surgical instrument

专利摘要:
SURGICAL STAPLER WITH ROTARY CAM DRIVE. The present invention deals with a surgical circular stapler, which has a handle assembly, a rod, a stapling assembly, a motor, a drive assembly, and a trigger assembly. The stem extends distally from the handle assembly. The stapling assembly is attached to a distal end of the nail. The longitudinal translation of the firing assembly causes the stapling assembly to drive a plurality of staples in a circular array to secure the two tissue lumens together. The stapling assembly can further drive a blade to cut any excess tissue within the circular array of staples. The motor is operable to rotate the drive assembly to thereby translate the trip assembly. A resilient member proximally polarizes the firing assembly. Through cooperation between the trigger assembly and the resilient member, the trigger assembly is moved distally and proximally to complete a trigger stroke in response to rotation of the trigger assembly through a single revolution.
公开号:BR112016006299B1
申请号:R112016006299-0
申请日:2014-09-19
公开日:2022-01-25
发明作者:Richard L. Leimbach；Richard F. Schwemberger；John P. Measamer；Johnny H. Alexander Iii；Christopher C. Miller；Brian F. Dinardo；Jason M. Rector
申请人:Ethicon Endo-Surgery, Llc；
IPC主号:

专利说明:

BACKGROUND
[0001] In some situations, a surgeon may wish to position a surgical instrument through a patient's orifice and use the instrument to adjust, position, attach and/or otherwise interact with tissue within the patient. For example, in some surgical procedures (eg, colorectal, bariatric, thoracic, etc.), portions of the gastrointestinal tract and/or esophagus, etc., 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 reattached to each other in an end-to-end anastomosis. Such a tool for performing these anastomotic procedures is a circular stapler, which is inserted through a naturally occurring patient orifice. Some circular staplers are configured to cut fabric and staple fabric substantially simultaneously. For example, a circular stapler can cut excess tissue that is within an annular array of staples at an anastomosis to provide a substantially smooth transition between lumen sections that are joined at the anastomosis.
[0002] Examples of circular surgical staplers are described in U.S. Patent. No. 5,205,459 entitled "Surgical Anastomosis Stapling Instrument", issued April 27, 1993; US Patent No. 5,271,544 entitled "Surgical Anastomosis Stapling Instrument", issued December 21, 1993; US Patent No. 5,275,322 entitled "Surgical Anastomosis Stapling Instrument", issued January 4, 1994; US 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; and in US Patent Publication No. 2012/0292372 entitled "Low Cost Anvil Assembly for a Circular Stapler" published November 22, 2012. The disclosure of each of the US patents and US patent application publication cited above is incorporated in this descriptive report as a reference. Some of these staplers are operable to grip the fabric layers, cut through the attached fabric layers, and drive staples through the fabric layers to substantially seal the cut fabric layers together near the cut ends of the fabric layers. thus joining two cut ends of an anatomical lumen.
[0003] Other merely additional 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; 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; US Patent No. 7,367,485 entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", issued May 6, 2008; US Patent No. 7,380,695 entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing" issued June 3, 2008; US Patent No. 7,380,696 entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism" issued 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; and U.S. 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 aforementioned U.S. patents is incorporated herein by way of reference. Although the aforementioned surgical staplers are described as used in endoscopic procedures, it must be understood that these surgical staplers can also be used in open procedures and/or other non-endoscopic procedures.
[0004] Although various types of surgical stapling instruments and associated components have been produced and used, it is believed that no one prior to the inventor(s) has produced or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS
[0005] 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 numbers similar references identify the same elements, and where:
[0006] Figure 1 depicts a side elevation view of an exemplary circular stapling surgical instrument;
[0007] Figure 2A depicts 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;
[0008] Figure 2B depicts an enlarged longitudinal cross-sectional view of the stapling head assembly of Figure 2A showing the anvil in a closed position;
[0009] Figure 2C depicts an enlarged longitudinal cross-sectional view of the stapling head assembly of Figure 2A showing an exemplary staple driver and blade in a fired position;
[00010] Figure 3 depicts an enlarged partial cross-sectional view of an exemplary clamp formed against the anvil;
[00011] Figure 4A depicts an enlarged side elevation view of an example actuator handle assembly of the surgical instrument of Figure 1 with a portion of the frame removed, showing a trigger in an unfired position and a lock feature in a non-fired position. blocked;
[00012] Figure 4B depicts an enlarged side elevation view of the actuator cable assembly of Figure 4A, showing the trigger in a triggered position and the lock feature in an unlocked position;
[00013] Figure 5 depicts an enlarged partial perspective view of an exemplary indicator assembly of the surgical instrument of Figure 1 showing an indicator window and indicator lever;
[00014] Figure 6 depicts a diagrammatic view of the indicator window of Figure 5 showing an exemplary indicator bar and corresponding exemplary clip representations;
[00015] Figure 7 depicts a perspective view of an exemplary reciprocating circular stapling surgical instrument having a motor and a multiple exemplary cam assembly;
[00016] Figure 8 depicts a side elevation view of the instrument, motor and multi-cam assembly of Figure 7;
[00017] Figure 9A depicts a side elevation view of the engine and multiple cam assembly of Figure 7 in a first rotational position;
[00018] Figure 9B depicts a side elevation view of the engine and multiple cam assembly of Figure 7 in a second rotational position;
[00019] Figure 9C depicts a side elevation view of the engine and multiple cam assembly of Figure 7 in a third rotational position;
[00020] Figure 10A depicts a perspective view of the multiple cam assembly of Figure 7 in the first rotational position;
[00021] Figure 10B depicts a perspective view of the multiple cam assembly of Figure 7 in the second rotational position;
[00022] Figure 10C depicts a perspective view of the multiple cam assembly of Figure 7 in third rotational position;
[00023] Figure 11A describes a side elevation view of an exemplary motor and inclined cam that can be incorporated into the instrument of Figure 7, in a first rotational position;
[00024] Figure 11B depicts a side elevation view of the engine and inclined cam of Figure 11A in a second rotational position;
[00025] Figure 12 depicts a perspective view of an exemplary alternative inclined cam that may be incorporated into the instrument of Figure 7;
[00026] Figure 13 depicts a perspective view of another exemplary alternative circular stapling surgical instrument having a motor and a cam;
[00027] Figure 14 depicts a perspective view of the engine and cam of Figure 13;
[00028] Figure 15 depicts a front perspective view of the engine and cam of Figure 13;
[00029] Figure 16A depicts a side elevation view of the instrument, motor and cam of Figure 13 in a first rotational position;
[00030] Figure 16B depicts a side elevation view of the instrument, motor and cam of Figure 13 in a second rotational position;
[00031] Figure 17 describes a perspective view of the firing weapon of the instrument of Figure 13;
[00032] Figure 18 depicts a perspective view of an exemplary alternative fire weapon that may be incorporated into the instrument of Figure 13;
[00033] Figure 19A describes a side elevation view of a firing weapon assembly that can be incorporated into the instrument of Figure 13, in a first position;
[00034] Figure 19B depicts a side elevation view of the exemplary firing weapon assembly of Figure 19A in a second position;
[00035] Figure 20A describes a side elevation view of another exemplary firing weapon assembly that can be incorporated into the instrument of Figure 13, in a first position;
[00036] Figure 20B depicts a side elevation view of the exemplary firing weapon assembly of Figure 20A in a second position;
[00037] Figure 21 depicts a perspective view of an exemplary multi-engine firing assembly;
[00038] Figure 22 depicts a side elevation view of an exemplary reciprocating circular stapling surgical instrument having an obliquely oriented motor;
[00039] Figure 23 depicts a perspective view of an exemplary reciprocating circular stapling surgical instrument having an obliquely oriented motor; and
[00040] Figure 24 depicts an exemplary force profile associated with a firing stroke of a circular stapling surgical instrument.
[00041] The drawings are not intended to be limiting in any way and it is contemplated that various embodiments of the technology may be performed 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 specification illustrate various aspects of the present technology and, in conjunction with the description, 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
[00042] The following description of certain examples of the technology cannot be used to limit its scope. Other examples, features, aspects, modalities and advantages of the technology will become apparent to those skilled in the art with the following description, which is by way of illustration one of the best contemplated modes for carrying out the technology. As will be understood, the technology described herein is capable of other different and obvious aspects, all without disregarding the invention. Accordingly, the drawings and descriptions must be regarded as illustrative and not restrictive in nature. I. Overview of the exemplary circular stapling surgical instrument
[00043] Figures 1-6 depict an exemplary circular stapling surgical instrument (10) that has a stapling head assembly (20), a stem assembly (60) and an actuator cable assembly (70), each one of which will be described in detail below. The stem assembly (60) extends distally from the actuator handle assembly (70) and the stapling head assembly (20) is coupled to a distal end of the stem assembly (60). Briefly, the actuator cable assembly (70) is intended to actuate a staple driver (24) of the stapling head assembly (20) to drive a plurality of staples (66) out of the stapling head assembly ( 20). The clamps (66) are curved to form complete clamps by an anvil (40) which is attached to the distal end of the instrument (10). Consequently, the tissue (2), shown in Figures 2A-2C, can be stapled using the instrument (10).
[00044] In the present example, the instrument (10) comprises a closing system and a fastener discharge 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) has the purpose of longitudinally translating the trocar (38) with respect to the stapling head assembly (20), thus translating the anvil (40) when the anvil (40) is coupled to the trocar (38), to clamp the tissue between the anvil (40) and the stapling head assembly (20). The trigger system comprises a trigger (74), a trigger actuation assembly (84), a trigger actuator (64) and a clamp trigger (24). The staple driver (24) includes a knife (36) configured to cut the fabric when the staple driver (24) is activated longitudinally. In addition, the staples (66) are positioned distally to a plurality of staple drive features (30) of the staple driver (24) so that the staple driver (24) also inserts the staples (66) into distal position when the clamp driver (24) is activated longitudinally. In this way, when the trigger (74) is activated and the trigger actuation assembly (84) activates the clamp driver (24) through the trigger actuator (64), the knife (36) and the elements (30) of substantially simultaneously they break the tissue (2) and insert the staples (66) distally to the stapling head assembly (20) into the tissue. The components and functionality of the closing system and triggering system will now be described in more detail. A. Exemplary anvil
[00045] As shown in Figures 1-2C, the anvil (40) is selectively attachable to the instrument (10) to provide a surface against which the clamps (66) can be curved to clamp the material contained between the set of stapling head (20) and anvil (40). The anvil (40) of the present example is selectively attachable to a trocar or pointed rod (38) that extends distally to the stapling head assembly (20). Referring to Figures 2A-2C, the anvil (40) is selectively attachable by coupling a proximal stem (42) of the anvil (40) to a distal tip of the trocar (38). The anvil (40) comprises a generally circular anvil head (48) and a proximal rod (42) which extends proximally from the anvil head (48). In the example shown, the proximal rod (42) comprises a tubular member (44) having resiliently polarized retaining loops (46) to selectively couple the anvil (40) to the trocar (38), although this is merely optional, and accurate. It is understood that other retaining features for coupling the anvil (40) to the trocar (38) may also be used. For example, C-clamps, grips, threads, pins, stickers, etc. can be used to couple the anvil (40) to the trocar (38). In addition, although the anvil (40) is described as selectively attaching to the trocar (38), in some versions the proximal rod (42) may include a one-way coupling feature so that the anvil (40) cannot can be removed from the trocar (38) once the anvil (40) is fixed. Merely exemplary unidirectional elements include barbs, unidirectional snaps, tweezers, collars, flaps, bands, etc. Of course, still other configurations for coupling the anvil (40) to the trocar (38) will be apparent to one 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 sharp shaft which can be inserted into the hollow shaft.
[00046] 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 directed out of the stapling head assembly (20) into the staple forming pockets (52), as shown in Figure 2C, the legs (68) of the clips (66) are folded to form complete clips.
[00047] With the anvil (40) as a separate component, it must be understood that the anvil (40) can be inserted and secured to a portion of tissue (2) prior to being attached to the stapling head assembly (20) . By way of example only, the anvil (40) may 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 a portion of the anvil (40), and the second tubular tissue portion (2) can be sutured to or around the trocar (38). .
[00048] As shown in Figure 2A, the anvil (40) is then coupled to the trocar (38). The trocar (38) of the present example is shown in a more distal activated position. Such an extended position for the trocar (38) can provide a larger area to which tissue (2) can be attached prior to attachment of the anvil (40). Furthermore, the extended position of the trocar (38) may also provide easier attachment of the anvil (40) to the trocar (38). Trocar (38) additionally includes a tapered distal tip. Such a tip may be capable of puncturing tissue and/or assisting in the insertion of the anvil (40) into the trocar (38), although the tapered distal tip is merely optional. For example, in other versions, the trocar (38) may have a blunt tip. Additionally, or alternatively, the trocar (38) may include a magnetic portion (not shown) that may attract an anvil (40) towards the trocar (38). Of course, additional configurations and arrangements for the anvil (40) and trocar (38) will be apparent to one skilled in the art in view of the teachings of the present invention.
[00049] When the anvil (40) is coupled to the trocar (38), the distance between the proximal face of the anvil (40) and a distal face of the stapling head assembly (20) defines a span distance d. The trocar (38) of the present example is longitudinally translatable with respect to the stapling head assembly (20) via an adjustment knob (98) located at a proximal end of the actuator cable assembly (70), as will be described in more detail. detail below. Consequently, when the anvil (40) is coupled to the trocar (38), rotation of the adjustment knob (98) increases or decreases the span distance d by activating the anvil (40) with respect to the stapling head assembly (20) . For example, as shown sequentially in Figures 2A-2B, the anvil (40) is shown being activated proximally to the actuator handle assembly (70) from an initial open position to a closed position, thus reducing the distance span of the distance between the two fabric portions (2) to be joined. Once the span distance d falls within a predetermined range, the stapling head assembly (20) can be triggered, as shown in Figure 2C, to staple and cut the tissue (2) between the anvil (40) and the stapling head assembly (20). The stapling head assembly (20) is for the purpose of stapling and cutting the tissue (2) by a user turning a trigger (74) of the actuator cable assembly (70), as will be described in more detail below.
[00050] As noted above, span distance d corresponds to the distance between the anvil (40) and the stapling head assembly (20). When the instrument (10) is inserted into a patient, this span distance d may not be readily visible. Accordingly, a movable indicator bar (110), shown in Figures 5-6, is provided to be visible through an indicator window (120) positioned opposite the trigger (74). The indicator bar (110) is operable to move in response to 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), which indicates that the anvil span is within a desired operating range (e.g., a green colored region or "green zone") and a corresponding clamp compression representation at each end of the scale (130). By way of example only, as shown in Figure 6, a first staple image (132) depicts a large staple height while a second staple image (134) describes a small staple height. Accordingly, a user can view the position of the attached anvil (40) in relation to the stapling head assembly (20) through the indicator bar (110) and scale (130). The user can then adjust the position of the anvil (40) via the adjustment knob (98) accordingly.
[00051] Returning to Figures 2A-2C, a user sutures a portion of tissue (2) around the tubular element (44) so that the anvil head (48) is situated within a portion of the tissue (2) at be stapled. When the tissue (2) is attached to the anvil (40), the retaining clips (46) and a tubular element portion (44) emerge from the tissue (2) so that the user can attach the anvil (40) to the trocar. (38). With tissue (2) attached to the trocar (38) and/or another portion of the stapling head assembly (20), the user attaches the anvil (40) to the trocar (38) and activates the anvil (40) proximal toward the stapling head assembly (20) to reduce span distance d. Once the instrument (10) is within operating range, the user then staples the fabric ends (2), thus forming a substantially contiguous tubular portion of fabric (2).
[00052] The anvil (40) may 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; US Patent No. 5,533,661; and/or US Publication No. 2012/0292372, the disclosures thereof being incorporated herein by reference; and/or in other embodiments as will be apparent to one of skill in the art in view of the teachings of the present invention. B. Sample Staple Head Assembly
[00053] The stapling 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 staple driver (24) and a plurality of staples (66) contained within staple pockets (32). Clips (66) and clip pockets (32) are arranged in a circular array around the tubular housing (22). In the present example, the staples (66) and the staple pockets (32) are arranged in a pair of concentric annular rows of staples (66) and the staple pockets (32). The clamp driver (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-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) arranged circumferentially around the central recess. (28) and extends distally to the stem assembly (60). Each element (30) is configured to contact and engage a corresponding clip (66) of the plurality of clips (66) within the clip pockets (32). Consequently, when the clamp driver (24) is activated distal to the actuator handle assembly (70), each element (30) directs a corresponding clamp (66) out of its clamp pocket (32) through of a clip opening (34) formed at a distal end of the tubular housing (22). As each element (30) extends from the staple driver (24), the plurality of staples (66) are directed 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 directed into the staple forming pockets (52) to flex the legs (68) of the staples (66), thereby stapling the material situated between the anvil. (40) and the stapling head assembly (20). Figure 3 depicts a merely exemplary clip (66) directed by an element (30) to a clip-forming pocket (32) of the anvil (40) for flexing the legs (68).
[00054] The staple driver (24) additionally includes a cylindrical knife (36) which is coaxial with the trocar opening (26) and inserted from the staple pockets (32). In the present example, the cylindrical knife (36) is arranged within the central recess (28) to translate distally with the clamp driver (24). When the anvil (40) is attached to the trocar (38) as described above, the anvil head (48) provides a surface against which the cylindrical knife (36) cuts the material contained between the anvil (40) and the assembly. stapling head (20). In some versions, the anvil head (48) may include a recess (not shown) for the cylindrical knife (36) to assist in cutting the material (eg, providing a cooperative shear edge). In addition, or alternatively, the anvil head (48) may include one or more opposing cylindrical knives (not shown) offsetting the cylindrical knife (36) so that a scissor-like cutting action can be provided. Other configurations will be apparent to one skilled in the art in view of the teachings of the present invention. The stapling head assembly (20) is thus operable for both staple and cut fabric (2) substantially simultaneously in response to actuation by the actuator cable assembly (70).
[00055] Of course, the stapling head assembly (20) may 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; US Patent No. 5,533,661; and/or US Publication No. 2012/0292372, the disclosures thereof being incorporated herein by reference; and/or in other embodiments as will be apparent to one of skill in the art in view of the teachings of the present invention.
[00056] 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 stapling head assembly (20) and/or stem assembly (60). As shown in Figures 2A-2C, the trocar (38) is coupled to a trocar actuator (39) so that the trocar (38) can be activated longitudinally by rotating the rotary knob (98), as will be described in more detail. details below refer to actuator cable assembly (70). In the present example, the trocar actuator (39) comprises a relatively rigid stem coupled to the trocar (38), although this is merely optional. In some versions, the actuator (39) may comprise a longitudinally rigid material while allowing lateral bending so that instrument portions (10) may be selectively bent or curved during use; or instrument (10) may include a predefined flexed stem assembly (60). When the anvil (40) is coupled to the trocar (38), the trocar (38) and the anvil (40) are translatable through the actuator (39) to adjust the gap distance d between the anvil (40) and the set of stapling head (20). Other additional configurations for the actuator (39) to longitudinally drive the trocar (38) will be apparent to one skilled in the art in view of the teachings of the present invention. C. Example rod assembly
[00057] The Stapling Head Assembly (20) and Trocar (38) are positioned at a distal end of the Nail Assembly (60), as shown in Figures 2A-2C. The rod assembly (60) of the present example comprises an outer tubular member (62) and an actuator actuator (64). The outer tubular member (62) is coupled to the tubular housing (22) of the stapling head assembly (20) and to a frame (72) of the actuator cable assembly (70), thus providing a mechanical foundation for the components of acting there. The proximal end of the actuator actuator (64) is coupled to a trigger actuation assembly (84) of the actuator cable assembly (70), described below. The distal end of the trigger actuator (64) is coupled to the clamp driver (24) so that rotation of the trigger (74) longitudinally activates the clamp driver (24). As shown in Figures 2A-2C, the actuator actuator (64) comprises a tubular element that has an open longitudinal axis so that the actuator (39) coupled to the trocar (38) can act longitudinally and with respect to the actuator actuator ( 64). Of course, it must be understood that other components may be arranged within the actuator actuator (64) as will be apparent to one skilled in the art in view of the teachings of the present invention.
[00058] The rod assembly (60) may 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; US Patent No. 5,533,661; and/or US Publication No. 2012/0292372, the disclosures thereof being incorporated herein by reference; and/or in other embodiments as will be apparent to one of skill in the art in view of the teachings of the present invention. D. Example Actuator Cable Assembly
[00059] Now referring to Figures 4A-5, the actuator cable assembly (70) comprises a frame (72), a trigger (74), a lock feature (82), a trigger actuation assembly (84). ) and a trocar actuation set (90). The trigger (74) of the present example is pivotally mounted to the frame (72) and is coupled to the trigger actuation assembly (84) so that rotation of the trigger (74) from an unfired position (shown in Figure 4A) to a triggered position (shown in Figure 4B) activates the actuator actuator (64) described above. A spring (78) is coupled to the frame (72) and the trigger (74) to bias the trigger (74) towards the unfired position. The locking feature (82) is a pivoting element that is coupled to the frame (72). In a first locked position, the lock feature (82) is rotated up and away from the frame (72) so that the lock feature (82) engages the trigger (74) and mechanically resists actuation of the trigger (74). by a user. In a second unlocked position, like that shown in Figures 1 and 4B, the locking feature (82) is rotated downward so that the trigger (74) can be activated by the user. Accordingly, with the lock feature (82) in the second position, the trigger (74) can engage a trigger actuation assembly (84) to trigger the instrument (10).
[00060] As shown in Figures 4A-4B, the trigger actuation assembly (84) of the present example comprises a sliding trigger carrier (86) engaged with a proximal end of the trigger actuator (64). The carrier (86) includes a set of tabs (88) at a proximal end of the carrier (86) for engaging and engaging a pair of trigger arms (76) extending from the trigger (74). Consequently, when the trigger (74) is rotated, the conveyor (86) is longitudinally activated and transfers longitudinal motion to the actuator actuator (64). In the example shown, the carrier (86) is fixedly coupled to the proximal end of the actuator actuator (64), although this is merely optional. Indeed, in a merely exemplary alternative, the carrier (86) may simply be contiguous with the actuator actuator (64) while a distal spring (not shown) biases the actuator actuator (64) proximally to the cable assembly. of actuator (70).
[00061] 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; US Patent No. 5,533,661; and/or US Publication No. 2012/0292372, the disclosures thereof being incorporated herein by reference; and/or in other embodiments as will be apparent to one of skill in the art in view of the teachings of the present invention.
[00062] The frame (72) also houses a Trocar Actuation Assembly (90) configured to drive the Trocar (38) longitudinally in response to rotation of the Adjustment Knob (98). As best shown in Figures 4A-5, the trocar actuation assembly (90) of the present example comprises the adjustment knob (98), a grooved rod (94) and a sleeve (92). The grooved stem (94) of the present example is located at a proximal end of the trocar actuator (39), although it should be understood that the grooved shaft (94) and the trocar actuator (39) may alternatively be separate components that engage with each other. to transmit longitudinal motion. Although the grooved rod (94) is configured to translate within the frame (72), the grooved shaft (94) does not rotate within the frame (72). The adjustment knob (98) is rotationally supported by the proximal end of the frame (72) and is operable to rotate the sleeve (92) which is engaged with the grooved rod (94) via an inner tab (not shown). The adjustment knob (98) also defines the internal threading (not shown), as will be described in more detail below. The grooved shank (94) of the present example comprises a continuous groove (96) formed on the outer surface of the grooved shank (94). Consequently, when the adjustment knob (98) is turned, the inner tab of the sleeve (92) passes into the groove (96) and the grooved rod (94) is activated longitudinally with respect to the sleeve (92). As the grooved stem (94) is located at the proximal end of the Trocar Actuator (39), turning the Adjustment Knob (98) in a first direction advances the Trocar Actuator (39) in a distal position with respect to the Drive Handle Assembly. (70). Consequently, the gap distance d between the anvil (40) and the stapling head assembly (20) is increased. By turning the adjustment knob (98) in the opposite direction, the Trocar Actuator (39) is activated proximally to the Drive Cable Assembly (70) to reduce the gap distance d between the anvil (40) and the stapling head assembly (20). Thus, the trocar actuation set (90) is intended to actuate the trocar (38) in response to the rotation of the adjustment knob (98). Of course, other configurations for the Trocar Actuation Assembly 90 will be apparent to those skilled in the art in view of the teachings of the present invention.
[00063] The groove (96) of the present example comprises a plurality of different portions (96A, 96B, 96C) that have different intervals or different 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, the distal portion (96A) comprises a fine pitch or a high number of grooves along a short axial length of the grooved rod (94). The middle portion (96B) comprises a section with a comparably larger pitch or few grooves per axial length so that relatively few rotations are required for the inner flap of the sleeve (92) to traverse a long axial distance. When anvil (40) is in an initial distal position with respect to the stapling head assembly (20), the inner flap of the sleeve (92) is positioned in the central portion (96B). Consequently, the span distance d can be quickly reduced by relatively few rotations of the adjustment knob (98), while the inner sleeve of the sleeve (92) traverses the middle portion (96B). The proximal portion (96C) of the present example is substantially similar to the distal portion (96A) and comprises a fine pitch or a high number of grooves over a small axial distance of the grooved rod (94) so that a large number of rotations are required. to traverse the short axial distance. The proximal portion (96C) of the present example is engaged by the internal thread defined by the knob (98) when the anvil (40) is substantially close to the stapling head assembly (20), so that the indicator bar (110) moves within the indicator window (120) along the scale (130) to indicate that the anvil gap is within a desired operating range, as will be described in more detail below. Consequently, when the grooved rod (94) reaches a proximal position where the proximal portion (96C) of the groove (96) engages the internal thread of the knob (98), each rotation of the adjustment knob (98) can reduce the span distance d by a relatively small amount to provide fine tuning. It should be understood that the inner flap of the sleeve (92) can be disengaged from the groove (96) when the proximal portion (96C) is engaged with the internal thread of the button (98).
[00064] The Trocar Actuation Assembly (90) 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, the disclosures thereof being incorporated herein by reference; and/or in other embodiments as will be apparent to one of skill in the art in view of the teachings of the present invention.
[00065] In the example shown in Figures 4A-4B, a U-shaped clip (100) is attached to an intermediate portion of the trocar actuator (39) located distally to the grooved stem (94). In the present example, a trocar actuator extension (39) engages a slot in the cable assembly housing (70) to prevent the trocar actuator (39) from rotating about its axis when the adjustment knob (98) is rotated. The U-shaped tab (100) of the present example additionally includes an elongated slot (102) on each of its opposite sides for receiving a fastener, such as a screw, bolt, pin, etc., to selectively adjust the position. lengthening of the elongated slot (102) of the U-shaped clip (100) with respect to the trocar actuator (39) for the purposes of calibrating the indicator bar (110) with respect to the scale (130). In some versions, the attachment member (e.g., screw, bolt, pin, etc.) engages with a portion of the frame (72) to substantially prevent the trocar actuator (39) from rotating about its axis when the adjustment knob (98) is turned.
[00066] As shown in Figure 5, the actuator cable assembly (70) additionally 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 frame (72) along a pair of slots formed in the frame (72). The indicator bracket (140) comprises a rectangular plate (144), an indicator arm (146) and an angled flange (142). The angled flange (142) is formed at the proximal end of the rectangular plate (144) and includes an opening (not shown) for slidingly mounting over the trocar actuator (39) and/or grooved stem (94). A coil spring (150) is interposed between the flange (142) and a boss (152) to bias the flange (142) against the U-shaped clip (100). Consequently, when the U-shaped clamp (100) acts distally with the Trocar Actuator (39) and/or the Grooved Rod (94), the Coil Spring (150) urges the Indicator Bracket (140) to follow distally with the U-shaped clip (100). In addition, the U-shaped clip (100) urges the indicator bracket (140) proximally to the boss (152) when the Trocar Actuator (39) and/or the Grooved Rod (94) translates proximally. , thus compressing the coil spring (150). Of course, it must be understood that in some versions the indicator bracket (140) can be attached to the trocar actuator (39) and/or grooved rod (94).
[00067] In the present example, a portion of the locking feature (82) adjoins a surface (141) of the indicator bracket (140) when the indicator bracket (140) is in a longitudinal position that does not correspond to when the span of the anvil is within a desired operating range (e.g. a green colored region or "green zone"). When the anvil gap is within a desired operating range (e.g. a green colored region or "green zone"), the indicator bracket (140) narrows to provide a pair of gaps (145) on each side. of an indicator arm (146) that allows the lock feature (82) to rotate, thereby releasing the trigger (74). Accordingly, 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. Of course it has to be understood that the blocking feature (82) may be omitted entirely in some versions.
[00068] This operating range can be visually communicated to the user via an indicator bar (110) of an indicator (104) shown against a scale (130), described briefly above. At a distal end of the indicator bracket (140) is an indicator arm (146) that projects distally and terminates in a finger (148) that projects laterally to control movement of the indicator (104). The index arm (146) and finger (148), best shown in Figure 5, are configured to engage a tab (106) of the index (104) so that the index (104) is rotated when the index bracket (140) ) is activated longitudinally. In the present example, the indicator (104) is pivotally coupled to the frame (72) at a first end of the indicator (104), although this is merely optional and another pivot points to the indicator (104) will be apparent to the skilled artisan. technique in view of the teachings of the present invention. 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). Accordingly, 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).
[00069] Of course the indicator bracket (140), the indicator (104) and/or the actuator cable assembly (70) may additionally be constructed in accordance with at least some of the teachings of US Patent Nos. 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; and/or US Publication No. 2012/0292372, the disclosures thereof being incorporated herein by reference; and/or in other embodiments as will be apparent to one of skill in the art in view of the teachings of the present invention. II. Exemplifying monitored circular surgical stapling instrument with translation cam follower
[00070] In some cases, it may be desirable to drive the staples (66) and knife (36) in a way that avoids manually driving the circular surgical stapling instrument (10). For example, in the case where the operator has inadequate hand strength to drive the circular surgical stapling instrument (10), it may be desirable to provide a motorized assembly for the staple driver (24) and knife (36). Motorization of at least part of the instrument (10) can also reduce the risk of operator error in driving the staple driver (24) and knife (36). In some cases, operator error with a manually operated instrument (10) may cause the instrument (10) to fail to fully trigger. This can occur when the operator is unable to fully manually pull the trigger (74), which can result in clips (66) not fully molded and therefore not fully attached to an anastomosis. In this way, the motorized drive of the staple driver (24) and knife (36) can ensure that the knife (36) is fully driven to cut the fabric, and that the staples (66) are fully deployed to secure the fabric, in a single drive stroke. Various examples of how the instrument (10) can be reconfigured to incorporate a motor will be described in greater detail below; while other examples will be apparent to those skilled in the art in accordance with the teachings of the present invention. It must be understood that the examples described below can function substantially similarly to the instrument (10) described above. In particular, the circular surgical stapling instruments described below can be used to clamp tissue in an annular array and cut off excess tissue that is within the annular array of staples to provide a substantially smooth transition between lumen sections.
[00071] While it may be desirable to at least partially motorize the circular surgical stapling instrument (10), it may not necessarily be desirable to motor all portions of the circular surgical stapling instrument (10). For example, it may be desirable to maintain manual adjustment of knob (98) or a similar feature to control the distance d between the anvil (40) and stapling head assembly (20). Other suitable portions of the circular surgical stapling instrument (10) may also rely on manual actuation despite the motorization of other features, as will be apparent to those skilled in the art having regard to the teachings of the present invention.
[00072] A merely exemplary variation of a motorized circular surgical stapling instrument (200) is shown in Figure 7. The instrument (200) of the present example comprises a closure system and a fastener discharge system. The closure system of the present example comprises a rotary knob (298), which is operable to actuate an anvil (240). The closure system and button (298) of the present example function substantially similar to the closure system and button (98) of the instrument (10) described above. In particular, the knob (298) can be rotated to longitudinally drive a trocar actuator (239) to increase or decrease a gap distance between the proximal face of an anvil (240) and a distal face of a stapling head assembly. (218).
[00073] The triggering system of the present example functions substantially similar to the triggering system of the instrument (10) described above except for the differences discussed below. In particular, the triggering system of the present example can be used to trigger a staple driver and a knife (not shown). The trigger system of the present example comprises a motor (210), a follower interface feature (284), an actuator actuator (264), a clamp driver (e.g. similar to the clamp driver (24) described above ) and a knife (e.g. similar to knife (36) described above). The actuator actuator (264) of the present example is configured to operate substantially similar to the actuator actuator (64) of the instrument (10) discussed above. In particular, a distal end of the actuator actuator (264) is coupled with the clamp actuator and a knife so that the actuator motor (210) longitudinally translates the actuator actuator (264), which in turn longitudinally drives the actuator (264). staple driver and a knife. The motor (210) of the present example is powered by a battery pack (212), although it should be understood that the motor (210) may be powered by any other suitable power source including an external power source (e.g., a wall outlet, etc.). As will be discussed in more detail below, the motor (210) is operable to drive the staple head assembly (218). In the present example, the motor (210) is oriented along an axis that is parallel to the longitudinal axis defined by the actuator actuator (264). However, it must be understood that the motor (210) may alternatively be oriented obliquely to the longitudinal axis defined by the actuator actuator (264). By way of example only, a merely illustrative oblique motor orientation is described in greater detail below with reference to Figures 22-23.
[00074] The stapling head assembly (218) includes the staple driver, a plurality of staples, and the knife, which is configured to cut the fabric when the staple driver is driven longitudinally. The stapling head assembly (218) of the present example functions substantially similar to the stapling head assembly (20) described above, except for the differences discussed below. In particular, the stapling head assembly (218) of the present example can be used to drive an annular array of staples into the fabric and to drive the knife to cut off excess tissue that is within the annular array of staples to provide a transition. substantially smooth between lumen sections in response to clamp driver actuation. The proximal end of the actuator actuator (264) is coupled with the follower interface feature (284) of an actuator cable assembly (270). A distal end of the driver actuator (264) is coupled with the clamp driver and a knife so that longitudinal translation of the follower interface feature (284) drives the clamp driver and knife. As will be discussed in more detail below, the motor (210) is operable to translate the follower interface feature (284) longitudinally through a drive assembly. Thus, when the motor (210) is driven, the follower interface feature (284) actuates the staple driver and the knife through the driver actuator (264) to substantially simultaneously cut the tissue and insert the staples distally. to the fabric.
[00075] As shown in Figure 7, the motor (210) is in communication with an operator input (202). Operator input (202) may include a manually operated trigger (eg, similar to trigger (74), etc.) and/or some other operable input to activate the motor (210). For example, operator input (202) may include a button, trigger, lever, slider, touch-sensitive elements, etc. which electrically activates the motor (210). In addition or alternatively, the operator input (202) may include an operator-operated electrical or software inserted actuator to activate the motor (210). In some versions, operator input (202) may include a foot pedal in communication with the motor (210). Other suitable forms that operator input 202 may take will be apparent to those skilled in the art in view of the teachings of the present invention.
[00076] It will also be understood that the operator input (202) may be placed in any suitable position on or in relation to the circular surgical stapling instrument (10) as will be apparent to one skilled in the art in view of the teachings contained herein . For example, the operator input (202) may be positioned on any portion of the actuator cable assembly (70) as seen in Figure 1. Alternatively, the operator input (202) may also be positioned somewhere separately from the instrument. surgical stapler (10), which may include locating the operator input (202) on a separate console or computer. The operator input (202) can also be located on a console or wireless communication device with the circular surgical stapling instrument (10). Other suitable locations for operator entry 202 will be apparent to those skilled in the art in view of the teachings of the present invention.
[00077] A. First example motor and drive assembly with cam follower translation
[00078] As shown in Figure 8, the motor (210) is disposed within the actuator cable assembly (270) parallel to a proximal portion of the actuator actuator (264). A multiple cam assembly (220) is coupled with a distal end of the motor (210). The motor (210) is operable to cause the multiple cam assembly (220) to rotate about a longitudinal axis (LA1) defined by the motor (210). As best seen in Figures 9A-10C, the multiple cam assembly (220) comprises a shaft (222) and a pair of cams (230, 240) mounted eccentrically on the shaft (222) at different longitudinal positions along the shaft. longitudinal (LA1). In the present example, the cable assembly housing (270) provides simple support for the shaft (222) and the remainder of the multi-cam assembly (220). Alternatively, the shaft (222) and the remainder of the multiple cam assembly (220) may be supported in any other suitable form and/or from any other suitable component(s).
[00079] As shown in Figures 10A-10C, on an outer surface of the first cam (230) it comprises a first portion (232) and a second portion (234). The first portion (232) and the second portion (234) are disposed on radially opposite sides of the first cam (230). The first portion (232) has a portion of the first cam (230) having a radial distance from the longitudinal axis (LA1) that is greater than a radial distance from the second portion (234) of the longitudinal axis (LA1). The first cam (230) further comprises intermediate portions (233, 235) disposed between the first portion (232) and the second portion (234). Intermediate portions (233, 235) are contoured to provide substantially smooth transition between the first portion (232) and second portion (234) along radially opposite sides of the first cam (230). Thus, at a specific point along an outer surface of the first cam (230), as the first cam (230) is rotated through one revolution, a radial distance from the first cam (230) to the longitudinal axis (LA1) ) will change from the largest radial distance presented by the first portion (232); for the smaller radial distance presented by the second portion (234) through the intermediate portion (233); and back to the greater radial distance presented by the first portion (232) through the intermediate portion (235).
[00080] As also shown in Figures 10A-10C, an outer surface of the second cam (240) comprises a first portion (242) and a second portion (244). The first portion (242) and the second portion (244) are disposed on radially opposite sides of the second cam (240). The first portion (242) has a second cam portion (240) having a radial distance from the longitudinal axis (LA1) that is greater than a radial distance from the second portion (244) of the longitudinal axis (LA1). The second cam (240) further comprises intermediate portions (243, 245) disposed between the first portion (242) and the second portion (244). Intermediate portions (243, 245) are contoured to provide substantially smooth transition between the first portion (242) and second portion (244) along radially opposite sides of the second cam (240). Thus, at a specific point along an outer surface of the second cam (240), as the second cam (240) is rotated through one revolution, a radial distance from the second cam (240) to the longitudinal axis (LA1) ) will change from the largest radial distance presented by the first portion (242); for the smaller radial distance presented by the second portion (244) through the intermediate portion (243); and back to the greater radial distance presented by the first portion (242) through the intermediate portion (245).
[00081] The first cam (230) and the second cam (240) are oriented so that the first portion (232) of the first cam (230) and the first portion (242) of the second cam (240) are in different positions. angled around the rod (222). Furthermore, the first cam (230) and the second cam (240) are oriented so that the second portion (234) of the first cam (230) and the second portion (244) of the second cam (240) are in different positions. angled around the rod (222). As can best be seen in Figures 9A-9C, the radial distance of the first portion (232) of the first cam (230) is greater than the first portion (242) of the second cam (240). The radial distance of the second portion (234) of the first cam (230) is greater than the second portion (244) of the second cam (240).
[00082] As shown in Figure 9A-9C, the follower interface feature (284) is coupled with a pivot cam follower (290). The cable assembly comprises a pivot pin (272) to which the cam follower (290) is rotationally coupled so that the cam follower (290) is free to rotate about the pivot pin (272). A first arm (292) of the cam follower (290) is in contact with the first cam (230) on an upper part of the first cam (230) directly vertical to the rod (222) and longitudinal axis (LA1). A second arm (294) of the cam follower (290) is in contact with the second cam (240) on an upper part of the second cam (240) directly vertical to the rod (222) and longitudinal axis (LA1). A third arm (296) of the cam follower (290) has a slot (295). The follower interface feature (284) comprises a pin (289) extending transversely from the follower interface feature (284). The pin (289) is slidably and pivotally arranged within the slot (295) so that the cam follower (290) is thus coupled with the follower interface feature (284) and further so that as cam follower (290) rotates about pivot pin (272), follower interface feature (284) translates longitudinally. As shown in Figure 8, a spring (274) disposed around the actuator actuator (264) within the actuator cable assembly (270) polarizes the follower interface feature (284) proximally longitudinally.
[00083] As shown in Figure 9A and 10A, with the multiple cam assembly (220) in a first rotational position, the second portion (234) of the first cam (230) is positioned above the longitudinal axis (LA1). In this first rotational position, the first arm (292) of the cam follower (290) is in contact with the second portion (234) of the first cam (230). The second portion (244) of the second cam (240) is positioned towards the longitudinal axis (LA1). However, the second arm (294) of the cam follower (290) is not in contact with the outer surface of the second cam (240). With the multiple cam assembly (220) in this first rotational position, the follower interface feature (284) is in a proximal longitudinal position.
[00084] As shown in Figures 9B and 10B, the multiple cam assembly (220) is rotated approximately 135° to a second rotational position. In this second rotational position, the first cam (230) has been rotated so that the first portion (232) of the first cam (230) is positioned above the longitudinal axis (LA1) and so that the first arm (292) of the cam (290) is now in contact with the first portion (232) of the first cam (230). It should be understood that as the first cam (230) is rotated from the first rotational position to the second rotational position, the first arm (292) of the cam follower (290) is driven from the smaller radial distance. presented by the second portion (234) to the greater radial distance presented by the first portion (232) through the intermediate portion (233), thus rotating the cam follower (290) around the pivot pin (272). In addition, as the cam follower (290) rotates around the pivot pin (272), the third arm (296) is rotated, and the follower interface feature (284) is driven longitudinally distal to a first longitudinal distance (LD1) against the proximal bias of the spring (274) by rotating the third arm (296). Furthermore, in this second rotational position, the second cam (240) has been rotated so that the intermediate portion (243) of the second cam (240) is positioned on top of the second cam (240) and so that the second arm (240) is positioned on top of the second cam (240). 294) of the cam follower (290) is now in contact with the intermediate portion (243) of the second cam (240) in the second rotational position.
[00085] As shown in Figure 9C and 10C, the multiple cam assembly (220) is rotated approximately an additional 45° to a third rotational position. In this third rotational position, the second cam (240) has been rotated so that the first portion (242) of the second cam (240) is positioned above the longitudinal axis (LA1) and so that the second arm (294) of the cam (290) is now in contact with the first portion (242) of the second cam (240). It must therefore be understood that as the second cam (240) is rotated from the first rotational position to the second rotational position and then to the third rotational position, the second arm (294) of the cam (290) is driven from the shortest radial distance caused by contact between the first arm (292) and the second portion (234) of the first cam (230) to the greater radial distance presented by the first portion (242) of the second cam. (240) through the intermediate portion (243), thus further rotating the cam follower (290) about the pivot pin (272). As the cam follower (290) rotates further about the pivot pin (272), the third arm (296) is also rotated further, and the follower interface feature (284) is driven longitudinally into position. distal to a second longitudinal distance (LD2) against the proximal bias of the spring (274) to a distal longitudinal position. Also in this third rotational position, the first cam (230) has been rotated so that the intermediate portion (235) of the first cam (230) is positioned above the longitudinal axis (LA1) and so that the first arm (292) of the follower cam (290) is no longer in contact with the first cam (230).
[00086] Further rotation of the multi-cam assembly (220) will transition the multi-cam assembly (220) back to the first rotational position after the multi-cam assembly (220) completes a full 360° of rotation thereby allowing the follower interface feature (284) to be driven back to the proximal longitudinal position. The follower interface feature (284) may be actuated proximally by the spring (274) as the rotated cams (230, 240) provide clearance for such proximal movement. It should be understood that proximal movement of the follower interface feature (284) will cause the cam follower (290) to remain in contact with the multiple cam assembly (220). Translation of the follower interface feature (284) from the proximal longitudinal position to the distal longitudinal position and back to the proximal longitudinal position will cause the clamp driver to be actuated from a proximal position to a distal position and vice versa via the actuator actuator (264). Distal movement of the actuator actuator (264) will implant staples at the anastomosis site and cut excess tissue within the anastomosis; while subsequent proximal movement of the actuator actuator will facilitate removal of the stapling head (218) and anvil (240) assembly from the anastomotic site.
[00087] It must be understood that the longitudinal distances (LD1, LD2) can be manipulated by manipulating the radial distances represented by the portions (232, 234, 242, 244) of the cams (230, 240) and/or the arms ( 292, 294, 296). For example, in the present example, the first longitudinal distance (LD1) is greater than the second longitudinal distance (LD2). Different longitudinal distances (LD1, LD2) can confer a mechanical advantage to the actuator actuator (264) that varies through the full range of distal motion of the actuator actuator (264). This advantage of mechanical variation can make it easier to break a washer, as will be described in more detail below; and/or may provide other results, as will be apparent to those skilled in the art in light of the teachings of the present invention.
[00088] The intermediate portions (233, 243) and the intermediate portions (234, 245) may have different contours. These different contours may represent different rates of change of the radial distance from the outer cam surfaces (230, 240) to the longitudinal axis (LA1) presented by the first portions (232, 242) to the second portions (234, 244) and vice versa. -versa. In particular, the intermediate portions (233, 243) may represent a more gradual rate of change from the radial distance presented by the second portions (234, 244) to the radial distance presented by the first portions (232, 242), while the intermediate portions (235, 245) may represent a faster rate of change from the radial distance presented by the first portions (232, 242) to the radial distance presented by the second portions (234, 244) or vice versa, depending on which direction the cams (230, 240) are rotated. These different rates of change will be communicated to the follower interface feature (284), driver actuator (264), and the clamp driver through the cam follower (290), thus causing different rates of longitudinal translation of the drive interface feature (290). follower (284), driver actuator (264) and clamp driver. For example, the intermediate portions (233, 243) can provide a relatively slow rate of distal advancement of the actuator actuator (264), while the intermediate portion (235, 245) provides a relatively fast rate of proximal retraction of the actuator actuator (264). 264). Of course, these rates can be varied in any suitable way.
[00089] In some versions of the instrument (200), the anvil (240) contains a breakable washer that is broken by the knife when the knife completes a full distal range of motion. In some cases, the washer thus provides audible or haptic feedback through the actuator cable assembly (270) as the washers break in response to the completion of the knife's full advance toward the anvil (240), although such Audible/haptic feedback is not required. It must be understood that the presence of the washer may present a sudden increase in the force required to advance the actuator actuator (264) in a distal position. Figure 24 shows an exemplary force profile imparted by the actuator actuator (264) during the distal path range of the actuator actuator (264). In a first range (1200) of distal movement, the actuator actuator (264) encounters a load or resistance force that gradually increases as the knife passes through the tissue. In a second range (1210) of distal movement, the actuator actuator (264) encounters a peak in load or resisting force as the knife passes through the washer. In a third range (1220) of distal movement, the actuator actuator (264) first encounters a sudden drop in load or resisting force after the washers break, then a subsequent increase in load or resisting force as the stapling head assembly (218) inserts the staples into the anvil (240) to thereby shape the staples to their final height. In view of the foregoing, it should be further understood that, during the transition from the position shown in Figure 9A to the position shown in Figure 9C, the radial distances represented by the cam portions (232, 234, 242, 244) 230, 240) and/or arms (292, 294, 296) can provide increased mechanical advantage as the actuator actuator (264) reaches the end of its distal movement, thus providing a greater force by which to break. the washer and shape the clamps. For example, the knife may encounter the washer as the knife travels through the second longitudinal distance (LD2), and the mechanical advantage provided during movement through the second longitudinal distance (LD2) may be greater than the mechanical advantage provided during the movement. movement through the first longitudinal distance (LD1), in order to account for the increase in mechanical strength provided by the washer that forms the clamps. Of course, in some versions, the breakable washer may be omitted entirely in some versions. B. Second sample motor and cam follower translation drive assembly
[00090] As a variation of the instrument (200) discussed above, the instrument (200) may be provided with a motor coaxially aligned with the actuator actuator (264). Such an arrangement is shown in Figures 11A-11B, which show exemplary alternative components that may be incorporated into instruments (200) to drive the staple driver and knife. In particular, Figures 11A-11B show an exemplary reciprocating motor (310) and cylindrical cam (320) configured to operate substantially similar to the motor (210) and cylindrical cam (220) discussed above, except for the differences discussed above. below. The motor (310), cylindrical cam (320) and a spring (not shown) are configured to drive a stapling head assembly (not shown) distally and proximally through one revolution of the cylindrical cam (320) through translation of an actuator actuator (364) and a cam follower (384). The cam follower (384) is coupled to the actuator actuator (364). The actuator actuator (364) of the present example is configured to operate substantially similar to the actuator actuator (64) of the instrument (10) discussed above. In particular, a distal end of the actuator actuator (364) is coupled to the stapling head assembly so that the actuator actuator (364) drives the stapling head assembly when the motor (310) longitudinally translates the actuator actuator. (364).
[00091] As shown in Figures 11A-11B, the motor (310) is arranged within an actuator cable assembly (not shown) so that the motor (310) is coaxially aligned with the actuator actuator (364) . In some other versions, the motor (310) is oriented obliquely to the longitudinal axis defined by the actuator actuator (364). By way of example only, a merely illustrative oblique motor orientation is described in greater detail below with reference to Figures 22-23. In the present example, a cylindrical cam (320) is coupled with a distal end of the motor (310) via a rod (312). The motor (310) is operable to rotate the cylindrical cam (320) about a longitudinal axis (LA2) defined by the motor (310). As shown in Figure 11A, the cylindrical cam (320) comprises an inclined distal cam face (322). The angled cam face (322) comprises a distal portion (324) and a proximal portion (326). The distal portion (324) and the proximal portion (326) are disposed on radially opposite sides of the cylindrical cam (320). The distal portion (324) has an inclined cam face portion (322) that has a longitudinal position with respect to the longitudinal axis (LA2) more distal than that of the proximal portion (326), thus defining a longitudinal distance ( LD3) between the distal portion (324) and the proximal portion (326). The inclined cam face (322) further comprises intermediate portions (325, 327) disposed between the distal portion (324) and the proximal portion (326). Intermediate portions (325, 327) are contoured to provide substantially smooth transition between the distal portion (324) and proximal portion (326) along opposite sides of the cylindrical cam (320). Thus, at a specific point along the sloped cam face (322) as the cylindrical cam (320) is rotated through one revolution, a longitudinal position of the sloped cam face (322) will change from the proximal position. presented by the proximal portion (326) to the distal position presented by the distal portion (324) and back again.
[00092] As shown in Figures 11A-11B, the cam follower (384) comprises a contact pin (386) that extends proximally from the cam follower (384). Contact pin (386) is secured to cam follower (384) so that longitudinal translation of contact pin (386) causes longitudinal translation of cam follower (384). A proximal end of the contact pin (386) is in contact with the angled cam face (322). The contact pin (386) is configured to remain in contact with the angled cam face (322) as the cylindrical cam (320) rotates. For example, a spring (not shown) can be positioned coaxially over the actuator actuator (364) within the actuator cable assembly to proximally bias the cam follower (384) such that the contact pin (386) engages. keeps in contact with the angled cam face (322). Thus, as the cylindrical cam (320) is rotated through one revolution, a longitudinal position of the cam follower (384) will translate from a proximal position caused by contact between the proximal end of the contact pin (386). ) and the proximal portion (326) of the angled cam face (322) to a distal position caused by contact between the proximal end of the contact pin (386) and the distal portion (324) of the angled cam face (322); and return again to the proximal position caused by the resilient biasing of the spring.
[00093] Figure 11A shows a configuration where the contact pin (386) is in a proximal longitudinal position, in contact with the proximal portion (326) of the inclined cam face (322) of the cylindrical cam (320). In this position, the cam follower (384) is in the proximal position and thus the clamp driver remains in the proximal position. As shown in Figure 11B, as the motor (310) rotates the cylindrical cam (320) through 180°, the contact pin (386) remains in contact with the inclined cam face (322) due to the proximal polarization of the cam (322). spring. During this rotation, the contact pin (386) is transitioned through the intermediate portion (325) from the proximal portion (326) to the distal portion (324) and thus the cam follower (384) is driven distally at a distance. from the longitudinal distance (LD3) to a distal longitudinal position against the proximal bias of the spring. As the motor (310) still rotates the cylindrical cam (320) a full 360°, the contact pin (386) remains in contact with the angled cam face (322) due to the proximal bias of the spring. During this rotation, the contact pin (386) is transitioned through the intermediate portion (327) from the distal portion (324) to the proximal portion (326) so that the spring drives the cam follower (384) proximally to a distance. longitudinal (LD3) to the proximal longitudinal position. Translation of the cam follower (384) from the proximal longitudinal position to the distal longitudinal position and back to the proximal longitudinal position will cause the clamp driver to be actuated from a proximal position to a distal position and back. again through the actuator actuator (364).
[00094] In some versions, it may be desirable to vary the mechanical advantage conferred on the cam follower (384) along the longitudinal distance (LD3) through the angular path range by the cylindrical cam (420). A merely exemplary variation of a cylindrical cam (420) is shown in Figure 12. The cylindrical cam (420) is driven by a motor (410). The cylindrical cam (420) comprises a variable angled face (422) configured to operate substantially similar to the cylindrical cam (320). In particular, the cylindrical cam (420) and a spring (not shown) are configured to drive a clamp driver (not shown) distally and proximally through a revolution of the cylindrical cam (420) through translation of an actuator. driver (464) and a follower cam (484). The variable angled face (422) features a series of arcuate slopes with different slopes and contours that represent a number of different advantages conferred on the cam follower (484). The cam follower (484) comprises a contact pin (486). Contact pin (486) is secured to cam follower (484) so that longitudinal translation of contact pin (486) causes longitudinal translation of cam follower (484).
[00095] A proximal end of the contact pin (486) is in contact with the variable angled cam face (422). The contact pin (486) is configured to remain in contact with the angled face (422) as the variable cylindrical cam (420) rotates due to the proximal bias exerted by the spring on the cam follower (484). In this way, as the cylindrical cam (420) rotates through a full revolution, the cam follower (484) is driven longitudinally with different mechanical advantages through a series of different translation rates that vary from a proximal position to a distal position and back to the proximal position. This variable longitudinal translation of the cam follower (484) from the proximal longitudinal position to the distal longitudinal position and back to the proximal longitudinal position will cause the clamp driver to be actuated from a proximal position to a distal position. and vice versa via actuator actuator (464). In the present example, the motor (410) is oriented along an axis that is parallel to the longitudinal axis defined by the actuator actuator (464). However, it must be understood that the motor (210) may alternatively be oriented obliquely to the longitudinal axis defined by the actuator actuator (264). By way of example only, a merely illustrative oblique motor orientation is described in greater detail below with reference to Figures 22-23.
[00096] Some versions of the instrument (400) contain a breakable washer that is broken by the knife when the knife completes a full distal range of motion, as discussed above with reference to Figure 24. It must still be understood that the arcuate slopes of the angled face (422) can provide an increase in mechanical advantage as the knife reaches the end of its distal movement, thus providing a greater force by which the washer breaks. Again, however, the breakable washer may be omitted entirely in some versions. III. Exemplifying motorized surgical stapling instrument with pivot cam follower
[00097] Figure 13 shows an alternative exemplary circular surgical stapling instrument (500); while Figures 14-15 show a cam (520) of the instrument (500) in greater detail. The instrument (500) is configured to operate substantially similar to the apparatus (200) discussed above, except for the differences discussed below. In particular, the instrument (500) can be used to clamp tissue in an annular array and cut off excess tissue that is within the annular array of staples to provide a substantially smooth transition between the lumen sections of the anastomosed tissue. The instrument (500) comprises a motor (510) disposed within an actuator cable assembly (570) parallel to a proximal portion of an actuator actuator (564). As can best be seen in Figure 14, the cam (520) is coupled with a distal end of the motor (510) through a rod (512). The motor drive (510) is configured to cause the cam (520) to rotate about a longitudinal axis (LA3) defined by the motor (510). In the present example, the motor (510) is oriented along an axis that is parallel to the longitudinal axis defined by the actuator actuator (564). However, it must be understood that the motor (510) may alternatively be oriented obliquely to the longitudinal axis defined by the actuator actuator (564). By way of example only, a merely illustrative oblique motor orientation is described in greater detail below with reference to Figures 22-23.
[00098] As also shown in Figures 14-15, an outer surface of the cam (520) comprises a first portion (524) and a second portion (526). The first portion (524) and the second portion (526) are disposed on radially opposite sides of the cam (520). The first portion (524) has a cam portion (520) having a radial distance from the longitudinal axis (LA3) that is greater than a radial distance from the second portion (526) of the longitudinal axis (LA3). The cam (520) further comprises intermediate portions (525, 527) disposed between the first portion (524) and the second portion (526). Intermediate portions (525, 527) are contoured to provide substantially smooth transition between the first portion (524) and second portion (526) along opposite sides of the cam (520). Thus, it must be understood that at a specific point along the outer surface of the cam (520), as the cam (520) is rotated through one revolution, a radial distance from the outer surface of the cam ( 520) for the longitudinal axis (LA3) will change from the smallest radial distance presented by the second portion (526) to the largest radial distance presented by the first portion (524) through the intermediate portion (527) and back to the smallest radial distance presented by the second portion (526) through the intermediate portion (525).
[00099] As shown in Figures 16A-16B, the spring (574) is arranged around the actuator actuator (564) within the actuator cable assembly (570) and polarizes the follower interface feature (584) longitudinally proximally. The cable assembly (570) comprises a pivot pin (572) to which a pivot cam follower (590) is rotationally coupled so that the cam follower (590) is free to rotate about the pivot pin ( 572). A first arm (592) of the cam follower (590) is in contact with the outer surface of the cam (520) due to proximal bias applied by a spring (574) over the follower interface feature (584). A proximal end of the first arm (592) is configured to remain in contact with the outer surface of the cam (520) as the cam (520) rotates. Thus, as the cam (520) is rotated through one revolution, a radial distance from the proximal end of the first arm (592) to the longitudinal axis (LA3) will change from the smaller radial distance caused by the contact with the second portion (526) to the greatest radial distance caused by contacting the first portion (524) and back to the smallest radial distance caused by contacting the second portion (526). This change in radial distance from the distal end of the first arm (592) will cause the cam follower (590) to rotate around the pivot pin (572) from a first position (Figure 16A) to a second position (Figure 16B). ) and back to the first position (Figure 16A).
[000100] The follower interface feature (584) comprises a pin (589) that extends transversely from the follower interface feature (584). The pin (589) is rotationally disposed within an opening (595) formed in a second arm (594) of the cam follower (590) so that the cam follower (590) is thus coupled with the cam follower (590) feature. follower interface (584) and yet so that as the cam follower (590) rotates around the pivot pin (572), the follower interface feature (584) translates longitudinally. It must therefore be understood that as the cam (520) is rotated through one revolution, the cam follower (590) is rotated from a first position to a second position and back to the first position, thereby translating the follower interface feature (584) from a proximal longitudinal position to a distal longitudinal position and back to the proximal longitudinal position due to the proximal bias of the spring (574). Such longitudinal translation of the follower interface feature (584) from the proximal longitudinal position to the distal longitudinal position and back to the proximal longitudinal position will cause the clamp driver to be actuated from a proximal position to a distal position. and back again through the actuator actuator (564).
[000101] As shown in Figure 16A, with the cam (520) in a first rotational position, the second portion (526) of the cam (520) is positioned above the longitudinal axis (LA3). With the cam (520) in this first rotational position, the proximal end of the first arm (592) of the cam follower (590) is in contact with the second portion (526) of the cam (520) due to the proximal bias of the spring (574). ). At this stage, the cam follower (590) is in the first position and the follower interface feature (584) is in a proximal position and thus the clamp driver remains in a proximal position.
[000102] As shown in Figure 16B, the cam (520) is rotated 180° to a second rotational position. In this second rotational position, the cam (520) has been rotated so that the first portion (524) of the cam (520) is positioned above the longitudinal axis (LA3) and so that the distal end of the first arm (592) of the follower cam (590) is now in contact with the first portion (524) of cam (520). As the cam (520) is rotated from the first rotational position to the second rotational position, the first arm (592) of the cam follower (590) is driven from the smaller radial distance presented by the second portion (526) for the greater radial distance presented by the first portion (524) through the intermediate portion (527), thus rotating the cam follower (590) around the pivot pin (572). As the cam follower (590) rotates around the pivot pin (572), the second arm (594) is also rotated, and the follower interface feature (584) is driven longitudinally in a distal position through rotation. of the second arm (594) to a distal longitudinal position.
[000103] Further rotation of the cam (520) - so that the cam (520) has been rotated 360° - will transition the cam (520) back to the first rotational position, thus allowing the of follower interface (584) is driven proximally back to the proximal longitudinal position due to the proximal bias of the spring (574). As discussed earlier, this longitudinal translation of the follower interface feature (584) from the proximal longitudinal position to the distal longitudinal position and back to the proximal longitudinal position will cause the clamp driver to be actuated from a proximal position. to a distal position and back again through the actuator actuator (564).
[000104] As can be seen better in Figure 15, the intermediate portion (525) and the intermediate portion (527) have different contours. These different contours represent different rates of change of the radial distance from the cam surface facing away from the channel (522) to the longitudinal axis (LA3) presented by the first portion (524) to the second portion (526) and vice versa. . In particular, the intermediate portion (525) represents a more gradual rate of change from the radial distance presented by the second portion (526) to the radial distance presented by the first portion (524), while the intermediate portion (527) represents a rate of change. faster change from the radial distance presented by the first portion (524) to the radial distance presented by the second portion (526) or vice versa, depending on the direction in which the cam (520) is rotated. It must be understood that these different rates of change will be communicated to the follower interface feature (584), actuator actuator (564) and the clamp driver via the cam follower (590), thus conferring different mechanical advantage and causing different rates of longitudinal translation of the follower (584) interface feature, driver actuator (564) and clamp driver. For example, the intermediate portion (525) can provide a relatively slow rate of distal advancement of the actuator actuator (564), while the intermediate portion (527) provides a relatively fast rate of proximal retraction of the actuator actuator (564). Of course, these rates can be varied in any suitable way. 1. First exemplary reduced friction linkage member
[000105] It may be desirable to minimize the force required to rotate the cam (520). Such a reduction in force can be achieved by reducing the force required to rotate cam follower (590) about pivot pin (572). A merely exemplary variation of a reduced friction pivot cam follower (690) is shown in Figure 18. The cam follower (690) is configured to operate substantially similar to the cam follower (590) discussed above. In particular, the cam follower (690) is configured to rotate around a pivot pin and thereby longitudinally translate the follower interface feature (584) due to rotation of the cam (520) by the motor (510). . The cam follower (690) comprises a first arm (692) configured to operate substantially similar to the first arm (592) of the cam follower (590). In particular, a distal end of the first arm (692) is configured to contact the cam (520) as the cam (520) rotates to longitudinally translate the actuator actuator (564). A distal end of the first arm (692) of the cam follower (690) has a curved edge (693). The curved edge (693) is configured to contact the outer surface of the cam (520) as the cam (520) rotates. As shown in Figure 17, the distal end of the first arm (592) of the cam follower (590) from the previous example has a flat edge (593). It should be understood that the curved edge (693) of the cam follower (690) can reduce friction between the cam follower (690) and the cam (520) compared to the friction between the flat edge (593) of the follower. cam (590) and cam (520).
[000106] In addition or alternatively, the curved configuration of the curved edge (693) can provide a more efficient transfer of force from the cam (520) to the cam follower (690). As the cam (520) rotates, laterally oriented forces transmitted from rotating the cam (520) to the flat edge (593) can be lost to friction and converted to heat without actually causing the cam follower (590) to rotate. In contrast, the curved edge (693) may be able to convert some of these same laterally oriented forces into cam follower pivoting motion (690), effectively taking the vertical components of the normal force and converting them into follower rotational motion. cam (690). Therefore, the curved edge (693) can provide a more productive and/or efficient transfer of force from the cam (520) to the cam follower (690) over a greater range of rotation of the cam (520). 2. Second exemplary reduced friction linkage member
[000107] Figures 19A-19B show another merely exemplary variation of a reduced friction pivot cam follower (790). The cam follower (790) is configured to operate substantially similar to the cam follower (590) discussed above, except for the differences discussed below. In particular, as shown in Figure 19B, the cam follower (790) is configured to rotate about a pivot pin and thereby longitudinally translate a follower interface feature (784) due to the rotation of the cam (720). ) by the motor (not shown). The follower interface feature (784) is configured to operate substantially similar to the follower interface feature (584) discussed above, except for the differences discussed below. In particular, the longitudinal translation of the follower interface feature (784) causes the longitudinal translation of a clamp driver and a knife (not shown).
[000108] The cam follower (790) comprises a first portion (792) configured to operate substantially similar to the first arm (592) of the cam follower (590), except for the differences discussed below. In particular, a proximal end of the first portion (792) is associated with an outer surface of the cam (720) such that rotation of the cam (720) causes rotation of the cam follower (790), which in turn causes the longitudinal translation of the follower interface feature (784). A proximal end of the first portion (792) of the cam follower (790) has a socket (793). A ball bearing (794) is rotationally positioned within the socket (793). The ball bearing (794) is configured to contact the outer surface of the cam (720) as the cam (720) rotates. It should be understood that the ball bearing (794) can reduce the friction between the cam follower (790) and the cam (720) compared to the friction between the cam follower (590) and the cam (520). In addition, it must be understood that the curved surface of the ball bearing (794) can provide a more productive and/or efficient transfer of force from the cam (720) to the cam follower (790) over a range. increased cam rotation (720).
[000109] As also shown in Figures 19A-19B, a proximal end of the follower interface feature (784) of the present example comprises a wheel (786). The wheel (786) is freely rotatable with respect to the follower interface feature (784). The cam follower (790) comprises a second portion (796) configured to operate substantially similar to the second arm (592) of the cam follower (590), except for the differences discussed below. In particular, the rotation of the cam follower (790) is configured to longitudinally translate the follower interface feature (784) through the second portion (792). The second portion (796) contacts the wheel (786) so that as the cam follower (790) rotates, the second portion (796) will pass and rotate the wheel (786) while driving the follower interface feature (784) distally. It must be understood that the wheel (786) can reduce friction between the cam follower (790) and the follower interface feature (784) as compared to the friction between the cam follower (590) and the cam follower feature (784). follower interface (584).
[000110] While the present example comprises both ball bearings (794) and wheel (786), the cam follower (790) and follower interface feature (784) need not include ball bearings (794) the wheel (786). For example, some versions may include the ball bearing (794) but not feature the wheel (786). As another illustrative example, some versions may include the wheel (786) but not have the ball bearing (794). Other suitable arrangements and configurations will be apparent to those skilled in the art in view of the teachings herein. 3. Exemplifying reduced friction third joint member
[000111] Yet another merely exemplary variation of a reduced friction pivot cam follower (890) is shown in Figures 20A-20B. The cam follower (890) is configured to operate substantially similar to the cam follower (590) discussed above, except for the differences discussed below. In particular, as shown in Figure 20B, the cam follower (890) is configured to rotate about a pivot pin (872) and thereby longitudinally translate a follower interface feature (884) due to rotation of the cam (820) by the motor (not shown). The follower interface feature (884) is configured to operate substantially similar to the follower interface feature (584) discussed above, except for the differences discussed below. In particular, the longitudinal translation of the follower interface feature (884) causes the longitudinal translation of a clamp driver (not shown).
[000112] The cam follower (890) comprises a first portion (892) configured to operate substantially similar to the first arm (592) of the cam follower (590), except for the differences discussed below. In particular, a proximal end of the first portion (892) is associated with an outer surface of the cam (820) such that rotation of the cam (820) causes rotation of the cam follower (890), which in turn causes the longitudinal translation of the follower interface feature (884). A proximal end of the first portion (892) of the cam follower (890) of the present example is directly coupled to a rod (894). A proximal end of the rod (894) comprises a ball (896). The ball (896) is rotationally secured within a socket formed in a cylinder (898) so that the ball (896) is free to rotate within the cylinder (898). The cylinder (898) is positioned to contact the outer surface of the cam (820) as the cam (820) rotates such that rotation of the cam (820) causes the cylinder (898) to rotate about the sphere (896). It should be understood that the ball (896) and cylinder (898) can reduce the friction between the cam follower (890) and the cam (820) compared to the friction between the cam follower (590) and the cam ( 520).
[000113] As further shown in Figures 20A-20B, a proximal end of the follower interface feature (884) of the present example comprises a wheel (886). The cam follower (890) comprises a second portion (899) configured to operate substantially similar to the second arm (592) of the cam follower (590), except for the differences discussed below. In particular, the rotation of the cam follower (890) is configured to longitudinally translate the follower interface feature (884) through the second portion (899). The second portion (899) contacts the wheel (886) so that as the cam follower (890) rotates, the second portion (899) will pass and rotate the wheel (886) while driving the follower interface feature (884) distally. It should be understood that the wheel (886) can reduce the friction between the cam follower (890) and the follower interface feature (884) as compared to the friction between the cam follower (590) and the cam follower feature (884). follower interface (584).
[000114] Although the present example comprises the ball (898), cylinder (896) and wheel (886), the cam follower (890) and follower interface feature (884) need not include the ball (898). ), the cylinder (896) and the wheel (886). For example, some versions may include the sphere (898) but not feature the wheel (886). As another illustrative example, some versions may include the wheel (886) but not have the sphere (898) and cylinder (898). Other suitable arrangements and configurations will be apparent to those skilled in the art in view of the teachings herein. IV. Exemplifying monitored circular surgical stapling instrument with dual motors
[000115] As a variation of the instrument (200) discussed above, the instrument (200) may be provided with a plurality of motors. In particular, the cable assembly (270) may be reconfigured to accommodate a plurality of motors to drive the clamp driver. By way of example only, a plurality of motors may be desirable in order to drive the staples through, and/or cut through, the thick or thick fabric. Various examples of how the instrument 200 can be reconfigured to incorporate a plurality of motors will be described in greater detail below; while other examples will be apparent to those skilled in the art in accordance with the teachings of the present invention. It should be understood that the examples described below may function substantially similar to the instrument 200 described above. In particular, the variations of circular surgical stapling instrument (200) described below can be used to clamp tissue in an annular array and cut off excess tissue that is within the annular array of staples to provide a substantially smooth transition between the staples. lumen sections.
[000116] Figure 21 shows exemplary alternative components that can be incorporated into the instrument (200) to drive the staple driver and a knife. In particular, Figure 21 shows a first motor (910), a second motor (912) and other components coupled with the motors (910, 912). The motors (910, 912) of the present example may be powered by an internal power source (e.g. battery, etc.) and/or an external power source (e.g. wall outlet, etc.). As will be discussed in more detail below, the motors (910, 912) are configured to drive a clamp driver. The staple driver includes a plurality of staple driver members, a plurality of staples, and a knife configured to cut the fabric when the staple driver is driven longitudinally. The clamp driver of the present example functions substantially similar to the clamp driver of the instrument 200 described above. In particular, the staple driver of the present example can be used to drive an annular array of staples on the fabric and to drive a knife (not shown) to cut excess tissue that is within the annular array of staples to provide a transition. substantially smooth between lumen sections in response to clamp driver actuation.
[000117] A proximal end of an actuator actuator (not shown) is coupled to rods (926, 928), which are described in greater detail below, and which can be positioned within an actuator cable assembly (not shown). ). A distal end of the driver actuator is coupled to the clamp driver so that longitudinal translation of the rods (926, 928) drives the clamp driver through the driver actuator. As will be discussed in more detail below, the motors (910, 912) are operable to cause longitudinal translation of the rods (926, 928) through a drive assembly. Thus, when the motors (910, 912) are driven and translate the rods (926,928), the knife and staple insertion members substantially simultaneously cut through the tissue and insert the staples distally into the tissue.
[000118] The motors (910, 912) are arranged along different axes within the actuator cable assembly. The motors (910, 912) rotate their respective drive rods (915, 917) in opposite orientations. A first helical gear (914) is attached to a distal end of the motor (914) via the rod (915). A second helical gear (916) is attached to a distal end of the motor (912) via the rod (917). A drive rod (920) has helical threading (922). The rod (920) is disposed within and rotationally secured to the actuator cable assembly so that the helical thread (922) engages both the first worm gear (914) and the second worm gear (916). The first worm gear (914) and the second worm gear (916) engage the helical thread (922) on radially opposite sides of the shaft (920). A drive nut (924) is disposed around the rod (920) and surrounds the helical thread (922) so that rotation of the rod (920) causes longitudinal translation of the drive nut (924). A pair of rods (926, 928) extend distally from the drive nut (924). The distal ends of the rods (926, 928) are attached to the actuator actuator so that longitudinal translation of the actuator nut (924) causes concomitant longitudinal translation of the actuator actuator. Consequently, it must be understood that rotation of the motors (910, 912) causes longitudinal translation of the clamp driver through the driver actuator.
[000119] The motors (910, 912) may be driven so that the motors (910, 912) rotate the rod (920) in a first direction to drive the rods (926, 928) distally from a position proximal longitudinal to a distal longitudinal position. The motors (910, 912) may be driven such that the motors (910, 912) rotate the rod (920) in a first direction to drive the rods (926, 928) distally from a longitudinal position proximal to a distal longitudinal position. This longitudinal translation of the rods (926, 928) from the proximal longitudinal position to the distal longitudinal position and back to the proximal longitudinal position will cause the clamp driver to be actuated from a proximal position to a distal position and vice versa. -versa via the actuator actuator. Other suitable ways in which the motors (910, 912) may be operated will be apparent to those skilled in the art in view of the teachings of the present invention. V. Exemplifying oblique motor orientation
[000120] While the examples discussed above comprise a motor(s) disposed within an actuator cable assembly in an orientation that is parallel to a proximal portion of a actuator actuator, it must be understood that the motor(s) may be oriented in another suitable orientation. For example, as shown in Figure 22, a motor (1010) may be disposed within an oblique pistol grip (1020) of a circular surgical stapling instrument (1000) so that the motor (1010) is oriented obliquely towards a longitudinal axis defined by an actuator actuator (1064). A cam (1030) is attached to the motor (1010) so that the motor drive (1010) rotates the cams (1030). A pivot cam follower (890) rotates about a pivot pin (1072). The cam follower (890) is configured to operate substantially similar to the cam follower (590) discussed above. In particular, the cam follower (890) is associated with the cam (1030) and a follower interface feature (1084) such that rotation of the cam follower (890) causes the follower interface feature to translate longitudinally. (1084). It should be understood that the cam (1030) could be configured in accordance with any of the cams (320, 420, 520) or set of cams (220) discussed above. It should also be understood that the present example is merely illustrative. Other suitable motor orientations will be apparent to those skilled in the art in view of the teachings of the present invention.
[000121] As shown in Figure 23, a motor (1110) can be disposed within an oblique pistol grip (1120) of a circular surgical stapling instrument (1100) so that the motor (1110) is oriented obliquely towards a longitudinal axis defined by an actuator actuator (1164). A first bevel gear (1112) is attached to the motor (1110) so that rotation of the motor (1110) causes rotation of the bevel gear (1112). A second bevel gear (1114) is attached to a proximal end of the cam (1140). The first bevel gear (1112) and the second bevel gear (1114) engage so that rotation of the first bevel gear (1112) causes rotation of the second bevel gear (1114). Rotation of the motor (1110) in this way will cause the cam (1140) to rotate. It should be understood that the cam (1140) could be configured in accordance with any of the cams (320, 420, 520) or set of cams (220) discussed above. It should also be understood that the present example is merely illustrative. Other suitable ways to obtain oblique motor orientations will be apparent to those skilled in the art in view of the teachings of the present invention. By way of example only, a cable assembly may provide a perpendicularly or obliquely oriented pistol grip and/or motor in accordance with the teachings of US Patent Application No. [Attorney's Document Number END7287USNP.0606452], entitled SURGICAL STAPLER WITH ROTARY CAM DRIVE AND RETURN, filed on the same date hereof, the disclosure thereof being incorporated herein by reference. SAW. Several
[000122] In any of the examples described above, a microcontroller, ASIC, and/or other type of control module can be placed in communication with a power supply and motor (210, 310, 410, 510) and can be configured to automatically stop the motor (210, 310, 410, 510) thus providing a way to dynamically stop the motor (210, 310, 410, 510) so that the motor (210, 310, 410, 510) can be driven for exactly one rotation of a corresponding drive rod. By way of example only, this control module may be in communication with an encoder that is in communication with the drive rod or any other component that moves in response to motor activation (210, 310, 410, 510). As another illustrative example, this control module may be in communication with one or more magnetic switches that are in communication with the actuating rod or any other component that moves in response to motor activation (210, 310, 410, 510 ). Other suitable types of sensors and control modules that can be used to provide accurate motor stop (210, 310, 410, 510) (e.g. based on tracked rotation of a component, based on translation of a component and/or or based on some other parameter, etc.) will be apparent to those skilled in the art in view of the teachings of the present invention. Of course, a control module can be configured to control the motor (210, 310, 410, 510) to activate any suitable number of revolutions, etc. In some cases, motor start and stop control (210, 310, 410, 510) may be performed in accordance with the teachings of US patent application No. [Attorney's Document Number END7291USNP.0606446], entitled CONTROL FEATURES FOR MOTORIZED SURGICAL STAPLING INSTRUMENT, deposited on the same date hereof, the description thereof being incorporated herein by reference.
[000123] It must 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 cannot therefore be seen 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 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.
[000124] At least some of the teachings contained in this document can be easily combined with one or more of the teachings of US Patent No. 7,794,475 entitled "Surgical Staples Having Compressible or Crushable Members for Securing Tissue Therein and Stapling Instruments for Deploying the Same ", granted on September 14, 2010, the description thereof being incorporated herein by way of reference; US Patent Application No. 13/693,430 entitled "Trans-Oral Circular Anvil Introduction System with Dilation Feature", filed December 04, 2012, the disclosure thereof being incorporated herein by reference; US Patent Application No. 13/688,951 entitled "Surgical Staple with Integral Pledget for Tip Deflection", filed November 29, 2012, the disclosure thereof being incorporated herein by reference; US Patent Application No. 13/706,827 entitled "Surgical Staple with Integral Pledget for Tip Deflection", filed Thursday, December 6, 2012, the disclosure thereof being incorporated herein by reference; US Patent Application No. 13/688,992 entitled "Pivoting Anvil for Surgical Circular Stapler", filed November 29, 2012, the disclosure thereof being incorporated herein by reference; patent application No. 13/693,455, entitled "Circular Anvil Introduction System with Alignment Feature", filed on December 04, 2012, the description of which is incorporated herein by way of reference; US patent application US patent application No. 13/716,313 entitled "Circular Stapler with Selectable Motorized and Manual Control, Including a Control Ring", filed on December 17, 2012, the description of which is incorporated herein by way of reference; US Patent Application US Patent Application No. 13/716,318 entitled "Motor Driven Rotary Input Circular Stapler with Modular End Effector" filed December 17, 2012, the disclosure thereof being incorporated herein by reference; and/or U.S. Patent Application No. 13/176,323 entitled "Motor Driven Electrosurgical Device with Mechanical and Electrical Feedback", filed December 17, 2012, the disclosure thereof being incorporated herein by reference. Various suitable ways in which such teachings may be combined will be apparent to those skilled in the art.
[000125] While the examples presented herein have been provided here in the context of a circular stapling instrument, it must be understood that the various teachings described herein can be readily applied to various other types of surgical instruments. By way of example only, the various teachings described herein can be readily applied to linear stapling devices (e.g. endocutters). For example, various teachings contained in this document can be easily combined with various teachings from US Publication No. 2012/0239012 entitled "Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly", published September 20, 2012, the description thereof incorporated herein by reference and/or US Publication No. 2010/0264193 entitled "Surgical Stapling Instrument with An Articulatable End Effector", published October 21, 2010, the description thereof being incorporated herein, by way of reference, as will be apparent to those skilled in the art. As another merely illustrative example, the various teachings described herein can easily be applied to a powered electrosurgical device. For example, various teachings contained in this document can be easily combined with various teachings from US Publication No. 2012/0116379 entitled "Motor Driven Electrosurgical Device with Mechanical and Electrical Feedback", published May 10, 2012, the disclosure of which is incorporated herein by way of reference, as will be apparent to those skilled in the art. Other types of suitable instruments to which the teachings described herein may be applied, and various ways in which the teachings described herein may be applied to such instruments, will be apparent to those skilled in the art.
[000126] It is to be understood that any patent, publication, or other descriptive material, in whole or in part, considered to be incorporated into the present invention by way of reference, will be incorporated into the present invention only if the material incorporated does not conflict with the existing definitions, statements, or other descriptive material 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 existing definitions, statements, or other descriptive material presented herein, is incorporated herein only to the extent that there is no conflict between the material embedded and existing description material.
[000127] 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.
[000128] 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 particular parts, or parts of the device may be selectively replaced or removed in any combination. By cleaning and/or replacing particular 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 may use a variety of sets of disassembly, cleaning/replacement, and reassembly procedures. The use of such sets of procedures and the resulting refurbished device are within the scope of this application.
[000129] By way of example only, the versions described here can be sterilized before and/or after a procedure. In a set of sterilization procedures, the device is placed in a closed and 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 electrons from high energy, which can penetrate the container. Radiation can kill bacteria in the device and container. The sterile device can then be stored in the sterile container for later use. The device may also be sterilized using any other set of procedures known in the art, including, but not limited to, beta or gamma radiation, ethylene oxide, or water vapor.
[000130] 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 by means of suitable modifications by the skilled artisan 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, ratios, steps and the like discussed above are illustrative and not mandatory. Accordingly, the scope of the present invention needs to be considered in accordance with 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 (6)
[0001]
1. Surgical instrument (200), comprising: (a) a cable assembly (270); (b) a rod extending distally from the handle assembly, the rod comprising a proximal end and a distal end; (c) a stapling assembly, wherein the stapling assembly is disposed at the distal end of the rod, the stapling assembly being configured to move selectively from an open position to a closed position, and the assembly being clip is operable to drive a plurality of clips on the fabric; (d) a motor (210); (e) a cam assembly (220) coupled with the motor, the motor being configured to rotate the cam assembly; and (f) a trigger assembly coupled with the cam assembly, wherein the cam assembly is configured to drive a distal portion of the trigger assembly through a distal path strip with a variable longitudinal force profile such that the cam assembly is configured to provide a variable mechanical advantage to the distal portion of the firing assembly along the distal path range; characterized in that the cam assembly comprises a first cam (230) and a second cam (240), and wherein (g) the first cam and the second cam have different cam profiles; wherein the trigger assembly comprises a pivot member (290) rotatably secured to the handle assembly, wherein a first portion (292) of the pivot member is associated with the first cam, wherein a second portion (294) of the pivot member is associated with the second cam, and wherein a third portion of the pivot member is engaged with the trigger assembly, wherein the cam assembly is configured to rotate to thereby cause rotation of the pivot member, and wherein the pivot member is configured to pivot to thereby provide variable mechanical advantage to the distal portion of the firing assembly.
[0002]
2. Instrument according to claim 1, characterized in that the cam assembly is operable to trigger the trigger assembly by rotating the cam assembly through a single revolution.
[0003]
3. Instrument according to claim 1, characterized in that the first cam and the first portion of the articulation member are configured to come into contact to thus cause the longitudinal translation of the firing assembly along a first longitudinal distance, and wherein the second cam and the second portion of the pivot member are configured to make contact to thereby cause longitudinal translation of the firing assembly over a second longitudinal distance.
[0004]
4. Instrument, according to claim 1, characterized in that a proximal portion of the firing assembly defines a longitudinal axis, with the motor being oriented obliquely in relation to the longitudinal axis.
[0005]
5. Instrument, according to claim 4, characterized in that the cable assembly defines a pistol grip, with the motor being positioned in the pistol grip.
[0006]
6. Instrument, according to claim 1, characterized in that it further comprises a resilient member configured to polarize the firing assembly longitudinally proximally.

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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]|

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

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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 19/09/2014, 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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US14/033,763|US9713469B2|2013-09-23|2013-09-23|Surgical stapler with rotary cam drive|

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US14/033,763|2013-09-23|

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PCT/US2014/056510|WO2015042367A2|2013-09-23|2014-09-19|Surgical stapler with rotary cam drive|

---