Anastomosis instrument and method for performing same

Abstract

A surgical instrument for anastomosis of first and second blood vessels includes a housing having distal and proximal ends, a handle and a disposable loading unit removably mounted to the distal end of the housing. The loading unit includes upper and lower fastener support members having a passage defined therethrough for receiving an end of the second blood vessel and configured to releasably support a plurality of surgical fasteners. The loading unit also includes a retractable anvil located at a distal end of the loading unit, the anvil being movable relative to the fastener support member in response to actuation of the handle to simultaneously deform the of surgical fasteners.

What is claimed is:  
     
         1 . A surgical instrument for anastomosis of first and second blood vessels, comprising: 
 a housing having distal and proximal ends and a handle; 
 a disposable loading unit removably mounted to the distal end of the housing having:  
 upper and lower fastener support members having a passage defined therethrough for receiving an end of the second blood vessel and configured to releasably support a plurality of surgical fasteners; and  
 a retractable anvil located at a distal end of the loading unit, the anvil being movable relative to the fastener support member in response to actuation of the handle to simultaneously deform the surgical fasteners.  
   
     
     
         2 . A surgical instrument according to  claim 1  wherein the loading unit further comprises a first retracting sleeve which moves the anvil in response to actuation of the handle.  
     
     
         3 . A surgical instrument according to  claim 1  wherein the fastener support member supports the fasteners in an array-like manner.  
     
     
         4 . The surgical instrument according to  claim 1  wherein the distal end of the first sleeve includes a plurality of elongated channels for supporting the surgical fasteners.  
     
     
         5 . The surgical instrument according to  claim 4  wherein each of the channels includes a distal and proximal end wherein each distal end is radially offset from the proximal end such that the proximal and distal ends of the surgical fasteners are supported in a radially offset manner.  
     
     
         6 . A surgical instrument according to  claim 1  wherein the anvil has an angled surface such that the distal ends of the surgical fasteners deform proximally upon actuation of the handle.  
     
     
         7 . A surgical instrument according to  claim 4  further comprising a second retracting sleeve for releasably retaining the surgical fasteners within the elongated channels of the first retracting sleeve.  
     
     
         8 . A surgical instrument according to  claim 1  wherein the loading unit further comprises second retracting sleeve which is movable in response to actuation of the handle.  
     
     
         9 . A surgical instrument according to  claim 8  wherein continued movement of the handle moves the second retracting sleeve relative to the first retracting sleeve.  
     
     
         10 . A surgical instrument according to  claim 9  wherein movement of the second retracting sleeve relative to the first retracting sleeve releases the surgical fasteners.  
     
     
         11 . A surgical instrument according to  claim 8  wherein the second retracting sleeve includes a plurality of fingers for releasably retaining the surgical fasteners against the anvil.  
     
     
         12 . A surgical instrument according to  claim 1  further comprising an actuator which moves the first and second retracting sleeves in response to movement of the handle.  
     
     
         13 . A surgical instrument according to  claim 12  wherein the actuator includes a cam.  
     
     
         14 . A surgical instrument according to  claim 13  wherein the cam includes more than one cam follower.  
     
     
         15 . A surgical instrument according to  claim 13  wherein the cam includes multiple stages.  
     
     
         16 . A surgical instrument for anastomosis of first and second blood vessels, comprising: 
 a housing having distal and proximal ends; 
 a loading unit having: 
 a fastener support member for supporting a plurality of surgical fasteners;  
 first and second retracting sleeves which are movable relative to the fastener support member from a first position wherein the distal ends of the retracting sleeves are disposed relative to the fastener support member to a second position wherein the distal ends of the retracting sleeves are disposed in closer proximity to the fastener support member, and  
 
 an actuator for moving the first and second sleeves relative to the fastener  13  support member.  
   
     
     
         17 . The surgical instrument according to  claim 16  wherein the actuator includes a handle.  
     
     
         18 . The surgical instrument according to  claim 16  wherein the loading unit is comprised of two halves which are pivotable relative to one another.  
     
     
         19 . The surgical instrument according to  claim 18  wherein the two halves of the loading unit when closed form an elongated aperture for receiving the second vessel therethrough.  
     
     
         20 . The surgical instrument according to  claim 16  wherein the distal end of the first sleeve includes a plurality of elongated channels for supporting the surgical fasteners.  
     
     
         21 . The surgical instrument according to  claim 20  wherein each elongated channel includes a distal and proximal end wherein each distal end is radially offset from the proximal end.  
     
     
         22 . The surgical instrument according to  claim 16  wherein the fastener support supports the surgical fasteners in an array-like manner.  
     
     
         23 . The surgical instrument according to  claim 20  wherein the second sleeve includes a plurality of resilient fingers which releasably secure the surgical fasteners within the elongated channels.  
     
     
         24 . The surgical instrument according to  claim 16  wherein continued movement of the actuator moves the second sleeve relative to the first sleeve.  
     
     
         25 . The surgical instrument according to  claim 16  wherein the actuator includes a cam.  
     
     
         26 . The surgical instrument according to  claim 16  wherein the actuator includes a multi-staged cam.  
     
     
         27 . The surgical instrument according to  claim 26  wherein a first stage of the multi-staged cam imparts movement to both the first and second sleeves and a second stage of the multi-staged cam imparts movement to the second sleeve relative to the first sleeve.  
     
     
         28 . The surgical instrument according to  claim 16  wherein the actuator includes at least one spring.  
     
     
         29 . The surgical instrument according to  claim 16  further comprising a locking mechanism which locks the actuator to the housing after the instrument is fired.  
     
     
         30 . The surgical instrument according to  claim 16  wherein the loading unit is releasably mounted to the housing.  
     
     
         31 . The surgical instrument according to  claim 16  wherein the instrument further comprises a locking tab for selectively mounting the loading unit to the housing.  
     
     
         32 . The surgical instrument according to  claim 31  wherein the locking tab is movable from a first position which enables the loading unit to be mounted to the housing to a second position which secures the loading unit to the housing.  
     
     
         33 . The surgical instrument according to  claim 16  wherein the loading unit is disposable.  
     
     
         34 . The surgical instrument according to  claim 16  wherein the distal end of the first sleeve includes an anvil for retaining the distal ends of the surgical fasteners and for supporting an everted end of the second vessel.  
     
     
         35 . The surgical instrument according to  claim 34  wherein the anvil includes an angled surface which causes the distal end of the surgical fasteners to deform proximally during firing.  
     
     
         36 . A surgical instrument for anastomosis of first and second blood vessels, comprising: 
 a housing having distal and proximal ends; 
 a loading unit having:  
 upper and lower fastener support members for supporting a proximal end of a plurality of surgical fasteners in an array-like manner;  
 first and second retracting sleeves disposed between the upper and lower fastener support members, the retracting sleeves being movable relative to the fastener support members from a first position wherein the distal ends of the sleeves are disposed relative to the fastener support member to a second position wherein the distal ends of the sleeves are disposed in closer proximity to the fastener support members;  
 an actuator for moving the first and second sleeves relative to the fastener support member.  
   
     
     
         37 . The surgical instrument according to  claim 36  wherein the second sleeve is movable relative to the first sleeve  
     
     
         38 . The surgical instrument according to  claim 37  wherein continued movement of the actuator moves the second sleeve relative to the first sleeve.  
     
     
         39 . The surgical instrument according to  claim 38  wherein the housing includes a second key-like arm for moving the second sleeve relative to the first sleeve.  
     
     
         40 . The surgical instrument according to  claim 36  wherein the first sleeve includes a base and a sleeve cap, the sleeve cap being selectively pivotable relative to the base.  
     
     
         41 . The surgical instrument according to  claim 36  wherein the second sleeve includes upper and lower cuffs, the upper cuff being disposed between the upper fastener support and the first retracting sleeve and the lower cuff being disposed between the lower fastener support and the first retracting sleeve.  
     
     
         42 . The surgical instrument according to  claim 36  wherein each of the fastener support members includes a plurality of radially inscribed channels for supporting the proximal end of the surgical fasteners.  
     
     
         43 . The surgical instrument according to  claim 36  wherein the distal end of the first retracting sleeve includes a plurality of elongated channels for supporting the surgical fasteners.  
     
     
         44 . The surgical instrument according to  claim 43  wherein each elongated channel includes a distal and proximal end wherein the distal end is radially offset from the proximal end.  
     
     
         45 . The surgical instrument according to  claim 43  wherein the second retracting sleeve includes a plurality of resilient fingers which releasably secure the surgical fasteners within the elongated channels of the first retracting sleeve.  
     
     
         46 . The surgical instrument according to  claim 36  wherein the loading unit further comprises a post which upon movement of the actuator bias the first and second retracting sleeves relative to the fastener support members.  
     
     
         47 . The surgical instrument according to  claim 46  wherein the post further comprises a spacer for locking the first retracting sleeve relative to the fastener support members to permit subsequent movement of the second retracting sleeve relative to the first retracting sleeve upon continued movement of the actuator.  
     
     
         48 . The surgical instrument according to  claim 36  wherein the loading unit is comprised two halves which are pivotable relative to one another.  
     
     
         49 . The surgical instrument according to  claim 48  wherein the two halves of the loading unit when closed form an elongated aperture for receiving the second vessel therethrough.  
     
     
         50 . The surgical instrument according to  claim 49  wherein prior to actuation of the handle, the two halves of the loading unit are pivotally secured relative to one another and upon actuation of the handle, the two halves are unsecured allowing the halves to pivot relative to one another to release the second vessel from within the aperture.  
     
     
         51 . The surgical instrument according to  claim 36  wherein the second retracting sleeve includes a plurality of resilient fingers which releasably secure the surgical fasteners within the elongated channels of the first retracting sleeve.  
     
     
         52 . The surgical instrument according to  claim 36  wherein the surgical fasteners are supported normally relative to a longitudinal axis extending through the loading unit.  
     
     
         53 . The surgical instrument according to  claim 36  wherein the surgical fasteners are supported in an angular manner relative to a longitudinal axis extending through the loading unit.