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1. (WO1997016122) METHOD AND ANASTOMOTIC INSTRUMENT FOR USE WHEN PERFORMING AN END-TO-SIDE ANASTOMOSIS
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CLAIMS
1. Method of connecting an end region (10) of a first vessel (9) to the side of a second vessel (11) by carrying out an end-to-side anastomosis, said method being of the kind comprising the following steps a-d:
a) forming an opening in the side of said second vessel

(11) ,
b) inserting in said opening a generally tubular anastomosis instrument (1; 101) carrying said first vessel (9) in its central longitudinal cavity and with said end region (10) everted about a circumferential member (3; 103) constituting a forward portion of said instrument (1; 101) in such a manner, that the intima side of said end region (10) comes into contact with the intima side of said second vessel (11) at an edge region (12) of said opening, c) joining said end region (10) to said edge region

(12) by inserting penetratingly therethrough and leaving therein a plurality of spiked members (7) , and
d) removing said instrument (1; 101) from the joint formed between said first (9) and second (11) vessels,
characterized by
e) the use of an anastomosis instrument (1; 101) comprising
el) a first elongate member (2; 102), to one end of which is rigidly secured a circumferential anvil member (3; 103) in such a manner, that said first vessel (9) may be placed within said first elongate member (2; 102) with its end region (10) everted about said anvil member (3; 103) with the terminal part of said end region facing towards the opposite end of said first elongate member (2; 102), e2) staple-bending recesses (4; 104) provided in said anvil member (3; 103) and facing towards said opposite end,
e3 ) a second elongate member (5; 105, 105A, 105B) longitudinally moveable relative to said first elongate member (2; 102) and adapted to be moved towards said anvil member (3; 103) so as to make it possible to clamp together therebetween said end region (10) on said first vessel (9) and an edge region (12) on said second vessel (11), and
e4) stapling plungers (6; 106) longitudinally moveable relative to said first (2; 102) and second (5; 105, 105A, 105B) elongate members and adapted to insert staples (7) penetratingly through said clamped end (10) and edge (12) regions into engagement with said stapling-bending recesses (4; 104) so as to bend permanently said staples (7) into a shape, in which they hold said end (10) and edge (12) regions together.

2. Anastomotic instrument (1; 101) for carrying out the method of claim 1, characterized bv
a) a first elongate member (2; 102), to one end of which is rigidly secured a circumferential anvil member (3; 103) in such a manner, that said first vessel (9) may be placed within said first elongate member (2; 102) with its end region (10) everted about said anvil member (3; 103) with the terminal part of said end region facing towards the opposite end of said first elongate member (2; 102),
b) staple-bending recesses (4; 104) provided in said anvil member (3; 103) and facing towards said opposite end,
c) a second elongate member (5; 105, 105A, 105B) longitudinally moveable relative to said first elongate member (2; 102) and adapted to be moved towards said anvil member (3; 103) so as to make it possible to clamp together therebetween said end region (10) on said first vessel (9) and an edge region (12) on said second vessel (11) , and
d) stapling plungers (6; 106) longitudinally moveable relative to said first (2; 102) and second (5; 105, 105A, 105B) elongate members and adapted to insert staples (7) penetratingly through said clamped end

(10) and edge (12) regions into engagement with said stapling-bending recessses (4; 104) so as to bend permanently said staples (7) into a shape, in which they hold said end (10) and edge (12) regions together.

3. Anastomotic instrument (101) according to claim 2, characterized in that the external surface of said first elongate member (102) constitutes at least a part of the external surface of said instrument (101) , so as to make it possible to hold the latter by manually gripping the former.

4. Anastomotic instrument according to claim 3, characterized in that said first elongate member (102) is rigidly connected to said anvil member (103) through an end wall (102A) rigidly secured to or integral with the end of said first elongate member (102) and at least one connecting member (103A, 103B) rigidly secured to said end wall (102A) and said anvil member (103) .

5. Anastomotic instrument according to claim 4, characterized in that said second elongate member (105, 105A, 105B) comprises a) a rearward part (105) longitudinally moveable in said first elongate member (102) ,
b) an intermediate part (105A) rigidly secured to or integral with said rearward part (105) and
c) a plurality of forward clamping columns, each at the end (105B) being rigidly secured to said intermediate part (105A) , extending through said end wall (102A) and each on the opposite end having a clamping surface facing said anvil member (103) .

6. Anastomotic instrument according to any one or any of the claims 2-5, characterized in that each said stapling plunger (106) with a rear end is rigidly secured to a stapling plunger carrier (106A) rigidly secured to a third elongate member (106B) longitudinally moveable in said rearward part (105) of said second elongate member

(105, 105A, 105B) and with the remainder extending moveably through said intermediate part (105A) and said clamping columns (105B) .

7. Anastomotic instrument (1; 101) according to any one or any of the claims 2-6, charazterized bv such an arrangement that said second elongate member (5; 105, 105A, 105B) can only be advanced relative to said first elongate member (2; 102) and said anvil member (3; 103) to an extent leaving a gap slightly smaller than the combined thickness of said end region (10) and said edge region (12), said movement being limited e.g. by a suitable stop member.

8. Anastomotic instrument according to claim 7, characterized bv a mechanism adapted to move said second elongate member (105, 105A, 105B) and said stapling plungers (106) relative to said first elongate member (102) and said anvil member (103) in dependence on the movement of a single operating member moveable in a first direction and then returnable in the opposite direction in the following manner:
a) when said operating member is moved in said first direction, said second elongate member (105, 105A, 105B) is advanced to said limiting position leaving said gap immediately upon which said stapling plungers (106) are actuated to join said end region (10) to said edge region (12) , immediately upon which both said second elongate member (105, 105A, 105B) and said stapling plungers (106) are withdrawn to leave a large gap between said clamping plungers (105B) and said anvil member (103) allowing the instrument (101) to be removed from the joint, and b) when said operating member is moved in said second direction, the mechanism is re-set in readiness for a new movement in said first direction.

9. Anastomotic instrument (101) according to claim 8, characterized bv means, such as a spring, adapted to move said operating member in said second direction, as soon as the force moving it in said first direction is removed .

10. Anastomotic instrument (1; 101) according to any one or any of the claims 2-9, characterized in that at least one of the mutually cooperating clamping surfaces on said anvil member (3; 103) and the said second elongate member (5; 105, 105A, 105B) are modified to improve the gripping effect on the tissue parts (10, 12) to be joined.

11. Anastomotic instrument according to claim 10, characterized in that said mutually cooperating clamping surfaces are roughened or embossed with a grip-improving pattern.
12. Anastomotic instrument according to claim 10, characterized in that said mutually cooperating clamping surfaces are provided with elastically flexible fins or fingers (13) in the relaxed state extending obliquely inwardly (Figure 13).