Method and apparatus for effecting dorsal vein ligation and tubular anastomosis and laparoscopic prostatectomy

A surgical apparatus for effecting the ligation of a vein adjacent a hollow, tube-like body member comprising:

• (a) an operator comprising an elongated hollow tube having a proximal end and a distal end and dimensioned to be inserted in and through said body member to position said distal end generally adjacent the vein to be ligated and including selectively operable first connection-permitting means provided in said distal end;
• (b) a tip component comprising a hollow bullet-shaped case and first and second suture needles carried by said case, said case having a proximal end and a distal end and dimensioned to be inserted in and through the body member and including selectively operable second connection-permitting means provided in said proximal end operable for engagement with said first connection-permitting means for connecting said tip component to said distal end of said elongated hollow tube, said distal end of said hollow case being smoothly rounded and having a substantially transverse slot therein;
• and
• (c) drive means for remotely driving said first and second needles longitudinally out of said case through said slot.

A method for effecting ligation of a vein adjacent a hollow, tube-like body member, comprising the steps of:

• inserting into the hollow tube-like body member a bullet-shaped hollow sound dimensioned to be inserted in and through the tube-like body member, the hollow sound having a longitudinal axis, an open end, a closed, smoothly-rounded end, a substantially transverse slot in said rounded end, first and second suture needles longitudinally movable inside the hollow sound and aligned with the transverse slot, and a suture having first and second ends respectively attached to the first and second needles;
• positioning the hollow sound generally adjacent the vein to be ligated;
• driving the first and second needles out through the slot, and through the wall of the hollow, tube-like body member on either side of the vein to be ligated;
• and
• forming a suture around the vein to be ligated using the first and second sutures.

A surgical apparatus for effecting the connection of first and second hollow body members comprising:

• (a) female and male connector components;
• (b) a first operator comprising an elongated hollow tube having a distal end and dimensioned to be inserted in and through the first body member to position said distal end generally adjacent a part of the first body member to be joined to the second body member and including selectively operable first connection permitting means provided in said distal end;
• (c) anvil means dimensioned to be positionable in said first body member and including second connection permitting means operable for engagement with said first connection permitting means for connecting said anvil means to said distal end of said elongated hollow tube and further including first alignment means spaced from said second connection permitting means and a female connector component supporting means for supporting said female connector component, said anvil means being selectively expandable and contractible;
• (d) a second operator including a tubular housing having a distal end and being dimensioned to be positionable in the second body member with its distal end adjacent a portion of the second body member to be joined to the first body member, a male connector component supporting means in said distal end for supporting said male connector component, and second alignment means engageable with said first alignment means of said anvil means for effecting proper alignment of said female and male connector components in a ready condition and force exerting movable means mounted for movement in said tubular housing toward said anvil means when said first and second alignment means are in said ready condition, for forcefully moving said male connector component toward said female connector component to effect locking engagement of said female and male connector components;
• and
• (e) wherein said female and male connector components include mutually facing clamping surfaces for clamping generally annular tissue portions of the first and second body members together when said second alignment means is engaged with said first alignment means and wherein said female connector component includes a plurality of resilient legs extending upwardly to said clamping surface thereof and a plurality of bores, each of said bores extending through said clamping surface and one of said resilient legs, and wherein said legs are movable between a retracted position when said anvil means is contracted and a distended position when said anvil means is expanded, and wherein said male connector component includes a plurality of post means for piercing said annular tissue portions in response to actuation of said force exerting means and for matingly engaging said plurality of bores in said female connector component when said legs are in the distended position, and wherein said post means and said bores hold said annular tissue portions in clamped engagement with each other following locking engagement of said female and male connector components.

A method for effecting a laparoscopic prostatectomy, comprising the steps of:

• insufflating the abdomen of the patient;
• inserting three trocars into the patient, two small lateral ports and one umbilical port;
• inserting a curved operator into the posterior urethra, the curved operator being provided at its distal end with a sound having a pair of suture needles therein;
• extruding the suture needles through the anterior urethral wall on either side of the deep dorsal venous complex;
• ligating the deep dorsal vein laparoscopically using the suture needles;
• inserting the curved operator provided with a inflatable anvil at its distal end into the apical urethra, the inflatable anvil having a hollow core tube extending therethrough and a female connector component seated thereon;
• partially inflating the inflatable anvil;
• securing the apical urethra to the core tube of the inflatable anvil;
• excising the apex of the urethra and the prostate;
• inserting a connector actuator through the umbilical trocar, the connector actuator having a male connector component seated on the distal end thereof;
• aligning the connector actuator with the inflatable anvil using a laparoscopic camera;
• and
• actuating the connector anvil and fully inflating the inflatable anvil to engage the male and female connector components to effect an anastomosis of the bladder and the urethral tissue.