Articulating endoscopic surgical apparatus

203-589 CIP IIl (1273 CIP III' ARTICIJ~ A7'~NG ~I'IDOSCOPIC~ SlURGICA~, APPARATtJS BACKGROUND OF TH~, ~NVF.NTI~N 1.

Field of the Inventioni The subject invention relates to surgical a~u~lus for ~lrO~ g laparoscopic and endoscopic surgical procedures, and more particularly to apparatus having an end portion which can be articulated in a patient's body during a surgical procedure.

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Vescription of Relate~l Art In laparoscopic and endoscopic surgical procedures a small incision or puncture is made in the patient's body to provide access fo~ a tube or cannula device.

Once extendsd into the patient's body, the cannula allows insertion of various surgical instruments such as scissors, dissectors or retractors to per~orm the surgery.

An exarnple of an endoscopic surgical instrument is illustrated in U.S.

Patent No.

2,113,246 which issued to Wappler on April 5, 1938.

This patent discloses endoscopic forceps co",p~ic;l-ganelongatedconduitwithjawsatthedistalendthereof,acontrolrodintlleconduitfor ,', controlling the operation of the jaws, and a control handle at the proximal end of the conduit which is ope,a~ cly connected to the control r~ This surgical i~si~ ulllcnt is extremely limited in its applications in that the angle of the conduit portion mounting the jaws cannot be adjusted in relation to the remaining por~on of the conduit during a surgical pluce~l~u~.

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CA 02106243 1998-0~-28 ~ -2 Improvements have been made in the art of surgical instruments to increase theirrange of operability.

For example, U.S.

Patent No. 4,763,699 which issued to Jaeger on August 16, 1988 discloses a microsurgery instrument with an adjustable angle of operation for obtaining cervical biopsies.

Similarly, U.S.

Patent No. 4,880,015 which issued to Nierman on November 14, 1989 discloses a surgical device having an increased range of operability.

In particular, this patent shows a biopsy forceps designed for use through a flexible fiberoptic bronchoscope.

The biopsy forceps includes a handle connected to a thin elongated flexible shaft with a distal portion thereof hinged to the shaft. A grasping tool or biopsy forceps is ~tt~çhed to the distal hinged portion.

Control wires extended from the handle to the distal end to the shaft for controlling the angular rotation of the distal portion of the instrument.

Of the references discussed above, none of these instruments disclose a laparoscopic instrument for insertion into the body cavity through a cannula and adapted for a wide range of laparoscopic surgical applications.

Further, the instruments disclosed therein are not provided with means for rotating the tool head about the longitu~lin~l axis of the endoscopic portion of the instrument.

Tn~te~d7 a surgeon using either of these prior art instruments must physically rotate the entire instrument in order to change the rotational orientation of the distal end of the conduit or tube.

Accordingly, it is desirable to provide an endoscopic surgical instrument having a tool head which is independently moveable about two axes of rotation relative to the handle while the instrument is in use.

It is also desirable to provide a lightweight endoscopic surgical instrument which can provide a clearer line of sight for a surgeon during a surgical procedure.

It is also desirable to provide an endoscopic surgical instrument in which a wide variety of di~elenl tool heads may be employed.

It is also desirable to provide an endoscopic surgical instrument which may be used to perform electrocauterization during surgical procedures.

CA 02106243 1998-0~-28 It is further desirable to provide an endoscopic surgical instrument which may be used for performing retraction, grasping or di.csecting tasks during gynecological procedures.

It is further desirable to provide an endoscopic surgical hl~L~ulllenl for pelro~ g retraction, grasping or ~icsecting tasks during abdominal surgery.

It is further desirable to provide an endoscopic surgical instrument which is inexpensive to m~nuf~ctllre.

Accordingly, an object of the present invention is to provide an improved endoscopic surgical instrument that addresses the above drawbacks in the prior art.

This and other objects of the subject invention will be made more apparenl from the following description taken in conjunction with the accolllpanying drawings.

SUMMARY OF THE INVENTION An endoscopic surgical instrument is disclosed for use in a wide variety of roles including grasping, di.csecting, clamping, or retracting materials or tissue during surgical procedures performed within a patient's body and particularly within the abdominal cavity.

The surgical instrument of the subject invention includes a handle portion having a fixed handle, and an endoscopic portion which depends from the handle portion.

The endoscopic portion includes an elongated tubular section and an artic~ ting section which is pivotally connected adjacent to the distal end of the tubular section.

Tool means are operatively connected to the articul~ting section of the endoscopic portion. A linkage mech~nicm is associated with the endoscopic portion of the instrument for selectively pivoting the articulating section in an angular plane relative to the longitudin~l axis of the tubular section within about 90~ sector of rotation.

This linkage mech~nicm is preferably controllable from the handle portion of the instrument.

CA 02106243 1998-0~-28 -3a In one embodiment of the subject invention, the surgical instrument may include a handle portion having a fixed handle and a pivoting handle. A cable extends from the pivoting handle through the endoscopic portion to the tool means.

In this embodiment, the tool means may comprise a pair of cooperating jaws.

The movement of which is controlled by operating the pivoting handles.

The linkage mechanism for pivoting the articulating section of the endoscopic portion preferably may include an elongated push rod ext~ntling from the handle portion, through the endoscopic portion.

The push rod would be connected to a link member, which, in turn may be pivotally connected to the articul~tin~ section of the endoscopic portion.

In addition, the linkage mech~ni~m may include a reciprocating member having a gear rack disposed adjacent to the handle portion of the instrument in cooperation with the proximal end of the elongated push rod.

The gear 2106213 rack member would be movable in m axial direction in response to rotation of an aMular pinion gear in the handle portion of the L.s~l ulllGnt.

Rotation of the pinion gear would cause the gear rack member to translate coaxially, causing the push rod to move, and thereby causing the articulating section of the endoscopic portion to pivot within 90' sector of rotation relative to the longih-rlin~ axis of the elldoscop;c portion of the i~ ulll~ Preferred emborlimpntg of the subject invention may also include means for rotating the endoscopic portion of the surgical instrument about the 1~ n~iturlin~l axis thereo~ In this instance, an annular bushing, which may be c~ cen~ lly disposed within an annular cuff, would be provided in the handle portion of the hl~llullh,nt.

The proximal end of the f ~ Gsc~ic portion of the ins~nent would be arrangcd within the bushing and would be rotatable about its longitudinal axis by rotating the annular cuff.

In another e.llbodi~-lcnl of the subjc-ct invention, ~e surgical insLIulnGlll may include a handle portion conrl~,uJ~I as a pistol-grip and an endoscopic portion inchl~ling an elongated fixed tubular section which depends from the handle portion and an ar~icul~ting section pivotally cc~ ~ ted to the fixed section adjacent the distal end thiereof.

An l~longa~l paddle tool would ~le~e~.~l~ from the arliculs~tine section of the ~ndosclJp:c portion for p~Lr~ g ~ dclion tasks during surgical procedures.

In addition, a linkage ",~l~";!~"~ would then be acsoc:s~ with the ~ cndosco~;c por~on of the insl,ulll~,nl for pivoting the a~ ;ng section relative to the longit~ in~l axis of the fixed section, with a 90~ sector of rota~on.

The inslluJl.~,lll could also be provided wi~h means for rotating the endosc~ic portion thereof about its lonEi~ lin~l axis.

In yet another ~ ."ho l;"~en~ of the subject invention, the surgical hlsl~ulll~ l includes an axial handle portion firom which extends an e1one~t~ doscol ~~ portion having an articulating distal section. A retractor assembly is Op~dl.ive~ ~ciS~tf~d with ~e ar~icul~tin~ section and may include a pair of coopG~aLIg f~ ;C retractorrod l~rlllh...~i or all~J~ ively~ aplurality of ~ t~ 'actor blade ~r~ n both ;~ r~s~ the retractor assembly is m ~nir~ t~d -'5 between a closed position and an open position by a dIiving assembly housed in the handle portion of the ,1l~ ulll~,nl.

The driving as~mbly includes a rotatable knob member which is threadably cc)~ ~t~-l to an axially a~l~d.lc~ble screw member.

Rotation of the h~ob member will cause co.~ n~ axial Illu~ lls of the screw mernber ~elative to ~e handle portion.

This :

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~5~ 2106~3 aIrAn~t mf n~ also pem~its controlled deployment of the retractor rods or interleaved retractor blades into a variety of i"~ ;A~f; positions between the open and closed position depending upon the specific retraction task at hand.

Connective means extend from ~e screw member to the retractor assembly for h~nslalil~g the axial m~en~clll of the driving assembly eo the retractor assembly.

Also, in both inc~2nr~s, the articulating section of the endoscopic portion of the surgical instrument is manipulated within an angular degree of rotation by a c~ min~ assembly which is a-s~ ~ with the handle portion thereof.

The cAmmi~ assembly includes a cam member which is movable between a proximal position and a distal position with respect to the handle portion of the ':

inshulllcnl.

Linkage means în~l~iolln~ls the cam member with the retractor assembly for tra~ cl ~in~ axial ~llovelllent of the cam member to the retractor assembly.

In s~ll another embodiment of the subject invention, the surgical instrument compric~s a retractor assembly which is o~ vly ~sc~c;-lr,d wi~ the ar~içul~ting portion of the ap~dlalus and which includes a plurality of illl~llea~d retractor blades each having a distal portion which depends angularly th~l~iolll to define an ~ ir, sur~ace.

Pre~erably, each of the retractor blades have a distinct length for p~ oL:ng efficient stacking or nes~ng of adjacent blades when the retractor as~ l,bly is in the closed position. ~ addition, the i.,sll ul,lent includes a rotator assembly which is ~csoc~ 1 with the handle portion for remotely ~rr~l.-~ the ar~ on of the distal portion of the a~alalus.

The rotator as~ ,lbly includes a hlob member threadably ~csoc~ d with a k~l~g;~ ly 1~ g drive screw which is u~t4~o~ frl~ to the articulating portion of the al~p~-r ~lls by an Plon~ ~ d control shaft.

Gradual manipula~on of the rotator knob will erî~lu~ C~ g progressive articul~ion of the distal portion of the d~ within an angular sector of rotadon to increase ~e range of operabili~ of the inshul~en~ 1~ an all_."~ 4 e.llbOdiJIICIll of ~e bladed retractor ill~h Uln411l of the subject invention, spacer means are disposed between adjaçent retractor blades for . . . ~ n~ clP~r~nre _Ihclcbct~ so as to inhibit tissue damage du~ing at~ ion of the retractor hs~l~lbly. ~ addi~on, clutch means are ~ ' with the dr;ving as~.nbly of the .r~sk L~ c.~l to prevent over-rotation of the knob member during ~!' tl ~;ol~ of the r~t~ctor assembly. ~,f~,lably, the clutch means c~ ,s a ratchet m~h~ni$m configured for controlling ~e axial rotation of ~e dAving assembly of the ill~hulllC"t.

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:. ... . .. . : . ' , -6- 2~2~ ~ urther features of the subject invention ~11 become more readily apparent from the following detailed description of the invention t~ken in conjunction with ;Icco~ Iyillg drawings.

BR~FF nlF SCRTPTION OF T~7~ l)R ~W~l~GS ~ ,f~lcd embo lim~ont.~ of the subject invention will be described hereinbelow with e.~cc to the drawings, wherein:

Fig 1 is a p~ *C~ v view of an arhc~ ting endoscopic surgical instrament in acc(,l.lance with a ~ f~llcd e. . ,~1;, . ~r~ ~ of the subject invention;

Fig. 2 is an eYrlo~led view of the ar~icul~ng endoscopic surgical i"shulllen~ of Fig.

Fig. 3 is a side cross-sectional view taken along line 3-3 of Fig. 1 illustrating the handle portion of the endoscopic illsll Ulll~ nt;

Fig. 4 is a side cross-sectional view talcen along line ~4 of Fig. 1 illnst~ting the distal end of the endo~o~:c surgical il~ Fig. S is a top plan view cross-section view taken along line 5-5 of Fig. 4;

Fig. 6 is a side CIUSS s~liol-~l view of the distal end of the endoscopic surgical i(lsLIulll~nl showing ~e jaws in a closed position;

Fig. 7 is a side cross-section~l view showing, in solid and in phqntQm lines, the various pivoting IllU~ lki of dle al~ E section of ~e endoscopic pordon of the surgical insL~..Il~nl shown in Fig. l;

Fig. 8 is an enlarged side cross-se~tionql view of ~e distal end of the endoscopic surgical ill~h ull,elll taken along line 8-8 o~ Fig. 7;

Fig. 9 is an enlarged side cross-sectional view of the distal end of the Pn~loscopic surgical i~ ulll~nt ilhlctr~ting the various pGS;I.iOllS of ~e pinon gear which c~ "p~;ces a portion of _the linkagc ".~1~ c.~ of the subject invention;

Fig. 10 is a front cross-sectional view taken along line 10-10 of Fqg. 9;

Fig. 11 is a side cross s~Lional view i~ ctratine an all~ll,ati~c embodiment of the J tool head o~the e-~loscop:c surgical in;~llUlll~,nt of the subject invention in an open position.

- Fig. 12 is a top cross-sectional view taken along line 12-12 of Fig. 11;

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--7- 2~2~ Fig. 13 is a side cross-section. l view of the tool head shown in Fig. 11 in a closed position.

Fig 14 is a side cross-sectional view showing, in a solid and in phantom lines the pivotal l-lu~elllellb of the artirul~tin~ section of the endoscopic portion of the subject invention with the alternate elllbo~ .ellt of the tool head shown in Figs. 11-13;

Fig. 15 is a front cross-sectional v;ew taken along line 15-15 of Fig. 14;

Fig. 16 is a p.,~ ive view of an alternate embodiment of the subject invention which includes an articulating paddle for p~,.,rul~lullg re~action tasks;

Fig. 17 is a side cross-section~l view t~ken along line 17-17 of Fig. 16;

Fig. 18 is a side cross-sec~jo~l view taken along line 18-18 of Fig. 16;

Fig. 19 is a side cross-sectir~nql view taken along line 17-17 of Fig. 16;;

Fig 20 is a p.,l~ye~ v view of another emhorlim~ont of the ar~i~ul~ting el.dos~ surgic l instrument of the subject invention;

Fig. 21 is an eYrloded view of ~e artic~ ting endoscopic surgical insllulll~,nl of Fig. 20;

Fig. 22 is a p~l~yc~liv~ view of another ell ,ho.l'.,.~ of the articulating endoscopic surgical il~ t of the subject invention adapted for gynecological yl~lu~ Fig. 23 is an r l.lod~l p~ ye~;Lve view of the articulq~ing endûscopic surgical instrument of Fig. 22;

Fig. 24 is a side cross-section~l view of the endoscopic surgical instrument of Pig.

22 with the retractor assembly thereûf in a closed position;

Fig. 25 is a side cross-sectional view of the çndoscopic surgical instrument of Fig.

22 with the retractor assembly thereof in an open position;

Fig. 26 is a side cross-sectionql view of the endoscopic surgical inshun~en~ of Fig.

22 with the distal end portion thereof disyosed in an arti~ulated position;

Fig. 27 is a y~ ~e.-live view of yet anothe~mbodiment of the endoscopic surgicalsl, u~ll.,nl of the subject invention;

~ ig. 28 is an eYrloded ~ y~~ , view of the articula~ng e.ldoscoyic surgical i".;~ ofPig.~7 , ~' ~,è 2~0~2~L3 ;

Fig. 29 is a top cross-sectional view of the aTticulating endoscopic surgical LI w~nl of Fig. 27 ~,vith the retractor assembly thereof in a closed position;

Fig. 30 is a top cross-sectional view of the aTticulating endoscopic instrument of Fig. 27 with the retractor assembly t~lereof in an opened position;

Fig. 31 is a side cross-sectional view of the articulating endoscopic il,sl~ument of Fig. 27;

Fig. 32 is a side cross-sectional view of the articnl~tine endoscopic surgical inshu.l..,nl of Fig. 27 with the distal end portion thereof disposed in an articulated position;

Fig. 33 is a side cross-sectional view o~an endoscopic surgical instrument of the present invention equipped with a removable cervix seal;

' ~ Figs. 34 and 35 are side cross-sectional views of an endoscopic surgical instrument of the present invention having fluid injection s~racture and an articulating sleeve cover, Fig. 36 is a perspective view of another embodiment of the endoscopic surgical i~.sL.ul.l~.l of the subject invention;

Pig. 37 is a p~ ~e ;~ive view of still another embodiment of the endoscopic surgical illsLI ull~nl of the subject in~ ion;

Fig. 38 is an eYploll~ view of the endoscopic surgical instrument of Fig. 37;

Fig. 39 is an exploded view of an alt-,..lati~e em~odill~.,nt of the endoscopic surgical illsllulll~nl of Fig. 37; and Fig 40 is a par~al cross-sectional view of the blade ~ 1." .~ ..t portion of theendoscopic surgical ill~hulll.,nl of Fig. 39.

~ ' Fig. 41 is a cross-sectinn~l view taken along line 41-41 of Fig. 37 illustrating the r' . relative ~ e~,,r~l of each of the blade m~rnl~r~ of the retractor assembly.

D~.TAI~.F.r~ D~.~CR~PTION OF TH~ P~2RFlF.RRF.D l~.MBODIMli.NT The ar icnl~ing e"~osco~:c surgical illSLI ul~ul of the subjecL invention is illus~rated in Fig. 1 and is de~ t~A generally by l~f"le nce numeral 10.

Surgical i,.~l. u...c..t 10 co---~.i~s a handle por~on 12 including a fixed handle 14 and a pivoting handle 16.

An en~10scopic por~on 18 extends o. ~,ogonally from handle portion 12 and includes an ~lon~ted fixed tubular section 20 and an ar~ Cn~ section 22.

The ~r~ tin~ section 22 is pivotal co~ t~ to the fixed section 20 by :

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-9 ~10'~2~3 a pin 24 disposed adjacent the distal end 26 of section 22. A tool head 28 having cooperating jaws 30, 32 depends from the articulating section 22 and may be formed in a wide variety of configurations including graspers, dissectors, or clamps.

Turning to Fig. 2, the handle portion 12 and the a~oci~t~ fixed handle 14 co",~ escomrl;",r.u~ sections24and36whicharemountedtooneanotherbyapluralityof bosses 38 formed on section 34.

The plurality of bosses 38 are arranged for çng~lgl~.ml~.nt in co,l~,s~onding ayel~ul~s (not shown), which are formed in section 36 of handle portion 12.

In addition, each of the comrlim~-nt~ry sections 34, 36 of handle por~on 12 are formed with a portion of a stepped bore 40 which is provided therein for acc~mmod~ting various components of the subject invention, all of which will be desçnhed in greater detail hereinbelow.

Stepped bore 40 includes a Cil~ wllial flange 41 for securing the tubular section 20 of endoscop:c portion 18 in handle portion 12.

The fixed tubular section 20 of endoscopic portion 18 is forrned with a longit-ldin~ slot 42 ~Yten-1ing proximally from the distal end 26 thereof.

Slot 42 is particularly adapted for enabling the pivotal n,uvel"el,t of artic~ ting section 22 about pivot pin 24.

An aperture 44 is provided adjacent distal end 26 for . "~ i, .; ,-g the pivot pin 24.

Pivot pin 24 is provided with a i~ el~ diverging bore hole 25, which is best seen in Fig. 4. A cil.;ul~ Lial groove 45 is formed in the tubular section 20 adjacent the proximal end 27 thereof for enabling tubular section 20 to be securely mounted in the stepped bore 40 of handle portion 12.

The tool head 28 which depends from arhc~ fing section 22 includes cooperating jaws 20, 32, shown here in a clarnp configuration.

Jaws 30, 32 pivot about a pin 46 which passes through ~cliures 48, 50 in jaws 30, 32, lej~ iv~ly and through aperture 52 formed in articul~ting section 22.

Jaws 30, 32 also include camming slots 53, 54 respectively formed in ~e proximal end~s thereof for receiving a camming pin 55.

Pin 55 is mounted in a yoke 56 and is adapted for JlV~ coaxial movement within the fixed section 20 of endoscopic portion 18. A flexible cable 58 having opposed proximal and distal ends 60 and 52 is mounted, at the distal end 62 thereof, to yoke 56, and at the proximal end 60 ~ereof, to the distal end 64 of a plunger member 66.

Plunger member 66 includes a head portion 68 which is retained in a pivotal clip assembly 70 having opposed cornpli..,~,nt~ sections 72 and 74.

Opposed clip sections 72 and 74 are mounted to one anotht r and a~c disposed wilhin a port 76 fonm~d in he pivohng handlo l 6 0f h tndlo ponion l2.

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--1 0-~0~2~3 .~ Movements of pivoting handle 16 thus causes collG~ollding coaxial movements of plunger member 66.

Referring now to Figs. 2 and 3, the endoscopic surgical insLIul.lenl 10 of the subject invention further includes a linkage assembly which is q~sori~tPd with the endoscopic portion 18 and handle portion 12 for pivoting the articulqting portion 22 thereof.

The linkage assembly includes an elongq~P,d push rod 78 having opposed proximal and distal ends 80 and 82, with the proximal end 80 thereof being formed with an aperture 84 for receiving a pin 86.

In addition, rod 78 includes a mounting flange 88 provided on the distal end 72 thereof which include an aperture 90 for receiving a pin 92.

Pin 92 functions to pivotally connect a link rod 94 to mounting flange 88 through an aperture 96 disposed in the proximal end of link rod 94.

Link rod 94 is provided with an aperture 98 in the distal end ~ereof, through which a pin 100 extends to be pivotally mounted in an aperture 102 which is provided in articulating section 22 of endoscopic portion 18.

The linkage ml~rh~ li~m of the subject invention further includes an elongated gear rack member 104 which is capable of being reciprocated in an axial direction.

Gear rack member 104 which is capable of being l~iyrocdt~d in an axial direction.

Gear rack member 104 is forrned with cilcu~ Gl~ tial gear teeth 106 and an . xial bore 107 which is provided to permit flexible cable 58 to extend through so as to reach plunger member 66.

Gear rack member 104 is further provided with a mounting flange 108 having an aper~ure 109.

Pin 86 extends through aperture 109 and is mounted in aperture 84 so as to connect rack member 104 to the proximal end 80 of push rod 78.

An annular pinion gear 110 is mounted on a sh~t 112 ,a~ot-;qt~d with handle portion 12.

Pinion ge. r 110 meshes with the C~t~un~ Lial ge~ teeth 106 on rack member 104.

Rot. tion of pinion gear 110 is achieved by rotating a pair of opposed wing ~I~enlb~,ls 114 and 116 which are mounted on the opposed ends of shaft 112.

The endoscopic surgical instrument 10 of the subject invention further co~ 5es am.~rhq~icm for rotating the endoscopic portion 18 about its 1ongihulinq1 axis relative to handle portion 12.

This ~ ,ch 3 n ;~, ., c~ ;ses . n annular bushing~ 120 that is col~c~ ;r,qlly mounted within a rotatable collar l~ mounted within the stepped bore 40 formed in h. ndie portion 12.

Bushing 120 is ., ~ ;I.ecl against collar 122 by a coiled spring 124 disposed in a section of bore ~0.

Spring 124 acts to bias bushing 120 toward the proximal end of the surgical i~lSLlUlllt~lL 10.

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211 ~62~3 proximal end 27 of fixed section 20 of endoscopic portion 18 extends through bushing 120 and is mounted therein for rotation.

Referring to Figs. 3-6, the operation of the cooperating jaws 30 and 32 of tool head 28 is accomrliched by moving the pivoting handle 16 as shown in Fig 3.

Upon moving the pivoting handle 16, the head 68 of plunger member 66 travels axially causing cable 58 to translate.

In order to close the cooperating jaws 30 and 32, which are normally open as illustrated in Fig. 4, the pivoting handle 16 is squeezed by the surgeon, thereby causing the plunger mernber 66 to pull cable 58 in a proxirnal direction.

The ll~ovelll~,nl of cable 58 causes a co~ ,o~"l;ng axial movement of yoke 56, as shown by the indicator arrow in Fig. 6.

Inparticular, the ~l~ove~ent of yoke 56 causes pin 55 to carn proximally within slots 53 and 54 of jaws 30 and 32 l~,~e~ ely, so as to cause jaws 30 and 32 to close.

Turning now to Figs. 7-10, the pivoting mo~ ,nl of the artic~ ting section 22 of endoscopic portion l8 is ~rc-)mrli.~h~d by rotating wing members ll4 and ll6 to a desired angular position.

More particularly, a detent eng;lg-ng member 118 is coaxially mounted on shaft 2 along with wing ~ "~ l l4 and l l6 which can rotatably engage in yarious ~ h ~ " ~;"p~ positions in~licnt~d on handle portion 12 which cull~ ol d to 30D, 60~, or 90~of rotation de pc n,l;"g UpOIl the surgical procedure being ~l-,folllled.

To pivot the tool head. 28 angularly with respect to the longihl~l;n5,l axis of the oscopic por~ion 18, the wing members 114 and 116 are rotated in a counter clockwise direction.

This counter-cloc~wi~e rotation causes pinion gear 110 to rotate on shaft 112 in a counter-clockwise direction.

Simlllt~neously, gear rack member 104 adva.~ces proximally within stepped bore 40 causing the el~ n~tffl push rod 78 to advance proximally along the longihulin~l axis of ~n~lscopic por~on 18.

Link member 94 is pulled in a generally proximal direction, a shown by the indicator arrow lunning parallel to link member 94 in Fig. 7, causing the a~ nl~ting section 22, and the ~s.oc: ~:d tool head 28, to pivot in an ~ngular direction about pin 24.

Once the art~ ting section 22 is in a desired angular position relative to the longit~ in~l axis of endoscopic por~on 18, the COO~al ing jaws 30 and 32 may be opened or closed by ol~erating the pivoting handle 16 in handle portion 12 as lli~,u$sed previously.

Tuming now to Figs. 11-15, an alternate embo lill-cnt of ~e tool head 28 of the endoscopic surgical in~l~un~c~ 10 of ~e subject invention is illustrated. ~ ~his embo~lilnent, ~e tool head 28 includes coopolclting dissecior jaws 150, 152 which are pivotally mounted on the ~ '~ .

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,, . . . . . ~ ~ --12- ' 21062~3 a~ic~ ting section 22 of endoscopic portion 18. F~ ore, dissector jaws 150, 152 are provided with camming slots 154, 156 l~s~lively formed in the distal ends thereof.

As in the ylur~ d embodunent, c~mrning pin 55 is acc~J~ dated within slots 154, 156 and slides in response to axial movemenes of yoke member 56 when the pivoting handle 16 is operated to open and close jaws 150 and 152.

Referring to Figs. 14 and 15, when link rod 94 is moved in a generally proximal direction, tool head 28 pivots relative to the lon~itn-lin~l axis of endoscopic portion 18.

Upon reaching a desired angular position, the cooperating dissector jaws 150 and 152 may be opened or closed by op~,.aling pivoting handle 16 of handle porti~n 12.

Moreover, when pivoting handle 16 is operated, cable 58, which extends through the diverging bore 25 formed in pivot pin 24, pulls on yoke member 56 causing pin 55 to slide within slots 154 and 156, thereby opening or closing the dissector jaws 150 and 152.

Tuming now to Fig. 16, an alternate endoscopic surgical illsi u~ nt 200 of the subject invention is i~ t~ Surgical illsL.u...~l.t 200 co~ es a handle portion 202 configured as a pistol-glip, and an endoscopic portion 204.

Endoscopic portion 204 includes a fixed tubular section 206 having opposed distal and proximal ends 208 and 210, and an ar~i~nl~iting section 212 which is pivotally conne~Pd to the f~ed section 206 by a pivot pin 214 disposed adjacent to the distal end 208 ~ereof.

Surgical insLIulll~,nt 200 further c~ cs an elongated paddle 216 which depends ~rom artirul~ting section 212 and which is intendc-d for use as a retractor tool during surgical ~vce lul~s.

An elecllocaut~ c~ f ~t, ,~ 213 is provided and extends from the handle portion 202 for Cdut ~ ;on of tissue at the surgical site during the surgical ~lvc~lu c.

The co.-.~ecl~-~ 213 is in electrical c~nnec~ion with the tool 216.

In order to protect the surgeon who is using the device from electrical shock, the handle 202 is ~ reldbly co~stlu~iied of a rigid non-conducting material which renders the a~alu;, lightweight and elcctrica~y in~ t~1 Referring to Fig. 17, surgical h~s~lu~ ,nt 2C)~ is provided with a linkage assembly that is similar to the aiss~,l..bly provided in the ~,~,f~l~ embo li,~enl of the subject i.l~en~ion.

It c(...~ es an .ol~ngiPt~d push rod 218 which is pivotally cl nn~rted to a link member 220 by a pin ~2.

Link member 220 is pivotally con~ l to articulating sestion 212 by a pin 224.

Referling to Fig. 18, the linkage assembly also includes an annular pinon gear 226 which is mounted for ''' .. . . , . ,: . : :

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- 13 ' 21~62~3 rotation on a shaft 228 provided in handle portion 202.

Wing ll~l~ 230 are coaxially mounted on shaft 228 for rotating pinon gear 226.

Pinon gear 226 meshes with a reciprocating gear rack member 232 disposed within the stepped bore 234 which is formed in handle portion 202.

Furtherrnore, gear rack member 232 is conne iled to elong~t~d push rod 218.

Surgical insLI ulllent 200 also includes an assembly for rotating the endoscopicportion 204 about its longihl~linq1 axis.

The rotating assembly includes an annular collar 236 which is disposed within a port 238 formed in bore 234, and an annular bushing 240 concPntri~ ~lly disposed within the annular collar 236.

Bushing 240 is provided for ~cco, ~ .odating the proximal end of e.ldGsco~ic portion 206, which is mounted therèin for rotation. A coiled spring 242 is disposed within stepped bore 234 for biasing bushing 240 in a proximal direction so as to maintain it within collar 236.

Referring now to Fig. 19, to lower the retractor paddle 216 into a position parallel to the longitudinal axis of endoscopic portion 204, the wing m~.ml~r.c 230 are rot~ted in a clockwise direction.

This clockwise rotation of wing m~.mbe.rs 230 causes a clockwise rotation of pinion gear 226 about shaft 228.

Cons~ucnlly, gear rack member 232 is caused to advance distally along the axis of endos * ~~ portion 204.

Push rod 218 adY~ccs distally within the fixed section 206 of elldoscop;c portion of 204.

Upon advancing, push rod 218 causes link member 220 to move in a generally distal di~ction, ~ereby causing paddle 216 to pivot dvwllwal~lly, as shown by the in~lieat( r arrow in Fig. 19.

Turning to Figs. 20 and 21, an alt~ ali~ ndosco~:c surgical illsl-ul~lcnl 300 of the subject ill~ erlL~n is ill - ~.

Surgica1 ir ~ wn~nl 300 is structurally similar to the ~ rcl.~ c .~lhO~ r~ll of the subject ulve~llion.

However, the Iange of operability of the tool head 28 of surgical inshulllent 300 is distinct in th-at it can be pivoted in a h~ri7Ont~1 plan with respect to the e.~dG~ol)ic portion 18 of surgical ihl tll Ulll~ nl 300.

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.:. ' ":- : , ' ' ' ', :, '': ' " ;, ~',, ' ' -14 ., 2106243 In this embodirnent, ~he components and function of the linkage assembly remainsessçnti~lly the same as in the pl~r~ll~ emho~limPnt In particular, annular pinion gear 110 which is mounted on a shaft 112 in handle portion 12, meshes with the ~ .;un~ lllial gear teeth 106 of gear rack member 104.

The proximal end 80 of the ~long~ted push rod 78 is piYotally conn~cted to the flange 108 of gear rack member 104 and the distal end 82 of the elongated push rod 78 is pivot~lly coml~led to link member 94 by a pin 92.

The linkage assembly of surgical instrument 300 is o~di~,.,ly CO"~ i to an ar~ ting section 302.

Articulating section 203 includes a slotted distal portion 304 and a ~ lal portion 306 having a bore 308 for receiving pivot pin 24. A cleat 310 extends outwardly from the proximal portion 306 af articulating section 302 and includes an aperture 312 for receiving a pivot pin which connects the link member 94 to the articulating section 3 0 2 .

To pivot the tool head 28 angularly, in a hori7l~nt~l plane, with respect to thelo~giturlin~l axis of the endoscopic portion 18, the wing members 114 and 116 are rotated.

Simnl~nPously, gear rack member 104 advances wi~hin stepped bore 40 causing the elong~t~d push rod 78 to advance along the lon~ihlAin~l axis vf f n~los~opi~ portion 18.

Movement of the l long~ push rod 78 causes link member 94 to pivot in such a manner so as to cause the articulating section 302, and the ~SC~Ci?~ tool head 28, to pivot in an angular direction about pivot pin 24 Once the articl-lqtin~ section 302 is in a desired angular position relative to the l~ngitn~lin~l axis of ~n~os . ~ portion i8, the cou~~ g jaws 30 and 32 may be operated by rnanipulating the pivoting handle 16 in handle portion 12 as ~1;5"~csed hereinabove.

Referring to Fig. 22, another endoscopic surgical insllul~lent 400 of the subject invention is ill ' A ~1 which may be used as a retractor during gynecological procedures and particularly as an ;..l.,.. ~ retractor.

Surgical i~ ul"tlll 400 conlrri~es a ~.lbsl~tially barrel shaped axial handle portion 402, and an elongated endoscopic portion 404 which extends outwardly from handle poItion 402.

Endoscopic portion 404 includes a tubular section 406 by a pivot pin 414 adjacent the distal end portion 410 thereo~. A retractor ass-embly 416 is operatively Qccoc;Q~d with ~e ar~i~ulQ~in~ section 412 0f clldosco~:c portion 404 alld includes a pa~ of cooperating a~ ie rod .~ 418 and 420 each having ~iylin~ical bodies with blunt heads configured so as not to cause darnage to tissue during retraction p uc~ s.

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--15-21~2~ Turning to Fig. 23, the handle portion 402 of surgical retractor 40û includes a twopart handle having right and left mountable hemi-sections 422 and 424.

Once ~Csen hled, the hemisections 422 and 424 defined a stepped axial bore 42~ which extends through the handle portion 402.

The axial bore 426 has a proxirnal chamber 428, a primary medical chamber 430, a secondary medial chamber 432, a teItiary medial chamber 433, a ~luatcl~y medial chamber 434, and a distal chamber 436 defined therein.

The handle por~ion 402 houses, within the axial bore 426, a driving assembly which manipulates the retractor assembly 416, and a camrning assembly which manipulates the articulating section 412 of endoscopic portion 404.

The driving assembly of surgical insLIuh~ent 4û0 includes knob member 438 and an~cSOri~t~ threadably advanceable driving screw member 440.

Knob member 438 comprises a proximal grasping portion 442, an intPnn~ te cavity portion 444, and a distal engaging poItion 446. A threaded axial bore 448 extends at least partially through the knob member 438 from the distal enga~ing portion 446 thereof to the proximal grasping portion 442 where it is capped by a threaded closure membPr 450.

Knob member 438 is mounted within the axial bore 426 of handle portion 402 in such a manner so that the distal ~n~ing portion 446 thereof is n~i"l~;nPd within the ,~ plimary medial chamber 430 of axial bore 426 which the ;.. l~ i cavity portion 444 is ."~;"1~;"~1 within the proximal chamber 428 of axial bore 426.

Once mountsd, knob member 438 ~ is rotatable about the lonp~ihl-1in~l axis of handle portion 402.

'-- The d~iving screw member 440 of the driving assembly c~ " 'l" ;~es an elongated threaded body portion 452 having a proximal end portion 454 which engages Optl ~ively within the threaded axial bore 448 of knob memb r 438, and a distal head portion 456 which extends from the i threaded body potion 452 thereof.

Lateral slots extend along ~he body portion 452 of screw member 440 for coo~laLively Pn~eing prol ~ S 457 projecting radially into the 5~,ccln~1u,y .

medial chamber 432 of axial bore 426.

The ~n~g~ nt of the pfoiub~lance 457 within lateral slot 455 prohi~it~ rotational mo~e.nent of screw member 440 when the knob member 43~ is rotated and in qd~lition~ provides guidance for the screw member 440 within the axial bore 426.

A bore 458 extends axially into the distal head potion 456 of the driving screw member 440 for p~ ; Ll; l~g retsntion of elements of endoscopic portion 404 therein. A ~ns~ e aperture 460 is provided in the head portion 456 of screw member 4~,LO for i~CCQ- I l- - ~oi~ting a two;' part universal locking clip 462, 463 which engages an element of endoscopic portion 404 extending , ~ .

.

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': ' ' '', ' . ' ' ' ' . ,' ' '.',: ' .' '. ':,, .,', ': ,,' ' :' ''.. '. :'.: , :' - -16 - 2~2~3 into bore 458.

Once mounted within the handle portion 402, the threaded body portion 452 of screw member 440 is ~ Aill~d partially within the secondary medial charnber 432 of axial bore 426.

Rotations of the knob member 438 relative tot he handle portion 402 will cause corresponding axial trAnsl~tion of the driving screw member 440 within the secondary medial chamber 432 of axial bore 426 in handle portion 402.

The c~mming assembly for manipulating the artic~ ting section 412 of endoscopic portion 404 includes a cylindrical cam follower having right and left hemi-portions 464 and 466 mountable to one another by bosses such as, for eY~mple boss 468 on right hemi-portion 464.

An axial pathway 470 is formed in the cylindrical cam folrower 464, 466 for accol"-lloddling elements of endoscopic po~tions 404.

In particular, an annular groove 471 is formed therein for engagement pu~poses. A cam follower post 472 projects radially outward from the periphery of left hemi-potion 466 and travels within cam slot 474 formed in the left herni-section 422 of handle portion 402.

The carn slot 474 is d;sposed wi~in a ~ i~culnrGl~,nlial groove 476 defined in the outer su~face of handl~ portion 402 external ~om the tertiary medial chambe~ 433 of axial bore 426.

The ~iylin~llical cam follower 464, 466 is adapted and con~lgured to move axially and rotatably within the tertiary medial charnber 433 of stepped axial bore 426 in response to rotation of a two-part manipulating collar having right and left hemi-portions 478 and 480 mountable to one another by molmting projections, such as, for eY~rnplP, mounting projection 482.

An aperture 484 extends radially through hemi-portion 478 of the manipulating collar for receivably ~.ng~ging the cam follower post 472 so as to Op-,la~ ,ly interlock the elements of the c~rnming âssembly.

Rotation of collar 478, 480 will cause cam post 472 to be driven in a cam slot 474 causing axial a~l~a re~ of the c~nming assembly relative to the handle portion 402.

The endoscopic portion 404 of surgical instrument 400 extends from handle portion 402, and col . 'l"; ~ s a plurality of coaxial tubular . .

Ir~ in~lnrling an ooter tubular member 490 having an axial bore 492 nd a stepped proximal end which defines a first annular ridge portion 494, and a second annular ridge por~ion 496 for mounting the en~doscopic portion 404 to handle por~on 402.

The first annular ridge portion 494 is ~"~ A;nfd in the 4uanlen~u~ medial chamber 434 of axial bore 426, while the second annular ridge portion 496 is l . .~ d in ~he distal chlnber 436 of axial bore 426 for mounting the endos~ol~ic po~ion 402 to handle por~on 402.

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- . -. : , .. :, , - , - - --17- 2 ~ ~ Endoscopic portion 404 also includes an inner tubular member 500 having an axialpassageway 502, and a proximal annular mollnting flange 504 flim~n~;oned for locking Png~çmPnt in the armular groove 471 of the axial bore 470 in cylindrical cam follower 464,466.

An internal control member 510 extends through the axial passageway 502 of inner tubular member 600 and includes an outer sleeve 5129 and a central rod 514.

Central control rod 514 has a proximal tail portion 516 which is ~ng~g~ble within the distal head portion 456 of screw member 440 by the twopart universal clip 462,463 such that axial tr~n~l~t;on of screw member 440, in response to rotations of knob member 438, will cause co.~ olldil~g axial ~¢anslation of the center control rod i~ 514 within çn~loscopic portion 404. A distal end portio~n 515 of central control rod 514 is flexible 1' for F~ g operation of the retractor assembly 416 when rhe ar~culating section 412 is pivoted into an o~laLive position.

The distal end portion 410 of endoscopic portion 404 defines a sleeve member ~- which includes a yoke poItion 518 having a longit~ in~lly extending slot 520 provided therein '~' defining a pair of opposed ~lepPn-ling anns s~ and 524 for acch,- 111 ,orl~ing pivotal ~n( ve~llenl of the articulating section 412 relative to endoscopic poItion 404.

Apertures 526 and 528 are . respectively provided in the opposed de~ ,~ g arms 522 and 524, and a tail po~tion 530 extends proximally from the yoke portion 518 thereof with a cil~,un~e~enlial grooYe 532 provided therein.

A tang 534 is fonned adjacent the distal end of the outer tubular portion 490 for lockingly en~ging the c~ groove 532 in tail portion 530 of yoke portion 518 when it is e~t~n-l~1 into the axial bore 492 thereof to connect the distal end portion 419 tot he r~.m ~:n-ler of endoscopic por~on ~; 404.

In addition, an axial pasjag~ và,)~ of at least the distal portion 515 of central control road 514.

. ~ Surgical i~ n~,.lt 400 furd?er co"~i";~es a linkage m~ch~n;~m for moving the ar~c~ ting section 412 of endoscopic portion 404 within a defiIned angular degree of rotation.

The linkage, . ,~,l ~ . " includes a base link 540 having a body portion 542 and a tail portion defined by an ~ e~ elltial groove section 544 and a proximal annular section 546.

Base link 540 is secured within the axial pas~d~v~ 502 of inner tugular portion 500 by a tang 545 forrned adjacent the distal end of inner tubular portion 500, and configured for en~ing the cil~;u-~ enlial groove section 544 thereof. A cen~ral passageway 548 extends through base link 540, adjacent the lower edge thereof, ~or ar~o"~,nod~ g a proximal phot pin S52 which int~r links the base link S40 with a col~n~li~v Iink 554 through a proximal aperture 556 provided therein. A distal aperture 558 ;~.; ,.. .

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'; is also provided in connective link 554 for accommo lAtin~ distl pivot pin 560 which is received in a corresponding aperture 562 provided in the proximal portion 564 of artirulA~in~ section 412 adjacent the lower edge thereof, Thus, connective linl~ 554 functions to interlink the articulating section 412 to the base link 540 of the linkage .I,f~l.,l);~....

~. The areiculating section 412 of endoscopic portion 404 has a centrally disposed transverse aperture 566 formed in the proximal portion 564 thereof for Arcnmm~Atin~ the main pivot pin 414. A longihulin~l aperture 570 extends through the art;c~ ting seceion 412 for ,, p~.. ,.;ll;.. ~exeensionofthecentralcontrolrodmemberS14~ etll.uugh.

Artir~ tin~:section4l2 '~i further includes opposed depending yoke arms 572 an~ 574 each having an aligned longit~ in:

~ cam slots 576 and 578 formed therein les~P~ ,ly, for coop~l~ting with a c n follower pin 580.

.~ addition, opposed aligned pivot ports 582 and 585 are provided in the lateral yoke anns 572 and :~ 574, r~,~eclively.

The coopclaling ~ n ,~ lAlir retractor rod mP.mh~.rs 418 and 420 are pi-votably ,. connPctP~l to the opposed lateral yoke arms 572 and 574 of arhrlllAting section 412 by en~Pn~Pnt . of a pivot pin 586 within the opposed pivot ports 582 and 584, md also within COlle~Ol~ding pivot ports S88 and,-59O provided in the retractor rod mP.mh~.rs 418 and 420, lc;~eclively.

Sylll~ y s.disposed angular camming slots 592 and-594 are also formed in retractor rod member 418 and 420 ely; for workingwith cam follower pin 580. A transverse bore 596 is provided in pivot pin 586 for p~ ;ne of a portion of the distal end l5 of centrl control rod 5l4 ~ Gtlllo~lgh~ and a llans~ e bore 598 is provided in c~rnmin~ pin 580 for receivable eng~gin~ a distal end portion of ' central control rod 514.

The t~nin~ion of ~e distal portion SlS of cen~ral control rod 514 within cammingpin 580 achieves complete col~n~iLivi~ between the driving assembly in handle portion 402 and the ' A. retractor assembly 416 of endoscopic portion 404. MO1GOY~, axial muv~ c lt~ of the central control rod 514, in response to axial tr~n~lqtion of driving screw 440, will cause cûll~ olldillg coop~ live movement of the retractor rod ~ 418 a~d 420 through ~e tr~n~l~tion of eS~mmine pin 580 relative ~o the angular cam slots 592 and 594.

Referring now to Figs. 24-26, the surgical ~I-sl-u---~--i 400 may advantageously be employed as a rehactor during ~ .Ec ~ ,ir ~l yr~ w~s by rotating the knob membe~ 438 cuuntelelockwise (as viewed ~om the proximal end of the i~ unlcnl) to move the couy~lali~re :

:

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--19-21~6243 retractor rod members 418 and 420 from the closed position of Fig. 24, to the opened position of Fig. 25.

More particularly, upon rotating knob member 438 counterclockwise, the drive screw member 440 will translate in the direction of arrow "C".

As screw member 440 retreats, the tail portion 516 of the central control rod 514 is pulled in a proxirnal direction causing the camrning pin 580, which is fixed to the distal end thereof, to move proximally within the angled cOmmin~ slots 592 and 594 of rod Illcn~b~ 418 and 420.

Distal movement of camming pin 580 within ci~mming slots 592 and 594 causes the cooperating retractor rod members 418 and 420 to open in the direction of arrow "B".

Closure of rod members 418 and 420 is achieYed through counter rotation of knob member 438.

Transposition of the rotation from counterclockwise to clockwise for purposes of deploying the retractor assembly is also with the scope of the invention.

Turning now to Fig. 26, in operation, the articulating section 412 of endoscopicportion 404 may be pivoted in the direction of a~row _E" within a vertical plane widl Iespect to the !- ngitudini~l axis of endoscopic portion 4Q4 into various angularly disposed positions.

To achieve this articulated m~ .nent, the manipulating collar 476, ns is rotated dockwise (as viewed from the proximal end of the h~ ulnent), causing cylindrical cam follower 466,468 to rotate conro~ y i~ .

As a cam follower 466, 468 rotates, the cam post 472 ~ncik~t~.s within the cam slot 474 f~om a first position, best seen in Fig 24, wherein collar 478 is in its proximal most position within ci,.;ull,r~ nlial groove 476, to a second position, best seen in Fig. 25, wherein collar 478 is in its (li~t~lml)st position within groove 476.

The axial ~n~ n of ~,ylin~Lical cam follower 464, 466 causes the inner tubular portion 500 of endosco~hc portion 404 to move in a distal direction, since the proximal flange 504 of inner tubular portion 500 is engaged in the groove 471 defined in passageway 470 of cam follower 464, 466.

As inner tubular por~on 504 moves distally, it extends oulw~dly from the axial bo~e 535 in the sleeve member defined by the distal portion 410 of endoscopic portion 404, such that base link 540 is urged distally within the slotted area 520 of distal portion 410. TIIe1~JPOI1~ connective link 554 is urged in a generally distal direction, pivoting about pivot pins 552 and 560, and causiilg the articulating section 412 to be pivoted angularly with respect to the longi~l-lin~l axis of endosc~")ic portion 404 about the main pivot pin 414.

The angle of vertical l, ,,,~cl ~ ;o-- of ~ section 412 can vary depr,n(l;~-~ upon the degree of rotation of manipulating collar 478.

In addition, once in an articulated position, the .

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'' ', ''' ' '' ' ' . , ' '' ' ' ' " . ' ' ' ' . ' ' '' ' : ' ' ' ~ - - - - ; -20210~2~3 retractor assembly 416 can be manipulated incl~.pe.~ ly, since dle distal encl portion 515 of the central control rod 514 is snbst~nti~lly flexible, as seen in Fig. 26.

Transposition of the rotation from clockwise to counterclock~-vise for articulating the instrument is also within the scope of the invention.

Turning to Fig. 27, yet another embodiment 600 of the articulAting surgical retractor of the subject invention is illn~trAtP,d which may be used endoscopically or during laya~OscOyic proced u~s within the ~hdomin~l cavity.

Surgical ill~Llulnelll 600 comrriges an axial handle por~ion 602, and an clol-g~ l endoscopic portion 604 extending from the axial handle portion 602 and inrl~l~ing an elongated tubular section 606, and an artir'~ ting distal section 608 pivotably connP~t~ to the P~ g7't~1 tubular section 606 adjacent the distal end thereof by a main pivot pin 610. A retractor assembly 612 is opel~Lively ~soci itp~l with the articulating section 608 and includes a plurali~,r of coopelaLive interleaved retractor blade n~eillbcl~ 614, 616, and G18.

j:!' Referring to Fig. 28, the hanclle portion 602 of surgical ill~L~ument 600 is s.~l~s~ lly identical to that of surgical il~sLI ulll~,nt 400.

It comrriges l..o~ le right and left herni-sections 622 and 624 having a stepped axial bore 626 ~xt~n-1ing lhc;~ ugh defined by a proxirnal chamber 628, a primary medial chamber 630, a secondary medial chamber 632, a tertiary - medical chamber 633, a 4~J~ 1 medial chamber 634, and a distal chamber 26.

The handle . r portion 602 houses, within the axial bore 626, a driving assembly for manipulating the re~ractor as ,en.bl~, and a c I "...;,-g assembly for manipula~ng the ar~irul~ting section 608 of endosc~ic portion 604.

llle cl~iving assembly includes a rotatable knob member 638 and an a~ially a.lv~c~able driving screw 640.

Driving screw 640 varies from the driving screw 44~) of surgical il'lSLIw~ 400 in that it includes a body porlion 642 haYing a distal head portion 644 provided with a l,~ e slot 646 for accommod~ting a LldllS~ i planar engaging clip 648.

Engaging clip 648 is formed wi~ a Jetention notch 650 for lockingly retaining an ~cl~ e element of endoscopic portion 604.

The hlob mem~r 638 is formed with an inte~nal ~readed bore 652 eYt~rlding at least par~ally ~ u~gh for op~ ,ly en~gin~ the driving member 640, and which is covered by closure member 654.

The c~mming assellll,ly includes a cylindrical cam follower haYing mount~ble right and left herni-sections 656 and 658 configu~d for rotational and axial movement within ~e teltiary ~' .

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-212 ~ 2 ~ 3 medial chamber 633 of axial bore 626. A c5.. l ....i .~ post 660 extends radially outward from the p~ hv.y of left hemi-section 658 and is dimPncioned for trangl~ting within a cam slot 662 formed in a ~ uu~ vlllidl groove 664 defined in the outer surface of handle po tion 602 external from the tertiary medial charn'oer 633. A rotatable manipulating collar defined by mountable right and left hemi-portions 666 and 668 is configured for being mounted in ci'uul''re'v'~tial groove 664 and includes a port 670 for receivably engaging the cam post 660 so as to intPrlo-~r the elements of the camming assembly.

Rotation of manipulating coliar 666, 668 will cause translation of cam post 660 in cam slot 662, and consequent axial translation of the cylindrical cam follower 656, 658 along c the axial center line of the handle portion 602 with the ~ertiary medial chamber 633.

'~ The vndoscù~;c portion 604 of surgical i~,sL~ulllen~ 60nv co.. ,~ es a centra~ control rod 680 having a tail portion 682 which extends into an axial bore 684 in driving screw member ' ~ 640 to be lockingly engaged therein by the notch 650 in locking clip 648.

In doing so, the axial tr~nC1~ion of the driving screw 640 will cause cullv~on~ling axial Illuvenlvn~ of the control rod 680. A conn~li~,v rod 686 is engaged in the distal end 685 of control rod 680 for i,lt~.onne~l;..g the retractor assembly 612 with the control rod 680.

Connective rod 686 is hexible to permit operation of the retractor assembly 612 when the articulating section 608 of endoscopic portiûn 604 is pivoted into an ~.,l,llive position..

Endosco~:c portion 604 further colll~lises an inner tubular portion 690 having an annular flange 692 formed ont he proximal end thereof.

Flange 692 is "~ ~lim~on~ion~d for eng~m~nt in a cil~;ull~t;lc;nLial groove 694 formed in the axial bore 696 of the lin~ical cam follower 656, 658, such that the inner tubular portion 690 will translate axially when the cylindrical cam follower 656, 658 moves within the tertiary medial chamber 633 of axial bore 626.

The inner tubular portion 690 is disposed within the outer tubular portion 698 whîch ; is provided for a lon~itl~lin~lly extending slot 700 in the distal end portion thereof for a~o..~ tin~ the pivotal nlùven~ ls of ar~icul ~in~ section 608. A LlallSVtl~ aperture area 702 is defined adjacent the proximal end 704 of the outer tubular poRion 698 for recçiving a radially inwardly projecting stem 706 disposed in the distal chamber 636 of axial bore 626 in handle portion 602. F.n~ of stem 706 in aperhlre area 702 achieves ISxation of the endoscopic portion 604 ~;~ and the handle portion 6û2.

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~ -22 21~62~3 A primary yoke member 710 is mountable in the distal end portion of the outer tubular portion 698 which comprises a body portion 712 having a pair of opposed lateral yoke arms 714and716de~ .ling~ efion~anddefiningaslottedarea718 therebetween. A ci~cu~ el~tial groove 720 is provided in the body portion 712 for being engaged by a locking tang 722 formed adjacent the slotted area 700 in the outer tubular portion 698.

Opposed pivot ports, of which 724 is one, are defined in the opposed lateral yoke arms 714 and 716 for arcomm()dating main pivot pin 610 which is formed integral with the articul~ting section 608 of endoscopic portion 604.

A linkage assembly ;..t. ..li~-L ~ the ar~iclllati~ section 608 with the inner tubular portion 690 of endoscopic portion 604.

The linkage assembly includes a base link 730 having a body portion 732 from which e~tends a proximal tail portion 734 provided with a ci.~ elenlial groove 736.

The tail por~ion 734 is adapted to be eYten(led into the distal end 738 of inner tubular poltion 690 and is . . . ~ therein by a locking tang 740 which is engagable in the circumferential groove 736.

An axil bore 742 extends through the base link 730 for pf ....;~ g passage of roml~iYe rod 686 therethrough.

In addition, an aperture 744 is provided in the body portion 732 of base link 730, adjacent the upper edge thereof, for receiving a proxirnal pivot pin 746 which int~-rlinl ~ base link 730 with a conne~live link 748 through a proximal aperture 750 formed therein.

Conll~ivc; link 748 has a distal aperture 752 for receiving a distal pivot pin 754 which is provided for intprlinking collile~ e link 748 with the articulating secdon 608 of endoscopic portion 604 through an aperture 756 provided in the proximal end portion 758 of artic-llating section 608.

Axial translation of the inner tubular po~tion 690, in Ic;s~onse to Inc, ~ .lt of the carnm;~g assembly, will cause the CC~ ,s~Oll~illg translation of the base link 730 within the slotted portion 718 of prim. ry yoke m--ember 710, whereby the connective link 748 will move generally axially to cause pivoting Illo . ~ Gl~L ~f ~1;.~ g section 608 in a vertical plane relatiYe to the ll~n~itu~lin~l axis of the ~.~dGscop:c portion 604 of surgical instrument 600.

The articulating seetion 608 of ~n(loscopic portion 602 is formed with a sloned area 760 for açcollll~ g the retractor assembly 612 of surg~cal illsLIun~e~t 600.

The retractor asse..,bly 612 includes a secollda.y yoke member 762 having opposed upper and lower yolce arms 764nd766definingaslottedretractorblade...~ ;n;ngarea768~ bGI~.,en.

Opposed y ~ guide slots 770 and 772 are provided in upper and lower yoke arms 764 and 766, lG;~ ly, as well as opposed pivot a~,.Lu,~,s 774 and 776, lGsp~,Li~vly. A guide pin ;~ .

-23 ~ 21~2~3 778 extends through a ,n~ .. g aperture 780 in ~e artiç~ ting section ~08, and into the opposed guide slot 770 and 772, while a carnn~ing pin 782 extends through the opposed pivot ~ ,s 774 and 776.

Guide pin 778 and camllung pin 782 both cooperate with the interleaved retractor blades 614,616, and 618.

More particularly, CO~ ,onding pivot ports 814, 816 and 818 are provided -s~ cly in the inte.ledYed retractor blade 614,616, and 618, for receiving guide pin 778.

Retractor blades 614,616 and 618 are made of a suitable surgiral material having snffiri~nt strength for the desired retractor function.

Such m ~t~ri~l~ include stainless steel, plastics and/or co..~l.;ni~;ons thereof. C'~rnming slots are provided in the retractor blades for working with c~mming pin 782, and include an angularly disposed c~rnming slot 824 is formed in retractor blade 614, a longit-l-lin~ y disposed c~mming slot 826 is forrned in retractor blade 616, and an angularly disposed c~mmin~ slot 828 is formed in retractor blade 618. ('~mming slots 824 and 828 are alTanged in ~ leLIical r~l~tionchir, such that translation of the camming pin 782, in response to ,.n~nls of secondary yoke member 762, ~-vill cause a fan-like deployment of the i/ t~lledved r~tractor blades 614,616, and 618.

Refe~ing to Figs. 29-32, in use, the retractor blade assembly 612 is moved from the closed position illustrated in Fig. 29, to an opened position illustrated in Fig.30, by rotating the knob member 638 counterclockwise (as viewed from the proximal end of the insLIulllenl) to cause Cul~ o~ axial tr~nClotion of screw member 640 in the direction of aTrow _G", within the axial bore 626 of handle portion 602.

As driving screw member 640 retreats, the tail portion 682 of the central control rod 680 is pulled proximally, along with the colme~ e rod 686, the distal end of which is fixedly mounted in the proximal end of second~ yoke member 762.

At such a time, the opposed g ude slots 770 and 772 in secondal ~ yoke member 762 permit relative tr~n~ on of seconda~ yoke member 762 in relation to the guide pin 778.

Ful~el~llore, as the secondary yoke member 762 is drawn in a proximal direction, cqmmin~ pin 782 Ll~"cl ~-r s proximally within the camming slots 824,826, and 828 of the retractor blades, causing the illlclleaved retractor blades 614,616, and 618 to deploy in a fan-like configuration.

Turning now to Figs.31 and 32, to pivot the articulating section 608 of çn~oscopic portions 604 in the direction of alrow "H" in a vertical plane with respect to the longit~l(lin~l axis of scop c portion 604 during a surgical P~ UIG~ the manipulating collar 666,668 is rotate do~kw;~c (as viewed from the proximal end of ~e instrumçnt), such that the cylindrical cam .

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: :' ' ' ' .............. -, . ' " ' '.. .' ' ' ,' ' , .. , :, ''' , ~- , - ' ' --24- '-~ 21062~3 s follower 656, 658 is caused to advance from a proxirnal position to a distal position with the tertiary medial chamber 633 of axial bore 626.

At the sarne t;me, cS~mming post 660 translates within the çs~mming slot 662 formed in the c~l~ u~ n~ial groove 664 in handle porlion 602.

Consequently, the inner tubular portion 690 of endoscopic portion 604 moves in a distal direction, urging the base link 730 distally within the slotted area 718 of prirnary yoke member 710.

Thereupon, connective link 748 is urged in a generally distal direction, causing the articulating section 608 to pivot about main pivot pin 610 in a vertical plane relative to the lnngi~(linS~l axis of endoscopic po~tion 604.

The angle of vertical tr~n~l~tinn of a~ S ~ g section 608 can vary depending upon the degree of rotation of the m~nip~ ing collar.

Furthermore, while~the articulS~ting section 608 is in an angular position, the retractor assembly may be actuated in-l.o,pe,nrlently, since the con"culive rod 686 is ~ subsPnti~lly flexible, as seen in Fig. 32.

Fig. 33 shows an endoscopic surgical retractor 600 s~lhst~ntiS~lly the same as that shown in Figs. 27-32.

This retractor 600 is particularly adapted for use in gynecological surgery involving the cervix or uterus.

An annular cervical seal 850 is removably disposed on ~nllc~c( Q~:e portion 604 ;nt~ ~ "~ , the axial handle portion 602 and the art-~ulS~ting dist~l section 608.

This cervical seal 850 assists in p~ven~ing the egress of ingllMs tion gases from the uterus during retractor l~aJ~ ulalions.

'~ ~ use, the uterus is ;~'S~'rnS~t~ ~l and the retractor is inserted to a point wherein the cervical seal 850 is adjacent the cervix of the patient.

In this position the cervical se l 850 inhibit the flow of insufflation gas from the uterus Iround the exterior of the endoscopic portion 604 of the i~,sLlulll~ l 600.

Figs. 34 and 35 show two alternative em~rliment~ of the endGscopic surgical retractor in accunldnce with the present hlvention.

These ~ iUl~ are specifi~lly designed and adapted for gynecological appli~ s~ion~ and include all~u--,atic upper and lower blades 852, B54 configured in a streS~mlin~l se IL_i uular cross section.

In the retracted configuration, the blades i.lt., le~e to forrn a smooth rounded re~ractor assembly for ~ l . a, . . n~ insertion, particularly when used without a cannula port.

The endoscopic surgical ~llaelul j shown in Figs. 34 and 35 are also provided with a sleeve 856 eYt~n~lin~ around the distal end of ~e endoseop;c portion 604 and ~e proximal end of the arhrU~ ng portion 608.

This sleeve 856 seIves to enclose and protect the ar~culating linkages . ~ '~1' v~ .. .: . ., , . . :. - ": .. , ~. , . ~ - . . .. ..

--25-2~062~3 from external cont~minqtion.

Also, the sleeve 856 prevents tissue or organs from becoming ~n~qn~l~d in the linkages during operation.

The sleeve 856 is preferably formed of an elastic or silastic material capable of moving with the articul ~ing portion 608.

Referring specifically to Fig. 34, the endoscopic surgical retractor includes aninjection port 858 disposed, djacent a distal end of the handle portion 602.

The injection port 858 co,ll"~".,in .~f s with the interior of the endoscol ~~ portion 604 to permit fluid to be injected t~ tlllougll into the surgical site.

The injection port 858 of the retractor in Fig. 34 coll~l;ses a subst~ -tiqlly inverted "T" structure providing direct access to the passages in the endoscopic portion 604.

This structure may advantageously be used for fl~id irrigation or m~ ,qtion of the operative site.

Alternatively, the port may be used to ~lmini~ter dyes or marker substqnres intr, vaginally such as, for ~ , radiopaque dyes injected to d~ t . .";n~ the p tency of the fqllop;qn tubes, etc.

Where a surgical retractor having an injection port fe, ture is to be used in an insllM~ted cavity, valve 866 is pc,s;l;ol-~1 in line to inhibit i~ rrl~ion gases from exiting the cavity through the port.

The endoscopic surgical retractor of Fig. 35 is substantially the same as the retractor of Fig 34 except that the injection port 860 Col I II I I' l ' l;[~t~s with a plurality of distribution ports 862 through tube 864 disposed co. xially in endoscc,l);c portion 604.

This configuration allows for more accurate delivery of fluids and may eyen be used to ~-l.";~ t~ 'e5~ e;l aerosols II.~eLlll.~ugh.

Refernng to Fig. 36, another embo~im~nt of an endoscopic surgical retractor 900 is illn~ tP,rl, which includes an axial handle portion 902, an elongated tubular body 904 eYt~n~ling lon~tll-1in~lly f~om the handle portion 902, and an aIticulating portion 906 pivotably col.nrcl~d to the tubular body 904 at a distal end thereof by a Ll~ls~ e pin 908. A pair of retractor blades 910 and 912 are opera~vely ~coc;~ted with ~e ~ ;..g portion 906 of surgical i~ ent 900 and are adapted to move between an open position and a closed position through remote manipulation of a proximal knob member 914 disposed at the proximal end of handle portion 9û2.

Retractor blades 910 and 912 ha~e a suhstantiAlly C-shaped ~ s~_l .. cross-sectionA1 configuM~ion defining ,a~ AIil~ surfaces for manipulating tissue during gynecological ~foce-lul~,s.

A cervical se. l 915 of fiusto-conical col,flguldtion is provided on the artic~ ing portion 906 of surgical ~p~aluS 900 adjacent the distal end of the tubular body 904.

The cervical seal 915 f mrtior\C to inhibit the egress, from the uterus, of in~ tic)n gas, or fluid introdueed into ~e uterus through . n irrigAtion system ori~;natin~ at an inlet port 916 which extends longitudinally ~ ~.

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--2 6 ~- 21~62~3 from the proximal end of handle portion 902.

Surgical instIurnent 90C also includes a mechanism for ~O~;lGS .;vely ar~irul~ting the distal portion 906 thereof which is rirf~luated by remote manipulation of a distal knob member 918, helcinar~cr more fully described.

Tuming to Figs. 37 and 38, yet another embodiment of the surgical instrument of the subject invendon is illustrated and is (leci~n~tf~l generally by l~ ,nce numeral 1000.

Surgical in~.LIw~,nt 1000 comprises an axial handle portion 1010 having opposed hemi~portions 1012 and 1014 mo~mt~ble to one another to define an enclosure for housing a mf ~h~nigm for remotely moving a re~ractor blade assembly 1016 between an open position and a closed position, and a second mf~lloni~m for progressively articulating the distal portion 1018 of the endoscopic tubular body 1020 within an angular sector of rotation relative to a longitudinal axis of tubular body 1020 about a pivot pin 1025.

The l~f~.hS~ for moving the retractor blade assembly 1016 between an open position and a closed position comprises an axial drive screw 1022 disposed within handle portion 1010 and having an elongated threaded body portion 1024 op(.aLively connestf~ to a rotator member 1026 which is manipulated hy a proximal knob member 1028.

An f long~tf~ control rod 1030 is mounted to the distal portion 1032 of axial drive screw 1022 by a C-shaped clip 1033 and extends through the tubular body lo2o of ~alalus l~oo for Llall~ g ~oneibl~lin~ lel~t of ~e axial drive screw to a flexible control wire 1034 adapted to bend as ~e insllulll.,.,l is alticulated.

A coupling 1038 extends from the distal end of control wLre 1034 for o~lalively intPr1inl~ing the retractor blade assembly 1016 to the manipulation m-o~h~ni.~m of surgical apparatus 1000.

Thus, manipulation of the proximal knob member 1028 will callse rotator member 1026 to turn, thereby urging drive screw 1024 to translate axially relative to handle portion 1010.

Consequently, control rod 1030 will translate lonei~l-lin~1ly within tubular body 1020, moving the retractor assembly 1016 between an open and closed position.

The retractor blade assembly 1016 of surgical ins~ nl 1000 cnmpri ~es a plurality of '- ~ed CQO~ e retractor blades inrl~ldine ~lrst th~rough fifth retractor blades 1041s 1()42 1043, 1044, and 1045.

By providing a~ itior ~l blades, any gaps between the blades at the p u,~i.nal end are smaller, and thus tissue is less likely to ~n~lla~c; the area ;"t. - ~ e the blades.

In addition, as best seen in Fig. 41, the blades of retractor assembly 1016 are alTanged in a stepped confi~ ;on ~1- he~..1;.)e from the first retractor blade 1041 to the fi~ retractor blade 1045.

This .

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., stepped arrangernent provides a smooth retraction surface and promotes blade flexure to enhance tissue release during a surgical procedure.

Each blade of the retractor assembly 1~16 has an angularly clepenfling distal portion 1046 which has a lr~ .f~,d cover provided thereon for defining an ailau.~ ic surface suitable for manipulating tissue or organs within the ~kklmin~l cavity.

Alternatively, the distal portion 1046 may be stamped out to define the ~ l, ,.l l,, ,,.l ;-~ surface.

This will also increase the rigidity of the blade h and it will thicken the ptlil-~l~,. and ~lict~lmost portions thereof.

In the closed position, the first through fifth blades of retractor assembly 1016 are stacked in a nested configuration to facilitate insertion and removal of the i.-sL~ ,"l through a troca~ or cannula device.

To promote effective staclcing of ~e blades in the closed position, each blade of the retractor assembly 1016 is of a dlstinct length so that the angularly depen(1inE portions thereof nest with one ~nother.

Center blade 1043 is ~e longest of the blades of retractor assembly 1016, and includes a dow~ .-cd tail por~on 104~ formed with a slot 1050 ~or engaging coupling member 1038.

Furthermore, each blade of retractor ~sse...l)ly 1016 is provided wi~ a eam slot 1052, with that of the center blade 1043 being disposed parallel to the lon~ih..lin~l a~is thereof, while the respectiYe c~m slots 1052 of the outer blades of retractor assembly 1016 are disposed angularly with respect to dle lon~itn~in~l axis of the blades, thereby crr~~ a fan-lilce deployment of the retractor assembly 1016 as it is moved , ' from a closed position to an open posi~ion. A L~ , cam pin 1054 is mounted within the distal portion 1018 of surgical ay~alatus 1000 and extends through each of the cam slots 1052 for c~ rning the blades as center blade 1043 is cau~ed to translate lon~itn;in~lly in response $o axial r~ l,l.,.~,.. ,cn~ of control rod 103û.

Pivot d~ , 1056 are formed at the proximal end of each blade of retractor assembly 1016 for l~C~iiVing a pivot pin 1058 which opc~ively ~csoc i~s the plurality of i~ lca~d retractor blades.

The mech~nigm for remotely ar~nul~ting the distal por~on 1018 of the tubular body 1020 of surgical ill~ 1000 relative to the lon~t~lfin~l axis thereof includes a distal knob member 1060 which is ~Ccor ~lp~ vith the handle portion 1~10 and which has a threaded intemal passageway for l~;ving a cooperating axial drive member 1062.

Drive member 1062 is provided with an exteInal threaded portion 1064 and a nipple 1û66 which extends distally lh~ Çlol~ for n ~0~ ;n~ an ~ control shaft lo68 Which i. ~ the 1ongibl~in~1 motion of drive member - 1062 through tubular body 1020.

The proxiimal end of con~¢ol shaft 1068 extends through a clevis . --28-';' 21062~3 i, 1070 which is m~ t2in~d within the distal end of tubular body 1020, to a base link 1072 having a nipple 1074 extending proximally therefrom for mounting the distal end of control shaft 1068. A longitudinal passageway 1076 extends through base link 1072 for acco.~ ting contTol wire 1034 and a link member 1080 ,ntclco~ ecb base link 1072 to the articnl~ting distal portion 1018.

Link member 1080 is mounted to base link 1072 by a pivot pin 1082, and to the articulating distal portion 1018 by a pivot pin 1084.

Clevis memker 1070 is provided with an aperture 1086 for receiving the pivot pin 1025 which is ~soc ~ IP,d with the ar~iculqting distal portion 1018. A sleeve 1090 covers the dist~l portion 1018 of surgical apparatus 1000 for ~ t~oling the internal ~ s thereof.

In addition, a primary annular seal member 1092 is ~c50c~ d with the distal end of control shaft 1068 for forming a seal between the control shaft 1068 and tubular body 1020 to inhibit the egress of in~ tinn gas through the endoscopic portion of surgical ap~dus 1000.

Similarly, a s~ondOly annular seal member 1094 is ~s~oci~ed wi~ the distal end of control rod 1030 for forrning a seal between the control rod 1030 and the tubular control shaft 1068.

1~ operation, progressive ar~iculation of the distal portion 1018 of surgical ~ h-C 1000 is achieved through gradual rotation of distal knob member 1060 which causes col,~"yo~l;ng axial llnll~ ;ol- of drive member 1062 within handle por~ion 1010, clriving control shaft 1068 diseally with respect eo tubular body 1020.

Consequently, base link 1072 is 1ranc~ d in a distal direction causing link member 1080 to pivot, urging the distal portion 1018 of surgical insllw~ t 1000 into a desired articulated position, thus illcl~,ai,lng its range of operability.

Turning now to Figs. 39 and 40, an alternative embodiment of surgical ir,sL.ulllc.lt 1000 is illllC~t~l in which structure is provicled for .., -;"I~ ;ng Cl~ between retractor blades 1041, 1043, and 1045 of ~etractor assembly 1016 to inhibit the e~ n~ of tissue I .,n.

T.his safety structure includes first and second annular spacers 1102 and 1104.

The first annular spacer 1102 is disposed between Ietractor blades 1041 and 1043, while the second annular spacer 1104 is disposed between retractor blades 1043 and 1045.

In use, when the retractor blades are moved from an open position to a closed position, the annulSar spacers will subst~nti~lly reduce the .lihood that tissue will become trapped and/or ~l~m~d by pinrhing.

Another feature of surgical appaldlus 1000 CO~ ;ces a clutch m~h~ni~m inculpo,aled into the axial driving assembly for inhibiting over-rotation of the axial drive screw 1022.

In addition, the clutch ....-~h~ serves to limit the ",~rl~ l fo~ces resul~ng from ,:

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, ., : ... .

v --29- '' 21062~3 operating axial drive screw 1022 which can darnage tissue if it becomes e~ ~ed between the retractor blades of retractor assembly 1016. rne clutch m~rh~nigm includes a distal sontrol collar 1106, a coiled bias~ng spring 1108, and a proximal control collar 1110.

Distal control collar 1106 is threadably :~csori~t~d with dnving screw 1022 and is provided with ratchet teeth 1112 ext.on~ing ~ual~aldly ~ UIII to interact opelalively with c~ll.,st)oll~lg ratchet teeth 1114 which extend for~-vardly from proximal con~ol collar 1110.

Proximal control collar 1110 is engaged within rotator knob 1028 so as to rotate therewith during ortn~;on of retractor assembly 1016.

Biasing spring 1108 moint~inc the spacial r~l~fionghir between distal control collar 1106 and proximal control collar 1110 so as to ensure an;. . t- - ~ I ~e~l-ed relo~i~mhip between ratchet teeth 1112 and 1114.

In operation, when a pl~3e~ d rotational force is exerted upon the axial driving assembly, the ratchet teeth 1112 and 1114 will slip past one another to prevent over-rotation andlor tissue damage.

The endoscopic surgical i~ ul~enl of the subject invention is ct~mr~rt, lightweight and easy to use.

It is intended to enable the surgeon to use the i--s~ -ent with one hand, thus freeing the other hand for p~,lfc,lmdnce of other surgical tasks.

To ~e extent not akeady indicated, it also will be u--dcl~luod by those of ordinary skill in the art that any one of the variaus specific embo.li~ herein ~ies~ri~d and illustrated may be fi~her mo~lified to incolt/ulat~ features shown in other of the specific em~o-limP.nte.

Al~ough the en~oscopic surgical i~,shu,llenl of ~e subject invention has ;been ~e~ ;~d with respect to a ~ ~ellbd elll~li.n~,nt~ it is apparent that changes may be made to the invention without depar~ng from the spirit and scope of the invention as defined by the ~l.pe ~d~i clairns.

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