Devices and methods for minimally invasive surgical procedures
A suture clip applier for applying a suture around a tubular tissue adjacent to an open lumen. The suture clip applier includes an elongated body having a tissue clinching mechanism at one end of the body. The tissue clinching mechanism comprises two arms that are movable between open and clinched positions. The suture clip applier includes a plurality of deformable suture clips mounted along a longitudinal length of the elongated body, wherein each suture clip is configured to be detachably positioned within an interior of the two arms and to be deformed between open and clinched positions in response to the two arms being moved between the open and clinched positions. The suture clip applier further includes a length of suture comprising a pre-formed adjustable fastening and a loop extending from the pre-formed adjustable fastening, the loop extending between the two arms.
1 . A method of using a surgical device to intracorporeally resect a bowel specimen from a subject, the surgical device comprising:
a first arm and a second arm each having a longitudinal length with opposite proximal and distal end portions, at least one of said first arm and said second arm being movable between an open position and a clamped position,
wherein the surgical device includes a suturing mechanism comprising:
a first row of suture staples positioned along the longitudinal length in said first arm, and a second row of suture staples positioned along the longitudinal length in said second arm; and a length of suture comprising first and second end regions coupled together by a pre-formed adjustable fastening held in the surgical device, a first threaded region of the suture extending through the first row of suture staples, a second threaded region of the suture extending through the second row of suture staples, a first unthreaded region extending along the longitudinal length of said first arm, and a second unthreaded region extending along the longitudinal length of said second arm;
the method comprising:
clamping the first arm and the second arm over a proximal margin of resection between the specimen and a healthy bowel portion;
actuating a cutting mechanism to divide the bowel at the proximal margin of resection, actuating a stapling mechanism to close an interior lumen of the specimen by applying the staples to a proximal edge portion of the specimen;
actuating the suturing mechanism to attach the first and second rows of suture staples to an edge portion of the proximal bowel portion, wherein the suture comprising the pre-formed adjustable fastening detaches from the surgical device and forms a loop around the edge portion of the proximal bowel portion, a portion of the suture extending through the suture staples; and clamping the first arm and the second arm over a distal margin of resection between the specimen and a healthy bowel portion;
actuating the cutting mechanism to divide the bowel at the distal margin of resection, actuating the stapling mechanism to close an interior lumen of the specimen by applying the staples to a distal edge portion of the specimen;
actuating the suturing mechanism to attach the first and second rows of suture staples to an edge portion of the distal bowel portion, wherein the suture comprising the pre-formed adjustable fastening detaches from the surgical device and forms a loop around the edge portion of the distal bowel portion, a portion of the suture extending through the suture staples; and,
extracting the sample specimen through the subject's rectum, wherein the extracting comprises the steps of transanally inserting a grasping tool through the distal bowel portion, grasping the specimen with the grasping tool and extracting the specimen through the subject's rectum.
2 . The method according to claim 1 , wherein actuating the cutting mechanism, actuating the stapling mechanism and actuating the suturing mechanism occur simultaneously, or substantially simultaneously, in response to a single actuation by a surgeon.
3 . The method according to claim 1 further comprising:
intracorporeally forming an anastomosis between the proximal bowel portion and the distal bowel portion, wherein intracorporeally forming the anastomosis comprises transanally inserting a circular stapler and advancing the circular stapler through the distal bowel portion, the circular stapler comprising a stapling cartridge and an anvil component removably coupled hereto.
4 . The method according to claim 1 , wherein the pre-formed adjustable fastening together with the length of suture is configured to form a loop around the edge portion of the distal bowl portion.
5 . The method according to claim 1 , wherein the pre-formed adjustable fastening detaches from within a shaft of the surgical instrument such that the pre-formed adjustable fastening is released between the first arm and the second arm.
6 . A method of intracorporeally resecting a bowel specimen from a subject, the method comprising:
clamping a first arm and a second arm over a proximal margin of resection between the specimen and a healthy bowel portion;
actuating a cutting mechanism to divide the bowel at the proximal margin of resection tranversally across a lumen, actuating a stapling mechanism to close an interior lumen of the specimen by applying the staples to a proximal edge portion of the specimen;
actuating a suturing mechanism to attach a first and a second row of suture staples to an edge portion of the proximal bowel portion, wherein the suture comprises a pre-formed adjustable fastening, wherein the fastening detaches from the surgical device and forms a loop around the edge portion of the proximal bowel portion, a portion of the suture extending through the suture staples; and clamping the first arm and the second arm over a distal margin of resection between the specimen and a healthy bowel portion;
actuating the cutting mechanism to divide the bowel at the distal margin of resection transversally across the lumen, actuating a stapling mechanism to close an interior lumen of the specimen by applying the staples to a distal edge portion of the specimen;
actuating the suturing mechanism to attach the first and second rows of suture staples to an edge portion of the distal bowel portion, wherein the suture comprising the pre-formed adjustable fastening detaches from the surgical device and forms a loop around the edge portion of the distal bowel portion, a portion of the suture extending through the suture staples; and,
extracting the specimen having a lumen through the subject's rectum before connecting the distal and proximal bowel portions by the formation of an anastomosis, wherein the extracting comprises the steps of transanally inserting a grasping tool through the distal bowel portion, grasping the specimen having a lumen with the grasping tool and extracting the specimen having a lumen through the subject's rectum.
7 . The method of claim 6 , wherein the step of extracting the specimen through the subject's rectum further comprises inserting the specimen into a transanally inserted endoscopic bag.
8 . The method according to claim 6 further comprising:
intracorporeally forming an anastomosis between the proximal bowel portion and the distal bowel portion, wherein intracorporeally forming the anastomosis comprises transanally inserting a circular stapler and advancing the circular stapler through the distal bowel portion, the circular stapler comprising a stapling cartridge and an anvil component removably coupled thereto.
9 . The method according to claim 6 , wherein the step of extracting the specimen through the subject's rectum is accomplished without the specimen coming into contact with the bowel lumen.
10 . The method according to claim 6 , wherein the pre-formed adjustable fastening together with the length of suture is configured to form a loop around the edge portion of the distal bowl portion.
11 . The method according to claim 6 , wherein the pre-formed adjustable fastening detaches from within a shaft of the surgical device such that the pre-formed adjustable fastening is released between the first arm and the second arm.
12 . The method of claim 6 , wherein the step of extracting the specimen through the subject's rectum further comprises inserting a transrectal retractor into the distal bowel portion before insertion of the grasping tool and expanding the bowel wall.