APPLIANCE FOR FABRIC STAPLING

专利摘要:
system for introducing circular anvil with alignment component. The present invention relates to a tissue stapling apparatus. the apparatus includes an anvil and a trocar selectively coupled with the anvil. the anvil may have an internal opening and a plurality of staple pockets aligned around a surface of the anvil. the anvil can be inserted transorally through an esophagus before being attached to the trocar. the trocar may include a stem and locking assembly. the locking assembly can hold the anvil in position relative to the trocar when the locking assembly is in the expanded position. the apparatus may also include an alignment assembly for aligning the anvil's staple pockets with respect to the apparatus. the apparatus may also include an introduction assembly to guide the anvil through the esophagus.
公开号:BR112015013143B1
申请号:R112015013143-3
申请日:2013-12-04
公开日:2021-08-31
发明作者:Charles J. Scheib；Cortney E. Henderson；Frederick E. Shelton Iv
申请人:Ethicon Endo-Surgery, Inc.；
IPC主号:

专利说明:

Background
[001] In some configurations, a surgeon may wish to position a surgical instrument through a patient's orifice and use the instrument to adjust, position, secure and/or otherwise interact with tissues within the patient. For example, in some surgical procedures, portions of the gastrointestinal tract may be cut and removed to eliminate unwanted tissue, or for other reasons. Once the desired tissue is removed, the remaining portions may need to be re-attached between them. One of the tools for performing these anastomotic procedures is a circular stapler that is inserted through a patient's orifice.
[002] Examples of surgical circular staplers are described in US Patent No. 5,205,459 entitled "Surgical Anastomosis Stapling Instrument," issued April 27, 1993; U.S. Patent No. 5,271,544 entitled "Surgical Anastomosis Stapling Instrument," issued December 21, 1993; U.S. Patent No. 5,275,322 entitled "Surgical Anastomosis Stapling Instrument," issued January 4, 1994; U.S. Patent No. 5,285,945 entitled "Surgical Anastomosis Stapling Instrument," issued February 15, 1994; US Patent No. 5,292,053 entitled "Surgical Anastomosis Stapling Instrument," issued March 8, 1994; US Patent No. 5,333,773 entitled "Surgical Anastomosis Stapling Instrument," issued August 2, 1994; US Patent No. 5,350,104 entitled "Surgical Anastomosis Stapling Instrument," issued September 27, 1994; and US Patent No. 5,533,661 entitled "Surgical Anastomosis Stapling Instrument," issued July 9, 1996. The disclosure of each of the above-cited US patents is incorporated by reference into the present invention. Some of these staplers work to secure layers of fabric, cut through the secured layers of fabric and cause the staples to pass through the layers of fabric to substantially seal the cut layers of fabric together, near the cut ends of the layers of fabric, joining , thus, two cut ends of an anatomical lumen.
Other merely additional examples of surgical staplers are disclosed in US Patent No. 4,805,823 entitled "Pocket Configuration for Internal Organ Staplers," issued January 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; US Patent No. 5,597,107 entitled "Surgical Stapler Instrument", issued January 28, 1997; US Patent No. 5,632,432 entitled "Surgical Instrument", issued May 27, 1997; US Patent No. 5,673,840 entitled "Surgical Instrument", issued October 7, 1997; US Patent No. 5,704,534 entitled "Articulation Assembly for Surgical Instruments", issued January 6, 1998; US Patent No. 5,814,055 entitled "Surgical Clamping Mechanism", issued September 29, 1998; US 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 Multi-Stroke Firing Mechanism with a Flexible Rack", issued December 4, 2007; U.S. 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", granted June 3, 2008; in US Patent No. 7,380,696 entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism", granted June 3, 2008; US Patent No. 7,404,508 entitled "Surgical Stapling and Cutting Device", issued July 29, 2008; US Patent No. 7,434,715 entitled "Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout", granted in October 14, 2008; and US Patent No. 7,721,930 entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010. The disclosure of each of the above-cited US patents is incorporated herein. to the present and invention by reference. Although the aforementioned surgical staplers are described as being used in endoscopic procedures, it should be understood that these surgical staplers can also be used in open procedures and/or other non-endoscopic procedures.
[004] Although various types of surgical stapling instruments and associated components have been manufactured and used, it is believed that no one prior to the inventor(s) has manufactured or used the invention described in the appended claims. Brief Description of Drawings
[005] Although the specification concludes with claims that specifically indicate and distinctly claim this technology, it is believed that this technology will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings, in which the same numbers references identify the same elements and where:
[006] Figure 1 represents a side elevation view of an exemplary circular stapling surgical instrument;
[007] Figure 2A represents an enlarged longitudinal cross-sectional view of an exemplary stapling head assembly of the instrument of Figure 1 showing an exemplary anvil in an open position;
[008] Figure 2B represents an enlarged longitudinal cross-sectional view of the clamping head assembly of Figure 2A showing the anvil in a closed position;
[009] Figure 2C represents an enlarged longitudinal cross-sectional view of the stapling head assembly of Figure 2A showing an exemplary staple driver and a blade in a fired position;
[0010] Figure 3 is an enlarged partial cross-sectional view of an exemplary clamp formed against the anvil;
[0011] Figure 4A represents an enlarged side elevation view of an actuator cable assembly exemplifying the surgical instrument of Figure 1 with a portion of the body removed, showing a trigger in an unfired position and a locking element in a locked position ;
[0012] Figure 4B represents an enlarged side elevation view of the actuator cable assembly of Figure 4A, showing the trigger in a fired position and the locking element in an unlocked position;
[0013] Figure 5 is an enlarged partial perspective view of an exemplary indicator assembly of the surgical instrument of Figure 1 showing an indicator window and indicator lever;
[0014] Figure 6 is a diagrammatic view of the indicator window of Figure 5 showing an exemplary indicator bar and corresponding exemplary clip representations;
[0015] Figure 7 represents a schematic view of an exemplary circular stapler system being used in an esophagectomy procedure;
[0016] Figure 8A is a cross-sectional view of an exemplary anvil inserting assembly suitable for use with the stapler system of Figure 7, showing an anvil sleeve removed from an anvil;
[0017] Figure 8B is a cross-sectional view of the anvil insert assembly of Figure 8A, showing the anvil sleeve being inserted into the anvil;
[0018] Figure 8C is a cross-sectional view of the anvil insert assembly of Figure 8A, showing the anvil sleeve inserted into the anvil;
[0019] Figure 9A is a cross-sectional view of the anvil insertion assembly of the Figure, showing a trocar positioned for insertion into the anvil glove;
[0020] Figure 9B is a cross-sectional view of the anvil insertion assembly of Figure 8A showing the incus coupled to the trocar with an anvil locking element in a flattened position;
[0021] Figure 9C is a cross-sectional view of the anvil insertion assembly of Figure 8A showing the incus coupled to the trocar with the anvil locking element in an expanded position;
[0022] Figure 9D is a cross-sectional view of the anvil insert assembly of Figure 8A showing the anvil coupled to the trocar with the anvil locking member in the expanded position and the anvil sleeve being removed;
[0023] Figure 10 is an enlarged partial perspective view of another exemplary trans-oral circular anvil removed from a trocar;
[0024] Figure 11A is a cross-sectional view of the incus and trocar of Figure 10 showing the incus being positioned for engagement with the trocar, with an incus locking member in a flattened position;
[0025] Figure 11B is a cross-sectional view of the incus and trocar of Figure 10 showing the incus coupled to the trocar, with the incus locking member in a flattened position;
[0026] Figure 11C is a cross-sectional view of the incus and trocar of Figure 10 showing the incus coupled to the trocar, with the incus locking member in an expanded position;
[0027] Figure 12A is a cross-sectional view of another exemplary trans-oral circular anvil removed from a trocar;
[0028] Figure 12B is a cross-sectional view of the incus and trocar of Figure 12A showing the incus coupled to the trocar, with an incus locking member in a flattened position;
[0029] Figure 12C is a cross-sectional view of the incus and trocar of Figure 12A showing the incus coupled to the trocar, with the incus locking member in an expanded position;
[0030] Figure 13 is an enlarged perspective view of the anvil of Figure 12A;
[0031] Figure 14 represents an enlarged perspective view of another exemplary anvil;
[0032] Figure 15A is a partial perspective view of the anvil of Figure 14 positioned for engagement with a trocar;
[0033] Figure 15B is a partial perspective view of the incus and trocar of Figure 15A showing the incus being coupled to the trocar;
[0034] Figure 15C is a partial perspective view of the incus and trocar of Figure 15A showing the incus coupled to the trocar, with an incus locking member in an expanded position;
[0035] Figure 16 represents a partial perspective view of another exemplary trocar;
[0036] Figure 17 represents a cross-sectional view of the trocar of Figure 16;
[0037] Figure 18 represents a plan view of another exemplary anvil for coupling with the trocar of Figure 16;
[0038] Figure 19 is an enlarged partial perspective view of the exemplary threading of the anvil of Figure 18;
[0039] Figure 20 is a cross-sectional view of another exemplary anvil;
[0040] Figure 21A is an enlarged partial perspective view of the anvil of Figure 20 positioned for engagement with a trocar;
[0041] Figure 21B is a partial perspective view of the incus and trocar of Figure 21A showing the incus being coupled to the trocar;
[0042] Figure 21C is a partial perspective view of the incus and trocar of Figure 21A showing the incus coupled to the trocar, with an incus locking member in an expanded position;
[0043] Figure 22 is a partial perspective view of another exemplary trans-oral circular anvil assembly;
[0044] Figure 23 is a cross-sectional view of the anvil assembly of Figure 22 being coupled to a trocar;
[0045] Figure 24A is a cross-sectional view of another exemplary trans-oral circular anvil assembly showing an anvil being coupled to a trocar;
[0046] Figure 24B is a cross-sectional view of the incus and trocar assembly of Figure 24A showing the trocar partially inserted into the incus;
[0047] Figure 24C is a cross-sectional view of the incus and trocar assembly of Figure 24A showing the incus coupled to the trocar, with an incus locking member in a flattened position;
[0048] Figure 24D is a cross-sectional view of the incus and trocar assembly of Figure 24A showing the incus coupled to the trocar, with the incus locking member in an expanded position;
[0049] Figure 25A is a partial perspective view of another exemplary trans-oral circular anvil assembly, disposed in a transected section of the esophagus;
[0050] Figure 25B is a cross-sectional view of the incus assembly of Figure 25A showing the incus being coupled to a trocar approaching another transected section of the esophagus, with an incus alignment component in a flattened position;
[0051] Figure 25C is a cross-sectional view of the incus assembly of Figure 25A showing the incus sliding over the trocar with the stretch of the incus alignment component;
[0052] Figure 25D is a cross-sectional view of the anvil assembly of Figure 25A showing the incus coupled to the trocar with the incus alignment component in a stretched position;
[0053] Figure 26 is a cross-sectional view of the anvil assembly of Figure 25A showing the anvil alignment component in the flattened position;
[0054] Figure 27 is a cross-sectional view of the anvil alignment component of Figure 25A, along line 27-27 of Figure 26;
[0055] Figure 28 is a partial perspective view of another exemplary trans-oral circular anvil being pulled through a section of the esophagus by an instrument that is transorally inserted;
[0056] Figure 29 is a partial perspective view of the anvil of Figure 28 being pulled through a section of the esophagus by an instrument that is inserted from the bottom of the section of the esophagus;
[0057] Figure 30 is a partial perspective view of the instrument of Figure 28 being removed from the anvil;
[0058] Figure 31 is a partial perspective view of the upper face of the anvil of Figure 28;
[0059] Figure 32 is a partial perspective view of the underside of the anvil of Figure 28;
[0060] Figure 33A is a partial perspective view of another exemplary trans-oral circular anvil being pulled through a section of the esophagus, with the anvil oriented in a vertical position;
[0061] Figure 33B is a partial perspective view of the anvil of Figure 33A, with the anvil oriented in a horizontal position;
[0062] Figure 34 is a partial perspective view of an exemplary anvil system; and
[0063] Figure 35 represents a cross-sectional view of the anvil of Figure 34.
[0064] The drawings are not intended to be limiting in any way, and it is contemplated that various modalities of the technology may be carried out in a variety of other ways, including those not necessarily represented in the drawings. The drawings incorporated in the annex and forming a part of the descriptive report illustrate various aspects of the present technology, and together with the description they serve to explain the principles of the technology; it is understood, however, that this technology is not limited precisely to the provisions shown. Detailed Description
[0065] The following description of some examples of the technology should not be used to limit its scope. Other examples, features, aspects, modalities and advantages of the technology will become evident to those skilled in the art with the following description, which is through illustrations, one of the best ways contemplated for carrying out the technology. As will be understood, the technology described here is capable of other different and obvious aspects, all without departing from the technology. Consequently, the drawings and descriptions are to be regarded as illustrative in nature and not restrictive. I. Overview of the exemplary surgical instrument for circular stapling
[0066] Figures 1 to 6 show an exemplary circular surgical stapling instrument (10) that has a stapling head assembly (20), a rod assembly (60), and an actuator cable assembly (70), each one of which will be described in more detail below. The stem assembly (60) extends distally from the actuator cable assembly (70), and the clamping head assembly (20) is coupled to a distal end of the stem assembly (60). In summary, the actuator cable assembly (70) functions to activate a clamp driver (24) of the clamping head assembly (20) to drive a plurality of clamps (66) out of the clamping head assembly ( 20). To form finished clips, the clips (66) are bent by an anvil (40) which is attached to the distal end of the instrument (10). Consequently, the fabric (2) shown in Figures 2A to 2C can be stapled using the instrument (10).
[0067] In the present example, the instrument (10) comprises a closing system and a triggering system. The closure system comprises a trocar (38), a trocar actuator (39) and a rotary knob (98). An anvil (40) can be attached to a distal end of the trocar (38). The rotary knob (98) is intended to longitudinally translate the trocar (38) in relation to the stapling head assembly (20), thus translating the anvil (40) when it is coupled to the trocar (38), to staple the fabric between the anvil (40) and the stapling head assembly (20). The triggering system comprises a trigger (74), a trigger trigger assembly (84), a trigger actuator (64) and a clamp trigger (24). The staple driver (24) includes a knife (36) configured to cut fabric when the staple driver (24) is actuated longitudinally. In addition, the clips (66) are positioned distally to a plurality of clip drive elements (30) of the clip driver (24), so that the clip driver (24) also drives the clips (66) distally when the staple driver (24) is actuated longitudinally. In this way, when the trigger (74) is actuated and the trigger drive assembly (84) activates the clamp driver (24) by means of the drive actuator (64), the knife (36) and the elements (30) substantially simultaneously cut the tissue (2) and drive the staples (66) distally to the staple head assembly (20) and into the tissue. The components and functionalities of the closing system and the triggering system will now be described in more detail. A. Anvil Example
[0068] As shown in Figures 1 to 2C, the anvil (40) is selectively attachable to the instrument (10) to provide a surface against which the clamps (66) can be bent to staple the material contained between the head assembly clip (20) and the anvil (40). The anvil (40) of the present example is selectively attachable to a trocar or sharpened rod (38), which extends distally to the clamping head assembly (20). Referring to Figures 2A to 2C, the incus (40) is selectively attachable by coupling a proximal shaft (42) of the incus (40) to a distal tip of the trocar (38). The anvil (40) comprises a generally circular anvil head (48) and a proximal shaft (42) extending proximally from the anvil head (48). In the example shown, the proximal shaft (42) comprises a tubular element (44) having resiliently slanted retaining clips (46) to selectively couple the anvil (40) to the trocar (38), although this is merely optional, and should It will be understood that other retention features for attaching the anvil (40) to the trocar (38) may also be used. For example, C-clips, staples, threads, pins, stickers, etc. can be used to couple the incus (40) to the trocar (38). Furthermore, although the anvil (40) is described as selectively attachable to the trocar (38), in some versions the proximal rod (42) may include a one-way coupling feature so that, once attached, the anvil (40) ) cannot be removed from the trocar (38). Merely exemplary unidirectional elements include barbs, unidirectional snap buttons, tweezers, collars, flaps, bands, etc. Of course, still other configurations for coupling the anvil (40) to the trocar (38) will be apparent to the person skilled in the art in view of the teachings of the present invention. For example, the trocar (38) may instead be a hollow shaft, and the proximal shaft (42) may comprise a sharpened shaft that can be inserted into the hollow shaft.
[0069] The anvil head (48) of the present example comprises a plurality of staple-forming pockets (52) formed on a proximal face (50) of the anvil head (48). Consequently, when the anvil (40) is in the closed position and the staples (66) are driven out of the staple head assembly (20) and into the staple forming pockets (52) as shown in Figure 2C, the legs (68) of the staples (66) are bent to form finished staples. It should be understood that the staple forming pockets (52) are merely optional, and may be omitted in some versions.
[0070] With the anvil (40) as a separate component, it should be understood that the anvil (40) can be inserted and secured to a portion of tissue (2) before being coupled to the stapling head assembly (20). By way of example only, the anvil (40) can be inserted and secured to a first tubular tissue portion (2), while the instrument (10) is inserted and secured to a second tubular tissue portion (2). For example, the first tubular tissue portion (2) can be sutured to or around an incus portion (40), and the second tubular tissue portion (2) can be sutured to or around the trocar (38) .
[0071] As shown in Figure 2A, the incus (40) is then coupled to the trocar (38). The trocar (38) of the present example is shown in a more distal actuated position. This extended position of the trocar (38) can provide a larger area to which the tissue (2) can be attached, prior to fixation of the incus (40). In addition, the extended position of the trocar (38) may also provide easier attachment of the incus (40) to the trocar (38). The trocar (38) additionally includes a tapered distal tip. This tip may be capable of piercing through tissue, and/or assisting in the insertion of the incus (40) into the trocar (38), although the tapered distal tip is merely optional. For example, in other versions the trocar (38) may have a non-perforating tip. Additionally, or alternatively, the trocar (38) may include a magnetic portion (not shown) that can attract the incus (40) toward the trocar (38). Of course, other configurations and arrangements for the anvil (40) and trocar (38) will be apparent to those skilled in the art in view of the teachings contained herein.
[0072] When the anvil (40) is coupled to the trocar (38), the distance between a proximal face of the anvil (40) and a distal face of the clamping head assembly (20) defines a span distance d. The trocar (38) of the present example is translatable longitudinally with respect to the clamping head assembly (20) by means of an adjustment knob (98) located at a proximal end of the actuator cable assembly (70), as will be described with more details below. Consequently, when the anvil (40) is coupled to the trocar (38), the rotation of the adjustment knob (98) widens or reduces the span distance d, by actuating the anvil (40) in relation to the clamping head assembly (20). For example, as shown sequentially in Figures 2A to 2B, the anvil (40) is shown acting proximally to the actuator cable assembly (70), from an initial open position to a closed position, thereby reducing the gap distance d is the distance between the two pieces of fabric (2) to be joined. When the span distance is set within a predetermined range, the stapling head assembly (20) can be fired, as shown in Figure 2C, to staple and cut the fabric (2) between the anvil (40) and the assembly. clipping head (20). The stapling head assembly (20) is intended to staple and cut the fabric (2) by a user turning a trigger (74) of the actuator cable assembly (70), as will be described in more detail below.
[0073] As noted above, the span distance d corresponds to the distance between the anvil (40) and the clamping head assembly (20). When the instrument (10) is inserted into a patient, this gap distance d may not be easily visible. Accordingly, a movable indicator bar (110) shown in Figures 5 to 6 is provided to be visible through an indicator window (120) positioned opposite the trigger (74). The indicator bar (110) is intended to move in response to the rotation of the adjustment knob (98) so that the position of the indicator bar (110) is representative of the span distance d. As shown in Figure 6, the indicator window (120) further comprises a scale (130) that indicates that the anvil span is in a desired operating range (e.g., a green colored region or "green zone") and a corresponding staple compaction representation at each scale end (130). By way of example only, as shown in Figure 6, a first staple image (132) represents a large staple height, while a second staple image (134) represents a small staple height. Consequently, a user can view the position of the attached anvil (40) in relation to the clamping head assembly (20) by means of the indicator bar (110) and the scale (130). The user can then adjust the placement of the anvil (40) via the adjustment knob (98) as needed.
[0074] Referring again to Figures 2A to 2C, a user sutures a portion of the tissue (2) around the tubular element (44) so that the head of the anvil (48) is situated in a portion of the tissue (2) to be stapled. When the fabric (2) is attached to the anvil (40), the retaining clips (46) and a portion of the tubular element (44) protrude from the fabric (2) so that the user can attach the anvil ( 40) to the trocar (38). With tissue (2) attached to the trocar (38) and/or the other portion of the stapling head assembly (20), the user attaches the incus (40) to the trocar (38) and actuates the incus (40) proximally at towards the clamping head assembly (20) to reduce the gap distance d. When the instrument (10) is within the operating range, the user then staples the ends of the fabric (2), thus forming a substantially contiguous tubular portion of the fabric (2).
The anvil (40) can be further constructed in accordance with at least some of the teachings of US Patent No. 5,205,459; US Patent No. 5,271,544; US Patent No. 5,275,322; US Patent No. 5,285,945; US Patent No. 5,292,053; US Patent No. 5,333,773; US Patent No. 5,350,104; U.S. Patent No. 5,533,661, the disclosures of which are incorporated herein by reference; and/or in other embodiments, as will be apparent to one skilled in the art in view of the teachings of the present invention. B. Example Stapling Head Assembly
[0076] The clipping head assembly (20) of the present example is coupled to a distal end of the rod assembly (60) and comprises a tubular housing (22) housing a sliding clip driver (24) and a plurality of clips (66) contained in the clip pockets (32). Clamps (66) and clamp pockets (32) are arranged in a circular matrix around the tubular housing (22). In the present example, staples (66) and staple pockets (32) are disposed in a pair of concentric annular rows of staples (66) and staple pockets (32). The clamp actuator (24) is intended to act longitudinally within the tubular housing (22) in response to rotation of the trigger (74) of the actuator cable assembly (70). As shown in Figures 2A to 2C, the clamp driver (24) comprises an enlarged cylindrical element having a trocar opening (26), a central recess (28) and a plurality of elements (30) circumferentially disposed around the central recess. (28) and extending distally to the stem assembly (60). Each element (30) is configured to contact and engage with a corresponding clip (66) of the plurality of clips (66) in the clip pockets (32). Consequently, when the clip driver (24) is actuated distally to the cable actuator assembly (70), each element (30) drives a corresponding clip (66) out of its clip pocket (32) through a clamp opening (34) formed in a distal end of the tubular housing (22). As each element (30) extends from the staple driver (24), the plurality of staples (66) are driven out of the staple head assembly (20) at substantially the same time. When the anvil (40) is in the closed position, the staples (66) are guided into staple-forming pockets (52) for flexing the legs (68) of the staples (66), thereby staple the material located between the anvil (40) and the stapling head assembly (20). Figure 3 depicts a merely exemplary staple (66) driven by an element (30) in a staple-forming pocket (32) of the anvil (40) for flexing the legs (68).
[0077] The staple driver (24) additionally includes a cylindrical knife (36) that is coaxial to the opening of the trocar (26) and insertion of the staple pockets (32). In the present example, the cylindrical knife (36) is disposed within the central recess (28) to translate distally with the clamp driver (24). When the anvil (40) is secured to the trocar (38), as described above, the head of the anvil (48) provides a surface against which the cylindrical knife (36) cuts the material contained between the anvil (40) and the assembly. of stapling head (20). In some versions, the anvil head (48) may include a recess (not shown) for the cylindrical knife (36) to help cut material (e.g., by providing a cooperative cutting edge). Additionally, or alternatively, the anvil head (48) may include one or more opposing cylindrical knives (not shown) offsetting the cylindrical knife (36) so that it can provide a scissor-like cutting action. Still other configurations will be evident to those skilled in the art in view of the teachings contained herein. The stapling head assembly (20) thus functions both to staple and to cut the fabric (2) substantially simultaneously in response to actuation by the actuator cable assembly (70).
[0078] Logically, the clamping head assembly (20) can be further constructed in accordance with at least some of the teachings of US patent No. 5,205,459; US Patent No. 5,271,544; US Patent No. 5,275,322; US Patent No. 5,285,945; US Patent No. 5,292,053; US Patent No. 5,333,773; US Patent No. 5,350,104; U.S. Patent No. 5,533,661, the disclosures of which are incorporated herein by reference; and/or in other embodiments, as will be apparent to one skilled in the art in view of the teachings of the present invention.
[0079] As noted earlier, the staple driver (24) includes a trocar opening (26). The trocar opening (26) is configured to allow the trocar (38) to slide longitudinally with respect to the clamping head assembly (20) and/or stem assembly (60). As shown in Figures 2A to 2C, the trocar (38) is coupled to a trocar actuator (39) so that the trocar (38) can be actuated longitudinally by rotating the rotary knob (98), as will be described with more details below with reference to the actuator cable assembly (70). In the present example, the trocar actuator (39) comprises an elongated, relatively rigid rod coupled to the trocar (38), although this is merely optional. In some versions, the actuator (39) can comprise a longitudinally rigid material while allowing lateral flexion so that portions of the instrument (10) can be selectively flexed or curved during use; or the instrument (10) may include a previously prepared bent rod assembly (60). A merely exemplary material is nitinol. When the anvil (40) is coupled to the trocar (38), the trocar (38) and the incus (40) are translatable by means of the actuator (39) to adjust the span distance d between the anvil (40) and the assembly. of stapling head (20). Still other additional configurations for the actuator (39) to longitudinally actuate the trocar (38) will be evident to the person skilled in the art, in view of the teachings contained herein. C. Rod Assembly Example
[0080] The stapling head assembly (20) and the trocar (38) are positioned at a distal end of the rod assembly (60), as shown in Figures 2A to 2C. The rod assembly (60) of the present example comprises an outer tubular member (62) and a drive actuator (64). The outer tubular element (62) is coupled to the tubular casing (22) of the clamping head assembly (20) and to a body (72) of the actuator cable assembly (70), thus providing mechanical support for the actuator components there. contained. The proximal end of the actuating actuator (64) is coupled to a trigger actuating assembly (84) of the actuator cable assembly (70), described below. The distal end of the trigger actuator (64) is coupled to the staple driver (24) so that rotation of the trigger (74) longitudinally actuates the staple trigger (24). As shown in Figures 2A to 2C, the actuating actuator (64) comprises a tubular element having an open longitudinal axis so that the actuator (39) coupled to the trocar (38) can actuate longitudinally and in relation to the actuating actuator (64 ). It should, of course, be understood that other components may be disposed within the drive actuator (64), as will be evident to one of ordinary skill in the art in view of the teachings contained herein.
[0081] The rod assembly (60) may be further constructed in accordance with at least some of the teachings of US Patent No. 5,205,459; US Patent No. 5,271,544; US Patent No. 5,275,322; US Patent No. 5,285,945; US Patent No. 5,292,053; US Patent No. 5,333,773; US Patent No. 5,350,104; US Patent No. 5,533,661. which disclosures are incorporated herein by reference; and/or in other embodiments, as will be apparent to one skilled in the art in view of the teachings of the present invention. D. Example of Actuator Cable Assembly
[0082] Now with reference to Figures 4A to 5, the actuator cable assembly (70) comprises a body (72), a trigger (74), a locking feature (82), a trigger drive assembly (84) and a trocar drive assembly (90). The trigger (74) of the present example is pivotally mounted to the body (72) and is coupled to the trigger drive assembly (84) so that the trigger drive (74) rotates from an unfired position (shown in Figure 4A) to a triggered position (shown in Figure 4B) engage the drive actuator (64) described above. A spring (78) is coupled to the body (72) and the trigger (74) to bias the trigger (74) toward the unfired position. The locking feature (82) is a pivoting element that is coupled to the body (72). In a first, locked position, the locking feature (82) is rotated up and away from the body (72) so that the locking feature (82) engages the trigger (74) and mechanically resists the triggering of the trigger. (74) by a user. In a second unlocked position, as shown in Figures 1 and 4B, the locking feature (82) is rotated downward so that the trigger (74) can be actuated by the user. Consequently, with the locking feature (82) in the second position, the trigger (74) can engage a trigger drive assembly (84) to trigger the instrument (10).
[0083] As shown in Figures 4A and 4B, the trigger drive assembly (84) of the present example comprises a sliding trigger carriage (86) engaged with a proximal end of the drive actuator (64). Carriage (86) includes a set of tabs (88) on a proximal end of carriage (86) for retaining and engaging a pair of trigger arms (76) extending from trigger (74). Consequently, when the trigger (74) is rotated, the carriage (86) is driven longitudinally and transfers the longitudinal movement to the drive actuator (64). In the example shown, carriage (86) is fixedly coupled to the proximal end of drive actuator (64), although this is merely optional. In fact, in a merely alternative example, the carriage (86) may simply be bordered by the drive actuator (64), while a distal spring (not shown) tilts the drive actuator (64) proximally to the actuator cable assembly (70).
[0084] The trigger actuation assembly (84) may be further constructed in accordance with at least some of the teachings of US Patent No. 5,205,459; US Patent No. 5,271,544; US Patent No. 5,275,322; US Patent No. 5,285,945; US Patent No. 5,292,053; US Patent No. 5,333,773; US Patent No. 5,350,104; U.S. Patent No. 5,533,661, the disclosures of which are incorporated herein by reference; and/or in other embodiments, as will be apparent to one skilled in the art in view of the teachings of the present invention.
[0085] The body (72) also houses a trocar drive assembly (90) configured to drive the trocar (38) longitudinally in response to rotation of the adjustment knob (98). As best shown in Figures 4A through 5, the trocar drive assembly (90) of the present example comprises the adjustment knob (98), a splined rod (94) and a sleeve (92). The splined stem (94) of the present example is situated at a distal end of the trocar actuator (39), although it should be understood that the splined stem (94) and the trocar actuator (39) may alternatively be separate components which engage to transmit longitudinal movement. The adjustment knob (98) is pivotally supported by the proximal end of the body (72), and functions to rotate the sleeve (92) which is engaged with the splined rod (94) by means of an inner tab (not shown ). The splined rod (94) of the present example comprises a continuous groove (96) formed in the outer surface of the splined rod (94). Consequently, when the adjustment knob (98) is turned, the inner tab moves into the groove (96) and the splined rod (94) is actuated longitudinally with respect to the sleeve (92). As the splined rod (94) is situated at the distal end of the trocar actuator (39), turning the adjustment knob (98) in a first direction advances the trocar actuator (39) distally relative to the actuator handle assembly ( 70). Consequently, the gap distance d between the anvil (40) and the clamping head assembly (20) is increased. By turning the adjustment knob (98) in the opposite direction, the trocar actuator (39) is actuated proximally to the actuator cable assembly (70) to reduce the gap distance d between the anvil (40) and the stapling head assembly (20). Thus, the trocar drive assembly (90) is intended to drive the trocar (38) in response to the rotary adjustment knob (98). Of course, other configurations for the trocar drive assembly (90) will be evident to one of ordinary skill in the art in view of the teachings contained herein.
The groove (96) of the present example comprises a plurality of different portions (96A, 96B, 96C) having a different range or number of grooves per axial distance. The present groove (96) is divided into a distal portion (96A), a middle portion (96B) and a proximal portion (96C). As shown in Figure 5, a distal portion (96A) comprises a fine pitch or a high number of grooves along a short axial distance from the splined rod (94) so that a large number of rotations of the adjustment knob are required. (98) to travel the short axial distance. The middle portion (96B) comprises a section with comparably thicker gap or with fewer grooves per axial distance so that relatively few rotations are needed to traverse a long axial distance. Consequently, the span distance d can be quickly reduced by relatively few rotations of the adjustment knob (98). The proximal portion (96C) of the present example is substantially similar to the distal portion (96A) and comprises a thin gap or a high number of grooves for a short axial distance from the splined rod (94) so that a large number of rotations is required. to traverse the short axial distance. The proximal portion (96C) of the present example is positioned in the sleeve (92) when the anvil (40) is substantially close to the clamping head assembly (20) so that an indicator bar (110) moves within the indicator window ( 120) along the scale (130) to indicate that the anvil span is within a desired operating range, as will be described in detail below. Consequently, when the tab is within the proximal portion (96C) of the groove (96), each rotation of the adjustment knob (98) can reduce the span distance d to a small amount to provide fine tuning.
[0087] The trocar actuation assembly (90) can be further constructed in accordance with at least some of the teachings of US Patent No. 5,205,459; US Patent No. 5,271,544; US Patent No. 5,275,322; US Patent No. 5,285,945; US Patent No. 5,292,053; US Patent No. 5,333,773; US Patent No. 5,350,104; U.S. Patent No. 5,533,661, the disclosures of which are incorporated herein by reference; and/or in other embodiments, as will be apparent to one skilled in the art in view of the teachings of the present invention.
[0088] In the example shown in Figures 4A through 4B, a U-shaped clip (100) is attached to an intermediate portion of the trocar actuator (39) located distally from the splined rod (94). The U-shaped clip (100) engages with a body portion (72) to substantially prevent the trocar actuator (39) from rotating about its axis when the adjustment knob (98) is rotated. The U-shaped tab (100) further includes an elongated slot (102) on each of its opposite sides for receiving a fastening element, such as a screw, bolt, pin, clip, etc., for selectively adjusting the longitudinal position of the elongated slit (102) of the U-shaped clamp (100) with respect to the trocar actuator (39), for the purpose of calibrating the indicator bar (110) with respect to the scale (130).
[0089] As shown in Figure 5, the actuator cable assembly (70) further includes an indicator bracket (140) configured to engage and rotate an indicator (104). The indicator bracket (140) of the present example is slidable relative to the body (72) along a pair of slits formed in the body (72). The indicator bracket (140) comprises a rectangular plate (144), an indicator arm (146) and an angled flange (142). Angle flange (142) is formed at the proximal end of the rectangular plate (144), and includes an opening (not shown) to be slidably mounted over the trocar actuator (39) and/or the splined rod (94). A coil spring (150) is interposed between the flange (142) and a protrusion (152) to bias the flange (142) against the U-shaped tab (100). Consequently, when the U-shaped clip (100) acts distally with the trocar actuator (39) and/or the splined rod (94), the coil spring (150) forces the indicator bracket (140) to move distally with the U-shaped loop (100). In addition, the U-shaped clamp (100) forces the indicator bracket (140) proximally to the protrusion (152) as the trocar actuator (39) and/or the splined rod (94) translate proximally, compressing , thus, the coil spring (150). Of course, it should be understood that, in some versions, the indicator bracket (140) may be fixedly attached to the trocar actuator (39) and/or the splined rod (94).
[0090] In the present example, a portion of the locking feature (82) abuts a surface (141) of the indicator bracket (140), when said indicator bracket (140) is in a longitudinal position that does not correspond to when the anvil span is within a desired operating range (for example, a green colored region or "green zone"). When the anvil span is within a desired operating range (eg, a green colored region or "green zone"), the indicator bracket (140) thins to provide a pair of spans (145) on either side of an indicator arm (146) that allows the locking feature (82) to rotate, thereby releasing the trigger (74). Consequently, the locking feature (82) and indicator bracket (140) can substantially prevent a user from releasing and operating the trigger (74) until the anvil (40) is in a predetermined operating range. It should be understood, of course, that the locking feature (82) may be omitted entirely in some versions.
[0091] This operating range can be visually communicated to the user by means of an indicator bar (110) of an indicator (104) shown against a scale (130) described briefly above. At the distal end of the index bracket (140) is a distally extending index arm (146) which terminates in a laterally extending finger (148) to control movement of the index (104). The indicator arm (146) and finger (148), best shown in Figure 5, are configured to engage a tab (106) of the indicator (104) so that the indicator (104) is rotated when the indicator bracket ( 140) is actuated longitudinally. In the present example, the indicator (104) is rotatably coupled to the body (72) at a first end of the indicator (104), although this is merely optional, and other pivot points of the indicator (104) will be evident to those skilled in the art. technique, in view of the teachings contained herein. An indicator bar (110) is positioned at the second end of the indicator (104) so that the indicator bar (110) moves in response to actuation of the indicator bracket (140). Consequently, as discussed above, the indicator bar (110) is displayed through an indicator window (120) against a scale (130) (shown in Figure 6) to show the relative span distance d between the anvil (40) and the stapling head assembly (20).
[0092] Logically, the indicator bracket (140), the indicator (104), and/or the actuator cable assembly (70) can be additionally constructed in accordance with at least some of the teachings of US Patent No. 5,205,459 ; US Patent No. 5,271,544; US Patent No. 5,275,322; US Patent No. 5,285,945; US Patent No. 5,292,053; US Patent No. 5,333,773; US Patent No. 5,350,104; U.S. Patent No. 5,533,661, the disclosures of which are incorporated herein by reference; and/or in other embodiments, as will be apparent to one skilled in the art in view of the teachings of the present invention. II. Trans-oral circular anvil exemplifying systems
[0093] As described above, the anvil (40) can be provided as a separate component, so that the anvil (40) can be inserted and secured to a portion of tissue (2) before being coupled to the head assembly. clipping (20). For example, it may be desirable to introduce the incus (40) trans-orally for procedures into a patient's gastrointestinal tract (eg, an esophagectomy). Figure 7 represents an early stage of an anastomosis procedure to attach cut sections of the esophagus (2, 4) after an esophagectomy. The incus (40) is inserted trans-orally through the esophagus and is positioned within a first cut section (2) of the esophagus. The instrument (10) is inserted through the stomach and positioned within a second cut section (4) of the esophagus. The incus (40) is then attached to the trocar (38) of the instrument (10) to staple and join cut sections (2, 4) of the esophagus in an anastomosis. The anvil (40) may also be inserted into other body lumens or regions of the gastrointestinal tract to perform an anastomosis, as will be apparent to one of skill in the art in view of the teachings of the present invention. After insertion, it may be desirable to provide a trans-oral circular incus locking assembly to couple the incus (40) to the trocar (38). It may also be desirable to align the staple pockets (52) with the staples (66) of the staple head assembly (20) with an anvil alignment assembly. The incus (40) can be introduced through a naturally occurring bodily lumen (eg, the esophagus) to couple the incus (40) to the trocar (38) using an incus delivery system. The examples below include several versions of the anvil (40) that can be easily introduced into an anastomotic site trans-orally. Various versions of rotational anvil alignment elements are also described below, which can be easily inserted to align the staple pockets (52) of the anvil (40) with the staples (66) of the stapling head assembly (20) . Other examples of these elements will be apparent to one skilled in the art in view of the teachings of the present invention. It should be understood that the teachings below can be easily incorporated into the instrument (10) described above. A. Exemplary anvil locking elements
[0094] Figures 8A-9D show an exemplary anvil locking element (200). The anvil locking member (200) comprises an anvil (240), an anvil sleeve (242), and a trocar (238). The anvil (240) is similar to the anvil (40) described above. The anvil (240) has a disk-shaped configuration comprising a proximal surface (250) and a distal surface (248), with an internal opening (243). The anvil (240) further comprises staple pockets (252) aligned around the proximal surface (250). Staple pockets (250) may also be formed on the distal surface (248).
[0095] The anvil sleeve (242) is sized to be inserted into the inner opening (243) of the anvil (240). The anvil glove (242) comprises the flaps (244) and the suture (246). The tabs (244) can be resiliently tensioned to extend outwardly from the anvil sleeve (242) as shown in Figure 8A. The anvil sleeve (242) is inserted into the inner opening (243) of the anvil (240) through the proximal surface (250), as also shown in Figure 8A. When the anvil sleeve (242) is inserted into the anvil (240), the tabs (244) are pushed against the inner opening (243) to slide through the inner opening (243), as shown in Figure 8B. When the flaps (244) of the anvil sleeve (242) are inserted after the anvil (240), the flaps (244) fold to their original position and extend outward from the sleeve (244) as shown in the figure. 8C. The tabs (244) rest against the distal surface (248) of the anvil (240) to prevent the anvil (240) from sliding distally out of the anvil sleeve (242). The suture (246) of the anvil glove (242) is then used to pull the anvil (240) and the anvil glove (242) through a naturally occurring bodily lumen (e.g., esophagus, colon, or other portion of the body). GI tract) to a desired location (eg, an anastomotic site).
[0096] When the incus (240) is positioned at a desired location within the patient, the trocar (238) is coupled to the incus (240) as shown in Figures 9A-9D. The trocar (238) comprises the rod (260), the inner rod (261), the tip (264), and the wings (262). The shank (260) is sized to match the internal opening (243) of the anvil (240). The tip (264) is positioned at the distal end of the rod (260). The inner rod (261) is positioned along the rod (260) proximal to the tip (264) and comprises a smaller diameter than the rod (260). The wings (262) are coupled to the trocar (238) so that the wings (262) are positioned along the inner shaft (261) and are flush with the shaft (260). The wings (262) rotate relative to the trocar (238) via pins (263). The tip (264) of the trocar (238) is inserted into the internal opening (243) of the anvil (240) through the anvil sleeve (242). The taper of the tip (264) and the flared configuration of the proximal end of the anvil glove (242) help guide the trocar (238) into the anvil glove (242). As the trocar (238) moves distally through the anvil (240), the rod (260) and wings (262) contact the tabs (244) of the anvil sleeve (242) to rotate the tabs (244) flush with the sleeve (242) as shown in figure 9B. When the tabs (244) are rotated, the suture (246) is pulled proximally to slide the anvil sleeve (242) proximally across the anvil (240). When the glove (242) is pulled proximally, the trocar (238) continues to be pushed distally through the anvil (240). When the wings (262) of the trocar (238) are pushed past the incus (240), the wings (262) rotate outwardly relative to the shaft (261). The wings (262) can be resiliently pulled to pivot outward to extended positions; or the wings (262) can be actuated to rotate to these positions. The wings (262) then rest against the distal surface (248) of the incus (240) to lock the trocar (238) relative to the incus (240), as shown in Figure 9C. The sleeve (242) continues to be pulled proximally along the shaft (262) of the trocar (238) to remove the sleeve (242) from the anvil (240), as shown in Figure 9D. Alternatively, the sleeve (242) can be destroyed to completely remove the sleeve (242) from the shaft (262) of the trocar (238). Suitable methods for removing the glove (242) will be apparent to one of skill in the art in view of the teachings of the present invention.
[0097] Another exemplary anvil locking element (300) is shown in Figures 10-11C. The anvil locking member (300) comprises an anvil (340) and a trocar (338). The anvil (340) is similar to the anvil (240) described above. The anvil (340) comprises an internal opening (343) and staple pockets (352) aligned around a surface of the anvil (340). The anvil (340) may also have two sides so that staple pockets (252) can be formed on both surfaces of the disc-shaped anvil (340). The trocar (338) comprises an expansion tip (364), a rod (360), an inner member (366) and fins (368). The expansion tip (364) is configured to fit within the internal opening (343) of the anvil (340) and comprises the recesses (363). The recesses (363) align and correspond with the wall of the inner opening (343) of the anvil (340). The expansion tip (364) is positioned distally to the rod (360). The inner element (366) is positioned within the rod (360) so that the inner element (366) translates relative to the rod (360). The inner element (366) comprises a cam portion (362) at the distal end of the inner element (366). The cam portion (362) comprises the recesses (361). The inner member (366) further comprises a flange (372) for securing the resilient member (370) within an inner recess (371) of the rod (360). The resilient member (370) is tensioned to push the flange (372) and the inner member (366) proximally into the rod (360). The fins (368) are coupled to the rod (360) so that the fins (368) rotate with respect to the rod (360) via live hinges (369). The fins (368) are resiliently pulled inward towards the rod (360). The fins (368) comprise inwardly extending protrusions (367) that correspond to the recesses (361) of the cam portion (362).
[0098] As shown in Figures 11A-11C, the trocar (338) is inserted into the incus (340) to secure the incus (340) relative to the trocar (338). As shown in Figure 11A, the incus (340) is being attached to the trocar (338). Before the wall of the inner opening (343) of the anvil (340) reaches the recesses (363) of the expansion tip (364), the fins (368) are in a flattened position so that the protrusions (367) of the fins (368) are engaged with the recesses (361) of the cam portion (362). The protrusions engage the recesses (361) to longitudinally secure the inner member (366) with respect to the rod (360). With the expansion tip (364) in a flattened position, the tip (364) is inserted deeper into the inner opening (343) of the anvil (340). As shown in Figure 11B, the tip (364) of the trocar (338) is further inserted into the incus (340) to align the wall of the inner opening (343) with the recesses (363). When the anvil (340) is aligned around the trocar (338), the anvil (340) contacts the fins (368) to rotate the fins (368) outward from the shaft (360) through live hinges. (369). As the fins (368) rotate outward, the protrusions (367) disengage from the recesses (361) of the inner member (366). This unlocks the inner member (366) from the fins (368) to allow the inner member (366) to translate longitudinally relative to the shaft (360). As shown in Figure 11C, the resilient member (370) pushes the flange (372) of the inner member (366) proximally to the stem (360) in response to the inner member (366) being unlocked from the fins (368). When the inner member (366) translates proximally, the cam portion (362) slides proximally to push the expansion tip (364) outwardly to an expanded position. The recesses (363) of the expansion tip (364) then engage the wall of the inner opening (343) of the incus (340) to lock the incus (340) with respect to the trocar (338). The actuator (39) is then used to adjust the span distance d between the anvil (340) and the trocar (338). The trigger (74) is actuated to direct the stapling head assembly (20) to perform an anastomosis between the cut sections of the esophagus. B. Exemplary anvil locking and alignment elements
[0099] In addition to securing an anvil (40) to a trocar (38), the anvil (40) is pivotally aligned with the trocar (38) so that the staple pockets (53) of the anvil (40) are aligned with the clamps (66). Various examples of such rotational alignment features will be described in more detail below, while other examples will be apparent to those skilled in the art in view of the teachings of the present invention. 1. Exemplary pivoting tabs
[00100] Figures 12A-13 show an exemplary anvil alignment assembly (400). The anvil alignment assembly comprises the anvil (440) and the trocar (438). The anvil (440) is similar to the anvil (340), except that the anvil (440) additionally comprises alignment elements (442). As shown in Figure 13, a plurality of alignment elements (442) are aligned around the inner opening (443) of the anvil (440). The alignment elements (442) comprise inwardly extending recesses around the anvil (440). The trocar (438) comprises a tip (464), a rod (460), the inner element (480), the fins (468), and expansion elements (462, 466). The tip (464) is positioned at the distal end of the stem (460). Stem (460) comprises fins (468) that extend outwardly from stem (460). The fins (468) comprise engaging elements (469) and tabs (470). The engagement elements (469) comprise protrusions extending distally from the fins (468) and are configured to complement and engage the alignment elements (442) of the anvil (440). The tabs (470) rotate relative to the fins (468) via the pins (467). The tabs (470) comprise cam surfaces (472) and protrusions (474). The protrusions (474) fit into the openings (476) of the inner member (480), which is translatable relative to the stem (460). The first expansion element (462) is coupled to a protrusion (461) of the inner element (469). The first expansion element (462) pivots outwardly relative to the rod (460). The second expansion element (466) is coupled to the first expansion element (462) via pins (463). The second expansion element (466) is coupled to the rod (460) next to the first expansion element (462) via pins (465). The second expansion element (466) also pivots outwardly relative to the rod (460). Although two sets of expansion elements (462, 466) are shown, any other suitable quantity can be used.
[00101] As shown in Figure 12A, the trocar (438) is coupled to the incus (440) when the incus alignment assembly (400) is in a flat configuration. In this configuration, the expansion elements (462, 466) rest against the rod (460). The tabs (470) are pivoted out so that the protrusions (474) are engaged with the openings (476) of the inner member (480). This secures the inner element (480) relative to the rod (460). The tip (464) of the trocar (438) is then inserted into the internal opening (443) of the incus (440) as shown in Figure 12B. When the trocar (438) is inserted into the anvil (440), the engagement elements (469) of the fins (468) are inserted into the alignment elements (442) of the anvil (440). This ensures that the anvil (440) is rotated to a position in which the staple pockets (452) are aligned with the staples (66) of the staple head assembly (20). The cam surfaces (472) of the flaps (470) engage the wall of the inner opening (443) to rotate the flaps (470) inwardly while the trocar (438) is inserted into the anvil (400). As the tabs (470) pivot inward, the protrusions (474) unlock from the openings (476) of the inner member (480). This allows the inner element (480) to translate relative to the rod (460). As shown in Figure 12C, the inner member (480) is translated proximally with respect to the shaft (460) to expand the anvil alignment assembly (400) to an expanded configuration. By way of example only, the inner element (480) may be translated by an element similar to the resilient member (370) within a recess (371) of the rod (460) as described above. Other suitable ways in which the inner member (480) may be translated will be apparent to those skilled in the art in view of the teachings of the present invention. When the inner member (480) translates proximally, the bulge (461) of the inner member (480) also translates proximally. Because a second expansion element (466) is attached to the rod (460), the translation of the inner element (480) causes the proximal end of the first expansion element (462) to rotate outwardly from the rod (460 ) and a distal end of the second expansion element (466) pivots outwardly from the rod (460). The second expansion element (466) contacts the anvil (440) to hold the anvil (400) in place relative to the trocar (438) between the second expansion element (466) and the fins (468). The actuator (39) is then used to adjust the span distance d between the anvil (340) and the trocar (338). The trigger (74) is actuated to direct the stapling head assembly (20) to perform an anastomosis between the cut sections of the esophagus. 2. Exemplary trocar with ribs
[00102] Another exemplary anvil alignment set (500) is shown in Figures 14 to 15C. The anvil alignment assembly (500) comprises the anvil (540) and the trocar (538). The anvil (540) is similar to the anvil (340), except that the anvil (540) additionally comprises alignment elements (542). The alignment elements (542) each comprise an angled surface (541). As shown in Figure 14, a plurality of alignment elements (542) are circumferentially spaced around the wall of the inner opening (543) of the anvil (540). The trocar (538) comprises a stem (560), the tip (564), the ribs (562), and the flaps (568). The rod (560) extends from the clamping head assembly (20). The diameter of the rod (560) gradually reduces as the rod (560) extends from the clamping head assembly (20). The tip (564) is positioned at the distal end of the rod (560). At least one rib (562) extends along the stem (560). Any suitable amount of ribs (562) will be apparent to one skilled in the art in view of the teachings of the present invention. For example, the number of ribs (562) can correspond to the number of alignment elements (542). The tabs (568) extend and rotate relative to the rod (560).
[00103] As shown in Figures 15A-15C, the trocar (538) is inserted into the incus (540). When the trocar (538) is inserted, the ribs (562) of the shaft (560) engage the alignment elements (542) of the anvil (540). The angled surfaces (541) of the alignment elements (542) cause the anvil (540) to rotate into position to align with the ribs (562). This also aligns the staple pockets (552) of the anvil (540) with the staples (66) of the staple head assembly (20). The trocar (538) continues to be inserted through the incus (540). The flaps (568) of the trocar (538) can be resiliently tilted to an outward position. As the anvil (540) passes over the flaps (568), the anvil (540) causes the flaps (568) to rotate inward. When the anvil (540) passes the tabs (568), the tabs (568) then pivot back outward to engage the top surface of the anvil (540), as shown in Figure 15C. This holds the incus (540) in place relative to the trocar (538). The actuator (39) is then used to adjust the span distance d between the anvil (540) and the trocar (538). The trigger (74) is actuated to direct the stapling head assembly (20) to perform an anastomosis between the cut sections of the esophagus.
[00104] Another exemplary incus alignment assembly (1500) is shown in Figures 16 to 19. The incus alignment assembly (1500) comprises the incus (1540) and the trocar (1538). The anvil (1540) is similar to the anvil (540), except that the anvil (1540) comprises a pair of alignment elements (1580). As shown in Figures 18 to 19, the pair of alignment elements (1580) extends from the wall of the inner opening (1543) of the anvil (1540) and comprises an inclined configuration in the form of a coarse half-thread. The two alignment elements (1580) extend around only a portion of the inner wall of the opening (1543) to form recesses (1581) between the alignment elements (1580). The helical and slanted configuration of the alignment elements (1580) allows the anvil (1540) to rotate to come into alignment. The slanted configuration of the alignment elements (1580) provides a two-sided anvil (1540) so that the anvil (1540) is rotated by the alignment elements (1580) when the trocar (1538) is inserted on either side of the anvil ( 1540). The trocar (438) comprises a stem (1560), the tip (1564), a pair of ribs (1562), and the flaps (1568). The rod (1560) extends from the clamping head assembly (20). The tip (1564) is positioned at the distal end of the rod (1560). The ribs (1562) extend along the shank (1560) to match the recesses (1581) of the anvil (1540). The ribs (1562) comprise angled surfaces (1561) for engaging the alignment elements (1580) of the anvil (1540) to orient the anvil (1540) for rotational alignment. The tabs (1568) extend and rotate relative to the stem (1560). As shown in Figure 17, the tabs (1568) are resiliently biased outward by the resilient member (1566). The flaps (1568) are angled to allow the anvil (1540) to slide over the flaps (1568) and push them inward.
[00105] In an exemplary use, the trocar (1538) is inserted into the incus (1540). When the trocar (1538) is inserted, the ribs (1562) of the rod (1560) engage the alignment elements (1580) of the anvil (1540). The slanted configuration of the alignment elements (1580) allows the anvil (1540) to rotate into position until the ribs (1562) insert into the recesses (1581). This also aligns the staple pockets (1552) of the anvil (1540) with the staples (66) of the staple head assembly (20). The trocar (1538) continues to be inserted through the incus (1540). As the anvil (1540) passes over the tabs (1568), the anvil (1540) causes the tabs (1568) to rotate inward against the resilient member (1566). When the anvil (1540) passes the tabs (1568), the resilient member (1566) then tilts the tabs (1568) back outward to engage the top surface of the anvil (1540). This holds the incus (1540) in place relative to the trocar (1538). The actuator (39) is then used to adjust the span distance d between the anvil (1540) and the trocar (1538). The trigger (74) is actuated to direct the stapling head assembly (20) to perform an anastomosis between the cut sections of the esophagus. 3. Exemplary recessed trocar
[00106] Alternatively, a trocar shaft (638) may comprise cam alignment recesses (672) instead of ribs (562) as shown in Figures 20 through 21C. The incus alignment assembly (600) is similar to the incus alignment assembly (500), except that the trocar (638) comprises the recesses (672). The anvil (640) comprises alignment elements (642) that extend from the wall of the inner opening (643) to match the recesses (672) of the trocar (638). Although two recesses (672) and two alignment elements (642) are shown, any suitable number of recesses (672) can be used to match any number of alignment elements (642). The recesses (672) comprise cam surfaces (670) for orienting the alignment elements (642) of the anvil (640) to the detents (672). This allows the anvil (640) to rotate into position to align with the recesses (672) which align the staple pockets (652) of the anvil (640) with the staples (66) of the staple head assembly (20) . Similar to the anvil alignment assembly (500), the tabs (668) of the anvil alignment assembly (600) hold the anvil (640) in place with respect to the trocar (638). C. Exemplary anvil insertion and locking elements
[00107] As shown in Figures 22 to 23, an anvil (740) is introduced through a naturally occurring bodily lumen (eg, the esophagus) using an incus delivery system (700). The anvil (740) is similar to the anvil (40) described above. The anvil (740) further comprises a sleeve (750) extending from the anvil shank (744). The sleeve (750) comprises a flexible section (748), openings (742), and the collar (749). The flexible section (748) allows the sleeve (750) to deform to various angles and configurations, such as the 90 degree angle shown in Figure 22. The openings (742) are located on opposite sides of the proximal end of the sleeve (750) . The collar (749) extends from the sleeve (750) and is positioned proximal to the openings (742). The collar (749) is formed from a rigid material. The system for introducing the anvil (700) further comprises the suture (746) and the tube (747). The suture (746) is wound through the anvil (740) and the glove (750) to form a loop. The suture (746) is then pulled through the tube (747) to hold the ends of the suture (746) together. The tube (747) and suture (746) are then used to pull the incus (740) through the esophagus (or some other region of the gastrointestinal tract, etc.) to a desired stapling location.
[00108] Once in position, the tube (747) and suture (746) are removed from the incus (740) and the incus (740) is attached to the trocar (738). The trocar (738) of this example comprises a rod (760) extending from the clamping head assembly (20). The rod (760) comprises a tip (764) at the distal end of the rod (760) and resilient tabs (766) extending from the rod (760). The tip (764) of the trocar (738) is inserted into the glove (750) until the tabs (766) align with the openings (742) of the glove (750). When the trocar (738) is inserted into the glove (750), the collar (749) flexes the tabs (764) inwardly to allow the trocar (738) to slide into the glove (750). The tabs (764) then flex outwardly through the openings (742) to secure the glove (750) relative to the trocar (738). The flexible section (748) of the glove (750) then flexes to stretch the glove (750) and align the anvil (740) with the clamping head assembly (20) while the trocar (738) is pulled proximally to pull the anvil. (740) toward the stapling head assembly (20).
[00109] Another exemplary system for introducing the anvil (800) is shown in Figures 24A-24D. The incus introduction system (800) is similar to the incus introduction system (700), except that the incus introduction system (800) comprises an expansion trocar (838) to lock the incus (840) with respect to the trocar (838). The trocar (838) comprises a rod (860) with recesses (863), an inner member (866) with a cam portion (862) at the distal end of the inner member (866), and an expansion tip (864). The inner element (866) is positioned within the rod (860) and is translatable relative to the rod (860). As described above, the trocar (838) is inserted into the anvil glove (850). As the trocar (838) advances through the sleeve (850), the flexible section (848) flexes to grind the sleeve (850) and align the anvil (840) with the clamping head assembly (20), as shown in the figure. 24B. A conventional gripper can be used to grip the anvil glove (850) to hold the anvil glove (850) in place while the trocar (838) is advanced through the anvil glove (850). The trocar (838) advances through the sleeve (850) until the recess (863) is aligned above the sleeve (850), as shown in Figure 24C. The inner element (866) is then pulled or translated proximally. When the inner member (866) slides proximally, the cam portion (862) of the inner member (866) pushes the expansion tip (864) outward so that the recesses (863) engage the upper face of the sleeve (850) to secure the incus (840) relative to the trocar (838). The inner member (866) may comprise a protrusion to align with an opening in the shaft (860) to maintain the longitudinal position of the inner member (866) relative to the shaft (860). Alternatively, any other suitable elements can be used to selectively lock the longitudinal position of the inner element (866) relative to the rod (860).
[00110] Another exemplary system for introducing the anvil (900) is shown in Figures 25A to 27. The system for introducing the anvil (900) is similar to the system for introducing the anvil (700), except that the sleeve (950) comprises a plurality of rigid sections (948) along the flexible sleeve (950). The anvil sleeve (950) is inserted through the inner opening (943) of the anvil (940). The sleeve (950) is formed from a malleable material and comprises a plurality of rigid sections (948), a first ring (982), a second ring (983), and openings (942). The rigid sections (948) are aligned along one side of the sleeve (950) to allow the sleeve (950) to flex approximately 180 degrees. Alternatively, the sleeve (950) may be formed of a rigid material and comprise a plurality of flexible sections that are positioned across the sleeve (950) and act as living hinges to allow the sleeve (950) to flex. Other suitable configurations for rigid sections (948) will be apparent to one skilled in the art in view of the teachings of the present invention. The rings (982, 983) are positioned on the ends of the sleeve (950). The rings (982) are formed from a rigid material. The openings (942) are positioned adjacent to the rings (982, 983). The sleeve (950) is configured so that either end of the sleeve (950) can be attached to the trocar (938). The trocar (938) comprises a rod (960) extending from the clamping head assembly (20), a tip (964) at the distal end of the rod (960), and tabs (968) extending therefrom. of the rod (960). The tabs (968) are configured to flex inward and align with the openings (942) in the sleeve (950).
[00111] As shown in Figure 25A, the sleeve (950) is inserted and wrapped around the anvil (940). The jaws (946) of a claw (947) are then used to grip a ring (982) of the glove (950) and pull the anvil (940) down through a first cut section of the esophagus (2) to a desired anastomotic site. The claw (947) can be used to pull a ring (982) from the sleeve (950) through a portion of the first cut section of the esophagus. The trocar (938) and stapling head assembly (20) can be inserted through a second cut section of the esophagus. The claw (947) then slides the ring (982) over the trocar (938). When the tip (964) of the trocar (938) is inserted into the sleeve (950), the ring (982) flexes the tabs inward until the tabs (968) align with the openings (942) of the sleeve (950). The flaps (968) then flex outward through the openings (942) to lock the sleeve (950) to the trocar (938), as shown in Figure 25B. The claw (947) can then be removed. The trocar (938) is then translated relative to the stapling head assembly (20) to pull the sleeve (950) into the stapling head assembly (20). When the sleeve (950) is translated proximally, the flexible and rigid sections (948) of the sleeve (950) slide across the anvil (940) to stretch the sleeve (950) and align the anvil (940) with the head assembly. clipping (20), as shown in figure 25C. As the trocar (938) continues to retract into the clamping head assembly (20), the anvil (940) slides along the sleeve (950) until the anvil (940) reaches the ring (983) at the end of the sleeve (950), as shown in figure 25D. Depending on which end of the glove (950) is attached to the trocar (938), one of the rings (982, 983) holds the incus (950) in place relative to the trocar (938). The actuator (39) is then used to adjust the span distance d between the anvil (940) and the trocar (938). The trigger (74) is actuated to direct the stapling head assembly (20) to perform an anastomosis between the cut sections of the esophagus.
[00112] Alternatively, an anvil (1040) is introduced through a body lumen (eg the esophagus) with the incus delivery system (1000) shown in Figures 28 to 32. As shown in Figures 31 to 32, the anvil (1040) comprises clip pockets (1052) aligned around both surfaces of the disc-shaped anvil (1040). The anvil (1040) further comprises an internal opening (1043) and an integral loop (1042) extending from a sidewall of the anvil (1040). A suture (1046) is tied to the loop (1042) of the anvil (1040). The inner opening (1043) comprises flexible tabs (1044) for engaging a trocar (38, 238, 338, 438, 538, 638, 738, 838, 938), similarly to a coil spring. The other end of the suture (1046) is tied to a loop (1049) of the introducer element (1048). The introducer element (1048) is used to guide the anvil (1040) through the esophagus to a desired stapling location. The introducer element (1048) can be trans-orally inserted with the anvil (1040) to pull the anvil (1040) through the esophagus (Figure 28). Alternatively, the introducer element (1048) can be inserted through the stomach and upward through the esophagus. The anvil (1040) can then be trans-orally inserted and coupled to the insert (1048). The introducer element (1048) can then pull the anvil (1040) back through the esophagus (Figure 29). As shown in Figure 30, when the incus (1040) is positioned in the esophagus at a desired staple location, the suture (1046) is cut from the loop (1042). The introducer (1048) and suture (1046) are then removed from the anvil (1040). The anvil (1040) is then aligned and coupled to a trocar (38, 238, 338, 438, 538, 638, 738, 838, 938).
[00113] Alternatively, an anvil (1140) may be introduced through a body lumen (eg the esophagus) with the incus delivery system (1100) shown in Figures 33A to 33B. The anvil (1140) is similar to an anvil (1040), except that the anvil (1140) comprises a plurality of integral loops (1142). As shown, the anvil (1140) comprises three lugs (1142) evenly spaced around the anvil (1140). However, a varying number of lugs (1142) can be used and the lugs (1142) can be spaced asymmetrically around the anvil (1140). Other suitable loop configurations will be apparent to one of skill in the art in view of the teachings presented herein. A suture (1146) is tied around each loop (1142). The sutures (1146) can comprise metal, plastic, or some other malleable element. Sutures (1146) are used to allow control of the orientation of the incus (1140) within the esophagus. Although three sutures (1146) are shown, any adequate number of sutures (1146) can be used.
[00114] The incus (1140) is inserted trans-orally through the esophagus in a vertical position. One of the sutures (1146) can be used to pull the incus (1140) through the esophagus. When the anvil (1140) is pulled to a desired stapling location within the esophagus, the other two sutures (1146) are pulled to turn the anvil (1140) to a horizontal position. All three sutures (1146) are then pulled against an esophageal wall to secure the incus (1140) in place. A trocar (38, 238, 338, 438, 538, 638, 738, 838, 938) is then coupled to the anvil (1140) to perform an anastomosis. D. Exemplary Washer
[00115] During operation of the stapling instrument (10), the knife (36) may fracture a washer (1250) to provide auditory feedback that the stapling instrument (10) has fired. As shown in Figures 34 to 35, the anvil (1240) comprises clip pockets (1252) aligned around both surfaces of the disc-shaped anvil (1240). The anvil (1240) further comprises an inner wall (1242) which forms the inner opening (1243). The anvil configuration (1240) can be used in any of the configurations described above. The washer (1250) may be provided within the stapling head assembly (1220) so that the washer (1250) rests against the knife (1236). The outer diameter of the washer (1250) is sized to match the inner wall (1242) of the anvil (1240) so that the washer (1250) can engage the inner wall (1242). When the knife (1236) is fired, the knife (1236) is configured to push the washer (1250) against the inner wall (1242) of the anvil (1240) until the knife (1236) fractures the washer (1250) against the anvil (1240).
[00116] The incus (1240) can be inserted trans-orally through the esophagus as described above. The anvil (1240) is then coupled to a trocar (38, 238, 338, 438, 538, 638, 738, 838, 938) and to the clamping head assembly (1220). The actuator (39) is then used to adjust the gap between the anvil (1240) and the clamping head assembly (1220). The trigger (74) is actuated to direct the stapling head assembly (20) to perform an anastomosis between the cut sections of the esophagus. When the stapling instrument (10) is fired, the knife (1236) pushes the washer (1250) against the inner wall (1242) of the anvil (1240) and fractures the washer (1250) to provide auditory feedback that the instrument of clipping (10) fired. Other suitable variations of the washer (1250) and related elements, as well as other suitable ways in which auditory feedback can be provided, will be apparent to one of skill in the art in view of the teachings of the present invention. III. Other considerations
[00117] It should be understood that any one or more of the teachings, expressions, modalities, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, modalities, examples, etc. which are described here. Therefore, the teachings, expressions, modalities, examples, etc. described above should not be viewed in isolation from one another. Various suitable ways in which the teachings of the present invention may be combined will be readily apparent to those skilled in the art in view of the teachings of the present invention. These modifications and variations are intended to be included within the scope of the appended claims.
[00118] It is understood that any patent, publication, or other disclosure material, in whole or in part, which is said to be incorporated into the present invention by way of reference, is incorporated into the present invention only if the incorporated material does not conflict with definitions, statements, or other extant disclosure material presented in this disclosure. Accordingly, and to the extent necessary, the description as explicitly stated herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, which is hereby incorporated by reference into the present invention, but which conflicts with existing definitions, statements, or other descriptive materials set forth herein will be incorporated herein only to the extent that no conflict. arise between the embodied material and the existing descriptive material.
[00119] Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in robotic-assisted medical treatments and procedures. By way of example only, various teachings of the present invention can be readily incorporated into a robotic surgical system such as the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, California, USA. Similarly, those skilled in the art will recognize that the various teachings of the present invention can be easily combined with the various teachings of US Patent No. 6,783,524 entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument", issued August 31 of 2004, the description of which is incorporated herein by reference.
[00120] The versions described above can be designed to be discarded after a single use, or they can be designed to be used multiple times. Versions can, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps of disassembling the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, some versions of the device can be disassembled, and any number of particular parts or parts of the device can be selectively replaced or removed in any combination. With cleaning and/or replacement of particular parts, some versions of the device can be reassembled for subsequent use in a reconditioning facility, or by a user immediately prior to a surgical procedure. Those skilled in the art will understand that reconditioning a device can utilize a variety of techniques for disassembly, cleaning/replacement and reassembly. The use of such techniques, and the resulting refurbished device, are all within the scope of this order.
[00121] Just as an example, the versions described here can be sterilized before and/or after a procedure. In a sterilization technique, the device is placed in a closed, sealed container such as a plastic or TYVEK bag. The container and device can then be placed in a radiation field, such as gamma radiation, X-rays or high energy electrons, which can penetrate the container. Radiation can kill bacteria in the device and container. The sterilized device can then be stored in a sterile container for later use. The device may also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide, or water vapor.
[00122] Having shown and described various embodiments of the present invention, other adaptations of the methods and systems described in the present invention can be carried out by means of suitable modifications by a person skilled in the art without departing from the scope of the present invention. Several of these possible modifications have been mentioned, and others will be evident to those skilled in the art. For example, the examples, modalities, geometry, materials, dimensions, proportions, steps and the like discussed above are illustrative and not necessary. Accordingly, the scope of the present invention is to be considered in accordance with the terms of the following claims and it is understood that it is not limited to the details of structure and operation shown and described in the specification and drawings.

权利要求:
Claims (14)
[0001]
1. Apparatus for tissue stapling, characterized in that it comprises: (a) an anvil (240), wherein the anvil comprises: (i) a body, wherein the body is disc-shaped, (ii) a internal opening (243) formed through the body, and (iii) a plurality of clip pockets (252) positioned along a top surface (248) of the disc-shaped body, and (iv) a second plurality of pockets clamps (252) positioned along a lower surface (250) of the disc-shaped body; wherein the anvil (240) is configured to be inserted through a body lumen; and (b) a trocar (238) selectively coupled to the anvil (240), wherein the trocar (238) comprises: (i) a rod (260), and (j)) a locking assembly, wherein the assembly The locking assembly comprises a flattened position and an expanded position, wherein the locking assembly is intended to hold the anvil (240) in position relative to the trocar (238) when the locking assembly is in the expanded position.
[0002]
2. Apparatus according to claim 1, characterized in that the locking assembly comprises at least one resilient flap (1568) extending from the rod (1560) of the trocar (1538).
[0003]
3. Apparatus according to claim 2, characterized in that the locking assembly comprises a pair of resilient tabs (1568) extending from the trocar shaft (1538).
[0004]
4. Apparatus according to claim 2, characterized in that the tab (1568) is resiliently pulled by a resilient member (1566).
[0005]
5. Apparatus according to claim 2, characterized in that the at least one tab (1568) is configured to engage a top surface (248) of the anvil (240) when the locking assembly is in the expanded position.
[0006]
6. Apparatus according to claim 4, characterized in that the anvil (740) further comprises a glove (750) extending from the anvil (740), wherein the glove (750) comprises at least one opening (742), wherein the at least one tab (766) is configured to engage the at least one opening (742) when the locking assembly is in the expanded position.
[0007]
7. Apparatus according to claim 6, characterized in that the glove (950) is configured to extend through the inner opening (943) of the anvil (940), wherein the glove (950) comprises at least one opening (942) adjacent a first end of the sleeve (950) and at least one opening (942) adjacent a second end of the sleeve (950), so that the sleeve (950) is configured to engage the first end or the second end of the glove (950) with the trocar (938).
[0008]
8. Apparatus according to claim 6 or 7, characterized in that the glove (950) comprises a flexible section (748).
[0009]
9. Apparatus according to claim 1, characterized in that the locking assembly comprises an expansion element (364) configured to engage the anvil (340) when the locking assembly is in the expanded position.
[0010]
10. Apparatus according to claim 9, characterized in that the expansion element (364) comprises a recess (363) configured to engage a wall of the inner opening (343) of the anvil (340) when the locking assembly is in the expanded position.
[0011]
11. Apparatus according to claim 9, characterized in that the locking assembly further comprises a caming element (362), wherein the caming element (362) is translatable within the rod (360) of the trocar ( 338), wherein the cam element (362) is intended to move the locking assembly from the flat position to the expanded position.
[0012]
12. Apparatus according to claim 11, characterized in that the trocar (338) further comprises at least one fin (368) configured to engage a bottom surface of the anvil (340).
[0013]
13. Apparatus according to claim 12, characterized in that the at least one fin (368) is intended to lock the caming element (362) in relation to the rod (360) of the trocar (338).
[0014]
14. Apparatus according to claim 9, characterized in that the locking assembly comprises an internal element (480) translatable in relation to the rod (460) of the trocar (438), a first expansion element (462) attached to the inner element (480), and a second expansion element (466) coupled to the first expansion element (462) and secured to the rod (460) of the trocar (438).

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BR112015013143A2|2017-07-11|

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法律状态:
2018-11-21| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-12-17| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2021-06-29| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-08-31| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 04/12/2013, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US13/693,455|2012-12-04|

---

US13/693,455|US9724100B2|2012-12-04|2012-12-04|Circular anvil introduction system with alignment feature|

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PCT/US2013/073106|WO2014089203A2|2012-12-04|2013-12-04|Circular anvil introduction system with alignment feature|

---