Surgical stapler with plurality of cutting elements
1 claim: 1 independent, 0 dependent
- 1Zastrzeżenia patentowe 1. Urządzenie zawierające:(a) korpus;(b) zespół (30) wałka rozciągający się w dalej od korpusu, przy czym zespół wałka określa oś wzdłużną, przy czym zespół wałka ma dalszy koniec;(c) chwytak (40) umieszczony na dalszym końcu zespołu wałka, przy czym chwytak zawiera dolną szczękę, obrotowe kowadełko i nóż dokonujący translacji, przy czym nóż dokonujący translacji jest wykorzystywany do translacji względem dolnej szczęki i kowadełka;(d) wkład (370), przy czym wkład jest wprowadzalny do dolnej szczęki, przy czym wkład zawiera wiele zszywek;i (e) urządzenie uruchamiające (378) członu napędzającego zszywek umieszczone wewnątrz wkładu i ruchome w kierunku dalszym, w celu napędzania zszywek w tkankę, przy czym nóż dokonujący translacji chwytaka jest wykorzystywany, aby ciąć tkankę i napędzać element uruchamiający członu napędzającego zszywek dalej w celu napędzania zszywek w tkankę;znamienne tym, że urządzenie uruchamiające (378) członu napędzającego zszywek zawiera ponadto wtórny element tnący (380), który porusza się w dalej z urządzeniem uruchamiającym członu napędzającego zszywek, gdy napędza zszywki w tkankę. 2. Urządzenie według zastrz. 1, w którym wtórny element tnący zawiera prostą krawędź tnącą, zwróconą pod kątem skośnym względem wkładu. 3. Urządzenie według zastrz. 1, w którym wtórny element tnący zawiera zakrzywioną krawędź tnącą. 4. Urządzenie według dowolnego poprzedniego zastrzeżenia, przy czym wtórny element tnący zawiera krawędź tnącą przystosowaną do cięcia tkanki miękkiej. 5. Urządzenie według któregokolwiek z zastrz. 1-3, przy czym wtórny element tnący zawiera krawędź tnącą przystosowaną do cięcia gęstej tkanki. 6. Urządzenie według dowolnego poprzedniego zastrzeżenia, przy czym wtórny element tnący jest przystosowany do wybiórczego poruszania między położeniem wycofanym i położeniem rozciągniętym, przy czym wtórny element tnący jest umieszczony wewnątrz wkładu, gdy wtórny element tnący jest w położeniu wycofanym, przy czym część wtórnego elementu tnącego przebiega przez wzdłużnie rozciągający się kanał we wkładzie, gdy wtórny element tnący znajduje się w położeniu rozciągniętym. 7. Urządzenie według zastrz. 6, w którym wtórny element tnący jest sprężyście odkrzywiony w kierunku położenia wycofanego. 8. Urządzenie według zastrz. 7, przy czym wtórny element tnący jest wykorzystywany, aby rotować pomiędzy położeniem wycofanym i położeniem rozciągniętym. 9. Urządzenie według zastrz. 7, przy czym wtórny element tnący jest wykorzystywany do translacji pod kątem ukośnym względem wkładu w celu przejścia między położeniem wycofanym i położeniem rozciągniętym. 10. Urządzenie według zastrz. 9, przy czym wtórny element tnący obejmuje sanie translacyjne, przy czym urządzenie uruchamiające członu napędzającego zszywek zawiera ponadto szczelinę translacyjną, przy czym sanie translacyjne i szczelina translacyjna są przystosowane do współpracowania do przechodzenia wtórnego elementu tnącego między położeniem wycofanym i położeniem rozciągniętym. 11. Urządzenie według zastrz. 10, przy czym urządzenie uruchamiające członu napędzającego zszywek zawiera ponadto sprężysty człon (686), przy czym wtórny element tnący zawiera ponadto człon rozciągający się dalej, przy czym człon rozciągający się dalej jest przystosowany do sprzęgania się ze sprężystym członem urządzenia uruchamiającego członu napędzającego zszywek w celu sprężystego odkrzywienia wtórnego elementu tnącego w kierunku położenia wycofanego. 12. Urządzenie według zastrz. 1, w którym wtórny element tnący jest zamocowany względem urządzenia uruchamiającego członu napędzającego zszywek. 13. Urządzenie według zastrz. 12, w którym wkład obejmuje osłonę (469) wystającą ze wkładu, przy czym osłona jest ustawiona bliżej na wkładzie, przy czym wtórny element tnący może wybiorczo wchodzić i wychodzić z osłony. 14. Urządzenie według zastrz. 12, w którym dodatkowy element tnący zawiera dalszy występ i dalej zwróconą krawędź tnącą, przy czym dalszy występ jest usytuowany powyżej krawędzi tnącej. 15. Urządzenie według dowolnego poprzedniego zastrzeżenia, zawierające ponadto podporę, w której co najmniej część podpory jest zwrócona przylegająco do wkładu, przy czym wtórny element tnący jest przystosowany do przecinania co najmniej części podpory. 16. Urządzenie według zastrz. 1, w którym: wkład jest wymiennym wkładem i zawiera: (i) obudowę, (ii) wskazane liczne zszywki umieszczone w obudowie, (iii) pokład umieszczony nad wieloma zszywkami, pokład wyznaczający otwory, przy czym każdy otwór jest zasadniczo umieszczony nad odpowiednią zszywką, oraz (iv) podporę (280) co najmniej częściowo umieszczoną na pokładzie;i dodatkowy element tnący ma ostrą krawędź przystosowaną do oddzielania co najmniej części podpory. 17. Urządzenie według zastrz. 1, przy czym wskazany wkład jest jednym z wielu wkładów zszywek, przy czym każdy wkład zszywek z wielu wkładów zszywek jest przystosowany jako wymiennie wprowadzalny do chwytaka, w którym każdy wkład zszywek z wielu wkładów zszywek jest przystosowany do innej procedury chirurgicznej. Ethicon Endo-Surgery, Inc., Stany Zjednoczone Ameryki Pełnomocnik: EP 2 997 906 B1 Z-16694/17 Fig.1 EP 2 997 906 B1 Z-16694/17 EP 2 997 906 B1 Z-16694/17 3/27 Fig.3 EP 2 997 906 B1 Z-16694/17 4/27 Fig.4 EP 2 997 906 B1 Z-16694/17 5/27 O Fig.5 EP 2 997 906 B1 Z-16694/17 6/27 Fig.6 EP 2 997 906 B1 Z-16694/17 EP 2 997 906 B1 Z-16694/17 8/27 O - m rσ Li_ EP 2 997 906 B1 Z-16694/17 9/27 CM CD Fig.8 EP 2 997 906 B1 Z-16694/17 100 £ g ύ o ’Ξ o W 10/27 Fig.9 EP 2 997 906 B1 Z-16694/17 /27 102 Fig.10 EP 2 997 906 B1 Z-16694/17 Fiq. 1 1 EP 2 997 906 B1 Z-16694/17 Fig.12 EP 2 997 906 B1 Z-16694/17 14/27 284 ro O OJ Fig.13 EP 2 997 906 B1 Z-16694/17 15/27 Fig.14 EP 2 997 906 B1 Z-16694/17 16/27 280 CM CD Fig. 1 5 EP 2 997 906 B1 Z-16694/17 17/27 Fig. 1 6 EP 2 997 906 B1 Z-16694/17 15/27 380 oo Fig.17 EP 2 997 906 B1 Z-16694/17 19/27 470 Fig.18 EP 2 997 906 B1 Z-16694/17 20/27 Fig.19 EP 2 997 906 B1 Z-16694/17 21/27 480 Fig.20 EP 2 997 906 B1 Z-16694/17 22/27 Fig.21 EP 2 997 906 B1 Z-16694/17 25/27 K) CM CM CM σ EP 2 997 906 B1 Z-16694/17 24-/27 Fig.23 EP 2 997 906 B1 Z-16694/17 25/27 Fig.24 EP 2 997 906 B1 Z-16694/17 26/27 Fig.25 EP 2 997 906 B1 Z-16694/17 27/27 Fig.26
172 paragraphs in 1 section, as filed
[0001] In some cases, endoscopic surgical instruments may be preferred over traditional open surgery instruments because a smaller incision can reduce postoperative recovery time and complications. Consequently, some endoscopic surgical instruments may be suitable for placing the distal gripper at the desired surgical site through the trocar cannula. These further grippers can couple the tissue in many ways to get a diagnostic or therapeutic effect (e.g. endo-knife, catcher, knife, stapler, clamp applicator, access device, drug delivery / gene therapy device, and energy delivery device using ultrasound, RF, laser, etc.). Endoscopic surgical instruments can include a roller between the gripper and the part of the handle that is operated by a practitioner. Such a roller may allow insertion to the desired depth and rotation about the longitudinal axis of the roller, thus facilitating the positioning of the gripper within the patient. Positioning of the gripper can be further facilitated by the inclusion of one or more articulated joints or elements, enabling selective articulation of the gripper or other deflection relative to the longitudinal axis of the shaft.
[0002] EP 2,764,836 describes an endoscopic surgical stapler with a handle, a shaft extending further from the handle, and a suturing gripper at the distal end of the shaft. The gripper includes a staple cartridge located in the cartridge channel, a rotary anvil and a knife that translates through the gripper when it is fired. The stapler drive member in the cartridge moves further to drive the staples into the tissue. The stapler launching member also travels further and is used to arrange the distal cutting blade. A further cutting blade can be placed after the firing stroke of the device or earlier. The stapler driving member and the firing member move independently of each other. The distal cutting blade does not move proximal, which is the direction in which both the actuator of the staple driving member and the firing member move; moves in a transverse direction to the proximal-distal direction when the firing member actuates the respective cam. The arrangement of the cutting blade releases the support material from the insert. Examples of endoscopic surgical instruments include surgical staplers. Some such staplers are capable of clamping tissue layers, cutting the clamped tissue layers and pushing the staples through the tissue layers to substantially seal the severed tissue layers together near the severed ends of the tissue layers. Common exemplary surgical staplers are disclosed in US Patent No. 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers," issued February 21, 1989;
U.S. Patent No. 5,415,334, entitled "Surgical Stapler and Staple Cartridge," issued May 16, 1995;
U.S. Patent No. 5,465,895, entitled "Surgical Stapler Instrument," issued November 14, 1995;
U.S. Patent No. 5,597,107, entitled "Surgical Stapler Instrument," issued January 28, 1997;
U.S. Patent No. 5,632,432, entitled "Surgical Instrument," issued May 27, 1997;
US Pat.No. 5,673,840, entitled "Surgical Instrument," issued October 7, 1997; U.S. Patent No. 5,704,534, entitled "Articulation Assembly for Surgical Instruments," issued January 6, 1998;
U.S. Patent No. 5,814,055, entitled "Surgical Clamping Mechanism," issued September 29, 1998;
U.S. Patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism," issued December 27, 2005;
U.S. Patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems," issued February 21, 2006;
U.S. Patent No. 7,143,923, entitled "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil," issued December 5, 2006;
US Patent No. 7,303,108, entitled "Surgical Stapling Instrument Incorporating a MultiStroke Firing Mechanism with a Flexible Rack," issued December 4, 2007;
US Patent No. 7,367,485, entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission," issued May 6, 2008;
U.S. Patent No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing," issued June 3, 2008;
U.S. Patent No. 7,380,696, entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece EBeam Firing Mechanism," issued June 3, 2008;
US Patent No. 7,404,508, entitled "Surgical Stapling and Cutting Device," issued July 29, 2008;
U.S. Patent No. 7,434,715, entitled "Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout," issued October 14, 2008;
U.S. Patent No. 7,721,930, entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device," issued May 25, 2010;
U.S. Patent No. 8,408,439, entitled "Surgical Stapling Instrument with An Articulatable
End Effector, ”published on April 2, 2013; and
U.S. Patent No. 8,453,914, entitled "Motor-Driven Surgical Cutting Instrument with
Electric Actuator Directional Control Assembly, 'issued on June 4, 2013.
[0003] Although the surgical staplers referred to above are described as being used in endoscopic procedures, it should be understood that such surgical staplers can also be used in open procedures and / or other non-endoscopic procedures. For example only, a surgical stapler can be inserted through a thoracotomy, and thus between the patient's ribs, to reach one or more organs in a surgical chest procedure that does not use trocar as a stapler channel. Such procedures may include using a stapler to separate and close the vessel leading to the lung. For example, the vessels leading to the organ can be separated and closed by a stapler before the organ is removed from the chest. Of course, surgical staplers can be used in various other settings and procedures.
[0004] Examples of surgical staplers that may be particularly suitable or used by thoracotomy are disclosed in US Patent Publication No. 2014/0243801, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks," published August 28, 2014;
US Patent Publication No. 2014/0239041, entitled "Lockout Feature for Movable Cutting Member of Surgical Instrument," published August 28, 2014;
US Patent Publication No. 2014/0239042, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," published August 28, 2014;
Publication of US Patent No. 2014/0239036, entitled "Jaw Closure Feature for End Effector of Surgical Instrument," published August 28, 2014;
US Patent Publication No. 2014/0239040, entitled "Surgical Instrument with Articulation Lock having a Detenting Binary Spring," published August 28, 2014;
US Patent Publication No. 2014/0239043, entitled "Distal Tip Features for End Effector of Surgical Instrument," published August 28, 2014;
US Patent Publication No. 2014/0239037, entitled "Staple Forming Features for Surgical Stapling Instrument," published August 28, 2014;
US Patent Publication No. 2014/0239038, entitled "Surgical Instrument with MultiDiameter Shaft," published August 28, 2014; and US Patent Publication No. 2014/0239044, entitled "Installation Features for Surgical Instrument End Effector Cartridge," published August 28, 2014.
[0005] Although various types of surgical stapling tools and related components have been made and used, it is believed that no one before the inventor (s) has invented or used the invention described in the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS The attached drawing, which is incorporated and forms part of this description, illustrates embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
FIG. 1 is a perspective view of an exemplary pivoting surgical stapling tool;
FIG. 2 shows a side elevational view of the tool of FIG. 1;
FIG. 3 is a perspective view of the tool gripper of FIG. 1, with the gripper in a closed configuration;
FIG. 4 is a perspective view of the gripper of FIG. 3, with the gripper in open configuration;
FIG. 5 is an exploded perspective view of the gripper assembly of FIG. 3;
FIG. 6 shows a cross-sectional side view of the gripper of FIG. 3, along line 6-6 of FIG. 4; FIG. 7A is a cross-sectional view of the side view of the gripper of FIG. 3, along line 77 of FIG. 4, with the firing beam proximal;
FIG. 7B is a cross-sectional view of the side view of the gripper of FIG. 3, along line 77 of FIG. 4, with the firing beam in distal position;
FIG. 8 is a perspective view of the gripper of FIG. 3, located in the tissue and once activated in the tissue;
FIG. 9 is a schematic view of an exemplary control circuit for use in the tool of FIG. 1;
FIG. 10 is a perspective view of the tool handle assembly of FIG. 1, with half housing and some internal parts removed;
FIG. 11 is a perspective view of drive assembly components from the handle assembly of FIG. 10;
FIG. 12 is a perspective view of an elongate member of the drive assembly of FIG. 11, in combination with a firing beam;
FIG. 13 is a partial perspective view of the exemplary gripper staple cartridge of FIG. 3, with an exemplary support positioned above and on the outer top surface of the staple cartridge;
FIG. 14 is an elevational view of the gripper of FIG. 3 and the support of FIG. 13 arranged on and between the bottom of the anvil and the outer top surface of the staple cartridge;
FIG. 15 is a perspective view of the gripper with the support of FIG. 13, the gripper having fired and released staples and supports of FIG. 13 to and on tissue;
FIG. 16 is a partial perspective view of the exemplary version of the gripper of FIG. 3, with a gripper portion cut out to reveal wedge sleds equipped with a secondary rotary cutting blade according to the invention;
FIG. 17 is a side elevational view of the wedge slide of FIG. 16 with a secondary cutting blade in an extended position according to the invention;
FIG. 18 is a partial perspective view of another exemplary version of the gripper z
FIG. 3, with the gripper portion cut out to reveal wedge sleds provided with a fixed secondary cutting blade;
FIG. 19 is a lateral cross-sectional view of the wedge slide of FIG. 18, along line 19-19 of FIG. 18, with the sledge in the proximal position;
FIG. 20 is a lateral cross-sectional view of the wedge slide of FIG. 18, along line 19-19 of FIG. 18, with the wedge-shaped sledge in the distal position;
FIG. 21 is a cross-sectional view of the exemplary variation of the wedge slide of FIG. 18; FIG. 22 is a perspective view of other example wedge sleds for use with the gripper of FIG. 3, wherein the wedge sled has up-translated secondary cutting blades;
FIG. 23 is a lateral cross-sectional view of the wedge slide of FIG. 22, along lines 23-23 of FIG. 22, with the secondary cutting blade in retracted position;
FIG. 24 is a lateral cross-sectional view of the wedge sled in FIG. 22, along lines 23-23 of FIG. 22, with the secondary cutting blade in an extended position;
FIG. 25 is a perspective view of other example wedge sleds for use with the gripper of FIG. 3, a wedge sled having a fixed secondary cutting blade with a stabilizing nose; and
FIG. 26 is a lateral cross-sectional view of the wedge slide of FIG. Along lines 26-26 in FIG. 25, with the secondary cutting blade extended further.
[0007] The drawing is not intended to limit in any way, and it is contemplated that various embodiments of the invention may be implemented in a variety of ways, including not necessarily those shown in the drawing. The attached drawing incorporated into and forming part of the description illustrates several aspects of the present invention and together with the description serves to explain the principles of the invention; however, it should be understood that the invention is not limited to the exact arrangements shown.
DETAILED DESCRIPTION [0008] The invention is defined in the attached set of claims, and in particular in Fig. 16 and 17. The following description of some examples of the invention should not be used to limit the scope of the present invention. Other examples, elements, aspects, embodiments and advantages of the invention will become apparent to those skilled in the art from the following description, which is by way of example, one of the best ways contemplated for carrying out the invention. As will be understood, the invention may have other various and obvious aspects, all without departing from the invention. Therefore, the Drawing and description should be treated as illustrative, not limiting.
AND. Exemplary Surgical Stapler [0009] FIG. 1 shows an example of a surgical stapling and separation tool (10) that includes a handle assembly (20), a roller assembly (30) and a gripper (40). The gripper (40) and the distal portion of the shaft assembly (30) are dimensioned for insertion, in an non-tilted state, as shown in FIG. 1, through the trocar cannula to the patient's surgical site to perform a surgical procedure. By way of example, such a trocar may be inserted into the patient's abdominal cavity, between the patient's two ribs or elsewhere. In some settings the instrument (10) is used without the trocar. For example, the gripper (40) and the distal portion of the roller assembly (30) may be inserted directly through a thoracotomy or other type of incision. It should be understood that terms such as "proximal" and "distal" are used herein to refer to a practitioner practitioner grabbing the instrument handle (20) (10). Thus, the gripper (40) is distal to the more proximal handle assembly (20). It should also be appreciated that for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used herein to refer to a drawing. However, surgical instruments are used in many turns and positions, and these terms are not intended to be limiting and absolute.
AND. Exemplary handle assembly and roller assembly [0010] As shown in FIG. 1-2, the handle assembly (20) of this example includes a pistol grip (22), trigger (24) closing and trigger (26) firing. Each trigger (24, 26) is selectively pivotable towards and away from the pistol grip (22) as this will be described in more detail below. The handle assembly (20) further includes an anvil release button (25), a beam reversal switch (27) and a removable battery pack (28). These components will also be described in more detail below. Of course, the handle assembly (20) may have many other components, elements and functions, in addition to or in place of any of the above. Other suitable configurations of the handle assembly (20) will be apparent to those skilled in the art in light of the present teachings.
[0011] As shown in FIG. 1-3, the roller assembly (30) of this example includes an outer closure tube (32), an articulated section (34) and a ring (36 closure ) which is further connected to the gripper (40). The closing pipe (32) extends along the length of the shaft assembly (30). The closure ring (36) is located farther to the articulated section (34). The closure pipe (32) and the closure ring (36) are adapted for translation longitudinally relative to the handle assembly (20). The longitudinal translation of the closure pipe (32) is communicated to the closure ring (36) via the articulated section (34). Exemplary elements that can be used to provide longitudinal displacement of the closure pipe (32) and closure ring (36) will be described in more detail below.
[0012] The articulated section (34) is capable of laterally pivoting the closure ring (36) and gripper (40) laterally away from the longitudinal axis (LA) of the shaft assembly (30) at the desired angle (α). The gripper (40) can thus reach behind the organ or approach, at the desired angle, or for other reasons to the tissue. In some versions, the articulated section (34) allows the gripper (40) to be deflected along a single plane. In some other variations, the articulated section (34) allows the gripper to be deflected along more than one plane. In this example, the articulation is controlled by means of the articulation control knob (35) which is located at the proximal end of the shaft assembly (30). The knob (35) can be rotated around an axis that is perpendicular to the longitudinal axis (LA) of the shaft assembly (30). The closure ring (36) and gripper (40) rotate about an axis that is perpendicular to the longitudinal axis (LA) of the shaft assembly (30) in response to the rotation of the knob (35). For example only, turning the knob (35) clockwise can result in a clockwise rotation of the closure ring (36) and gripper (40) in the articulated section (34). The articulated section (34) is adapted to communicate the longitudinal translation of the closure tube (32) to the closure ring (36), regardless of whether the articulated section (34) is in a straight or articulated configuration.
[0013] In some versions, the articulated section (34) and / or knobs (35) for controlling the joint are constructed and operate in accordance with at least some of the teachings of Patent Application No. 13 / 780,067, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks, "filed February 28, 2013. The articulated section (34) can be constructed and operate in accordance with at least some of the teachings of the US Patent Application No. 14 / 314,125, entitled "Articulation Drive Features for Surgical Stapler," filed June 25, 2014 and / or according to various teachings below. Other suitable forms that the articulated section (34) and the articulated knob (35) can take will be apparent to those skilled in the art in the light of these teachings.
[0014] As shown in FIG. 1-2, the roller assembly (30) of this example further includes a rotary knob (31). The rotary knob (31) is used to rotate the entire shaft assembly (30) and gripper (40) relative to the handle assembly (20) about the longitudinal axis (LA) of the shaft assembly (30). In some versions, the rotary knob (31) can selectively lock the angular position of the shaft assembly (30) and gripper (40) relative to the handle assembly (20) about the longitudinal axis (LA) of the shaft assembly (30). For example, the rotary knob (31) may be translatable between a first longitudinal position in which the roller assembly (30) and the gripper (40) are rotatable relative to the handle assembly (20) about the longitudinal axis (LA) of the roller assembly (30); and a second longitudinal position in which the roller assembly (30) and the gripper (40) are not rotatable relative to the handle assembly (20) about the longitudinal axis (LA) of the roller assembly (30). Of course, the shaft assembly (30) may have many other components, elements and functions, in addition to or instead of any of those indicated above. By way of example only, at least part of the shaft assembly (30) is constructed in accordance with at least some of the teachings of US Patent Application 13 / 780,402, entitled "Surgical Instrument with Multi-Diameter Shaft," filed February 28, 2013. Other suitable configurations for the roller assembly (30) will be apparent to those skilled in the art in light of the present teachings.
B. Exemplary Gripper [0015] As also shown in FIG. 1-3, the gripper (40) of this example includes a lower jaw (50) and a rotatable anvil (60). The anvil (60) comprises a pair of integral, outward-extending pins (66) which are located in the corresponding curved slots (54) of the lower jaw (50). Pins (66) and slots (54) are shown on
FIG. 5. The anvil (60) is rotatable towards and away from the lower jaw (50) between the open position (shown in Fig. 2 and 4) and the closed position (shown in Fig. 1, 3 and 7A-7B). The use of the term "rotational" (and similar terms as "rotation" as a basis) should not be read as requiring a necessary rotational movement about a fixed axis. For example, in this example, the anvil (60) rotates around an axis that is defined by pins (66) that slide along the curved slots (54) of the lower jaw (50) when the anvil (60) moves toward the lower jaw ( 50). In such versions, the axis of rotation translates along the path defined by the slots (54), while the anvil (60) simultaneously rotates around this axis. Additionally or alternatively, the axis of rotation may slide along the slots (54) first, with the anvil (60) then rotating about the axis of rotation after the axis of rotation has moved a certain distance along the slots (54). It should be understood that such shifting / translational rotational motion is encompassed by concepts such as "rotation", "rotation", "rotation", "rotationally", "rotation" and the like. Of course, some versions can provide rotational motion of the anvil (60) about an axis that remains fixed and does not translate in the slot or channel, etc.
[0016] As best seen in FIG. 5, the lower jaw (50) of this example defines a channel (52) that is adapted to receive a staple cartridge (70). The staple cartridge (70) can be inserted into the channel (52), the gripper (40) can be actuated, and then the staple cartridge (70) can be removed and replaced with another staple cartridge (70). The lower jaw (50) thus detachably holds the staple cartridge (70) in alignment with the anvil (60) to actuate the gripper (40). In some embodiments, the lower jaw (50) is constructed according to at least some of the teachings of the US Patent Application No. 13 / 780,417, entitled "Installation Features for Surgical Instrument End Effector Cartridge," filed February 28, 2013. Other suitable forms that the lower jaw (50) may take will be apparent to those skilled in the art in light of the present teachings.
[0017] As best seen in FIG. 4-6, the staple cartridge (70) of the present example includes a cartridge body (71) and a tray (76) attached to the underside of the cartridge body (71). The upper side of the body (71) of the cartridge shows a deck (73) against which tissue can be squeezed when the anvil (60) is in the closed position. The cartridge body (71) further defines a longitudinally extending channel (72) and a plurality of staple pockets (74). A staple (77) is placed in each staple pocket (74). The staple driver (75) is also located in each staple pocket (74), below the respective staple (77) and above the tray (76). As will be described in more detail below, the staple driving members (75) may operate to perform up-translation in the staple pockets (74) to thereby drive the staples (77) up through the staple pockets (74) and engage with the anvil ( 60). The staple driving members (75) are driven upwards by a wedge slide (78) which is captured between the cartridge body (71) and the tray (76) and which is translated longitudinally by the cartridge body (71). The wedge slide (78) includes a pair of diagonally inclined surfaces (79) of cams that are adapted to engage with the staple driving members (75) and thereby drive the staple driving members (75) up as the wedge slide (78) moves lengthwise through the insert (70). For example, when the wedge slide (78) is in a proximal position as shown in FIG. 7A, the staple driving members (75) are in the downward position, and the staples (77) are in the staple pockets (74). When the wedge slide (78) is driven to the distal position shown in FIG. 7B through the translating knife member (80), the wedge sled (78) drives the staple driving members (75) up, thereby driving the staples (77) from the staple pocket (74) and into the staple forming pocket (64). In this way, the staple driving members (75) translate along the vertical dimension when the wedge slide (78) translates along the horizontal dimension.
[0018] It should be understood that the configuration of the staple cartridge (70) can be changed in many ways. For example, the staple cartridge (70) in this example includes two longitudinally extending rows (74) of staples on one side of the channel (72); and another set of two longitudinally extending rows (74) of staples on the other side of the channel (72). However, in some other versions, the staple cartridge (70) includes three, one or another number of staple pockets (74) on each side of the channel (72). In some versions, the staple cartridge (70) is constructed and may operate in accordance with at least some of the teachings of the US Patent Application No. 13 / 780,106, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," filed February 28, 2013. Additionally or alternatively, the staple cartridge (70) may be constructed and operated in accordance with at least some of the teachings of the US Patent Application No. 13 / 780,417, entitled "Installation Features for Surgical Instrument End Effector Cartridge," filed February 28, 2013. Other suitable forms that the staple cartridge (70) may take will be apparent to those skilled in the art in light of the teachings disclosed herein.
[0019] As best seen in FIG. 4, the anvil (60) of the present example includes a longitudinally extending channel (62) and a plurality of staple forming pockets (64). The channel (62) is adapted to align with the channel (72) of the staple cartridge (70) when the anvil (60) is in the closed position. Each staple forming pocket (64) is positioned to lie above a respective staple pocket (74) of the staple cartridge (70) when the anvil (60) is in the closed position. The staple forming pockets (64) are adapted to deform the staple legs (77) when the staples (77) are driven by the tissue and into the anvil (60). In particular, the staple forming pockets (64) are adapted to fold the staple legs (77) to secure the formed staples (77) into the tissue. Anvil (60) may be constructed in accordance with at least some of the teachings of the US Patent Application No. 13 / 780,106, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," filed February 28, 2013; at least some of the teachings of US Patent Application No. 13 / 780,120, entitled "Jaw Closure Feature for End Effector of Surgical Instrument," filed February 28, 2013; and / or at least some of the teachings of the US Pateng Application No. 13 / 780,379, entitled "Staple Forming Features for Surgical
Stapling Instrument, "filed February 28, 2013. Other suitable forms that the anvil (60) may take will be apparent to those skilled in the art in light of the present disclosures. [0020] In the present example, the knife member (80) is adapted for translation by the gripper (40). As best seen in FIG. 5 and 7A-7B, the knife member (80) is attached to the distal end of the firing beam (82) that extends through a portion of the roller assembly (30). As best seen in FIG. 4 and the knife member (80) is disposed in the channels (62, 72) of the anvil (60) and staple cartridge (70). The knife member (80) further includes the cutting edge (84) shown, which is adapted to separate the tissue that is compressed between the anvil (60) and the tray (73) of the staple cartridge (70) when the knife member (80) translates in the direction further through the gripper (40). As noted above and as shown in FIG. 7A-7B, the knife member (80) also drives the wedge slide (78) further when the knife member (80) translates further through the gripper (40), thereby directing the staples (77) through the tissue and the anvil (60) for forming. The various elements that can be used to drive the knife member (80) further through the gripper (40) will be described in more detail below.
[0021] In some versions, the gripper (40) includes access lock elements that are adapted to prevent the knife member (80) from advancing through the gripper (40) when the staple cartridge (70) is not inserted into the lower jaw (50). Additionally or alternatively, the gripper (40) may include access lock elements that are adapted to prevent the knife member (80) from sliding through the gripper (40) when the staple cartridge (70) has already been actuated (e.g. all staples (77) arranged therefrom) are inserted into the lower jaw (50). By way of example only, such access blocking elements may be adapted in accordance with at least some of the teachings of the US patent application No. 13 / 780,082, entitled "Lockout Feature for Movable Cutting Member of Surgical Instrument," filed February 28, 2013. and / or at least some of the teachings of the US Patent Application 14 / 314,108, entitled "Method of Using Lockout Features for Surgical Stapler Cartridge," filed June 25, 2014. Other suitable forms that may have access blocking elements will be apparent to those skilled in the art in light of the teachings disclosed herein. Alternatively, the gripper (40) may simply bypass such access lock elements.
C. Example of anvil actuation [0022] In the present example, the anvil (60) is driven towards the lower jaw (50) by means of a sliding ring (36) closing further relative to the gripper (40).
The closure ring (36) cooperates with the anvil (60) by cam action to drive the anvil (60) towards the lower jaw (50) in response to further translation of the closure ring (36) relative to the gripper (40). Similarly, the closure ring (36) may cooperate with the anvil (60) to open the anvil (60) from the lower jaw (50) in response to closer translation of the closure ring (36) relative to the gripper (40). By way of example only, the closure ring (36) and anvil (60) may interact in accordance with at least some of the teachings of the US Patent Application No. 13 / 780,120, entitled "Jaw
Closure Feature for End Effector of Surgical Instrument, "filed February 28, 2013 and / or in accordance with at least some of the teachings of US Patent Application No. 14 / 314,108, entitled" Jaw Opening Feature for Surgical Stapler, "filed June 25, 2014. Exemplary elements that can be used to provide longitudinal translation of the closure ring (36) relative to the gripper (40) will be described in more detail below.
As indicated above, the handle assembly (20) includes a pistol grip (22) and a closing trigger (24). As also noted above, the anvil (60) is closed towards the lower jaw (50) in response to further displacement of the closing ring (36). In this example, the closing trigger (24) is pivoted towards the pistol grip (22) to drive the closure tube (32) and the closure ring (36) further. Various suitable components that can be used to convert the rotary closing movement (24) of the closure towards the pistol grip (22) for further translation of the closure tube (32) and closure ring (36) relative to the handle assembly (20) will be apparent to those skilled in the art. in the light of these teachings. When the closing trigger (24) reaches the fully articulated state so that the anvil (60) is in the completely closed position relative to the lower jaw (50), the locking elements of the handle assembly (20) block the position of the trigger (24) and the closing pipe (32), thereby locking the anvil (60) in a completely closed position relative to the lower jaw (50). These locking elements are released by actuating the anvil release button (25). The anvil release button (25) is adapted and positioned so that it is actuated with the thumb of the hand of the operator who has gripped the pistol grip (22). In other words, the operator can grip the pistol grip (22) with one hand, trigger the closing trigger (41) with one or more fingers of the same hand, and then actuate the anvil release button (25) with the same-hand thumb without releasing the pistol grip (22) ) with the same hand. Other suitable components that can be used to actuate the anvil (60) will be apparent to those skilled in the art in light of the present teachings.
D. Exemplary launching of the firing beam [0024] In this example, the tool (10) provides motorized control of the firing beam (82). FIG. 9-12 show examples of components that can be used to provide motorized beam control (82). In particular, FIG. 9 shows an example of a control circuit (100) that can be used to power an electric motor (102) by means of electricity from a battery (28) (also shown in Fig. 1-2). The electric motor (102) operates to translate the beam (82) to fire longitudinally, as will be described in more detail below. It should be understood that the entire control circuit (100) including the motor (102) and battery (28) can be located in the handle assembly (20). FIG. 9 shows the firing trigger (26) as an open switch, although it should be understood that this switch is closed when the firing trigger (26) is actuated. The circuit (100) of this example also includes a safety switch (106) that must be closed to close the circuit (100), although it should be understood that the safety switch (106) is only optional. The safety switch (106) can be closed by operating a separate button, slider or other element on the handle assembly (20). The safety switch (106) can also provide mechanical locking of the firing trigger (26) so that the firing trigger (26) is mechanically locked before actuation until the safety switch (106) is actuated.
[0025] The circuit (100) of this example also includes an access lock switch (108) that is configured as closed by default but is automatically opened in response to the access lock status. By way of example only, the access lock condition may include one or more of the following: no cartridge (70) in the lower jaw (50), worn out (e.g. previously fired) cartridge (70) in the lower jaw (50), anvil (60) not sufficiently closed, determination that the tool (10) has been fired too many times and / or any other appropriate condition. Various sensors, algorithms and other elements that can be used to detect access blocking conditions will be apparent to those skilled in the art in the light of these teachings. Similarly, other appropriate types of access blocking conditions will be apparent to those skilled in the art in light of the present teachings. It should be understood that the circuit (100) is open and therefore the motor (102) cannot operate when the access lock switch (108) is open. Access lock indicator (110) (e.g. LED etc.) Works to provide a visual indication of the status of the access lock switch (108). For example only, the access lock switch (108), the access lock indicator (110) and related components / functions may be adapted in accordance with at least some of the indications of the US Patent No. 7,644,848, entitled "Electronic Lockouts and Surgical Instrument Including Same," issued January 12, 2010.
[0026] When the firing beam (82) reaches the furthest position (e.g. at the end of the cutting stroke), the end of stroke switch (112) is automatically switched to the closed position, reversing the polarity of the voltage applied to the motor (102). This reverses the direction of rotation of the engine (102), and it is understood that at this stage of operation the operator released the firing trigger (26). In this operating state, the current flows through the reverse direction indicator (114) (e.g. LED etc.) to provide the operator with a visual indication that the engine speed (102) has been reversed. In this example, as best seen in FIG. 12, the actuating arm of the switch (134) extends laterally from the rack member (130), and is arranged to engage the end-of-stroke switch (112) when the firing beam (82) reaches its most distant position (e.g. after the tissue (90) was separated and the staples (77) were driven into the tissue (90)). Various other suitable methods in which the end of stroke switch (112) can be automatically switched to the closed position when the firing beam (82) reaches its most distant position from each other will be apparent to those skilled in the art in teaching here. Similarly, various suitable forms that may take an inverse direction indicator (114) will be apparent to those skilled in the art in the light of these teachings.
[0027] The handle assembly (20) in this example also includes a manual return switch (116) which is also shown in the circumference (100). In the present example, the return switch is activated by actuating the reverse switch (27), which is shown on the handle assembly (20) in FIG. 1. The manual return switch (116) can provide functionality similar to the end-of-stroke switch (112), reversing the polarity of voltage applied to the motor (102), thus inverting the direction of rotation of the motor (102). Again, this inversion can be visually indicated by the reverse direction indicator (114). In some versions, the handle assembly (20) further includes a mechanical return element that allows the operator to manually return the firing beam (82) and thereby mechanically retracts the firing beam (82). In this example, this manual return element includes a lever that is covered by a removable panel (21) as shown in FIG. 1. The manual return switch (116) and the mechanical return element are adapted to act as a "bailout" element, enabling the operator to quickly start retracting the beam (82) from firing closer during the firing stroke. In other words, the manual return switch (116) or mechanical return element may be actuated when the firing beam (82) has only been partially moved further distant.
[0028] In some versions, one or more switches (26, 106, 108, 112, 116) are in the form of microswitches. Other suitable forms will be apparent to those skilled in the art in light of the present disclosures. In addition to or in place of the above, at least part of the circuit (100) may be adapted in accordance with at least some of the teachings of US Patent No. 8,210,411, entitled "Motor-Driven Surgical Instrument", issued on July 3, 2012.
[0029] FIG. 10 shows the engine (102) located in the pistol grip (22) of the handle assembly (20). Alternatively, the motor (102) may be located elsewhere inside the handle assembly (20). The motor (102) has a drive shaft (120) which is connected to the gear assembly (122). Thus, after starting the engine (102), the drive shaft (120) actuates the gear assembly (122). As shown in FIG. 11, the gear assembly (122) communicates with the drive gear (124) which meshes with the idler (126). The pinion (126) is located on a shaft (128) which is supported in the handle assembly (20) and which faces parallel to the drive shaft (120) of the motor (102). The pinion (126) is further coupled to the rack member (130). In particular, the pinions (126) mesh with the teeth (132) at the proximal end of the rack member (130). The rack member (130) is slidably supported in the handle assembly (20). It should be noted from the above that when the motor (102) is started, the corresponding rotation of the drive shaft (120) is communicated to the pinion (126) via the gear assembly (122), and the corresponding rotation of the pinion (126) is transformed into the translation of the member (130) ) gears with the teeth (132). As shown in FIG. 10-12, the elongate member (136) extends further from the rack member (130). As shown in FIG. 12, the engaging member (138) connects the firing beam (82) to the longitudinal member (136). The rack member (130), longitudinal member (136), engaging member (138), firing beam (82) and knife member (80) translate together relative to the handle assembly (20) in response to engine start (102). In other words, activation of the motor (102) eventually translates the firing beam (82) in the longitudinal direction, the direction of such translation depending on the direction of rotation of the drive shaft (120).
[0030] It should be understood that the distal portion of the longitudinal member (136), the coupling member (138) and the firing beam (82) extends through the roller assembly (30). Part of the firing beam (82) also extends through the articulated section (34). In some versions, the rack member (130), longitudinal member (136) and engaging member (138) are substantially straight and rigid; while the firing beam (82) has sufficient flexibility to bend in the articulated section (34) and translate longitudinally through the articulated section (34) when the articulated section (34) is in a bent or articulated state.
[0031] In addition to or in place of the above, elements suitable for driving the firing beam (82) may be adapted in accordance with at least some of the teachings of US Patent No. 8,453,914.
[0032] Other suitable components, elements and configurations to provide motorization of the firing beam (82) will be apparent to those skilled in the art in light of the present teachings. It should also be understood that some other versions may provide for manual control of the firing beam (82) in such a way that the engine can be omitted. By way of example only, the firing beam (82) may be activated in accordance with at least some of the indications of any of the references cited herein.
[0033] FIG. 8 shows the gripper (40) that has been actuated by a single stroke through the tissue (90). As shown, the cutting edge (84) (covered in Fig. 8) she cut the tissue (90), while the staple driver (75) drove two staggered rows of staples (77) through the tissue (90) on each side of the cutting line banished by the cutting edge (84). The staples (77) are oriented essentially parallel to the cutting line in this example, although it should be understood that the staples (77) may be arranged in any appropriate returns. In this example, the gripper (40) is retracted from the trocar after the first stroke, the used staple cartridge (70) is replaced with a new staple cartridge (70), and the gripper (40) is then reintroduced through the trocar to reach the stapling location in for further cutting and stapling. This process can be repeated until the desired number of cuts and staples has been delivered (77). The anvil (60) may need to be closed to facilitate insertion and removal through the trocar; and the anvil (60) may need to be opened to facilitate the replacement of the staple cartridge (70).
[0034] It should be understood that the cutting edge (84) can separate the tissue substantially simultaneously with the staples (77) that are driven by the tissue during each actuation stroke. In this example, the cutting edge (84) is slightly behind the staple driver (77) so that the staple (47) is pierced by the tissue just before the cutting edge (84) passes through the same tissue area, although understand that this order can be reversed or that the cutting edge (84) can be directly synchronized with adjacent staples (77). While FIG. 8 shows that the gripper (40) is actuated in two layers (92, 94) of tissue (90), it should be understood that the gripper (40) can be actuated by a single layer of tissue (90) or more than two layers (92, 94) tissue. It should also be understood that forming and positioning the staples (77) adjacent to the cutting line formed by the cutting edge (84) can essentially seal tissue at the cutting line, thereby reducing or preventing bleeding and / or leaking of other body fluids on the cutting line. In addition, while FIG. 8 shows that the gripper (40) is actuated on two substantially flat, opposed layers of tissue (92, 94), it should be understood that the gripper (40) can also be actuated on a tubular structure, such as a blood vessel, gastrointestinal tract - enteric etc. FIG. 8 it should therefore not be seen as indicating any restriction on the uses of the gripper considered (40). The various appropriate settings and procedures in which the instrument (10) may be used will be apparent to those skilled in the art in the light of these teachings.
[0035] It should also be understood that any other tool components or elements (10) may be adapted and operated in accordance with any of the references cited herein. Additional sample modifications that may be provided for the tool (10) will be described in more detail below. The various appropriate ways in which the following teaching can be incorporated into the tool (10) will be apparent to those skilled in the art. Similarly, various suitable methods in which the following teachings may be combined with the various teachings of the references cited herein will become apparent to those skilled in the art. It should also be understood that the following teachings are not limited to the tool (10) or devices taught in the cited references. The following teachings can easily be applied to various other tools, including tools that would not be classified as surgical staplers. Various other appropriate tools and settings in which the following teachings may be used will become apparent to those skilled in the art in the light of these teachings.
II. Exemplary Alternative Staple Cartridge [0036] FIG. 13-14 are an example of an alternative staple cartridge (270) that can be inserted into the lower jaw (50) of the gripper (40). Unlike the following, the staple cartridge (270) of this example is substantially similar to the staple cartridge (70) as described above. For example, the cartridge (270), such as the cartridge (70) includes a cartridge body (271) and a tray (not shown) attached to the underside of the cartridge body (271). Similarly, the upper side of the body (271) of the cartridge has a deck (273) against which tissue can be compressed when the anvil (60) is in the closed position.
[0037] In contrast to the cartridge (70), the cartridge (270) is equipped with a support (280) located on the deck (273) of the cartridge body (271). In this example, the support (280) includes a strong but flexible material adapted to structurally support the staple line. Additionally or alternatively, the support (280) may be a material containing, for example, a haemostatic agent, such as fibrin, to help blood clot and reduce bleeding at the site of the separated and / or sutured surgical site along the tissue (90).
[0038] In other examples, the support (280) may be materials other than those discussed above. For example, other secondary or haemostatic agents, such as thrombin, may be used, so that the support (280) may assist in blood clotting and reduce the amount of bleeding at the surgical site. The hemostatic ability of such additives may also contribute to the use of additives such as adhesives and sealants. These agents may aid in blood clotting at the surgical site, allowing it to stick to the tissue surrounding such blood and, for example, prevent leakage along the sutured side of the tissue. Other secondary agents or reagents that may be incorporated into the support (280) may also include, but are not limited to, medical fluids or matrix components. By way of example only, the support (280) may be natural or genetically modified absorbable polymers or synthetic absorvable polymers or mixtures thereof. The only illustrative examples of natural or genetically modified absorbable polymers are proteins, polysaccharides and combinations thereof. Only illustrating examples of proteins, which can be used include prothrombin thrombin, fibrinogen, fibrin fibronectin, heparinase, factor X / Xa, factor VII / VIla, factor IX / IXa, factor XI / XIa, factor XII / XIIa, tissue factor batroksobinę, ancrod, ekarynę, von Willebrand factor, collagen, elastin, albumin, gelatin, platelet surface glycoproteins, vasopressin, vasopressin analogues, epinephrine, selectin, procoagulative venom, plasminogen activator inhibitor, platelet activating factors, synthetic peptides with hemostatic activity, and / or combinations thereof. Polysaccharides include, but are not limited to, cellulose, alkyl cellulose, e.g. methylcellulose, alkilohydroksyalkilocelulozę, hydroxyalkyl, cellulose sulfate, carboxymethyl cellulose salts, carboxymethyl cellulose, carboxymethylcellulose, chitin, carboxymethylchitin, hyaluronic acid, hyaluronic acid salts, alginate, alginic acid propylene glycol alginate, glycogen, dextran, dextran sulfate, curdlan, pectin, pullulan, xanthan, chondroitin, chondroitin sulfate, carboxymethyl, carboxymethylchitosan, chitosan, heparin, heparin sulfate, heparan, heparan sulfate, dermatan sulfate, keratan sulfate, carrageenan, chitosan, starch, amylose, amylopectin, poly N-glucosamine, polymannuronic acid, polyglucuronic acid polyguluronic acid and derivatives of any of the above. Examples of synthetic absorbable polymers are aliphatic polyester polymers, copolymers and / or combinations thereof. Aliphatic polyesters are usually synthesized in ring-opening polymerization of monomers, including but not limited to lactic acid, lactide (including L-, D-, meso and mixtures of D, L), glycolic acid, glycolide, ε-caprolactone, p -dioxanone (1,4-dioxan2-one) and trimethylene carbonate (1,3-dioxan-2-one). Other suitable compounds, materials, substances etc. that can be used in medical fluids or matrix will be apparent to those skilled in the art in light of the present disclosures.
[0039] The support (280) includes a cartridge portion (282), anvil portion (284) and an intermediate portion (286) disposed between the proximal ends of the cartridge portion (282) and the anvil portion (284). The anvil portion (284) includes a flap (288) that wraps over the distal end of the anvil (60) as shown in FIG. 14. The tab (288), for example, defines a pocket (not shown) sized to receive the distal end of the anvil (60) to thereby attach part of the anvil (284) of the support (280) to the anvil (60). The intermediate portion (286) of the support (280) may include a pre-formed fold to facilitate loading of the insert (270) in the lower jaw and insertion of the anvil (60) into the pocket defined by the flap (288).
[0040] The insert (270) further includes fasteners such as hooks (290) that grip on the supports (280). The hooks (290) and the support (280) can provide a fastening compound, such as a hook and loop fastening compound, in which the hooks (290) attach to the loops formed in the support material (280). Although this example is shown to have hooks (290), it should be understood that any other suitable means can be used to attach a portion (282) of the support insert (280) to the deck (273) of the insert (270).
[0041] In use, the pad (270) with the support (280) is removably received into the lower jaw (50) of the gripper (40) as shown in FIG. 13. When a gripper (40) comprising the insert (270) and support (280) is used, as shown in FIG. 15, staples (277) pierce the tissue (90) simultaneously or slightly before the firing beam (82) cuts the tissue (90) while simultaneously cutting the support (280). The staples (277) may grip the support parts (280) and drive these parts to the tissue (90) or at least secure the support (280) to the tissue (90). The firing beam (82) cuts the support (280) while separates the tissue (90) in use, applying material from the support (280) to the separated tissue.
[0042] While the support (280) is shown to have a certain configuration, it should be understood that the exact configuration of the support (280) can be changed. For example, in some versions, the medical fluid may be suspended in a biocompatible carrier. Suitable carriers may include, for example, physiological buffer solution, liquid gel solution, saline solution and water. For gel solutions, the tissue repair composition may be in the form of a liquid gel before delivery to the target site, or may form a gel and remain in place after delivery to the destination. Liquid gel solutions may contain one or more gelling materials with or without added water, saline or physiological buffer solution. Exemplary gelling materials include proteins, polysaccharides, polynucleotides and other materials such as alginate, cross-linked alginate, poly (N-isopropylacrylamide), poly (oxyalkylene), copolymers of poly (ethylene oxide) poly (propylene oxide), poly (vinyl alcohol), glycerol / polyethylene glycol polyacrylate or succinate monostearate (MGSA / PEG) and combinations of any of the above.
[0043] The support (280) may alternatively contain a fibrous pad, foam, mesh or other structure capable of containing glue or other type of medical fluid. By way of example only, the contribution (270) and / or support (280) can be constructed in accordance with the teaching of US Patent Publication No. 20013/0068816, entitled "Surgical Instrument and Buttress Material", published March 21, 2013;
Publication of US Patent No. 2013/0062391, entitled "Surgical Instrument with Fluid Fillable Buttress", published on March 14, 2013;
US Patent Publication No. 2013/0068820, entitled "Fibrin Pad Matrix with Suspended Heat Activated Beads of Adheasive", published March 21, 2013;
US Patent Publication No. 2013/0082086, entitled "Attachment of Surgical Staple Buttress to Cartridge", published April 4, 2013;
Publication of US Patent No. 2013/0037596, entitled "Device for Applying Adjunct in Endoscopic Procedure", published February 14, 2013;
US Patent Publication No. 2013/0062393, entitled "Resistive Heated Surgical Cartridge Cartridge with Fase Change Sealant", published March 14, 2013;
Publication of US Patent No. 2013/0075446, entitled "Surgical Staple Assembly with Hemostatic Feature", published March 28, 2013;
US Patent Publication No. 2013/0062394, entitled "Surgical Staple Cartridge with SelfDispensing Staple Buttress," published March 14, 2013;
US Patent Publication No. 2013/0075445, entitled "Anvil Cartridge for Surgical Fastening Device", published March 28, 2013; and
Publication of US Patent No. 2013/0075447, entitled "Adjunct Therapy for Applying Hemostatic Agent", published on March 28, 2013.
III. Exemplary Alternative Wedge Sleigh [0044] In some cases, it may be desirable to provide additional and / or alternative structures and cut tissue and / or support (280). For example, in some examples the tool (10) can be reused, while the cartridge (70, 270) can be disposable. For this reason, repeated use of the tool (10) may cause the cutting edge (84) of the firing beam (82) to become dull. Such blunting can be strengthened by using an insert (270) which includes a support (280) similar to that discussed above. Additionally or alternatively, the cutting edge (84) and / or other parts of the firing beam (82) may encounter an accumulation of material that forms the support (280) when the same firing beam (82) is fired through multiple supports (280). Such accumulation of material may adversely affect the ability of the beam (82) to fire to separate the tissue and / or additional supports (280). In additional or alternative, such a build up of material may provide increased friction or interference that requires additional force to drive the beam (82) from firing further. Various examples of additional and / or alternative structures that can be used to provide at least some disposable cutting elements are described in more detail below, while other examples will be apparent to those skilled in the art in light of this teaching.
AND. Exemplary wedge slide with rotary blade [0045] FIG. 16 is a perspective view in section of a partial lower jaw (50) and alternative staple cartridge (370). The staple cartridge (370) can be used as a replacement for the staple cartridge (70). Furthermore, or alternatively, the staple cartridge (370) may include a support (280), such as a staple cartridge (270) or any other type of support, including but not limited to various supports described in various references cited herein. The staple cartridge (370) is substantially similar to the staple cartridges (70, 270) described above, the main difference being that the staple cartridge (370) is provided with an exemplary alternative wedge slide (378). The wedge sled (378) is similar to the wedge sled (78) described above. In this example, the wedge slide (378) has been modified relative to the wedge slide (78) to accommodate a second cutting blade (380) that can rotate into a wedge slide (378). In particular, as shown in FIG. 16-17, the wedge slide (378) comprises a body (377) multiple surfaces (379) of the cam. The body (377) defines the blade gap (382). The surfaces (379) of the body and cam are shorter compared to the surfaces (79) of the wedge slide cam (78), however, the body (377) and surfaces (379) of the cam face at an angle that is steeper than the angle of the surface (79) of the cam wedge-shaped sleds (78). Therefore, the wedge slide (378) occupies the same longitudinal space inside the insert (370) as the wedge slide (78) in the insert (70, 270), so that the wedge slide (378) is substantially interchangeable with the wedge slide (78 ). The cam angle (379) allows the wedge carriage (378) to direct multiple staple driving members (75) up simultaneously and / or in a predetermined order.
[0046] The blade gap (382) is adapted to accommodate rotation of the blade (380) within the wedge-shaped carriage (378). As best seen in FIG. 17, the blade gap (382) has a shape approximately corresponding to the shape defined by the blade (380) rotating between the retracted position (shown in outline) and the stretched position. In addition, the blade gap (382) defines a stop element (383) which, as will be described in more detail below, prevents blade rotation near the proximal extended position. The shape of the blade slot (382) further defines the proximal hole (384) in the wedge slide (378). As will be described in more detail below, the proximal opening provides access to the blade (380) so that the blade can be actuated by the firing beam (82) from the retracted position to the stretched position. In other examples, the blade gap (382) may have any other suitable shape, as will be apparent to those skilled in the art in light of this teaching.
[0047] As can be seen in FIG. 17, the wedge slide (378) further includes a pivot pin or shaft (385) that passes through the slot (382) of the blade. The through hole (386) in the blade (380) allows the blade (380) to rotatably connect to the wedge carriage (378), such that the blade (380) can rotate further to the retracted position. Although not shown in FIG. 17, it should be understood that the rotary shaft (385) may be equipped with sleeves, bearings or other components or elements suitable for assisting in knife rotation (380). In addition, the rotary shaft (385) may be equipped with components or elements, such as springs suitable for elastically deforming the blade (380) towards the retracted or extended position.
[0048] The blade (380) has a cross-sectional shape similar to a small knife. In particular, with respect to the blade (380) in the extended position, the blade (380) has an upper cutting part (388) and a lower fixing part (394). The upper cutting part (388) comprises a cutting edge (390) further facing the edge and a flat part (392) facing closer. The cutting edge (390) extends at an angle upwards from the clamping part (394). Although the cutting edge (390) includes a straight edge stretching at an angle, it should be understood that the cutting edge (390) can take any other suitable shape. For example, the cutting edge (390) can be curved, serrated, in the form of saw teeth, and / or otherwise adapted. The cutting edge (390) can also be tilted differently from the angle shown.
[0049] The flat portion (392) extends upwardly from the attachment portion (394). As with the cutting edge (390), the flat part (392) need not be limited to the shape described herein. As will be described in more detail below, the flat portion (392) provides a surface that can engage the wedge slide stopper element (383) (378). [0050] The upper cutting part (388) of the blade (380) extends up to a certain height above the wedge sled (378). In this example, the height of the upper cutting portion (388) is adapted to cut both the support (280) and tissue (90). In other examples, the upper cutting part (388) may have a height that is less than the height shown, so that the upper cutting part (388) only crosses the support (280) immediately adjacent to the cartridge (370), not necessarily cutting the tissue (90) that is located above the support (280). It should be understood that the upper cutting portion (388) or other cutting portion components (388) described above may have any other suitable shape, height or configuration as will be apparent to those skilled in the art in the light of this teaching.
[0051] In the exemplary mode of operation, the blade (380) is in a retracted position before inserting the insert (370) into the lower jaw (50). In the retracted position the blade (380) is completely recessed in the insert (370) and wedge carriage (378). Accordingly, the operator is protected against inadvertent contact with the blade (380) when inserting the cartridge (70,
270) to the lower jaw (50).
[0052] When the operator inserts the insert (370) into the lower jaw (50), the blade (380) remains retracted until the operator begins the firing sequence. After starting the firing sequence, the firing beam (82) is driven further such that the knife member (80) contacts the wedge carriage (378). The knife member (80) may include one or more protruding elements (not shown) adapted to engage the blade (380) so that the blade can be actuated in an extended position with the stop member (383) stopping further rotation. Alternatively, the wedge slide (378) may be provided with means suitable for actuating the blade (380) on the knife member (80) in contact with the wedge slide (378). In the extended position, the knife (380) extends through the deck (373) of the insert (370).
[0053] With the blade (380) in the extended position, the firing beam (82) continues to advance further by driving the cutting edge (390) of the blade (380) through the support (280) (if equipped) and tissue (90). The cutting edge (84) of the knife member (80) may follow the blade (380) briefly, so that the cutting edge (84) cuts tissue (90) or support material (280) not cut by the blade (380). It should be understood that the cutting edge (84) of the knife member (80) and the cutting edge (390) of the blade (380) follow a substantially identical path. Such a path may generally be defined by a longitudinally extending channel (372) of the insert (370). By making the first cutting passage through the support (280) (and in some versions also tissue (90)), the blade (380) can reduce wear and / or build-up on the knife member (80), thereby extending the life of the knife member (80). In addition, it should be understood that both the blade (380) and the knife member (80) follow the cam surfaces (379) so that the wedge slide (378) will drive the staples (77) through a given area of tissue before that particular area of tissue is cut with a knife (380) or (80) knife. The stapling and cutting operation can still be considered to be substantially simultaneous in this area of the tissue, since the wedge slide (378) is adapted such that the difference in synchronization between stapling and cutting is substantially short.
[0054] After the tool (10) has been fired, the cartridge (370) can be removed along with the blade (380) so that a new cartridge (370) and / or blade (380) can be inserted into the lower jaw (50). It should be understood that the cartridge (370) can be replaced by an identical cartridge (370) or another cartridge (70, 270, 370). For example, some cartridges (370) may be equipped with blades (380) adapted for different procedures. By way of example only, the cartridge (370) may include a sharper blade (380) for use with lung tissue. Alternatively, the cartridge (370) may include a more robust blade (380) for use with stomach tissue. Of course, the cartridge (370) may include a blade (380) suitable for cutting any tissue, as will be apparent to those skilled in the art in light of this teaching.
B. Exemplary Wedge Sleigh with Fixed Blade [0055] FIG. 18 is a partial perspective view of another exemplary alternative staple cartridge (470) which is provided with an exemplary alternative wedge slide (478). In this example, the cartridge (470) is essentially the same as the cartridge (70, 270) described above, except that the cartridge (470) includes an upwardly projecting cover (469) that is unitary connected to the deck (473) of the cartridge (470) . Like the cartridge (70, 270), the cartridge (470) includes a longitudinally extending channel (472) in the deck (473), which also extends through the cover (469). As will be discussed in more detail below, the cover (469) is adapted to cover the blade (480) that is permanently attached to the wedge carriage (478). [0056] The wedge sled (478) is similar to the wedge sled (78, 378) described above. In this example, like the wedge sled (378), the wedge sled (478) was modified relative to the wedge sled (78) to accommodate a second cutting blade (480) that is permanently attached to the wedge sled (478). In particular, as best seen in FIG. 19, the wedge slide (478) includes a body (477) that defines the blade gap (482). The body (477) may also include a plurality of cam surfaces (not shown) suitable for driving the staples (77) with the staple driving members into the tissue. The body (477) is shorter than the surface (79) of the wedge sledge cam (78), however the body (477) and the cam surfaces face an angle that is steeper than the angle of the surface (79) of the wedge sledge cam (78). Accordingly, the wedge slide (478) occupies the same space longitudinally within the insert (470) as the wedge slide (78), so that the wedge slide (478) is substantially interchangeable with the wedge slide (78). The wedge slide angle (478) allows the wedge slide (478) to drive multiple staple driving members (not shown) up simultaneously and / or in a certain predetermined order.
[0057] The blade gap (482) is adapted to accommodate the blade (480) inside a wedge slide (478). As best seen in FIG. 19, the blade slot (482) has a shape approximately corresponding to the shape defined by the lower blade area (480). In contrast to the blade (380) of the wedge-shaped carriage (378), the blade (480) of the wedge-shaped carriage (478) is immobilized in relation to the wedge-shaped carriage (478). Thus, the blade gap (482) need not be adapted to accommodate rotation or rotation of the blade (480). In other examples, the blade gap (482) may have any other suitable shape, as will be apparent to those skilled in the art in light of the present teaching.
[0058] As can be seen in FIG. 19, the wedge slide (478) further includes a pin or shaft (485) that passes through the slot (482) of the blade. The through hole (486) in the blade (480) allows the blade (480) to be firmly attached to the wedge carriage (478), so that the blade (480) is substantially fixed relative to the wedge carriage (478).
[0059] The blade (480) has a cross-sectional shape similar to the blade (380). In particular, the blade (480) has an upper cutting portion (488) and a lower mounting portion (494). The upper cutting part (488) has an arcuate cutting edge (490) facing away and a flat part (492) facing closer. The cutting edge (490) extends at an angle upwards from the clamping part (494).
As with the cutting edge (390) and flat portion (394) described above, the cutting edge (490) and flat portion (494) may include any suitable alternative configuration, as will be apparent to those skilled in the art in light of this teaching. [0060] The upper cutting portion (488) of the blade (480) extends up to a certain height above the wedge sled (478). In this example, the height of the upper cutting portion (488) is adapted to cut both the support (280) and tissue (90). Although, as with the upper cutting part (388) described above, the height of the upper cutting part (488) can be changed to cut any desired combination of support (280) and / or tissue (90), as will be apparent to those skilled in the art in the light of this teaching. [0061] In the exemplary mode of operation, as shown in FIG. 19, the blade (480) is retracted into the guard (469) before inserting the insert (470) into the lower jaw (50). When the blade (480) is retracted into the cover (469), the blade (480) is completely inside the cartridge (470). Accordingly, the operator is protected against inadvertent contact with the blade (480) while the operator operates the cartridge (470) and inserts the cartridge (470) into the lower jaw (50). In addition, the sheath (469) can prevent premature tissue and blade contact (480) when closing the anvil (60) toward the deck (473) until the firing sequence begins (e.g. until the knife member (80) is moved further). For example, in the absence of a cover (469), the closing action of the anvil (60) may tend to direct the tissue closer towards the blade (480) when the anvil (60) squeezes the tissue against the deck (473). If such closer tissue milking occurs, the sheath (469) blocks the driven tissue closer to engaging the blade (480).
[0062] When the operator inserts the insert (470) into the lower jaw (50), the blade (480) remains retracted until the operator begins the firing sequence. After starting the firing sequence, the firing beam (82) is driven further until the wedge sled (478) contacts. As shown in FIG. 20, the firing beam (82) continues to travel further, driving the inspiratory slide (478) further, and thereby extends the blade (480) from the shield (469), so that the cutting edge (490) of the blade (480) can cut the support (280) ) (if equipped) and tissue (90). The cutting edge (84) of the knife member (80) may follow the blade (480) briefly so that the cutting edge (84) cuts tissue (90) or support material (280) left uncut (480). It should be understood that the cutting edge (84) of the knife member (80) and the cutting edge (490) of the blade (480) follow a substantially identical path. Such a path may generally be defined by a longitudinally extending channel (470) of the insert (770). By making the first cutting pass through the support (280) (and in some versions also tissue (90)), the blade (480) can reduce wear and / or buildup on the knife member (80), thereby extending the life of the knife member (80). In addition, it should be understood that both the blade (480) and the knife member (74) follow the surfaces (479) of the cam such as the wedge slide (478) will drive the staples (77) through a given area of tissue before a particular area of tissue is cut with blades (480) or (80) of the knife. The stapling and cutting operation can still be considered to be substantially simultaneous in this area of the tissue, since the wedge slide (478) is adapted that the difference in synchronization between stapling and cutting is substantially short.
[0063] After the tool (10) has been fired, the cartridge (470) can be removed together with the blade (480) so that a new cartridge (70, 370, 470) and / or blade (480) can be inserted into the lower jaw (50) . It should be understood that the cartridge (470) can be replaced by an identical cartridge (470) or another cartridge (70, 270, 370). For example, with the cartridge (370) discussed above, some of the cartridges (470) may be equipped with blades (480) adapted to various procedures such as those described above.
[0064] FIG. 21, shows an alternative wedge slide (578) that can be used with the insert (70, 270, 470). The wedge slide (578) is functionally and structurally identical to the wedge slide (478) discussed above, unless otherwise stated below. Unlike the wedge sled (478), the wedge sled (578) contains a different secondary cutting blade (580). In particular, the blade (580) is shorter than the blade (480), so that the blade (580) is adapted to cut only the support material (280), without reaching also to the tissue (90) located above the support (280).
[0065] Under certain circumstances, the support material (280) may have a different thickness than the thickness shown. In this connection, it should be understood that the cutting blade (580) is not limited to cutting the support (280) or cutting through the entire support (280). Indeed, under certain circumstances the blade (580) may accidentally cut some tissue (90). In other circumstances, however, the blade (580) may only cut part of the support (280), leaving the remaining material of the support (280) to be cut with the cutting edge (84) of the knife member (80).
C. Exemplary wedge slide with a curved secondary blade [0066] FIG. 22 is a perspective view of other example alternative wedge-shaped sleds (678) that can be used with the cartridge (670), which is a modified version of the cartridge (70, 270). In many respects the wedge sled (678) of this example is similar to the wedge sled (78, 378, 478, 578) described above. In this example, like the wedge sled (378, 478, 578), the wedge sled (678) was modified relative to the wedge sled (78) to accommodate the additional cutting blade (680). In particular, as best seen in FIG. 23, the wedge slide (678) includes a body (677) and multiple cam surfaces (679). The body (677) defines a blade gap (682) that is adapted to receive the blade (680), as will be described in more detail below. The cam body (677) and surfaces (679) are shorter compared to the surfaces (79) of the wedge slide cam (78), but the surfaces (679) of the cam are facing an angle that is more inclined than the angle of the surface (79) of the wedge sled cam (78). Accordingly, the wedge slide (678) occupies the same longitudinal space within the insert (70, 270) as the wedge slide (78), which makes the wedge slide (678) substantially interchangeable with the wedge slide (78). The cam angle (679) allows the wedge slide (678) to direct multiple staple driving members (not shown) up simultaneously and / or in a certain predetermined order.
[0067] The blade slot (682) is adapted to accommodate the blade (680) within the wedge carriage (678). As best seen in FIG. 23, the blade slot (682) includes a translation slot (683) and an actuation cavity (684). The translation slot (683) corresponds to the sled (692) translation of the blade (680). As will be described in more detail below, the translation sled (692) is adapted to interact with the knife member (80) to translate the blade (680) from the retracted position to the stretched position by means of the translation slot (683). [0068] The actuation cavity (684) defines a space for certain blade components (680) (described below) and the resilient member (686) of the wedge slide (678). The resilient member (686) comprises a leaf spring that extends closer to the distal attachment element (688), which has a uniform structure with a wedge slide (678). As will be described in more detail below, the resilient member (686) acts to bend up and down within the actuating cavity (684) to resiliently warp the blade (680) towards the retracted position. Accordingly, the actuating cavity (684) is at least partly determined by the bending movement range of the elastic member (686). Although the actuating cavity (684) is shown to have a certain shape, it should be understood that the shape of the actuating cavity (684) may vary depending on the shape and range of motion of the elastic member (686). Additionally or alternatively, as will be understood from the description below, the shape of the actuating cavity (684) may also vary depending on the shape or translation path of the blade (680).
[0069] The blade (680) comprises an upper cutting portion (690), a translation sled (692) and a retainer (694). The cutting portion (690) includes a sharp, downstream cutting edge (691) that is adapted to cut the support (280) and / or tissue (90). As with the cutting edge (390, 490) described above, the cutting edge (691) can have many alternative configurations that can be adapted to cut various materials. [0070] The translation sleds (692) have a uniform structure with the blade (680) and extend outwardly from the blade (680). In other examples, the translation sled (692) may be separate and permanently attached to the blade (680). The translation sled (692) are substantially integrated into the blade (680) and extend further and outward from the front, right and left sides of the blade (680). As best seen in FIG. 22, the translation sled (692) has a substantially rectangular shape with rounded distal and proximal ends. The longitudinal portion of the translation rectangular shape (692) generally defines a plane that is skewed relative to the longitudinal axis of the insert (670). As will be described in more detail below, the translation sled (692) is slidably positioned in the translation slot (683) that is formed in the wedge sled body (680). The translation slot (683) provides the cam surface for the translation sled (692) such that the translation gap (693) and the translation sled (692) provide upward movement of the blade (680) relative to the wedge sled (678) when the blade (680) is further driven relative to the wedge sled (678). Although the sled (692) shown is directed at a certain angle relative to the blade (680), it should be understood that the translation sled (692) can be turned at any suitable angle, as will be apparent to those skilled in the art in light of these teachings.
[0071] The retainer (694) extends further from the blade (680). In particular, the retainer (694) initially extends substantially perpendicular to the longitudinal axis of the blade (680). As the retainer (694) continues, the retainer (694) curves downwardly at an angle. As will be understood, the shape of the retainer (694) is adapted to engage the resilient member (686) to resiliently warp the blade (680) toward the retracted position. In this way, the retainer (694) can assume various alternative shapes, depending on the particular relationship between the wedge slide (678) and the blade (680) and other components thereof.
[0072] In contrast to the blade (380, 480, 580) of the wedge sled (378, 478, 578), the blade (680) of the wedge sled (678) is adapted for translation obliquely to the wedge sled (478). In particular, the slot (683) of the wedge slide (678) is adapted to cooperate with the slide (692) of the blade (680) translation. The translation slot (683) and the translation sled (692) are oriented in such an angle that the translation slots (683) and the translation sled (692) operate to jointly translate the blade (680) upwards when the blade (680) is moved in further direction. In this way, the translation gap (683) and the translation sled (692) operate to move the blade (680) from the retracted position to the stretched position when the blade (680) is moved further.
[0073] As best seen in FIG. 23, the elastic member (686) of the wedge slide (678) and the retainer (694) of the blade (680) are adapted to engage with each other such that the elastic member (686) exerts a force having a downward component and a closer component on retainer (694). This force shifts the sled (692) of the blade translation (680) towards the proximal end of the slot (683) of the wedge sled (678), thus resiliently twisting the blade (680) towards the retracted position. In some versions, the distal edge of the distal projection (83) faces at an angle between 75 degrees and 90 degrees relative to the horizontal. This angle can provide a cam effect that helps overcome the distortion of the elastic member (686) to retract the blade (680) closer.
[0074] In the exemplary operating mode, the blade (680) is retracted initially to the retracted position to insert the insert (670) into the lower jaw (50). When the blade (680) is in the retracted position, the blade (680) is completely in the cartridge (670). Accordingly, the operator is protected against inadvertent contact with the blade (680) when inserting the insert (670) into the lower jaw (50).
[0075] When the operator inserts the cartridge (670) into the lower jaw (50), the blade (680) remains retracted until the operator starts the firing sequence. After starting the firing sequence, the firing beam (82) is driven further such that the knife member (80) contacts the blade (680) to first actuate the blade (680) to the extended position, and then to drive the blade (680) and wedge sled (678) closer. As shown in FIG. 23-24, the knife (80) includes a distal projection (83) that is adapted to contact the blade (680). Thus, when the firing beam (82) is driven further, the blade (680) is correspondingly further driven relative to the wedge carriage (678) by means of the distal projection (83) of the knife member (80). When the blade (680) is driven further, the slot (683) of the wedge slide translation (678) and the sled (692) of the blade translation (680) simultaneously and cooperate drive the blade (680) up to the extended position, as can be seen in the transition from the state shown in FIG. 23 to the state shown in FIG. 24. It should be understood that because the blade (680) is elastically deformed to its retracted position, the blade (680) is only stretched when the knife (80) acts on it. Further advancing the firing beam (82) moves the wedge slide (678) further and drives the cutting edge (691) of the blade (680) through the support (280) and / or tissue (90). The cutting edge (84) of the knife member (80) may follow the blade (680) briefly so that the cutting edge (84) cuts any tissue material (90) or supports (280) remaining uncut through the blade (680).
[0076] It should be understood that the cutting edge (84) of the knife member (80) and the cutting edge (690) of the blade (680) follow a substantially identical path. Such a path may generally be defined by a longitudinally extending channel (not shown) of the insert (670). By making the first cutting pass through the support (280) (and in some versions also tissue (90)), the blade (680) can reduce wear and / or build-up on the knife member (80), thereby extending the life of the knife member (80). In addition, it should be understood that both the blade (680) and the knife member (74) follow the surfaces (379) of the cam in such a way that the wedge slide (678) will drive the staples (77) through a given region of tissue before that specific area of tissue will be cut with a knife (680) or a knife member (80). The stapling and cutting operation can still be considered to be substantially simultaneous in this area of the tissue, since the wedge slide (678) is adapted such that the difference in synchronization between stapling and cutting is substantially short.
[0077] After the tool (10) is actuated, the knife member (80) can be moved closer. A closer retraction of the knife member (80) allows the elastic member (686) to drive the blade (680) back to the retracted position. The blade (680) is thus retracted into the used cartridge (670), protecting the operator against unwanted contact with the cutting edge (691) when the operator removes the used cartridge (670) to replace the used cartridge (670) or otherwise disposes of used cartridge (670). The cartridge (670) can be removed together with the blade (680) in such a way that a new cartridge (70, 270, 370, 470, 570) equipped with a blade (380, 480, 580, 680) can be inserted into the lower jaws (50). It should be understood that the cartridge (670) can be replaced by an identical cartridge (670) or another cartridge (70, 270, 370, 470, 570). For example, as with the wedge-shaped carriage (378, 478, 578) discussed above, some cartridges (70, 270, 370, 470, 570) may be equipped with blades (680) adapted to various procedures such as those described above .
D. Exemplary Wedge Sleigh With Translationalable Blade [0078] FIG. 25-26 show other examples of alternative wedge sleds (778) for use with an insert (770), which is a modified version of the insert (70, 270). In many respects the wedge slide (778) of this example is similar to the wedge slide (78, 378, 478, 578, 678) described above. Like the wedge sled (378, 478, 578, 678), the wedge sled (778) was modified relative to the wedge sled (78) to include the integral secondary cutting blade (780). In particular, as best seen in FIG. 25, the wedge slide (778) comprises a body (777) and a cam surface (779). The cam body (777) and surface (779) are shorter compared to the surface (79) of the wedge slide cam (78), however, the surface (779) of the cam faces at an angle that is steeper than the angle of the surface (79) of the wedge slide (78). Therefore, the wedge slide (778) occupies the same space longitudinally within the insert (70, 270) as the wedge slide (78), which means that the wedge slide (778) is substantially interchangeable with the wedge slide (78). The cam angle (779) allows the wedge carriage (778) to drive a plurality of staple driving members (75) up simultaneously and / or in a predetermined order.
[0079] The blade (780) comprises an upper cutting part (790), a body part (792) and a stabilizing member (794). The cutting portion (790) includes a sharp, distal cutting edge (791) that is adapted to cut the support (280) and / or tissue (90). As with the cutting edge (390, 490, 590, 691) described above, the cutting edge (791) can have many alternative configurations that can be adapted to cut a variety of materials.
[0080] The body portion (792) uniformly connects the blade (780) to the wedge carriage (778). In other words, the wedge slide (778) and blade (780) contain a single unitary component in this example. In other examples, the blade (780) may be separated from and attached to a wedge-shaped carriage (778). The body portion (792) is sized to lift the cutting portion (790) to a height suitable for the cutting support (280). While the body part (792) is shown to have a certain height, it should be understood that the height of the body part (792) can vary depending on many factors such as deck height (773), support (280), thickness, etc.
[0081] The stabilizing member (794) is located above the cutting edge (791) and extends further from the blade (780). As best seen in FIG. 26, the stabilizing member (794) is positioned to align with the upper surface of the support (280). Accordingly, the stabilizing member (794) acts to direct the support (280) toward the cutting edge (791), and may further assist in preventing the support (280) from separating from the deck (773) in an area adjacent to the blade (780) as this is described in more detail below. In addition, the stabilizing element (794) acts as a guard to prevent the operator from inadvertently touching the cutting edge (791). Although the stabilizing member (794) is shown to have a substantially rectangular shape extending a given distance, it should be understood that the stabilizing member (794) can have any suitable size or shape. For example, in other examples, the stabilizing member (794) may extend further than shown. In other examples, the stabilizing member (794) may taper outwards or inwards to a width that is wider or narrower than the blade (780). Of course, the stabilizing member (794) may include any other suitable configuration, size and / or shape, as will be apparent to those skilled in the art in light of the teachings herein.
[0082] In the exemplary mode of operation, the blade (780) initially projects beyond the cartridge (70, 270) at the proximal end of the cartridge (70, 270). The stabilizing member (794) is adapted to protect the operator against inadvertent contact with the cutting edge (791) while the insert (70, 270) is inserted into the lower jaw (50). Accordingly, the operator is protected against unintentional contact with the blade (780), even when the blade (780) protrudes out of the cartridge (70, 270).
[0083] After the user has inserted the refill (70, 270) into the lower jaw (50), the firing sequence can be started. After starting the firing sequence, the firing beam (82) is driven further such that the knife member (80) contacts the wedge carriage (778). As shown in FIG. 26, the knife member (80) contacts the wedge carriage (778) and begins to drive the wedge carriage (778) and blade (780) further. When the blade (780) is driven further, the stabilizing member (794) of the wedge slide (778) moves on the upper surface of the support (280) to stabilize the cutting process. It should be understood that because the stabilizing member (794) moves on top of the support (280), the blade (780) only cuts off the support (280). In other examples, the blade (791) of the blade (780) may be adapted to be vertically higher. In some such examples, the stabilizing member (794) can move on tissue (90) or support (280) adjacent to the anvil (60). Thus, in other examples, the blade (780) may be adapted to cut other materials besides the support (280), such as tissue (90) or other additional supports (280). The cutting edge (84) of the knife member (80) may follow the blade (780) briefly so that the cutting edge (84) cuts any tissue material (90) or supports (280) left uncut by the blade (780).
[0084] It should be understood that the cutting edge (84) of the knife member (80) and the cutting edge (790) of the blade (780) follow a substantially identical path. Such a path may generally be defined by a longitudinally extending channel (not shown) of the cartridge (770). By making the first cutting pass through the support (280) (and in some versions, also tissue (90)), the blade (780) can reduce wear and / or build-up on the knife member (80), thereby extending the life of the knife member (80) . In addition, it should be understood that both the blade (780) and the knife member (80) may follow the surfaces (779) of the cam, so that the wedge slide (778) will drive the staples (77) through a given area of tissue before that specific area of tissue will be cut with a knife (480) or a knife member (80). The stapling and cutting operation may still be substantially simultaneous in this area of the tissue, since the wedge slide (778) is adapted such that the difference in synchronization between stapling and cutting is substantially short.
[0085] After the tool (10) is actuated, the cartridge (70, 270) can be removed along with the blade (780) so that a new cartridge (70, 270, 470, 570) can be inserted into the lower jaw (50). It should be understood that the cartridge (70, 270) can be replaced by an identical cartridge (70, 270) or another cartridge (70, 270, 470, 570). For example, as with the wedge slide (378, 478, 578, 678) discussed above, some cartridges (570) may be equipped with blades (780) adapted to various procedures such as those described above.
IV. Miscellaneous [0086] It should be understood that in the various examples described above, the articulation joint is adapted to allow the gripper to articulate along the first plane and thus deviate from the longitudinal axis of the shaft assembly. The locking assembly operates to selectively lock the articulation. The locking assembly includes a locking member that is movable along a second plane to selectively engage the first locking member and thereby block the articulation. The second plane is shifted relative to the first plane. The second plane is also not parallel to the first plane. In some cases, the second locking member may move along a second axis that is perpendicular to the longitudinal axis of the shaft assembly. The unlocking member may selectively drive the locking member. The unlocking member may move along a third plane that can be offset relative to and / or in a non-parallel relationship with the first and / or second plane (s). The unlocking member may move along a third axis which may be perpendicular to the longitudinal axis of the roller assembly and / or the second axis.
[0087] It is to be understood that any one or more of the teachings, expressions, embodiments, etc. described herein. may be combined with any one or more other teachings, expressions, embodiments, etc., which are described herein. The teachings, expressions, examples, examples etc. described above. therefore, it should not be seen in isolation from each other. Various suitable ways in which these teachings can be combined herein will be apparent to those skilled in the art in the light of these teachings. Such modifications and variations are intended to be included in the scope of the claims. It should also be understood that the various teachings presented herein can easily be combined with the teachings of the various references cited herein.
[0088] Versions of the devices described above may be used in conventional medical procedures and physician-led procedures, as well as in medical robot procedures and procedures. By way of example only, the various teachings outlined herein can easily be incorporated into a robotic surgical system such as the DAVINCI ™ system from Intuitive Surgical, Inc. of Sunnyvale, California. Similarly, one of ordinary skill in the art will recognize that the various teaching provided herein can easily be combined with the various teaching of any of the following:
US Patent No. 5,792,135, entitled "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity," issued August 11, 1998. US Patent No. 5,817,084, entitled "Remote Center Positioning Device with Flexible Drive," issued October 6, 1998,
US Patent No. 5,878,193, entitled "Automated Endoscope System for Optimal Positioning," issued March 2, 1999,
US Patent No. 6,231,565, entitled "Robotic Arm DLUS for Performing Surgical Tasks," issued May 15, 2001,
US Patent No. 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument," issued August 31, 2004,
U.S. Patent No. 6,364,888, entitled "Alignment of Master and Slave in a Minimally Invasive Surgical Apparatus," issued April 2, 2002,
US Patent No. 7,524,320, entitled "Mechanical Actuator Interface System for Robotic Surgical Tools," issued April 28, 2009,
US Patent No. 7,691,098, entitled "Platform Link Wrist Mechanism," issued April 6, 2010,
US Patent No. 7,806,891, entitled "Repositioning and Reorientation of Master / Slave Relationship in Minimally Invasive Telesurgery," issued October 5, 2010,
US Publication No. 2013/0012957, entitled "Automated End Effector Component Reloading System for Use with a Robotic System, published January 10, 2013,
Publication US No. 2012/0199630, entitled "Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities," published on August 9, 2012,
US Publication No. 2012/0132450, entitled "Shiftable Drive Interface for RoboticallyControlled Surgical Tool," published May 31, 2012,
US Publication No. 2012/0199633, entitled "Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements," published August 9, 2012,
Publication US No. 2012/0199631, entitled "Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds," published on August 9, 2012,
Publication US No. 2012/0199632, entitled "Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector," published on August 9, 2012,
Publication US No. 2012/0203247, entitled "Robotically-Controlled Surgical End Effector
System, "published on August 9, 2012,
Publication US No. 2012/0211546, entitled "Drive Interface for Operably Coupling a
Manipulatable Surgical Tool to a Robot, "published August 23, 2012;
US Publication No. 2012/0138660, entitled "Robotically-Controlled Cable-Based Surgical End Effectors," published June 7, 2012, and / or US Publication No. 2012/0205421, entitled "Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems, "published on August 16, 2012.
[0089] Versions of the devices described above may be designed so that they can be discarded after a single use or can be designed for multiple use. Versions may, in one or both cases, be regenerated for reuse after at least one use. Regeneration may include any combination of stages of device disassembly, followed by cleaning or replacement of individual elements and subsequent reassembly. In particular, some versions of the device can be dismantled, and any number of specific parts or components of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing individual parts, some versions of the device may be reassembled for later use at the regeneration plant or by the user immediately before the procedure. Professionals in the art will appreciate that device regeneration can utilize a variety of techniques to disassemble, clean / replace, and reassemble. The use of such techniques and the resulting regenerated device is within the scope of this application.
[0090] By way of example only, the versions described herein can be sterilized before and / or after the procedure. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic bag or TYVEK. The container and device can then be placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays or high energy electrons. Radiation can kill bacteria on the device and in the container. The sterilized device can then be stored in a sterile container for later use. The device can also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide or steam.
[0091] After presenting and describing various embodiments of the present invention, further adaptations of the methods and systems described herein can be achieved by appropriate modifications by a person skilled in the art without departing from the scope of the present invention. Several such potential modifications have been identified, and others will be apparent to those skilled in the art. For example, the examples, embodiments, geometries, materials, dimensions, ratios, steps and the like discussed above are illustrative and not required. Accordingly, the scope of the present invention should be considered with reference to the following claims and should not be limited to the details of the structure and operation shown and described in the description and drawing.
Ethicon Endo-Surgery, Inc., United States of America Representative:
EP 2 997 906 B1 Z-16694/18
27 sheets
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24 members in 7 offices
Priority claims7
| Document | Office | Kind | Date |
|---|---|---|---|
| 201414489746 | United States of America | A | |
| 201414489746 | United States of America | A | |
| 15185898 | European Patent Office (EPO) | A | |
| 151858982 | – | – | – |
| 201414489746 | – | – | – |
| EP20150185898 | – | – | – |
| US201414489746 | – | – | – |
Members24
| Document | Office | Kind | |
|---|---|---|---|
| EP2997906A1 | European Patent Office (EPO) | A1 | |
| US2016081690A1 | United States of America | A1 | |
| WO2016043999A1 | World Intellectual Property Organization (WIPO) | A1 | |
| CN107106171A | China | A | |
| JP2017529159A | Japan | A | |
| BR112017005356A2 | Brazil | A2 | |
| EP2997906B1 | European Patent Office (EPO) | B1 | |
| PL2997906T3This record | Poland | T3 | |
| US10105142B2 | United States of America | B2 | |
| US2019083095A1 | United States of America | A1 | |
| US2019365384A1 | United States of America | A1 | |
| CN107106171B | China | B | |
| JP6625619B2 | Japan | B2 | |
| US2020008808A1 | United States of America | A1 | |
| US2020015821A1 | United States of America | A1 | |
| US11045198B2 | United States of America | B2 | |
| US11109864B2 | United States of America | B2 | |
| US11123069B2 | United States of America | B2 | |
| BR112017005356B1 | Brazil | B1 | |
| US11284898B2 | United States of America | B2 | |
| US2022233194A1 | United States of America | A1 | |
| US12076017B2 | United States of America | B2 | |
| US2024366225A1 | United States of America | A1 | |
| US12533133B2 | United States of America | B2 |
Numbers
- Publication
- 2997906
- Publication, DOCDB
- 2997906
- Publication, EPODOC
- PL2997906T
- Application
- 15185898
- Application, DOCDB
- 15185898
- Application, EPODOC
- PL20150185898T
Titles2
- English
- SURGICAL STAPLER WITH PLURALITY OF CUTTING ELEMENTS
- Polish
- STAPLER CHIRURGICZNY Z WIELOMA ELEMENTAMI TNĄCYMI
Classification
- CPC, 8
- A61B17/105
- A61B17/07207
- A61B17/068
- A61B17/07292
- A61B17/3209
- A61B2017/07278
- A61B2017/07285
- A61B2017/07271
- IPC, 1
- A61B17 072
