Method and apparatus for performing end-to-end and end-to-side anastomosis with eversion of tissue edges

摘要

An element for use in anastomosis and a method and apparatus for installing the element (having tines that extend from a central portion) at the open end of a blood vessel (or other tubular body structure). To install an embodiment of the element, a carriage holds the element and shields the tines, the vessel's open end is passed through the shielded element and fitted over an anvil, the tines are exposed, and the carriage is actuated to fire the element against the anvil so that the tines pierce the vessel and curl against the anvil (everting the tissue around the vessel's open end). The anvil preferably forms the vessel end portion into a hooded shape suitable for creating an anastomotic junction. Or, the element is installed by inserting an intraluminal anvil through an incision in the vessel's upper wall, advancing an extracorporeal anvil against the vessel's lower wall (pinching the vessel closed at a location between the incision and the vessel's open end), and firing the element against the anvils so that tines at the incision's heel pierce the upper wall, tines at the incision's toe pierce both upper and lower wall, and all tines curl against the anvils. Preferably, the element is formed from sheet metal with the tines extending out from the central portion's inner edge and the tines are then bent relative to the central portion. Alternatively, the element is installed by sliding it onto (and inserting an anvil in) the vessel and folding it to cause the tines to pierce the vessel and curl against the anvil, or the element is C-shaped and is installed by sliding it onto the vessel, squeezing it to make it O-shaped, and firing it against an anvil that has been inserted in the vessel.