Patent Application
20070181631
1. Field of the Invention
The present invention relates to a surgical stapling and cutting instrument adapted for use in trans-anal resection and an associated method for performing trans-anal resection. More particularly, the present invention relates to a surgical stapling and cutting instrument having a curvature particularly adapted to fit within the rectum adjacent the anal canal for the performance of the trans-anal resection as well as the method for using the surgical stapling and cutting instrument.
2. Description of the Prior Art
Surgical stapling and cutting instruments are commonly utilized in the diagnosis and treatment of pathologies treated by staple resection. Surgical stapling instruments provide a mechanism to extend the transluminal exploitation of mechanical suturing devices introduced via the anal canal, mouth, stomach and service accesses. Although surgical stapling and cutting instruments are most commonly utilized with rectal pathologies, surgical stapling and cutting instruments may be used in a variety of environments.
Surgical stapling and cutting instruments generally include a support frame, an anvil attached to the support frame and a cartridge module carrying a plurality of staples. The instruments also include a driver within the cartridge module which pushes all of the staples out simultaneously into the anvil to form the staples into a generally B-shape, suturing tissue together. In addition, these instruments include approximation mechanisms for moving the cartridge module from a spaced position relative to the anvil to accept tissue therebetween to a closed position where the tissue is clamped between the anvil and the cartridge module. Finally, the instruments include a firing means for moving the staple driver forward to form the staples against the anvil.
In addition to other procedures, surgical stapling and cutting instruments have been utilized in conjunction with trans-anal resections. Trans-anal resection is a surgical procedure utilized to remove tissue, for example, tumorous tissue, within the rectum by operating through the anus. This procedure is commonly performed to treat early stage rectal cancer or rectal tumors close to the anus. In accordance with this procedure, a section of the rectum is removed and the remaining opposed edges are coupled to complete the linking of the anus with the remainder of the rectum.
With the foregoing in mind, those skilled in the art will appreciate the need for more advanced procedures relating to trans-anal resection, as well as the need for advanced instruments specifically designed to facilitate the advanced surgical procedures. The present invention addresses this need through the provision of a technique for trans-anal resection and an associated curved cutter stapler adapted for assisting in the performance of the procedure.
It is, therefore, an object of the present invention to provide a surgical instrument adapted for applying a plurality of surgical fasteners to body tissue. The surgical instrument includes a frame having a proximal end and a distal end, with a handle positioned at the proximal end and an end effector positioned at the distal end. The end effector is shaped and dimensioned for supporting a cartridge module. A firing mechanism is associated with the end effector and the cartridge module for selective actuation. The end effector has a radius of curvature optimized for a trans-anal resection such that the end effector has a curvature of at most approximately a 40 mm diameter.
It is also an object of the present invention to provide a surgical instrument wherein the end effector has a curvature of between approximately a 20 mm diameter and approximately a 40 mm diameter.
It is another object of the present invention to provide a surgical instrument wherein the end effector has a curvature adapted to fit within an envelope having a diameter of approximately 40 mm.
It is a further object of the present invention to provide a surgical instrument wherein the end effector has a curvature of approximately a 36 mm diameter.
It is also another object of the present invention to provide a surgical kit adapted for the performance of trans-anal resection. The surgical kit includes a surgical instrument as described above and a dilator having an opening with a curvature of at most approximately a 40 mm diameter.
It is a further object of the present invention to provide a surgical instrument wherein the dilator has a curvature of approximately 40 mm.
Other objects and advantages of the present invention will become apparent from the following detailed description when viewed in conjunction with the accompanying drawings, which set forth certain embodiments of the invention.
FIGS. 8 to 16 disclose the various steps in performing a trans-anal resection in accordance with the present invention.
The detailed embodiments of the present invention are disclosed herein. It should be understood, however, that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, the details disclosed herein are not to be interpreted as limiting, but merely as the basis for teaching one skilled in the art how to make and/or use the invention.
Referring to
The linear surgical stapler 20 in accordance with the present invention is particularly adapted for use in the performance of trans-anal resection. In particular, access to, and the performance of procedures adjacent to, the anus are made difficult by the limited size of the anus and rectum. The present surgical stapler 20 is specifically shaped and dimensioned for access through the anus and alignment within the rectum during trans-anal resection. In particular, the end effector 80 of the linear surgical stapler 20 is adapted to fit and function within a circular envelope having a diameter of at most 40 mm. With this in mind, and in accordance with a preferred embodiment of the present invention, the linear surgical stapler 20 has a distal end with a tissue end effector 80 having a curvature between a diameter of approximately 20 mm to approximately 40 mm, and more preferably, approximately 36 mm, in order to fit into a minimum oval envelope permitting passage through the anus and performance of a rectal resection procedure. In accordance with a preferred embodiment, an effector having a curvature with a diameter of approximately 36 mm would be structured such that it defines an arc length of approximately 30 mm.
The end effector 80 is a surgical fastening assembly that includes a cartridge module 120 (see
As will become apparent based upon the following disclosure, the present linear surgical stapler 20 is designed as a multiple firing device with a replaceable cartridge module 120. However, it should be understood that many of the underlying concepts of the present invention may be equally applied in single firing devices without departing from the spirit of the present invention. While the present end effector 80 is disclosed below as being adapted for use in conjunction with a replaceable cartridge module 120 having various components, the concepts underlying the present invention could be applied to a variety of end effectors and cartridge module constructions without departing from the spirit of the present invention.
The supporting structure 81 of the end effector 80 is respectively attached to the right and left handle plates 34, 35, by a shoulder rivet 82 and posts 83 which extend from the supporting structure 81 into receiving holes in the handle plates 34, 35. In accordance with a preferred embodiment of the present invention, the supporting structure 81 is formed via a single piece construction. More specifically, the supporting structure 81 is formed by extrusion, for example, of aluminum, with subsequent machining to create the supporting structure 81 disclosed in accordance with the present invention. By constructing the supporting structure 81 in this manner, multiple parts are not required and the associated cost of manufacture and assembly is substantially reduced. In addition, it is believed the unitary structure of the supporting structure 81 enhances the overall stability of the present linear surgical stapler 20. In addition, the unitary extruded structure of the supporting structure 81 provides for a reduction in weight, easier sterilization since cobalt irradiation will effectively penetrate the extruded aluminum and less trauma to tissue based upon the smooth outer surface achieved via extrusion.
The handle 21 of the linear surgical stapler 20 includes a hand grip 24 which the surgeon grasps with the palm of his hand (see FIGS. 2 to 5). The hand grip 24 is composed of a right hand shroud handle 25 (see
The handle 21 of the linear surgical stapler 20 contains a tissue retaining pin actuation mechanism 100. The tissue retaining pin actuation mechanism 100 includes a saddle shaped slide 101 positioned on the top surface of the handle 21. Manual movement of the slide 101 results in distal movement of the push rod 102. The push rod 102 is coupled to the retaining pin 125 of the cartridge module 120. The distal movement or proximal retraction of the push rod 102 results in corresponding movement of the retaining pin 125. The retaining pin actuation mechanism 100 is also releasably coupled to the closure trigger 26 within the handle 21 such that actuation of the closure trigger 26 will result in automatic distal movement of the retaining pin 125 if it has not already been manually moved to its most proximal position.
Referring briefly to FIGS. 2 to 5, there is illustrated what happens when the cartridge module 120 is loaded and the closure and firing triggers 26, 27 are sequentially squeezed toward the hand grip 24 to actuate the end effector 80 of the linear surgical stapler 20. The linear surgical stapler 20 is loaded with the cartridge module 120, as shown in
When the closure trigger 26 is partially squeezed to rest in its first detent position shown in
When the closure trigger 26 is fully squeezed so that it is adjacent the forward end of the hand grip 24, as illustrated in
The present linear surgical stapler is constructed in a manner similar to commonly owned and copending applications. As such, further details regarding the structure and operation of the linear surgical stapler 20 may be found in commonly owned U.S. patent application Ser. No. 11/014,910, filed Dec. 20, 2004, entitled “CURVED CUTTER STAPLER SHAPED FOR MALE PELVIS”, which is incorporated herein by reference.
In practice, and referring to
Thereafter, and with reference to FIGS. 11 to 16, a first whip stitch 202 is secured about the rectum 200 from a one o'clock position to an eleven o'clock position. The deep bites of the whip stitch 202 capture and fold the rectum wall 204 in a desired manner. In addition to the placement of a whip stitch 202 as discussed above, a traction suture 206 is positioned beneath the whip stitch 202 and is used to maintain tension on the tissue as the procedure is performed. Thereafter, a traditional linear surgical stapling instrument well known to those skilled in the art is positioned between the whip stitch 202 and the traction suture 206 to create a longitudinal staple line 208 in the rectal wall 204 at a position approximately at one o'clock. Thereafter, the present instrument 20 is placed in the rectal canal 200 and is positioned for capturing the rectal wall 204 held by the first whip stitch 202 positioned between one o'clock and ten o'clock. The instrument 20 is fired and a circumferential first staple line 210 extending from one o'clock to ten o'clock is created. Once this portion of the resection is completed, a second whip stitch 203 is placed from ten o'clock to seven o'clock to capture the rectal wall 204. The instrument 20 is then once again placed in the rectal canal 200 to capture the rectal wall 204 held by the second whip stitch 203 from ten o'clock to seven o'clock and the instrument 20 is fired creating a staple line 212 thereacross. In accordance with a preferred embodiment of the present invention, a figure eight suture 211 is then placed at the junction of the first and second staple lines 210, 212. Thereafter, a third whip stitch 205 is placed from seven o'clock to four o'clock and the instrument 20 is positioned and fired once again creating a third staple line 214 extending from seven o'clock to four o'clock. As with the prior step, a figure eight suture 213 is placed at the junction of the second and third staple lines 212, 214. Finally, the steps are repeated until the complete rectal section is fully stapled and resected adding a fourth staple line 218 and a figure eight suture 215.
While the preferred embodiments have been shown and described, it will be understood that there is no intent to limit the invention by such disclosure, but rather, is intended to cover all modifications and alternate constructions falling within the spirit and scope of the invention.
