Abstract
Surgical tissue fusion instrument and support structure having two gripping structures which are movable relative to each other and which are designed to bring together biological tissue sections that are to be connected to each other, with heat-generating means which are assigned to the gripping structures and, during tissue fusion, cause heat to be introduced in the area of a connection site of the biological tissue sections, and also with a support structure which is held between the gripping structures and, during tissue fusion, is operatively connected to the tissue sections. The support structure has at least one additional physical functional structure for aiding or promoting the tissue fusion.
Claims
1. A surgical tissue fusion instrument with two gripping structures which are movable relative to each other and which are designed to bring together biological tissue sections (G.sub.1, G.sub.2) that are to be connected to each other, with heat-generating means which are assigned to the gripping structures and, during tissue fusion, cause heat to be introduced in the area of a connection site of the biological tissue sections (G.sub.1, G.sub.2), and also with a support structure which is assigned to the gripping structures and, during tissue fusion, is operatively connected to the tissue sections (G.sub.1, G.sub.2), wherein the support structure has opposite end faces and at least one additional physical functional structure for aiding or promoting the tissue fusion, wherein the physical functional structure has profiles in the form of angular protuberances or indentations, which are provided on at least one end face of the opposite end faces of the support structure directed toward a gripping structure wherein the support structure is constructed from two annular shells, which are connected to each other at their edge areas, and wherein a storage space for accommodating a liquid or flowable additive is provided between the annular shells, and wherein end walls and side walls of the annular shells surround the storage space, wherein the end walls and side walls of the annular shells are designed in such a way that they are able to burst or tear open when a pressure load is applied to the end faces of the support structure.
2. The surgical tissue fusion instrument of claim 1, wherein the physical functional structure has apertures or material weakenings in the support structure which are positioned in areas where the heat introduced by the heat-generating means passes through the support structure and the tissue sections (G.sub.1, G.sub.2).
3. The surgical tissue fusion instrument of claim 2, wherein the apertures are designed as linearly extending or circularly extending oblong holes.
4. The surgical tissue fusion instrument of claim 2, wherein the apertures are designed as perforations.
5. The surgical tissue fusion instrument of claim 1, wherein the storage space serves to aid tissue fusion in the area of the connection site between the tissue sections (G1, G2).
6. The surgical tissue fusion instrument of claim 1, wherein the storage space is integrated in the support structure.
7. The surgical tissue fusion instrument of claim 1, wherein the physical functional structure is designed to be electrically conductive at least in parts.
8. The surgical tissue fusion instrument of claim 7, wherein the physical functional structure is designed as an electrical pole for electrical activation of the energy input by the heat-generating means.
9. The surgical tissue fusion instrument of claim 1, wherein the physical functional structure is formed by a shape-change structure, which can be activated according to a change of at least one physical or chemical environmental parameter.
10. The surgical tissue fusion instrument of claim 9, wherein a change of temperature and/or change of water content acting on the functional structure is provided as the change of environmental parameters.
Description
(1) Further advantages and features of the invention will become clear from the claims and also from the following description of preferred exemplary embodiments of the invention that are shown in the drawings.
(2) FIG. 1 shows a perspective view of an embodiment of a surgical tissue fusion instrument according to the invention in a circular form.
(3) FIG. 2 shows an enlarged view of a head area of the tissue fusion instrument according to FIG. 1 in the open position.
(4) FIG. 3 shows an enlarged perspective view of an embodiment of a support structure according to the invention, for arrangement in the head area of the tissue fusion instrument according to FIG. 2.
(5) FIG. 4 shows a perspective view of a further embodiment of a support structure according to the invention.
(6) FIG. 5 shows a plan view of the support structure according to FIG. 4.
(7) FIG. 6 shows a sectional view of the support structure according to FIGS. 4 and 5.
(8) FIG. 7 shows a schematic sectional view of the inclusion of the support structure according to FIGS. 4 to 6 between two biological tissue sections after a tissue fusion procedure using the tissue fusion instrument according to FIGS. 1 and 2.
(9) FIG. 8 shows a perspective view of a further embodiment of a support structure according to the invention.
(10) FIG. 9 shows a plan view of the support structure according to FIG. 8.
(11) FIG. 10 shows a sectional view, along section line X-X, of the support structure according to FIGS. 8 and 9.
(12) FIG. 11 shows a schematic sectional view of the inclusion of the support structure according to FIGS. 8 to 10 between two tissue sections to be connected to each other using a tissue fusion instrument according to FIGS. 1 and 2.
(13) FIG. 12 shows a schematic view of the head area of the tissue fusion instrument according to FIG. 2, with a further embodiment of a support structure according to the invention which is inserted between the tissue sections to be connected to each other.
(14) FIG. 13 shows a schematic view of the head area of the tissue fusion instrument according to FIG. 2, with a further embodiment of a support structure according to the invention which has a polygonal shape and is insertable between the tissue sections.
(15) FIG. 14 shows a further schematic view of the head area of the tissue fusion instrument according to FIG. 2, similar to FIGS. 12 and 13, wherein a further embodiment of a support structure according to the invention is inserted between an anvil part and a base part of the head area and has a shape-change structure.
(16) FIG. 15 shows the configuration according to FIG. 14, with a schematic view of how the support structure has changed shape.
(17) FIG. 16 shows a schematic view of a further embodiment of a tissue fusion instrument according to the invention, with a support structure which externally encloses the tissue sections.
(18) FIG. 17 experiences a change of shape in the manner of a heat-shrink sleeve.
(19) A surgical tissue fusion instrument according to FIGS. 1 to 17 is designed as a circular tissue fusion instrument 1. The tissue fusion instrument 1 has a grip area (not shown in any detail) which can be grasped by hand in order to operate the tissue fusion instrument. The grip area is assigned an actuation handle 5, which permits activation and control of the tissue fusion instrument 1. The tissue fusion instrument 1 is supplied with current by a power cable designated by reference sign 4. Alternatively, the tissue fusion instrument 1 can be supplied with current by means of an accumulator. The use of an accumulator has the particular advantage of permitting the installation of an energy source, in particular a high-frequency current generator, into the surgical tissue fusion instrument 1. In this case, the energy source and the accumulator are preferably integrated in the grip area of the surgical tissue fusion instrument 1. A head area of the tissue fusion instrument 1 protrudes from the grip area via an elongate neck and has a base part 2 and an anvil part 3. The anvil part 3 is mounted longitudinally displaceably in the base part 2 by means of an anvil shaft 6 coaxial to a central longitudinal axis M of the neck of the head area. By means of a drive system (not shown in any detail), the anvil part 3 can travel relative to the base part 2 along the central longitudinal axis M between an open position (FIG. 2) and a closed position (FIG. 1). The base part 2 and the anvil part 3 have end faces which are directed toward each other and which form contact faces by which biological tissue sections to be connected to each other are grasped and brought together. The anvil part 3 and the base part 2 both define a gripping structure within the meaning of the invention.
(20) The two end faces of the base part 2 and of the anvil part 3 are provided with electrode arrangements 8, 9 which, as heat-generating means, are acted upon electrically and thus, by way of high-frequency electromagnetic waves, apply heat to the biological tissue sections that are to be connected to each other. The contact area defined between the contact faces of the base part 2 and of the anvil part 3 in the closed position is designated as connection area or as connection site for the tissue sections. The electrode arrangements 8, 9 permit a focused and directional application of energy to the connection area, such that a high level of heat can be introduced into the tissue sections to be connected to each other and can bring about a desired tissue fusion between the tissue sections. This results in a cohesive connection between the tissue sections, which connection can be assisted or strengthened mechanically by additional mechanical connecting means such as staples or the like. The circular tissue fusion instrument 1 is able in particular to connect biological tissue sections that are formed as hollow organs.
(21) To aid and promote the connection between the tissue sections, the head area of the tissue fusion instrument 1 is additionally assigned a support structure 7, 7a to 7g, which has an at least substantially rotationally symmetrical design and coaxially surrounds the central longitudinal axis M of the head area. The support structure 7 according to FIG. 2 is simply a schematic view in the manner of a placeholder for the support structures 7a to 7g shown in detail in FIGS. 3 to 17. The schematically depicted support structure 7 shows the arrangement of the support structures 7a to 7f in the head area of the tissue fusion instrument 1.
(22) All the embodiments of support structures 7, 7a to 7g are made from a medically compatible material, or have such a material, and are dimensionally stable in an unloaded initial state with the tissue fusion instrument 1 opened according to FIG. 2. Each of the support structures 7, 7a to 7g serves to promote and aid the tissue fusion between the tissue sections G.sub.1, G.sub.2. All of the support structures 7a to 7g have a physical functional structure, in particular an additional physical functional structure. In the embodiments according to FIGS. 3 to 11, the physical functional structure is formed by mechanical functional sections. All of the support structures 7, 7a to 7g are preferably made of a resorbable material or have such a material.
(23) The support structure 7a according to FIG. 3 has apertures D.sub.1 extending along arcs of a circle and distributed uniformly about the circumference of the support structure 7a. The support structure 7a is disk-shaped and has a central receiving eye 10a, which serves to mount the support structure 7a on the anvil shaft 6 of the anvil part 3. The apertures D.sub.1 are positioned flush with the electrode arrangements 8 and 9 of the anvil part 3 and of the base part 2 and are accordingly located at the sites of the greatest input of energy. During tissue fusion, the tissue sections G.sub.1, G.sub.2 are connected to each other through the apertures D.sub.1, thereby sandwiching the support structure 7a between them.
(24) In the embodiment according to FIG. 4, the support structure 7b likewise has apertures D.sub.2 which, in this embodiment, are designed as perforations. The apertures D.sub.2 also designed as perforations extend about a circumference of the support structure 7b, which is designed as an annular disk. The support structure 7b has a receiving eye 10b analogously to the above-described support structure 7a. The apertures D.sub.2 are distributed uniformly in the shape of a circle about the circumference of the support structure 7b and are arranged flush with the electrode arrangements 8, 9, so as to be able to obtain, in the area of the highest input of energy, a particularly good connection between the tissue sections G.sub.1, G.sub.2. The support structure 7b is additionally provided with an edge web 11, which is formed integrally on the outer periphery of the disk-shaped support structure 7b and protrudes axially, with respect to a radial plane of the support structure 7b, on opposite sides relative to a disk surface of the support structure 7b. After tissue fusion has taken place, the edge web 11 flanks the tissue sections G.sub.1, G.sub.2 radially to the outside in the area of the connection site between the tissue sections G.sub.1, G.sub.2. The edge web 11 accordingly contributes to stiffening and supporting the connection site between the tissue sections G1, G2. It will be seen from FIG. 7 that the support structure 7b is sandwiched between the tissue sections G.sub.1, G.sub.2, which are in the form of hollow organs. Radially with respect to an imaginary central longitudinal axis of the mutually aligned tissue sections G.sub.1, G.sub.2 formed as hollow organs, the connection site extends as a planar connection in the area of the radial plane predefined by the support structure 7b.
(25) The support structure 7c according to FIGS. 8 to 11 is likewise disk-shaped, with a central receiving eye 10c for mounting on the anvil shaft 6 of the anvil part 3. On its opposite end faces, the support structure 7c has, as additional physical functional structures, profiles 14, 16 which protrude axially outward in the form of humps from the end face. The profiles 14, 16 protrude outward from the opposite end faces of the support structure 7c.
(26) The support structure 7c is constructed from two annular shells 12 and 13, which are tightly connected to each other at their edge areas. A storage space 15 for accommodating a liquid or flowable additive is provided between the annular shells 12 and 13 and serves to aid or promote tissue fusion in the area of the connection site between the tissue sections G.sub.1, G.sub.2. The liquid or flowable additive is medically compatible and can in particular have properties of adhesion or properties that promote wound-healing.
(27) The end walls and side walls of the annular shells 12, 13 surrounding the storage space 15 are designed in such a way that they are able to burst or tear open when a pressure load is applied to the end faces. In this way, the additive is freed and is able to spread out in the area of the connection site between the tissue sections G.sub.1, G.sub.2. The profiles 14, 16 deform when pressure is applied during closure of the head area of the tissue fusion instrument 1 and aid the tearing open or bursting open of the walls of the storage space 15.
(28) In the embodiment according to FIG. 12, the support structure 7e in the head area of the tissue fusion instrument is beaker-shaped and has a disk-shaped area, extending radially with respect to a central longitudinal axis of the head area, and an axially extending annular wall, which surrounds the outside of the base part 2 and the associated tissue section G.sub.2. The material of the beaker-shaped support structure 7e is electrically conductive at least in parts. It is used as a positive pole 20 for a corresponding application of heat to the tissue sections G.sub.1, G.sub.2 by means of electrical energy, whereas the electrode arrangements 8 and 9 are controlled as negative pole 19.
(29) In the embodiment according to FIG. 13, the support structure 7f, starting from a disk-shaped initial state analogous to FIG. 2, has already been deployed into a three-dimensional, polygonal shape-change state. For this purpose, the support structure 7f preferably has a shape-memory material, which is activated in particular by application of temperature, electrical energy or moisture. The shape into which the support structure 7f can deploy is dependent in particular on the use that is intended. In the deployed form, the support structure can either bear internally on the tissue sections G.sub.1, G.sub.2 or enclose these on the outside in the area of the connection site.
(30) In the embodiment according to FIGS. 14 and 15, the support structure 7d, in an initial state, is provided as a two-part annular disk with a first ring part 17 and a second ring part 18, which are joined flat onto each other in the radial plane. The support structure 7d is also provided with a shape-change property, wherein the two parts 17 and 18, after activation, deploy into oppositely directed beaker-shaped or sleeve-shaped forms, as can be seen from FIG. 15. In their shape-changed state, the parts 17 and 18 radially enclose the outside of the tissue sections G.sub.1, G.sub.2 via their ring walls along a defined axial length, such that the support structure 7d, in addition to defining a radial surface connection to the tissue sections G.sub.1, G.sub.2 in the area of the radial connection site, also defines an external jacket along a defined axial length.
(31) In the embodiment according to FIGS. 16 and 17, the support structure 7g has a tubular configuration and radially surrounds the outside of the tissue sections G.sub.1, G.sub.2 and the head area of the tissue fusion instrument. The support structure 7g is also provided with a shape-change structure. Activated by a physical or chemical environmental parameter, in particular by temperature application, the shape-change structure is shrunk from an initial state (FIG. 16) in the connection area between the anvil part 3 and the base part 2, as a result of which an annular constriction 21 forms, which is pressed axially between the tissue sections G.sub.1, G.sub.2 when anvil part 3 and base part 2 are brought together.
