Motorized surgical cutting and fastening instrument

[0001] Surgical staplers known in the art have been used to simultaneously make a longitudinal incision in a tissue and to apply rows of staples to the opposite sides of the incision. Such devices typically comprise a pair of cooperating jaw members that, if the device is intended for endoscopic or laparoscopic applications, can pass through the cannula channel. In one of the jaw elements, a staple cartridge is provided, having at least two rows of staples spaced laterally in the transverse direction. The second jaw member forms an anvil having staple-forming pockets aligned with the rows of staples in the cartridge. Such devices usually comprise a plurality of reciprocating wedges which, driven in the distal direction,

[0002] An example of a surgical stapler suitable for endoscopic applications is described in US Patent Application No. 2004/0232196 A1, entitled "Surgical stapling instrument of separate closing and firing systems". A physician using such a tool can close the stapler jaws on the tissue to establish tissue position before triggering. When the physician determines that the jaw elements grip the tissue correctly, it can trigger the surgical stapler, cutting and stapling the tissue. The simultaneous stages of cutting and stitching help to avoid complications that may arise from performing such operations in a sequential manner, with the help of various surgical tools that only cut or sew only.

[0003] Furthermore, in the prior art, a solution is known in which the end effector comprises electrodes that can be used to emit / receive radio frequency energy to form a line that inhibits bleeding along the cutting line. U.S. Patent No. 5,403,312, entitled "Electrosurgical hemostatic device" (referred to herein as "312 patent"), discloses an electrosurgical device with an end effector that compresses the tissue between one pole (or electrode) of a bipolar energy source on one cooperating surface and the other. a second pole (or electrode) on the second cooperating surface. Radio frequency energy is applied to the compressed tissue in the end effector, causing the cauterization of the tissue. The end effector described in the patent '

[0004] Also known in the art are surgical cutting and attachment devices with motor drive, in which the motor powers a cutting device, such as described in published US Application No. 2007/0175962 A1, entitled "Motor-driven surgical cutting and fastening instrument with tactile position feedback ".

[0005] WO 2007/137304 discloses a surgical cutting and securing device according to the preamble of claim 1.

SUMMARY OF THE INVENTION [0006] In one aspect, the embodiments of the present invention relate to surgical cutting and securing instruments. The instruments may be endoscopic devices, such as linear endocells or circular knives, or laparoscopic devices. The devices may include staples and / or RF electrodes for anchoring the tissue clamped in the end effector.

[0007] Several embodiments disclosed herein relate to cordless motor-driven instruments. The devices may be powered by a power supply comprising a DC power supply, e.g. one or more serially connected cells. The cell selector switch can control how many cells will be used to power the engine at a given moment to control the amount of power provided to the engine. As a result, the operator of the instrument has more control over the speed and power of the engine. The apparatus includes a power regulator, including a DC-DC converter, which regulates the voltage supplied to the motor. In addition, the voltage setting point for the power controller can be set in such a way that the voltage supplied from the power source is less than the voltage at which the power source provides maximum power.

DRAWINGS [0008] Various embodiments of the present invention have been described herein by way of example with reference to the following figures, in which fig. 1 and fig. 2 show perspective views of a cutting and securing surgical instrument in accordance with various embodiments of the present invention;

Figs. 3-5 are views of a cutaway end effector and tool shank in accordance with various embodiments of the present invention;

Fig. 6 shows a side view of an end effector in accordance with various embodiments of the present invention;

Figure 7 is an exploded view of the instrument holder in accordance with various embodiments of the present invention;

Fig. 8 and Fig. 9 show partial perspective views of a holder in accordance with various embodiments of the present invention;

Fig. 10 is a side view of a holder in accordance with various embodiments of the present invention; Fig. 11 illustrates an exemplary circuit diagram used in a device;

12-14 and 17 are diagrams of circuits used to power the motor of an apparatus in accordance with various embodiments of the present invention;

Fig. 15 is a block diagram showing a charge management circuit in accordance with various embodiments of the present invention;

Fig. 16 is a block diagram showing a base of a charging device in accordance with various embodiments of the present invention;

Fig. 18 shows a typical battery power curve;

19-22 illustrate an example of a torque limiting electromagnetic coupling device according to various embodiments of the present invention;

Figs. 23-25, 27-28 and 59 are views of the bottom surface of an exemplary anvil; Figures 26, 53, 54 and 68 are cross-sectional views in front of an exemplary end effector; Figs. 29-32 show an exemplary end effector having RF electrodes;

Figs. 33-36 show a further embodiment of an exemplary end effector having RF electrodes;

37-40 show another exemplary end effector having RF electrodes;

Figs. 41-44 show another exemplary end effector having RF electrodes;

Figures 45-48 show another exemplary end effector having RF electrodes;

Figs. 49-52 show another exemplary end effector having RF electrodes;

FIG.

and 56 are side views of an exemplary end effector; Fig. 57 is a schematic of an exemplary apparatus handle;

Fig. 58 is a partial view of an exemplary apparatus handle of Fig. 57;

Figs. 60-66 show an example of a multilayer circuit board;

Fig. 67 is a diagram showing an exemplary end effector;

Figs. 69 and 70 show a diagram of a device comprising a flexible neck assembly.

DESCRIPTION [0009] Fig. 1 and Fig. 2 show a cutting and securing surgical instrument 10 in accordance with various embodiments of the present invention. The present embodiment relates to an endoscopic apparatus and in general embodiments of the device 10 described herein relate to endoscopic cutting and securing surgical instruments. However, it should be noted that, in accordance with other embodiments of the present invention, the device may be a nonendoscopic cutting and securing surgical instrument, such as a laparoscopic device.

[0010] The surgical instrument 10 shown in Figures 1 and 2 comprises a handle 6, a shaft 8, and an articulated end effector 12 pivotally connected to a shaft 8 in the joint 14.

A joint control 16 may be provided adjacent to the handle 6 to cause rotation of the end effector 12 around the articulation 14. In the embodiment shown, the end effector 12 is configured to function as an endpiece for clamping, cutting and stapling tissue, though, in other embodiments, other types of end effectors may be used, such as end effectors for other types of surgical devices, such as grippers, knives, staplers, terminal applicators, access devices, dispensing devices for drug / gene therapies and ultrasound devices, frequency radio, laser, etc. More details about the radio frequency can be found in the '312 patent.

[0011] The holder 6 of the device 10 may include a closing trigger 18 and a trigger trigger 20 for actuating the end effector 12. It should be noted that instruments having end effectors for various surgical tasks may have different numbers or types of triggers or other suitable regulators for operating the effector 12. The end effector 12 is shown separated from the holder 6 by a preferably elongated shaft 8.

In one embodiment, the physician or the operator of the device 10 can articulate the end effector 12 relative to the shaft 8, using articulation 16 as described in detail in US Patent Application No. 2007/0158385 A1, entitled "Surgical Instrument Having an Articulating End Effector," Geoffrey C. Hueil and others.

the trigger trigger 20 can rotate slightly towards the pistol grip 26 in such a way that the operator can access it with one hand. The operator can then pivot the trigger trigger 20 towards the pistol grip 26 to cause stapling and cutting of the clamped tissue in the end effector.

12. In other embodiments, other types of clamping means may be used outside of the anvil 24, such as, for example, opposing jaws, and the like. [0013] It should be noted that the terms "proximal" and "distal" are used herein to refer to the physician holding the grip 6 of the device 10. As a result, the end effector 12 is distal to the proximal part of the handle 6. Furthermore, it should be noted that for convenience and transparency, spatial terms such as "vertical" and "levels" are used herein in connection with the drawings. However, surgical instruments are used in many directions and positions, and these terms are not limiting or absolute.

[0014] The closing trigger 18 can be activated in the first place. Once the physician accepts the position of the end effector 12, he can pull the closing trigger 18 to its fully closed, locked position closer to the pistol grip 26. The trigger trigger 20 can then be activated. The firing trigger 20 returns to the open position (shown in FIG. 1 and FIG. 2) when the doctor releases the pressure, as described in more detail below. The release button on the handle 6, after being pressed, may release the lockable locking trigger 18. The release button may be implemented in various forms, e.g. as the sliding release button 160 depicted in Fig. 7 or any of the mechanisms described in published US Patent Application No. 2007 / 01755955 A1.

[0015] Fig. 3 shows an exploded view of the end effector 12 in accordance with various embodiments. As shown in the embodiment shown, the end effector 12 may include, in addition to the aforementioned duct 22 and anvil 24, a cutting device 32, a sled 33, a staple cartridge 34 which is arranged removably in the duct 22, and a screw shaft 36. The cutting device 32 may for example be a knife. The anvil 24 may be articulated openable and closed at a pivot point 25 connected to the proximal end of duct 22. Anvil 24 may also include a flap 27 at its proximal end that is inserted into a component of the mechanical locking system (described in detail below) to open and close the anvil. 24. When the closing trigger 18 is activated, i.e.

Patent stapling mechanism "

10, the anvil 24 can rotate around the pivot point 25 to a clamped or closed position. If the gripping of the end effector 12 is satisfactory, the operator may trigger the trigger 20, which, as explained in detail below, causes the knife 32 and sled 33 to move along the channel 22, cutting the tissue clamped in the end effector 12. Movement of the sled 33 along the channel 22 causes the staples from the staple cartridge 34 to be guided through the cut tissue and to the closed anvil 24, which in turn causes the staples to fix the incision tissue. In various embodiments, the carriage 33 may be an integral component of the cartridge 34

6,978,921, entitled "Surgical incorporating an Ebeam firing, detailed information on such two-stroke cutting and securing instruments. The sleds 33 may be part of the cartridge 34 in such a way that when the knife 32 retracts after the cutting operation, the slides 33 do not reverse.

[0016] It should be noted that although the embodiments of the tool described herein employ an end effector 12 that sutures the tissue being cut, other techniques for securing or sealing the incision tissue may be used in other embodiments. For example, it is also possible to use end effectors that use radio frequency energy or a binder to fix the incision tissue. U.S. Patent No. 5,709,680, entitled "Electrosurgical Hemostatic Device", Yates et al., And U.S. Patent No. 5,688,270, entitled "Electrosurgical Hemostatic Device with Recessed and / or Offset Electrodes", Yates et al., Disclose an endoscopic cutting device that uses radio frequency energy for sealing the incision tissue. United States Patent Application No. 2007/0102453 A1, Jerome R. Morgan et al. And US Published Patent Application No. 2007/0102452 A1, by Frederick E. Shelton, IV, et al. Disclose endoscopic cutting devices that use binders for securing incisions tissue. Accordingly, although the present description relates to a cutting / stitching operation and the like, it should be noted that this is only an embodiment and that it is not limiting. It is possible to use other techniques of tissue attachment. although the description herein relates to a cutting / stitching operation and the like, it should be noted that this is only an embodiment and that it is not limiting. It is possible to use other techniques of tissue attachment. although the description herein relates to a cutting / stitching operation and the like, it should be noted that this is only an embodiment and that it is not limiting. It is possible to use other techniques of tissue attachment.

[0017] Fig. 4 and Fig. 5 show exploded views, and Fig. 6 shows a side view of end effector 12 and roller 8 in accordance with various embodiments. As shown in the embodiment shown, the shaft 8 may include a proximal closure tube 40 and a further closure tube 42 hingedly connected by articulation fittings 44. The distal closure tube 42 includes an opening 45 into which the flap 27 on the anvil 24 is inserted to open and close the anvil. 24, as described in detail below.

<td>Inside</td><td>tubes</td><td>closing 40,</td><td colspan="2">42 can be placed</td>

<td>closer</td><td>tube</td><td>dorsal 46.</td><td>Inside closer</td><td>tubes</td>

<td colspan="2">dorsal 46</td><td colspan="2">can be placed main rotary</td><td>(or</td>

<td>closer)</td><td>roller</td><td>drive 48, which</td><td>connects to the other</td><td>(or</td>

further) by a drive shaft 50 by a bevel gear 52. A second drive shaft 50 is connected to a gear 54 that meshes with the drive gear 56 of the helical shaft 36. A vertical bevel gear 52b can be located and rotated in a well 57 the distal end of the dorsal tube 46. The distal dorsal tube 58 can be used to position the second drive shaft 50 and the drive gears 54, 56. Including the main drive shaft 48, the second drive shaft 50 and the articulation assembly (e.g. conical gear 52a-c) are sometimes referred to as the "main drive shaft assembly".

which causes the drive element of the knife 32 to travel along the channel 22 to cut the tissue clamped in the end effector. Sledges 33 can be made of, for example, plastic and may have a further inclined surface. As the sleds 33 move along channel 22, the inclined front surface can push or guide the staples in the staple cartridge through the clamped tissue and the anvil 24. The crotch 24 bends the staples, thereby stapling the incision tissue. During the retraction of the knife 32, the knife 32 and the sledges 33 can be disengaged, as a result of which the sleds 33 remain at the distal end of the channel 22. the inclined front surface can push or guide the staples in the staple cartridge through the clamped tissue and the anvil 24. The crotch 24 bends the staples, thereby stapling the incision tissue. During the retraction of the knife 32, the knife 32 and the sledges 33 can be disengaged, as a result of which the sleds 33 remain at the distal end of the channel 22. the inclined front surface can push or guide the staples in the staple cartridge through the clamped tissue and the anvil 24. The crotch 24 bends the staples, thereby stapling the incision tissue. During the retraction of the knife 32, the knife 32 and the sledges 33 can be disengaged, as a result of which the sleds 33 remain at the distal end of the channel 22.

[0019] Fig. 7-10 show an exemplary motorized endo- knife. The endo-knife shown provides feedback to the user about the ejection and cutting force of the cutting device in the end effector. In addition, the endo-knife may use the energy provided by the user when releasing the trigger trigger to power the device (so-called "power assistance" mode). As shown in the exemplary end cutter, the handle 6 includes outer lower side members 59, 60 and upper outer side members 61, 62 that are adapted to each other so that together they form the outer part of the handle 6. A battery 64, such as a lithium battery The powder 64 feeds the motor 65 located in the upper part of the pistol grip 26 of the handle 6.

[0020] The motor 65 may be a DC brush motor having a maximum rotational speed of approximately 25,000 revolutions per minute without load. The motor 64 may drive a 90 ° bevel gear 66 including a first bevel gear 68 and a second bevel gear 70. The bevel gear 66 may drive the planet gear 72. The planet gear 72 may include a pinion 74 connected to the drive shaft 76. The pinion 74 may drive the ring gear 78, which drives the helical wheel 80 by the drive shaft 82. The ring 84 can be screwed onto the wheel drum 80. As a result, when the motor rotates, the ring 84 moves along the helical wheel drum 80 via a planetary gear gear 66, 72, and a ring gear 78.

[0021] The handle 6 may also include a motor start-up sensor 110 (see Fig. 10) connected to the firing trigger 20 to detect when the firing trigger 20 has been pulled (or "closed") towards the handle part of the gun handle 6 by the operator to thereby commencing a cutting / stapling operation by the end effector 12. Sensor 110 may be a proportional sensor, such as e.g. a rheostat or adjustable resistor. When the firing trigger 20 is attracted, the sensor 110 detects motion, and sends an electrical signal indicative of the voltage (or energy) to be supplied to the motor 65. When the sensor 110 is an adjustable resistor or the like, the rotary motion of the motor 65 may be generally proportional to the amount of dislocation of the trigger 20. This means that if the operator only slightly pulls or closes the firing trigger 20, the rotation of the motor 65 is substantially small. When the firing trigger 20 is fully extended (or in the fully closed position), the rotary motion of the motor 65 is maximum. In other words, the harder the user pulls the trigger 20, the higher the voltage is supplied to the motor 65, resulting in a higher rotational speed.

[0022] The holder 6 may comprise a central holder element 104 adjacent the upper part of the firing trigger 20. The holder 6 may also include a deflection spring 112 connected between the posts on the handle central element 104 and the firing trigger 20. The deflection spring 112 may deflect the firing trigger 20 to a position completely open. In this way, when the operator releases the trigger trigger 20, the deflection spring 112 will pull the trigger trigger 20 to the open position, thereby immobilising the sensor 110 and stopping the rotary motion of the motor 65. Furthermore, with the biasing spring 112, each time the user closes the trigger triggering 20, will feel resistance at closing, and receive feedback about the amount of rotational motion exerted by the motor 65.

[0023] The distal end of the helical wheel drum 80 includes a further drive shaft 120 that drives a ring gear 122 cooperating with a pinion 124. The gobock 124 is connected to the main drive shaft 48 of the main drive shaft assembly. In this way, the rotation of the motor 65 causes the main drive shaft assembly to rotate, which causes the end effector 12 to be actuated as described above. [0024] The ring 84 screwed onto the wheel drum 80 may include a post 86, which is positioned in the slot 88 of the slotted shoulder 90. The shoulder 90 having a slot has an opening 92 at its opposite end 94, which adopts a pivot pin 96, which is connected between the outer side members of the handle 59, 60.

[0025] Furthermore, the handle 6 may comprise a motor reverse sensor 130 (or a stroke end sensor) and a motor stop sensor 142 (or stroke start). In various example devices, the engine reverse sensor 130 may be a limit switch located on the distal end of the helical wheel drum 80 in such a way that the ring 84 screwed onto the helical wheel drum 80 contacts and triggers the engine reverse sensor 130 when the ring 84 reaches further. end of the screw wheel 80. The motor reverse sensor 130, in the case where it is activated, transmits a signal to the motor 65 to change its rotating direction, thus retracting the knife 32 of the end effector 12 after the cutting operation. The motor stop sensor 142 may, for example, be a normally closed end switch.

In operation, when the operator of the device 10 pulls the trigger 20, the sensor 110 detects the release of the firing trigger 20 and sends a signal to the motor 65, causing the motor to rotate forward, e.g., at a rate proportional to how the operator will pull the release trigger 20. The rotary motion of the forward motor 65 in turn causes rotation of the ring gear 78 at the distal end of the planetary gear assembly 72, thereby causing rotation of the helical drum 80, which in turn makes the ring 84 shot on the helical wheel drum 80 moves further along it. The rotational movement of the helical wheel drum 80 also drives the main drive shaft assembly as described above, which in turn causes the knife 32 to slide out in the end effector 12. This means

[0027] As the cutting / stitching operation with the end effector 12 is completed, the ring 84 on the screw wheel 80 achieves its further completion, causing the motor reverse sensor 130 to be triggered and sends a signal to the motor 65 causing a change in the direction of rotation of the motor 65. This in turn causes the retraction of the knife 32, as well as moving the ring 84 on the drum 80 of the screw wheel back to its proximal end.

[0028] The central holder element 104 includes a side arm 106 that connects to the leg 90 with a slit, as best shown in FIGS. 8 and 9. The center handle member 104 also has a forward stop 107 associated with the trigger trigger 20. Movement of the arm 90 with a gap is controlled, as explained above, by the rotation of the motor 65. When the shoulder 90 with the slot rotates counterclockwise (CCW) when the ring 84 moves from the proximal end of the wheel drum 80 to the distal end, the central handle element 104 will rotate freely in a counter-clockwise (CCW) direction. As a result, when the user pulls the trigger trigger 20, it will engage the front stop of the movement 107 of the center member 104 of the holder, causing rotation of the central handle member 104 in a counter-clockwise direction (CCW). However, with the side arm 106 engaging the slotted arm 90, the center handle member 104 will be able to rotate only counterclockwise (CCW) as far as the shoulder 90 with the slit permits. In this way, if the motor 65 stops rotating for some reason, the arm 90 with the slot stops rotating and the user can not continue to pull the trigger trigger 20, because the central holder element 104 will not be able to rotate freely in the opposite direction to the movement. clockwise (CCW) due to shoulder 90 with a slit. connecting with the slotted arm 90, the center handle member 104 will be able to rotate only counterclockwise (CCW) as far as the arm 90 with a slit permits. In this way, if the motor 65 stops rotating for some reason, the arm 90 with the slot stops rotating and the user can not continue to pull the trigger trigger 20, because the central holder element 104 will not be able to rotate freely in the opposite direction to the movement. clockwise (CCW) due to shoulder 90 with a slit. connecting with the slotted arm 90, the center handle member 104 will be able to rotate only counterclockwise (CCW) as far as the arm 90 with a slit permits. In this way, if the motor 65 stops rotating for some reason, the arm 90 with the slot stops rotating and the user can not continue to pull the trigger trigger 20, because the central holder element 104 will not be able to rotate freely in the opposite direction to the movement. clockwise (CCW) due to shoulder 90 with a slit.

[0029] The components of an exemplary closure system for closing (or compressing) the anvil 24 of the end effector 12 by retracting the closure trigger 18 are also shown in Figs. 7-10. In the illustrated device, the closing system comprises a yoke 250 connected to a closing pin 18 by a bolt 251 which is introduced through openings in one axis in the closing spout 18 and yoke 250. A pivot pin 252 around which the locking trigger 18 is rotated is inserted through another opening in the closing spout 18, which is offset from the place where the pin 251 is inserted by the closing trigger 18. As a result of the withdrawal of the closing trigger 18, the upper part of the closing trigger 18 to which the yoke 250 is fixed by the pin 251 rotates in the direction counter clockwise (CCW). The distal end of the yoke 250 is connected by means of a pin 254 to the first closing bracket 256. The first closing bracket 256 connects to a second closing bracket 258. Together, the closing brackets 256, 258 define an opening in which the proximal end of the proximal closure tube is positioned (see FIG. 4) and maintained in such a way that the longitudinal movement of the closing brackets 256, 258 causes a longitudinal movement of the proximal closing tube. The apparatus 10 also comprises a closing bar 260 located within the proximal closing tube. The closing bar 260 may include a window 261 in which a post 263 is placed on one of the outer members of the holder, such as an outer lower side member 59 in the illustrated embodiment to permanently connect the closing bar 260 to the handle 6. In this way, the proximal closing tube can move longitudinally relative to the closing rod 260. The closing bar 260 may also include a distal flange 267 that fits into the cavity 269 in the proximal dorsal tube 46 and is held there by the cap 271 (see FIG. 4).

[0030] In operation, when the yoke 250 rotates due to retraction of the closing trigger 18, the closing brackets 256, 258 cause further movement of the proximal closure tube (i.e., from the end of the apparatus holder 10), which causes the distal tube The closing end moves further, which causes the anvil 24 to rotate around the pivot point 25 to a clamped or closed position. When the closure trigger 18 is unlocked from the locked position, the proximal closure tube moves closer, which causes the distal closure tube 42 to move closer, which due to the flap 27 inserted through the window 45 of the distal closure tube 42, causes the anvil 24 to rotate about the pivot point 25, to an open or released position. Thanks to this, by withdrawing and blocking the closing trigger 18,

[0031] Fig. 11 is a schematic view of the electrical circuit of the device 10. When the operator pre-pulls the trigger 20 after locking the closing trigger 18, the sensor 110 is activated to allow current to flow through it. If the normally open engine reverse switch 130 is open (meaning that the end end of the end effector is not reached), the current will flow to the single-pole and binary relay 132. As the sensor 130 of the motor reverse sensor 130 is not closed, relay coil 134 132 will not be charged, which means that the relay 132 will be in an uncharged state. The circuit also includes a cartridge lock sensor 136. If the end effector 12 includes a staple cartridge 34, the sensor 136 will be in the closed state allowing the current to flow. Otherwise,

[0032] When the staple cartridge 34 is present, the sensor 136 is closed, which charges the unipolar and monaural relays 138. When the relay 138 is charged, the current flows through the relay 136, through the resistor variable sensor 110, and to the motor 65 via a bipolar relay 140. and binary, thereby powering the motor 65 and allowing it to rotate in a forward direction. When the end effector 12 reaches the end of the stroke, the motor reverse sensor 130 will be activated, thereby closing the switch 130 and charging the relay 132. This causes the relay 134 to become charged (not shown in Figure 13) which causes the current to be celebrated. the cartridge lock sensor 136 and the adjustable resistor 110 and instead causes, that the current flows into a normally closed bipolar and binary relay 142 and back to the motor 65, but via a relay 140, causing a change in the direction of motor rotation 65. As the motor stop sensor switch 142 is normally closed, the current will flow back to the relay 134 to keep it closed until the switch 142 opens. When the knife 32 is completely retracted, the motor stop sensor switch 142 is activated, causing the switch 142 to open, thereby disengaging the power supply from the motor 65. to keep it closed until the switch 142 opens. When the knife 32 is completely retracted, the motor stop sensor switch 142 is activated, causing the switch 142 to open, thereby disengaging the power supply from the motor 65. to keep it closed until the switch 142 opens. When the knife 32 is completely retracted, the motor stop sensor switch 142 is activated, causing the switch 142 to open, thereby disengaging the power supply from the motor 65.

[0033] In other embodiments, instead of the proportional-type sensor 110, an on / off sensor may be used. In such embodiments, the rotational speed of the motor 65 will not be proportional to the force applied by the operator. Instead, the motor 65 will generally rotate at a constant speed. However, the operator will still experience feedback about the force, because the trigger trigger 20 is meshed with the transmission drive.

[0034] Additional configurations for surgical motorized devices are disclosed in published US Patent Application No. 2007/0175962 A1, entitled "Motor-driven surgical cutting and fastening instrument with tactile position feedback".

[0035] In a motor-operated surgical instrument, such as one of the endoscopic motor-operated devices described above or in a circular motor-cutting device, the motor may be powered by a series of cells connected in series. In addition, under certain circumstances, it may be required to supply the engine using parts from the total number of cells. For example, as shown in Fig. 12, the motor 65 may be powered by a power supply 299 comprising six (6) cells 310 connected in series. The cells 310 may be, for example, 3 volt lithium cells, such as the CR 123 A cells, although in other embodiments other types of cells (including cells with different voltage levels and / or other chemical compositions) may be used. If six 3-volt cells 310 have been connected in series to power the motor 65, the total voltage available for motor supply 65 may be 18 volts. Cells 310 may include rechargeable or non rechargeable cells.

In this embodiment, at the heaviest loads, the input voltage of the motor 65 may decrease to approximately nine to ten volts. In this operating mode, the power supply 299 provides a maximum power to the motor 65. Accordingly, as shown in FIG. 12, the circuit may include a circuit breaker 312 that selectively allows the motor 65 to be powered by (1) all of the battery cells 310 or (2) a part of the cells In Fig. 12, it can also be seen that by suitable selection, switch 312 can provide power to the motor 65 through six links or four links. In this way, switch 312 can be used to power the motor 65 with 18 volts (if all 6 cells 310 are used) or 12 volts (using four cells). In various embodiments, the selection of a construction concerning the number of cells in part,

[0037] The switch 312 can be, for example, an electromechanical switch, such as for example a micro switch. In other embodiments, the switch 312 may be implemented using a semiconductor switch, such as a transistor. A second switch 314, such as a button, can be used to determine if power is at all applied to the motor 65. Furthermore, the front / rear switch 316 can be used to control the direction of rotation of the motor 65 in the forward or reverse direction. The front / rear switch 316 may be implemented using a bipolar and a binary switch, such as the relay 140 shown in Fig. 11.

During operation, the user of the device 10 can select the required power level using a certain type of switching control, e.g. a position dependent switch (not shown), such as a toggle switch, a mechanical lever switch or a cam that controls the position of the switch 312. it may activate the second switch 314 to connect the selected links 310 to the motor 65. Furthermore, the circuit illustrated in Figure 12 may be used to power the motor for other types of motorized surgical instruments, e.g., circular knives and / or laparoscopic devices. More information on circular knives can be found in published US patent applications with numbers

2006/0047307 A1 and 2007/0262116 A1.

[0039] In other embodiments, as shown in Fig. 13, a primary energy source 340, such as a battery cell, e.g. a CR2 or CR123A battery cell, can be used to charge a series of second battery devices 342. The primary energy source 349 can contain one or several series connected in series, which are preferably interchangeable in the embodiment shown. The second battery devices 342 may include, for example, rechargeable cells and / or supercapacitors (also known as "ultracap- tents" or "double layer electrochemical capacitors" (EDLC)). Supercapacitors are electrochemical capacitors that have an extremely high energy density compared to ordinary electrolytic capacitors,

The primary power source 340 may charge the second battery devices 342. Once sufficiently charged, the main power source 340 may be removed and the second battery devices 342 may be used to power the motor 65 during the surgery or operation. Charging of accumulators 342 may take about fifteen to thirty minutes, depending on the circumstances. Supercapacitors have the property that they can be charged and unloaded extremely fast compared to standard batteries. In addition, while batteries are a good solution only for a limited number of charge / discharge cycles, supercapacitors can often be recharged / unloaded several times, sometimes for several dozen million cycles.

[0041] As can be seen in FIG. 14, the charge management circuit 344 may be used to determine when the second battery devices 342 are sufficiently charged. The charge management circuit 344 may include an indicator, such as one or more LEDs, an LCD display and the like, which is activated to notify the user of the device 10 when the second battery devices 342 are sufficiently charged.

The main energy source 340, the second battery device 342, and the charge management circuit 344 may be part of the power supply in the pistol grip portion 26 of the device holder 10 or other instrument portion 10. The power supply may be removed from the pistol grip portion 26 and in such In the case where the device 10 is to be used for surgery, the power supply can be inserted aseptically into the pistol grip portion 26 (or other position in the device according to other embodiments), e.g. by a nurse assisting in the operation. After inserting the power supply, the nurse may place the exchangeable primary power source 340 in the power supply to charge the second battery devices 342 for some time before using the instrument 10, e.g. for thirty minutes. When the second battery devices 342 are charged, the load management circuit 344 may indicate that the power supply is ready for use. At this point, the replaceable energy source 340 can be removed. During operation, the user of the device 10 can activate the motor 65, e.g. by activating the switch 314, whereby the second battery devices 342 supply the motor 65. As a result, instead of a series of disposable batteries for powering the motor 65, it is possible to use one disposable battery (as the main source energy 340) in such an embodiment, and the second battery device 342 may be used repeatedly. However, in alternative embodiments, it should be noted that second battery devices 342 may not be rechargeable and / or reapplied.

[0043] The charge management circuit 344 may also include indicators (e.g., LEDs or LCD display) that indicate how much charge remains in the second battery devices 342. In this way, the surgeon (or other user of the device 10) can see how much charge it remains in the process associated with the instrument 10.

[0044] The charge management circuit 344, as shown in Fig. 15, may include a charge meter 345 for measuring the charge in the second batteries 342. The charge management circuit 344 may also include non-volatile memory 346, such as flash memory or ROM, and also one or more processors

348. The processor (s) 348 may be coupled to memory 346 to control the memory. In addition, the processor (s) 348 may be connected to the charge meter 345 to read measurements or otherwise control the charge meter 345. In addition, the processor (s) 348 may control the LEDs or other external devices of the charge management circuit 344. The processor (s) 348 may store device parameters 10 in memory 346. Parameters may include instrument operating parameters that are detected by various sensors that can be installed or used in the instrument 10, e.g., number of triggers, levels of forces exerted, distance of compression gap between the opposing end effector jaws 12, the amount of articulation and the like. In addition, the parameters stored in memory 346 may include ID values ​​for various components of the instrument 10 that can read and store the charge management circuit 344. Components having such IDs may be interchangeable devices, such as a staple cartridge 34. The IDs may, for example, be RFID tags read by the load management circuit 344 by the RFID transponder 350. The RFID transponder 350 may read RFID markers from instrument components, such as staple cartridge 34, which include RFID markers. The ID values ​​can be read, stored in the memory 346, and also compared by the processor 348 with a list of accepted ID values ​​stored in memory 346 or other memory associated with the payload control circuit to determine, for example, whether the removable / interchangeable component associated with the read ID value is authentic and / or appropriate. If the processor

348 that the removable / interchangeable component associated with the read ID value is not authentic, charge management circuit 344 may prevent the device 10 from using the power supply, such as opening the switch (not shown), which could prevent the power from supplying the motor to power 65. Various parameters that can be estimated by the processor 348 to determine whether the component is authentic and / or appropriate include: date code, component type / model, manufacturer name, region information, as well as previous error codes.

[0045] The payload management circuit 344 may also include an i / o interface 352 for communication with another device such as described below. In this way, the parameters stored in the memory 346 can be downloaded to another device. The i / o interface 352 may be, for example, a wired or wireless interface.

[0046] As mentioned before, the power supply may comprise second batteries 342, charge management circuit 344 and / or switch f / r 316. As shown in FIG. 16, the power supply 299 may be connected to the charging base base 362, which may include , charge the second 342 batteries in the power supply. Charge device base 362 may be connected to power supply 299 by aseptically connecting the charging device base 362 to the power supply 299 when the power supply is installed in the apparatus 10. In other situations in which the power supply may be removed, the charging system base 362 may be combined with the power supply 299 by removing the power supply 299 from the apparatus 10 and connecting it to the base 362 of the charging device. In such cases, after the base 362 of the charging device properly charges the second batteries 342,

[0047] As can be seen from FIG. 16, the charging station base 362 may include an energy source 364 for charging second batteries 342. The power source 364 of the base 362 of the charging device may be, for example, a battery (or a series of batteries connected in series) or an AC / DC converter. which converts AC energy, e.g. from an electrical supply network to DC energy, or any other suitable energy source for charging second batteries 342. The charging base base 362 may also include indicator devices such as LEDs, LCD display and the like for presentation the charging status of the second batteries 342.

Furthermore, as can be seen in Fig. 16, the base 362 of the charging device may comprise one or more processors 366, one or more memory units 368, and i / o interfaces 370, 372. Via the first interface i / o 370 the charging device base 362 can communicate with the power supply 299 (via the i / o interface of the power supply 352). In this way, for example, data stored in the memory 346 of the power supply 299 can be downloaded to the memory 368 of the base 362 of the charging device. In this way, the processor 366 can estimate the ID values ​​of the removable / interchangeable components taken from the cargo management circuit 344 to determine the authenticity and suitability of the components. Operating parameters taken from the load management circuit 344 can also be stored in the 368 memory,

The base of the charging device 362 may also include a charge meter 374 for measuring the charge in the second batteries 342. The charge meter 374 can be connected to the processor (s) 366 such that the processor (s) 366 can determine the real-time suitability of the power supply 299 for use in order to guarantee high performance.

[0050] In an embodiment, as can be seen in Fig. 17, the battery circuit may include a power controller 320 to control the power provided by the power saving circuit 310 to the motor 65. The power controller 320 may also be part of the power supply 299 or may be a separate component . As mentioned above, the motor 65 may be a DC brush motor. The speed of brush motors DC is usually proportional to the input voltage used. The power controller 320 may provide a precisely adjusted output voltage to the motor 65 in such a way that the motor 65 will operate at a constant (or substantially constant) speed. According to various embodiments, the power controller 320 may include a pulse transducer, such as a buck-boost converter, as illustrated in the example of FIG. 17. Such a buck-boost converter 320 may include a power switch 322, such as FET, rectifier 32, inductor 326, and capacitor 328. When the power switch 322 is turned on, the input voltage source (e.g., power source 310) is connected directly to induction coil 326, which stores energy in this state. In this state, the capacitor 328 provides energy to the output load (e.g., motor 65). When the power switch 320 is in the off state, the inductor coil 326 is connected to an output load (e.g., motor 65) and capacitor 328, and thus energy is transferred from the inductor 326 to the capacitor 328 and load 65. The control circuit 330 can control the circuit breaker 322. The control circuit 330 may use digital and / or analogue control loops. Furthermore, in other embodiments, the control circuit 330 may receive control information from the main controller (not shown) via a communication link, such as a serial or parallel digital data bus. It is possible to set a voltage setpoint for the output signal from the power controller 320, e.g. half the open circuit voltage at which the maximum power from the source is available.

[0051] In other embodiments, various power transducer topologies may be utilized, including linear or pulse transducers. Other topologies of pulse transmitters that can be used include flyback, forward, buck, boost and SEPIC. The set voltage for the power controller 320 may be varied depending on how many battery cells are used to power the motor 65. In addition, the power controller 320 may be used with the second battery devices 342 shown in Figure 13. In addition, the forward-back switch 316 may be included in the power controller 320, although shown in Figure 17 it is shown separately.

[0052] Batteries can usually be presented as an ideal voltage source and source resistance. In the ideal model, when the source resistance and load are matched, the maximum power is transferred to the load. Fig. 18 shows a typical battery power curve. When the battery circuit is open, the voltage on the battery is high (with an open circuit) and the current drawn from the battery is zero. The power supplied from the battery is also zero. When more current is drawn from the battery, the battery voltage drops. The power supplied by the battery is the product of current and voltage. The power reaches its maximum at a voltage level that is lower than the open circuit voltage. As can be seen in Figure 18, for most chemical compositions of the battery there is a dramatic drop in voltage / power at higher currents,

[0053] In particular, for embodiments using a battery (or batteries) to power the motor 65 during the procedure, the control circuit 330 can monitor the output voltage and control the setpoint of the controller 320 in such a way that the battery operates on the "left" side or side. increasing power of the power curve. If the battery reaches the peak power level, the control circuit 330 may change (e.g., lower) the controller setpoint in such a way that less total power is required from the battery. The motor 65 may then release. In this way, a request from the power supply can rarely, if ever, exceed the peak available power in such a way that the case of power reduction during the procedure can be avoided.

[0054] Furthermore, the power drawn from the battery can be optimized in such a way that the chemical reactions in the cells can have time to restore the normal state and thus optimize the current and power available from the battery. In the case of pulse loads, the battery usually provides more power at the beginning of the pulse than at the end of the pulse. This is due to several factors, including: (1) PTC can change its resistance during the pulse; (2) the temperature of the battery may change; (3) the rate of the electrochemical reaction varies due to the depletion of the electrolyte at the cathode, and the diffusion speed of the fresh electrolyte limits the reaction speed. The control circuit 330 may control the transducer 320 in such a way that it draws less current from the battery to allow the battery to be restored before the pulse again.

[0055] The exemplary device 10 may include a torque limiting coupling device. The torque limiting coupling device may for example be between the motor 65 and the conical gear 68, between the bevel gear 70 of the planetary gear assembly 72 or the output shaft of the planetary gear assembly 72. According to various example devices, the torque limiting device may use an electromagnetic clutch or a permanent magnet coupling. [0056] Figures 19 to 22 show an example electromagnetic clutch 400 that can be used in device 10. The clutch 400 can include a horseshoe stator 402 having magnetic discs 404, 406 at each end. The first disk 404 may be connected to an axially displaceable rotatable pole element 408, such as the output pole of the motor 65. The second magnetic disk 406 may be connected to a fixed axial rotatable pole element 410, such as the input pole of the instrument gear box 10. On views of the figs 19 and 20, the first pole member 408 is axially offset from the second pole member 410 through the clearance 412 in such a way that the magnetic disks 404, 406 are not connected. The coil (not shown) that can be wound around the stator 402 can be used to create the electromagnetic flux required to actuate the clutch 400. When the coil conducts electric current, the resulting magnetic flux can cause two magnetic disks 404, 406 to attract, causing an axial movement of the first pole member 408 towards the second pole member 410, resulting in the connection of two magnetic disks 404, 406, as shown in FIGS. 21 and 22, such that the two pole members 408, 410 rotate together until the torque exceeds the moment of friction generated between the discs 404 and 406. [0057] The pull force between the two discs 404, 406 and the corresponding torque capacity of the coupling 400 can be controlled by controlling the diameters of the discs 404, 406, the coefficient of friction between the contacting surfaces of the magnetic discs 404 and 406, and also by the use of magnetic materials for discs 404, 406 that saturate at known and controlled flux density. Because,

[0058] The use of such a coupling involves many additional potential benefits. The electrically operated clutch 400 can be quickly deactivated by removing the current from the conduit to limit the amount of heat generated in the clutch 400 and the motor 65. By disconnecting the motor from the rest of the transmission drive via the clutch 400, most of the stored inertia energy in the transmission drive can be disengaged, limiting the shock when the exit was madenot suddenly blocked. In addition, due to electrical control, a limited slip may be provided to help reduce shock when the gear drive is restarted under load. In addition, since the magnetic saturation properties of one or more components (e.g., magnetic disks 404, 406) in the clutch may be used to control the torque limitation instead of the coil current, the clutch 400 may be less sensitive to changes in the system voltage. The torque limitation may mainly be a function of the physical dimensions of the clutch components (e.g. magnetic disks 404, 406) and voltage regulators or other external components may not be required for proper operation.

[0059] In another exemplary apparatus, instead of using an electromagnetic clutch, the torque limiting device may comprise a permanent magnet (not shown). The permanent magnet may be connected to, for example, the first axially displaceable pole element 408 and to attract the axially fixed second pole element 410 or vice versa. In such devices one of the discs 404, 406 may be made of a permanent magnet and the other of a magnetic material such as iron. With a small change, the stator 402 can be made in the form of a permanent magnet, making the magnetic disks 404 and 406 are attracted to each other. Due to the use of a permanent magnet, two disks 404, 406 can always be connected. The use of a permanent magnet may not provide such precise torque control as for the electromagnetic clutch configuration described above, but may have the following advantages: (1) it does not require control elements or logic control systems to control the current flowing through the coil; (2) provides a more compact design than the configuration of the electromagnetic clutch and (3) simplifies the construction of the instrument 10.

[0060] As mentioned before, the end effector 12 may emit radio frequency energy to cause coagulation of the tissue clamped in the end effector. The radio frequency energy may be transmitted between the electrodes in the end effector 12. The radio frequency source (not shown), including for example, in addition to other components, an oscillator and an amplifier that can supply radio frequency energy to the electrode may be in the instrument itself, for example, in the holder 6 intended for the wireless device 10 or the radio frequency source may be external to the apparatus 10. The radio frequency source may be activated as described in detail below.

[0061] According to various exemplary devices, the end effector 12 may comprise a plurality of electrode sections (or segments). For example, as shown in the example of Figure 23, the bottom surface of the anvil 24 (i.e., the face facing the staple cartridge 34) may include three co-linear RF segments. In this example, each segment has the same length (e.g. 20 mm), although in other devices there may be more or fewer segments and the segments may have different lengths. In the example of Fig. 23, there are three pairs of active "anode" terminals or electrodes 500 aligned in length along each side of the channel length on the bottom surface of the anvil 24. In particular, the shown apparatus has a pair of further electrodes 5001, a pair of central electrodes 5002, and a pair of proximal electrodes 5003 on each side of the knife channel 516. The metal outer part or channel 22 of the end effector 12 or metal anvil 24 may act as a counter electrode (or cathode) for each of the three upper active electrodes (or anodes) 500. Upper electrodes 500 they can be coupled to a radio frequency source. When energized, the radio frequency energy can propagate between the upper 500 electrodes and the counter electrode, causing coagulation of the tissue clamped between the electrodes.

[0062] The electrodes 500 may be energized simultaneously or in a different order, for example sequentially. In the case of devices in which the electrodes 500 are energized in accordance with the sequence, the sequence may be automatic (controlled, for example, by a controller (not shown) connected to a radio frequency source) or selected by the user. For example, the proximal electrodes 5003 can be energized first, followed by the central electrodes 5002, and later the further electrodes 5001. In this way, the operator (e.g., the surgeon performing the operation) can selectively coagulate the areas of the stapling lines. The electrodes in such a device can be controlled by means of a multiplexer and / or a generator with a plurality of outputs, as will be described in detail below. In this way, the tissue below each electrode 500 can be treated separately in accordance with the requirements for coagulation. Each electrode in a pair can be connected to a radio frequency source in such a way that they can be powered at the same time. This means that a pair of active electrodes 5001, each located on the opposite side of the knife channel, can be powered by a radio frequency source at the same time. The same applies to the middle pair of electrodes 5002 and the proximal pair of electrodes 5003, although in a device in which the electrode pairs are fed sequentially, the further pair is not supplied at the same time as the middle and proximal pairs, and so on. that they can be powered at the same time. This means that a pair of active electrodes 5001, each located on the opposite side of the knife channel, can be powered by a radio frequency source at the same time. The same applies to the middle pair of electrodes 5002 and the proximal pair of electrodes 5003, although in a device in which the electrode pairs are fed sequentially, the further pair is not supplied at the same time as the middle and proximal pairs, and so on. that they can be powered at the same time. This means that a pair of active electrodes 5001, each located on the opposite side of the knife channel, can be powered by a radio frequency source at the same time. The same applies to the middle pair of electrodes 5002 and the proximal pair of electrodes 5003, although in a device in which the electrode pairs are fed sequentially, the further pair is not supplied at the same time as the middle and proximal pairs, and so on.

[0063] Furthermore, various electrical parameters such as impedance, power or energy supplied and the like can be monitored, and the output signal to individual electrodes 500 can be modified to generate the most desirable effect in terms of tissue. In addition, another advantage is in the case of a metal staple or other electrically conductive object left behind as a result of a prior release of the device or a surgical procedure, which may cause shorting of the electrodes. Such a short circuit can be detected by a generator and / or a multiplexer and the energy can be modulated in a short-circuit-specific manner.

Furthermore, the sequential feeding of the electrodes 500 reduces the instantaneous power required by the radio frequency source compared to a structure that may have one set of electrodes of such length as the total length of the three segment electrodes 500 shown in FIG. 23. For example, the electrode configurations shown in FIG. of the '312 patent show that fifty to one hundred watts may be required to successfully conduct a 45 mm coagulation on each side of the cutting line. By using smaller active electrodes (e.g. upper electrodes 500) that have a smaller surface area than larger passive electrodes (e.g. metal anvil 24), smaller active electrodes 500 can concentrate therapeutic energy at the tissue, while the larger reactive electrode is used to supplement the circuit with minimal impact on the tissue adhesion surface. In addition, the reactive electrode preferably has a larger mass and thus can remain cooler during electrosurgical use.

[0065] The electrodes 500 may be surrounded by a nonconducting electric current 504, which may comprise a ceramic material.

[0066] Fig. 24 shows another exemplary instrument having RF electrodes. In the embodiment shown in Fig. 24 there are four collinear segment electrodes 5001-4 of equal length (in this example 15 mm). As with the apparatus of Figure 23, the electrodes 500 of Figure 24 may be energized simultaneously or sequentially.

[0067] Fig. 25 shows another exemplary instrument in which segment electrodes have different lengths. The presented device has four collinear segment electrodes, but the farthest electrodes 5001, 5002 have a length of 10 mm, and the two proximal electrodes 5003, 5004 have a length of 20 mm. Short further electrodes can provide the benefit of concentrating therapeutic energy as described above.

[0068] Fig. 59 shows an exemplary apparatus having fifteen pairs of segmented RF 500 electrodes on a printed circuit board 570 or other type of suitable substrate, on the bottom surface of the anvil 24 (i.e., the face facing the channel 22). The different electrode pairs are powered by a radio frequency source (or generator) 574. The multiplexer 576 can distribute the RF energy to various electrode pairs according to the control requirements of the controller 578. According to various example devices, radio frequency source 574, multiplexer 576, and a controller 578 may be in the holder 6 of the device.

[0069] In such a device, the circuit board 570 may comprise a plurality of layers that provide electrical connections between the multiplexer 576 and the various electrode pairs. For example, as can be seen in Figures 60 to 63, the circuit board may comprise three layers 5801-3, each layer 580 providing connections for five electrode pairs. For example, the top layer 5803 may provide connections to the closest five pairs of electrodes, as shown in Figs. 60 and 61, the middle layer 5802 may provide connections to the five central electrode pairs, as shown in Figs. 60 and 62, the lowest layer 5801 may provide connections to the five most distal electrode pairs, as shown in Figs. 60 and 63.

[0070] Fig. 64 is a side view in cross-section of anvil 24 according to such an apparatus. The circuit board 570, adjacent to staple pockets 584, has three conductive layers 5801-3 having insulation layers 5821-4 between them. Figs. 65 and 66 show how different layers 5801-3 can be stacked to be connected back to multiplexer 576 in a holder.

The advantage of multiple RF electrodes in the end effector 12, as shown in Fig. 67, is that in the case of a line 590 of metal staples or other electrically conductive object left in the tissue 592 in the event of an early release of the device or procedure. surgical, which may cause shorting of the electrodes, the short circuit can be detected by the generator and the multiplexer, and the energy can be modulated in a way appropriate for the short circuit.

[0072] Fig. 27 shows a further end effector 12 with RF electrodes. In such an exemplary apparatus, the end effector 12 includes only the further electrodes 5001 and a metallic anvil 24 performing the function of a passive electrode. The further electrodes 5001 do not cover the entire length of the anvil 24, but only a part of the length. In the present device, the further electrodes 5001 are only approximately 20 mm long, the anvil is 60 mm, i.e. the further electrodes 5001 occupy only approximately 1/3 of the longest length of the anvil. In other electrode instruments further

5001 can occupy the farthest 1/10 to 1/2 of the length of the anvil. Such devices may be used for point coagulation as described in U.S. Patent No. 5,599,350.

[0073] Fig. 28 shows another exemplary end effector device 12 with RF electrodes. In such a device, the active electrode 500 is located at the distal end of the anvil 24, which is insulated through the anvil 24 by means of a non-conducting electrical insulator 504, which can be made of a ceramic material. Such an instrument can be used for spot coagulation.

[0074] Figures 29 to 32 show another exemplary end effector device 12 that may be useful for spot coagulation. In these devices, the anvil 24 includes a pair of electrodes 5001, 5002 at the distal end of the anvil 24 and along the side of the anvil 24. Fig. 29 shows a front view of the anvil 24, Figure 30 is a side view, Figure 31 shows an enlarged frontal fragmentary view, and Fig. 32 is a top view. In such an example device, the metal anvil 24 may act as a passive electrode. The active electrodes 5001, 5002 may be isolated from the anvil 24 by means of non-conductive insulators 504, which may comprise a ceramic material.

[0075] Figs. 33 to 36 show an exemplary device in which the anvil 24 comprises two further electrodes 5001, 5002 located on the upper central portion of the anvil 24. Again, the metal anvil 24 may act as a passive electrode and the active electrodes 5001, 5002 may be isolated from the anvil 24 using non-conductive insulators 504.

Figures 37 to 40 show an exemplary apparatus in which one active electrode 5001 (e.g. active electrode) is on the anvil 24 and the second active electrode 5002 is located on the lower jaw 22, preferably on the cartridge 34. Metal anvil 24 can act as a passive electrode. The anvil electrode 5001 is insulated from the anvil 24 by means of insulator 504. Electrode 5002 in the cartridge 34, which is preferably made of non-conductive material such as plastic, is insulated from the metal channel 22 by means of the cartridge 34.

[0077] Figs. 41 to 44 show an exemplary apparatus in which the anvil 24 has two active electrodes 5001, 5002 at the farthest end of the anvil 24 that extends completely from the top surface of the anvil 24 to the bottom surface. Again, the metal anvil 24 may act as a passive electrode and the active electrodes 5001, 5002 may be isolated from the anvil 24 by means of non-conductive insulators 504.

[0078] Figs. 45 to 48 show an exemplary apparatus in which the cartridge 34 has two active electrodes 5001, 5002 at the farthest end of the staple cartridge 34. In such a device, the metal anvil 24 or the metal channel 22 can act as a passive electrode. In this illustrated apparatus, the electrodes 5001, 5002 are connected to the insulators 503, but in other devices, insulator pads 503 can be omitted, and the plastic cartridge 34 can act as an insulator for electrodes 5001, 5002.

[0079] Figs. 49 to 52 show an exemplary device having one active electrode 5001 at the farthest end of the anvil 24 and a second active electrode 5002 at the farthest end of the cartridge 34. Again, in such an instrument, the metal anvil 24 or metal channel 22 may act as a passive electrode. . In this illustrated device, the electrode 5002 is connected to the insulator 503, 505, but in other devices, the insulator inserts 503, 505 may be omitted, and the plastic cartridge 34 may function as an insulator for the electrode 5002.

[0080] Fig. 57 is a side view and Fig. 58 is a side cross-sectional view of the handle 6. The illustrated device includes only one trigger, a closing trigger 18. Activation of the knife, staple driver elements and / or RF electrodes in the device may be implemented by means other than similar triggering trigger. For example, according to FIG. 57, actuation of the knife, staple driver elements and / or RF electrodes can be activated by a button 540 or other type of switch that is in a position that is convenient for the operator. In Fig. 57, the switch 540 is shown in the upstream part of the handle 6. In another device, the switch may be located near the distal end of the handle 6 in such a way that pulling on the nozzle 539 activates the switch, to trigger the device to start. In such a device, a switch (not shown) may be located below or near the nozzle 539 in such a way that the movement of the nozzles causes the switch to switch.

[0081] Alternatively, actuation of the knife, staple driver elements and / or RF electrodes may be activated by a voice or other auditory commands detected by the microphone 542. In another exemplary apparatus, the handle 6 may include a 541 RF or audio transceiver that may receive and / or transmit RF or audible signals to activate the instrument. Furthermore, according to FIG. 58, the foot pedal or switch 544 can be used to activate the device 10. The foot pedal 544 can be connected to the handle 6 by means of a wire 545. Furthermore, the handle 6 can include a knob 546 or other suitable control device for actuation control. segmented RF electrodes (see, for example, Figures 23 and 24).

[0082] The apparatus 10 shown in Figs. 57 and 58 also includes a plurality of feedback systems for the user. As mentioned above, the device 10 may include a loudspeaker 543 for amplifying commands or instructions to the operator's needs. In addition, the holder 6 may include visual indicators 548, such as LEDs or other light sources that provide visual feedback on the actuation of various segmented RF electrodes. For example, each of the visual indicators 548 may correspond to one of the pair of segmented RF electrodes. A corresponding indicator 548 can be activated when the pair of segmented RF electrodes is activated. In addition, the holder 6 may comprise an alphanumeric display 550, which may be, for example, an LED or LCD display. The display 550 may be connected to the circuit board 552 within the holder 6. The holder 6 may also include a vibrator 554 in the pistol grip portion 26 that can provide vibratory feedback to the operator. For example, the vibrator 554 may generate vibrations each time one of the segmented RF electrode pairs in the end effector 12 is activated.

[0083] Fig. 26 shows a cross-sectional view of the end effector 12 according to various exemplary devices, wherein the electrodes are on the upper jaw (or anvil) 24. In the present device, the active electrode 500 is adjacent to the knife slot 516. A metal anvil 24 can be used as a passive electrode. The 504 insulators, which can be made of ceramic material, insulate the electrodes 500 from the metal anvil 24. The exemplary apparatus of Fig. 68 is similar to that of Fig. 26 except that the electrodes 500 are smaller, meaning that some insulators 504 it can run between the respective electrodes 500 and the edges of the knife channel 516.

[0084] Fig. 53 is a cross-sectional side view of the end effector 12 according to a further exemplary apparatus. In such a device, as in the embodiment of Fig. 26, the active electrodes 5001, 5002 are located on the anvil 24 on opposite sides of the knife channel. The electrodes 5001, 5002 are isolated from the metal anvil by means of insulators 504, which again preferably comprise a ceramic material. However, in this instrument, the 504 insulators are made very thin (compared to Fig. 26). The implementation of the very thin insulators 504 provides the potential advantage that the anvil 24 may comprise a relatively large metal area 520 above the electrodes 500, thereby supporting a potentially narrower anvil profile for a given stiffness of the anvil or a stiffer profile for a given dimension of the anvil cross section. 504 insulators can be cast or coated on the anvil 24.

[0085] Fig. 54 shows another exemplary instrument. In such a device, active electrodes 5001, 5002 are cast or connected to insulators 504 that can be cast or connected to anvil 24. Like the exemplary apparatus of Fig. 53, this design allows a larger anvil material above the electrodes. In such a device, electrodes 5001, 5002 can contain silver, which is a good conductor of electricity and has antibacterial properties.

[0086] Fig. 55 is a side view of an end effector in accordance with a further exemplary apparatus. In this device, a thin film of electric current insulating material 530 is applied to the surface of the cartridge 34. The insulating film 530 preferably comprises a heat-resistant material and an electric arc, such as a ceramic material. This increases the resistance of the cartridge 34 to an electric arc and short circuit, allowing more triggering between changes of the cartridge 34. Furthermore, if the cartridge 34 is a poor conductor of electrical current, it can promote faster heating of the tissue and reduction to overall energy requirements. Active electrodes (not shown in Fig. 55) may be located in the anvil 24, as described in the exemplary apparatus above.

[0087] Fig. 56 shows an exemplary apparatus that is similar to that shown in Fig. 55, except that in Figure 56, a thin layer 532 of low electrically conductive material is applied to the top portion of the insulation film 530. Thin conductivity, poorly The conductive layer 532 may be smaller than the conductivity of the tissue clamped in the end effector 12 for processing. The thin, poorly conductive layer 532 may provide a path with reduced conductivity to provide additional heating of the compressed tissue. This can lead to a reduction in the time required to heat the tissue and obtain coagulation.

[0088] As described above, the device 10 may include a joint 14 for moving the end effector 12. The physician or the operator of the device 10 may articulate the end effector 12 relative to the shaft 8 by using the articulation 16 as described in detail in US Patent Application No. 2007/0158385 A1, entitled "Surgical Instrument Having an Articulating End Effector," by Geoffrey C. Hueil et al. In another example device, instead of a control device that is integrated with the device 10, the end effector 12 can be moved by means of a separate device such as a clamp that is inserted into the patient's body such that its working portion is near the end effector. 12 in such a way that it can move the end effector 12 if necessary. A separate device may be inserted through another opening as the end effector 12 or through the same opening. In addition, different operators may operate separate devices or one person may operate both devices to move the end effector 12. In the subsequent concept of the passive end effector 12, it can be articulated by carefully pressing it against other parts of the body to achieve the required articulation.

[0089] In a further exemplary apparatus, the end effector 12 may be connected to the handle by means of a flexible cord. In such a device, the end effector 12 can be placed as desired and held in position by using another device, e.g. a separate clamping device. Furthermore, in other exemplary devices, the end effector 12 can be placed by means of a separate device and clamped by a second separate device. Furthermore, the end effector 12 can be made as small enough, e.g. 8 to 9 mm wide and 10 to 11 mm high, meaning that a "pull to close" mechanism can be used to clamp the end effector from the holder 6. The "pull to close" mechanism may be adapted from the example described in U.S. Patent No. 5,562,701, titled "Cable-Actuated Jaw Assembly For Surgical Instruments". The razor 600 can be disposed in or along a flexible endoscope for use in, for example, operations of the lower GI tract.

[0090] In a further exemplary apparatus that is shown in Figs. 69 and 70, the device 10 may include a flexible neck assembly 732 for articulating the end effector 12. As the articulation assembly 731 connected to the shaft 8 is rotated, it may cause a remote the articulation of the elastic neck assembly 732. The elastic neck assembly 732 may include first and second portions of the flexible neck 733, 734 that receive the first and second elastic band 735, 736. During rotation of the articulated drive assembly 731, one of the first and second elastic band assembly 735, 736 is moved forward and the second band assembly is moved backward. In response to the reciprocating movement of the bands in the first and second parts of the flexible neck 733, 734 of the flexible neck assembly 732, the flexible neck assembly 732 is bent to provide articulation. A further description of the flexible neck is found in U.S. Patent No. 5,704,534.

[0091] The devices disclosed herein may be designed to be removed after one use or may be designed to be used repeatedly. However, in any case, the device may be regenerated for reuse after at least one use. The regeneration may comprise any combination of steps of dismantling the device, cleaning or replacing individual elements, and then reassembling. In particular, the device may be dismantled and any number of individual elements or parts of the device may be selectively replaced or removed in any combination. After cleaning and / or replacing individual parts, the device can be reassembled for further use in a regeneration plant or surgical team immediately before surgery. Those skilled in the art will be aware that the regeneration of the device may include a number of different techniques for disassembling, cleaning / replacing elements and reassembling. The use of such techniques, as well as the resulting regenerated device, is within the scope of the present application.

[0092] Preferably, various embodiments of the invention described herein will be prepared prior to the cleaning operation. According to the surgical procedure. First, a new or used device is obtained and, if necessary, the instrument can then be sterilized. one of the sterilization techniques the device is placed in a closed and sealed package, such as a thermoformed plastic coating covered with a TYVEK plastic layer. The packaging and device are then placed in a radiation field that can penetrate the packaging, such as gamma radiation, X-rays or electron radiation with increased energy. Radiation destroys the bacteria on the instrument and in the packaging. The sterilized device can then be stored in a sterile package. The sealed package keeps the device sterile until it is opened in a medical facility.

[0093] It is advantageous to carry out the sterilization of the device. This can be accomplished using any method known to those skilled in the art, including beta or gamma radiation, sterilization with ethyl acetate or steam, and other methods.

[0094] Although the present invention has been described by means of a description of several embodiments, and illustrative embodiments have been described in more detail, the intention of the applicant is not to limit in any way the scope of the appended claims to such details. Additional benefits and modifications will be apparent to those skilled in the art. The various embodiments of the present invention represent significant improvements over prior stapling systems that require different staple sizes to be used in one cartridge to obtain staples that have different formed (final) heights.

[0095] Accordingly, the present invention has been discussed with reference to endoscopic procedures and devices. However, the term "endoscopic" as used herein should not be construed as a limitation of the present invention to a surgical stapling and cutting device for use only in conjunction with an endoscopic tube (i.e., a tricell). On the contrary, it is believed that the present invention may find application in any procedure where access is limited, including but not limited to laparoscopic procedures as well as open procedures. In addition, the unique and novel aspects of the various embodiments of the staple cartridge of the present invention may find application when combined with other forms of stapling devices without departing from the scope of the appended claims.

26368 / EP / 16

EP2090256