Note: Descriptions are shown in the official language in which they were submitted.
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SURGIC~L SUTU~ING INST~U~T ~OR APP~IC.~ION OF A
STAP~ SUTURE
The present lnvention relates to medical equipment and
more particularly to a ~urgical suturing i~strument for appli-
cation of a staple su$ure, e.g., when suturing various organs
and tissues with metallic staples, especially the stumps oi
hollow organs, such as blood ves~els, intestines, the stomach,
the bronchu~, pulmonary tis~ue, and some other organs, as well
as ~or establishing an artificial filter on a blood vessel
during operations for thrombus formation.
Up till now a great variety o~ surgieal suturing instru-
ments ~or applying a staple suture have been developed. Said
instruments are designed ~or ~uturing (closing) the stumps of
hollow organs. Ae it is ~nown commonly different organs and
operati~e techniques involved in suturing the stlmps oi hollo~
organs require the use of different t~pe~ o~ sutures to be
appli ed. Thus, for i~stance, the linear suture is applied ior
~tuFing the intestinal stumps~ while for s~turing the bro~chial
stump the palisade or the oblique (diagonal) suture i~ pl~ced;
whenever an extra staunch suture is requixed, the decussate
~ haped) suture i~ expedient to be applied. Surgical sutures
are also classified by amd dif~er in length and thicknes~ o~ the
ti~sues being stitched up. ~hu~, the suture established in stit-
ching up the gastric stump i~ as long as 120 mm, ~here~s the
suture applled in stitchin~ up the stump~ of intenstine~, the
bronchus, or the vascular bundle is up to 40 mm long.
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One prior-art ~urgical suturing instrument for application
of a staple suture is heretofore known to u~e commonly for stit-
ching up v~riou3 orga~s and ti#sues with metallic staples,
e~pecially for stitchin~ up the ~tumps of ~ollow organs (cf. US
Patent ~o.3,079,606).
Said in~truments comprises a supporting body with a repla-
ceable die having a number of r~ce~e~ ~or the staples to bend,
a mechanically actuated carriage-holder with a change magazine,
a staple ejector, a mechanical ~ctuator of the carriage-holder
and a mechanical actuator oi the ~taple e~ector.
The supporting bo~y is an oblong trough provided with
guides and a hook to the inner suriace o~ which a replaceable ;
die is held, h~ g a number of rece~ses for the staples to
bend. The carriage-holder with a cha~ge magazine is slidable
along the guide~ of the supporting body, and i~ also provided
with guide#. ~he ~taple maga~ine has staple slot~ arraneed 80
as to suit the arrangement of the die rece~ee. Ea¢h of the :
staple ~lots i~ to accomodate a 3ingle metallic etRple. ~he
~taple ejector with prong~ i~ slidable along the carriage-hol-
der guides, the ejector prongs being arranged to the pattern
of the staple ~lot~ in the magazine.
~ he carriage-holder is screw-actuated, while the staple
ejector is leYer-actuated,
~ he instrwment operates as followY. The ~oo~ i~ brought
under the organ being utured. ~he carriag~-holder along with
the staple ma~azine and ejector is advanced towards the die by
rotating the nut of the carriage-holder actuator, with the
result that the tissue being ~utured i~ compres3ed until blood
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flow is arrested and the so-called suturing gap i~ defined
between the die surface, wherein the opened staple ~lot9 are
provided, and the staple magazine ~urface. Then the staple
e~ector i~ al90 advanced towards the die by pre~ing the
ejector actuating lever, with the result that the ejector
prongs enter the ~taple slots to ~rive the staples out o~ them.
~ etallic ~taples, aiter having pierced with their leg~
the compres~ed ti~ue, catch the die rece~es ~ith ~aid legs
and thrust thereagai~st to be bent into the shape of the
letter ~, thus uniting the tissue firmly-
However, ~aid in~trument i8 capable o~ placing a ~ingle
type o~ ~uture only, e.g., the linear ~uture.
In order to apply all other type~ o~ suture~ one mu~t ha~e
at his disposal such a ~umber of in~trument~ as to apply e~ery
type o~ suture, which re~ult~ in a con~iderable amount of sur-
gical equipment invol~ed.
- It is the ma$n object of the present invention to provide
various types of suture~ applied ~ith the use o~ a ~ingle ~u-
turing instrument.
It is another object of the pre3ent invention to provide
a surgical suturing instrument tbat wdll preclude any error on
the part of surgeon in conforming the die, magazine and staple
ejector which would re~ult, at best, in breakage o~ the in~tru-
ments, and at worst, in f~ lure of the suture followed by the
lethal outcome.
It i9 one more object o~ the pre~ent in~ention to cut down
a total cost of the equipment (i.e., suturing instrument~ and
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accessories) aimed at obtaining a variety of sutures needed
in surgical practice.
It is a further object of the present invention to
provide convenience and reliability in using the standardized
units of the suturing instrument which require standard mani-
pulations in order to obtain different types of sutures in
practical surgery.
Said and other objects are accomplished due to the
fact that in a surgical suturing instrument for application of
a staple suture, comprising a supporting body with a replaceable
die having a number of recesses for bending the staples fed
from a change magazine provided with staple slots and mounted
on a mechanically actuated carriage-holder, as well as a mechan-
ically actuated ejector adapted to drive the staples out of
the magazine and bring them in engagement with the replaceable
die so as to establish a staple suture, according to the
invention use is made of a replaceable die and of a magazine for
establishing every type of suture, said replaceable die has an
end guide plate situated in a plane square with the surface
having staple bending recesses and jutting out from the die on
its side facing the magazine, and the surface of the guide
plate of every replaceable die has different shape to suit each
of the suture types, while the end surface of every change maga-
zine for each type of suture is shaped so as to suit the
shape of the guide plate of the die for said type of suture,
the staple ejector is also replaceable and its end surface is
shaped similarly to the shape of the end of the magazine for
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the respective type of s~ture.
Owing to the provi~ion o~ a replaceable staple ejector
and an end guide plate of the die ~haped similarly to the eha-
pe of the end surfaces oY the magazine and e~ector, the dis-
closed instx~ment assures a positive eonformity of the die,
ejector and magazine, which make~ it po~ible to obtain di~e-
rent types of suture~ with the same instrument, to avoid any
surgeon'~ errors in 3etting the die, e~eotor and magazine
which corre~pond to a definite type of ~uture and hence to
lo obviate failure of the s~ture ap~lied, a~ well a3 cuts down
the cost3 of the equipment adapted ~or applying diverse type~
o~ suture~ and adds to the convenience of handling the instru-
ment.
It i~ expedient that the ~haped surface of the guide
plate be defined by #lots opening towards the magazine, while
the magazine and ejector be provided with the respective pro-
~ections adapted to enter said slot~.
In what follow# the invention i~ illu#trated in a detail-
ed description of ~ome ~pecific exemplary embodiments thereo~
with referonce to the attached drawing# wherein:
FIG.l is a general, fragmentarily eutaway side eleva~
tion ~iew of the in~trument, accord~ng to the invention;
~IG.2 i~ a general plan view of the in~trument, accord-
ing to the invention;
FIG.3 i9 a #e~tion taken along the line III-III in ~IG.l;
FIG.4 i~ a ~ection taken along the line IV-IV in ~IG.l;
FIG.5 illustrate~ conventional symbols of various t~pes
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of ~utures made use oi in modern surgery;
~ IG.6 is a ~caled-up perspective view o~ the ejector,
magazine and die for applying the linear suture;
FIG.7 is a scaled-up per~pective view of the eJector,
magazine and die for applying the pali3ade suture;
~ IG.8 i~ a scaled-up per~pective view of the ejector,
magazine and die ior applying the oblique (diagonal) ~uture;
and
FIG.9 is a scaled-up per~pective ~iew of the ejector,
lo magazine and die for applying the decu~sate (~-shaped) suture.
The surg$cal suturing in~trument for application oi a
~taple suture comprises a ~upporting body 1 (FIG.l) with a
replace~ble die 2, wherein a number o~ recesses 3 (~IGS 3, 4,
6, 7, 8, 9) are provided ior staples 4 (FIG.4) to bend, a
mechanically-actuated carriage-holder 5 (FIG.l) with a change
magazine 6, a staple ejector 7, a mechaniaal actuator 8 o~
the carriage-holder, and a mechanical actuator 9 o~ the ~tap-
le ejector.
~he supporting body i~ an oblong trough 10 having guides
11 (indicated with a dotted line) and a hook 12 held to the
inner ~urface o~ which iq the die ~. A ~-~lot 13 (FIGS 6, 7,
8, 9) i~ provided in the replaceable die 2 in order to set
the latter i~to the instrument, while a T-shaped projection 14
(FIG.2) is provided on the i~ner suriace of the hook 12 for the
purpo~e. A tailpieoe 15 (FIG.l) of the supporting body has a
lug 1~ adapted to interact with the carriage-holder mecha~i-
cal actuator 8. ~he supporting body 1 ha~ a grlp 17 ior con-
venience in injtrument handling.
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~ he mechanicall-actuated carriage-holder 5 i9 shaped a~
an oblong tem h~Ying a tailpiece 18 at one end and a holder
20 carrying the change staple magazine 6, at the other end.
In order to keep the magazine 6 in place on the holder
20 a number of lugs 21 (FIG.2) are provided on the latter,
whlle the same number o~ ~haped ~lot~ 22 are made in the
magazine 6 (~IGS 6, 7, 8, 9)0 In additio~, ~ome through ~lots
23 for staple~ are made i~ the magazine 6, the arr~ngement
pattern of said ~lot~ corre~ponding to that o~ the rece~ses 3
in the die. The mechanicall~-actuated carriage-holder 5 ha~
lug~ 24 to interact with the supporting body 1 (FIG.l). ~he
tailpiece 19 of the carriage-holder is a hollow structure
provided with external and internal thread.
The staple eiector 7 i~ also shaped as an oblong ~tem
25 having a T-slot (not shown) at one end, and a head ~6 with
prongs ~7, at the other end.
The configuration and arrangement pattern of the prong~
27 of the ejeotor 7 corre~pond to those of the stapl.è ~lots
23 (FIGS 6, 7, 8, 9).
A~cording to the invention the e~ector 7 (FIG.l) is a
replaceable compone~t; to thi~ end, the ejector i8 detachably
joined, through its T-~lot, with a T-~haped projection 40 of
the mechanical actuator 9 oi the ejector 7.
The mechanical actuator 8 o~ the carriage-holder 5 19 in
fact a nut 28 having an annular groove 29.
The nut 28 establishes a ~crew pair align with the Exter-
DP1 thread of the tailpiece 19, and with its annular groove
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29 i~ slidably engaged with the lug 16 of the supportine body
1. The mechanical actuator 9 of the eieotor 7 is essentiall~
a sCrew 30 having an annular groo~e 31.
The ~crew 30 establishe~ another screw pair along with
the internal thre~d of the tailpiece 19 of the carriage-hol-
der, and with its annular groove 31 is slidably engage~ with
the yoke (not shown) of the e;~ctor 7.
According to the i~ention an end guide plate 32 i9 pro-
~ided on the replaceable die 2 (FIGS 6, 7, 8, 9), arranged
~quare with a ~ur~ace 33, wherein the reces~es are made, said
guide plate jutting out towards the magszine.
The end guide plate 32 ha~ a shape 34 which i8 imparted
only to a de~inite type of ~uture ~FIG.5). O~e of the end
surface~ 35 (FIGS 6, 7, 8, 9) of the magaæine 6 and one o~
the end ~urface~ 36 o~ the ejector 7 are ~hPped 90 as to 3uit
the shape o~ the end guide plate 32 ~or a ~trictly de~inite
type o~ suture.
- The ~hape of the end guide plate may be established by
~lots 37, while the shape of the magazine and ejeetor ends,
by similar lugs 38-
In order to pre~ent the ti~ue beiQg sutured from esc~p-
ing beyond the zone of suture i~ the course of operation, a~
extra component i~ provided in tke i~trument, ~iz. a re~tric-
tion ~trip 39 (FIG-l), capable of reckprocating between the
hook 1~ and the nut ~8.
When applying a staple ~uture to the inte~tinal stump the
present sur~ical ~uturing i~trume~t operates as follows.
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According to the technique~ adoped in the modern ~urgery the
intestinal stump i8 to be qtitched up with the linear suture.
So one must select the appropriate replaceable die 2 (FIG.6)~
the change magazine 6 Qnd the replaceable ejector 7. Then the
nut 28 (FIG.l) o~ the ~arriage-holder mechanical actuator is
rotated counterclockwise to retract the carriage-holder to
the initial position, whereupon the carriage-holder is extract-
ed from the supporting body.
The eje¢tor i9 SO set th~t its T-slot (not shown) ~hould
embrace the annular groove 31 of the screw o~ the ejector me-
chanioal sctuator 9 and it~ head 26 should enter the holder
20; in thi~ case the shaped end surface 36 (FIG.6) should be
directed oppositely to the lug 24 (FIG.l~.
~ext the mechanically-actuated carriage-holder 5 alo~g
with the e~ector 7 is placed in the troughlike portion 10 o~
the ~upporting body 1 90 that the eje¢tor 7 be at the bottom
~of said troughlike portion. Then the nut 28 of the mecha~ical
actuator of the carriage-holder is given a revolution, whereby
the lug~ 24 engage the guide slots 11 (shown with a dotted
line) in the supporting body 1. Thu3, a slidable ~oint is
obtained, capable of reciprocating lengthwi~e ~rom the hook
1~ toward~ the tailpiece 15 Or the ~upporting body 1.
The change magazine ~ (FIG.2) i~ ~itted i~to the carriage-
-holder in such a manner that the lugs 21 should engage the
~lots 22 in the magazine 6, whereupon the magazine is ad~anced
all the way along the lugs 21.
The die 2 i~ then fitted onto the hook 12 (FIG.l) of the
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supporting body 1 in ~uch a manner that the T-shaped projec-
tion 14 (FIG.2) of the supporting body 1 should engage the
slot 13 (FIG.6) in the die 2 (~IG.2); in this case the end
guide plate should face the magazine 6. ~ext the hook of the
supporting body i9 brought under the organ bein~ s~tured
(i.e., the intestine in this particular oase), and the
res~riction strip 39 (~IG.l) i9 advanoed towards the hook so that
that the organ being ~utured ~hould be confined within the
die 2, the magazine 67 the hook 12 Rnd the restriction strip
39.
Thereupon the nut 28 of the carriage-holder mechanical
actuator i~ rotated to advance the carriage-holder along with
the magazine 6 and the ejector 7 towards the die 2, thus com-
pressing the ti~sue being sutured to de~ine the suturing gap.
This done, the screw 30 of the ejector aetuator 9 i5 rota-
ted clockwise to adcance the ejector towards the die, with
the result that the eiector prongs 27 enter the staple ~lot~
23 of the magazine 6 to driYe the staples out o~ the magazlne
slots.
Upon being expelled from the 310t5 the staples pierce
with their legs the tissue being sutured~ thru3t against the
die reces~es and get bent into the shape of the letter ~,
thus establishing a suture.
.. ~.
~ ext the organ being sutured is cut along the plane of the
instrument, and the nut 28 of the carriage.holder mechanical
aotuator is rotated counterclockwise to retract the car~iage-
-holder 5 along with the ejector 7 into the initial position.
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~hu~, the organ is released. ~his terminates the suturing
procedure.
In the instrument proposed by the present invention a
positive conformity of a replacea~le die, magazine and ejector
is carried out, whereby any po~sible errors of medical person-
nel concerned with setting said change components into the
instrument are avoided. This is a feature o~ paramount impor-
tance as otherwise, should any of said component~ (die, ejec_
tor, or magazine) adapted ~or applying a de~inite type o~ ~u-
ture, e.g., the li~ear euture be set to operat~ in conaunction
with the change components ~or applying another type of sl~ture,
such a~ the palisade suture, this will result, at best, in the
ejector breakage, while at wor~t this ~ill lead in wrongly bent
staples ~hich in turn might involve subsequently a ~ailure of
the suture and an eventual lethal outcome.
Said errors are completely eliminated in the disclosed
instrument as should only one of the change components be con-
fused mistakenly the instrument will ~ail to operate at the
ver~ beginning of the suture applieation prooedure, i.e., will
fail to co~press the ti~sue bein~ 3utured, since the ~hape of
the end guide plate 32 will not mate that of the magazine end
sur~ace, whlch thereiore will prevent t~e meohanically-actuated
carriage-holder from being brought together with the die.
~hus, the diæclosed instrument is capable of applying
different types of sutures, obviates any errors in suture appli-
cation and hence any po~sibllity of ~ailure of the applied 3U-
ture, cuts down a total cost of eguipment involved in applica-
tion of diverse types of sutures, and render~ the handling
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a~d manipulation with the in~trument ea~y and conYenient due
to unification and standardization of the ba~ic units thereof.
