JPH114832A - Auxiliary device for automatic digestive tract anastomosis device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an auxiliary device of an automatic digestive tract anastomosis apparatus capable of increasing an anastomotic diameter by side-to-end anastomosis of a digestive tract. SOLUTION: This is an auxiliary tool for an automatic digestive tract anastomosis apparatus, comprising: a main body for anastomosis between a cut end section of the digestive tract and a side wall of the digestive tract; and an auxiliary tool detachably attached to the main body. The auxiliary tool is a flat disk-shaped anvil 1
And an anvil 1 has a connecting portion 3 for mounting a detachable shaft 2 at a central portion.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an auxiliary device for an automatic digestive tract anastomosis apparatus. More specifically, the present invention relates to an auxiliary device for an automatic digestive tract anastomosis apparatus used for anastomosis of a stump of a digestive tract such as an intestinal tract cut by a surgical operation.

[0002]

2. Description of the Related Art Conventionally, a gastrointestinal tract automatic anastomosis apparatus used for so-called inversion anastomosis in which a stump of a gastrointestinal tract is squeezed inward in an axial direction of the gastrointestinal tract and anastomized is shown in FIG. As described above, there is a main body 53 having the operation part 50 and the compression receiving part 52 connected to the operation part 50 via the outer cylinder 51, and an auxiliary tool 54 detachably attached to the main body 53. The operation unit 50 is
A feed nut 56 for expanding and contracting a shaft 55 inserted into the outer cylinder 51 and the compression receiving portion 52;
2 and a handle 57 for projecting a staple and a cutter. On the other hand, the assisting tool 54 includes an anvil 58 having a triangular pyramid shape, and a rod 59 crimped to the anvil 58.
The auxiliary tool 54 is attached to the shaft 55 by press-fitting or a screw structure. For example, in the case of press-fitting, a conical engagement notch formed at the end of the rod 59 is formed in the end of the shaft 55. The conical shape is opposite to the conical shape, and is attached to an engagement notch that can be expanded in diameter.

[0003] The anastomosis by such an anastomosis apparatus is end-to-end anastomosis. First, an affected part such as a cancer part is excised from the intestinal tract, and then an anvil 58 of the anastomosis apparatus is inserted into a patient's external anus, and the anvil 58 is attached to the anvil. Insert up to the resection. Then
As shown in FIG. 13, the stump of the intestinal tract is tied to the rod 59 so as to surround the anvil 58, and the stump of the other intestine is tied to the shaft 55. Next, as shown in FIGS. 12 to 14, the intestinal wall is compressed and adhered by feeding two intestinal tracts and turning the nut 56. Then, the handle 57 is squeezed as much as possible, and an anastomosis is performed through the intestinal wall turned inward by a stapler arranged in a ring shape in the compression receiving portion 52.
At this time, an extra lumen of the intestinal wall is cut off by a cutter, leaving an anastomotic portion by the stapler.

[0004]

However, in the anastomosis using such an anastomosis device, the anastomotic digestive tract diameter is smaller than the original digestive tract diameter, and the diameter of the stapler array can be the outermost of the compression receiving portion. Absent. From this point, the diameter of the anastomotic intestinal tract is further reduced. As shown in FIG. 15, in such an anastomosis apparatus, when an anastomosis of digestive tracts having different diameters, for example, when an anastomosis is performed on a colon S1 having a diameter of 2r and a rectum S2 having a diameter of 2R, the outer diameter of the compression receiving portion to which the gastrointestinal tract is adapted. The intestinal tract after anastomosis is smaller than the smaller GI tract because it must be adjusted to the smaller one.

On the other hand, in the anastomosis, the side-to-end anastomosis of the digestive tract is an established technique, and a side-to-end anastomosis of an anastomosis apparatus for performing anastomosis with a needle instead of a stapler is also performed. For example, first, the anastomotic device body with the auxiliary tool removed is inserted from the stump of the colon, and then the cylinder is passed through a hole formed in the side wall with a scalpel, and then the side wall of the colon is sutured. Then, an auxiliary tool is attached to the cylinder. Next, the anvil of the assisting device is inserted into the stump of the other ileum, and after suturing, the feed nut and the handle are operated to anastomose the outer peripheral portions of the intestinal walls to be anastomosed.

However, as a practical problem, the anastomotic diameter of the rectum when the anastomotic apparatus is used is such that even when an anvil having an outer diameter of 33 mm is used, the anastomotic diameter is such that a finger can pass. Therefore, in rectal anastomosis and esophagus, gastric anastomosis may cause postoperative stenosis and obstruction of intestinal contents,
There is a keen need for a wider anastomosis.

[0007] As described above, in the conventional anastomosis assisting device, the diameter of the anvil entering the small digestive tract is the maximum usable diameter, and the wider digestive tract side is left behind during the anastomosis. In addition, when performing side-to-end anastomosis in the middle of a long gastrointestinal tract, there is a problem that the auxiliary tool of the conventional anastomosis apparatus cannot be used.

In view of the above circumstances, an object of the present invention is to provide an auxiliary device for an automatic gastrointestinal anastomosis apparatus capable of increasing the anastomotic diameter by side-to-end anastomosis of the gastrointestinal tract.

[0009]

According to the present invention, there is provided an automatic digestive tract anastomosis apparatus according to the present invention, wherein a main body for anastomosing a cross section of an end of a digested tract and a side wall of the digestive tract and an auxiliary tool detachably attached to the main body. An auxiliary tool for a gastrointestinal automatic anastomosis apparatus comprising: a flat disc-shaped anvil; and a connecting portion for attaching the detachable shaft to the center of the anvil. Further, a stapler pressing mark is engraved on a peripheral portion of the inner surface on the mounting side of the shaft body.

[0010]

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view of a gastrointestinal tract automatic anastomosis apparatus according to the present invention.

FIG. 1 is a perspective view showing an embodiment of the assisting device of the automatic digestive tract anastomosis apparatus of the present invention, FIG. 2 is a front view of the anvil in FIG. 1, FIG. 3 is a bottom view of the anvil in FIG. 4 is an enlarged sectional view showing a connecting portion of the anvil in FIG. 1, FIG. 5 is an explanatory view showing an example of use of the assisting device, FIG. 6 is a sectional view of the digestive tract, and FIG. 8 is an explanatory view showing an anastomotic state, and FIGS. 9 to 11 are explanatory views showing another example of use of the assisting device.

As shown in FIGS. 1 to 4, the assisting device is detachably attached to the main body of the automatic digestive tract anastomosis apparatus, and includes an anvil 1 and a rod-shaped shaft 2 detachable from the anvil 1. It is composed of As shown in FIG. 12, for example, the main body of the gastrointestinal tract automatic anastomosis apparatus includes a shaft 55, a compression receiving portion 52 having a staple and a cutter therein, a feed nut 56 for expanding and contracting the shaft 55 at a base end, and the staples. An operation unit 50 provided with a handle 57 for projecting the cutter, and a compression receiving unit 5
2 and an outer cylinder 51 connecting the operation unit 50.

The anvil 1 of the auxiliary tool has a flat disk shape, and has a connecting portion 3 for mounting the shaft 2 at a central portion, and a flat inner surface on the mounting side of the shaft 2. At a peripheral portion (inside of the outer edge) of the stapler 4, there are stapler pressing traces 5 carved so as to be arranged in two rows in a staggered state, for example. The center of the anvil 1 has a sufficient height (thickness) H for coupling with the shaft 2, and the periphery has a rounded portion so as not to damage the digestive tract. .
For example, it is preferable that the aspect ratio% expressed by the ratio of H to the diameter D of the anvil 1 is 2 to 50%.

As a material of the anvil 1, a synthetic resin such as polyethylene terephthalate, polycarbonate, polystyrene and polypropylene, a metal such as stainless steel and titanium, or a composite material of the synthetic resin and the metal can be used. Such a composite material is, for example, formed by mixing a metal powder or a metal piece with a synthetic resin, or by molding a metal surface with a synthetic resin.

The connecting portion 3 is formed of a cylindrical opening opening on the inner surface 4. On the inner wall of this opening,
A female screw 6 is formed as coupling means for mounting the shaft 2, and a conical bearing portion 7 is provided on the inner side of the inner wall.
Are formed.

On the other hand, at one end of the shaft body 2, there is formed a distal end portion 8 corresponding to the conical shape of the bearing portion 7 and a male screw 9 which is a first coupling portion to be screwed to the screw 6. Have been. At the other end, a notch portion 10 or a screw portion which is a second coupling portion for attaching to a shaft of a conventional main body is formed. The shaft 2 is short, for example, 3 to 4 cm long and can be attached to and detached from the shaft of the main body, so that the work of attaching and detaching the disc-shaped anvil 1 and the shaft 2 is easy. And can be easily worn at any site in the abdominal cavity.

In this embodiment, it is preferable to form a thin closing piece 11 at the upper end of the opening. By forming the closing piece 11, the shaft 2 is connected to the anvil 1.
When the screw is screwed into the opening, the tip 8 finally penetrates the thin closing piece 11, so that the sound generated at this time can confirm that the shaft 2 is securely fixed to the anvil 1.

In the present embodiment, the connection between the anvil and the shaft body is fixed by a screw structure. However, the present invention is not particularly limited to this, and it is sufficient that the anvil and the shaft can withstand pressure during anastomosis. Any structure can be used as long as the shaft can be fixed at a position that matches the strength of the stapler and the compression mark for the stapler.
For example, the shaft body can be inserted and fixed (press-fitting) into the opening by inserting a wedge or the like, or can be fixed by a stopper as in the case of the notch.

Next, an example of use of the assisting device in the present embodiment will be described. In general, intestinal anastomosis is often performed on a small-bore intestine and a large-bore intestine, as shown in FIG.
A flat anvil 1 adapted to the large intestinal diameter is placed in the small intestinal lumen. Next, after a hole 12 is made in the intestinal wall of the anastomosis portion, the shaft 2 is fixed to the anvil 1 from outside the digestive tract wall.

On the other hand, after inserting the pressure receiving portion 13 of the main body having a diameter substantially equivalent to the diameter of the large intestine into the large intestine, the cut end of the digestive tract is sutured around the shaft 14 by a conventional method. I do. Then, the shaft 2 on the side of the anvil 1 is attached to the shaft 14, and an anastomosis is performed in the conventional manner. As shown in FIG. 8, the small-bore intestinal tract having the open end A is closed at the stump with an automatic suturing device, and the large-bore anastomosis is completed.

In the use of side-to-end anastomosis in the upper gastrointestinal tract, such as the small intestine, the anvil 1 is moved alone into the long gastrointestinal tract and guided to the anastomotic site, as shown in FIG. After the shaft 2 is inserted from the intestinal wall of the digestive tract at the site, and then attached and fixed to the anvil 1,
A normal anastomosis operation can be performed.

In the conventional anastomosis apparatus, when the stump of the digestive tract having a radius r is anastomosed, the anastomosis diameter becomes smaller than r. On the other hand, when the opposite walls of the circular digestive tract S are combined as shown in FIGS. 6 and 7, the width becomes approximately πr. Therefore, by inserting a thin disk-shaped anvil into the digestive tract in this state,
Since a disk having a diameter of πr is theoretically inserted, in this embodiment, a radius of 1 mm is inserted into the digestive tract as shown in FIG.
When an anastomosis with an anvil 1 having a diameter of / 2πr is anastomosed by a shaft and a main body attached from the outside of the intestinal wall, an anastomosis diameter smaller than a radius r or less can be obtained by the conventional method.
The radius becomes πr, and a theoretically maximum anastomosis diameter of about 1.57 times can be obtained.

Therefore, in the case of anastomosis of different digestive tracts having a caliber of about 1.57 times or less, if the side-to-end anastomosis is used as in the present embodiment, it is necessary to adjust to the smaller intestinal tract diameter. The missing anastomosis diameter can be anastomosed with the large intestinal anastomosis diameter.

Alternatively, the anvil 1 can be placed alone in the long digestive tract, moved to a site for anastomosis, and a side-to-end anastomosis can be performed at that site.

Next, another example of use of the assisting device according to the present embodiment will be described.

In intestinal resection using an abdominal cavity, when an anastomotic device is used for intestinal anastomosis, the operation is performed in the abdominal cavity. In this case, intraperitoneal contamination from the opened intestinal tract becomes a serious problem. However, when the flat anvil according to the present embodiment is used, taking an anastomosis from the anus as an example, as shown in FIG.
The intestinal stump will not be opened in the abdominal cavity if the anvil 1 is indwelled on the mouth side from 1 and the resection B1 on the mouth side is closed in a temporary sewing state with an automatic suturing machine and then cut off. After that, the intestine is cut at the resection part B2 on the anal side of the affected part B. In this case, if you close it with an automatic suture machine and cut it,
The resected intestinal tract can be resected with both the oral and anal sides closed. As a result, the stump of the intestinal tract and the stump of the anal tract are closed. Next, as shown in FIG. 10, the shaft 2 is passed through the intestinal wall through the flat anvil 1 on the mouth side.
Attach. On the other hand, on the anal side, as shown in FIGS. 10 to 11, the shaft 14 of the main body is protruded from the intestinal wall near the suture portion of the closed intestinal tract, is joined to the shaft body 2 of the oral intestinal tract, and Completes the side-to-end anastomosis. Next, after removing the shaft body 2 from the anvil 1, the cut portion B1 in the temporary stitching state is unwound, the anvil 1 is taken out, and the cut portion B1 is again put in the final stitching state. In a series of actions, there is no operation to stitch and fix the intestinal tract to the shaft, and the digestive tract is not left open in the abdominal cavity, so there is no risk of intraperitoneal contamination.

[0027]

As described above, according to the present invention,
Since a flat anvil is used during the digestive tract anastomosis, a digestive tract anastomosis having the same anastomotic diameter as the larger intestinal tract can be obtained in the side-to-end anastomosis in the digestive tract anastomosis having different calibers. In addition, the side-to-end anastomosis of the digestive tract can be performed even in the region having the same digestive tract diameter.
Further, in an operation under an abdominal endoscope, automatic anastomosis can be performed without leaving the resected intestinal tract open in the abdominal cavity.

[Brief description of the drawings]

FIG. 1 is a perspective view showing one embodiment of an assisting device of the automatic digestive tract anastomosis device of the present invention.

FIG. 2 is a front view of the anvil in FIG. 1;

FIG. 3 is a bottom view of the anvil in FIG. 1;

FIG. 4 is an enlarged sectional view showing a connecting portion of an anvil in FIG. 1;

FIG. 5 is an explanatory diagram showing a usage example of an assisting tool.

FIG. 6 is a sectional view of a digestive tract.

FIG. 7 is an explanatory view showing a state where the opposite walls of the digestive tract in FIG. 6 are flattened together.

FIG. 8 is an explanatory diagram showing an anastomotic state.

FIG. 9 is an explanatory diagram showing another usage example of the assisting device.

FIG. 10 is an explanatory diagram showing another usage example of the assisting device.

FIG. 11 is an explanatory diagram showing another usage example of the assisting device.

FIG. 12 is a front view showing an example of a conventional automatic digestive tract anastomosis apparatus.

FIG. 13 is an explanatory diagram showing how to use the automatic digestive tract anastomosis device in FIG.

14 is an explanatory view showing how to use the automatic digestive tract anastomosis apparatus in FIG.

FIG. 15 is an explanatory view showing another method of using the automatic digestive tract anastomosis apparatus in FIG.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Anvil 2 Shaft 3 Connecting part 4 Inner surface 5 Mark for stapler compression 6 Female screw 7 Bearing part 8 Tip part 9 Male screw 10 Notch part 11 Closure piece 12 Hole 13 Compression receiving part 14 Shaft

Claims (4)

[Claims] 1. An assisting device for an automatic digestive tract anastomosis apparatus comprising: a main body for anastomosis between a cut end section of a digestive tract and a side wall of the digestive tract; and an auxiliary device detachably attached to the main body. And the auxiliary tool has a flat disk-shaped anvil,
An auxiliary tool for an automatic gastrointestinal anastomosis apparatus, wherein the anvil has a connecting portion for mounting a detachable shaft body at a central portion. 2. The assisting device for an automatic anastomotic gastrointestinal anastomosis apparatus according to claim 1, wherein the anvil has a stapler pressing mark engraved on a peripheral portion of an inner surface on a mounting side of the shaft. 3. The assisting device for an automatic gastrointestinal anastomosis apparatus according to claim 1, wherein said connecting portion comprises a connecting means for mounting said shaft body and a conical bearing portion. 4. The assisting device for an automatic gastrointestinal anastomosis apparatus according to claim 1, wherein a thin closing piece is formed at an upper end of the connecting portion.