巴西专利BR112016002890B1 surgical device

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专利摘要:
SURGICAL STAPLER WITH ROLLING FIXED GRIP. An apparatus comprising a rod and an end actuator. The end actuator is positioned at the distal end of the rod and is operable to form a set of fasteners to hold the tissue. The end actuator includes first and second fastener assembly forming elements. The first forming element of the fastener set is rotatable with respect to the rod. The fastener set is formed by the first and second elements of the fastener set. The first element of the set of fasteners comprises a reinforcing strip received by the first forming element of the set of fasteners. The second element of the fastener assembly comprises a wire with protruding portions or a strip of fasteners with integrated protruding fasteners. The reinforcing strip receives the protruding portions or protruding fasteners for securing the fabric between the reinforcing strip and the yarn or fastener strip. The end actuator can tranect fabric layers and clamp the fabric layers together on each side of the transection.
公开号:BR112016002890B1
申请号:R112016002890-2
申请日:2014-08-12
公开日:2022-01-25
发明作者:Charles J. Scheib；Jeffrey C. Gagel；Jeffrey S. Swayze
申请人:Ethicon Endo-Surgery, Llc；
IPC主号:

专利说明:

BACKGROUND
[0001] In some cases, endoscopic surgical instruments may be preferred over devices for traditional open surgery, as a smaller incision can reduce recovery time and complications in the postoperative period. Consequently, some endoscopic surgical instruments may be suitable for placing a distal-end actuator at a desired surgical site via a trocar cannula. These distal end actuators can clamp tissue in a variety of ways to achieve a diagnostic or therapeutic effect e.g. endocutter, gripper, cutter, stapler, clip applier, access device, drug/gene therapy delivery device and delivery device. of energy through the use of ultrasound, RF, laser, etc. Endoscopic surgical instruments may comprise a rod between the end actuator and a handle portion, which is manipulated by the physician. This stem can allow insertion to a desired depth and rotation around the longitudinal axis of the stem itself, thus facilitating the positioning of the end actuator on the patient. Positioning of an end actuator may be further facilitated by the inclusion of one or more joints or articulation elements, allowing the end actuator to be selectively pivoted or otherwise deflected with respect to the longitudinal axis of the stem.
[0002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers work by attaching layers of fabric, cutting through the attached layers of fabric, and causing the staples to go through the layers of fabric to substantially seal the cut layers of fabric together near their cut ends. Merely exemplary surgical staplers are disclosed in US Patent No. 4,805,823 entitled "Pocket Configuration for Internal Organ Staplers", issued February 21, 1989; US Patent No. 5,415,334 entitled "Surgical Stapler and Staple Cartridge," issued May 16, 1995; US 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; US Patent No. 7,000,818 entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", issued February 21, 2006; US 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; US Patent No. 7,367,485 entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", issued May 6, 2008; in US Patent No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", issued 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", issued October 14, 2008; US Patent No. 7,721,930 entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010; in US Patent Publication No. 2010/0264193 entitled "Surgical Stapling Instrument with An Articulatable End Effector", published October 21, 2010; and in US Patent Publication No. 2012/0239012 entitled "Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly", published September 20, 2012. The description of each of the cited US patents and US patent publications above is incorporated herein by reference.
[0003] Although the aforementioned surgical staplers are described as 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. By way of example only, a surgical stapler may be inserted through a thoracotomy and thus between the patient's ribs to reach one or more organs in a thoracic surgical procedure that does not utilize a trocar as a conduit for the stapler. Such procedures may include using a stapler to cut and close a blood vessel leading to a lung. For example, the vessels leading to an organ can be cut and closed with a stapler before removing the organ from the chest cavity. Of course, surgical staplers can be used in many other scenarios and procedures.
[0004] Although various types of surgical stapling instruments and associated components have been produced and used, no one prior to the inventors is believed to have produced or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS
[0005] The accompanying drawings, which are incorporated into this specification and which form part thereof, illustrate embodiments of the invention and, together with the general description provided above, and the detailed description of the embodiments provided below, serve to explain the principles of the present invention.
[0006] Figure 1A represents a perspective view of a articulating exemplifying surgical instrument with an end actuator in a non-hinged position;
[0007] Figure 1B represents a perspective view of the surgical instrument of Figure 1A with an end actuator in a pivoted position;
[0008] Figure 2 represents a perspective view of an open end actuator of the surgical instrument of Figures 1A and 1B;
[0009] Figure 3A represents a side cross-sectional view of the end actuator of Figure 2, taken along line 3-3 of Figure 2, with the trigger bar in a proximal position;
[00010] Figure 3B represents a side cross-sectional view of the end actuator of Figure 2, taken along line 3-3 of Figure 2, but showing the trigger bar in a distal position;
[00011] Figure 4 represents a cross-sectional view of the end actuator of Figure 2, taken along line 4-4 of Figure 2;
[00012] Figure 5 represents an exploded perspective view of the end actuator of Figure 2;
[00013] Figure 6 represents a perspective view of the end actuator of Figure 2, positioned in the fabric and after being actuated once in the fabric;
[00014] Figure 7 represents a schematic view of an exemplary alternative end actuator and other components that may be incorporated into the instrument of Figures 1A-1B;
[00015] Figure 8 represents a partial perspective view of the upper jaw of the end actuator of Figure 7;
[00016] Figure 9 represents a partial perspective view of the lower jaw of the end actuator of Figure 7;
[00017] Figure 10 represents a side cross-sectional view of the lower grip of Figure 9, taken along line 10-10 of Figure 9;
[00018] Figure 11 represents a cross-sectional view of the end actuator of Figure 7, taken along line 11-11 of Figure 7;
[00019] Figure 12 represents a cross-sectional side view of the end actuator of Figure 7, taken along line 12-12 of Figure 11;
[00020] Figure 13 represents an end cross-sectional view of an exemplary alternative end actuator, which may be incorporated into the instrument of Figures 1A-1B;
[00021] Figure 14 represents a cross-sectional side view of the end actuator of Figure 13, taken along line 14-14 of Figure 13;
[00022] Figure 15 represents a side elevation view of another exemplary end actuator that can be incorporated into the instrument of Figures 1A-1B, arranged through a trocar in a straight configuration;
[00023] Figure 16 represents a side elevation view of the end actuator of Figure 15, pivoted in an angled configuration;
[00024] Figure 17 represents a perspective view of the end actuator of Figure 15 transection and securing the fabric; and
[00025] Figure 18 represents a side cross-sectional view of the end actuator of Figure 15.
[00026] By no means are the drawings intended to be limiting and it is contemplated that various embodiments of the invention may be practiced in a variety of other ways, including those not necessarily represented in the drawings. The accompanying drawings incorporated and forming a part of the specification illustrate various aspects of the present invention and, together with the description, serve to explain the principles of the invention; it being understood, however, that this invention is not specifically limited to the provisions shown. DETAILED DESCRIPTION
[00027] The following description of specific examples of the invention should not be used to limit the scope of the present invention. Other examples, features, 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 illustration, one of the best contemplated modes for carrying out the invention. As will be understood, the invention may have other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and descriptions are to be regarded as illustrative and not restrictive in nature. I. Exemplary surgical stapler
[00028] Figures 1 to 6 show an exemplary stapling and cutting surgical instrument 10 that is sized for insertion, in a non-articulated state as depicted in Figure 1A, through the passage of a trocar cannula to a surgical site in a patient to perform a surgical procedure. The surgical stapling and cutting instrument 10 includes a handle portion 20 connected to an implement portion 22, the latter additionally comprising a rod 23 terminating distally in a hinge mechanism 11 and an end actuator 12 connected distally. When the linkage mechanism 11 and the end actuator 12 are inserted through the passage of a trocar cannula, the linkage mechanism 11 can be remotely articulated, as shown in Figure 1B, by means of the linkage control 13. End actuator 12 can reach behind an organ or approach tissue from a desired angle or for other purposes. It should be understood that terms such as "proximal" and "distal" are used in the present invention with reference to a physician holding the handle portion 20 of the instrument 10. Thus, the end actuator 12 is distal to the handle portion 12. 20 more proximal. It will be further understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in connection with the drawings. However, surgical instruments are used in many orientations and positions, and such terms are not intended to be limiting and absolute.
[00029] The end actuator 12 of the present example includes a lower jaw 16 and a swivel fixed jaw 18. The handle portion 20 includes a pistol grip 24 towards which a closing trigger 26 is pivotally pulled by the medical device, to cause gripping or closing of the fixed jaw 18 towards the lower jaw 16 of the end actuator 12. Such closure of the fixed jaw 18 is provided through a cylindrical outermost locking socket 32, which translates longitudinally with respect to the portion of handle 20 in response to rotation of closure driver 26 relative to pistol grip 24. A distal closure ring 33 of closure cylindrical socket 32 is indirectly supported by frame 34 of implement portion 22. In hinge mechanism 11, a Proximal closure tube 35 of cylindrical closure fitting 32 communicates with distal closure ring 33. Structure 34 is flexibly attached to lower jaw 16 through the mechanism 11 articulation hand, allowing articulation in a single plane. Frame 34 also longitudinally and slidably supports a triggering member, not shown, that extends through rod 23 and communicates a triggering movement from trigger 28 to trigger bar 14. Trigger trigger 28 is in the farthest part of the closing actuator 26 and is pivotally actuated by the physician to do the stapling and separation of the tissue trapped in the end actuator 12, as will be described in more detail below. After that, the release button 30 is pressed to release the tissue from the end actuator 12.
[00030] Figures 2 to 5 represent the end actuator 12 driving an electronic beam trigger bar 14 to perform numerous functions. As best seen in Figures 3A to 3B, the firing bar 14 includes a transversely oriented upper pin 38, a firing bar cover 44, a transversely oriented intermediate pin 46 and a distally presented cutting edge 48. The upper pin 38 is positioned and releasable within a fixed jaw cavity 40 of the fixed jaw 18. The firing bar cover 44 slidably engages a lower surface of the lower jaw 16 by causing the firing bar 14 to extend through the slot of the channel 45 (shown in Figure 3B) which is formed through the lower jaw 16. The intermediate pin 46 slidably engages an upper surface of the lower jaw 16, cooperating with the firing bar cover 44. Thus, the firing bar 14 positively spaces the end actuator 12 during firing, preventing pinching that can occur between the fixed jaw 18 and the lower jaw 16 with a minimal amount of tissue trapped and preventing I walk the malformation of the staple with an excessive amount of tissue stuck.
[00031] Figure 2 shows the firing bar 14 situated proximally and the fixed jaw 18 rotated to an open position, allowing an unspent staple cartridge 37 to be removably installed in a groove of the lower jaw 16. As can best be seen in Figures 4 to 5, the staple cartridge 37 of this example includes a cartridge body 70, which has an upper support 72 and which is coupled to a lower cartridge tray 74. As can best be seen in Figure 2 , a vertical slot 49 is formed through part of the staple cartridge 37. As also best seen in Figure 2, three rows of staple openings 51 are formed through the upper platform surface 72 on one side of the vertical slot 49, with another set of three rows of clip openings 51 being formed through the upper platform surface 72 on the other side of the vertical slot 49. Again with reference to Figures 3 to 5, a cotter slider. Triangle body 41 and a plurality of staple drivers 43 are captured between cartridge body 70 and tray 74, with triangle body slider 41 being located proximal to staple drivers 43. Triangle body slider 41 is movable longitudinally within the staple cartridge 37; whereas the staple drivers 43 are vertically movable within the staple cartridge 37. The staples 47 are also positioned within the cartridge body 70, above the corresponding staple drivers 43. In particular, each clip 47 is driven vertically within the cartridge body 70 by a clip driver 43 to drive the clip 47 out through an associated clip opening 51. As can best be seen in Figures 3A to 3B and 5, the triangular body slider 41 has angled cam surfaces that force the staple drivers 43 upward as the triangle body slider 41 is driven distally through the staple cartridge. 37.
[00032] With the end actuator 12 closed, as shown in Figure 3A, the trigger bar 14 is driven forward in engagement with the fixed jaw 18, by inserting the upper pin 38 into a longitudinal slot of the fixed jaw 42 A pusher block 80 is located at the distal end of the trigger bar 14 and is configured to engage the triangular body slider 41 such that the triangular body slider 41 is pushed distally by the pusher block 80 as the trigger bar 14 is advanced distally through the staple cartridge 37. During such firing, the cutting edge 48 of the firing bar 14 enters the vertical slot 49 of the staple cartridge 37, cutting the tissue trapped between the staple cartridge 37 and the fixed jaw 18 As shown in Figures 3A to 3B, the middle pin 46 and the drive block 80 together drive the staple cartridge 37 by entering a slot 49 within the staple cartridge 37, which carries the triangle body slider. air 41 into upward contact of the cam with the clamp drivers 43 which in turn push the clamps 47 out through the clamp openings 51 and into contact with the clamp forming cavities 53 in the surface inside of the fixed jaw 18. Figure 3B shows the firing bar 14 fully translated in the distal direction after completing the tissue cutting and stapling.
[00033] Figure 6 shows end actuator 12 after being driven through a single pass through fabric 90. Cutting edge 48 cut through fabric 90, while staple drivers 43 pushed three alternating rows of staples 47 through of the fabric 90 on either side of the cut line produced by the cutting edge 48. The staples 47 are all oriented substantially parallel to the cut line in this example, although it should be understood that the staples 47 can be positioned in any suitable orientation. In the present example, the end actuator 12 is removed from the trocar after the first stroke is completed, the spent staple cartridge 37 is replaced with a new staple cartridge, and the end actuator 12 is then reinserted through the trocar. to reach the stapling location for additional cutting and stapling. This process can be repeated until the desired amount of cuts and staples 47 have been provided. It may be necessary to close the fixed jaw 18 to facilitate insertion and removal through the trocar; and it may be necessary to open the fixed jaw 18 to facilitate replacement of the staple cartridge 37.
[00034] It should be understood that the cutting edge 48 can cut the fabric substantially contemporaneously with the driving of the staples 47 through the fabric during each drive stroke. In the present example, the cutting edge 48 has a slight delay with respect to the driving of staples 47, so that a staple 47 is driven through the fabric just before the cutting edge 48 passes through the same region of the fabric, although it should be understood that this order may be reversed or that the cutting edge 48 may be directly synchronized with adjacent clamps. While Figure 6 shows the end actuator 12 being actuated across two layers 92 and 94 of fabric 90, it should be understood that the end actuator 12 may be actuated through a single layer of fabric 90 or more than two layers 92 and 94 of fabric. It should also be understood that the formation and positioning of the staples 47 adjacent to the cut line produced by the cutting edge 48 can substantially seal the tissue at the cut line, thereby reducing or preventing bleeding and/or leakage of other bodily fluids into the line. cutting. Various suitable scenarios and procedures in which the instrument 10 may be used will be apparent to those skilled in the art based on the teachings of the present invention.
[00035] It is to be understood that instrument 10 may be configured and operative in accordance with any of the teachings of US Patent No. 4,805,823; US Patent No. 5,415,334; US Patent No. 5,465,895; US Patent No. 5,597,107; US Patent No. 5,632,432; US Patent No. 5,673,840; US Patent No. 5,704,534; US Patent No. 5,814,055; US Patent No. 6,978,921; US Patent No. 7,000,818; US Patent No. 7,143,923; US Patent No. 7,303,108; US Patent No. 7,367,485; US Patent No. 7,380,695; US Patent No. 7,380,696; US Patent No. 7,404,508; US Patent No. 7,434,715; and/or US Patent No. 7,721,930.
[00036] As noted above, the disclosures of each of these patents are incorporated herein by reference. Additional exemplary modifications that may be provided for the instrument 10 will be described in more detail below. Various suitable ways in which the teachings below may be incorporated into instrument 10 will be apparent to those skilled in the art. Similarly, various suitable ways in which the teachings below may be combined with various teachings of the patents cited in the present invention will be apparent to those skilled in the art. It should also be understood that the teachings below are not limited to the instrument 10 or devices taught in the patents cited in the present invention. The teachings below can readily be applied to many other types of instruments, including instruments that would not be classified as surgical staplers. Various other suitable devices and scenarios to which the teachings below can be applied will be apparent to those skilled in the art based on the teachings of the present invention. II. Example end actuator for continuous stapling
[00037] It should be understood that the length of tissue transection achieved during each actuation stroke of the instrument 10 is limited by the length of the cartridge 37. If the operator wishes to cut the tissue along a length greater than the length of the cartridge 37 , the operator will need to reload the instrument 10 with a new cartridge 37. The same principle applies if the operator wishes to transection tissue at one location on the patient and then cut tissue at another location on the patient - the operator he will still need to reload the instrument 10 with a new cartridge 37 each time he wants to trigger the instrument 10. In some versions, the operator will need to remove the end actuator 12 from the patient to remove the spent cartridge 37 and load a new cartridge 37; and then reinserting the end actuator 12 into the patient. This process can be tiring in some situations. Therefore, it may be desirable to allow an operator to perform transections (including fasteners along each side of the transection) over a length greater than that achievable using the cartridge 37. Similarly, it may be desirable to allow an operator to perform multiple transections (including fasteners along each side of each transection) within a patient using an instrument that does not need to be removed from the patient between each transection. The various examples described below include variations of the instrument 10 that are operable to provide these results. Other variations will be apparent to those skilled in the art based on the teachings of the present invention. A. Example end actuator for continuous stapling with hinged jaw and wire closure
[00038] Figures 7 to 12 show an exemplary alternative end actuator 100 that can be incorporated into an instrument such as the instrument 10 discussed above. The end actuator 100 of this example comprises an upper jaw 110, a lower jaw 120 and a fabric cutting member 130. The upper jaw 110 is pivotable with respect to the lower jaw 120 so that the jaws 110 and 120 can be opened. and selectively closed to capture tissue. Various suitable ways in which upper jaw 110 can be pivoted relative to lower jaw 120 will be apparent to those skilled in the art based on the teachings of the present invention. As will be described in more detail below, the end actuator 100 is operable to cut layers 92 and 94 of fabric and join layers 92 and 94 of fabric on each side of the transection line using a fastening assembly formed by a wire 170 and a reinforcing strip 160. The end actuator 100 can therefore be used in a similar manner to the end actuator 12 described above, with the fastening assembly formed by a wire 170 and a reinforcing strip 160 having a similar effect to the formed clips. 47 applied by end actuator 12. However, it will be understood that end actuator 100 of the present example eliminates the need to replace an equivalent cartridge 37, thus facilitating longer transection lines and/or a series of transections within of a patient without having to repeatedly remove the end actuator 100 from the patient.
[00039] As shown in Figure 7, upper jaw 110 includes a pair of rolling fixed jaws 140 that are driven by a drive rod 150. Fixed jaws 140 rotate about an axis that is perpendicular to the longitudinal axis of the actuator. end 150; while the drive rod 150 rotates about an axis that is parallel to the longitudinal axis of the end actuator 150. The fixed jaws 140 rotate together and simultaneously in the same direction. Various suitable transmission configurations that can be used to couple drive rod 150 to fixed jaws 150 will be apparent to those skilled in the art based on the teachings of the present invention. Drive rod 150 is coupled to rotating drive source 152 which may include a motor and/or any other suitable type of rotating drive source 152. As best seen in Figure 8, upper jaw 110 defines a slot 112 that is configured to slidably receive the fabric cutting element 130. The upper jaw 110 also defines a pair of channels 114 and openings 116 on each side of the slot 112. The openings 116 are positioned to expose portions of the fixed jaws 140. In In particular, openings 116 are configured to receive protruding portions 174 of wire 170 to allow fixed jaws 140 to form the fastening assembly, as will be described in more detail below.
[00040] As shown in Figures 12, each fixed jaw 140 includes flanges 142 that extend radially and form chamber side walls 144, which cooperate to form a series of chamber recesses 146 around the perimeter of the fixed jaw 140. Although six recesses 146 are shown in the present example, it should be understood that any other suitable number of recesses 146 may be used. As will be described in more detail below, the recesses 146 are configured to receive a reinforcing strip 160 and protruding portions 174 of the wire 170. The recesses 146 are further configured to deform the protuberant portions 174 of the wire 170 to produce the formed portions 176 of the wire 170. Each fixed jaw 140 also defines a hole 148 which is configured to receive a shaft 141. The shaft 141 is driven by drive rod 150, as noted above. Although both fixed jaws 140 share a common axle 141 in the present example, some other versions may provide separate axles 141 for the fixed jaws 140.
[00041] Reinforcement strips 160 of the present example are provided over the top of fixed jaws 140, as shown in Figure 12. Reinforcement strips 160 may be formed of any suitable material or materials including, but not limited to, following: Polyglutamic acid polymer (PGA); polyglycolic acid:trimethylene carbonate (PGA:TMC); bovine pericardium; compressible hemostatic material such as, for example, oxidized regenerated cellulose (ORC) or a bioabsorbable foam (for example, compressed into a sheet); polydioxanone (PDS); poly(glycerol sebacate) (PGS); polyglycolic acid (PGA); polycaprolactone (PCL); polylactic acid (PLA); poly(hydroxyalkanoate) (PHA); polyglecaprone (PGCL); polylactic acid (PLA or PLLA); poly(hydroxyalkanoate) (PHA); polycaprolactone (PCL); polyurethane; polypropylene (PP); polyethylene (PE); polycarbonate; polyamides such as nylon, polyvinyl chloride (PVC), polymethylmethacrylate (PMMA), polystyrene (PS), polyester, polyether ether ketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), polypropylene ethylene fluoride (FEP), polyacetal, polysulfone, silicones and combinations of any of the aforementioned materials. In addition, the reinforcing strips 160 may be formed from foamed elastomers and/or porous elastomers, such as, for example, silicone, polyisoprene, expanded polytetrafluoroethylene (ePTFE), urethane copolyetherester foam, and/or any other material(s). ) suitable. Various other suitable materials and configurations that can be used to form the reinforcing strips 160 will be apparent to those skilled in the art based on the teachings of the present invention.
[00042] Each fixed jaw 140 receives a respective reinforcement strip 160. In some versions, the fixed jaws 140 include protrusions and the reinforcement strips 160 include openings that cooperate with the protuberances of the fixed jaws 140 to provide a tractor feeder configuration. , so that the fixed jaws 140 directly pull the reinforcing strips 160 distally as the fixed jaws 140 rotate. Other suitable ways in which the reinforcement strip 160 can be advanced distally will be apparent to those skilled in the art based on the teachings of the present invention. In the present example, each reinforcing strip 160 is released from a respective spool or spool 162. The spools 162 may be located within a cable portion, such as cable portion 20, and/or any other suitable location. The spools 162 may be configured to freely release the reinforcement strips 160 as the reinforcement strips 160 are pulled distally and/or the spools 162 may include elements that selectively lock/unlock the release of the reinforcement strips 160 from the spools 162. In some versions, the spools 162 are equipped with a motor to turn and thus actively supply the reinforcing strips 160.
[00043] As best seen in Figures 11 to 12 and as will be described in greater detail below, the reinforcing strips 160 are configured to receive respective protruding portions 174 of wire 170 as protruding portions 174 enter recesses 146 Reinforcement strips 160 may include pre-formed openings that facilitate passage of protruding portions 174 through reinforcement strips 160. Alternatively, protruding portions 174 may simply pierce or otherwise penetrate reinforcement strips 160 as the reinforcement strips 160 protruding portions 174 enter recesses 146.
[00044] As shown in Figure 9, the lower jaw 120 defines a slot 122 which is configured to slidably receive the fabric cutting element 130. The lower jaw 120 also defines a pair of channels 124 that terminate in openings 126 at each side of slot 122. Apertures 126 are positioned to align with openings 116 of upper jaw 110 when upper jaw 110 is in a closed position relative to lower jaw 120. As best seen in Figure 10, groove 124 is sized to receive wire 170. In particular, channel 124 is configured to allow wire 170 to communicate distally through lower jaw 120 without interfering with protruding portions 174. Channel 124 additionally includes a redirection zone 129 configured to redirect the path of wire 170 from a distal to a proximal direction as wire 170 approaches the distal end of lower jaw 120. A cylinder Ro 125 is positioned in redirection zone 129 and rotates freely with respect to lower jaw 120, thus reducing friction between wire 170 and lower jaw 120 in redirection zone 129. Of course, cylinder 125 is merely optional. The terminal end of each channel 124 includes a slope 127 adjacent the opening 126. Each slope 127 defines a shallow obtuse angle to the upper platform surface 121 of the lower jaw 120, allowing wires 170 to exit the openings 126 along paths. which are approximately parallel to the upper platform surface 121 of the lower jaw 120. Various suitable angles for the slopes 127 will be apparent to those skilled in the art based on the teachings of the present invention.
[00045] As noted above, each yarn 170 includes a plurality of transversely protruding portions 174. The protruding portions 174 are separated by base lengths 178 of the yarn 170. The yarn 170 is malleable so that the formed portions 176 will substantially maintain their shape. once formed. The wire 170 may be formed from various types of metals and/or any other suitable material(s). The protuberances 174 are configured to penetrate the fabric layers 92 and 94, as shown in Figure 12. In some versions, the protuberances 174 are sharpened to facilitate penetration into the fabric, although such sharpening is not necessarily required. While the yarn 170 has sufficient flexibility to allow the formation of portions 176 formed by the fixed jaws 140, the yarn 170 has sufficient rigidity for the ridges 174 to substantially maintain their configuration while the ridges 174 penetrate the fabric. Various other suitable materials and compositions that can be used to form yarn 170 will be apparent to those skilled in the art based on the teachings of the present invention. In the present example, each wire 170 is released from a respective spool or spool 172. The spools 172 may be located within a cable portion 20 and/or at any other suitable location. Spools 172 may be configured to freely release wires 170 as wires 170 are pulled distally, and/or spools 172 may include elements that selectively lock/unlock the release of wires 170 from spools 172. In some versions, spools 172 are equipped with a motor to rotate and thus actively supply the wire 170.
[00046] The tissue cutting element 130 is similar to the firing bar 14, described above, in that the tissue cutting element 130 has a distal cutting edge 134 that is configured to cut tissue captured between the jaws 110 and 120. In some versions, the fabric cutting element 130 is operable to drive an upper jaw 110 toward the lower jaw 120 as the fabric cutting element 130 is advanced distally. In some other versions, the upper jaw 110 is driven towards the lower jaw by a separate element e.g. an element similar to the closing cylindrical socket 32, etc. As can best be seen in Figure 7, the cutting element of fabric 130 of the present example comprises an upper flange 136 and a lower flange 138 at the top and bottom, respectively, of the distal cutting edge 134. The lower flange 138 is slidably disposed in a groove 128 formed in the lower jaw. 120, as shown in Figure 10; while the upper flange 136 is slidably disposed in a groove (not shown) formed in the upper jaw 110. The distal cutting edge 134 is slidably disposed in slots 112 and 122 of the jaws 110 and 120. The fabric cutting element 130 is in communication with a drive assembly 132, which is operable to drive the tissue cutting element distally through slots 112 and 122 in jaws 110 and 120.
[00047] In the present example, the drive assembly 132 included a motor. In some versions, the rotating drive source 152 and the drive assembly 132 are driven by the same common motor. Various suitable elements that can be used to convert the activation of a motor into translation of a tissue cutting element 130 will be apparent to those skilled in the art based on the teachings of the present invention. In some other versions, the drive assembly 132 may include a manual mechanical drive train that is actuated by a user's command such as a trigger trigger 28 described above. Regardless of whether the tissue cutting element 130 is advanced by a motor or manually, some versions of the tissue cutting element 130 are operable to vibrate at an ultrasonic frequency e.g. approximately 55.5 kHz to cut tissue and simultaneously denature proteins in adjacent tissue cells, thus providing a coagulative effect with relatively little thermal dispersion. It should be understood, therefore, that the drive assembly 132 may include one or more piezoelectric elements that are operable to convert electrical energy into ultrasonic vibrations. As yet another illustrative element, the tissue cutting element 130 can be selectively activated with RF energy. In some of these versions, one or more features of the end actuator 100 provide a return path for such RF energy, so that the end actuator 100 operates as a bipolar electrosurgical end actuator. In some other versions, a grounding pad is placed on or under the patient so that the end actuator 100 operates as a monopolar electrosurgical end actuator.
[00048] As shown in Figure 7, the drive assembly 132 and the rotary drive source 152 are both coupled with a control module 104, which is additionally coupled to a power source 102. The control module 104 is operable to selectively supplying power from power source 102 to drive assembly 132 and/or rotary drive source 152 based on user input and/or other information. By way of example only, the control module 104 may include one or more switches that are in communication with user data input (e.g. trigger trigger 28, etc.), which may thus selectively complete a circuit. between user inputs, drive assembly 132, rotary drive source 152, and power source 102. Additionally or alternatively, control module 104 may be in communication with one or more sensors (e.g., coding wheel , *reed switch(s) (encapsulated switches or contact relays), tissue contacting electrodes, etc.) fabric between jaws 110 and 120, etc.) and control activation of the rotary drive source 152 and/or the power source 102, based on such information. Various other configurations for module 104, data inputs that can be processed by control module 104, and results of such processing will be apparent to those skilled in the art based on the teachings of the present invention. It is also to be understood that the external power source 102 may comprise a battery (e.g. located within the cable portion 20, etc.), an external power source (e.g., coupled to the cable portion 20 via the cable ) and/or some other type of power source 102. Alternatively, the power source 102 may be eliminated. For example, the entire operation of end actuator 100 can be manually operated by the operator's hand.
[00049] In an exemplary use, the operator may position layers 92 and 94 of fabric between jaws 110 and 120, and then drive upper jaw 110 toward lower jaw 120 to clamp fabric layers 92 and 94 between the jaws 110 and 120. The operator can then drive rotary drive source 152 to rotate fixed jaws 140. Rotation of fixed jaws 140 pulls reinforcing strips 160 distally and around fixed jaws 140. Rotation of jaws Attachments 140 also pull wires 170 distally and around cylinders 125. This action eventually drives reinforcing strips 160 and wires 170 proximally, with protruding portions 174 of wire 170 penetrating through the inner side of layers 92 and 94. while reinforcing strip 160 is applied in apposition to the upper side of layers 92 and 94, as best shown in Figure 12. Upon further penetration of reinforcing strips 160, protruding portions 174 of wire 170 meet fixed jaws 140, q which deform the protruding portions 174 to form the formed portions 176 of the wire 170 on the upper side of the reinforcement strip 160. The formed portions 176 act as rivet heads, preventing the wire 170 from being pulled back through the reinforcement strip 160 and the fabric layers 92 and 94 under the reinforcement strip 160. The base lengths 178 of the yarn 170 additionally secure the yarn 170 to the underside of the fabric layers 92 and 94. Therefore, the formed yarn 170 and the reinforcement strip 160 cooperate to secure fabric layers 92 and 94 together.
[00050] Before, during and/or after the fabric layers 92 and 94 are held together by the formed yarn 170 and the reinforcing strip 160, the fabric cutting element 130 can be driven to cut the fabric. In particular, the fabric cutting element 130 can cut layers 92 and 94 along the path that is parallel to and between the fastener assemblies formed by the yarn 170 and the reinforcing strip 160. The end result may appear similar to what is shown in Figure 7, in which the fastener assemblies formed by the wire 170 and reinforcing strip 160 are positioned adjacent to the tissue transection created by the tissue cutting element 130. In the present example, the slits 112 and 122 terminate distally at proximally to the openings 116 and 126 so that the fabric cutting element 130 does not advance distally to the point where the fabric layers 92 and 94 are secured by the thread 170 and the reinforcing strip 160. This can ensure that the fabric layers 92, 94 are secured before fabric layers 92 and 94 are transected. Additionally or alternatively, drive assembly 132 may be controlled manually and/or automatically to ensure proper timing of actuation of fabric cutting element 130 (e.g., in connection with thread attachment 170 and attachment strip 160 and/or in another way).
[00051] It should be understood that the fastener assemblies formed by the yarn 170 and the reinforcing strip 160 can provide the anchoring of the fabric layers 92 and 94 and can also provide hemostasis at the transection edges created by the fabric cutting element 130 Hemostasis can be further improved if jaws 110 and 120 are used to substantially compress tissue layers 92 and 94 when the fastener assembly is deployed. It should also be understood that the above process can be carried out and repeated for as long as desired, allowing the operator to create secure transections having an effectively indefinite length (e.g., especially if a significant amount of reinforcing strip 160 and wire 170 is pre-made). loaded), without having to remove the end actuator 100 from the patient. Similarly, the above process can be repeated to create multiple secure transections separately within the patient, without having to remove the end actuator 100 from the patient. In cases where the operator is moving from one transection site to another transection site, the operator may simply use a conventional cutting tool to cut the wire 170 and/or the reinforcing strip 160 before moving to the last transection site. transection.
[00052] In some variations, the end actuator 100 includes a feature that allows selective adjustment of the gap distance between closed jaws 110 and 120, which can effectively vary the height of fasteners ultimately formed by wire 170. This adjustability may be desired to accommodate varying tissue thicknesses. Several suitable ways in which selective adjustment of the gap distance between closed jaws 110 and 120 can be provided will be apparent to those skilled in the art based on the teachings of the present invention. As yet another merely illustrative variation, the end actuator 100 may allow adjustment of the distance between the shaft 141 and the lower surface of the upper jaw 110, which may effectively vary the height of the fasteners ultimately formed by the wire 170d. It should also be understood that span adjustment and/or fastener height adjustment may not be necessary. Other variations to the construction, use and operability of the end actuator 100 will be apparent to those skilled in the art based on the teachings of the present invention. B. Example End Actuator for Continuous Stapling with Pivoting Jaw and Rivet Fastener
[00053] Figures 13 and 14 show an exemplary alternative end actuator 200 that can be used in place of the end actuator 100 discussed above. The end actuator 200 of this example comprises a pair of upper rolling fixed jaws 240 and a pair of lower rolling guides 225. Fixed jaws 240 and guides 225 are provided in opposite pairs and each pair is positioned on opposite sides of a mounting member. fabric cutting 230. It should be understood that fixed jaws 240 may be located on an upper jaw such as upper jaw 110; while guides 225 may be located on a lower jaw such as lower jaw 120. Fixed jaws 240 are therefore similar to fixed jaws 140, with guides 225 being similar to cylinders 125 and fabric cutting element 230 being similar to the fabric cutting element 130. Fixed jaws 240 and/or guides 225 may be driven by something similar to a drive rod 150, etc. Tissue cutting element 230 may be operable to translate to cut tissue, vibrate at ultrasonic frequencies to cut tissue and coagulate tissue, and/or deliver RF energy to tissue, all as described above with respect to tissue cutting element 130 In the present example, the fabric cutting element 230 is positioned to cut the fabric layers 92 and 94 after the layers 92 and 94 are secured by the fastener assembly described below, although it should be understood that the fabric cutting element 230 may instead be positioned otherwise.
[00054] The end actuator 200 of the present example is configured to form a closure assembly with a strip of rivets 270, rivets 280 and a reinforcement strip 260. It should be understood that the reinforcement strip 260 can be viewed as a substitute for the reinforcement strip 160 described above; while the rivet strip 270 and the rivets 280 may be viewed together as a substitute for the wire 170. By way of example only, each strip 260 and 270 may be formed from any of the various materials listed above as being suitable for forming reinforcing strips 160. Various other suitable materials and configurations that can be used to form strips 260 and 270 will be apparent to those skilled in the art based on the teachings of the present invention. It is also to be understood that the reinforcing strip 260 may be formed of one material (or a combination of materials), while the rivet strip 270 is formed of a different type of material (or combination of materials).
[00055] Reinforcement strip 260 may be fed from a spool or other source; while the rivet strip 270 and rivets 280 may be fed from a spool or other source. Each rivet 280 comprises a lower flange 282 and a hollow shank section 284 with an open free end 286. The rivets 280 are arranged in a rivet strip 270, with lower flanges 282 positioned below the rivet strip 270 to prevent the rivets from 280 are pulled through rivet strip 270. Rivets 280 are configured for hollow rod section 284 to penetrate fabric layers 92 and 94 and pass through reinforcement strip 260. In some examples, reinforcement strip 260 includes pre-openings. -shaped that are spaced and configured to receive hollow rod sections 284. In some other examples, the hollow rod sections 284 form their own openings in the reinforcing strip 260.
[00056] After each free end 286 has passed through the reinforcing strip 260, the fixed jaw 240 deforms a free end 286 to form a rivet head on top of the reinforcing strip 260, as best seen in Figure 14. In particular, the fixed jaw 240 includes pointed projections 242 that extend radially outward and that are spaced and configured to penetrate successive free ends 286 as the closure assembly is fed between the rolling fixed jaw 240 and the rolling guide 225. The sharp edge of the projections 242 facilitates the entry of the projections into free ends 286 and further facilitates the spreading of the free ends 286 outwardly to form rivet heads. The rivets 280 are formed of a malleable material so that the free ends 286 formed substantially maintain the configuration of the rivet heads after the rivet heads are formed by the projections 242. By way of example only, the rivets 280 may be formed in a variety of ways. metal types (e.g. micro-stamped titanium, titanium-based alloys, etc.) and/or any other suitable materials (e.g. absorbable polyglecaprone (PGCL), such as MONOCRYL, produced by Ehticon, Inc., of Somerville, New Jersey, USA, etc.). Various other suitable materials that can be used to form the rivets 280 will be apparent to those skilled in the art based on the teachings of the present invention.
[00057] With the rivet heads formed at the free ends 286 above the reinforcing strip 260 and the flanges 282 below the rivet strip 270, it should be understood that the strips 260 and 270 and the rivets 280 will cooperate to hold the layers 92 and 94 of fabric together. It is also to be understood that the fabric layers 92 and 94 can be compressed between the fixed jaws 240 and the guides 225 as the rivet heads are formed, so that the strip assembly 260 and 270 and the rivets 280 maintain fabric layers 92 and 94 in a compressed configuration. It is further understood that such retention of layers 92 and 94 can provide tissue hemostasis, substantially preventing tissue bleeding in the transection cut formed by tissue cutting element 230. As noted above, the fixed jaws 240 and/or guides 225 may be driven by something similar to drive rod 150, etc. This driven movement of the fixed jaws 240 and/or guides 225 can additionally drive the straps 269 and 270 relative to the fabric, as shown in Figure 14.
[00058] End actuator 200 may be operated in a similar manner to the operation of end actuator 100 described above. It should be understood that the above process can be carried out and repeated for as long as desired, allowing the operator to create secure transections having an effectively indefinite length (e.g. especially if a significant amount of strips 260 and 270 and rivets 280 are preloaded). ), without having to remove the end actuator 200 from the patient. Similarly, the above process can be repeated to create multiple secure transections separately within the patient, without having to remove the end actuator 200 from the patient. In cases where the operator is moving from one transection site to another transection site, the operator may simply use a conventional cutting instrument to cut strips 260 and 270 before moving to the last transection site. Still other components, elements, configurations and suitable operating capabilities and variations that may be associated with the end actuator 200 will become apparent to those skilled in the art based on the teachings of the present invention. C. Example end actuator for continuous stapling with swivel head and opposing cylinders
[00059] Figures 15 to 18 show another exemplary end actuator 300, which can be used to provide continuous tissue transection and closure, similar to the end actuators 100 and 200 described above. The end actuator 300 of this example is disposed at the distal end of a rod 302. The end actuator 300 comprises a chassis 308 which is joined to the rod 302 by a pivot pin 304 so that the end actuator 300 is configured to pivot. relative to rod 302 around pivot pin 304 to transition between a straight configuration (Figure 16) and a pivoted configuration (Figure 17). When end actuator 300 is in a straight configuration, end actuator 300 and stem 302 can be fed through a conventional trocar cannula 400 to reach a surgical site within a patient in a minimally invasive manner. Once the end actuator 300 has been positioned within the patient, the end actuator 300 can then be rotated relative to the stem 302 as desired to achieve optimal orientation based on the patient's anatomy and the location of tissue that is to be transected/ closed. The desired degree of pivot can vary based on a number of other factors.
[00060] In the present example, the end actuator 300 is selectively pivoted by translation of a band 306 that extends across the stem 302 and is coupled to the chassis 308. The band 306 is pulled proximally to transition the actuator from end 300 from straight configuration to pivoted configuration. It should be understood that end actuator 300 may be oriented at various angles with respect to stem 302 when end actuator 300 is in a pivoted configuration. In some versions, the end actuator 300 is resiliently tilted to assume the straight configuration, so that the band 306 is simply released to transition the end actuator 300 from the pivoted configuration back to the straight configuration. In some other versions, the band 306 is actively pushed distally to transition the end actuator 300 from a pivoted configuration back to the straight configuration. Several other suitable ways in which the band 306 may be driven will be apparent to those skilled in the art based on the teachings of the present invention. Similarly, various other suitable ways in which the end actuator 300 can be moved from a straight to a pivoted configuration and vice versa will be apparent to those skilled in the art based on the teachings of the present invention. By way of example only, a cable, shelf, pin, chain drive and/or various other suitable elements may be used in addition to or in place of band 306.
[00061] End actuator 300 additionally comprises a pair of rolling fixed jaws 340 and rolling guides 325, all of which are pivotally secured to chassis 308. Fixed jaws 340 and guides 325 are arranged similarly to fixed jaws 240 and guides 225 as described above. In particular, the fixed jaws 340 and guides 325 are provided in opposite pairs and each pair is positioned on opposite sides of a fabric cutting element 330. Unlike end actuators 100 and 200, the end actuator 300 of this example it lacks a rotating claw. In some versions, the spacing between the fixed jaws 340 and the guides 325 is fixed. In some other versions, the end actuator 300 includes a feature that is operable to vary the spacing between the fixed jaws 340 and the guides 325. It should be understood that the fixed jaws 340 and/or the guides 325 can be driven in a different manner. swivel relative to chassis 308, such as by means of a drive rod, belt, cable and/or in any other suitable manner, as will be apparent to those skilled in the art based on the teachings of the present invention. Fabric cutting element 330 is configured to cut fabric and may be fixedly attached to chassis 308 or operable to move relative to chassis 308. By way of example only, fabric cutting member 330 may be operable to translate to cut tissue, vibrate at ultrasonic frequencies to cut and coagulate tissue, and/or deliver RF energy to tissue, all as described above with respect to tissue cutting element 130. In the present example, the cutting element of fabric 330 is positioned to cut layers 92 and 94 of fabric after layers 92 and 94 are secured by the closure assembly described below, although it is to be understood that the fabric cutting element 330 may instead be positioned in another way. mode.
[00062] The end actuator 300 of the present example is configured to form a closure assembly with a fastener strip 370, fasteners 380 and a reinforcement strip 360. It should be understood that the reinforcement strip 360 can be viewed as a substitute version for the reinforcement strip 160 described above; while the strip of fasteners 370 and fasteners 380 can be viewed as a substitute for the wire 170. By way of example only, each strip 360 and 370 may be formed from any of the various materials listed above as being suitable for forming strips of reinforcement 160. Various other suitable materials and configurations that can be used to form the strips 360 and 370 will be apparent to those skilled in the art based on the teachings of the present invention. It should be understood that the reinforcing strip 360 may be formed of one material (or a combination of materials) while the fastener strip 370 is formed of a different type of material (or combination of materials).
[00063] Reinforcement strip 360 may be fed from a spool or other source; while the strip of fasteners 370 and fasteners 380 may also be fed from a spool or other source. Each fastener 380 comprises a lower flange 382 and a rod section 384 with a barbed free end 386. Fasteners 380 are arranged on a fastener strip 370, with lower flanges 382 positioned below the fastener strip 370 to prevent fasteners 380 from are pulled through fastener strip 370. Fasteners 380 are configured so that barbed free ends 386 penetrate fabric layers 92 and 94 and pass through reinforcement strip 360. In some examples, reinforcement strip 360 includes pre-openings. formed that are spaced and configured to receive the barbed free ends 386. In some other examples, the barbed free ends 386 form their own openings in the reinforcing strip 360.
[00064] Each fixed jaw 340 includes a pair of radially extending flanges 342 and recesses 346 that are angularly disposed around the perimeter of the fixed jaw 340. Although eight recesses 346 are shown in the present example, it should be understood that any other suitable number of recesses 346 can be used. Flanges 342 are configured to guide and laterally retain reinforcing strip 360 with respect to fixed jaw 340; while the recesses 346 are configured to receive the free barbed ends 386 of the fasteners 380. In particular, the recesses 346 are configured to allow the free barbed ends 386 to pass through the reinforcing strip 360 without the fixed jaw 340 offering any resistance. Therefore, unlike the fixed jaws 140 and 240 described above, the fixed jaw 340 of the present example does not deform the fasteners 380. The guides 325 include recesses 326 which are configured to guide and laterally grip the flanges 382 relative to the guides 325. 346 and 326 are configured to successively align with each other at the interface of fabric layers 92 and 94 during rotation of fixed jaws 340 and guides 325, as shown above in Figure 18. It should be understood that the barbed configuration of the barbed free ends 386 substantially prevents the barbed free ends 386 from retracting through the reinforcing strip 360 after the barbed free ends 386 traverse the reinforcing strip 360. By way of example only, the fasteners 380 may be formed of various types of metal ( e.g. micro-stamped titanium, titanium-based alloys, etc.) and/or any other suitable materials (e.g. absorbable polyglecapron (PG CL) as MONOCRYL produced by Ehticon, Inc., of Somerville, New Jersey, USA, etc.). Other suitable materials that can be used to form fasteners 380 will be apparent to those skilled in the art based on the teachings of the present invention.
[00065] With the barbed free ends 386 above the reinforcing strip 360 and the flanges 382 below the fastener strip 370, it is to be understood that the strips 360 and 370 and fasteners 380 will cooperate to hold the fabric layers 92 and 94 together. together. It is also to be understood that fabric layers 92 and 94 may be pinched between fixed jaws 340 and guides 325 as the barbed free ends 386 are being guided through layers 92 and 94 so that the strip assembly 360 and 370 and fasteners 380 hold fabric layers 92 and 94 in a compressed configuration. It is further understood that such retention of layers 92 and 94 can provide tissue hemostasis, substantially preventing tissue bleeding in the transection cut formed by tissue cutting element 330. As noted above, the fixed jaws 340 and/or guides 325 can be triggered to rotate. Such motion of driving fixed jaws 340 and/or guides 325 can additionally drive strips 360 and 370 relative to the fabric, as shown in Figure 18.
[00066] End Actuator:300 can be operated in a similar manner to the operation of End Actuator 100 described above. It should also be understood that the above process can be carried out and repeated for as long as desired, allowing the operator to create secure transections having an effectively indefinite length (e.g. especially if a significant amount of reinforcing strips 360 and 370 and fasteners 380 are to be used). preloaded), without having to remove the 300 end actuator from the patient. Similarly, the above process can be repeated to create multiple secure transections separately within the patient, without having to remove the end actuator 300 from the patient. In cases where the operator is moving from one transection site to another transection site, the operator may simply use a conventional cutting instrument to cut strips 360 and 370 before moving to the last transection site. Still other components, elements, configurations and suitable operating capabilities and variations that may be associated with the end actuator 300 will become apparent to those skilled in the art based on the teachings of the present invention. III. Several
[00067] 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, embodiments, examples, etc. which are described in the present invention. The teachings, expressions, modalities, examples, etc. described above should therefore not be viewed in isolation from each other. Various suitable ways in which the teachings of the present invention may be combined will be readily apparent to those skilled in the art based on the teachings of the present invention. These modifications and variations are intended to be included within the scope of the appended claims.
[00068] It is to be understood that any patent, publication, or other descriptive material, in whole or in part, deemed to be incorporated by reference into the present invention is incorporated into the present invention only to the extent that the incorporated material does not in conflict with existing definitions, statements or other descriptive materials presented in this description. Accordingly, and to the extent necessary, the description as explicitly presented herein supersedes any conflicting material incorporated herein by reference. Any material, or portions thereof, which is incorporated herein by reference, but which conflicts with the existing definitions, statements, or other descriptive materials presented herein, is incorporated herein only to the extent that there is no conflict between the material embedded and existing description material.
[00069] 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 obtained from Intuitive Surgical, Inc., of Sunnyvale, California, USA.
[00070] 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 may, in either or both cases, be reconditioned for reuse after at least one use. Overhaul can include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts and subsequent reassembly. Specifically, some versions of the device may be dismantled, any number of specific parts, or parts of the device may be selectively replaced or removed in any combination. By cleaning and/or replacing specific parts, some versions of the device can be reassembled for subsequent use in a refurbishment facility or by a user immediately prior to a surgical procedure. Those skilled in the art will understand that refurbishing a device can use a variety of disassembly, cleaning/replacement and reassembly techniques. The use of such techniques and the resulting refurbished device are within the scope of this application.
[00071] By way of example only, 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 bag or TYVEK pouch. The container and device can then be placed in a field of radiation that can penetrate the container, such as gamma radiation, X-rays, or high-energy electrons. Radiation can kill bacteria in the device and container. The sterile device can then be stored in a sterile container for later use. The device may also be sterilized using any other technique known in the art, including, but not limited to, beta or gamma radiation, ethylene oxide, or water vapor. [00072] Having shown and described various embodiments of the present invention, further adaptations of the methods and systems described in the present invention may be made through suitable modifications by a person skilled in the art, without departing from the scope of the present invention. Several such possible modifications have been mentioned and others will be apparent 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 mandatory. 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 the same is not limited to the details of structure and operation shown and described in the specification and drawings.

权利要求:
Claims (18)
[0001]
1. Surgical apparatus, comprising: (a) a rod, the rod having a distal end; (b) an end actuator (100; 200; 300), the end actuator being disposed at the distal end of the rod, the end actuator defining a gap configured to receive tissue, the end actuator comprising : (i) a first fastener assembly forming element (140; 240; 340) positioned on a first side of the span, and (ii) a second fastener assembly forming element (120; 225; 325) positioned on a second gap side; (c) a first fastener assembly member (160; 260; 360), the first fastener assembly forming member (140; 240; 340) being configured to receive the first fastener assembly member (160; 260) ; 360) and positioning the first member of the fastener assembly (160; 260; 360) on the first side of the gap; and (d) a second fastener assembly member (170; 270; 370), wherein the second fastener assembly member (120; 225; 325) is configured to receive the second fastener assembly member (170; 270; 370) and positioning the second member of the fastener assembly (170; 270; 370) on the second side of the span, wherein (e) the first member of the fastener assembly (140; 240; 340) is rotatable with respect to to the stem; characterized in that: (f) the first and second fastener assembly elements (160, 170; 260, 270; 360, 370) are configured to be translated distally through the shank during rotation of the first assembly forming element of fasteners (140; 240; 340); and (g) the first and second fastener assembly elements (160, 170; 260, 270; 360, 370) are configured to join together and thereby form the fastener assembly.
[0002]
2. Apparatus, according to claim 1, characterized in that the end actuator further comprises: (i) a first grip (110), and (ii) a second grip (120), the first grip (120) being 110) is pivotable with respect to the second jaw (120) to selectively vary the span.
[0003]
3. Apparatus according to claim 2, characterized in that the first element forming the set of fasteners (140; 240) is arranged in the first claw (110), the second forming element of the set of fasteners (120) being ; 225) is arranged on the second jaw (120).
[0004]
4. Apparatus according to claim 3, characterized in that the first claw (110) defines a first channel (114) configured to guide the first element of the fastener assembly (160; 260) towards the first forming element. of the fastener assembly (140; 240), the second jaw (120) defining a second channel (124) configured to guide the second fastener assembly element (170; 270) towards the second fastener assembly forming element (170; 270). (120; 225).
[0005]
5. Apparatus according to claim 4, characterized in that the second channel (124) defines a redirection zone (129) configured to redirect the trajectory of the second element of the set of fasteners (170) from a distal direction to a proximal direction.
[0006]
Apparatus according to claim 1, characterized in that the end actuator further comprises a fabric cutting element (134) operable to cut fabric.
[0007]
7. Apparatus according to claim 6, characterized in that the fabric cutting element (134) is configured to translate with respect to the first and second forming elements of the fastener assembly (140, 120; 240, 225; 340, 325).
[0008]
8. Apparatus according to claim 6, characterized in that the tissue cutting element (134) is positioned proximally to the first and second fastener assembly forming elements (140, 120; 240, 225; 340, 325).
[0009]
9. Apparatus, according to claim 1, characterized in that the first element forming the set of fasteners (140, 240, 340) comprises a fixed grip.
[0010]
10. Apparatus according to claim 9, characterized in that the fixed grip (140) defines angularly arranged recesses (146) configured to deform portions (174) of the second element of the fastener assembly (170).
[0011]
11. Apparatus according to claim 9, characterized in that the fixed jaw (140) defines angularly arranged protrusions (242) configured to deform portions (280) of the second element of the fastener assembly (270).
[0012]
12. Apparatus according to claim 1, characterized in that the first element of the set of fasteners (160; 260; 360) comprises a reinforcing strip.
[0013]
13. Apparatus according to claim 1, characterized in that the second element of the set of fasteners (170) comprises a wire, the wire including malleable protruding portions (174), wherein the first element forming the set of fasteners (140) is configured to deform the malleable protruding portions (174).
[0014]
14. Apparatus according to claim 1, characterized in that the second element of the fastener assembly (270; 370) comprises: (i) a strip (270; 370), and (ii) a plurality of fasteners ( 280; 380) extending transversely from the strip (270; 370), the first member of the fastener assembly (240; 340) being configured to receive the plurality of fasteners (280; 380).
[0015]
15. Apparatus according to claim 14, characterized in that each of the fasteners (280) comprises a deformable free end (286), the first forming element of the set of fasteners (240) being configured to deform each free end (286) in a rivet head configuration.
[0016]
An apparatus according to claim 14, characterized in that each of the fasteners (380) comprises a barbed free end (386), the barbed free ends (386) being configured to lock within the first element of the fastener set (360).
[0017]
17. Apparatus, according to claim 1, characterized in that the entire end actuator (300) is pivotable in relation to the rod.
[0018]
18. Apparatus according to claim 1, characterized in that it further comprises: (a) a first spool (162), whereby a portion of the first element of the set of fasteners (160) is assembled on the first spool (162) ); and (b) a second spool (172), wherein a portion of the second member of the fastener assembly (170) is assembled on the second spool (172).

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EP2837337A1|2015-02-18|

EP2837337B1|2017-01-11|

CN105682571A|2016-06-15|

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JP2016529996A|2016-09-29|

PL2837337T3|2017-07-31|

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EP3207882A3|2018-01-31|

CN105682571B|2018-09-14|

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US11147553B2|2019-03-25|2021-10-19|Cilag Gmbh International|Firing drive arrangements for surgical systems|

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US11241228B2|2019-04-05|2022-02-08|Covidien Lp|Surgical instrument including an adapter assembly and an articulating surgical loading unit|

US11253254B2|2019-04-30|2022-02-22|Cilag Gmbh International|Shaft rotation actuator on a surgical instrument|

US11259803B2|2019-06-28|2022-03-01|Cilag Gmbh International|Surgical stapling system having an information encryption protocol|

US11224497B2|2019-06-28|2022-01-18|Cilag Gmbh International|Surgical systems with multiple RFID tags|

US11219455B2|2019-06-28|2022-01-11|Cilag Gmbh International|Surgical instrument including a lockout key|

US11246678B2|2019-06-28|2022-02-15|Cilag Gmbh International|Surgical stapling system having a frangible RFID tag|

US11241235B2|2019-06-28|2022-02-08|Cilag Gmbh International|Method of using multiple RFID chips with a surgical assembly|

US11051807B2|2019-06-28|2021-07-06|Cilag Gmbh International|Packaging assembly including a particulate trap|

US11224424B2|2019-08-02|2022-01-18|Covidien Lp|Linear stapling device with vertically movable knife|

US11123068B2|2019-11-08|2021-09-21|Covidien Lp|Surgical staple cartridge|

US11109862B2|2019-12-12|2021-09-07|Covidien Lp|Surgical stapling device with flexible shaft|

US11234698B2|2019-12-19|2022-02-01|Cilag Gmbh International|Stapling system comprising a clamp lockout and a firing lockout|

US11246593B2|2020-03-06|2022-02-15|Covidien Lp|Staple cartridge|

US20210353293A1|2020-05-12|2021-11-18|Covidien Lp|Surgical stapling device with replaceable staple cartridge|

US11191537B1|2020-05-12|2021-12-07|Covidien Lp|Stapling device with continuously parallel jaws|

US11191538B1|2020-06-08|2021-12-07|Covidien Lp|Surgical stapling device with parallel jaw closure|

US11266402B2|2020-07-30|2022-03-08|Covidien Lp|Sensing curved tip for surgical stapling instruments|

法律状态:
2020-02-18| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

2021-11-09| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

2022-01-25| 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 12/08/2014, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

申请号 | 申请日 | 专利标题

US13/967,958|2013-08-15|

US13/967,958|US9561029B2|2013-08-15|2013-08-15|Surgical stapler with rolling anvil|

PCT/US2014/050662|WO2015023641A1|2013-08-15|2014-08-12|Surgical stapler with rolling anvil|

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