[ 0066 ] fig1 shows schematically the attachment of end - to - end anastomoses . fig1 a shows an artery 10 and a vein 11 . the vein 11 is a transplant which is to be joined to the artery 10 . here , as in all the following illustrations , similar components are identified with similar reference numbers . in fig1 b an incision 12 has been made in the artery 10 . the end of the vein 11 has been cut on the diagonal so that a suitable opening 13 results , whose diameter approximately matches the diameter of the opening 12 . fig1 c shows how the two openings 12 and 13 of artery 10 and vein 11 are joined to each other and sutured , so that now an end - to - end anastomosis has been performed . [ 0067 ] fig2 shows a device under the invention , which can be used when creating anastomoses shown in fig1 . this device has a handle 1 , at the end of which a shoe 2 is formed as a needle carrier for needles . this shoe 2 , along with the needles disposed vertically on it , is covered by a needle cap 9 . above the needle cap 9 there is a needle seat 3 , whose function will be explained later . in addition , sections of sutures 4 are shown , which are connected to the ends of the needles . [ 0068 ] fig2 b shows the lower part of the device from fig2 c in an enlarged view in a lateral cross section . again , the shoe 2 can be seen , on which needles 7 are standing vertically in a ring around a holder 20 . these needles 7 are connected to sutures 4 by the ends facing the shoe 2 . above the points of the needles there is a sleeve 8 , which can be moved along the holder 20 by means of a sleeve linkage 23 . the entire arrangement of needles 7 and sleeve 8 is covered by a needle cap 9 , which can similarly be moved along the holder 20 by means of a linkage 21 , and in its lowered position provides a protective covering for the needles 7 and the sleeve 8 . above this protective cover 9 there is needle seat 3 , which can similarly be moved along the holder 20 by a suitable mechanism which is not shown here . [ 0069 ] fig2 a now shows in a cross section rotated by 90 ° to fig2 b a needle carrier 2 , which is inserted into an artery 10 . the needle carrier or shoe 2 was inserted into the artery 10 through a suitable incision not shown in the cross section and then , as shown in fig2 a , the needle cap 9 was raised . as a result , the needle points are now exposed inside the artery , but the rear wall of the artery is protected from the needles 7 by the shoe 2 . both the sleeve 8 and the needle cap 9 can be moved up or down by means of their corresponding linkages 23 or 21 through push buttons 5 or 6 on the handle 1 , as shown in fig2 c . [ 0071 ] fig3 shows the same arrangement as in fig2 b , however in an external view of the artery 10 . it can be seen clearly here that the needle seat 3 can be separated into two , where the needle seat 3 can be moved along the holder rod 20 by means of the linkage 22 . [ 0072 ] fig4 shows a similar view as in fig3 where however the position of the individual parts corresponds to that in fig2 a , i . e . the needle cap 9 has been pulled off the shoe 2 out of the opening in the artery 10 by means of its linkage 21 . [ 0073 ] fig5 shows the next step during the performance of the anastomosis , where the sleeve 8 has been pushed between the needles and the holder linkage 20 by means of its linkage , so that the needles are now standing sideways at an angle and are spread out radially . if the shoe 2 is now pulled up , or the needle seat 3 is pushed down , the tips of the needles 7 are pressed through the wall of the artery 10 along the circumference of the incision and they come to a stop in the needle seat 3 . this is shown in fig6 where following this position , the needle seat 3 can be withdrawn upward or opened , and the two halves of the needle seat 3 a and 3 b can be withdrawn laterally . this is shown in fig7 where it is can be seen that the needles are being removed together with the halves of the needle seat 3 a and 3 b , where they are pulling the sutures , here 4 a and 4 b , which are attached to them , through the suture holes . not all the sutures which come from the ends of the needles are shown in fig7 for the sake of clarity . but it must be made quite clear at this point that the end of each needle is provided with its own suture , which runs through the corresponding suture opening into the interior of the artery and then along the holder 20 and out of the incision . with this step , the first half of performing an anastomosis is concluded . next comes the suturing of the opening of the vessel to be attached , for example , of a vein . [ 0077 ] fig8 shows a suitable device , where , instead of a handle , a table stand 30 is being used , which has a center rod 31 as well as a needle carrier 32 , in which needles 37 are disposed in a circle around the center rod 31 . these needles 37 are connected at their ends to sutures 34 . it should be noticed that matching the diagonal cut at the opening of the vein , as shown in fig1 the needle carrier is beveled in the same way . [ 0078 ] fig9 shows the device from fig8 where an installation aid or insertion aid 35 , which is enlarged in one section , is mounted over the central rod 31 . alternatively , the insertion aid can be designed just to be dilatable , for example , by suitable inflation . [ 0079 ] fig1 shows another section from a device in accordance with fig8 and 9 , where a vein 11 is now pulled over the insertion aid 35 . the vein is now similarly greatly stretched in the enlarged section of the insertion aid , where the diameter of the vein in the stretched area is greater than the diameter of the needle arrangement with the needles 37 . in fig1 it can also be seen that one half 33 a of a two - part needle seat is placed on the vein above the enlarged area . in fig1 the needle seat 33 has been fully assembled from its two halves 33 a and 33 b . in fig1 it can be seen that the needles are now being pushed axially along the center rod 31 , or the vein with the seat 33 is being pushed in the direction of the needles , so that the needle points pierce the vein wall from inside the vein and come to a stop in the seat 33 . [ 0082 ] fig1 shows how the two parts of the needle seat 33 a and 33 b are pulled away upwards from the expanded part of the vein , whereby the sutures 34 , which are attached to the ends of the needles 37 , are pulled through the corresponding suture holes in the vein 11 . this pulls the corresponding sutures through the opening 13 of the vein , so that the two openings 12 or 13 of artery 10 or vein 11 respectively can now be joined to each other . for this , fig1 a and 14b once more show a holder corresponding to fig2 with a handle 1 , and in fig1 b the overall arrangement of shoe 2 with needles and sutures 4 and the table stand 30 with needles 37 and sutures 34 . as can be seen , the open ends of the sutures in both arrangements are attached to each other in each case . after the wall of both the artery and the vein have been pierced , the sutures 4 or 34 consequently run from outside the vein through a suture hole in the vein into the interior of the vein , from there into the interior of the artery and out again through a hole pierced in the wall of the artery . [ 0084 ] fig1 c , and in a section from it fig1 d , show an alternative to the table stand 30 . here the needle holder 32 with the needles 37 is attached to a handle 40 , where the handle ends in a tip over which the vein can be pulled in a suitable way . installation aids or insertion aids , as described above , can be attached here . [ 0085 ] fig1 shows the drawing in fig1 b in enlarged form . the sutures are shown in two examples 4 a , 4 b or 34 a , 34 b respectively . otherwise the drawings correspond to the illustrations in fig4 or 12 respectively . [ 0086 ] fig1 shows the illustration with the divided seat 3 a , 3 b or 33 a , 33 b respectively pulled back , where again only two sutures 4 a , 34 a or 4 b , 34 b respectively are shown as examples . otherwise the illustration in fig1 corresponds to the illustrations from fig7 and fig1 . [ 0087 ] fig1 shows a cradle 31 for the split needle seat from fig1 . this cradle 41 has slit - like openings 42 , the distance between which matches the distance between the sutures which come from the divided seats 3 a , 3 b or 33 a , 33 b respectively . [ 0088 ] fig1 shows how one seat 33 b is placed into the cradle 41 . the slit - like openings 42 here are designated by the reference numbers 42 a through 42 e , where only suture 34 b which is running through slit 42 e , is given a reference number . [ 0090 ] fig1 shows how one half 3 b of a needle seat and one half 33 b of an additional needle seat are placed next to each other in the cradle 41 . in order to tie the ends of the respective sutures together correctly , the seat 33 b is laid in a suitable way over the seat 3 b ( fig2 ). as a result , the two ends of the same suture , shown for example as 4 b and 34 b , are automatically located in each of the slits 42 . the ends of the sutures can be clipped together by means of a auxiliary instrument . fig2 shows such an instrument , where the entire instrument 45 with grip 46 and shaft 47 is shown in fig2 b , while fig2 a brings only the end of the shaft 47 . a clip holder 48 , which can hold up to five clips 49 is positioned at the end of the shaft 47 . with the aid of these clips 49 the specific suture ends can be attached to each other . [ 0093 ] fig2 shows another auxiliary instrument 45 , which , however , has a clip holder for only one clip 49 . instead , the instrument 45 from fig2 has a tong - like anvil 50 , so that two ends of the same suture can be clipped together in a simple fashion with this instrument 45 . it must be noted in the case of the procedures under the invention that before the ends of the sutures are clipped together the sutures from the artery side and the transplant side are pulled tight , so that the opening in the vein lies completely and in a sealing manner on the incision in the artery . then the sutures can be clipped together in this tightly approximated position . as an alternative to an auxiliary instrument , such as the one shown in fig2 and 21 , the ends of the sutures can , of course , be knotted in the conventional manner or other procedures such as adhesive bonding , thermal forming and similar methods can be employed . clips made of nitinol ( coalescent surgical co ., inc .) can also be used . [ 0096 ] fig2 shows a further embodiment for a device which corresponds to the one from fig8 . this device has a handle 40 to which a base 61 is attached . the base 61 acts as a holder for the needle carrier 32 in which needles 37 are disposed in an annular arrangement . a needle seat 62 is positioned in an axial direction to this annular arrangement 37 , with passages which extend in the axial direction of the individual needles and through which the needles are passed during an axial movement of the needle array 37 . another needle seat 33 a and 33 b is located adjacent to the seat 62 , into which the needles are introduced with the axial movement . this seat 33 is a divided seat , which can be subsequently separated into two halves 33 a and 33 b and removed with the needles 37 sticking in them . both the seat 62 and the needle seat 33 are formed as hollow bodies with passages extending in the axial direction of the needle array 37 . the seat 62 and the needle seat 33 are attached to the base 61 by means of an external bar - shaped bracket 65 . as can be seen from fig2 b and 23c , the seat 62 and the needle seat 33 are shaped in such a way that the cross - section of their passage can be made narrower . this can be achieved , for example , by creating air cushions . fig2 b shows how a transplant 11 is inserted into the passage of the seats 62 and 33 . fig2 c shows how , by means of the pressure cushions the seats 33 and 62 , the cross section of the passage and along with it the diameter of the transplant 11 is constricted locally , so that the cross section of the transplant remains unchanged only at the surface of the seat 62 . the transplant narrows down consequently starting from this surface 67 in a funnel shape in the axial direction of the needles 37 . the largest diameter of the passage of the seat 62 is now adjusted so that it is larger than the diameter of the ring of the needle array 37 . the constriction by means of the pressure cushions in the seats 33 and 62 continues down to a diameter that is smaller than the diameter of the needle array 37 . this creates a transition zone for the transplant in which the transplant tapers down in a funnel shape . if the needles are now punched through the transplant in an axial direction , they penetrate the transplant in the expanded area along the edge of the incision 67 and are pushed through the transplant in the funnel - shaped area 70 . it is advantageous if the seat 62 and / or the needle seat 33 are furnished with a device to apply a vacuum to the inner surface of their passage . in this case the transplant 11 can have suction applied on its outside and be held in position in this way . by holding the transplant in position by means of suction applied to the outside , damage to the inside of the transplant , particularly the endothelium , is avoided . [ 0102 ] fig2 shows the set up of the device for suturing the transplant and the artery . the needles in both devices are connected to each other by means of sutures 34 , where , just as in fig1 , only a part of the sutures is shown . for a further explanation , reference is made to the appropriate fig1 , where only the device shown there for suturing the transplant has been replaced by the device from fig2 for suturing the transplant . [ 0104 ] fig2 shows this arrangement of the two devices according to the invention , the ends of whose needles are connected in each instance by sutures 4 a , 34 a or 4 b , 34 b . [ 0105 ] fig2 shows the same arrangement after the needles 7 or 37 have been pulled through the artery 10 or the transplant 11 . the needles 7 or 37 are then pushed into the needle seats 3 or 33 respectively and held in position there . the needle seats are now separated into two needle seat halves 3 a , 3 b or 33 a and 33 b respectively and removed with forceps 69 whose ends are adapted to the seat . then the needle seats 3 a , 3 b , 33 a , 33 b can be set down in suitable seat cradles , and by pulling the sutures tight the transplant can be attached to the artery and thus sutured to it . [ 0106 ] fig2 shows in the subillustrations a through i the exact sequence of suturing the transplant . here a device in accordance with fig2 is used , where the same reference numerals are used for the same elements . fig2 a shows the device immediately prior to the suturing process . fig2 b shows how the transplant 11 is introduced into the needle seat 33 and the seat 62 . fig2 c shows the transplant being held by suction against the inner walls of the passage of seats 33 and 62 . in step 27 d the transplant is cut off using a knife 66 along the diagonal surface 67 of the seat 62 , so that it already has a diagonal aspect which matches the opening in the artery to which the transplant is to be sutured . in fig2 e the transplant 11 is being constricted behind its opening and the cutting surface 67 by means of pressure pads in the seats 33 and 62 . [ 0107 ] fig2 f shows how the needle array 37 is now displaced in an axial direction and thereby the individual needles 37 are pushed through the transplant 11 from the inside to the outside in the funnel - shaped constricted area . [ 0108 ] fig2 g shows how , after the needles have been passed through the transplant , the needle seat 37 is withdrawn in an axial direction over the transplant and is then separated , and the two parts of the seat 33 a and 33 b are removed from the transplant . [ 0109 ] fig2 h shows a cradle 41 for the needle seats 33 a and 33 b , while fig2 i shows how the needle seat 33 b is placed in the cradle in such a way that one suture 34 is deposited in each of the slits 42 of the cradle 41 . the remainder of the process of attachment is performed as described in the previous examples . in a further example , the instruments and devices presented could be designed as minimally invasive surgical instruments , so that it is not necessary to open the chest wall and the instrument is introduced into the body through small incisions , for example using a trocar . in additional examples the handles 1 can also be designed in such a way that they can be manipulated by a robot . in this way , extensive automation of the suturing procedure would be possible . in summary , it can be said that through the device under the invention , or through sets under the invention having two or more of such devices , at least one in each case for the artery side and one for the vein side , it is possible to join hollow organs together in a simple and safe manner . while the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment , it is to be understood that the invention is not to be limited to the disclosed embodiments but , on the contrary , is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims , which scope is to be accorded the broadest interpretation so as to encompass all such modifications and equivalent structures as is permitted under the law .
the invention relates to a device for joining hollow organs with an elongated holder and a needle carrier which is positioned at one end of the holder , where the needle seat extends radially , forming an overhang projecting beyond the periphery of the holder , as well as with a plurality of needles which are disposed standing vertically on the projecting overhang of the needle seat , surrounding the holder .