Handling of fasteners within surgical instrument

0001Field [0001] The disclosed embodiments relate to the handling of fasteners within surgical instruments.

0002background [0002] Surgical mesh fabrics or other prosthetic repair fabrics may be used to surgically repair the hernia. Prosthetic repair fabrics are generally placed in thoracotomy or laparoscopically. One or more fasteners may be placed in the underlying tissue through the prosthetic repair fabric to secure the repair fabric in place. Surgical instruments used during surgical repair or other appropriate procedure of a hernia often include magazines or other structures capable of holding multiple fasteners for placement from the surgical instrument. Including multiple fasteners in the surgical instrument can increase the speed of the procedure and also reduce the need to remove the surgical instrument and reintroduce the surgical instrument into the surgical field to provide additional fasteners. Can be done.

<p num="0003">Overview [0003] In one embodiment, the surgical instrument includes a handle and an elongated shaft assembly that extends distally from the handle. Surgical instruments also include a fastener placement system that includes a drive shaft located within the elongated shaft assembly. The drive shaft includes at least one guide surface that at least partially defines the internal channels of the drive shaft. The at least one guide surface is shaped and so arranged to maintain the orientation of at least one fastener within the drive shaft channel.</p><p num="0004"> [0004] In another embodiment, methods of manipulating surgical instruments include a handle, an elongated shaft assembly extending distally from the handle, and a drive shaft located within the elongated shaft assembly. A fastener indwelling system for indwelling fasteners from an elongated shaft assembly, including a fastener indwelling system in which the drive shaft contains an internal channel, and at least one fastener placed in the internal channel of the drive shaft. , The step of preparing the surgical instrument, the step of moving the drive shaft and activating the fastener indwelling system to indwell the second fastener from the elongated shaft assembly, and the step of indwelling the second fastener. Includes the step of maintaining at least one fastener orientation with respect to the drive shaft while the indwelling system is in operation.</p><p num="0005"> [0005] In yet another embodiment, the surgical instrument includes a handle and an elongated shaft assembly that extends distally from the handle. Surgical instruments also include a fastener indwelling system for indwelling fasteners from an elongated shaft assembly that includes a drive shaft located within the elongated shaft assembly. The drive shaft includes an internal channel adapted and arranged to include at least one fastener. Further, the cross section of the channel in the portion located on the tip end side of the drive shaft includes a flat portion and a rounded portion.</p><p num="0006"> [0006] In another embodiment, the surgical instrument includes a handle and an elongated shaft assembly that extends distally from the handle. Surgical instruments also include a fastener indwelling system for indwelling fasteners from the elongated shaft assembly and one or more fasteners located within the elongated shaft assembly and within the elongated shaft assembly. Includes associated followers. By operating the fastener indwelling system, the follower compresses from the first length to the second length, applies a tip-side guiding force to one or more fasteners, and moves the fasteners toward the tip. During the movement of one or more fasteners, the follower extends from the second length to the first length.</p><p num="0007"> [0007] In yet another embodiment, the surgical instrument includes a handle, an elongated shaft assembly extending distally from the handle. Surgical instruments also include a fastener indwelling system for indwelling fasteners from an elongated shaft assembly. The fastener indwelling system includes a drive shaft located within the elongated shaft assembly and a follower located within the elongated shaft assembly and associated with the drive shaft. The movement of the drive shaft toward the tip causes the fasteners to be placed from the elongated shaft assembly, the followers to move toward the tip, and one or more fasteners placed within the elongated shaft assembly toward the tip. Move to. The force applied by the drive shaft to the indwelling fasteners is greater than the force applied by the followers to one or more fasteners.</p><p num="0008"> [0008] In another embodiment, the surgical instrument includes a handle and an elongated shaft assembly that extends distally from the handle. Surgical instruments also have a fastener indwelling system for indwelling fasteners from the elongated shaft assembly and one or more fasteners in the elongated shaft assembly located within the elongated shaft assembly. Includes a follower for moving in the direction. The follower applies a first force to one or more fasteners prior to the activation of the fastener indwelling system, and one after the activation of the fastener indwelling system initiates the movement of one or more fasteners toward the tip. Alternatively, a second force is applied to multiple fasteners. The elongated shaft assembly is configured to apply a first binding force and a second binding force to one or more fasteners. The first force is less than the first binding force. Furthermore, the second force is greater than the first binding force and less than the second binding force.</p><p num="0009"> [0009] In yet another embodiment, the surgical instrument includes a handle and an elongated shaft assembly that extends distally from the handle. The first constraint element and the second constraint element are associated with the elongated shaft assembly. The second restraint element is arranged on the tip side from the first restraint element. The first constraint element and the second constraint element define the fastener placement position. Surgical instruments also include a fastener indwelling system for indwelling fasteners from an elongated shaft assembly. The fastener indwelling system includes a drive shaft adapted and arranged to apply an indwelling force to the fasteners located in the fastener indwelling position.</p><p num="0010"> [0010] In another embodiment, the method of operating the surgical instrument is a handle, an elongated shaft assembly extending from the handle to the tip side, and a fastener placement for indwelling the fastener from the elongated shaft assembly. Steps to prepare the system and followers that are located within the elongated shaft assembly and associated with one or more fasteners located within the elongated shaft assembly, and from the elongated shaft assembly to the fasteners. Steps to activate the fastener indwelling system to detain and move the follower to the tip side to compress the follower from the first length to the second length and tip side to one or more fasteners The follower moves from the second length to the first length during the movement of the one or more fasteners, including the step of applying an inductive force to move the one or more fasteners toward the tip side. Stretch.</p><p num="0011"> [0011] In yet another embodiment, the surgical instrument includes a handle and an elongated shaft assembly that extends distally from the handle. Surgical instruments also include a fastener indwelling system for indwelling fasteners from an elongated shaft assembly. The fastener indwelling system includes a drive shaft. The follower is configured to move the fastener stack and is located within the drive shaft. The follower and drive shaft form a walking beam assembly for sequentially moving the follower towards the tip during each operating cycle of the fastener indwelling system.</p><p num="0012"> [0012] In another embodiment, the surgical instrument comprises a handle and an elongated shaft assembly extending distally from the handle. Surgical instruments also include a fastener indwelling system for indwelling fasteners from an elongated shaft assembly. The fastener indwelling system includes a drive shaft. The retreat prevention element is such that the drive shaft moves to the tip side by the operation of the fastener indwelling system, and during each operation cycle, the retreat prevention element extends to a preset length by the movement toward the tip side of the drive shaft. Is associated with.</p><p num="0013"> [0013] As the present disclosure is not limited in this regard, it should be recognized that the above concepts and the further concepts described below may be adjusted in any suitable combination. The above and other aspects, embodiments and features of this teaching can be understood in more detail from the following description along with the accompanying drawings.</p><p num="0014">A brief description of the drawing [0014] The accompanying drawings are not intended to be drawn to a constant scale. In the drawings, the same or nearly identical components shown in the various figures may be designated by similar reference numerals. For clarity, not all components in each drawing are coded.</p>

0015<figref num="1">It is the schematic of the articulated surgical instrument.</figref><figref num="2">It is the schematic of the inside of the surgical instrument handle of FIG.</figref><figref num="3">FIG. 6 is a schematic exploded view of components arranged within a channel of an elongated shaft assembly and an elongated shaft assembly.</figref><figref num="4">It is a schematic diagram of a follower.</figref><figref num="5">It is the schematic of the tip side part of the reciprocating drive shaft.</figref><figref num="6">It is the schematic sectional drawing of the follower arranged in the drive shaft.</figref><figref num="7A">It is a schematic diagram of the stack and the follower of the fastener in the non-erected position.</figref><figref num="7B">It is a schematic diagram of the stack of fasteners to which urging force is applied and the follower of FIG.</figref><figref num="7C">It is a schematic diagram of the stack of fasteners and the follower of FIG. 6 after the stack of fasteners has moved to the tip side.</figref><figref num="8A">It is the schematic of the tip side part of the retreat prevention mechanism.</figref><figref num="8B">It is the schematic of the retreat prevention mechanism shown in FIG. 8A after one operation cycle.</figref><figref num="9">It is a schematic perspective view of the rigid straight line part including the 1st and 2nd restraint elements.</figref><figref num="10">It is the schematic end view of the rigid straight line part shown in FIG.</figref><figref num="11">It is a schematic side view of the rigid straight line part shown in FIG.</figref><figref num="12">It is a schematic side view which rotated the rigid straight line part shown in FIG. 11 by 120 °.</figref><figref num="13A">FIG. 3 is a cross-sectional view of an elongated shaft assembly, a reciprocating drive shaft and a fastener in a non-operating position.</figref><figref num="13B">FIG. 6 is a cross-sectional view of the elongated shaft assembly, reciprocating drive shaft and fasteners shown in FIG. 13A in the operating position.</figref><figref num="13C">FIG. 3 is a cross-sectional view of the elongated shaft assembly, reciprocating drive shaft and fasteners shown in FIG. 13A after operation.</figref><figref num="14">It is a schematic exploded view of a reciprocating drive shaft including a long shaft assembly and a stack of fasteners.</figref><figref num="15">It is a schematic top view of a fastener.</figref><figref num="16">It is a schematic bottom view of the fastener shown in FIG.</figref><figref num="17">It is a schematic perspective view of the fastener shown in FIG.</figref><figref num="18">It is a schematic end view of a reciprocating drive shaft including a stack of fasteners arranged inside.</figref><figref num="19">FIG. 3 is a schematic end-view of an elongated shaft assembly with a reciprocating drive shaft and a stack of fasteners arranged therein.</figref>

0016Detailed explanation [0039] The inventors have recognized that relative movements such as excessive force applied to the fastener stack during operation and rotation between adjacent fasteners can interfere with fastener placement.

0017[0040] In view of the above, the present inventors have recognized the advantage of imparting a controlled force to the stack of fasteners and facilitating the placement of fasteners. Further, in some embodiments, this force may be less than the approximate actuating force applied to the fasteners located at the distal fastener indwelling position. We also acknowledged several advantages of maintaining the orientation of individual fasteners within the fastener stack and holding the leading edge fasteners in the fastener placement position. The above advantages may also lead to improved consistency of fastener placement and surgical instrument operation.

0018[0041] In one embodiment, the surgical instrument may include a handle and an elongated shaft assembly extending distally from the handle. The elongated shaft assembly may include a fastener indwelling position located on the distal side, from which the fasteners may be indwelled. Surgical instruments may also include a fastener indwelling system for indwelling the fasteners out of the fastener indwelling position at the tip of the elongated shaft assembly. The fastener indwelling system may be embodied in any number of ways. Further, in some embodiments, the fastener indwelling system may include a magazine or other suitable structure for accommodating multiple fasteners. Depending on the particular embodiment, the plurality of fasteners may be arranged as a stack of nested fasteners, but other arrangement configurations are also envisioned. The fastener detention system also includes a follower or other suitable component associated with the fastener stack to move one or more fasteners towards the fastener detention position during the operation cycle of the fastener detention system. But it may be.

0019[0042] In addition to the fastener placement, the activation of the fastener placement system also causes the follower to move to the tip side, the fastener stack moves to the tip side towards the fastener placement position, and the next most advanced fastener is the fastener. It may be placed in the detention position. The fastener detention system may move the follower in any suitable manner. For example, in one embodiment, the follower may be associated with the drive shaft of the fastener indwelling system so that the follower moves toward the tip by moving the drive shaft toward the tip. The backward movement of the follower may also be prevented by the use of an appropriate anti-backward element associated with the follower. Regardless of the particular way the follower moves, the follower may be arranged and configured to apply a controlled force to the fastener stack during movement. The force applied to the fastener stack may be any suitable force and, in one embodiment, may be less than the working force applied to detain the fastener from the fastener placement position.

0020[0043] In certain embodiments, the follower may be made by any suitable method such as applying a similar force to the fastener stack during the subsequent operating cycle of the fastener indwelling system. For example, the follower may include a driven element, which is associated with the fastener indwelling system such that the driven element is moved to the tip side by the operation of the fastener indwelling system. The driven element may also be associated with a compressible elastic element associated with the indentation element. The elastic element may be adapted and arranged to exert a controlled force on the indentation element as the driven element moves. Elastic elements can apply force to coil springs, conical coil springs, air springs, well-shaped components made from compressible materials (eg rubber), or stacks of fasteners when compressed. May include any other suitable shape and size of compressible components. In some embodiments, in addition to exerting a controllable force on the fastener stack, the elastic element is an articulating portion of the elongated shaft assembly while the follower still applies force to the fastener stack. May be imparted with sufficient flexibility to allow it to pass through. In one such embodiment, the driven, elastic and indentation elements may also be sized and shaped to pass through the elongated shaft assembly in both linear and articular configurations.

0021[0044] Although the embodiments described herein mean and indicate driven, elastic and indentation components as separate components physically associated with each other, the present disclosure is a separate component. Not limited to the use of. For example, in some embodiments, the driven element, elastic element and indentation element may be provided as part of the integral component.

0022[0045] In some embodiments, the follower may be configured to exert a similar force on the fastener stack during a later working cycle. This may be achieved in any number of ways, but in one embodiment the follower may be manipulated in the following ways: When the fastener indwelling system is activated, the driven element may move to the tip side. The movement of the driven element towards the tip may compress the elastic element from the first length to the compressed second length. After compression of the elastic element, the elastic element may be stretched from the compressed second length to the original first length. As the elastic element extends to the second length, the fastener may move along the elongated shaft assembly towards the fastener indwelling position and towards the tip. In some embodiments, the difference between the first length and the second length may correspond to the length of one fastener. When the elastic element is in the stretched state corresponding to the first length, the elastic element may apply a first force to the stack of the indentation element and the fastener. Then, if the elastic element is in a compressed state corresponding to the second length, the elastic element may apply a second force to the stack of the indentation element and the fastener. As expected in the compressed elastic element, the second force is greater than the first force. In some embodiments, the first force may be near zero. However, in other embodiments, it may be desirable to impart tip-side bias to the fastener stack throughout the operating cycle to prevent the fastener stack from moving backwards. In one such embodiment, the first force may be greater than zero, which corresponds to the initial compression of the elastic element prior to activation of the fastener indwelling system.

0023[0046] In addition to the force applied to the fastener stack by the follower, a binding force is also applied to the stack fastener in order to prevent the fastener from moving toward the tip side until the force applied by the follower exceeds a preset threshold force. You can do it. For example, a first binding force may be applied to the fastener stack before and during operation of the fastener indwelling system. The first binding force may be applied to the fastener stack to resist the first force applied by the follower to the fastener stack. Therefore, prior to activation of the fastener indwelling system, the fastener stack may remain stationary within the elongated shaft assembly. However, during operation, the elastic element may be compressed to a second compression length to apply greater force to the fastener stack as shown above. When the applied force (for example, the second force) becomes larger than the first binding force, the fastener stack may be moved to the tip side by the follower, and the next fastener may be placed in the fastener indwelling position. A second binding force may then be applied to constrain the further tip-side movement of the fastener stack during its operating cycle.

0024[0047] Any of the binding forces described may be imparted by one or more binding elements. Furthermore, the constraint elements may be embodied in any number of ways. For example, the constraining element may include one or more tabs that extend inwardly and distally to the elongated shaft assembly, a stop mechanism, and other suitable features. In addition, the restraint element may be integrally formed with the elongated shaft assembly, or the restraint element may be formed separately and then include welding, soldering, adhesives, mechanical couplings, fasteners and tight fits. May be assembled to the elongated shaft assembly using any suitable method, but not limited to these.

0025[0048] In some embodiments, in addition to imparting binding to the fastener stack, the binding element may also be used to define the fastener placement position. For example, the fastener head or other suitable feature may be held between the first and second constraint elements to define the fastener placement position.

0026[0049] In addition to providing a follower to control the force applied to the fastener stack as shown above, the elongated shaft assembly as the fastener stack moves towards the fastener placement position by the follower. It may be desirable to provide a mechanism for maintaining the orientation of the fasteners within. In one embodiment, the guide surface may be sized and shaped to interact with at least a portion of the corresponding surface of the fastener and maintain the orientation of the fastener as it moves through the elongated shaft assembly. .. In some cases, the corresponding surface of the fastener may be shaped to be complementary to the guide surface in both shape and size. The guide surface is placed in any suitable component of the elongated shaft assembly, or in a component that interacts with the fastener as it travels within the elongated shaft assembly. May be good. Furthermore, since the present disclosure is not limited with respect to the position and range of the guide surface, the guide surface extends along the distal end portion of this component, a portion of this component corresponding to the stack of fasteners, or the entire length of this component. You may.

0027[0050] It should be understood that the guide surface and the corresponding surface on the fastener may contain any combination of suitable shapes and / or features capable of maintaining the orientation of the fastener. For example, as will be apparent to those skilled in the art, the corresponding surfaces of the guide surfaces and fasteners may include corresponding flat surfaces, protrusions and corresponding grooves, and other complementary arrangement configurations.

0028[0051] In one particular embodiment, the fasteners may be placed within the internal channels of a reciprocating drive shaft that reciprocates in the proximal and distal directions. Further, the guide surface may be incorporated into the inner surface of the channel. In one such embodiment, the guide surface may interact with the corresponding surface of the fastener to maintain the orientation of the fastener within the reciprocating drive shaft. During the operation of the fastener indwelling system, the drive shaft may be moved in the proximal direction to move towards the distal end side and indwell the fastener before preparing for the next actuation cycle. During this reciprocating motion of the drive shaft, the drive shaft may move relative to the fastener stack. In addition, the fastener stack may be moved towards the tip of the drive shaft with any suitable urging element during or after fastener placement, placing the next leading edge fastener in the fastener placement position. Good. For example, the fastener stack may be moved using the followers described herein. As the stack fasteners move toward the fastener placement position and as the drive shaft moves relative to the stack of fasteners placed therein, the guide surfaces maintain the fasteners in a preselected orientation with respect to each other and to the drive shaft. You may. As mentioned above, maintaining the fasteners in a pre-selected orientation with respect to each other and to the drive shaft ensures proper alignment of the fasteners and moves the fasteners within the articulating portion of the elongated shaft assembly. The required force may be reduced.

0029[0052] For clarity, the embodiments disclosed herein relate to laparoscopic devices. However, the present disclosure is not limited to laparoscopic devices. Instead, the followers, restraint elements and guide surfaces disclosed herein can be used in any suitable device for the placement of fasteners within the tissue. For example, any of the components disclosed herein or a combination of components disclosed herein may be an endoscopic device, a borescope device, a catheter, a surgical instrument for use in "thoracotomy" surgery, or any other. Can be incorporated into suitable surgical instruments. In addition, the surgical instrument may be loaded with one or more fasteners before being provided to the end user, or the surgical instrument may be loaded with one or more fasteners by the user. May be configured to enable. Further, although the various embodiments shown herein are described as being used with a particular fastener, in the embodiments disclosed herein, studs, clips, clasps, pins, tissue anchors. Any suitable fastener can be used, including bone anchors or any other suitable type of fastener.

0030[0053] With reference to the figures here, specific embodiments of surgical instruments are described.

0031[0054] FIG. 1 shows an embodiment of surgical instrument 2. Surgical instruments include a handle 4 and an elongated shaft assembly 6 extending distally from the handle 4. In addition to fasteners placed from the tip of the elongated shaft assembly, the elongated shaft assembly 6 may include a joint movable portion 8. Surgical instrument 2 may also include a trigger 14 for activating the corresponding fastener indwelling system 15 (see FIG. 2) and indwelling the fastener in the tissue.

0032[0055] The joint movable portion 8 uses the joint movement control unit 10 to joint between a first position such as a non-joint (that is, a straight line) movement position and a second position such as a complete joint movement position. It may work in an expression. In some embodiments, the articulated portion 8 may be articulated only between the first and second positions. Since the present disclosure is not limited in this manner, in other embodiments, the joint movable portion 8 is placed in one or more preselected joint movement positions or any (ie, non-preselected) joint movement positions. It may operate in an articulated manner. Further, depending on the embodiment, the articulated portion 8 may be articulated in only one direction or articulated in two directions. For example, the articulated part 8 can be articulated in approximately 0 ° to 90 °, 0 ° to 45 °, -90 ° to 90 °, -180 ° to 180 °, or any other suitable angular range. May be good. In addition, in some embodiments, the articulated portion 8 may articulate around two different axes (eg, joint motion in the horizontal and vertical directions).

0033[0056] In some embodiments, it may be desirable to rotate the elongated shaft assembly 6 to facilitate tip-side tip positioning. One such embodiment is shown in FIGS. 1 and 12. Rotation of the elongated shaft assembly 6 may be provided in any suitable manner. For example, the elongated shaft assembly 6 may simply be configured to be rotatable relative to at least a portion of the handle 4. Alternatively, one portion of the handle 4 that includes the elongated shaft assembly 6 may be rotatable relative to another portion of the handle 4, such as a portion that includes a grip. One such embodiment is shown in FIG. In the embodiments shown, the surgical instrument 2 includes a first handle portion 16 and a second handle portion 18 that includes an elongated shaft assembly 6. The first handle portion 16 and the second handle portion 18 may be configured and arranged in any suitable manner so as to be rotatable with respect to each other. The figure shows a surgical instrument including a rotatable elongated shaft assembly 6 or handle 4, but the present disclosure is not limited to this method and therefore an integrated handle and / or an elongated shaft assembly fixed to the handle. It should be understood that surgical instruments including 6 are also possible.

0034[0057] In certain applications, it may be advantageous to include a rigid linear portion 12 located on the distal end side from the joint movable portion 8. For example, if you do not want to be bound by theory, but the drive shaft applies force to the fastener as the fastener travels through a curve, the force applied by the drive shaft to the base end of the fastener is that of the fastener. It may not be aligned with the indwelling direction. As a result, a part of the applied force may be guided to the side surface of the elongated shaft assembly 6. On the other hand, when the drive shaft applies a force to the fastener along a straight portion, the applied force is aligned with the indwelling direction of the fastener. Therefore, by including the rigid straight portion 12 extending from the joint movable portion 8 to the tip side by a specific length, the applied operating force can be aligned with the indwelling direction, so that the fastener can be indwelled. It may be possible to reduce the operating force applied by the drive shaft. In addition, the consistency of fastener placement may also be improved as the surgical instrument changes between different joint angles due to the application of working force aligned with the placement direction. In addition to the above advantages, the rigid linear section 12 may also incorporate other components or features to assist in positioning and placement of the fasteners from the surgical instrument. Although the surgical instrument 2 including the distal rigid linear portion 12 is described herein and shown in the figure, the articulating portion 8 is a long shaft assembly so that the surgical instrument does not include the distal rigid linear portion. It should be understood that embodiments extending to the tip of 6 are also envisioned.

0035[0058] As mentioned above, the surgical instrument 2 may also include a fastener indwelling system 15 as shown in FIG. The fastener indwelling system 15 may be embodied in any number of different methods. However, in the particular embodiment shown in FIG. 2, the fastener indwelling system includes a trigger 14, a rigid link 20, a shuttle 22, a power assist device 24, a reciprocating drive shaft 26, and other configurations not shown. Elements and may be included. By operating the trigger 14, the rigid link 20 may move to the tip side, and the shuttle 20 may move to the tip side to store energy in the power assist device 24. After a preselected amount of operation, the power assist device 24 may release the stored energy, accelerate the drive shaft 26 towards the tip, and indwell the fasteners from the tip of the elongated shaft assembly 6.

0036Although a particular power assist device 24 is shown, the power assist device 24 may accommodate any suitable structure capable of assisting the placement of fasteners from the long shaft assembly 6 of the surgical instrument. Good. In certain embodiments, the power assist device 24 provides all of the power required to detain the fasteners in response to the activation of the trigger 14, but some of the power required to detain the fasteners. Only may be supplied. In one particular embodiment, the power assist device 24 is a POWER ASSIST DEVICE FOR A SURGICAL filed on the same day as the present application. It may match the power assist device disclosed in US Patent Application No. 13 / 804,043 named INSTRUMENT). Surgical instruments are shown that include a power assist device, but in some embodiments the surgical instrument 2 does not have to include a power assist device, in which case the activation of the trigger 12 allows the use of a suitable transmission. The drive shaft 26 may be moved either directly or indirectly by means of indwelling fasteners from the tip of the elongated shaft assembly 6.

0037[0060] FIG. 3 shows an exploded view of an embodiment of the elongated shaft assembly 6 and various components arranged within the elongated shaft assembly. In the embodiments shown, the drive shaft 26 is located within the elongated shaft assembly 6. As shown by FIGS. 2 and 3, when disposed within the elongated shaft assembly 6, the drive shaft 26 extends from the elongated shaft assembly 6 toward the proximal end in the handle 4. Surgical instruments also include a fastener stack 28, a follower 34, and an anti-retraction element located within the internal channel of the drive shaft 26. The fastener stack 28 may include one or more fasteners 30, and in some cases may be multiple fasteners 30.

0038[0061] In addition to the above components, the surgical instrument may also include a fastener guide 32 to assist in maintaining alignment of the anti-retraction element 36 within the internal channels of the fastener stack 28, follower 34 and drive shaft 26. Good. Any suitable structure may be used, but in the embodiments shown, the fastener guide 32 is an distally extending wire located approximately in the center of the drive shaft channel. The fastener guide 32 may be retained in the channel in any suitable manner. For example, the fastener guide 32 may be attached to a portion of the anti-backward element 36, a portion of the handle 4, or any other suitable structure. Further, the faster guide 32 may be attached using any suitable method including, but not limited to, adhesives, mechanical interference, clamping, soldering and welding.

0039Activating the trigger may actuate the fastener indwelling system, causing movement of the drive shaft 26 towards the tip. As described in more detail below, by moving the drive shaft 26 toward the tip end side, the state-of-the-art side fastener arranged at the fastener placement position is detained. The drive shaft 26 also moves the follower 34 to the tip side, moves the fastener stack 28, and places the next most advanced side fastener in the fastener placement position. The follower 34 and the retreat prevention element 36 may be associated with each other so that the retreat prevention element extending toward the tip side hinders the movement of the follower 34 toward the proximal end side by moving toward the tip end side of the following 34. After the fastener is placed and the next fastener is placed at the fastener placement position, the drive shaft 26 moves toward the base end side while hindering the movement of the fastener stack 28, the follower 34, and the receding prevention element 36 toward the base end side. However, the surgical instrument may be prepared for the next operation.

0040[0063] Figures 4-6 show the interaction between the follower 34 and the drive shaft 26.

0041[0064] In the embodiments shown, the follower 34 includes a driven element 100, an elastic element 102, and a pushing element 104. The driven element 100 is configured to interact with the drive shaft 26 to move the follower 34 toward the tip side. The driven element 100 includes a tab 106 that interacts with an opening 124 on the drive shaft 26. The tab 106 may be flexible and may extend outwardly and distally from the driven element 100. In addition, the tab 106 may be sized, shaped, or arranged so that the tab 106 can be placed in the opening 124 as the driven element 100 moves into the drive shaft 26 toward the tip. Good. The driven element 100 may also include a distal portion 108a and a shoulder portion 110. The tip side portion 108a and the shoulder portion 110 may be sized and shaped so as to hold the tip end portion of the elastic element 102 on the tip side portion 108a. The distal portion 108a may also include one or more holding feature portions 116. The holding feature portion 116 shown is a protrusion that is disposed on the distal end side portion 108a and interferes with the elastic element 102 to hold the elastic element on the distal end side portion 108a. Alternatively, the elastic element 102 may be held onto the driven element 100 using any suitable method, including but not limited to mechanical interference, interlocking, adhesives, welding, soldering and brazing. Good. The driven element 100 may also include a coupling 118 located in the proximal end portion 108b. The coupling 118 may be adapted and arranged to attach the follower 34 to the anti-backward element 36.

0042[0065] The elastic element 102 shown is a coil spring extending between the driven element 100 and the pushing element 104. As shown above, coil springs are shown, but other springs and suitable components can be used instead of coil springs. Regardless of the particular component used as the elastic element 102, the elastic element 102 may be sized, shaped, or arranged to correspond to both the driven element 100 and the indenting element 104. .. Further, by the use of a spring or other suitable compressible component, as the driven element moves towards the tip, the elastic element 102 is compressed and exerts a force on the indentation element 104. The greater the movement of the driven element 100 before the operation of the pushing element 104, the greater the compression of the elastic element 102, and similarly, the greater the force. Since the present disclosure is not limited to this method, the elastic element 102 may exhibit a linear force with respect to a moving relationship or a non-linear force with respect to a moving relationship, depending on a particular embodiment.

0043[0066] Like the driven element 100, the indentation element 104 may include a proximal end 112b and a shoulder 114 of a size and shape that hold the tip of the elastic element 102. The indentation element 104 may also include one or more holding features 116 for holding the elastic element 102, similar to those described above with respect to the driven element 100. The indentation element 104 may also include a distal portion 112a adapted and disposed to apply force to the fasteners located most proximal to the fastener stack. In some embodiments, the distal portion 112a may be in direct contact with at least the most proximal fastener in the fastener stack, but the distal portion 112a indirectly applies force to the fastener stack. Is also envisioned.

0044As shown in FIG. 5, the drive shaft 26 may include one or more fastener drive elements 120 located at the tip of the drive shaft 26. In some embodiments, the fastener drive element 120 may be one or more flexible tabs extending inwardly and laterally from the tip of the drive shaft 26. The fastener driving element 120 may be configured to apply a force to the fasteners arranged at the fastener placement positions to place the fasteners from the tip of the elongated shaft assembly. The drive shaft may also include a flexible portion 122 to adapt to the movement of the reciprocating drive shaft within the articulating portion of the elongated shaft assembly. In the embodiments shown, the flexible portion 122 is formed by providing a pattern of slots or notches in the drive shaft 26. As shown above, the drive shaft 26 may also include an opening 124 of a size and shape that accommodates the tab 106 of the driven element 100 in the extended position. One or more sets of openings 124 may be arranged axially spaced along one or more surfaces of the drive shaft 124. In some embodiments, the axial spacing between the openings 124 may correspond to the length of one fastener. In this embodiment, two sets of openings 124 extend along both sides of the drive shaft 26 to accommodate both tabs 106 of the driven element 100. The opening 124 may extend along the entire drive shaft 24, or as shown in the figure, the opening 124 is in place at the initial proximal position of the follower 34 and all fasteners are placed from the surgical instrument. It may extend along a part of the drive shaft 24 corresponding to the final tip side position of the follower 34 after the operation.

0045Although the corresponding features of the drive shaft 26 and follower 34 have been described, the interaction of these two components in operation in one possible embodiment is described herein (see FIG. 6). Prior to actuation, the tab 106 of the driven element 100 may be located within any one of the corresponding openings 124 of the drive shaft 26 in the extended state. While the tab 106 is in the extended state within the corresponding opening 124, the proximal portion of the drive shaft 124a, such as the proximal edge of the opening, is axially aligned with the proximal side 106a of the tab 106. May be good. Therefore, when the drive shaft 26 moves toward the tip end side during operation, the base end side drive shaft portion 124a applies a tip end side guiding force to the base end side side surface 106a of the tab 106 and moves the driven element 100 toward the tip end side. Occurs. After the fasteners are placed, the drive shaft 26 subsequently moves towards the proximal end. During the movement of the drive shaft 26 toward the proximal end, the distal end of the shaft 124b, such as the distal edge of the opening 124, may be pulled out onto an outer side surface 106b, such as the outer surface of the tab. As described in more detail below, the driven element 100 may be prevented from moving backward during the relative movement of the drive shaft 26 and the driven element 100. Moreover, as shown above, the tab 106 is flexible. Therefore, when the tip-side drive shaft portion 124b is pulled out onto the outer side surface 106b of the tab, the tab 106 moves inward and exits the opening 124 to allow relative movement between the driven element 100 and the drive shaft 26. It may be. The movement of the drive shaft 26 toward the proximal end is continued until the tab 106 is aligned with the next set of openings 124 located on the distal end and the tab 106 is extended within the opening 124. Good. In a later actuation cycle, the driven element 100 may continuously move towards the tip side as the driven element 100 engages with the next set of corresponding openings 124 in the drive shaft. In view of the above, the driven element 100 and the drive shaft 26 of the follower 34 are fastened.

0046[0069] Figures 7A-7B show the interaction of the fastener stack 28, follower 34 and retreat prevention element 36 during the operating cycle of the fastener indwelling system. As shown in the figure, the indentation element 104 may come into contact with the fasteners located on the proximal side of the fastener stack 28. The elastic element 102 may also be associated with a proximal end portion of the indentation element 104 and a distal end end portion of the driven element 100. The driven element 100 may be coupled to the rack arm 126 of the retreat prevention element 36 by a coupling 130. Even if the driven element 100 and the rack arm 126 are connected so that the rack arm 126 can extend toward the tip side with respect to the clawed arm 128 of the retreat prevention element 36 due to the movement of the driven element 100 toward the tip side. Good. Therefore, as the follower 34 moves toward the tip in the elongated shaft assembly, the anti-backward element 36 extends as well. Therefore, the movement of the follower 34 toward the proximal end may be impeded by the anti-backward element 36 throughout the operating cycle. As shown in the figure, the coupling 130 corresponds to a pin connection. However, any suitable connection may be used that includes, but is not limited to, interlocking mechanical features, set screws, fasteners, adhesives, welds, brazing and tight fits.

0047[0070] Prior to operation, as shown in FIG. 7A, the elastic element 102 of the follower 34 is in an extended state corresponding to the first length, and is placed on the indentation element 104 and the fastener stack 28 arranged on the tip side. The tip side inductive force of 1 may be applied. The follower 34 and the fastener stack 28 are prevented from moving toward the tip side by the retreat prevention element 36. In the embodiments shown, the anti-retraction element 36 includes a rack arm 126 that may move towards the distal end and a claw arm 128 that remains stationary during the operation of the surgical instrument.

0048[0071] Referring to FIG. 7B, when the fastener indwelling system is activated, a drive shaft (not shown) forces a force F on tab 106 of driven element 100._DMay be applied, thereby driving the driven element 100 toward the tip side as described above. First binding force F guided to the base end side_R1May be applied to the fastener stack 28. Initially, the first binding force F_R1Is force F_DMay be equal to. Therefore, the fastener stack 28 may remain stationary during the initial part of the motion, resulting in compression of the elastic element 102 between the indentation element 104 and the driven element 100. As the operation continues, the force applied to the driven element 100 may continue to increase as the elastic element 102 is further compressed. This continuous compression of the elastic element 102 applies an increasing tip-side inductive force to the fastener stack 28. At some point during operation, the spring may be compressed to a second length corresponding to the elastic element 102 and a second tip-side guiding force may be applied to the indentation element 104 and the corresponding fastener stack 28. This second tip side guiding force is the first binding force F_R1Greater than, stretching of the elastic element 102 and movement of the indenting element 104 and the corresponding fastener to the tip side of the stack 28 may occur (see FIGS. 7B-7C).

0049As shown in the figure, the elastic element 102 continues to stretch from the second length to the first length as the fastener stack 28 moves toward the tip side. When the elastic element 102 approaches the extended first length, the second binding force F is induced toward the base end side with respect to the fastener stack 28._R2May be applied to prevent further movement of the fasteners towards the tip of the stack. Second, to resist both the force applied by the elastic element 102 to the fastener stack 28 and the expected kinetic energy stored in the fastener stack 28 and follower 34 as they move toward the tip. Binding force F_R2May be greater than the first binding force. The second binding force may also be less than the working force for indwelling the fasteners from the elongated shaft assembly. In some embodiments, when the fastener placed on the tip side of the stack fastener 20 is placed at the fastener designated position, a second binding force F_R2May be applied. After the fastener stack 28 has moved to the distal side and the fastener placement system has been reset, the surgical instrument has been reactivated, resulting in further distal movement of the follower 34 and the corresponding fastener stack 28. May be good.

0050[0073] In addition to the movement of the follower 34 and the corresponding fastener stack 28, the activation of the fastener indwelling system may also result in the extension of the retreat prevention element 36 as shown above. More specifically, since the driven element 100 and the rack arm 126 are coupled, the movement of the driven element 100 to the tip side causes the rack arm 126 to move to the corresponding tip side with respect to the clawed arm 128. May be good. After the fastener stack 28 has moved to the tip side, the retract prevention element 36 may extend toward the tip side due to the movement of the rack arm 126 toward the tip side to prevent the driven element 100 from moving backward. The interaction between the rack arm 126 and the clawed arm 128 is shown in detail with reference to FIGS. 8A and 8B. The teeth 134 may be spaced apart along the axial length of the rack arm 126. The corresponding claw 132 may be placed on the tip end side portion of the claw arm 128. The claws 132 and the corresponding teeth 134 may be adapted and arranged to allow the rack arm 126 to move towards the tip in response to the driven element moving towards the tip. The claws 132 and the corresponding teeth 134 may also be adapted and arranged to prevent the rack arm 126 from moving towards the proximal end. In one embodiment, the distance between the teeth 134 may be approximately equal to the length of one fastener. However, embodiments where the distance between the teeth 134 is a fraction of the fastener length or longer than the fastener length are also envisioned. In addition to the above, the rack and claw system has been shown as the anti-back element 36, but any suitable mechanism that can prevent the follower and stack fasteners from moving backwards can be used.

0051[0074] FIGS. 9-12 show the internal tubular member 200, which is a component of the elongated shaft assembly 6. The internal tubular member 200 includes a rigid linear portion 12 that forms the tip of the elongated shaft assembly 6. The internal tubular member may also include one or more first restraint elements 202 and one or more second restraint elements 204 arranged within the rigid linear section 12. As shown in FIG. 9, the two second restraint elements 204 are arranged on the tip side with respect to the first restraint element 202. The first binding element may be adapted and placed to impart the first binding force to the fastener stack during operation. Similarly, the second restraint element 204 may be adapted and positioned to impart a second binding force to the stack fasteners during operation. As mentioned above, the first binding force may be smaller than the second binding force. Since the present disclosure is not limited to the method in which the binding force is applied to the stack of fasteners, various binding forces may be applied by any number of methods. In some embodiments, the constraint element may be integrally formed with the elongated shaft assembly or the components of the elongated shaft assembly. Alternatively, the constraint elements may be formed separately and assembled to the elongated shaft assembly in any suitable manner, including but not limited to welding, soldering, adhesives, clasps and fasteners.

0052[0075] Various first and second binding forces may be applied in any suitable manner. For example, in one embodiment, different compliances of the first and second binding elements may be used to impart different first and second binding forces. More specifically, the second constraint element may be less compliant than the first constraint element. In another embodiment, different first and second binding forces may be applied using different numbers of first and second binding elements. In one such embodiment, a larger number of second constraining elements may be used compared to the number of first constraining elements. Although the specific methods of providing different binding forces have been described above, other methods of providing binding forces are also contemplated.

0053[0076] In one possible embodiment, and as shown in FIGS. 9-12, the first constraint element 202 and the second constraint element 204 are internal relative to the internal tubular member 200 of the elongated shaft assembly. It may correspond to a tab extending in the direction and to the tip side. To provide the desired first and second binding forces, one more compliant first binding element 202 and two less compliant second binding elements 204 are tubular inside the elongated shaft assembly. It is incorporated into the rigid straight portion 12 of the member 200. The tab corresponding to the second constraint element 204 may have a shorter length and / or a wider width than the tab corresponding to the first constraint element 202. Although not desired to be constrained by theory, this makes the second constraint element 204 less compliant than the first constraint element 202. Therefore, the embodiment shown by using two less compliant tabs as the second constraint element 204 as compared to using one more compliant tab as the first constraint element 202 is the first embodiment. It is configured to give a second binding force that is greater than the binding force of. Although the specific arrangement of the first and second binding elements is shown in the figure and described above, it should be understood that other embodiments for imparting the first and second binding forces are also possible. is there.

0054[0077] The interaction between the first restraint element 202, the second restraint element 204, the fastener 30 and the drive shaft 26 of the fastener indwelling system, the elongated shaft assembly during operation of the fastener indwelling system. It is shown by FIGS. 13A to 13C showing a series of cross sections of the tip side portion of 6. Before the operation, the fastener 30 arranged on the tip side is arranged at the fastener indwelling position 206. The fastener indwelling position 206 may be defined by the relative position of the first constraint element 202 and the second constraint element 204. The first restraint element 202 and the second restraint element 204 may define the fastener indwelling position by holding the fastener 30 head 30a between them prior to activation. Holding the fastener 30 in the fastener placement position 206 using restraint elements 202 and 204 can advantageously prevent the fastener from unintentionally moving out of the elongated shaft assembly 6 and for the next placement. Provides a consistent position for fasteners. When the fastener indwelling system is activated, the drive shaft 26 moves to the tip side, and as a result, the fastener drive element 120 applies a force to the fastener 30 located in the fastener indwelling position 206. The applied working force is greater than the second binding force applied by the second restraining element 204, resulting in the movement and placement of the fastener towards the tip as shown in FIG. 13B. As shown above, the fastener stack is applied to move the fastener stack to the tip side, and to place the next fastener in the fastener placement position 206 for the next actuation cycle. They may have separate forces. When the drive shaft 26 is pulled out toward the proximal end to reset the fastener placement system for the next actuation cycle, the fastener drive element 120 is placed around the fastener 30 head 30a and fasteners located at the fastener placement position 206. Deforms beyond the head 30a of 30 (see Figure 13C). As shown in the figure, the tabs corresponding to the first constraint element 202 and the second constraint element 204 are tips from the constraint elements 202 and 204. It may be arranged and configured to withstand the movement of the fastener 30 arranged on the side toward the proximal end side. Therefore, when the drive shaft moves toward the proximal end side, the movement of the fastener 30 arranged at the fastener indwelling position 206 toward the proximal end side may be hindered by the first restraint element 202. Once the drive shaft 26 has fully moved towards the proximal end, the surgical instrument is ready to place the next fastener.

0055[0078] The above embodiment relates to a follower driven by the reciprocating motion of the drive shaft in the proximal end side direction and the distal end side direction, but other embodiments are also possible. For example, in one embodiment, the follower is associated with the rotating drive shaft so that rotation of the drive shaft may result in movement towards the tip of the follower and the corresponding fasteners located within the drive shaft. May be good. In another exemplary embodiment, the follower may be associated with another component of the fastener indwelling system such that the actuation of the fastener indwelling system causes movement towards the tip of the follower. For example, the follower may be associated with a trigger 14, a rigid link 20, or a shuttle 22. Further, the follower may be directly or indirectly associated with any of the above components.

0056[0079] As mentioned above, in addition to moving the fastener stack to place the next fastener in the fastener placement position, in some embodiments a particular orientation of the fastener within the elongated shaft assembly. It may be desirable to maintain. FIG. 14 shows a schematic exploded view of the elongated shaft assembly 6 and the drive shaft 26 which may be disposed within the elongated shaft assembly 6. The pattern of slots formed on the outside of the elongated shaft assembly 6 shown provides flexibility to the portion of the elongated shaft assembly 6 that corresponds to the articulating portion 8. In the embodiments shown, the drive shaft comprises an internal channel for accommodating one or more fasteners 30 disposed therein. The drive shaft 26 may also include a guide surface 136. The guide surface 136 may have any suitable shape and may correspond to a flat surface extending in the axial direction of the drive shaft 26 as shown in the figure. While the fastener 30 is located within the drive shaft 26 and during operation, the guide surface 136 is used to maintain the orientation of the fastener as the drive shaft reciprocates between the distal and proximal positions. It may interact with the corresponding surface of the fastener 30. In addition to the guide surface 136, the drive shaft 26 also includes a fastener drive element 120a that interacts with the corresponding surface of the fastener 30 to maintain the orientation of the fastener 30 when it is placed in the fastener placement position. But it may be.

0057[0080] In the embodiments shown, the flat surface corresponding to the guide surface 136 is on the inner surface of the internal channel of the drive shaft 26. Further, the guide surface 136 may optionally be present on the outer surface of the drive shaft 26. Although the particular shape of the guide surface 136 has been shown, any suitable shape or combination of features to maintain the orientation of the fasteners 30 placed within the drive shaft 26 may be present on the drive shaft 26. For example, the guide surface 136 may correspond to a protrusion, groove or any other suitable shape. Further, the guide surface 136 may extend along any suitable portion of the drive shaft 26. For example, since the present disclosure is not limited in this manner, the guide surface 136 is a tip side portion of the drive shaft, a flexible portion 122 of the drive shaft, a portion of the drive shaft corresponding to a stack of fasteners disposed within the drive shaft. Alternatively, it may extend along the entire length of the drive shaft.

0058[0081] Figures 15-17 show one possible embodiment of the fastener 30 for use with the drive shaft 26. An embodiment of the fastener 30 shown includes a head 30a, a shaft 30b extending from the head 30a, and a barbed end 30c at the tip of the shaft 30b. A surface 138 corresponding to the guide surface 136 of the drive shaft may be arranged on the head 30a. The surface 138 may be sized and shaped to complement the guide surface 136 drive shaft so that the fastener 30 smoothly joins the inner surface of the drive shaft 26. In the embodiments shown, the surface 138 includes flats and rounds of a size and shape such that the cross section of the head 30a complements the corresponding flats and rounds of the cross section of the internal channel of the drive shaft. Corresponds to a flat surface. The surface 138 corresponding to the guide surface 136 is shown to be located at the fastener head 30a, but the surface 138 may be located at any suitable portion of the fastener 30. For example, a portion of the shaft 30b or a barbed end 30c may be shaped, sized and arranged to interact with the guide surface 136 of the drive shaft to maintain the orientation of the fastener 30. Can include.

0059[0082] In addition to the surface 138 on the fastener 30 that corresponds to the guide surface 136, the fastener 30 also passes through the shaft 30b and the barbed end 30c from the proximal surface of the head 30a. A through hole 140 extending to the tip side may be included. As mentioned above, the through holes 140 may be sized and shaped to accommodate the fastener guides in order to maintain the alignment of the fasteners 30 within the elongated shaft assembly. The disclosure is not limited to where the through hole 140 is located, so the through hole 140 may be centered, offset radially, or placed in any other suitable location. Good. It may be desirable to include a through hole 140 to assist in maintaining the alignment of the fastener 30 within the elongated shaft assembly, but in certain embodiments, the fastener is pointed as shown in the figure. It may be desirable to provide the tip 142 of the. However, embodiments with non-cusp tips and corresponding needles are also envisioned. To accommodate the through hole 140, the tip 142 of the cusp may be offset radially with respect to the through hole 140.

0060[0083] FIG. 18 shows a fastener 30 located on the tip side, which is located in the internal channel 140 of the drive shaft 26. As shown in the figure, the guide surface 136 of the drive shaft 26 and the fastener drive element 120a are aligned with the corresponding surface 138 of the fastener 30. Due to the interaction between the flat portion of the internal channel cross section and the flat portion of the fastener head (that is, the guide surface 136 and the corresponding surface 138) and the rounded portion of the internal channel cross section and the rounded portion of the fastener head, the fastener 30 is driven by the drive shaft 26. It may be maintained in a preselected orientation over the entire length of the.

0061[0084] FIG. 19 shows the fastener 30 and drive shaft 26 of FIG. 18 arranged within the elongated shaft assembly 6. As best shown by FIG. 13B, in some embodiments, when the drive shaft 26 is moved to the tip side to indwell the fastener, the fastener drive element 120 is the first constraint element 202 and the second constraint element 202. It may extend to the tip side with respect to the restraint element 204. Therefore, it may be desirable to arrange the fastener drive element 120 and the first constraint element 202 and the second constraint element 204 so that they do not interfere with each other during movement toward the tip of the drive shaft. In the embodiments shown, the fastener drive element 120 is the drive shaft 26 so that the fastener drive element 122 does not interfere with the first constraint element 202 and the second constraint element 204 during movement towards the tip of the drive shaft. The first constraint element 202 and the second constraint element 204 are arranged in a triangular pattern around the inner surface of the elongated shaft assembly 6. .. Although specific numbers and arrangements of fastener driving and constraining elements have been illustrated and described herein, it should be understood that the present disclosure is not so limited. Alternatively, any suitable number and arrangement of fastener driving and constraining elements may be used. In addition, other suitable types of fastener drive and constraint elements may also be used.

0062Although the teachings have been described with various embodiments and examples, the teachings are not intended to be limited to such embodiments or examples. Conversely, as will be appreciated by those skilled in the art, the teachings include various alternatives, modifications and equivalents. Therefore, the above description and drawings are merely examples.