referring to fig1 there is a perspective view of an embodiment of the present invention . the said anastomosis gun according to the present invention is formed in the shape of a round rod having both ends in a larger diameter . a lining tube 5 is fitted in an outer tube 31 at one end with an anastomosis ring seat 6 installed in the lining tube 5 , the front end being fitted with a guide head 2 to facilitate insertion . the other end is in the shape of a round smooth nut 4 which is retained at the rear end for rotation by means of a pair of screws 81 . referring to fig2 there is an exploded perspective view showing an embodiment of the present invention . the sutureless intestinal anastomosis gun according to the present invention is comprised , in its essentials , of a guide head 2 , a housing 3 , a nut 4 , a lining tube 5 , an anastomosis ring seat 6 , a movable shaft 63 , a fixed shaft 7 , a spring 8 and screws 81 wherein the guide head 2 is in the shape of a smooth conic cover ; the housing 3 is comprised primarily of an outer tube 31 of a larger diameter connecting at the rear side with an elongated tube body 32 ; the nut 4 has a rear end formed into a smooth spherical faced round body which is provided in the center with a threaded hole ; one end of the lining tube 5 is formed with a stop edge 51 at an appropriate distance from the end face , a filler plate 52 being threaded to the other end thereof ; the anastomosis ring seat 6 has the lower end formed into a flange 62 with the upper end being divided into several segments by the same number of crossed grooves 61 ; the movable shaft 63 is provided with an elongate slit 64 , both ends thereof being formed with male and female threads , respectively ; and the spring 8 is a spiral compression spring . when assembling , the movable shaft 63 is first threaded to a screw rod 41 and then fitted in the tube body 32 together with the fixed shaft 7 by means of a screw 82 . the nut 4 is fitted at the rear end of the tube body 32 by a pair of screws 81 mating with a retaining groove 33 . the front end of the tube body 32 is connected to the outer tube 31 by means of the screws 83 . the end of the anastomosis ring seat 6 having a smaller diameter is placed in the lining tube 5 , followed by the spring 8 , and then both are restricted within the lining tube 5 by the filler plate 52 . finally , the lining tube 5 is placed into the outer tube 31 , causing the movable shaft 63 to extend through the filler plate 52 to be threaded to the anastomosis ring seat 6 , and the fixed shaft 7 to extend through the filler plate 52 into the anastomosis ring seat 6 , thus completing the assembly into the relationship as shown in fig3 . since the movable shaft 63 is connected to the screw rod 41 and restricted in the tube body 32 together with the fixed shaft 7 by means of the screws 82 fitting in the elongate slit 64 , the anastomosis ring seat 6 can be actuated to move linearly by the movable shaft 63 by rotating the nut 4 . moreover , since a compression spring is placed in the lining tube 5 between the filler plate 52 and the anastomosis ring seat 6 , the lining tube 5 and the anastomosis ring seat 6 are retracted at the same time during actual operation , and then the anastomosis ring seat 6 alone is retracted inwardly after the lining tube 5 has been retracted to the bottom , thereby resulting in the relative movement between the lining tube 5 and the outer tube 31 , and then the movement of the anastomosis ring seat 6 relative to the lining tube 5 . in the embodiment of the present invention , the actual operation is performed by first removing the diseased portion of the intestine and having the intestinal ends threaded with purse - string sutures . then the anastomosis ring 1 is tied to the end of the intestine 92 , and then the said anastomosis gun is properly adjusted for mounting the guide head 2 , the said anastomosis gun being inserted from the anus 9 , then passing through the rectum 91 and out from the upper end of the rectum 91 for mounting the anastomosis ring 1 as shown in fig4 . then the guide head 2 is removed as shown in fig5 and the open end of the rectum 91 is properly tied to the lining tube 5 of the said anastomosis gun as shown fig6 and the anastomosis ring 1 which has been connected to the intestine 92 is fitted over the anastomosis ring seat 6 in the condition as shown in fig7 . then the nut 4 is rotated in a clockwise direction as shown in fig8 urging the screw rod 41 to pull the movable shaft 63 , the anastomosis ring seat 6 , the spring 8 , the filler plate 52 , and the lining tube 5 to move down , thus causing the lining tube 5 to be retracted relative to the outer tube 31 and the open end of the rectum 91 such that the open end of the rectum 91 is introduced precisely by pushing the edge of the outer tube 31 into the gap of the anastomosis ring 1 as shown in fig9 . continued rotation of the nut 4 , after the end of the rectum 91 has been tied as shown in fig1 , will no longer move the lining tube 5 because the lower end thereof abuts against the bottom of the outer tube 31 , and only the movable shaft 63 pulling the anastomosis ring 6 will move down relative to the fixed shaft 7 and the lining tube 5 . when the anastomosis ring seat 6 is moved down into a proper position , the upper end thereof is spread out by the restricting head 71 on the upper end of the fixed shaft 7 such that the anastomosis ring 1 is retained as shown in fig1 and snapped into the closed condition as shown in fig1 . after the anastomosis ring 1 is fastened , the said anastomosis gun is disengaged from the anastomosis ring 1 and removed , thus to complete intesinal anastomosis . the said anastomosis gun can be disengaged from the anastomosis ring 1 in two ways . as shown in fig1 , the said anastomosis gun can be disengaged from the anastomosis ring 1 by moving the anastomosis ring seat 6 further down to pass through the anastomosis ring 1 by rotating the nut in a clockwise direction after it is closed . alternatively , after the anastomosis ring 1 is closed , rotate the nut in a counterclockwise direction to move the anastomosis ring seat 6 upwardly and back to the position where it is initially fitted into the anastomosis ring 1 as shown in fig1 , then the said anastomosis gun can be pulled straight down and disengaged from the ring . using the bar for anastomosis of the rectum is extremely difficult in the deep and narrow pelvic cavity . under such circumstances , it is initially visualized to study and design a suitable auxiliary device for use in combination with the bar for performing the intestinal anastomosis . it is much like that the bar is a bullet and the auxiliary device is a gun and the desired results can only be obtained by using both in cooperation . therefore , the following methods and steps were used and taken in the study : 1 . thorough understanding of the properties of the bar : efforts have been directed to making references to academic papers relating to the bar , collecting related data from the manufacturer , and analyzing samples of the bar . 2 . initial layouts were drawn after repeated thinking , visualization , making simple drawings , analysis , computer aided drawings , computer simulated operation , trial , and feasibility review . based on the layout and after a number of modifications , a prototype of the device was made by using various working machines such as a precision lathe and milling machine to make metal and plastic members . during the process , the difficulties encountered and the solutions are as follows : ( 1 ) how to transpose the combined body of the opening on the lower end of the intestine and the bar to the opening on the upper end of the rectum in a deep and narrow pelvic cavity : a metal tube of suitable size ( having the same diameter as the rectum ) is used which is inserted from the anus and extending out from the opening on the upper end of the rectum . then the combined bar body is placed on the opening of the metal tube by fingers followed by moving the top opening of the rectum to the bar . ( 2 ) how to tightly tie the purse - string suture of the rectal opening in the gap of the bar : the purse - string suture of the rectal opening is sutured and suitably tied to the inner tube by means of the related movement in position between the openings of the mutually slidable outer and inner tubes ( see fig6 ). then the opening of the rectum is precisely pushed into the gap of the bar via the end edge of the outer tube opening and then tightly tied ( see fig1 ). ( 3 ) how to close the bar to secure in the lumen of the intestine without damaging the intestinal wall : originally , the bar had to be snapped to secure it by compressing the intestinal wall and the bar with fingers , such that the soft frangible intestinal wall was frequently injured , resulting in hematoma or even rupture , due to squeezing in the bar . the only solution to prevention of injuries of the intestinal wall is to directly snap the bar to secure it by applying opposite forces on both sides in the intestine . to this end , various models have been made in trials after repeated scrutiny , actual drawing and computer simulated tests , which are then subject to experiments and actual tests , and finally the said anastomosis gun of the present invention has been designed comprising an anastomosis ring 6 , a lining tube 5 , a filler plate 52 , a compression spring 8 , a fixed shaft 7 , a rotatable nut 4 , a movable shaft 63 , etc as elaborated hereinbefore . with the said anastomosis gun of the present invention , the anastomosis ring can be simply snapped to secure it by rotating the nut clockwise , thus to complete the intestinal anastomosis . ( 4 ) how to test and evaluate the function of the said anastomosis gun of the present invention : 1 . the movements of the various components are repeatedly tested after they were disassembled . 2 . coordinated movement of the said anastomosis gun was tested after it had been integrally assembled . 3 . the essential requirements for high pressure sterilization such the endurance , resistance to force , temperature , and pressure of the above movements were tested . 4 . simulated intestines ( tubular foam rubbers ), intestines from animals ( pigs ), and large intestines from humans ( operation specimen of intestine ) were repeatedly tested . after numerous successful tests , the said anastomosis gun of the present invention was used for the first operation in taipei municipal jen ai hospital , taipei , taiwan on oct . 14 , 1993 . the operation was performed perfectly in which the large intestine and lower rectum was anastomosed sucessfully for a victim of rectal cancer ( mr . lin yin - tang , male , age 42 , registration no . 1229119 ). the patient was discharged uneventfully on oct . 19 , 1993 . 1 . early results : there were a number of disadvantages with the earlier models which were inconvenient to operate and inaccurate in mechanical movement due to their simple and crude structures . therefore , the construction and function of the earlier models have not yet been publicized and only the results of the clinical applications had been briefly reported . 2 . latest results : with the attention and encouragement by medical experts from abroad , further efforts have been directed to continued research and development . after a number of tests externally and trials internally of the body , modifications have been made to a great extent to completely overcome the disadvantages and defects with the earlier models , thereby to obtain the said anastomosis gun of the present invention which can actually be used for application on human bodies . heretofore , the said anastomosis gun of the present invention has been used in combination with the bar for the anastomosis of the lower rectum with the large intestine on eight patients . among them the seventh patient is a senior of age 100 , and with the fifth patient , anastomosis was performed with the bar at the distance one cm from the anus , both cases being new world records . from the foregoing , the said anastomosis gun can be operated by rotating a nut at one end , the end of the rectum can be pushed exactly to the gap of a bar , causing the bar to be snapped exactly to secure it at the other end and the said anastomosis gun can be disengaged from the bar , such that during deep rectal anastomosis , the said anastomosis gun can be inserted into the anal canal and protruded out from the upper end of the rectum to fit with the bar of the intestine for rectal anastomosis , thus to overcome the space limitation of pelvic cavity , thereby enabling the patients to avoid the misery from the artificial anus . ______________________________________list of reference numbers______________________________________ 1 anastomosis ring 41 screw rod 2 guide head 51 stop edge 3 housing 52 filler plate 4 nut 61 groove 5 lining tube 62 flange 6 anastomosis ring seat 63 movable shaft 7 fixed shaft 64 elongate slit 8 spring 71 restricting head 9 anus 81 , 82 , 83 screws31 outer tube 91 rectum32 tube body 92 large intestine33 retaining groove______________________________________
directing to the difficulties involved in the deep rectal surgery , the present invention relates to a sutureless intestinal anatomosis gun which facilitates the rectal surgery to be performed by entering through the anus and protruding out from the upper end of rectum so as to install an anastomosis ring that has been connected to the intestine for anastomosis of the rectum , comprising a plurality of tubes , an anastomosis ring seat , a fixed shaft , a screw rod and a nut . during the operation of intestinal anastomosis , the inner sleeve and the anastomosis ring seat can be driven in sequence by means of the nut and the screw rod such that the end of the rectum is pushed precisely to enter into the gap of the anastomosis ring and then the anastomosis ring is precisely closed . thereafter , the anastomosis ring seat and the anastomosis ring are disengaged and then the said anastomosis gun is removed to complete the intestinal anastomosis .