Device, tools and methods for performing anastomosis

Abstract

Devices for use in anastomosis, methods and apparatus for installing the devices around long incisions or other orifices in tubular members such as vessels (tissue or artificial graft, or combinations), organs, ducts and the like, and method for performing anastomosis. The devices evert the walls of the tubular members to which they are attached so that an anastomosis performed with the devices joins the two members by contacting the inner walls of the members.

1 . An anastomosis device for attachment around an orifice in a first tubular tissue or organ and for everting tissue around a perimeter of the orifice, in preparation for anastomosis with a second tubular tissue or organ, said device comprising: 
 a ring portion sized to extend around the orifice; and malleable tines extending radially inward from said ring portion and having tine tips bent at an angle with respect to said radially extending tines and adapted to extend into the orifice, adjacent the perimeter of the orifice, wherein said tine tips are deformable to grasp the perimeter of the orifice, from inside the tubular tissue or organ and said tines are further deformable to evert the tissue around the perimeter of the orifice.    
   
   
       2 . The anastomosis device of  claim 1 , wherein said tines each comprise a weakened portion adjacent said tine tips, respectively, wherein each of said the tines preferentially folds at the weakened portion in response to being subjected to bending force.  
   
   
       3 . The anastomosis device of  claim 1 , further comprising extensions extending from said tines adjacent said ring portion, wherein said extensions which are adjacent one another overlap.  
   
   
       4 . The anastomosis device of  claim 1 , further comprising extensions integrally joining portions of said tines adjacent said ring portion, thereby reinforcing said tines to provide at least a portion of said tines with increased bending strength.  
   
   
       5 . The anastomosis device of  claim 3 , wherein said extensions that overlap are fixed in an overlapping configuration, thereby reinforcing said tines to provide said at least a portion of said tines with increased bending strength.  
   
   
       6 . The anastomosis device of  claim 5 , wherein said extensions that overlap are fixed by spot welding.  
   
   
       7 . The anastomosis device of  claim 5 , wherein said extensions that overlap are fixed by riveting.  
   
   
       8 . The anastomosis device of  claim 2 , wherein each said weakened portion comprises at least one hole extending therethrough.  
   
   
       9 . The anastomosis device of  claim 1 , wherein said tines extend substantially perpendicularly from said ring portion.  
   
   
       10 . The anastomosis device of  claim 9 , wherein said tine tips extend substantially perpendicularly from said tines.  
   
   
       11 . The anastomosis device of  claim 1 , wherein said ring portion includes a pair of fastener elements adapted to mate with another device in performing the anastomosis.  
   
   
       12 . The anastomosis device of  claim 11 , wherein said pair of fastener elements comprises a pair of malleable tabs extending from opposite sides of said ring portion.  
   
   
       13 . The anastomosis device of  claim 11 , wherein said pair of fastener elements comprises a pair of docking slots formed in opposite sides of said ring portion.  
   
   
       14 . A method of attaching an anastomosis device to a tubular structure to be joined by anastomosis, said method comprising the steps of: 
 inserting an anvil having a bend forming surface into an orifice formed through a wall of the tubular structure;    advancing an anastomosis device having a ring portion with tines extending radially inward therefrom over the anvil, wherein the tines further include tine tips extending therefrom, substantially perpendicularly to the anvil as the device is advanced over the anvil;    continuing to advance the device until the tine tips extend into the orifice and past the inner wall surface of the tubular structure;    driving the tine tips against the bend forming surface of the anvil by continuing to advance the device, wherein the tine tips are curled under the wall of the tubular structure, thereby gripping the wall between the tine tips and the tines which form a curled tine structure.    
   
   
       15 . The method of  claim 14 , further comprising the step of retracting the anvil while holding an opposing force on the ring portion, wherein the anvil contacts the curled tine structure and bends the tines in an opposite direction to the direction of bending of the tine tips, thereby everting the wall of the tubular structure that peripherally surrounds the orifice.  
   
   
       16 . The method of  claim 15 , further comprising the step of advancing at least one additional member having a bend forming surface, over the anvil, contacting the curled tine structure and further bending the tines in the opposite direction to further evert the wall of the tubular structure.  
   
   
       17 . The method of  claim 16 , wherein said at least one additional member is a single sleeve and the bend forming surface comprises a single continuous camming surface.  
   
   
       18 . The method of  claim 16 , wherein said at least one additional member comprises two concentrically arranged sleeves each having a bend forming surface, wherein said sleeves are advanced together such that send bend forming surfaces align to form a single, substantially continuous camming surface.  
   
   
       19 . The method of  claim 16 , wherein said at least one additional member comprises two concentrically arranged sleeves each having a bend forming surface, wherein a second of said sleeves is held in abutment against a portion of the tines adjacent the ring portion when the anvil is retracted, after which the second sleeve is retracted and a first of said sleeves is advanced against the curled tine structure, followed by advancement of the second sleeve against the curled tine structure.  
   
   
       20 . The method of  claim 16 , wherein said further bending of the tines everts the wall of the tubular structure to an extent that the inside surface of the wall is exposed to be contacted during the anastomosis.  
   
   
       21 . A pair of anastomosis devices adapted to form an anastomosis between first and second tubular members having first and second orifices; 
 a first device of said pair being adapted for attachment around the orifice in the first tubular member and for everting the wall of the first tubular member at a perimeter of the orifice, and a second device of said pair being adapted for attachment around the orifice in the second tubular member and for everting the wall of the second tubular member at the perimeter of the orifice of the second tubular member;    said first device comprising a ring portion sized to extend around the orifice of the first tubular member; and malleable tines extending radially inward from said ring portion and having tine tips bent at an angle with respect to said radially extending tines and adapted to extend into the orifice, adjacent the perimeter of the orifice, wherein said tine tips are deformable to grasp the wall at the perimeter of the orifice, from inside the tubular member and said tines are further deformable to evert the tissue around the wall forming the perimeter of the orifice; and    said second device comprising a second ring portion sized to extend around the orifice of the second tubular member and sized to fit concentrically over said ring portion of said first device; and malleable second tines extending radially inward from said second ring portion and having second tine tips bent at an angle with respect to said radially extending second tines and adapted to extend into the orifice of the second tubular member, adjacent the perimeter of the orifice, wherein said second tine tips are deformable to grasp the wall at the perimeter of the orifice, from inside the tubular member and said second tines are further deformable to evert the wall forming the perimeter of the orifice.    
   
   
       22 . The pair of anastomosis devices of  claim 21 , wherein after attaching said first and second devices to the first and second tubular members, said second device is joined with said first device so that said second ring portion concentrically surrounds said first ring portion thereby contacting the everted inner wall surface of the first tubular member with the everted inner wall surface of the second tubular member.  
   
   
       23 . The pair of anastomosis devices of  claim 22 , wherein one of said first and second devices comprises at least a pair of mounting tabs extending from said ring portion or second ring portion, and the other of said first and second devices comprises at least a pair of docking slots formed in the other of said ring portion or second ring portion; said docking slots being arranged to mate with said mounting tabs for locking said first and second devices to complete the anastomosis.  
   
   
       24 . The pair of anastomosis devices of  claim 21 , wherein the first and second tubular members are vessels.  
   
   
       25 . The pair of anastomosis devices of  claim 21 , wherein the first and second orifices are formed in side walls of the first and second tubular members, respectively, and wherein the anastomosis is a side-to-side anastomosis.  
   
   
       26 . A method of performing an anastomosis, comprising the steps of: 
 inserting an anvil having a bend forming surface into an orifice formed through a wall of a first tubular member;    advancing a first anastomosis device having a ring portion with tines extending radially inward therefrom over the anvil, wherein the tines further include tine tips extending therefrom, substantially perpendicularly to the anvil as the device is advanced over the anvil;    continuing to advance the first device and driving the tine tips against the bend forming surface of the anvil by continuing to advance the device, wherein the tine tips are curled under the wall of the tubular member, thereby gripping the wall between the tine tips and the tines which form a curled tine structure;    everting the wall of the first tubular member along a perimeter of the orifice by bending the tines in an opposite direction to the direction of bending of the tine tips;    inserting an anvil having a bend forming surface into an orifice formed through a wall of a second tubular member;    advancing a second anastomosis device having a ring portion sized to fit concentrically over the first ring portion and having second tines extending radially inward therefrom, over the anvil, wherein the second tines further include second tine tips extending therefrom, substantially perpendicularly to the anvil as the second device is advanced over the anvil;    continuing to advance the second device and driving the second tine tips against the bend forming surface of the anvil by continuing to advance the second device, wherein the second tine tips are curled under the wall of the second tubular member, thereby gripping the wall of the second tubular member between the second tine tips and the second tines which form a second curled tine structure;    everting the wall of the second tubular member along a perimeter of the orifice by bending the tines in an opposite direction to the direction of bending of the second tine tips;    sliding the second ring portion concentrically over the first ring portion, thereby contacting the everted wall of the second tubular member with the everted wall of the first tubular member, so that the inner wall surfaces of the first and second tubular members make contact; and    fastening the first and second devices together to maintain contact between the everted wall surfaces and to maintain the second ring portion in a position concentrically surrounding the first ring portion.