Surgical stapling instrument incorporating a rotary transmission

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DESCRIPTION

Surgical stapling instrument incorporating a rotary drive.

Field of the invention

The present invention relates generally to the field of surgical stapling instruments that are capable of applying staple lines to tissue while cutting tissue located between those staple lines and, more specifically, to the field of improvements related to stapling instruments. and to improvements in the procedures for constituting various components of said stapling instruments that carry out the firing of staples with multiple pulses of a trigger,

Background of the invention

Endoscopic surgical instruments are often preferred over traditional open surgical devices, since a smaller incision tends to reduce recovery time and postoperative complications. Consequently, there has been considerable development in a range of endoscopic surgical instruments suitable for the precise placement of a distal end effector in a desired surgical site through a trocar cannula. These distal end effectors bind tissue in a variety of ways to achieve a diagnostic or therapeutic effect (e.g. endocutter, clamp, cutter, staplers, clip applier, access device, drug / gene delivery device, and delivery device ultrasound energy, RF, laser, etc.).

Known surgical staplers include an end effector that simultaneously makes a longitudinal incision in the tissue and applies lines of staples to opposite sides of the incision. The end effector includes a pair of cooperating jaw members which, if the instrument is intended for endoscopic or laparoscopic applications, are capable of traversing a passage of a cannula. One of the jaw members receives a staple cartridge having at least two laterally spaced rows of staples. The other jaw member defines an anvil having staple-shaping pockets aligned with rows of staples within the cartridge. The instrument includes a plurality of oscillating wedges, which, when activated distally, pass through the openings in the staple cartridge and engage with drive elements that support the staples to effect firing of the staples in the direction of the anvil. .

An example of a surgical stapler suitable in endoscopic applications is described in US Patent No. 5,465,895, which advantageously provides the differentiated closing and firing actions. Hereby, a practitioner is able to close the jaw members on the tissue to position the tissue prior to firing. Once the practitioner has determined that the jaw members are properly gripping the tissue, the practitioner can then fire the surgical stapler with a single firing pulse, thereby stapling and cutting the tissue. Simultaneous cutting and stapling avoids the complications that can arise when carrying out these actions sequentially with different surgical instruments that, respectively, only cut or staple.

A specific advantage of being able to close the instrument on the tissue before firing is that the clinician can verify by means of an endoscope that a cut has been achieved at a desired point, and that a sufficient amount of tissue has been captured between the opposing jaws. Otherwise, the opposing jaws can be closed too close to each other, especially by pinching at their distal ends, and without thereby effectively forming the closed staples in the cut tissue. At the other extreme, an excessive amount of grasped tissue can cause seizure and incomplete ejection of the staples.

In general, a single closing stroke followed by a single firing pulse is an appropriate and efficient way to perform cutting and stapling. However, in some cases, the application of multiple firing runs would be desirable. For example, surgeons can select from a range of jaw sizes, a corresponding length of staple cartridge for the desired cut length. Longer staple cartridges require a longer firing stroke. Thus, a manual push trigger is required to fire in order to exert a greater force on these longer staple cartridges in order to cut more tissue and drive more staples compared to a shorter staple cartridge. It would be desirable for the amount of force to be less comparable to shorter cartridges so as not to exceed the manual force of some surgeons. Also, some surgeons unaccustomed to large staple cartridges may be concerned about jamming and any other malfunctions that may occur when a higher force is unexpectedly required.

One proposal to reduce the required force of a firing stroke is a ratchet mechanism that enables a firing trigger to be depressed several times, as described in US Patent Nos. 5,762,256 and 6,330,965 which are considered to represent the closest prior art and disclose a surgical stapling instrument with a stapling head as an end effector, a shaft, a handle, a firing actuator, a rack and an anti-reverse mechanism instruments all exposed in the Claim 1. However, it is believed that converting the rocking motion of the firing trigger directly to a one-piece rack by means of a pawl limits the design options for a desired amount of firing motion du

ES 2 297 635 T3 ra during each firing stroke. Also, these known surgical stapling instruments with multi-stroke firing mechanisms do not have the advantages of a separate lock-and-shoot action.

Accordingly, there is an urgent need for a surgical stapling instrument that utilizes multiple firing strokes to achieve a desired length of cut and stapling with a desired ratio of displacement of the firing stroke relative to the longitudinal firing motion produced for the activation of an end effector.

Brief summary of the invention

The invention solves the above and other deficiencies of the prior art by providing a surgical stapling and cutting instrument according to claim 1 and having a rotary transmission that transfers a sequence of multiple firing strokes while preventing the recoil of a limb. shooting. In this way, an instrument end effector that requires increased firing forces and / or increased firing displacement can be easily fired with a multi-stroke firing trigger. Also, the instrument has a separate closure capability that enables a surgeon to position tissue without necessarily firing the end effector.

The surgical instrument has an end effector that acts in response to a longitudinal firing motion to perform a surgical operation. A user causes a movement in a firing actuator to create the firing motion that is selectively transferred by a firing mechanism. Specifically, a cam disc has a plurality of cam lobes around at least a portion of its circumference that are respectively locked by a driving wedge coupled to the firing actuator when a firing movement is effected. The cam disc is coupled to a rack via a gear connection to translate this intermittent rotary motion into longitudinal firing motion.

The surgical instrument has an end effector that cuts and staples tissue. In particular, the staple application assembly has an anvil incorporating a staple shaping surface, removable from an open position spaced from a plurality of staples to a closed position adjacent to the plurality of staples. A staple application mechanism has a rotating cam element with at least one cam lobe associated with at least one coupling member, such that rotation of the rotating cam member causes application of at least a portion of the staples to starting staple application assembly. In this way, a multi-stroke shot can be used to cut and staple tissue.

These and other objects and advantages of the present invention will be apparent from the accompanying drawings and the description thereof.

Brief description of the figures

The accompanying drawings, which are incorporated in and constitute a part of the present specification, illustrate certain embodiments of the invention and, together with the general description of the invention provided above, and with the detailed description of the forms of The embodiments provided below serve to explain the principles of the present invention.

Fig. 1 is a perspective view of the surgical cutting and stapling instrument having an open end effector.

Fig. 2 is a left side elevational view in cross section along lines 2-2 of the open effector of Fig. 1.

Fig 3 is a perspective view of the open end effector of Fig. 1.

FIG. 4 is an exploded perspective view of an auxiliary portion of the surgical cutting and stapling instrument of FIG. 1.

Fig. 5 is an exploded perspective view of a handle of the surgical cutting and stapling instrument of Fig. 1

Fig. 6 is a left side elevational view of the handle of the surgical cutting and stapling instrument of Fig. 1 in an open position with a left portion of a handle housing removed to expose a firing mechanism. that includes a rotary transmission for the realization of multiple firing races.

Fig. 7 is a right side elevational view of the handle of Fig. 6 with a right portion of the handle portion removed to expose a latch mechanism and anti-kickback features.

Fig. 8 is a top-down perspective view of the handle of Fig. 7.

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Fig. 9 is a side elevation view of the handle of Fig. 6 with the closing trigger closed and the firing trigger omitted to expose a firing actuation wedge and cam lobes located within a disc. of cams.

FIG. 10 is a top-down perspective view of the firing actuation wedge and cam lobes of FIG. 9.

Fig. 11 is a rear perspective view of a rotary drive firing mechanism of the handle of Fig. 1

Fig. 12 is a side elevation view of the grip of Fig. 6 in a closed and fired condition in which a small idler gear is omitted from the rotary transmission firing mechanism to expose an anti-reverse pendulum contacting a one-piece zipper.

Detailed description of the invention

Returning to the Drawings, in which the same reference numerals designate the same components throughout the different views, Figs. 1 through 4 illustrate a surgical cutting and stapling instrument 10 that is capable of practicing the unique benefits of the present invention. Surgical cutting and stapling instrument 10 incorporates an end effector 12 having an anvil 14 pivotally attached to an elongated channel 16, forming opposing jaws to engage tissue to be stapled and cut. End effector 12 is coupled via shaft 18 to handle 20. An executing portion 22, made up of terminal end 12 and shaft 18, is advantageously sized precisely for insertion through a trocar or small laparoscopic opening to carry out an endoscopic surgical procedure while being controlled by a surgeon who hold the grip 20. The handle 20 advantageously includes features that allow separate closing movement of the end effector with respect to firing, also allowing multiple firing strokes to effect the firing (namely, cutting and stapling) of the end effector 12 while indicating to the surgeon the degree of such cutting and stapling.

For these purposes, a closure tube 24 of shaft 18 is coupled between a closure trigger 26 and anvil 14 to cause closure of end effector 12. Within closure tube 24, a frame 28 is coupled between elongated channel 16 and the handle 20 to longitudinally position and support the end effector 12. A rotary handle 30 is coupled to frame 28, and both elements are rotatably coupled to handle 20 with respect to rotational movement about a longitudinal axis of axis 18. Thus, the surgeon can rotate end effector 12 by rotating the handle. rotation 30. Closure tube 24 is also rotated by rotation handle 30 but retains a degree of longitudinal displacement relative to it to cause closure of end effector 12. Within frame 18 a firing rod 32 is positioned for longitudinal displacement and it is coupled between anvil 14 and end effector 12 and a multi-stroke firing trigger 34. The closing trigger is distally of a pistol grip 36 of the grip 20, the firing trigger 34 being distal to both the pistol grip 36 and the closing trigger 26.

In an endoscopic operation, once the accessory portion 22 is inserted into a patient to access a surgical site, a surgeon references an endoscopic imaging or diagnostic device to position the tissue between the incus 14 and the elongated channel 16. By grasping the latch trigger 26 and pistol handle 36, the surgeon can repeatedly pinch and position the tissue. Once satisfied as to the location of the tissue with respect to the end effector 12, and as to the amount of tissue within it, the surgeon squeezes the latch trigger 26 fully towards the pistol handle 36, igniting the existing tissue. into end effector 12 and locking latch trigger 26 in this clamped (closed) position. If not satisfied with this position, the surgeon can release the closure trigger 26 by depressing a release button 38 (Fig. 4), the operation of which is described in more detail below, and then repeats the procedure to latch the tissue.

If the grip is correct, the surgeon can proceed with firing the stapling and cutting instrument 10. Specifically, the surgeon grasps the firing trigger 34 and the pistol handle 36, depressing the firing trigger 34 a predetermined number of times. The number of firing strokes is necessarily ergonomically determined based on a maximum hand size, a maximum amount of force that must be transmitted to the instrument during each firing stroke, and the required distance and force to be transferred. through firing rod 32 to end effector 12 during firing. As will be appreciated from the discussion below, each surgeon can choose to set the firing trigger 34 with a different angular range of motion, and thus increase or decrease the number of firing strokes.

In Fig. 1, after the surgical stapling and cutting instrument 10 is fired, a closure release lever 40 is activated to retract the firing mechanism. Depressing the latch release lever 40 disengages a rotary drive trigger 42 located within the handle 20, allowing a spring 172 to retract the trigger stem 32 out of the end effector 12.

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Executing Portion Including an E-Arm End Effector

The advantages of a handle 20 capable of providing a multi-stroke firing motion apply to a plurality of instruments, with an effector 12 of the type indicated in Figs. 1 to 4. The anvil 14 of the end effector 12 responds to a closing movement from the handle 20 that is transferred longitudinally and distally by the closing tube 24. Elongated channel 16 slidably engages translation and closure anvil 14 to form opposing jaws, and frame 28 engages fixed channel 16 to form a rigid connection to handle 20. Closure tube 24 engages with anvil 14 distal to the pin located in the slotted connection between anvil 14 and elongated channel 16. Thus, a distal displacement of the closure tube 24 with respect to the frame 28 causes closure and a proximal displacement with respect to the frame 28 causes the opening of the end effector 12.

With specific reference to Fig. 4, the executing portion 22 also includes components that respond to a firing movement from the handle 20, specifically from the firing rod 32 (not shown in Fig. 4) that engages a longitudinal movement between firing mechanism 42 of handle 20 and distal portion 22. In particular, firing stem 32 (shown disassembled in Fig. 5) rotatably engages with a firing through member 46 slidably positioned within a longitudinal recess 48 in frame 28. Firing through member 46 is longitudinally displaced within frame 28 in direct displacement of longitudinal displacement Trigger Stem 32. A longitudinal slot 50 in the closure tube 24 is operatively coupled with the rotation handle 30 (not shown), the longitudinal slot 50 also allowing the rotation handle 30 to engage with the frame 28 at the level of a small longitudinal slot. 52 located inside to carry out the rotation. A lug is positioned opposite the slot 50 on the closure tube 24 and the lug is bent down into the slot 52 in the frame 28 to couple the closure tube 24 to the frame 28. The length of the longitudinal slot 50 of the closing tube 24 is sufficient to allow longitudinal movement with the rotation handle 30 to carry out the respective opening and closing movements.

The distal end of frame through member 46 is attached to a proximal end of firing rod 56 that travels with frame 20 to project an E-arm 60 distally into end effector 12. End effector 12 includes a staple cartridge 62 that is actuated by E-arm 60 which causes staples to be propelled upwardly from staple openings 64 of cartridge 62 into contact with existing staple shaping grooves 68. on the anvil 14, creating the "B" shaped staples. With specific reference to Fig. 3, the body 68 of the staple cartridge further includes a vertical slot 70, open in the proximal direction, for the passage of a vertically oriented cutting surface disposed along a distal end of the E-shaped arm 60 for cutting tissue while it is being stapled.

Illustrative end effector 12 is described in greater detail in five US patent applications filed and pending with the current one: 1) "Surgical stapling instrument incorporating a single latch mechanism to prevent firing" ["SURGICAL STAPLING INSTRUMENT HAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING ”, No. 7,044,352 by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested June 20, 2003; 2) "Surgical stapling instrument incorporating separate and distinct locking and firing systems" ["SUGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS"], No. 7,000,818, by Frederick E. Shelton, Mike Setser, Brian J. Hemmelgarn, requested June 20, 2003; 3) “Surgical stapling instrument incorporating a spent cartridge latch” [“SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT”], No. 6,988,649, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested June 20, 2003; 4) "Surgical stapling instrument incorporating a firing latch for a non-closed anvil" ["SURGICAL STAPLING INSTRUMENT HAVING A FIRING LOCKOUT FOR AN UNCLOSED ANVIL"], No. 2004-0232199, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested June 20, 2003; and 5) “Surgical stapling instrument incorporating an E-arm firing mechanism” [“SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM”], No. 6,978,921, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested on June 20, 2003.

It should be appreciated that, although a non-articulated shaft 18 is illustrated herein, other applications of the invention may include articulation-capable instruments, such as those described in US patent applications filed legally and pending with the current one. : 1) "Surgical instrument incorporating an articulation mechanism that rotates around the longitudinal axis" ["SURGICAL INSTRUMENT INCORPORATING AN ARTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINAL AXIS"], ​​No. 2005-0006434, by Frederick E. Shelton, Brian J. Hemmelgarn, Jeff Swayze, Kenneth S. Wales, requested July 9, 2003; 2) "Surgical stapling instrument incorporating an articulation joint for a track of a firing rod" ["SURGICAL STAPLING INSTRUMENT INCORPORATING AN ARTICULATION JOINT FOR A FIRING BAR TRACK"], No. 6,786,382, by Brian J. Hemmelgarn, requested on July 9, 2003; 3) "A surgical instrument with a lateral displacement joint control" ["A SURGICAL INSTRUMENT WITH A LATERAL-MOVING ARTICULATION CONTROL"] No. 6,981,628, Jeff Swayze, filed July 9, 2003; 4) "Surgical stapling instrument incorporating a tapered firing rod for increased flexibility around the articulation joint" ["SURGICAL STAPLING INSTRUMENT INCORPORATING A TAPERED FIRING BAR FOR INCREASED FLEXIBILITY AROUND THE ARTICULATION JOINT"], No. 7,055,731, from Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested July 9, 2003; Y

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5) "Surgical stapling instrument incorporating articulation joint support plates to support a firing rod" ["SURGICAL STAPLING INSTRUMENT HAVING ARTICULATION JOINT SUPPORT PLATES FOR SUPPORTING A FIRING BAR"], No. 6,964,363, by Jeff Swayze , Joseph Charles Hueil, requested on July 9, 2003.

Multi-stroke firing handle

In Figs. 5 to 8, the handle 20 responds to the actuation of the closing trigger 26 and the firing trigger 34 to generate, respectively, the closing and firing movements in the executing portion 22. With respect to the closing movement, the closing trigger 26 includes an upper portion 76 that includes three side openings, a hole 78 located in a forward position for housing a pin, a rear pivot hole 80, located in a lower position, and a central notch 82. Three stems facing laterally between and engaged with right and left curved half plates 84, 86 of a handle housing 88 (with the right curved half plate 84 shown in Figs. 5 and 6 and the left curved half plate 86 shown in Fig. 7). In particular, a rear stem 90 passes through the rear pivot hole 84 of the upper portion 80 of the latch trigger 26, and thus the latch trigger 26 pivots around the rear stem 90. A front stem 92, which is located distal to the rear stem 90 and an upper stem 94, which is located on the front stem 92, pass through the central notch 86, which is shaped to limit the movement of the closing trigger 26 by contacting the front and upper rods 92, 94 located at each end of the trigger movement. Thus, the central notch 86 includes a vertical portion, the lower surface of which contacts the front stem 92 when the latch trigger 26 is in the forward (distal) position, and includes an upper portion, sloping in the proximal direction, the upper surface of which and forward contact upper stem 92, respectively, when latch trigger 26 is in its forward, relaxed position, and in its proximal, activated position.

A closure yoke 96, which engages with closure tube 24, is slidably housed within handle housing 92 and is connected at a distal end to a proximal end of closure tube 24, thereby transferring a longitudinal closure movement to closure tube 24 and hence to anvil 14 to effect closure of end effector 12. This connection enables rotation of closure tube 24 while closure fork 96 does not rotate. Above this connection, a side hole 100 for the introduction of a pin is coupled to a fastener strap 102 by means of a front pin 104, the other end of the fastener strap 102 being coupled to the hole 82 for housing a bolt. of the closing trigger 26 by means of a rear pin 106.

A triangular spacer 120 includes holes 122, 124, 126 for the housing of the rods 90, 92, 94, respectively, and is sandwiched between a cam disc 130 and the upper portion 80 of the closing trigger 26. The cam disc 130 rotates around the front stem 92 and includes a semicircular groove 132 in which the rear and top stems 90, 94 are housed. A central hole 104 houses the front stem 92. To the left of cam disc 130, a stem hole 136 located at the upper end 138 of firing trigger 34 receives upper stem 94. Firing trigger 34 rotatably mounts on stem 94 to sandwich the firing disc. cams 130 between triangular spacer 120 and firing trigger 34. A distally open recess 140 located in firing trigger 34 below stem housing hole 136 is aligned for front stem housing 92, allowing firing trigger 34 to be drawn distally at the time of Shooting. Actuation of closure trigger 26 tilts cam link 102 downward into contact with a wedge drive pin 184 extending inwardly from firing trigger 34 causing firing trigger 34 to be partially pulled distally and adjusting the firing trigger 34 to place it in the gripping position.

With specific reference to Figs. 5, 9 and 10, the cam disc 130 has a series of cam lobes 142 to 144 (Fig. 9) around the front portion (when in a non-firing condition, such as the one shown), specifically along its left side, which are respectively locked by the firing trigger 34 to transmit a top-to-front rotation (clockwise, viewed from the left) to the cam disk 130. This rotation is transferred through a gear train 150 (Figs. 5 and 11) of the rotary transmission firing mechanism 42, beginning with the gear portion 152 around the lower portion of the right side of the cam disc 120 which engages with a small idler gear 154, which rotates from top to back (clockwise) at an increased speed relative to the cam disc 130. A large idler gear 156 is connected by a small idler shaft 158 ​​idler gear 154 and thus rotates in the same direction and speed. A second small gear 160 is meshed with the large idler gear 156 and is therefore rotated from above to the front position (clockwise viewed from the left) at a higher speed. A large fine tooth gear 162 is connected via a second shaft 164 to the second small gear 160 and thus rotates in the same direction and speed as the second small gear 160. The gear train 150 thus simplifies the movement of the cam disc 120. by including a dual gear reduction feature to provide additional longitudinal firing motion. Large fine tooth gear 162 mates with a gear segment 168 located on an underside of a one-piece rack 160 whose distal end mates with the proximal end of firing rod 32. The rack 170 has its distal portion slidably longitudinally housed within the locking yoke 96 and its proximal portion slidably longitudinally housed between the right and left curved plate halves 84, 86 of the handle housing 88.

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Selective engagement of firing trigger 34 with cam lobes 142-144 provides additional longitudinal displacement allowing multiple firing strokes of firing trigger 34. To prepare the gear train 150 in the firing position, the cam disc 150 is pressed clockwise towards its non-firing position by means of a gear train retraction spring 172 attached to an integral pin 174 projecting to the left. formed within an annular recess 176 in a lower proximal edge of cam disc 120 (Figs. 9 and 10). The retraction spring 172 of the gear train has its other end fixed to a pin 178 integral with the housing 88 of the handle. Activation of firing trigger 34 rotates cam disc 130 in a counterclockwise direction to lengthen retraction spring 172. Continued activation of firing trigger 34 wraps elongated retraction spring 172 around the outer diameter of cam disc 130 as it rotates and into annular recess 176 (not shown).

With specific reference to Figs. 5, 9, 11, below and distal to the upper end 128 of firing trigger 34 is a hole 180 for insertion of a driving wedge pin and a hole 190 for insertion of a proximal pin. Drive wedge pin 184 and pin 196 extend inwardly from holes 180 and 190 (respectively) located in firing trigger 34. Drive wedge 182 and spreader finger 186 are pivotally mounted on drive wedge pin 184 and functionally connected by a mousetrap spring 188. An opposing tension spring 194 located between drive wedge 182 and pin 196 biases the drive wedge 182, spreader finger 186, and spring 188 clockwise (Fig. 10). When the firing trigger 34 is pulled (Fig. 9), the spreader finger 186 is positioned in contact with a central, non-camming circular surface of the cam disc 120 by rotating the spreader finger 186, spring 188, and drive wedge 182 counter-clockwise. The counterclockwise movement of the spreader finger 186 presses the drive wedge 182 into firing connection with the cam lobes 142-144 (FIG. 9).

With specific reference to FIG. 12 when the drive wedge 182 is drawn away from one of the cam lobes 142 to 144 between firing strokes, the cam disc 130 would tend to rotate up and back by the action of the spring. retraction 172 of the gear train if not for the action of a backstop lever 200. The side pins 202, 204 of the anti-reverse pendulum 200 engage with the respective right and left curved half plates 84, 86 of the handle housing 88. Above pins 202, 204, an anti-return tension spring 206 is attached to a pin integral 208 of the right curved half plate 88 distal to the anti-return pendulum 200. With specific reference to Fig. 5, a lower foot 210 of the anti-reverse pendulum 200 makes frictional contact with an upper surface 212 of the one-piece rack 120. When the lower foot 210 of the anti-kickback pendulum 200 is pulled proximally by a one-piece retraction rack 170, the anti-kickback lever 20 approaches a perpendicular engagement position with the one-piece rack 170 which increases the friction force, locking the one-piece rack 170, which is sufficient to overcome the rearward biasing force supplied by the gear train retraction spring 172. One-piece rack 170 is actuated distally by firing trigger 34, lower foot 210 is pushed distally, reducing friction and enabling firing. Excessive forward movement of lower foot 210 is prevented by idler shaft 158 ​​and by pressure from anti-reverse tension spring 206.

In FIG. 12, release button 38 is pivoted upward about its rear pivot pins 220, 222 raising its distal arm 224 above a proximally directed arm 226 of anti-reverse pendulum 200, allowing distal displacement of the lower foot 210 to lock zipper 170 between firing strokes. A locking grip lever 230 swivels about its lateral pivot pins 232, 234 to effect this lift of the release button 38. In particular, a projecting arm in the proximal and upward direction 236 of the grip locking lever 230 is slidably supported on a lower surface of distal arm 224 of release button 38. A distal projection lock arm 238 of grip lock lever 230 locks lock fork 96 in its grip position. In particular, a tab 240 extending downwardly between the proximal and upward projection arm 236 and the distal projection locking arm 238 is pressed proximally by a tension spring 242 which is also attached to the right curved half plate. 84 of the handle housing 88 at the level of a pin 244. With reference to Figs. 6 and 7, the distal projection locking arm 238 rests on a step 246 in an upper, proximal portion of the locking yoke 96, allowing the locking yoke 96 to be displaced in a distal direction to transfer the locking motion. . A gripping locking notch 248, which is a recess open distally and upwardly of step 246, receives distal projection locking arm 238 when locking fork 96 reaches its distal actuated position (Figs. 8, 9). Thus, the surgeon can release the closure trigger 26 while the end effector 12 remains attached.

With reference to Figs. 5 through 8, 12 In addition to the previously described anti-kickback feature and latch holding feature, a firing bolt feature is provided by a firing bolt lever 250. With the surgical stapling and cutting instrument 10 in its initial open and non-firing position, the firing latch lever 250 responds to the retraction of the locking yoke 90 by blocking the distal firing displacement of the one-piece zipper. 170, as particularly shown in Figs. 7 and 8. The firing latch lever 250 includes a distally extending arm 252 having a distally ramped upper surface 254 that is aligned with a right edge 256 along the proximal portion of the one-piece zipper 270. A lowered right edge 258 along the remaining distal portion of one-piece zipper 170 enables distally ramping upper surface 254 of firing bolt lever 250 to rotate upward, swinging about its proximal side pins 260, 262 pressed by

ES 2 297 635 T3 is a tension spring 264 connected to a vertical lug 266 that is attached perpendicularly and proximally to arm 252 extending in the distal direction. The other end of the tension spring 264 is connected to an integral pin 268 formed in the right curved half plate 84 of the handle housing 88 behind the vertical lug 266.

As shown in FIG. 8, distally ramping surface 254 blocks distal movement of one-piece zipper 170 by being wedged upward by a step 270 formed through the proximal end of locking yoke 96, open in the proximal and upward direction to accommodate the downwardly tilting arm 252 extending distally from the firing bolt lever 250. With the locking yoke 96 displaced distally to close the end effector 12, as shown in Fig. 12, the right edge 256 of one-piece zipper 170 is enabled to pass over the distally ramping surface 254 responsive to movement by moving downwardly the distally extending arm 252 to engage a step. lower 272 formed in the closure fork 96 in a direction proximal to the highest and most distal step 270. Engagement of the trigger latch lever 250 with the lower step 272 has the advantage of preventing retraction (proximal displacement) of the locking yoke 96 until the one-piece rack 170 is fully retracted. Thus, initiation retraction of firing mechanism 42 advantageously occurs prior to release of end effector 12, which would otherwise cause jamming of firing mechanism 42. Also, there may be sufficient frictional contact between the lower step 272 and the firing latch lever 250 to advantageously require a two-stage procedure to return the surgical stapling and cutting instrument 10 to its open and retracted position. . In particular, once the firing mechanism 42 has been retracted by depressing the release button 38, a slight pressure applied on the closing trigger 26 would tend to allow the firing bolt lever 250 to rise to its deadbolt position. Shooting. The release of the latch trigger 26 can then be advanced with the firing latch lever 250 aligned to engage with the upper step 270 when the latch fork 96 is fully retracted and thus the end effector 12 is open.

It should also be appreciated that the zipper 170 may advantageously be formed by tie rods that allow a proximal portion of the firing mechanism 42 to be curved inside the handle allowing a more compact design. Said articulated rack is described in greater detail in the jointly owned US patent "Surgical stapling instrument incorporating a firing mechanism having an articulated rack transmission" ["SURGICAL STAPLINGINSTRUMENTINCORPORATING A FIRING MECHANISM HAVING A LINKED RACK TRANSMISSION", No. 6,905,057 , from Jeffrey S. Swayze, Federick E. Shelton IV, requested on September 29, 2003.

In use, the surgeon positions end effector 12 and shaft 18 through the cannula of a trocar at a surgical site, positions anvil 14 and elongated channel 16, as opposing jaws to interlock tissue to be stapled, and chopped up. Once satisfied with the position of the end effector, the latch trigger 26 is fully depressed toward the pistol grip 36 of the grip 20 causing a latch strap 22 to advance a latch fork 96 and thereby a latch tube. 24 to close the end effector 12. The distally displaced locking yoke 96 has a clamp lock notch 248 where a clamp lock lever 230 is housed, which holds the end effector 12. Actuation of firing trigger 34 multiple times causes firing of firing rod 32 by sequentially connecting an actuation wedge 182 that is coupled to firing trigger 34 on cam lobes 142 through 144 located on cam disc 130 This ratchet rotation is transferred through the rotary drive firing mechanism 150 to distally advance the one-piece rack 170. With the locking yoke 96 advanced, the rack 170 can depress a trip lock lever 250 out of the way. Between firing strokes, backstop pendulum 100 is drawn into perpendicular locking contact with rack 170, opposing a retraction force transmitted by retraction spring 172 of gear train connected to cam gear 130. Once the full firing travel is complete, depressing the latch release lever 40 disengages the anti-reverse pendulum 100, allowing the one-piece rack 170 to retract and secondly disconnect the lock release lever. clamping 230 relative to the locking yoke 96 to remove an impediment from opening the end effector 12. The surgeon squeezes the locking yoke 96 to enable the firing lock lever 250 to release from the locking yoke 96 and release the locking trigger 26, allowing the locking yoke 96 to move proximally to where it grips the trigger bolt lever 250 to prevent one-piece rack 170 from firing. The executing portion 22 of the surgical stapling and cutting instrument 10 can then be removed, for example, for the purpose of replacing the staple cartridge 62 in preparation for another operation.

Although the present invention has been illustrated by the description of various embodiments and, although the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to the details. exposed. Those skilled in the art will readily appreciate the existence of additional advantages and modifications.

It should be appreciated that the terms "proximal" and "distal" are used herein with reference to a practitioner holding a handle of an instrument. Thus, end effector 12 is distal with respect to the most proximal grip 20. Likewise, it should be appreciated that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used herein with respect to to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

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The present invention is being disclosed in terms of endoscopic procedures and apparatus. However, the use herein of terms such as "endoscopic" should not be construed to limit the present invention to a surgical stapling and cutting instrument for use only in combination with an endoscopic tube (ie, a trocar). . Rather, it is believed that the present invention may find use in any procedure where access is limited to a small incision, including, without limitation, endoscopic procedures, as well as other open procedures.

For example, while a surgical stapling and cutting instrument 10 is described herein to advantageously have separate separate actuators other than closing and firing, it should be appreciated that applications in accordance with the present invention may include a handle that converts a single user actuation in a trigger offset that closes and triggers the instrument.

Also, while a manually operated handle is illustrated, a mechanical or otherwise powered handle can benefit from the incorporation of an articulated rack as described herein, allowing for handle size reduction or other benefits. For example, although the partial insertion of the articulated rack into the pistol grip is a convenient feature, it should be appreciated that the pivot connection between tie rods enables insertion of the tie rod in a parallel position with respect to the straight portion defined by the axis. and the cylindrical body of the handle.