Temporary Fixation Tools for Use with Circular Anastomotic Staplers

Abstract

The present invention relates to circular anastomosis stapler and kits comprising reinforcing buttress materials and fixation tools that are slidably installed on the anvil shaft of such staplers which provides a temporary mechanical fixation of a reinforcing buttress to the anvil surface of a circular stapler during the insertion of the anvil into the tubular tissue. When the anvil, loaded with the buttress, is in the desired location, the fixation tool is pulled back along the anvil shaft and removed. The shaft is then connected to the stapling head and the stapling is performed. The present invention also relates to methods for using the kits and devices therein.

Claims

1. A circular stapler comprising: a) an circular anvil having flat facing surface; b) a staple head assembly with an opposing flat surface; c) an anvil shaft that joins the anvil and staple head assembly; d) buttress material positioned on a facing surface; and e) a fixation tool having at a proximal end an elongated, cylindrical sleeve with an outer circumference and at a distal end a frustoconically shaped flange, wherein an interior axial opening traverses the entire length of the sleeve and the flange, said flange terminating at the distal end with a flat face portion, said flat face portion having a diameter larger than diameter of the cylindrical sleeve and a plurality of bumps disposed on said flat face portion, said sleeve having at least one slit starting at the proximal end and extending along the sleeve towards the flange.

2. The stapler of claim 1 further comprising a plurality of circumferential grips disposed at the proximal end of said sleeve, said grips comprising raised ridges or trenches along the outer circumference of the sleeve.

3. The stapler of claim 1 wherein said fixation tool comprises at least two slits, 20 to 80 bumps, and three to eight parallel, circumferential grips.

4. The stapler of claim 1 wherein said interior axial opening of the fixation tool fits over the anvil shaft of a circular stapler.

5. The stapler of claim 1 wherein the buttress material is bioabsorbable.

6. A method of establishing an anastomotic joint between tubular tissue lumens with an anastomotic stapler comprising the steps of: a) positioning a buttress and a fixation tool on an anvil shaft for a circular stapler of claim 1; b) slidably advancing the fixation tool towards anvil on the anvil shaft; c) immobilizing the buttress against anvil with the fixation tool; d) temporarily maintaining the fixation tool in a first position on the anvil shaft; e) inserting the anvil with the buttress and the fixation tool into a first tubular tissue; f) removing the fixation tool from the first tubular tissue leaving the anvil with the buttress inside the first tubular tissue; g) approximating the anvil with the buttress disposed within the first tubular tissue to a stapling head which is disposed within a second tubular tissue; h) compressing the first and the second tubular tissues between the stapling head and the anvil with the buttress disposed between the stapling head and the anvil but within the first tubular tissue; i) firing the anastomotic stapler, thus establishing a stapled anastomotic joint between the first and the second tubular tissues reinforced by the buttress.

7. The method of claim 6 wherein the staple further comprises a plurality of circumferential grips disposed at the proximal end of said sleeve, said grips comprising raised ridges or trenches along the outer circumference of the sleeve.

8. The method of claim 6 wherein the fixation tool comprises at least two slits, 20 to 80 bumps, and three to eight parallel, circumferential grips.

9. The method of claim 6 wherein said interior axial opening of the fixation tool fits over the anvil shaft of a circular stapler.

10. The method of claim 6 wherein the buttress material is bioabsorbable.

11. The method of claim 6 wherein the flat face portion diameter is sized to be from about 80% to about 125% of diameter of the anvil.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0023] FIG. 1 shows perspective view of a surgical anastomosis stapling instrument or stapling device for performing a circular anastomosis stapling operation.

[0024] FIG. 2 shows perspective view of temporary fixation tool of the present invention.

[0025] FIG. 3 shows a schematic frontal/perspective view of temporary fixation tool of the present invention.

[0026] FIG. 4A shows perspective view of temporary fixation tool of the present invention.

[0027] FIGS. 4B and 4C show perspective view of comparative fixation devices.

[0028] FIG. 5A shows schematic cross-sectional side view of temporary fixation tool of the present invention.

[0029] FIG. 5B shows schematic cross-sectional side view of comparative fixation device.

[0030] FIG. 6A shows perspective view of a buttress.

[0031] FIGS. 6B, 6C, 6D show schematic cross-sectional side views of temporary fixation tool positioned against buttress.

[0032] FIGS. 7A-7F show the sequence of performing anastomotic joining of tubular tissue lumens in a schematic cross-sectional side view.

DETAILED DESCRIPTION OF THE INVENTION

[0033] Surgery often involves joining of two or more layers of tissue together with optional simultaneous sectioning of a portion of the tissue along the staple line. For example, colorectal surgery in many cases involves the resection of a segment of the colon and rectum. Following a colorectal resection, the colon and rectum are drawn together with a circular stapler and an end-to-end anastomosis is performed. Post-op leakage of the anastomosis has been shown to lead to morbidity and mortality.

[0034] Typical surgical stapling instruments have a staple-containing component and an opposing anvil component, between which at least two tissue layers to be joined are compressed prior to delivery of staples from the staple-containing component, whereby staples are piercing both tissue layers and are bent, deformed, or closed against the opposing anvil component.

[0035] Referring now to FIG. 1, a generic surgical anastomosis stapling instrument or stapling device for performing a circular anastomosis stapling operation is shown, with the figure taken from the U.S. Pat. No. 5,271,544 “Surgical anastomosis stapling instrument”, assigned to Ethicon, Inc., Somerville, N.J., and incorporated herein by reference in its entirety for all purposes. Various modifications and iterations of the shown stapling device are known in the art, having similar features. The circular anastomosis surgical stapling instrument 500 includes a distal stapling head assembly 600 connected by a longitudinally curved support shaft assembly 700 to a proximal actuator handle assembly 800. The stapling instrument includes an anvil assembly or anvil 1000 which is slidable longitudinally relative to the stapling head assembly 600 and mounted on an axially extending moveable shaft 1040. An optional rotatable adjusting knob 820 is provided at the proximal end of the actuator handle assembly 800 for adjusting the spacing between the stapling head assembly 600 and the anvil assembly 1000. An optional movable indicator 840 is visible through an optional window 850 on top of the handle assembly 800 to indicate the staple height selected by rotation of the adjusting knob 820. The indicator 840 is movable indicating that the anvil gap is within a desired operating range of the stapling instrument 500. The position of the indicator 840 also indicates whether the selected staple height is large or small.

[0036] A staple actuating lever 860 is pivotally mounted on the actuator handle assembly 800 for driving the surgical staples from the stapling head assembly 600 when the anvil assembly 1000 is closed to provide the desired staple height. A pivotal latching member 880 is mounted on the handle assembly 800 for locking the staple actuating lever 860 against movement to preclude actuation of the stapling head assembly 600 when the anvil gap is outside of a predetermined range. The stapling head assembly 600 includes a tubular casing 610 as well as a hollow tubular connector 640 at the proximal end of the casing 610 which receives the distal end of the support shaft 700. A ferrule or sleeve 720 overlaps the joint between the tubular connector 640 and the distal end of the support shaft 700. The proximal end of the support shaft 700 is received by a tubular extension 740 at the distal end of the actuator handle assembly 800. A ferrule or sleeve 760 overlaps the joint between the proximal end of the support shaft 700 and the distal end of the tubular extension 740. The movable indicator 840 is visible through a window 850 on top of the handle assembly 800 to indicate the staple height selected by rotation of the adjusting knob 820.

[0037] Other versions and modifications of the circular surgical stapler are known to a skilled artisan. There are typically at least two and frequently more concentric stapling lines or concentric circular rows of staples-containing slots surrounding shaft 1040, with staples in each row typically staggered or offset relative to the staples in the adjacent row, to improve the sealing and prevent leakage along the stapling line.

[0038] The anastomosis can be performed by a variety of techniques known in the art. In one exemplary technique, low anastomosis of colon to rectum using the anastomotic stapler is performed. Briefly, after stapler 500 is inserted through the anus, the descending colon is fixated around anvil 1000, with purse string sutures tied around the shaft and the rectal stump is fixated around stapling head 600 with purse string sutures also tied around the shaft. Anvil 1000 is then pulled towards stapling head 600 and then the staples are deployed to join the tissue of the descending colon and rectal stump at their respective serosal surfaces, with simultaneous action of circular knife or scalpel (not shown) within the stapler 500 cutting away excessive tissue (inverted bowel) closest to shaft 1040, resulting in anastomosis. Stapler 500 is then removed.

[0039] A temporary fixation tool 10 for positioning annular structure such as a buttress for use with circular anastomotic staplers is shown in FIGS. 2 and 4A, in a perspective view, in FIG. 3 in frontal/perspective view, and in FIG. 5A in a schematic side cross-sectional view. Fixation tool 10 comprises an elongated sleeve 20 with a conically shaped flange 50 at a distal end 22. An axial opening 100 traverses sleeve 20 and flange 50 and is sized to slidably fit over the shaft of the circular stapler.

[0040] Flange 50 terminates with a flat face portion 60 at distal end 22, with flat face 60 having diameter larger than diameter of sleeve 20 and close to the diameter of stapler anvil 1000 (FIG. 1). Flat face 60 has a plurality of bumps or protrusions 70 with at least 2 bumps more preferably 8 bumps or as many as 200 or up to 1000 bumps 70, such as 20, 30, 40, 60, 80 bumps 70.

[0041] Sleeve 20 at a proximal end 21 has optional grips 40, comprising a plurality of raised circumferential ridges 40 or a plurality of circumferential trenches (not shown). In some embodiments, there are 3, 4, or 5 ridges 40. Sleeve 20 has at least one, preferably two or more slits or cuts 30, starting at proximal end 21 and extending through sleeve 20 towards flange 50, but terminating before flange 50. Two slits 30 opposing each other are shown, but 3, 4, 5, 6 or more slits 30 symmetrically disposed on sleeve 20 are contemplated. Slits 30 are sized to enable manual compressing sleeve 20 once fixation tool 10 installed onto anvil shaft 1040 for immobilizing fixation tool 10 on anvil 1000.

[0042] Fixation tool 10 is preferably monolithically formed, alternatively it can be assembled by joining flange 50 with sleeve 20. Fixation tool 10 can be made of any suitable inert material, such as polymeric materials, composites, metals, etc., and can be fabricated by injection molding, machining, stamping and the like.

[0043] The external diameter of sleeve 20 (not including ridges 40 or trenches) is about 10-100% larger than the diameter of anvil shaft 1040. In some embodiments, the external diameter of sleeve 20 is from about 5 mm to about 10 mm, such as 8 mm.

[0044] The length of sleeve 20 is from about 15 mm, to about 60 mm, such as 20 mm, 30 mm, 40 mm.

[0045] The diameter of axial opening 100 is sized to slidably fit over the shaft 1040 of the circular stapler, with the diameter of axial opening 100 being from 1% to 10% or 20% larger relative to the diameter of anvil shaft 1040. In some embodiments, the diameter of axial opening 100 is from about 4 mm to about 10 mm, such as 7 mm.

[0046] The diameter of flat face 60 is sized to be similar to the largest diameter of anvil 1000, i. e. from about 80% to about 125% of the largest diameter of anvil 1000, such as 90%, 100%, 110% of the largest diameter of anvil 1000. In some embodiments, the diameter of flat face 60 is 20 mm, 22 mm, 25 mm, 30 mm.

[0047] Bumps of protrusions 70 are generally spherical or semi-spherical, or elliptical, with a height from about 0. 5 mm to about 4 mm, such as 1 mm, 1. 5 mm 2 mm, 3 mm. As shown in the hemispherical embodiment, the height is approximately one half the diameter of the hemisphere.

[0048] In some embodiments grips 40 are raised circumferential ridges having semispherical cross-section of 1 to 2 mm diameter, such as 1.6 mm diameter.

[0049] Slits 30 are about 0.1 mm to about 1 mm wide, such as 0.5 mm or 0.8 mm wide, and have length from about 50% of the length of sleeve 20 to about 100% of the length of sleeve 20, such as 80% or 90%. In some embodiments, slits 30 are 18 mm, 25 mm or 30 mm long.

[0050] Conically shaped flange 50 formed by transition from larger diameter flat face 60 to smaller diameter sleeve 20, with cone angle 25 ranging from about 25 degrees to about 65 degrees, such as 30, 45, 60 degrees cone angle 25. The overall length of fixation tool 10 is about 25-50 mm, such as 30 mm.

[0051] Referring now to FIGS. 4A, 4B, 4C, inventive fixation tool 10 was comparatively tested versus alternative embodiments such as device 11 having trenches 75 in flat face 60 (FIG. 4B), or device 12 having no features in flat face 60 (FIG. 4C). The inventors discovered that the comparative devices failed to secure buttress or separate from the buttress in the animal testing of GI circular anastomosis, while the inventive fixation tool 10 having 10 arrays of 4 semispherical bumps as shown, performed well.

[0052] Referring now to FIGS. 5A, 5B, inventive fixation tool 10 was comparatively tested versus alternative embodiments such as device 13 (FIG. 5B), having the overall structure and the same bumps 70 but having flange 55 that is not a conically shaped flange as flange 50 of inventive fixation tool 10. The inventors discovered that comparative device 13 failed to adequately secure buttress or separate from the buttress in the animal testing of GI circular anastomosis, while inventive fixation tool 10 having conically shaped flange 50, performed well.

[0053] Referring now to FIGS. 6A-6D, fixation tool 10 is shown with annular structure such as a buttress 250, whereby: FIG. 6A shows annular structure or buttress 250, generally O-ring shaped in a perspective view; FIG. 6B shows schematic cross-sectional view of fixation tool 10 against buttress 250 with the diameter of flat face 60 being substantially equivalent to the diameter of buttress 250; FIG. 6C shows schematic cross-sectional view of fixation tool 10 against buttress 250 with the diameter of flat face 60 being smaller than the diameter of buttress 250, such as 10-25% smaller; FIG. 6D shows schematic cross-sectional view of fixation tool 10 against buttress 250 with the diameter of flat face 60 being larger than the diameter of buttress 250, such as 10-25% larger.

[0054] Referring now to FIGS. 7A-7F, the sequence of steps using fixation tool 10 during anastomotic stapling of tissue is illustrated in schematic cross-sectional views. FIG. 7A shows buttress 250 installed over shaft 1040 in proximity to anvil 1000, with fixation tool 10 slidably positioned over shaft 1040 with flange 50 facing towards anvil 1000. Arrow A indicates direction of moving fixation tool 10.

[0055] FIG. 7B shows buttress 250 fixated and immobilized against anvil 1000 by fixation tool 10 which holds buttress 250 against anvil 1000. Arrows B indicates direction of compressing or squeezing sleeve 20 to immobilize fixation tool 10 on shaft 1040.

[0056] FIG. 7C shows insertion of anvil 1000 with buttress 250 fixated and immobilized against anvil 1000 by fixation tool 10 into tubular tissue T1, typically intestinal or colon tissue. T1 can have a purse string (not shown), which is used to partially approximate close tubular tissue around shaft 1040.

[0057] Fixation tool 10 is then carefully slidably removed from tubular tissue T1 along shaft 1040, leaving anvil 1000 and buttress 250 within tubular tissue T1, as shown in FIG. 7D.

[0058] Purse string (not shown) is then tightened resulting in closing of tubular tissue T1 around shaft 1040 and covering anvil 1000 and buttress 250. Shaft 1040 is then inserted into stapling head 600 which is disposed within tubular tissue T2.

[0059] As shown in FIG. 7E, anvil 1000 with buttress 250 disposed within tubular tissue T1 and into stapling head 600 which is disposed within tubular tissue T2 are then approximated to each other, compressing tissue T1 and T2 between them,

[0060] FIG. 7F shows staples 320 fired and anastomotic stapler removed, thus establishing anastomotic joint reinforced by buttress 250.

[0061] In operation, as shown above, a health practitioner performs the following steps: [0062] Positioning a buttress 250 and fixation tool 10 on anvil shaft 1040; [0063] Slidably advancing fixation tool 10 towards anvil 1000 on anvil shaft 1040; [0064] Immobilizing buttress 250 against anvil 1000 with fixation tool 10; [0065] Manually squeezing sleeve 20 to hold or temporarily lock fixation tool 10 on anvil shaft 1040; [0066] Inserting anvil 1000 with buttress 250 and fixation tool 10 into tubular tissue T1; [0067] Removing fixation tool 10 from tubular tissue T1 leaving anvil 1000 with buttress 250 inside tubular tissue T1; [0068] Approximating anvil 1000 with buttress 250 disposed within tubular tissue T1 and stapling head 600 which is disposed within tubular tissue T2; [0069] Compressing tissue T1 and T2 between stapling head 600 and anvil 1000 with buttress 250 disposed between stapling head 600 and anvil 1000 but within tissue T1; [0070] Firing anastomotic stapler, thus establishing anastomotic joint between tissues T1 and T2 reinforced by buttress 250.

[0071] Advantageously, as can be seen from FIG. 7F, buttress 250 is disposed within tissue T1 after the stapling.

[0072] While the invention has been described above with reference to specific embodiments thereof, it is apparent that many changes, modifications, and variations can be made without departing from the inventive concept disclosed herein. Accordingly, it is intended to embrace all such changes, modifications, and variations that fall within the spirit and broad scope of the appended claims. All patent applications, patents, and other publications cited herein are incorporated by reference in their entirety.