Surgical Stapling System

Abstract

A system is provided for joining two tubular structures by a surgical stapling procedure. The system includes a series of sizers, a specifically designed graft, a loading unit, a wand, a tourniquet, and a stapling instrument. The sizers are for determining the diameter of a target aorta and the availability of a sufficient transected aortic length to perform a stapling procedure. The loading unit holds the graft in position in the body and deploys a circumferential line of staples through the graft and an overlapping end of the aorta. The graft includes a side port by which the loading unit holds the graft during the stapling procedure, and which may be closed once the stapling procedure has been completed. The wand may be used to introduce the loading unit and graft into the body, to position them within the transected aorta, and to hold them in place during the application of the tourniquet. The tourniquet includes a band formed from a flexible material and having a width greater than its thickness so as to facilitate the formation of an annular loop. With the tourniquet holding the aorta and graft in relative overlapping positions, the wand may be removed from the loading unit and the stapling instrument includes a plurality of anvils, which may be closed to form a circle overlying the aorta, and a trigger mechanism for firing the staples. When fired, the staples are deployed radially outward through the graft and aorta, whereupon their free ends are bent inwardly by staple returns on the anvils. As a result, a plurality of staples may be simultaneously deployed quickly and accurately in a circumferential pattern so as to join together two tubular structures. The system may be used in either an open surgical procedure or laparascopically.

1 . A method of joining a graft and a tubular structure using surgical staples, said method comprising:
 positioning a loading unit including a circumferential line of staples and a graft removably joined with said loading unit in a body within said transected length of said tubular structure adjacent an overlapping end of said tubular structure, said loading unit including a guidewire joined with an end of said loading unit and extending from an opposite end of said loading unit, said guidewire being configured to extend out of said graft and said body;   using said guidewire, moving a stapling instrument from a first position to a second position, said stapling instrument having a plurality of anvils and a trigger mechanism for firing said staples in said loading unit when said stapling instrument is connected to said loading unit in said second position, wherein said stapling instrument is not connected to said loading unit while in said first position, said stapling instrument is exterior to said body and said loading unit is located inside said body when in said first position, and said stapling instrument is connected to said loading unit and inside said body in said second position; and   actuating said trigger mechanism thereby firing said staples radially outwardly from said loading unit and through said graft and said tubular structure, thereby causing said staples to strike said anvils and bend inwardly.   
   
   
       2 . A method according to  claim 1 , further comprising:
 determining diameters of said tubular structure and a transected length of said tubular structure.   
   
   
       3 . A method according to  claim 1 , further comprising:
 holding said graft and said overlapping end in relative overlapping positions.   
   
   
       4 . A method according to  claim 1 , further comprising:
 withdrawing said stapling unit and said loading unit through an opening in said graft and from said body; and   closing any said opening is said graft.   
   
   
       5 . A method according to  claim 1 , further comprising:
 extending retractable fingers in said loading unit to temporarily join said graft with said loading unit; and   retracting said retractable fingers in said loading unit.   
   
   
       6 . A method according to  claim 1 , wherein said stapling instrument includes means for preventing accidental actuation of said trigger mechanism and firing of said staples in said loading unit.