members extend outwardly in a flared configuration from the distal end of the sleeve, wherein further each of the flared distal ends of the ring-engaging members are normally biased outwardly to engage an outer circumference the anastomotic ring device and each of the plurality of ring-engaging members are further configured to be individually movable in the longitudinal direction to individually engage with the anastomotic ring device without moving the other ring engaging members, wherein each of the ring engaging members comprises a wire, wherein each of the wires has a proximal end terminating at the handle, wherein each of the wires extends distally from the handle to a length longer than the sleeve, wherein each of the wires has a hook-shaped distal end, wherein the distal end of each wire curves proximally back toward the handle to form a hook shape before terminating;

wherein the sleeve is operable to slidably advance distally over the distal ends of the ring-engaging members after the ring-engaging members engage the anastomotic ring device, thereby drawing the normally outwardly biased distal ends of the ring-engaging members into longitudinal alignment with the sleeve to collapse the anastomotic ring device and to draw the distal ends and the collapsed anastomotic ring device into the hollow of the sleeve, the method comprising;

(a) positioning the plurality of ring-engaging members adjacent a deployed anastomotic ring device in a patient;

(b) individually engaging portions of the outer circumference of the anastomotic ring device with the plurality of ring-engaging members;

(c) advancing the hollow sleeve over the ring-engaging members to collapse at least a portion of the anastomotic ring device from the expanded position to the collapsed position;

(d) further advancing the hollow sleeve to bring the ring-engaging members and the anastomotic ring device within the hollow of the sleeve; and

(e) removing the ring-engaging members, hollow sleeve, and anastomotic ring device from the patient.

2. A for method of extracting an anastomotic ring device from an expanded state to a collapsed state using a surgical instrument comprising:

a handle;

an elongate shaft slidably attached to the handle, wherein the shaft comprises a hollow sleeve having a proximal end and a distal end defining a longitudinal axis therebetween;

a plurality of hook sheaths, each hook sheath having a proximal end integrally attached to the handle with a distal end extending from the hollow of the sleeve and a center portion housed within the sleeve, wherein the distal ends of the hook sheaths extending from the hollow of the sleeve are normally flared outwardly away from the longitudinal axis, with the center portion of the sheaths normally urged against an inner surface of the hollow sleeve; and

a plurality of ring-engaging members integrally attached to the handle at a proximal end, each ring-engaging member integrally terminating in a distal hook for engaging the outer circumference of the anastomotic ring device, wherein each distal hook has a hook shape, such that a first portion of each distal hook extends distally then curves to extend proximally in a second portion before terminating, wherein each of the ring-engaging members is housed within a respective one of the hook sheaths, wherein each ring-engaging member is independently moveable longitudinally, without moving the other ring-engaging members, from a first position in which a substantial portion of the respective hook is contained within the respective hook sheath, to a second position in which a substantial portion of the respective hook protrudes from the respective hook sheath, and the plurality of ring-engaging members are deflected outwardly from the longitudinal axis by the normal bias of the plurality of hook sheaths;

wherein the sleeve is operable to distally advance toward the distal ends of the hooks, wherein the distal advancement of the sleeve moves the normally outwardly biased hook sheaths and hooks inwardly toward the longitudinal axis and into substantial longitudinal alignment with the inner surface of the sleeve, wherein further the sleeve is operable to distally advance over the over the entirety of each of the plurality of hooks and over the anastomotic ring device and thereby capture the anastomotic ring device in the hollow of the sleeve for removal, the method comprising;

(a) positioning the plurality of ring-engaging members adjacent a deployed anastomotic ring device in a patient;

(b) individually engaging portions of the outer circumference of the anastomotic ring device with the plurality of ring-engaging members;

(c) advancing the hollow sleeve over the ring-engaging members to collapse at least a portion of the anastomotic ring device from the expanded state to the collapsed state;

(d) further advancing the hollow sleeve to bring the ring-engaging members and the anastomotic ring device within the hollow of the sleeve; and

(e) removing the ring-engaging members, hollow sleeve, and anastomotic ring device from the patient.

3. A method of extracting an anastomotic ring device using an instrument comprising:

a handle;

an elongate shaft having a longitudinal axis and a proximal end and a distal end, wherein the elongate shaft extends distally from the handle and further comprises a hollow tube longitudinally movable relative to the handle;

a plurality of ring-engaging members integrally attached to the handle and having a portion of each of the plurality of ring-engaging members extending distally from the hollow of the tube, each ring-engaging member having a distal hook end configured to engage the outer circumference of the anastomotic ring device, wherein the distal hook ends are normally flared outwardly from the longitudinal axis of the elongate shaft and each of the plurality of ring-engaging members is configured to be moved individually in a longitudinal direction without moving the other ring engaging members;

a plurality of hook sheaths associated with the ring-engaging members, wherein each hook sheath surrounds a substantial portion of a respective ring-engaging member, wherein each hook sheath has a proximal end attached to the handle, wherein a distal end of each of the plurality of hook sheaths is configured to be adjacent to a respective distal hook end of the plurality of ring-engaging members when the plurality of ring-engaging members are in a proximal most position, wherein each of the ring engaging members is independently and resiliently biased to the proximal most position such that each of the distal hook ends is independently and resiliently biased to a proximal most position, wherein the distal hook end of each ring engaging member is substantially positioned within its associated hook sheath when the ring engaging member is in the proximal most position, wherein each distal hook end is in an unactuated position when the distal hook end of each ring engaging member is substantially positioned within its associated hook sheath; and

wherein when one or more of the plurality of ring-engaging members moves to an actuated position, the respective distal hook end moves away from the adjacent respective hook sheath for reception of a portion of the anastomotic ring device therein, and when the respective distal hook end moves back to the unactuated position, the respective distal hook moves adjacent to the adjacent respective hook sheath to lock the portion of the anastomotic ring device to the surgical instrument and when the distal hook ends are attached to the anastomotic ring device, the surgical instrument is further configured to collapse the anastomotic ring device and to move the distal hook ends and the collapsed anastomotic ring into the hollow of the tube, the method comprising;

(a) positioning the plurality of ring-engaging members adjacent a deployed anastomotic ring device in a patient;

(b) individually engaging portions of the outer circumference of the anastomotic ring device with the plurality of ring-engaging members;

(c) advancing the hollow tube over the ring-engaging members to collapse at least a portion of the anastomotic ring device from an expanded state to a collapsed state;

(d) further advancing the hollow tube to bring the ring-engaging members and the anastomotic ring device within the hollow of the tube; and

(e) removing the ring-engaging members, hollow tube, and anastomotic ring device from the patient.

4. A method of extracting a deployed anastomotic ring device from an anastomotic opening, the anastomotic ring device having a dual headed hollow rivet shape when deployed and a hollow tubular shape when undeployed, the method comprising:

(a) inserting an elongate shaft of a surgical instrument adjacent a deployed anastomotic ring device in a patient, wherein the anastomotic ring device has an outer circumference and the surgical instrument has a distal end for insertion into the patient and a proximal end outside of the patient and a longitudinal axis extending therebetween;

(b) individually engaging portions of the outer circumference of the anastomotic ring device with a plurality of individually movable ring-engaging members integral to the elongate shaft, wherein each of the ring-engaging members is configured to move in a longitudinal direction independently without moving the other ring engaging members;

(c) advancing a hollow sleeve of the elongate shaft entirely over the ring-engaging members to collapse at least a portion of the anastomotic ring from an actuated, hollow rivet-shaped position to an unactuated, cylindrical-shaped position;

(d) further advancing the sleeve through the anastomotic opening to bring the ring engaging members entirely within the sleeve along with and the remainder of the anastomotic ring; and

(e) removing the shaft from the patient.

5. The method of claim 4, wherein the act of engaging comprises engaging one or more actuator buttons to move the ring-engaging members from a first position, in which a distal portion of each of the ring-engaging members is contained in a respective sheath, to a second position, in which the distal portion of each of the ring-engaging members extends from the respective sheath.

6. A method of extracting a normally expanded anastomotic ring device using a surgical instrument, the anastomotic ring device having a hollow tubular shape when compressed and a hollow, expanded dual headed rivet shape when expanded for clamping tissue between the expanded dual heads, the surgical instrument comprising:

a handle;

an elongate shaft defining a longitudinal axis and slidably engaged with the handle, the elongate shaft comprising a hollow sleeve movable proximally and distally along the longitudinal axis relative to the handle, wherein the sleeve has a distal edge; and

a plurality of elongate fingers extending longitudinally through the hollow of the sleeve and extending distally therefrom, wherein a distal end of each of the fingers is configured to engage with a portion of an expanded head of the anastomotic ring device and the plurality of elongate fingers are normally biased to flare outwardly away from the longitudinal axis and into contact with an inner surface of the hollow of the sleeve;

wherein each of the plurality of elongate fingers integrally attached to the handle is individually movable in the longitudinal direction without moving the other fingers, to individually engage the distal end of the finger with a portion of the expanded head of the anastomotic ring device, and the distal end of each of the flared plurality of elongate fingers is further configured to move inwardly toward the longitudinal axis in response to longitudinal movement of the sleeve to inwardly collapse the engaged expanded anastomotic ring device to the hollow tubular shape and to fully receive the plurality of elongate fingers and the attached anastomotic ring device within the hollow of the sleeve;

wherein the sleeve and the elongate fingers are configured such that the sleeve is movable distally to a position where the distal ends of the elongate fingers are proximal to the distal edge of the sleeve, such that the sleeve is configured to longitudinally capture the entirety of the attached anastomotic ring along a length of the sleeve between the distal ends of the elongate fingers and the distal edge of the sleeve, the method comprising;

(a) positioning the distal ends of the elongate fingers adjacent a deployed anastomotic ring device in a patient;

(b) individually engaging portions of the outer circumference of the anastomotic ring device with the distal ends of the elongate fingers;

(c) advancing the hollow sleeve over the elongate fingers to collapse at least a portion of the anastomotic ring device from the expanded dual headed rivet shape to the tubular shape;

(d) further advancing the hollow sleeve to bring the distal ends of the elongate fingers and the anastomotic ring device within the hollow of the sleeve; and

(e) removing the elongate fingers, hollow sleeve, and anastomotic ring device from the patient.

7. The method of claim 6, wherein the distal end of each finger comprises a hook.

8. The method of claim 6, wherein each finger further comprises a sheath fixably attached at one end to the handle, wherein each sheath houses at least a portion of a respective finger.

9. The method of claim 8, wherein each distal end of the finger includes a hook-shaped member.

10. The method of claim 9, wherein each finger is individually moveable from a first position where the corresponding hook-shaped member is adjacent to a distal end of the respective sheath to a second position where the corresponding hook-shaped member is spaced away from the distal end of the respective sheath.

11. The method of claim 8, wherein each finger comprises a wire.

12. The method of claim 8, further comprising a plurality of actuator buttons, wherein each actuator button is in communication with a respective finger, and wherein each actuator button is individually operable to communicate longitudinal motion to an individual respective finger, wherein the act of individually engaging portions of the outer circumference of the anastomotic ring device with the distal ends of the elongate fingers comprises actuating the plurality of actuator buttons.

13. The method of claim 12, wherein the actuator buttons are located on the handle.

14. The method of claim 12, wherein each actuator button integrally attached to the handle further comprises a spring, wherein each of the springs is configured to bias the respective finger to a first position.

15. The method of claim 6, further comprising a sleeve actuator in communication with the sleeve, wherein the sleeve actuator is operable to communicate sliding motion to the sleeve, wherein the act of advancing the hollow sleeve comprises actuating the sleeve actuator, wherein the act of further advancing the hollow sleeve comprises further actuating the sleeve actuator.

16. The method of claim 6, wherein at least a portion of each distal ends of each finger is flared outwardly from a longitudinal axis of the sleeve.

17. The method of claim 16, wherein said distal ends of the fingers are configured to engage the anastomotic ring at separations of 120 degrees.