Surgical instrument having an articulating end effector

The present invention relates generally to surgical instruments, and in particular to minimally invasive surgical instruments having an articulated end effector.

BACKGROUND ART [0002] Endoscopic and minimally invasive surgical instruments typically include an end effector positioned at the distal end of the longitudinal shaft and a handle at the proximal end of the longitudinal shaft, enabling the physician to manipulate the end effector. During use, the end effector is delivered to the treatment site via the trocar cannula. At the site of the procedure, the final effector affects the tissue in a number of ways to achieve a diagnostic or therapeutic effect. Endoscopic surgical instruments are often preferred over traditional open surgical instruments because they require smaller incisions that generally heal faster than traditional surgical incisions. Due to this, as well as other advantages of endoscopic surgery, there has been a significant development of endoscopic surgical instruments having end effectors that affect the tissue to perform a number of surgical tasks. For example, end effectors have been developed to act as endo-knives, grippers, knives, clamp applicators, access devices, dosing devices for drug / gene therapy, devices using ultrasound, radio frequency or laser, as well as other surgical instruments.

[0003] Figs. 1 and 2 show an example of a prior art surgical stapling and incision instrument 10 comprising an end effector 12 configured as an endo-knife for clamping, cutting and suturing tissue, for example as disclosed in US Publication No. 2004 / 0232196 A1. The surgical stapling and scoring tool 10 includes a portion of the handle 20 that is connected to the portion of the tool 22, which further includes a shaft 23, terminated from the distal end with the end effector 12. The portion of the handle 20 includes a pistol grip 24 in which it is pivotally pulled by a physician a closing trigger 26 to clamp or close the anvil 18 towards the longitudinal channel 16 of the end effector 12. The trigger 28 is further out of the closing trigger 26 and is pivotally pulled by the physician to cause stapling and cutting of the clamped tissue in the end effector 12.

[0004] The closing trigger 26 is activated first. When the physician accepts the position of the end effector 12, he can pull the closing trigger 26 to its fully closed, locked position closer to the pistol grip 24. The trigger release 28 can then be actuated. The trigger 28 returns in a resilient manner when the physician releases the pressure. The release button 30 at the proximal end of the handle portion 20 releases the locked closing trigger 26 when depressed.

[0005] The closing sleeve 32 surrounds the frame 34, which in turn surrounds the triggering drive element 36, which is set by the trigger trigger 28. The frame 34 connects a portion of the handle 20 to the end effector 12. In the case of retraction of the closing sleeve 32 proximal by means of the trigger closing member 26 as shown, the anvil 18 opens by pivoting from the longitudinal channel 16 and moving closer together with the closing sleeve 32. The elongate channel 16 receives the staple cartridge 37. [0006] When referring in particular to Fig. 2, the firing rod 14 comprises three vertically spaced pins that control the arrangement of the end effector 12 during firing. In particular, the upper pin 38 is configured to insert into the anvil pocket 40 near the pivot axis between the anvil 18 and the longitudinal channel 16. When triggered with the anvil 18 closed, the upper pin 38 moves distally inside the longitudinal slot of the anvil 42, running further down the anvil 18. Any smaller upward deviation in the anvil 18 is overcome by the downward force transmitted by the upper pin 38.

[0007] The firing rod 14 also includes the lowest pin or trigger rod cap 44 that engages in the upper direction the channel slot 45 in the longitudinal channel 16, thereby cooperating with the upper pin 38 to pull the anvil 18 and the longitudinal channel 16 slightly closer together in the case excess tissue clamped between them.

[0008] The firing rod 14 preferably includes a central pin 46 that passes through the firing driving slot 47 formed in the bottom surface of the cartridge 37 and the top surface of the longitudinal channel 16, thereby directing the staples to it as described below. The central pin 46 as a result of sliding on the bottom surface of the cartridge 37 preferably stops any tendency of the end effector 12 to tighten at its distal end.

[0009] The cutting edge 48 between the upper and middle pins 38, 46 on the firing rod 14 passes through the cartridge 37 to cut the clamped tissue. The correct arrangement of the firing rod 14 with respect to the longitudinal channel 16 and the anvil 18 guarantees that an effective cut will be carried out. [0010] The appropriate vertical arrangement provided by the E 14 beam trigger rod is suitable for the limited size available for endoscopic devices. In addition, the beam release rod E 14 allows the anvil 15 to be manufactured with a bend to give a vertical deflection at its distal end. Such an bent anvil 18 advantageously helps to achieve the required space in the end effector 12, even in the case of anvil 18 with a reduced thickness that is more suited to the size limitations of the endoscopic device.

[0011] The beam release rod E 14 also allows additional applications, in particular in combination with a number of staple cartridge configurations. For example, your doctor may choose a gray staple cartridge for 0.02 mm tissue space, a white staple cartridge for 0.04 mm tissue space, a blue staple cartridge for 0.06 mm tissue space or a green staple cartridge for tissue space 0.10 mm. The vertical height of each respective staple cartridge in combination with the length of the staples and the integrated wedge shoe 50 predetermines the required tissue thickness with the anvil 18 appropriately spaced vertically by the E 14 firing rod.

[0012] For the surgical instrument 10 and other minimally invasive instruments, the placement of the end effector at the surgical site is limited by the trocar. Generally, the elongated shaft 23 allows the physician to insert the end effector to the required depth and to rotate the end effector about the longitudinal axis of the shaft. This enables placement of the end effector at the surgical site to some extent. In the case of skillful placement of the trocar and the use of grippers, for example by another trocar, such placement is often sufficient. Depending on the nature of the procedure, further adjustment of the end effector placement of the endoscopic surgical instrument may be required. In particular, it is often required to set the end effector at any one of many angles relative to the longitudinal axis of the longitudinal shaft of the device.

[0013] Displacement of the end effector at different angles relative to the shaft of the device is often referred to as "articulation". The articulation is usually implemented by means of an articulated joint placed in an elongated shaft near the end effector. This enables the physician to articulate the end effector remotely in each direction for better staple line placement and easier tissue manipulation and alignment. The articulation of the end effector allows the physician to affect the tissue much easier in some cases, for example at the back of the organ. In addition, the articulation can advantageously allow the endoscope to be positioned behind the end effector without being blocked by the elongated shaft. [0014] The articulation displacement concepts of the end effectors seem to be complicated because the articulation displacement control mechanisms should be integrated with the end effector handling mechanisms. For example, the closing sleeve, drive element and articulation mechanisms should be implemented taking into account the limitations caused by the small diameter of the instrument shaft. One common design relates to a harmonica-like articulated mechanism ("flexible neck") which is moved by articulation by selectively retracting one of the two connecting rods through a shaft, each rod being arranged in displacement respectively on opposite sides of the shaft's center line. The connecting rods use a ratchet mechanism within a number of separate positions. [0015] Although this widely known concept ensures successful articulation of the end effector around the articulation, further efficiency improvement is desirable. As a result, there is a significant need for an improved articulated surgical instrument. European Patent Publication No. EP 06464356 discloses an articulated assembly for an endoscopic device along with the path of a surgical attachment. The assembly includes a distal end for retaining the end effector to manipulate tissue during a surgical procedure in the body cavity. The assembly includes an articulated joint connecting the longitudinal support housing with the distal end. The connector has an empty socket and a convex element that is inserted into the socket. The convex element defines a corridor for receiving an actuator that extends from the housing through the connector to actuate the end effector. The control element is provided on the housing and extends into the socket or convex element to move the distal end to and from alignment with the housing. A flexible path is provided to guide the fasteners through the connector.

[0016] EP 0603472 A2 discloses a device for driving surgical fasteners, comprising a mechanism or articulation, comprising a fixed drive roller, including a shaft portion around which the articulated cord or peripheral configuration is held.

BRIEF SUMMARY OF THE INVENTION [0017] The invention provides an articulated surgical instrument. The device comprises a shaft having a longitudinal axis. The end effector is operably coupled to the shaft at the articulation. The first tendon is operatively connected to the end effector and runs through at least a portion of the shaft. The articulation control is provided to apply force in a direction generally transverse to the longitudinal axis, the articulation control being operably connected to the first string in such a way that the force is transmitted through the first string to the end effector to cause the end effector to rotate about the shaft around joint.

[0018] The articulation control can be constructed to move in the first direction to apply force in the first lateral direction to cause the end effector to rotate in the first rotational direction relative to the shaft.

[0019] The articulation control can be constructed to move in a second direction to apply force in a second transverse direction opposite to the first transverse direction to cause the end effector to rotate in a second rotational direction relative to the shaft.

[0020] The device may further comprise a second tendon operably connected to and extending from the end effector through at least a portion of the shaft, the articulation control being operatively connected to the second tendon in such a way that such a force application is transmitted through the second tendon to the end effector for development the rotational motion of the end effector in a second rotational direction relative to the shaft.

[0021] The articulation control includes an articulation guide that can move laterally with respect to the shaft. The guide can move transversely to the shaft to the first, second and neutral position. The guide can move transversely with respect to the shaft to the third and fourth positions.

[0022] The first tie rod and the second tie rod may be pre-bent towards the longitudinal axis when the joint control is in the neutral position.

[0023] The articulated guide may define a gap near the longitudinal axis when the articulated guide is in the neutral position and the first and second tendons pass through the slit and the articulated guide is in a position offset from the longitudinal axis when the articulated guide is in one of the first and second positions.

[0024] The device may further comprise a first distal element, the first tendon being drawn from the end effector around the first distal element.

[0025] The device may further comprise a second tendon operably connected to and extending from the end effector through at least a portion of the shaft and a second distal element, the second tendon being from the end effector around the second distal element.

[0026] The articulation control may comprise an articulated guide that is movable in a direction generally transverse to the longitudinal axis, the articulation guide contacting the first tie during at least part of the articulation guide's range of motion. [0027] The force can be applied to the first tie. [0028] The device may further comprise a first hydraulic articulated bladder expandable towards the first tie rod.

[0029] The device may further comprise a hydraulic fluid source constructed to receive the force applied by the articulation.

[0030] The hydraulic fluid source may be a hydraulic actuating bladder fluidly connected to the first hydraulic articulated bladder.

[0031] The articulation control may include a first actuation button for compressing the first hydraulic articulation bladder and for directing hydraulic fluid to the first hydraulic articulation bladder to fill the first hydraulic articulation bladder when a force is applied to the first button.

[0032] The articulation control may further include a second hydraulic articulation bladder.

[0033] The first hydraulic articulated bladder and the second hydraulic articulated bladder may be located along the common side of the shaft.

[0034] The device may further comprise a second tie operatively connected to and extending from the end effector through at least a portion of the shaft, the second hydraulic articulated bladder being able to expand towards the second tie.

[0035] The expansion of the first hydraulic articulated bladder toward the first tie rod can cause the first tie to bend, which causes the end effector to rotate about the shaft around the joint in the first rotational direction, and the extension of the second hydraulic articulated bubble towards the second tie rod can cause the second tie to bend. causes the end effector to rotate relative to the shaft around the joint in a second direction of rotation.

[0036] The articulation control may be constructed to apply force in a first transverse direction or in a second transverse direction opposite to the first direction to cause the end effector to rotate in the first or second direction of rotation, respectively.

[0037] The first tendon is mechanically connected to the end effector at the point of the projection centered on the hinge in such a way that the force transmitted by the first tendon is transmitted to the protrusion to cause a rotational movement of the protrusion around the hinge.

[0038] The first tendon is mechanically connected to the projection at a first point spaced away from the articulation.

[0039] The device may comprise a second cable operably connected to and extending from the end effector through at least a portion of the shaft, the articulation control being functionally connected to the second cable and configured to apply force in the second transverse direction, the second cable being mechanically connected to protrusion in such a way that the force applied to the second tendon is transmitted to the protrusion to cause a rotational movement of the protrusion around the articulation.

[0040] The second tendon may be mechanically connected to the projection at a second point spaced from the articulation and away from the first point.

[0041] The device may further comprise a handle mechanically connected to the shaft.

[0042] The device may further comprise a second cable operably connected to and extending from the end effector through at least a portion of the shaft and wherein the second cable includes a spring assembly enabling the second cable to be elongated in response to stretching.

[0043] The first tendon may further include a spring assembly enabling the first tendon to be extended to a fixed distance in response to stretching.

[0044] The first cable and the second cable can be operably connected to the joint control at points offset from the longitudinal axis of the shaft.

[0045] The second string may be configured to receive a second force in a direction generally transverse to the longitudinal axis, the second force being transmitted by the second string to the end effector to cause the end effector to rotate relative to the shaft around the joint in the second direction.

[0046] The disclosure presents another articulated surgical instrument. The device comprises a shaft having a proximal end and a distal end. The end effector is pivotally connected to the shaft in the articulation at the distal end of the shaft, allowing the end effector to rotate relative to the shaft about the articulation axis. The first tendon extends through at least the first shaft portion, the first tendon comprising a first end mechanically connected to the end effector at a point offset from the articulated axis.

[0047] The device may further comprise a handle mechanically connected to the shaft at the proximal end of the shaft.

[0048] The device may further comprise a joint control rod that is movable towards the first tie rod.

[0049] The device may further comprise a first hydraulic articulated bladder expandable towards the first tendon.

[0050] The device may further comprise a distal element disposed in the shaft, the first tendon being directed to the end effector around the distal element. [0051] The device may further comprise a second tendon extending at least through the first shaft portion, the second tendon comprising a first end mechanically connected to the end effector at a second point spaced from the pivot axis.

[0052] The first and second tendons may be pre-bent.

[0053] The disclosure also describes, with respect to a surgical instrument comprising a shaft, an end effector mechanically connected to the shaft at a pivot, allowing the end effector to rotate relative to the shaft about an articulated axis, and a first tendon extending through at least part of the shaft, the first tendon comprising a first mechanically connected end with end effector at a point offset from the articulated axis, method of operating the device. The method includes applying force to the device in a direction that is substantially transverse to the shaft, the force causing the first tie to bend and wherein the first tie to bend causes the end effector to rotate relative to the shaft about the joint in the first direction.

[0054] The surgical instrument may further comprise a second tendon, comprising a first end mechanically connected to the end effector at a second point spaced from the articulated axis, the method further comprising applying a second force to the instrument in a second direction that is substantially transverse to the shaft. wherein the second force causes the second rod to bend and wherein the second rod bends to rotate the end effector relative to the shaft around the joint in a second direction.

BRIEF DESCRIPTION OF THE FIGURES [0055] The attached drawings, which are incorporated and form part of the present description, illustrate embodiments of the invention and together with the general description of the invention set forth above and the detailed description of the embodiments presented below, serve to explain the principles of the present invention.

Fig. 1 shows a partially cut away side view of a prior art surgical instrument.

Fig. 2 is a detailed cross-sectional side view taken along line 2-2 of Fig. 1 of the end effector of a prior art surgical instrument.

Fig. 3 is a three-dimensional view of a surgical instrument in accordance with various embodiments of the present invention.

Fig. 4 shows a side view of a surgical instrument in accordance with various embodiments of the present invention.

Fig. 5 shows a top view of a surgical instrument in accordance with various embodiments of the present invention.

Fig. 6 is a top cross-sectional view of the end effector and longitudinal shaft of the surgical instrument according to one embodiment of the present invention.

Fig. 7 is a top cross-sectional view of the articulation joint of the surgical device of Fig. 6 in the neutral position.

Fig. 8 is a top cross-sectional view of the articulation control of the surgical device of Fig. 6 in the neutral position.

Fig. 9A is an exploded view of the end effector and longitudinal shaft of a surgical device having a joint similar to that of the device shown in Fig. 6.

Fig. 9B is a top view of the firing rod of the device of fig. 9.

Fig. 10 is a cross-sectional side view of the articulated joint of the surgical instrument in Fig. 6.

Fig. 11 is a 3D view of the end effector and articulation of the surgical instrument of Fig.

10.

Fig. 12 shows the end effector, articulation and articulation control of the surgical instrument of Fig. 6 with the end effector turned to the left in accordance with various embodiments of the present invention.

Fig. 13 is a top cross-sectional view of the articulation control of the surgical device of Fig. 6 pressed to the left to displace the end effector as shown in Fig. 12.

Fig. 14 is a top cross-sectional view of the articulation joint of a surgical instrument according to another embodiment of the present invention.

Fig. 15 is an exploded view of the end effector and longitudinal shaft of a surgical device having a joint similar to that of the device of Fig. 14.

Fig. 16 is a cross-sectional side view of another embodiment of the articulation joint of the surgical instrument having the joint of Fig. 14.

Fig. 17 shows the end effector, articulation and articulation control of the surgical instrument of Fig. 1416 with the end effector in a neutral position.

Fig. 18 shows the end effector, articulation and articulation control of the surgical instrument of Fig. 1416 with the end effector turned to the left.

Fig. 19 is a top cross-sectional view of a surgical instrument in accordance with one embodiment of the present invention.

Fig. 20 is a top cross-sectional view of the articulation control of the surgical instrument of Fig. 19 in the neutral position.

Fig. 21 is a top cross-sectional view of the shaft, cables and spring assemblies of the surgical instrument of Fig. 19 in the neutral position.

Fig. 22 is a top cross-sectional view of the articulation control of the surgical device of Fig. 19 rotated to the left.

Fig. 23 is a top cross-sectional view of the surgical instrument of Fig. 19 rotated to the left. Fig. 24 is a top cross-sectional view of the shaft, cables, and spring assemblies of the surgical instrument of Fig. 19 rotated to the left.

Fig. 25 is a top cross-sectional view of the articulation joint of a surgical instrument according to another embodiment of the present invention.

Fig. 26 is a cross-sectional side view of the articulated joint of the surgical instrument of Fig. 25.

Fig. 27 is an exploded view of the end effector and longitudinal shaft of a surgical device having a joint similar to that of the device shown in Figs. 25 and 26.

Fig. 28 shows the hydraulically actuated articulation control of a surgical instrument useful in the embodiment of the present invention shown in Figs. 25 and 26.

Fig. 29 shows the end effector and joint of the surgical instrument 25-27 with the end effector in the neutral position.

Fig. 30 shows the end effector and joint of the surgical instrument 25-27 with the end effector turned clockwise.

DETAILED DESCRIPTION OF THE INVENTION [0056] Figs. 3-5 show an exemplary surgical instrument 100, typically including a handle 103, a shaft 104, as well as an articulated end effector 102 pivotally connected to a configured, surgical shaft 104 at a joint 110. The articulation control 112 is provided to cause the end effector 102 to rotate around the articulation location 110. The end effector 102 is shown to be configured to act as an endo-knife, cutting and stitching tissue, however, it should be noted that various embodiments of the present invention may include end effectors (not shown) to act as other devices including, for example, grippers, knives, staplers, clamp applicators, access devices, dosing devices for drug / gene therapy, devices using ultrasound, radio frequency or laser and the like.

[0057] Instrument handle 103 may include a closing trigger 114 and a trigger trigger 116 for actuating the end effector 102. It should be noted that instruments having end effectors for various surgical tasks may have a different number or type of triggers or other suitable regulators to operate the effector final. The end effector 102 is shown separated from the handle 103 by a preferably elongated shaft 104. The physician may articulate the end effector 102 relative to the shaft 104, using the articulation 112.

[0058] It should be noted that spatial terms such as vertical, horizontal, right, left and the like are used herein with reference to the drawings, assuming that the longitudinal axis of the surgical instrument 100 is coaxial with the center axis of the shaft 104, with drains 114, 116 downwards at an acute angle from the bottom of handle 103. In practice, however, the surgical instrument 100 can be set at different angles and these spatial terms are used relative to the surgical instrument 100 itself. In addition, the term "proximal" is used to determine the perspective of the physician who is behind the handle 103 and who places the end effector 102 in the direction away or away from each other.

[0059] As used herein, the term "fluidly connected" means that the elements are connected to each other using an appropriate line or other means to allow fluid under pressure, air and the like to pass between them. As used herein, the term "line" in the sense of "supply line", "hydraulic line", "return line" means a suitable fluid passage formed from a conduit, tube, pipeline, and the like to transport hydraulic fluid under pressure from one component to another.

[0060] The term "hydraulic fluid" as used herein refers to any fluid suitable for use in a hydraulic system. Non-limiting examples of hydraulic fluids include oil, air and the like. In one non-limiting embodiment, the hydraulic fluids may be biocompatible fluids, for example glycerin oil, saline and the like.

[0061] As used herein, the term "substantially transverse to the longitudinal axis", where "longitudinal axis" is the axis of the shaft, refers to a direction that is almost perpendicular to the longitudinal axis. However, it should be noted that those directions that deviate slightly from the perpendicular position to the longitudinal axis are also substantially transverse to the longitudinal axis.

[0062] Various embodiments of the present invention pertain to devices having a joint driven by cables or tie rods. Fig. 6 is a top cross-sectional view of an exemplary elongated shaft 104 and end effector 102 including a joint driven by a bent string. In the non-limiting embodiment of Fig. 6, the tendon 205 is mechanically connected to the projection 206 located at the hinge 110. The tendon 205 may include portions of the tendon 202 and 204 extending proximal to the projection 206 along the longitudinal shaft 104 and through articulation 112. The tendon 205 and the portions of the tendon 202, 204 preferably have a fixed length.

[0063] Fig. 7 is a cross-sectional view of the joint 110 shown in Fig. 6, including projection 206 and cable 205. The cable 205 can be mechanically connected to the projection 206 in the manner shown using any suitable fastening method, including for example glue, welding and the like. In various embodiments, each portion of the tendon 202, 204 can be provided as a separate tendon, each separate tendon having one end mechanically connected to the protrusion 206 and the other end running through the shaft 104 and articulation control 112 (not shown in Figure 7) . Separate tie rods can be mechanically connected to projection 206 in the manner described above.

[0064] The parts of the strand 202, 204 may extend from the projection 206, through the joint 110 and along the shaft 104 to control the joint 112, shown in Fig. 8. The control of the joint 112 may include the articulation guide 208, the frame 212 and the sheath 218. Parts of the rod 202 , 204 may pass through the articulated guide 208 through the slot 210 or other opening, although it should be noted that parts of the string 202, 204 may be connected to the guide 208 by any suitable means. The articulation guide 208 may be one piece, as shown in Fig. 8, or may in one non-limiting embodiment include two elements with a connector between two elements defining the slot 210. In one non-limiting embodiment, the articulated guide 208 may include multiple slots, for example, each slot corresponds to one of the parts of the tendon 202, 204. The cover 218 may cover various components of the joint control 112 to avoid the ingress of dirt.

[0065] In various embodiments, parts of the tendon 202, 204 can be attached to the frame 212 at the connection points 214, 216 located closer to the slot 210. The non-limiting embodiment of Fig. 8 shows that the parts of the tendon 202, 204 are pre-bent from the connection points 214, 216 to the slot 210 located near the longitudinal axis of the shaft 104. It should be noted that parts of the tendon 202, 204 can be attached anywhere in the apparatus 10 near the slot 210, including the handle 103.

[0066] Figs. 9A-11 are views of the end effector 102 and the longitudinal shaft 104 of the instrument 100, including the joint 110 shown in Fig. 7. The end effector 102 shown in Figs. 9A-11 is configured to act as an endo- knife. It should be noted that in various embodiments, the end effector 102 may be configured to perform other surgical tasks that require removal, modification, or addition of components compared to what is shown in the figures. In addition, it should be noted that the end effectors 102 shown in Figs. 3-6, 11 can be adapted in accordance with specific surgical applications. For example, fig. 3-6 and 10-12 show the end effector of a 45 mm endo-knife, while Figure 9A shows the end effector of a 60 mm endo-knife.

[0067] Fig. 9A is an exploded view of the end effector 102 and the elongated shaft 104 including various internal components. The end effector frame 150 and the roller frame 154 are configured to engage at the hinge 110. The projection 206 may be integrated with the end effector frame 150 with the tie 205 connecting the projection 206 in the manner shown. Roller frame 154 may include a distally directed pin 302 defining the opening 304. Bore 304 may be positioned to engage with a pivot pin (not shown) residing in end effector frame 150, allowing end effector frame 150 to rotate relative to shaft frame 154, and thus rotating end effector 102 relative to shaft 104. Once assembled, the various components can pivot around hinge 110 at the hinge axis 306 shown in Figs. 10 and 11.

[0068] Fig. 9A also shows the anvil 120. In this non-limiting embodiment, the anvil 120 is connected to the longitudinal channel 198. For example, the holes 199 of the longitudinal channel 198 can receive anvil pins 152, allowing the anvil 120 to be rotated from an open position to a closed position relative to elongated channel 198 and cartridge 118 with staples. The spring clip 158 is attached to the end effector frame 150 as a lock for the firing rod 172. The distal and proximal square apertures 164, 168 formed in the upper portion 150 of the end effector 150 may define a clamp bar 170 between them which receives the upper arm 162 of the spring clamp 158, whose lower distal arm 160 provides downward force on the portion raised trigger rod 172 discussed below. It should be noted that various embodiments may include other types of locks or may not have locks at all. [0069] In addition, Fig. 9A shows a firing rod 172 configured to move longitudinally through the roller frame 154, through a flexible closing and rotating frame hinge 110, and through the firing gap 176 in the further frame structure 150 to the end effector 102. The firing rod 172 may be constructed in one solid section or in various embodiments may comprise laminated material, including, for example, a stack of steel plates 173, as shown in Fig. 9B. It should be noted that the firing rod 172 made of laminated material may reduce the force required to move the articulated end effector 102. The distal protruding end of the firing rod 172 is attached to the beam E 178, which helps the anvil 120 move away from the staple cartridge 118 when the anvil 120 is in the closed position. The sharpened cutting edge 182 of the E 178 beam can also be used to cut the tissue.

[0070] In operation, the E 178 beam activates the staple cartridge 118. Staple cartridge 118 includes a molded cartridge body 195 that retains a plurality of staples 191 resting on staple drive members 192 within respective upward open staple openings 195. The wedge sled 190 is driven further down by a beam E 178 sliding on a cartridge tray 196 that holds together the various components of the replaceable staple cartridge 118. Wedge sleds 190 direct upward staple drive members 192 to push the staples 191 into deformation contact with the anvil 120 when the cutting surface 182 of the E 178 beam cuts into the clamped tissue.

[0071] In the figures, the firing rod 172 is shown as being inside the shaft 104 in such a way that it passes through the cartridge 194 when the device 100 is triggered. In one non-limiting embodiment, the firing rod 172 is instead placed inside the shaft 104 in such a way that all or part of the body of the firing rod element 172 is supported by a slot (not shown) in the anvil 120 during firing. Since the anvil 120 may be more durable than the cartridge 118, support from the gap may prevent bending of the firing rod 172, even when heavy loads are applied to the distal end of the firing rod 178. This may be useful in embodiments in which the firing rod element 172 contains 173 laminated boards.

[0072] It should be noted that the upper pins 180 of the E 178 beam connect to the anvil 120 during triggering, while the middle pins 184 and lower foot 186 connect to various parts of the cartridge body 194, cartridge tray 196, and elongated channel 198. In use the slot 193 of the cartridge body 194 is aligned with the slot 197 of the cartridge tray 196 and the slot 189 of the longitudinal channel 198. The leading edge of beam E 178 slides through the aligned slots 193, 197 and 189. As indicated in Fig. 9A, the bottom foot 186 joins the groove along the bottom surface of the channel 198 along the length of the gap 189. The middle pins 184 connect to the top surfaces of the trays 196 cartridge along the length of the 197 longitudinal slot. Foot 186 rests against the bottom of channel 198, and upper pins 180 rest against a groove on the bottom surface of anvil 120 to prevent the anvil 120 and channel 198 from being moved apart due to tissue resistance when the end effector is moved forward by a doctor or surgeon during use. Then, the firing rod 172 is retracted in the proximal direction, also causing the E 178 beam to retract, allowing the anvil 120 to open to release two stapled and cut tissue portions (not shown). [0073] Figs. 9A-11 also show assembly 121 of a dual rotary closing sleeve in accordance with various embodiments of the present invention. It should be noted that the invention is not limited to the construction of a dual rotary closing sleeve and may include any suitable closing sleeve or no closing sleeve at all. Referring in particular to Fig. 9A, the double swivel closing sleeve assembly 121 includes a section of the shaft closing tube 128 having upper and lower projecting rods 146, 148 in the distal direction. The end effector closing tube portion 126 includes a horseshoe-shaped opening 124 and a flap 123 for attachment to the opening flap 122 on the anvil 120. The horseshoe-shaped opening 124 and the flap 123 engage with the flap 122 when the anvil 120 is open. A section of the closing tube 126 is shown having an upper 144 and a lower (not shown) protruding in the proximal direction of the mandrels. The upper double swivel connector 130 includes an upwardly distal and proximal pivot pin 134, 136 that engage respectively with the upper bore 138 of the distal pivot in the upper protruding proximal spindle 144 and the upper bore 140 of the proximal pin in the upper protruding distal spindle 146. The lower double swivel connector 132 includes a downwardly projecting distal and proximal swivel pin (not shown in Fig. 9A, but see Fig. 10), which connect respectively to the lower hole of the distal pin in the lower protruding proximal mandrel and to the lower hole 142 of the proximal pin in the lower protruding mandrel 148.

[0074] In use, the closing sleeve assembly 121 is moved distally to close the anvil 120, for example in response to the actuation of the closing trigger 114. The anvil 120 is closed by the distal moving portion of the closing tube 126, and thus the sleeve assembly 121 , causing the proximal anvil 120 in Fig. 9A to lower to the left side of the flap 122. As can be seen more clearly in Fig. 10 and 11, the anvil 120 is opened by moving closer to the tube section 126 and the sleeve assembly 121, causing the flap 123 and the horseshoe-shaped hole 124 to contact and press against the flap 122 to raise the anvil 120. In the anvil open position, the anvil assembly 121 of the double rotary closing sleeve is moved to its proximal position.

[0075] In operation, the physician may articulate the end effector 102 of the instrument 100 relative to the shaft 104 about the joint 110, laterally pressing the joint control 112. Referring to FIG. 6 and 8, it should be noted that if parts of the tendon 202, 204 have a constant length and remain under tension during articulation, then the transverse force provided by the articulation control may not cause bending because, for example, part of the tendon 204 may prevent rotation of the end effector 102, when part of tendon 202 was bent. Accordingly, in the non-limiting embodiment shown in Fig. 8 cable 205 is constructed in such a way that parts of cable 202 and 204 are slightly longer than they should be to move the articulated end effector 102. Parts of cable 202, 204 are then pre-bent towards slot 210 which coincides with the longitudinal axis of shaft 104 when the end effector 102 is in the neutral position.

[0076] In the neutral position, the physician can articulate the end effector 102 to the left relative to the shaft 104 by providing lateral force relative to the left side of the articulation control 112. In response to force, the articulation guide 208 can be passed through the frame 212 as shown in Figure 12 and 13. When the guide 208 is passed through the frame 212, the slit 210 and a portion of the tendon 204 may move across the longitudinal shaft 104 in a transverse direction, for example in a direction substantially transverse or perpendicular to the longitudinal axis of the shaft 104. Therefore, a portion of the tendon 204 is exerted. there is a force causing it to further bend from the initial pre-bent position towards the opposite side of the shaft 104. At the same time, part of the tendon 202 is released from its pre-bent position. Further bending of tendon portion 204 combined with straightening of tendon portion 202 causes a counterclockwise rotational force at projection 206, which in turn causes projection 206 and end effector 102 to rotate left around hinge 110 by the required angle relative to the shaft axis 104, as shown in Fig. 12. Releasing the tendon portion 202 reduces the tension of that tendon portion, allowing the tendon portion 204 to articulate end effector 102 unhindered from the tendon portion 202. Note that the physician may also articulate end effector 102 clockwise relative to shaft 104 by providing a lateral force to the right joint control 112. This causes the cable portion 202 to bend, causing a clockwise rotational force at the protrusion 206, which in turn causes the protrusion 206 and the end effector to rotate clockwise around the articulation 110.

[0077] Figs. 14-18 show an additional embodiment of the articulated movement of the end effector 102 using the bending of tendons according to various embodiments. It should be noted that any type of end effector 102 can be used with the embodiments shown in Figs. 14-18. For example, Figures 14 and 1618 show all or part of a 45 mm end effector end effector, while Fig. 15 shows a 60 mm end effector end effector. Fig. 14 is a cross-sectional view of joint 110 including rods 401, 403 and projection 406. Rods 401, 403 may run in a distal direction to joint 110, as shown. The tendon 401 can run through the shaft 104 along its left side where it is guided around the tendon member 402 and across the right side of the shaft 104. The tendon 401 can be mechanically connected to a projection 406, e.g. at connection point 408. Similarly, tendon 403 may run through shaft 104 along its right side where it is guided around string member 404 and across the left side of the shaft. The 403 can be mechanically connected to the projection 406 at connection point 410.

[0078] Fig. 16 is a cross-sectional view of the joint 110. The tie rods 401 and 403 are shown spaced apart to prevent interference with movement in accordance with a non-limiting embodiment. For example, cable 401 is shown in a lower position than cable 403. In another non-limiting embodiment, the vertical position of cables 401 and 403 may be reversed. FIG. 15 is an exploded view of the end effector 102 and shaft 104 including internal components.

The end effector 102 shown in Fig. 15 is configured to act as an endo-knife for clamping, stapling and cutting the tissue, however it should be noted that various embodiments may use end effectors (not shown) for other surgical tasks. Cable members 402, 404 are shown attached to the shaft frame pin 302. In addition, projection 406 may include connection points 408, 410, as shown. Once assembled, the various components can rotate around the hinge 110 in place of the hinge axis 306 shown in Figure 16.

[0079] In use in the embodiment of Fig. 14, a non-articulated position may occur, as shown in Fig. 17. The control of the articulation 112 and the tie rods 401, 403 are shown in a central position approximately at the location of the longitudinal axis of the shaft 104. the end effector 102 is in the neutral or non-articulated position. In fig. 18 articulation control 112 is shown with the articulation guide 208 routed through the articulated frame to the right side of the shaft 104. Therefore, rods 401 and 403 are bent toward the right side of the shaft 104. It should be noted that bending the 401 to the right exerts a laterally directed force on projection 406, which is offset from the pivot point of projection 406. This shifted force causes the projection 406 to pivot around the hinge 110, thereby causing the end effector 102 to rotate clockwise, as shown. It should be noted that the pushing of the articulated guide 208 to the left side of the shaft 104 may exert a laterally directed force on the ties 401 and

403, by bending both tendons 401, 403 toward the left side of the shaft 104. Bending of tendon 403 exerts a laterally directed force on projection 406, which, as above, is offset relative to the pivot point of projection 406. This in turn causes projection 406 to rotate around the hinge, causing the end effector 102 to rotate left. [0080] Fig. 19-24 illustrate another embodiment of the articulated movement of the end effector 102 with tie rods 252, 254 positioned to connect to joint control 112 at points offset from the longitudinal axis of the shaft 104. Therefore, tie rods 252, 254 are generally more parallel to each other inside the shaft 104 than parts of tendon 202, 204 or 401, 403 shown in Figs. 6 and 17, respectively. 19 is a top cross-sectional view of an exemplary shaft 104, end effector 102 and joint control 112 according to the embodiment of Figs. 19-24. Rods 252, 254 are depicted running from projection 256 through shaft 104 to control joint 112. Spring assemblies 258 and 260 are located along the entire length of rods 252, 254, enabling extension of the rods. It should be noted that tendons 252, 254 may be separate tendons similar to, for example, tendons 401, 403 shown in Figs. 14-18, or may be one tendon with two parts, similar to tendon 205 and tendon 202, 204 in Figures 6-13. Similarly, it should be noted that the tendons 252, 254 can be directed from the projection 256 around the string members (not shown) similar to the string members 402, 404 shown in Figures 14-18.

[0081] Fig. 20 is a top cross-sectional view of an exemplary linkage between shaft 104 and pivot control 112 in accordance with the embodiments of Figs. 19-24. Rods 252, 254 can run through shaft 104 and connect joint control 112 at guide hole 262 of joint guide 280 before they are attached to joint control 112 at connection points 214, 216. Rods 252, 254 can be pre-bent between the guide hole 262 and connection points 214 and 216. However, it should be noted that because rods 252, 254 connect joint control 112 at points offset from center of shaft 104, they are not pre-bent to the same extent as parts of tendon 202 or 204 shown in Fig. 8.

[0082] Fig. 21 is a close-up view of a cross-sectional view of the spring assemblies 258, 260. The spring assemblies 258 and 260 are configured to allow extension of the tendons 252, 254 as a result of low stress, but stop the expansion of the assemblies 252, 254 as a result of high stress. . Referring to the spring assemblies 258, 260, the piston 272 moves within the shield 270. The spring 274 is connected to the piston 272 and the shield 270. When the cable 252 or 254 is subjected to a slight tension, then the spring 274 will slightly extend, allowing the piston 272 to move towards the opening 271 of the shield 270. When the cable 252 or 254 is subjected to greater stress, the piston 272 will be moved into contact with the shield 270 in near hole 271, preventing further expansion of spring assembly 258 or 260.

[0083] Fig. 22 shows the control of the pivot 112 of Fig. 20 with the articulated guide 280 pushed out from the left to the right across the longitudinal axis of the shaft 104. As a result, the rod 252 is bent towards the right of the shaft 104 while the rod 254 is held in its original position through the stop 282. Referring to Fig. 24, when the pull rod 252 is initially bent by pivot control 112, the spring 274 of the spring assembly 258 will extend until the piston 272 contacts the sheath 270 and the spring assembly 258 will not be able to lengthen further. At this point, further bending of cable 252 creates a counterclockwise rotation force at projection 256. When projection 256 begins to rotate in response to rotation, it causes tension on the bent cable 254. Accordingly, the spring 274 of the spring assembly 260 may extend, causing the pull rod 254 to elongate and allowing the rotation of the projection 256 counterclockwise to rotate. The rotational movement of the projection 256 causes the end effector 102 to rotate in a left-hand direction, as shown in Fig. 23. It should be noted that the tension of the tie 254 is low enough that the spring assembly 260 does not reach its maximum expansion during the required range of motion of the end effector 102.

[0084] The sliding of the articulated guide 280 across the shaft 104 from right to left, contrary to what is shown in Figs. 22-24, causes bending of rod 254 and causes clockwise rotation of projection 256 and clockwise articulated movement end effector 102 with inverted roles of tendons 252 and 254 compared to the above description. In addition, it should be noted that in various applications it may only be required to rotate the end effector 102 in one rotational direction relative to the shaft. Accordingly, the embodiments of Figs. 19-24 can be implemented using only one spring assembly disposed on the tie against the required direction of articulation. The spring assembly in this case can be any type of spring, including, for example, an elastic part of the respective tie rod.

[0085] Fig.

hydraulic

25-30 illustrate an embodiment of the articulation of the end effector 102 using bending lines or tie rods in accordance with various embodiments. It should be noted that any type of end effector 102 can be used with the embodiments shown in Figs. 25-30. For example, Figures 25-26 and 29-30 show all or part of the end effector of a 45 mm endo-knife, while Fig. 27 shows the end effector of a 60 mm endo-knife. Referring to Fig. 25, element 508 has been shown to be mechanically coupled to end effector 102. Element 508 can be pivotally connected to shaft 104 at pin 522 in a manner that allows end effector 102 and element 508 to rotate around pin 522. Pin 522 may in various embodiments, be positioned in place of the articulated axis 306 (shown in Fig. 26).

[0086] The tendons 502, 504 can be connected to the member 508, for example at the connection points 507 and 509, respectively. It should be noted that in various non-limiting embodiments of the tendons 502, 504 can be replaced by one tendon (not shown) that runs around element 508, for example similar to the embodiment shown in figure 7 above. Referring again to Fig. 25, tie rods 502 and 504 can run from the member 508, respectively, to the connection points 513 and 511 on the right side of the shaft 104. Each of tie rods 502, 504 is also arranged so that it remains in effective contact with the respective hydraulic bladder 510, 512 in shown way.

[0087] Blisters 510, 512 may expand in a proximal direction when pressurized with hydraulic fluid, for example through hydraulic lines 514 and 516. In the case of expansion, blisters 510, 512 exert a proximal bending force on rods 502, 504. For example, in the case of dilatation, bladder 510 exerts a bending force on the pull rod 504, which in turn exerts a force moved away from the pivot point of element 508 by rotating end effector 102 about pivot axis 306 (shown in Fig. 26). In the embodiment shown in Figs. 25-27 and 29-30, blisters 510, 512 are located on the right side of the shaft 104. It should be noted, however, that in other non-limiting embodiments, the bladders can be located on the left side of the roller 104 or each bladder 510, 512 can be located on the other side of the roller 104. The expansion of the blisters 510, 512 as a result of increasing the pressure can take place in any of several directions as long as the expansion exerts a force on the tie 502 or 504 with which the bladder is effectively in contact to cause a rotational force against the element 508 and the end effector 102.

[0088] Figs. 26-27 show additional views of the end effector 102 and the shaft 104 in accordance with the embodiment of Fig. 25. Fig. 27 is an exploded view of the components contained in the end effector 102 and the shaft 104. The end effector frame 150 is shown in a form mechanically connected to the element 508. In various non-limiting embodiments, the element 508 may be an integrated part of the end effector frame 150. The shaft frame 526 is depicted with the pin hole 520. Pin 522 can engage with the pin hole 518 defined by the element 522, thereby connecting the element 508 to the shaft frame 526 and allowing rotation of the element 508 and end effector 102 around the pin 522. Roller frame 526 is also shown with pockets for the hydraulic bladder 540 and 542 for enclosing the hydraulic bladders 510 and 512, respectively.

[0089] Hydraulic bladders 510 and 512 can be operated using joint control 501 shown in Fig. 28. Left and right actuating bladders 528, 530 located in joint control 501 when actuated provide hydraulic fluid under pressure to hydraulic lines 514, 516 The actuating bladders 528, 530 may be included in the frame assembly, including upper portion 532 and lower portion 534. The left and right pushbuttons 536, 538 located in the frame assembly allow the physician to squeeze one or the other hydraulic bladder 528 or 530, thereby activating the hydraulic bladder 528 or 530, forcing the movement of hydraulic fluid from the bladder through the associated hydraulic line 514, 516 to bladders 512 or 510, thereby causing the end effector 102 to rotate.

[0090] Figs. 29-30 are cross-sectional views of the embodiment of Fig. 25 during use.

In Fig. 29, neither bladder 510 nor bladder 512 are dilated. Accordingly, the end effector 102 is shown in the neutral or non-articulated position. In turn, Figure 30 shows the bladder 510 in the filled state. Bladder 510 is filled, for example, in response to a pressurized hydraulic fluid provided by hydraulic line 516. In its filled state, bladder 510 is expanded to provide bending force to the tie 504. The pull rod 504 then exerts a force offset to the pivot point of the member 508 to rotate the member 508 in a clockwise rotation, causing the end effector 102 to articulate clockwise, as shown.

[0091] Although the present invention has been described by way of description of several embodiments, and the illustrative embodiments have been described in quite detail, it is not intended by the applicant to limit the scope of the appended claims to such details in any way. Additional benefits and modifications will be apparent to those skilled in the art.

[0092] For example, although the above-described embodiments use an endoscopic surgical instrument 100 for cutting and suturing, similar embodiments may be used in other clinical procedures. It is generally accepted that endoscopic procedures are more common than laparoscopic procedures. Accordingly, the present invention has been discussed with respect to endoscopic procedures and devices. However, the term "endoscopic" as used herein should not be construed as limiting the present invention to a surgical instrument for use only in conjunction with an endoscopic tube (i.e. trachoma). On the contrary, it is believed that the present invention may find application in any procedure in which access is limited to a small incision, including but not limited to laparoscopic procedures as well as open procedures.

[0093] In another example, although the chuck portion 103 described herein is mechanically operated in response to a physician's action, it is in accordance with aspects of the invention for some or all of the functions of chuck parts driven by other means (e.g., pneumatic, electromechanical, ultrasonic , hydraulic and the like). In addition, controls for each of these functions may be provided for manual operation on a portion of the handle or may be controlled remotely (e.g., using a wireless remote control, an automated remote console, and the like).

26311 / PE / 16 EP2292152