surgical cutting and stapling instrument and surgical cutting and fixation instrument

专利摘要:
The present invention relates to surgical instruments and end actuators for them. In various implementations, the surgical instrument includes a surgical end actuator (4120) that comprises a lower jaw (4104) and an upper jaw (4020) that are supported for mobile displacement in, or in the opposite direction of, each other. The instrument may additionally include a trigger element (4610) that is operatively supported for selective operable displacement on the surgical end actuator. The instrument may also include a first jaw closure system (200) that operatively interconnects the lower jaw and is configured to selectively move the lower jaw relative to the upper jaw. A second jaw closure system (4110) operationally interconnects the upper jaw and is configured to selectively move the anvil in relation to the elongated groove. A trigger system that operatively links the trigger element and is configured to apply trigger movements to the trigger element to move the trigger element on the end actuator.
公开号:BR112016014768B1
申请号:R112016014768-5
申请日:2014-12-09
公开日:2021-02-23
发明作者:Chester O. Baxter, Iii；Frederick E. Shelton, Iv；John R. Dugan
申请人:Ethicon Endo-Surgery, Llc；
IPC主号:

专利说明:

BACKGROUND
[001] The present invention relates to surgical instruments and, in various modalities, surgical instruments for cutting and stapling and staple cartridges for them, which are designed to cut and staple fabrics. BRIEF DESCRIPTION OF THE DRAWINGS
[002] The features and advantages of this invention, and the way to obtain them, will become more evident and the invention itself will be better understood in reference to the following description of modalities of the invention, considered in conjunction with the attached drawings, on what:
[003] Figure 1 is a perspective view of an arrangement of the surgical instrument;
[004] Figure 2 is an enlarged perspective view of an end actuator and a portion of the elongated stem of the surgical instrument of Figure 1;
[005] Figure 3 is an exploded perspective view of the end actuator and the elongated stem assembly portion of Figures 1 and 2;
[006] Figure 4 is a perspective view of a portion of a distal portion of the anvil of the end actuator of Figures 2 and 3.
[007] Figure 5 is a bottom perspective view of an arrangement of the proximal anvil assembly tube of the proximal anvil assembly tube of Figures 2 and 3;
[008] Figure 6 is an elevation view of the distal end of the assembly tube of the proximal anvil of Figure 5;
[009] Figure 7 is a cross-sectional view of the distal portion of the anvil and the proximal anvil assembly tube together;
[0010] Figure 8 is an exploded perspective view of a portion of the cable assembly of the surgical instrument of Figure 1;
[0011] Figure 9 is another perspective view of the end actuator and the elongated stem assembly of Figure 2 with the anvil assembly in an open position;
[0012] Figure 10 is a perspective view of portions of the elongated stem assembly, the articulation system and the firing system of the surgical instrument of Figure 1;
[0013] Figure 11 is a side view of a portion of the articulation system of the surgical instrument of Figure 1 with portions thereof shown in cross section;
[0014] Figure 12 is a cross-sectional view of the end actuator and the portion of the elongated stem assembly of Figures 2 and 9 with the anvil assembly in a closed but not fired position;
[0015] Figure 13 is a cross-sectional view of the end actuator and the portion of the elongated stem assembly of Figures 2, 9 and 12 in an articulated position and after the cutting head assembly has been retracted to an initial position after being fired;
[0016] Figure 14 is a partial perspective view of the end actuator and the stem assembly portion elongated after the shaving head assembly has been retracted to an initial position after being fired;
[0017] Figure 15 is a partial perspective view of another end actuator and the elongated stem assembly with the end actuator in a closed position;
[0018] Figure 16 is a perspective view in cross section of the end actuator and the elongated stem assembly of Figure 15;
[0019] Figure 17 is an exploded perspective view of the end actuator and the elongated stem assembly of Figures 15 and 16;
[0020] Figure 18 is a perspective view in cross section of the end actuator and the elongated stem assembly of Figures 15 to 17;
[0021] Figure 19 is an exploded perspective view of a portion of the cable assembly of a surgical instrument;
[0022] Figure 20 is a perspective view of another surgical instrument;
[0023] Figure 21 is a partial perspective view of the end actuator of the surgical instrument of Figure 20 in a closed position;
[0024] Figure 22 is a perspective view in cross section of the end actuator of Figure 21;
[0025] Figure 23 is an exploded perspective view of the end actuator of Figures 21 and 22;
[0026] Figure 24 is a cross-sectional elevation view of the end actuator of Figures 21 to 23 with the anvil assembly thereof in an open position;
[0027] Figure 25 is another cross-sectional view of the end actuator Figures 21 to 24 in an articulated position and with the anvil assembly thereof in an open position;
[0028] Figure 26 is another cross-sectional view of the end actuator of Figure 24 after the anvil has been closed on the tissue;
[0029] Figure 27 is a perspective view of another surgical instrument;
[0030] Figure 28 is a partial perspective view of the end actuator of the surgical instrument of Figure 27 in a closed position;
[0031] Figure 29 is an exploded perspective view of the end actuator and the elongated stem assembly of Figures 27 and 28;
[0032] Figure 30 is a perspective view in cross section of the end actuator of Figures 28 and 29;
[0033] Figure 31 is a side view in cross section of the end actuator of Figures 28 to 30 with the anvil assembly thereof in a closed position;
[0034] Figure 32 is another side view in cross section of the end actuator of Figures 28 to 31 with the anvil assembly thereof in an open position;
[0035] Figure 33 is a side view in cross section of the end actuator of Figures 28 to 32 in an articulated position and with the anvil assembly thereof in an open position;
[0036] Figure 34 is a perspective view of portions of the articulation system and the firing system of the surgical instrument of Figure 27;
[0037] Figure 35 is a side view of a portion of the articulation system of Figure 34 with portions thereof shown in cross section;
[0038] Figure 36 is a perspective view of another surgical instrument;
[0039] Figure 37 is a partial perspective view of the end actuator of the surgical instrument of Figure 36 in a closed position;
[0040] Figure 38 is an exploded perspective view distal of the end actuator and the elongated stem assembly of Figures 36 and 37;
[0041] Figure 39 is an exploded perspective view proximal to the end actuator and the elongated stem assembly of Figures 36 to 38;
[0042] Figure 40 is an end view in cross section of a portion of the end actuator of Figure 36 to 39;
[0043] Figure 41 is a partial perspective view of portions of the end actuator of Figures 36 to 40 with the anvil assembly thereof in an open position;
[0044] Figure 42 is another partial perspective view of portions of the end actuator of Figures 36 to 41 with the anvil assembly thereof in an open position;
[0045] Figure 43 is a partial side view of a cutting beam head in its uncompressed state;
[0046] Figure 44 is another partial side view of the cutting beam head of Figure 43 in its maximum compressed state;
[0047] Figure 45 is an end view in cross section of an end actuator and a cutting beam head of Figures 43 and 44 in their maximum compressed state;
[0048] Figure 46 is another cross-sectional view of the end actuator and the cutting beam head of Figure 45 after the end actuator has cut and stapled the fabric;
[0049] Figure 47 is a perspective view of another surgical instrument;
[0050] Figure 48 is an exploded perspective view of another surgical end actuator of the present invention;
[0051] Figure 49 is an exploded view of the cable assembly of the surgical instrument of Figure 47;
[0052] Figure 50 is an exploded view of an elongated stem assembly of the surgical instrument of Figures 47 to 49;
[0053] Figure 51 is a cross-sectional side view of a portion of the surgical instrument of Figures 47 to 50 inserted through a portion of the trocar port;
[0054] Figure 52 is another side view in cross section of the surgical instrument of Figure 51 after it left the trocar port inside the patient;
[0055] Figure 53 is another side view in cross section of the surgical instrument of Figures 51 and 52 after the anvil set has been moved to an open position;
[0056] Figure 54 is another side view in cross section of the surgical instrument of Figures 51 to 53 with the anvil in the closed firing position;
[0057] Figure 55 is a side view in cross section of a portion of another surgical instrument inserted through a portion of a trocar port;
[0058] Figure 56 is another side view in cross section of the surgical instrument of Figure 55 after the end actuator has passed through the trocar port into the patient;
[0059] Figure 57 is a perspective view of a form of a control insert;
[0060] Figure 58 is a side view in cross section of a portion of another end actuator inserted through a portion of a trocar port;
[0061] Figure 59 is another side view in cross section of the end actuator of Figure 58 exiting the trocar port;
[0062] Figure 60 is a cross-sectional view of another arrangement of the end actuator;
[0063] Figure 61 is a cross-sectional view of another end actuator arrangement;
[0064] Figure 62 is a cross-sectional side view of a portion of another end actuator and the arrangement of the distal closing tube in which a portion of the end actuator is inserted through a portion of a trocar port;
[0065] Figure 63 is another side view in cross section of the end actuator of Figure 62 exiting the trocar port;
[0066] Figure 64 is a perspective view of a form of a surgical instrument of the present invention;
[0067] Figure 65 is an exploded perspective view of another form of the surgical end actuator of the present invention;
[0068] Figure 66 is an exploded perspective view of a portion of the surgical instrument of Figure 64;
[0069] Figure 67 is an exploded perspective view of that of another portion of the surgical instrument of Figure 64;
[0070] Figure 68 is an exploded perspective view of a portion of the elongated stem assembly of the surgical instrument of Figure 64;
[0071] Figure 69 is a perspective view of the surgical end actuator of Figure 65 and a segment of the distal closure tube;
[0072] Figure 70 is a rear perspective view of a portion of an anvil modality;
[0073] Figure 70A is an exploded perspective view of another set of the surgical end actuator;
[0074] Figure 70B is a rear perspective view of a portion of another embodiment of the anvil assembly and another embodiment of the segment of the closing tube;
[0075] Figure 70C is a perspective view of a portion of another anvil assembly and another segment of the distal closure tube;
[0076] Figure 70D is an exploded perspective view of another embodiment of the surgical end actuator;
[0077] Figure 70E is an exploded perspective view of another modality of the surgical end actuator;
[0078] Figure 71 is a side view in cross section of a surgical end actuator and the segment of the distal closing tube with the anvil assembly in an open position;
[0079] Figure 72 is another side view in cross section of a surgical end actuator and the segment of the distal closing tube of Figure 71;
[0080] Figure 73 is a perspective view of a portion of the surgical instrument of Figure 64 with a portion of the cable compartment removed;
[0081] Figure 74 is a perspective view of a portion of a trigger drive system;
[0082] Figure 75 is a perspective view of an intermediate portion of an elongated stem assembly embodiment;
[0083] Figure 76 is an elevation view of the distal end of the intermediate rod portion of Figure 75;
[0084] Figure 77 is a side elevation view of the intermediate stem portion of Figures 74 and 75;
[0085] Figure 78 is a plan view of the intermediate stem portion of Figures 74 to 77;
[0086] Figure 79 is an enlarged side elevation view of portions of the adjacent ribs of the intermediate stem portion of Figures 74 to 78;
[0087] Figure 80 is a plan view of another embodiment of the intermediate stem portion;
[0088] Figure 81 is a side elevation view of the intermediate rod portion of Figure 80;
[0089] Figure 82 is a cross-sectional plan view of the intermediate rod portion of Figures 80 and 81 articulated in a substantial U-shape;
[0090] Figure 83 is a perspective view of an arrangement of the surgical instrument;
[0091] Figure 84 is an exploded perspective view of an arrangement of the surgical end actuator;
[0092] Figure 85 is a side elevation view of an anvil;
[0093] Figure 86 is a cross-sectional side view of an end actuator and a portion of an elongated stem assembly with the end actuator shown in a non-hinged position in continuous lines and the end actuator shown in positions articulated in dashed lines;
[0094] Figure 87 is another cross-sectional view of an end actuator for a portion of the elongated stem assembly with the anvil in a closed position and the cutting head in a final position after having been fired distally through the Bobby pins;
[0095] Figure 88 is another side view in cross section of the end actuator and the portion of the elongated stem assembly of Figure 87 after the cutting head has been retracted proximally back to its initial position;
[0096] Figure 89 is another cross-sectional view of the end actuator and a portion of an elongated stem assembly with the anvil in an open position and the cutting head in an initial position;
[0097] Figure 90 is an enlarged cross-sectional view of the end actuator and the elongated stem assembly portion of Figure 89;
[0098] Figure 91 is a perspective view in cross section of the end actuator and the portion of the elongated stem assembly of Figure 8;
[0099] Figure 92 is a perspective view of the end actuator assembly and the elongated stem assembly;
[00100] Figure 93 is a cross-sectional view of a distal portion of an elongated stem assembly;
[00101] Figure 94 is a cross-sectional view of a proximal portion of the elongated stem assembly of Figure 11, together with a portion of an articulation system;
[00102] Figure 95 is a perspective view of an elongated stem assembly and the end actuator;
[00103] Figure 96 is a partial exploded perspective view of a cable assembly;
[00104] Figure 97 is a perspective view of an arrangement of the surgical instrument of the present invention;
[00105] Figure 98 is a perspective view of an exemplary loading unit that can be used in connection with the various surgical instruments disclosed here;
[00106] Figure 99 is another partial cross-sectional view of a portion of the loading unit shown in Figure 98;
[00107] Figure 100 is an exploded perspective view of the loading unit of Figures 98 and 99;
[00108] Figure 101 is a partial perspective view of a portion of a conductor and a modality of the articulation sphere assembly;
[00109] Figure 102 is a perspective view of an embodiment of the articulation tube;
[00110] Figure 103 is a partial cross-sectional view of the loading unit of Figures 98 to 100;
[00111] Figure 104 is a cross-sectional view of the loading unit of Figure 103 in a non-articulated position;
[00112] Figure 105 is another cross-sectional view of the loading unit of Figures 103 and 104 with the conductor and the anvil assembly articulated as a unit in a second direction;
[00113] Figure 106 is a partial perspective view of a loading unit and a portion of an elongated rod assembly before starting a coupling operation between the loading unit and a distal end of the elongated rod assembly;
[00114] Figure 107 is another perspective view of portions of the loading unit and the elongated rod assembly of Figure 106 after being coupled;
[00115] Figure 108 is a partial exploded perspective view of portions of the elongated stem assembly, coupling assembly and loading unit of Figure 106;
[00116] Figure 109 is another partial exploded perspective view of the rod assembly, coupling assembly and loading unit of Figure 106;
[00117] Figure 110 is a perspective view of a distal fixing portion of the loading unit of Figure 106;
[00118] Figure 111 is another perspective view of the distal fixing portion of the loading unit of Figure 106;
[00119] Figure 112 is a perspective view of a proximal fixing portion of the elongated stem assembly of Figure 109;
[00120] Figure 113 is another perspective view of a proximal fixing portion of the elongated stem assembly of Figure 109;
[00121] Figure 114 is a perspective view of the collar and a firing rod arrangement;
[00122] Figure 115 is a cross-sectional view in partial perspective of the loading unit, the coupling assembly and a proximal end of the elongated stem assembly of Figure 109, representing the loading unit attached to the elongated stem assembly;
[00123] Figure 116 is a partial elevation cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit not attached to the elongated stem assembly;
[00124] Figure 117 is a partial elevation cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit attached to the elongated stem assembly;
[00125] Figure 118 is an elevation view of the coupling assembly and the elongated stem assembly of Figure 109 taken along the plane indicated in Figure 115;
[00126] Figure 119 is a cross-sectional view in partial perspective of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit not attached to the elongated stem assembly and additionally representing the coupling collar in an initial orientation in relation to the elongated stem assembly;
[00127] Figure 120 is a partial cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit not attached to the stem and additionally representing the coupling collar in the initial orientation in relation to the elongated stem set;
[00128] Figure 121 is a partial cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit entering the elongated stem assembly and additionally representing the collar coupling in the initial orientation in relation to the elongated stem assembly;
[00129] Figure 122 is a partial cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit entering the elongated stem assembly and additionally representing the collar coupling in a secondary rotated orientation with respect to the elongated stem assembly;
[00130] Figure 123 is a partial cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit entering the elongated stem assembly and additionally representing the collar coupling in the secondary rotated orientation in relation to the elongated stem assembly;
[00131] Figure 124 is a cross-sectional view in partial perspective of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit fully inserted in the elongated stem assembly and additionally representing the coupling collar in the secondary rotated orientation in relation to the elongated stem assembly;
[00132] Figure 125 is a partial cross-sectional view of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit fully inserted in the elongated stem assembly and further representing the coupling collar in the initial orientation in relation to the elongated stem assembly; and
[00133] Figure 126 is a cross-sectional view in partial perspective of the loading unit, coupling assembly and elongated stem assembly of Figure 109, representing the loading unit fully inserted in the elongated stem assembly and additionally representing the coupling collar in the initial orientation in relation to the elongated stem assembly.
[00134] The corresponding reference characters indicate the corresponding parts through the various views. The exemplifications described herein illustrate preferred embodiments of the invention, in one form, and such exemplifications are in no way to be construed as limiting the scope of the invention. DETAILED DESCRIPTION
[00135] The applicant for this application is also the author of the following patent applications that were filed on the same date as this application and which are all incorporated herein by reference in their entirety: - US patent application entitled: "Surgical Staples and Staple Cartridges", Attorney Document No. END7341USNP / 130301; - US patent application entitled: "Surgical Staples and Staple Cartridges", Attorney document number END7331USNP / 130304: - US patent application entitled: "Surgical Staples and Methods For Making the Same", Attorney document number END7335USNP / 130305; - US patent application entitled: "Surgical Staples, Staple Cartridges and Surgical End Effectors", Attorney Document No. END7332USNP / 130306; - US industrial design patent application entitled: "Surgical Fastener", Attorney Document No. END7338USDP / 130307; - US patent application entitled: "Fastener Cartridge Comprising an Extendable Firing Member", Attorney document number END7344USNP / 130308; - US patent application entitled: "Fastener Cartridge Comprising a Firing Member Configured to Directly Engage and Eject Fasteners From the Fastener Cartridge", Attorney Document No. END7339USNP / 130309; - US patent application entitled: "Fastener Cartridge Comprising a Firing Member Including Fastener Surfaces", Attorney Document No. END7340USNP / 130310; - US patent application entitled: "Surgical Instruments With Articulatable Shaft Arrangements", Attorney Document No. END7343USNP / 130300; - US patent application entitled: "Articulatable Surgical Instruments With Separate and Distinct Closing and Firing Systems", Attorney Document No. END7333USNP / 130322; - US patent application entitled: "Articulatable End Effectors", Attorney Document No. END7334USNP / 130312; - US patent application entitled: "Surgical Cutting and Stapling Methods", Attorney document number END7330USNP / 130313; and - US patent application entitled: "Modular Surgical Instruments", Attorney Document No. END7342USNP / 130311.
[00136] Certain exemplifying modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods disclosed here. One or more examples of these modalities are illustrated in the attached drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary modalities, and that the scope of the various modalities of the present invention is defined only by the claims. The characteristics illustrated or described in relation to an exemplary modality can be combined with the characteristics of other modalities. Such modifications and variations are intended to be included in the scope of the present invention.
[00137] Throughout this specification, the terms "various modalities", "some modalities", "a modality" or "the modality" or similar, mean that a specific resource, structure or characteristic described together with the modality is included in at least one modality. Thus, the appearance of the expressions "in various modalities", "in some modalities", "in a modality" or "in the modality", or similar, in places throughout the specification is not necessarily referring to the same modality . In addition, specific resources, structures or characteristics can be combined in any suitable way in one or more modalities. Therefore, the specific resources, structures or characteristics illustrated or described in conjunction with a modality can be combined, in whole or in part, with the structures of the resources or characteristics of one or more other modalities, without limitation. Such modifications and variations are intended to be included in the scope of the present invention.
[00138] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[00139] Various devices and exemplifying methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the person skilled in the art will readily understand that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, those in conjunction with open surgical procedures. With the advancement of this Detailed Description, those of ordinary skill in the art will additionally appreciate that the various instruments disclosed here can be inserted into a body in any way, such as through a natural orifice, through an incision or perforation formed in fabric, etc. . The functional portions or portions of the instrument's end actuator can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end actuator and the elongated stem of a surgical instrument can be advanced.
[00140] In relation to the drawings in which numbers indicate similar components throughout the various views, Figure 1 shows a surgical instrument 10 which is capable of practicing several exclusive benefits of the present invention. The surgical instrument 10 is designed to manipulate and / or actuate various shapes and sizes of end actuators 12 which are operationally attached to an elongated stem assembly 100 of the surgical instrument. In the represented embodiment, for example, the end actuator 12 comprises a surgical stapling device that has jaws 13 and 15 that can be opened and closed. More specifically, the end actuator 12 includes an elongated groove 14 that forms a lower jaw 13 of the end actuator 12. See Figure 2. In the illustrated arrangement, the elongated groove 14 is configured to support a clamp cartridge 30 and also supports movable mode an anvil assembly 20 which functions as an upper jaw 15 of the end actuator 12.
[00141] In various implementations, end actuator 12 is configured to be coupled to an elongated stem assembly 100 that protrudes from a cable assembly or compartment 400. See Figure 1. End actuator 12 (when closed ) and the elongated rod assembly 100 can have similar shapes in cross section, and be sized to pass operationally through a trocar tube or working channel in another form of access instrument. As used herein, the term "operationally pass" means that the end actuator and at least a portion of the elongated stem assembly 100 can be introduced or passed through the opening of the channel or tube, and can be manipulated inside as needed to complete the stapling surgical procedure. In some embodiments, for example, when in a closed position, the jaws 13 and 15 of the end actuator 12 can provide the end actuator with an approximately circular cross-sectional shape that facilitates its passage through a circular passage / opening. However, the end actuators of the various modalities of the present invention, as well as the modalities of the elongated stem assembly, could conceivably be provided with other cross-sectional shapes that could otherwise pass through the access passages and openings that have non-circular shapes in cross section. In this way, an overall size of a cross section of a closed end actuator will be related to the size of the passage or opening through which it is intended to pass. In this way, an end actuator, for example, can be called an "5 mm" end actuator, which means that it can pass through an opening that is at least approximately 5 mm in diameter.
[00142] In various implementations, the elongated stem assembly 100 may have an outside diameter that is substantially equal to the outside diameter of end actuator 12 when end actuator 12 is in a closed position. For example, a 5 mm end actuator can be coupled to an elongated stem assembly 100 having a 5 mm cross-sectional diameter. However, with the advancement of the present Detailed Description, it will be apparent that various embodiments of the present invention can be used effectively with respect to the different sizes of end actuators. For example, a 10 mm end actuator can be attached to an elongated stem that has a transverse diameter of 5 mm. On the other hand, for those applications in which an opening or access passage of 10 mm or greater is provided, the elongated stem assembly 100 may have a transverse diameter of 10 mm (or greater), but may also be able to work with a 5 mm or 10 mm end actuator. Consequently, the outer stem assembly 100 may have an outer diameter that is equal to or different from the outer diameter of a closed end actuator 12 attached thereto.
[00143] With reference now to Figures 2 and 3, the elongated channel 14 can comprise an elongated bowl 700 which is configured to removably support the surgical staple cartridge 30 therein. In various implementations, for example, the elongated channel 14 can be manufactured from, for example, stainless steel series 300 and 400, 17-4 and 17-7, titanium etc., and can be formed with spaced sidewalls 702. As will be discussed in more detail below, the anvil assembly 20 may include a distal anvil portion 800 and a proximal anvil assembly tube 820. The distal anvil portion 800 may, for the most part, extend simultaneously with the portion of the elongated groove 14 that supports the staple cartridge 30. The distal anvil portion 800 can be manufactured from, for example, stainless steel series 300 & 400, 17-4 & 17-7, titanium etc., and may have a staple-forming bottom surface, generally identified as 22, which has a plurality of staple-forming pockets (not shown) formed thereon.
[00144] The elongated channel 14 can be configured to support a variety of surgical staple cartridges that are designed to be "implanted" within a patient. For example, the implantable surgical staple cartridge 30 may comprise any of the various surgical staple cartridge provisions disclosed in US Patent Application Publication No. 2012-0080484, filed September 30, 2010, entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM, the full description of which is hereby incorporated by reference. In at least one implementation, for example, the staple cartridge 30 includes a body portion 31 that consists of a compressible hemostatic material such as, for example, oxidized regenerated cellulose ("ORC") or a bioabsorbable foam, on which rows are supported. non-formed metal clamps 32. In at least some ways, in order to prevent the clamp from being affected and the hemostatic material being activated during the insertion and positioning process, the entire cartridge can be coated or wrapped in a biodegradable film, as a polydioxanone film, sold under the trademark PDS.RTM, or with a polyglycerol sebacate film (PGS) or other biodegradable films formed from PGA (polyglycolic acid, marketed under the trademark Vicryl), PCL (polycaprolactone) , PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, marketed under the trademark Monocryl) or a PGA, PCL, PLA, PDS compound that would be waterproof until it is broken. The body 31 of the staple cartridge 30 is dimensioned to be removably supported in the elongated groove 14, as shown, so that each staple 32 inside it is aligned with the corresponding staple forming pockets in the distal anvil portion 800 when the distal anvil portion 800 is actuated to contact the staple cartridge 30.
[00145] Referring to Figure 3, the elongated channel 14 can also include a framed mounting end 710 which includes a pair of spaced sidewalls 712 and a top wall 714. In at least one implementation, the end actuator 12 is configured to be articulated with respect to the elongated stem assembly 100 around a joint and a pivot axis AA around which the anvil assembly 20 is pivoted with respect to the elongated groove 14. The elongated stem assembly 100 defines a longitudinal axis of the LT-LT tool. The articulation and pivot axis A- A are transversal to the longitudinal axis of the LT-LT tool. The elongated stem assembly 100 comprises a hollow outer stem 300 and serves to function as the stem back of the elongated stem assembly 100. The proximal end of the elongated stem 100 can be rotationally supported by the cable assembly 400 so that the physician can selectively rotate the elongated stem assembly 100 and the end actuator 12 attached to it around the longitudinal axis of the LT-LT tool. The distal end 302 of the outer stem 300 is formed with a shackle arrangement 304 comprising a pair of spaced fixing tabs 306. Each fixing tab 306 has a mounting hole 308 in it which is adapted to receive a corresponding pivot pin. 310 through it.
[00146] In various implementations, the anvil set 20 includes a portion of distal anvil 800 and a proximal anvil assembly tube 820. As can be seen in Figures 2, 3 and 5, the proximal anvil assembly tube 820 includes a body portion 821 having a shackle portion 822 extending proximally which is formed by two anvil fixing tabs 824 extending proximally. Each anvil fixing tab 824 has an anvil mounting hole 826 through it which is configured to be pivotally seated on pivot pins 310. In various implementations, the distal anvil portion 800 is configured to be coupled to the tube proximal anvil assembly 820 so that the distal anvil portion 800 can "float" in relation to the proximal anvil assembly tube 820. Referring to Figure 5, the body 821 of the proximal anvil assembly tube 820 can be formed with a series of opposing grooves 830 of open end extending vertically. The grooves 830 are dimensioned to receive, in a sliding manner, the corresponding fixing shoulders 812 extending vertically and formed at a proximal end 810 of the distal anvil portion 800. See Figure 4. Each fixing shoulder 812 has a stop shoulder 814 formed there that is sized to be movably received in a stop groove 832 formed in each groove 830, as shown in Figure 5. Each stop groove 832 has a closed end 834. The proximal end 810 of the distal anvil portion 800 is movably coupled to the proximal anvil mounting tube 820 by aligning the fixing lugs 812 with the open bottom ends of the corresponding grooves 830 and then inserting the proximal end up into the proximal anvil mounting tube 820 This set can be completed before the anvil set 20 is pivotally seated on pivot pins 310. Once assembled and coupled pivoting to the elongated groove 14, the distal anvil portion 800 will be unable to slide off the proximal anvil assembly tube 820 due to contact with the elongated groove 14. The stop projections 812 will similarly come into contact with the ends 834 of the corresponding stop groove 832 to prevent the proximal end 810 of the distal anvil portion 800 from disconnecting from the proximal anvil assembly tube 820. See Figure 7. As can be seen in Figure 7, the distal anvil portion 820 can move up (arrow "U") and down (arrow "D") with respect to the proximal anvil mounting tube 820. Such a vertical displacement range of the distal anvil portion 800 with respect to the anvil mounting portion proximal 820 can be called "floating" vertical movement or displacement in the present invention.
[00147] With reference now to Figure 8, the initial closure of the anvil set 20 with respect to the elongated groove set 14 and the surgical staple cartridge 30 operationally supported there can be performed through a unique and innovative closure system, in generally referred to as 110. Closing system 110 may also be referred to in the present invention as a "second jaw closing system". In one implementation, closing system 110 includes an anvil closing rod 112 that has a proximal end 114 that has a flanged end 116 which is configured to be pivotally attached to a closing trolley 420 of the closing system that is operationally supported in compartment assembly 400. See Figure 8. The anvil closing rod 112 can also be called on present invention of "second jaw actuation bar 112." The closing carriage and firing system can be similar in construction and operation to the closing carriage and closing system revealed in US Patent Application Publication No. US 0074200 A1, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR, whose entire disclosure is hereby incorporated by reference.
[00148] Again with reference to Figure 8, the closing carriage 420 can comprise two carriage segments 422 (only one is illustrated) that are interconnected by adhesive, pressure snapping features, screws, etc. As used herein, the term "snap-fit feature" includes, but is not limited to, for example, a tab that has a protrusion that is configured to retain a corresponding locking portion of another component. Such features may be designed to releasably engage the locking portion or may not be designed or intended to be removed. In at least one form, the closing carriage 420 has a distal end 424 which has a groove arrangement 426 which is adapted to receive the flanged end 116 of the anvil closing rod 112. This arrangement serves to secure the proximal end 114 of the anvil closing rod 112 to the closing carriage 420 while facilitating its selective rotation of the anvil closing rod 112 in relation to the closing carriage 420. Therefore, the elongated stem assembly 100 and the end actuator 12 which is operationally coupled to it can be selectively rotated about the longitudinal axis of the LT-LT tool in relation to the housing assembly 400.
[00149] Still with reference to Figure 8, in several implementations, the compartment assembly 400 comprises a pistol-shaped cable compartment that can be manufactured in two or more pieces for assembly purposes. For example, housing assembly 400, as shown, comprises a right housing element 402 and a left housing element 404 (Figure 1), which are molded or otherwise manufactured from a polymer or plastic material and are designed to if they match. These housing elements 402 and 404 can be attached to each other by snap-fit features, molded dowels and sockets or otherwise formed there and / or by adhesive, screws, etc. When assembled, the compartment set 400 movably supports the closing carriage 420 for its selective axial displacement in response to actuation movements from the trigger, generically designated as 430. As the Detailed Description proceeds, however, it will be understood that the various unique and innovative aspects and attributes of the various implementations of the present invention can be effectively achieved when employed with robotically controlled systems or, otherwise, remotely controlled. Accordingly, the term "compartment" or "compartment assembly" can also encompass a compartment or similar portion of a robotic or automated control system that houses or sustains in any way at least one drive system configured to generate and apply at least a control movement that can be used to actuate various forms of surgical end actuators attached to them. For example, various implementations of the surgical instruments described herein can be used in connection with these robotic systems disclosed in US patent application Serial No. 13 / 536,323, entitled ROBOTICALLY POWERED SURGICAL DEVICE WITH MANUALLY ACTUATABLE REVERSING SYSTEM, deposited on June 28, 2012, whose full description is hereby incorporated by reference.
[00150] Trigger assembly 430 may, for example, comprise a primary trigger 440 and a secondary trigger 460. Primary and secondary triggers 440 and 460 are pivotally seated in a pivot pin assembly 430 formed in the compartment assembly 400, so that triggers 440 and 460 can essentially move relative to each other. Such an arrangement allows the trigger assembly 430 to pivot in relation to the compartment assembly 400 on a pivot axis PA-PA. See Figure 8. The primary drive 440 has an elongated gripping primary drive blade 442 that protrudes from the primary steering portion 444 that has a firing rack 446 formed therein. In one embodiment, the secondary driver 460 has a secondary driver blade 462 that projects from a secondary steering portion 464 that is pivotally seated on the pivoting pin assembly 430. The primary steering portion 444 has a slot 448 that is adapted to receive the secondary trigger portion 464 of secondary trigger 460 there when primary trigger paddle 442 is pivoted toward pistol grip handle portion 406 of housing assembly 400. This arrangement essentially allows secondary trigger 460 to " nest "inside the primary drive 440 during actuation. As will be discussed in detail below, the secondary drive 460 is pivoted by turning the primary drive 440. Thus, in other modalities, the secondary drive 460 may not have the secondary drive blade 442. In several ways, the trigger assembly 430 can be forced into position not actuated by a trigger spring (not shown).
[00151] As can be seen in Figure 8, the secondary drive portion 464 of the secondary trigger 460 may have a closing gear segment 466 formed therefrom that is configured to engage with a gear rack of the carriage 423 formed on the side bottom of the closing carriage 420. Thus, when the secondary trigger 460 is pivoted towards the pistol grip 406, the closing carriage 420 is activated in the distal direction "DD", which in this way activates the closing rod of the anvil 112 in the distal direction.
[00152] With reference again to Figure 3, the distal end 118 of the anvil closure rod 112 is configured to be attached to an anvil closure link 120. Anvil closure link 120 is pivotally attached to a slider anvil pin 122. An anvil cam pin 124 is mounted on the anvil pin slider 122 and is configured to be received within the anvil pin slots 720 provided on each side wall 712 of the framed mounting end 710 of the channel elongated 14 as well as cam slits of the anvil 840 in the proximal anvil assembly tube 820. The movement of the anvil closing rod 112 in the distal direction "DD" will cause the anvil assembly 20 to move from an open position towards to the elongated groove 14 (called in the present invention the "CD" closing direction) and the movement of the anvil closing rod 112 in the proximal direction "PD" will cause the anvil assembly 20 to move from a closed position hada to an open position (called in the present invention the "OD" opening direction). Such opening and closing of the anvil assembly 20 is achieved by the action of the cam or the movement of the anvil pin 124 in the cam slots of the anvil 840 in the proximal anvil mounting tube 820. Thus, the actuation of the closing system 110, also known as "second jaw closure system" will result in movement of the anvil assembly 20, also known as "second jaw 15" in relation to the elongated groove 14 also known as the "first jaw 13". Such a movement may, for example, comprise the pivoting displacement of the second mandible (anvil set 20) in relation to the first mandible (elongated groove 14) on a common pivot axis AA which is established at its fixation points at the distal end of the set elongated stem 100.
[00153] In various arrangements, end actuator 12 can be configured to be selectively articulated in relation to the longitudinal axis of the LT-LT tool. In other words, however, the first jaw 13 comprising the elongated channel 14 can be selectively movable in relation to the second jaw 15 comprising the anvil assembly 20. As described above, the elongated channel 14 is pivotally coupled to the distal end 302 of the outer tube 300 by pivot pins 310. Such a fixing arrangement allows the elongated channel 14 to pivot or move in a first "FD" direction over the pivot axis AA which is essentially the same direction as the set of anvil 20 moves when the anvil set 20 is moved from a closed position to an open position (the anvil opening direction "OD"). See Figure 9. This arrangement additionally facilitates movement or articulation in a second "SD" articulation direction which is essentially the same direction in which the anvil assembly 20 moves from an open position to a closed position (the closing direction of the anvil). anvil "CD"). To facilitate such movement of the elongated channel 14, a reciprocal hinge rod 150 is employed. The articulation rod 150 can also be called "first jaw actuation bar 150" in the present invention. More specifically and with reference to Figure 3, the articulation rod 150 is dimensioned to be movably received with the external tube 300 and has a distal end 152 that is pivotally fixed to an articulation link 160. The articulation link 160 is pivotally attached to a proximal fixing shoulder 722 at the end of the proximal framed assembly 710 of the elongated channel 14. As can be seen in Figure 10, a proximal end 154 of the hinge rod 150 has a hinge rack 156 formed there which performs the drive interface with a joint control system 200. The joint control system 200 can also be called in the present invention "first jaw closure system 200".
[00154] The component parts of a shape of the joint control system 200 are illustrated in Figures 10 and 11. In one shape, the joint control system 200 can include an actuator 210, a joint body 220 and a nozzle 250 The rotary movement of the actuator 210 causes the corresponding rotation of the articulation body 220 inside the nozzle 250. The rotation of the actuator 210 thus results in the axial displacement of the articulation rod 150 inside the outer rod 300 to cause the remote articulation of the end actuator 12.
[00155] Still with reference to Figure 10, the articulation body 220 has a platform 222 which consists of the first and second spaced and semicircular halves 224, 226 of the platform. The platform halves are mutually opposite and essentially represent mirror images of each other. The first and second halves of platform 224, 226 protrude from their surfaces mutually opposite the first and second holders 225, 227, respectively. Each half of platform 224, 226 has a set of platform teeth 228 spaced about 180 degrees from the set of platform teeth on the other half of the platform. The hinge body 220 has a pair of rotation stops 230 that protrude from its surface as well as a pair of finger recesses 232. A drive gear 240 protrudes laterally from the hinge body 220. The hinge gear drive 240 has an enlarged opening 242 through it and a side pivot 244. Inside the enlarged opening 242 of drive gear 240, there is a hole in the firing rod (not shown) for receiving a firing rod 530 through the even allowing the application of a firing movement to the end actuator 12. The drive gear 240 is configured to insert the articulation rack 156 to effect the desired reciprocating movement of the articulation rod 150.
[00156] The nozzle 250 of the articulation control system 200 may include a nozzle body 252. The nozzle body 252 can have an axial bore 254 through it which facilitates the passage of the articulation rod 150 and other operational components of the instrument. 10 including the proximal end 306 of the outer stem 300. See Figure 11. The nozzle frame 252 may also have a groove in frame 256 and flange 258 to rotationally secure the body of nozzle 252 to housing 400. In various forms, a holder housing 260 comprises a portion of the nozzle frame 252. See Figure 1. An annular matrix of the retainer teeth (not shown) is formed inside the retainer compartment 260. A floor of the retainer compartment is spaced from the teeth the retainer. The floor may have a pair of projections that interact within the rotation stops 230 of the hinge body 220 to limit the degree of rotation. When the hinge body 220 is inserted into the retainer compartment 260, the base of the hinge body 220 is supported on the floor in the retainer compartment 260, and the teeth of the platform 228 of the first and second halves of the platform, 224, 226 are aligned for engaging the retaining teeth of the retainer compartment 260. A spring element 268 is held within the pivot body to force the teeth of the platform 228 to engage with the retaining teeth.
[00157] Again with reference to Figure 10, the actuator 210 can consist of a lever arm 212, a cap 214 and a pair of retaining fingers 216. The lever arm 212 is mounted on top of the cap 214. The pair of fingers retainer 216 protrudes laterally from the bottom side of cover 214. Each retaining finger 216 has a retaining clip. The retaining fingers 216 are received within the finger recesses 232 of the hinge body 220. The first and second retainers 225, 227, on the platform halves of the hinge body are inserted into a slit depression within the underside of the lid circular 214. Advantageously, each of the three significant components of the joint control system, namely, actuator, joint body and nozzle, can be injection molded components. Such components, for example, can be manufactured from amorphous polyamide reinforced with fiberglass, marketed under the trade name Grivory GV-4H by EMS - American Grilon 150.
[00158] The ratchet rotation of the actuator 210 causes the elongation of the elongated groove 14 in the first and second direction in relation to the longitudinal axis of the LT-LT tool. Figures 1, 2, 9 and 12 illustrate the elongated channel 14 in a non-hinged position. When the drive gear 240 in the hinge body 220 of the hinge transmission 200 is rotated to thereby push the hinge rod 150 in the distal direction "DD", the elongated channel 14 will hinge in the first hinge direction "FD" in with respect to the longitudinal axis of the LT-LT tool, as shown in Figure 13. When the drive gear 240 in the hinge body 220 of the hinge transmission 200 has been rotated to pull the hinge rod 112 in the proximal direction "PD", the elongated groove 14 will pivot in a second "SD" direction in relation to the longitudinal axis of the LT-LT tool. The second "SD" direction is the same as the "CD" closing direction. See Figure 9.
[00159] Surgical instrument 10 may include a trigger system generally indicated as 410 that is supported on compartment assembly 400 and is operable to drive various components of instrument 10. With reference to Figure 8, trigger system 410 may, for example, example, include an actuation bar 470. The actuation bar 470 has a first actuation rack 472 formed in it that is configured to engage with the trigger rack 446 on the primary trigger 440. Thus, when the trigger rack 446 is in engagement with the first actuation rack 472, the actuation bar 470 is activated in the distal direction "DD" when the primary trigger 440 is pivoted towards the pistol grip 406. The actuation bar 470 has a second actuation rack 474 formed in the same configured to engage with clutch teeth 484 on a clutch rod 482 of a clutch assembly 480. In various embodiments, the clutch shaft gem 482 is pivotally supported inside compartment assembly 400 and is also laterally movable therein. The clutch shaft 482 has a central portion 486 that has a plurality of spaced teeth 488 that are configured to directionally engage the tooth openings 492 on a drive gear 490 that is pivotally supported on the clutch shaft 482. drive 490 has a drive gear segment 494 in it which is adapted for engagement with the firing rack 500 which is movably supported in compartment assembly 400.
[00160] Various embodiments of the clutch assembly 480 may additionally comprise a clutch plate 510 which is slidably seated on a clutch pin 449 provided in the primary steering portion 444 of primary trigger 440. Clutch pin 449 can be received movably within a vertical slot 512 in the clutch plate 510. The clutch plate 510 also has a clutch arm that extends in the distal position 514 which is adapted to engage a chamfer plate 489 formed on the clutch shaft 482. In addition, the clutch spring 520 is used to tilt the clutch shaft 480 sideways, so that teeth 488 on the clutch shaft 482 are brought into engagement with the tooth openings 492 on drive gear 490.
[00161] As can be seen in Figure 8, the firing rack 500 is coupled to the firing rod 530 which is attached to the proximal end of a cutter bar assembly 600. In various embodiments, the cutter bar assembly 600 can comprise a flexible three-layer cutting bar 602 that is flexible enough to accommodate the hinge of the end actuator 12 while remaining sufficiently rigid to be driven distally through the elongated stem assembly 100. An axial passageway 157 can be provided on the bar pivot 150 to axially receive the cutting bar 602 therein. See Figure 10. In the embodiment shown, the cutting bar 602 is attached to an I 610 beam cutting head. As can be seen in Figure 3, for example, the I 610 beam cutting head includes a body portion oriented vertically 612 having a bottom floor 614 and an upper flap 616 formed therein. A tissue cutting edge 620 is formed over the vertically oriented body portion 612.
[00162] Still referring to Figure 3, the vertically oriented body portion 612 extends through a longitudinally extending slit 704 in the elongated groove 14 and in a longitudinally extending slit 806 in the distal anvil portion 800. distal anvil 800 additionally has a bowl 809 formed on the upper surface for slidingly receiving the upper flap 616 therein. The distal end 618 of the upper flap 616 is angled to interconnect with the angled surfaces 811 formed in the portions 805 of the distal anvil portion 800 forming the slot 806. See Figure 14. The flexible firing bar 602 extends through the set of elongated rod 100 to be coupled to a distal end portion 532 of a firing rod 530 and are held in a contiguous orientation with each other as shown in Figure 10. The proximal end of firing rod 602 can be attached to the distal end portion 532 of the firing bar 530 by a coupling element 650. As will be discussed in more detail below, the firing rod 530 facilitates the application of the firing and retracting movements to the cutter bar assembly 600 by the firing system 410.
[00163] Again with reference to Figure 8, the firing rod 530 extends through the closing pad 540 that is mounted inside the compartment assembly 400. In at least one way, a pair of mounting studs 407 protrude from the cable housing elements 402, 404 and extends through corresponding slots in the closing carriage 420 to be received in a retaining slot in the cushion 540. The closing spring 550 which is attached to a retaining clip 552 is seated in the retaining cushion closing 540. The closing spring 550 extends between the structure of the nozzle 252 and an inner wall 425 in the closing carriage 420. Thus, the closing spring 550 serves to tilt the closing carriage 420 in the proximal direction "PD".
[00164] Various embodiments may also include a release locking lock assembly 560 that connects with the closing carriage 420 to selectively retain the closing carriage 420 in its most distal closed or stapled position. In at least one way, the locking lock assembly 560 includes a locking button 562 that is pivotally held in the housing assembly 400. Locking button 562 has a locking arm 564 that is configured to be in a boundary position with a locking protrusion 421 formed in the closing carriage 420 when the button 562 is in a locked position. In addition, the locking arm 564 has a loop 566 formed therefrom that is configured to release reliably with the locking clamp 502 at the proximal end of the firing rack 500. The locking spring 568 serves to tilt the locking button 562 in a locked position.
[00165] The operation of the surgical instrument 10 will now be described. Figure 9 illustrates the jaws 13 and 15 of the end actuator 12 in an open position. When the end actuator 12 is in an open position, the locking arm 564 is located on top of the locking protrusion 421 formed in the closing carriage 420, so that the locking clip 566 of the locking arm 564 is in locking engagement with locking latch 502 on firing rack 500. See Figure 8. Thus, when in its initial position, the cutter bar assembly 600 cannot be inadvertently actuated. The clutch plates 510, as well as the closing carriage, are each in their most close unacted positions. When in these positions, the clutch steering chamfer 489 on the clutch rod 482 is in contact with the closing carriage portion 420, which prevents the clutch rod 482 from moving laterally in gear engaged with the drive gear 490 under the traction of the clutch spring 520.
[00166] To start the closing process, a first movement is applied to the trigger set 430. That is, the trigger set 430 is initially pivoted towards the pistol grip 406. This pivoting action is used to direct the closing car 420 in the distal direction "DD" due to the gear engagement between the closing gear segment 466 on the secondary drive 460 and the rack of the carriage 423 formed on the underside of the closing carriage 420. Such distal movement of the closing carriage 420 also the anvil 112 closing axially advances in the distal direction "DD". As the anvil 112 closing rod moves distally, the closing link 120 moves the anvil pin 122 slider distally. As the anvil pin slider 122 moves distally, the anvil pin 124 moves above the cam slots 840 in the proximal anvil portion 820 to project the anvil assembly 20 towards the elongated groove 14 and the staple cartridge 30 sustained in it. If the surgeon simply wants to seize and manipulate the tissue before stapling it between the anvil assembly 20 and the surgical staple cartridge 30, the trigger assembly 430 can be pivoted to open and close the anvil assembly 20 without fully pivoting the trigger assembly 430 to the fully closed position.
[00167] Those skilled in the art will understand that, when the actuator assembly 430 is rotated towards the grip of the pistol 406, the actuation bar 470 will necessarily also be distally directed due to the gear engagement between the primary gear segment 446 on the primary drive 440 and the first actuating rack 472 on the actuating bar 470. The distal movement of the actuating bar 470 will also result in the application of a rotating actuation movement to the clutch shaft 482 due to the interlocking engagement between the clutch teeth 484 on the clutch shaft 482 and the second actuating rack 474 on the actuating bar 470. However, this pivoting motion is not applied to the drive gear 490 because the clutch arm 514 of the clutch plate 510, in contact with clutch steering chamfer 489 on clutch shaft 482, prevents axial movement of clutch shaft 482 in gear engagement with gear drive gear 490. In this way, the clutch shaft 482 rotates freely in relation to the drive gear 490. Consequently, the clutch assembly 480 automatically avoids the activation of the trigger rack 500 during the initial actuation of the drive assembly 430.
[00168] After the trigger assembly 430 has been initially and completely compressed to the closed position, the anvil assembly 20 will be locked in the closed position by the closing locking assembly 560, which prevents the proximal movement of the closing carriage 420. To drive the cutter bar assembly 600 distally through the tissue stapled to the end actuator 12, the surgeon pivots the primary trigger 440 again towards the pistol grip 406 of the compartment assembly 400. As the primary trigger 440 is pivoted , the firing rack 500, the firing rod 530 and the cutting bar assembly 600 are driven in the distal direction "DD". As the cutter bar assembly 600 is driven in the distal direction, the cutter head 610 also moves distally. As the cutting head 610 moves distally, the angled surface 618 on the upper flap 616 moves upward through the angled surface 811 on the distal anvil portion 800 by moving the floating distal anvil portion 800 in the downward direction "D" in the direction to the staple cartridge 30. As the distal anvil portion 800 is driven towards the stapled tissue and the staple cartridge 30, the action of stapling or crushing causes the staples to form against the bottom of the distal anvil portion 800 Thus, as the cutting head 610 is driven distally through the end actuator 12, the cutting surface of the fabric 620 cuts through the stapled fabric while forming the staples in the staple cartridge 30 on both sides of the cutting fabric. . Such a two-part anvil set allows the distal anvil portion to remain essentially parallel to the elongated groove and the top of the surgical staple cartridge during firing. Put more succinctly, the two-part floating anvil arrangement allows the lower staple forming surfaces to remain parallel to the top of the surgical staple cartridge and the elongated groove during firing.
[00169] After the cutting head 610 has been actuated through the tissue stapled to the end actuator 12, the surgeon then releases the primary trigger 440 to thus allow the primary trigger 440 to swivel to its unacted position under the pull of the trigger spring 432. When the primary trigger 440 pivots back to the starting position, the trigger rack 500, the trigger rod 530 and the cutter bar assembly 600 are dragged back proximally to their respective positions initials. The end actuator 12 remains in its stapled position, as shown in Figure 13.
[00170] To unlock the closing carriage 420 and the secondary actuator 460, the surgeon presses the locking button 562. When the locking button 562 is compressed, the locking arm 564 is pivoted out of the coupling that is in contiguity with the locking projection 426 in the closing carriage 420. Additional details regarding the operation of the closing and firing systems can be found in US Patent Application Publication No. 2012/0074200 which is hereby incorporated by reference, in its entirety. . As the closing carriage 420 moves proximally, the anvil closing rod 112 is also pulled proximally. As the anvil closing rod 112 moves proximally, the anvil pin slider 122 and the anvil pin slider 124 move proximally, causing the anvil set 20 to oscillate to the open position.
[00171] Surgical instrument 10 provides a number of advantages over previous surgical instruments. For example, the unique and innovative floating anvil arrangement is capable of automatically adjusting the anvil gap between the lower surfaces of the anvil and the staple cartridge or elongated groove. In this way, the floating anvil arrangement can automatically compensate for different thicknesses of tissue while allowing the lower staple-forming surface (s) of the anvil to remain parallel to the staple cartridge and the elongated channel. This is all achieved without sacrificing the stability of the anvil.
[00172] Another distinct advantage that surgical instrument 10 has over previous surgical instruments with an articulated end actuator is the nature in which the present end actuator is articulated in relation to the elongated stem assembly. As described in detail above, the elongated channel portion of the end actuator is pivotally mounted to the elongated stem assembly for selective pivoting movement relative to them on a pivot axis. The pivot axis is transversal to the longitudinal axis of the tool defined by the elongated shank assembly. The anvil set is also pivotally coupled to the elongated channel for their selective pivoting movement on the same pivot axis. This provides another distinct advantage over previous articulating end actuator arrangements due to at least the following reason.
[00173] During typical surgical procedures, the surgeon views the surgical site and the end actuator through a camera that can provide somewhat limited vision. For example, such camera arrangements commonly provide the surgeon with only a view of a portion of the surgical end actuator. When using a cutter, for example, the camera can only provide the surgeon with a view of a portion of the anvil and the cutter channel. In dispositions of the anterior articulating cutter, the cutter was coupled to the end of the elongated stem by means of a flexible joint or other arrangement that did not always provide a consistent reference axis on which the end actuator pivoted in relation to the elongated stem. Therefore, it was difficult for the surgeon, when seeing a portion of the end actuator, to have a reliable reference structure for knowing where the pivot shaft resided. Since the articulation axis is also the axis on which the anvil pivots, the surgeon has a more reliable reference structure with respect to the location of the pivot axis, when viewing the cutter anvil through the camera. In other words, when using the end actuator arrangement of the surgical instrument 10, the surgeon can determine where the elongated channel will pivot in relation to the elongated rod by seeing where the anvil is pivotally mounted on the elongated channel.
[00174] The surgical instrument 10 also employs separate control systems to move the jaws of the end actuator 13 and 15 with respect to each other. For example, the doctor may decide to move or articulate the lower jaw 13 (elongated groove 14) on the pivot axis AA towards the upper jaw 15 (anvil set 20), or in the opposite direction to it, without acting on the upper jaw 15 (anvil set 20). This can be achieved by operating the joint control system (or first jaw closure system) without operating the second jaw closure system 110. In this way, the elongated channel 14 can be selectively pivoted on the AA pivot axis while the anvil assembly 20 remains in a closed or open position. Similarly, the anvil assembly 20 can be actuated or moved without moving the elongated channel 14 by acting on the closing system 110 without acting on the joint control system. Such a unique and innovative arrangement provides the physician with more flexibility when positioning the jaws of the end actuator within the patient.
[00175] Figures 15 to 19 illustrate another 1010 surgical instrument that is capable of practicing several exclusive benefits of the present invention. The 1010 surgical instrument is designed to manipulate and / or actuate various shapes and sizes of 1012 end actuators that are operationally attached to an elongated stem assembly 1100 of the surgical instrument. In the represented embodiment, for example, the end actuator 1012 comprises a surgical stapling device that has jaws 1013 and 1015 that can be opened and closed. More specifically, end actuator 1012 includes a jaw groove 1014 that forms a lower jaw 1013 of end actuator 1012. See Figure 16. In the illustrated arrangement, jaw groove 1014 is configured to hold a clamp cartridge 30 and also movably supports an anvil assembly 1020 which functions as an upper jaw 1015 of end actuator 1012.
[00176] With reference now to Figures 15 and 17, the anvil assembly 1020 comprises a two-part arrangement including an anvil body portion 1021 and an anvil cover element 1023. The anvil body portion 1021 may include a portion assembly 1022 which has 1024 mounting trunnions protruding from there. The mounting trunnions 1024 are configured to be received in a vertically elongated mounting slot 1018 in the vertical side walls 1017 of a proximal mounting portion 1016 of the jaw groove 1014. Such an arrangement allows the anvil assembly to somewhat float up and down with respect to the elongated channel. In other words, the anvil body portion 1021 can move with respect to the elongated groove or the top of the staple cartridge supported in the elongated groove so that the staple-forming lower surfaces of the anvil body portion 1021 are parallel to the top. staple cartridge and the elongated groove. As will be discussed in further detail below, the anvil assembly 1020 is moved between an open and closed position by manipulating the position of an 1190 fabric cutting head.
[00177] In various arrangements, the end actuator 1012 can be configured to be selectively articulated around a longitudinal axis of the LT-LT tool which is defined by the 1100 elongated stem assembly. As can be seen in Figures 15 to 18, for example, the elongated stem assembly 1100 may include a flexible neck assembly 1110 to facilitate such articulation. Various flexible neck sets are known and can be used. For example, flexible neck assemblies are described in Provisional Patent Application Serial No. 61 / 386,117, filed on September 24, 2010, all of which is hereby incorporated by reference. Other flexible neck sets that can be used are disclosed in US Patent No. 5,704,534, entitled ARTICULATION ASSEMBLY FOR SURGICAL INSTRUMENTS, and issued January 6, 1998; US Patent Application Publication No. 2012/0074200 A1, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR, and filed on September 23, 2011; and in US patent application publication No. 2009/0090764 entitled SURGICAL STAPLER HAVING AN ARTICULATION MECHANISM, and filed on October 3, 2008, the disclosures of which are incorporated herein in full as a reference. As will be discussed in further detail below, however, the flexible neck assembly 1110 is configured to facilitate articulation of the end actuator 1012 in directions that are the same directions in which the jaws of the end actuator travel between the open and closed positions .
[00178] In at least one implementation, the flexible neck assembly 1110 can, for example, be manufactured in two parts 1110R and 1110L that are configured to be coupled by fasteners as push-fit elements, screws, threaded pins, adhesives, etc. The flexible neck parts 1110R and 1110L can be composed of rigid thermoplastic polyurethane marketed as ISOPLAST grade 2510 by the Dow Chemical Company. The right flexible neck portion 1110R includes a right upper rib segment 1112R and a right lower rib segment 1112L which are separated by an elongated right lateral back (not shown). Similarly, the left flexible neck portion 1110L includes a left upper rib segment 1112L and a left lower rib segment 1114L which are separated by an elongated left lateral back 1116. See Figure 17. When assembled, the right upper rib segments 1112R and the upper left rib segments 1112L form the upper ribs 1112 and the right lower rib segments 1114R and the left lower rib segments 1114L form the lower ribs 1114 that are spaced from each other and that together form a cylindrical configuration as shown in Figure 15. Such an arrangement allows the end actuator 1012 to articulate in a first "FD" direction which is essentially the same direction in which the anvil assembly 1020 moves when the anvil assembly 1020 is moved from a closed position to a open position (from this point on in this document called the anvil opening direction "OD" ). See Figure 18. The flexible neck assembly 1110 will additionally facilitate the articulation of the end actuator 1012 in a second "SD" articulation direction which is essentially the same direction in which the anvil moves from an open position to a closed position (this time). point in this document called the closing direction of the anvil "CD"). In various embodiments, the right flexible neck portion 1110R additionally has a right tubular portion 1113R and the left flexible neck portion 1110L has a left tubular portion 1113L. When joined together, the left and right tubular portions 1113R, 1113L serve to receive two fixation arms projected in distal position 1019 that project proximally from the jaw groove 1014. See Figures 16 and 17. The fixation arms 1019 they have connection tabs on them which engage the tubular portions 1113R and 1113L to fix the jaw groove 1014 to the elongated stem assembly 1100. Other methods of fixing the jaw groove 1014 to the elongated stem assembly 1100 can also be employed. In at least one embodiment, the elongated stem assembly 1100 includes a substantially rigid proximal outer stem segment 1300 that has a distal end 1302. The distal end 1302 has a pair of opposite side slots 1303 therein for receiving protruding ends proximally corresponding to the 1116L side back portions (the right back portion is not shown). See Figures 15 and 17. The external stem segment 1300 can be pressed on the flexible neck assembly 1110 or otherwise fixed to it by fasteners, pins, screws, etc.
[00179] The proximal end of the external stem segment 1300 can be attached to a cable assembly of the type described in US Patent Application Publication No. 2012/0074200 A1, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR, which has been incorporated herein as a reference, in its entirety. Additional details with respect to at least one method of attaching the external stem segment to the cable assembly and operation of the external stem segment and related components can be obtained from references to that publication. Such an arrangement allows the surgeon to rotate the external stem segment 1300 and the end actuator 1012 operationally coupled to it on the longitudinal axis of the LT-LT tool by rotating the nozzle element in relation to the cable assembly, as discussed in detail there. .
[00180] With reference to Figures 16 and 18, an upper slot 1120 extends through each upper rib 1112 to form a passage through the flexible neck assembly 1110 to receive a first set of flexible articulation band 1150 therethrough. Similarly, a lower slot 1121 extends through each lower rib 1114 in the flexible neck assembly 1110 to form a passageway for receiving a second set of flexible pivot band 1170 therethrough. Referring to Figure 17, in at least one embodiment, the first flexible pivot band assembly 1150 comprises a first flexible distal segment 1152 which is manufactured from, for example, spring steel, stainless steel 420, titanium, stainless steel grade 400 or 300, and has a first hook 1154 formed at its distal end. The first hook 1154 is configured to hookly engage a first feature, or upper feature, of receiving hook 1155U formed at the proximal end of the jaw groove 1014. The first set of articulation band 1150 additionally includes a first portion of structural band 1156 which is attached to (for example, pinned) the first distal segment 1152. The first portion of structural band 1156 can be manufactured from, for example, spring steel, 420 stainless steel, titanium. Similarly, the second hinge strip assembly 1170 comprises a second flexible distal segment 1172 which is manufactured from, for example, spring steel, stainless steel 420 and titanium and has a second hook or lower hook 1174 formed in its distal end. See Figure 17. The second hook 1174 is configured to hook a second feature, or lower feature, of hook reception 1155L formed in the jaw groove 1014. See Figure 18. The second set of articulation strips 1170 additionally includes a second portion of structural strip 1176 which is attached (for example, with pins) to the second distal segment 1172. The second portion of structural strip 1176 can be manufactured from, for example, grade 400 or 300 stainless steel. upper and lower joint range 1150 and 1170 can interface with, and be controlled by, a joint transmission and a 2000 control system of the type described in US patent publication No. 2012/0074200 A1 which is incorporated herein in its entirety, as a reference.
[00181] With reference to Figure 19, several modalities of the articulation system 2000 include an innovative articulation transmission 2030 that is sustained within the cable assembly 1900 for the application of articulation movements to the first and second articulation band assemblies 1150, 1170. In various forms, the 2030 articulation transmission includes a 2040 actuating disc that is swiveled on the cable assembly 1900 for selective rotation around an actuation axis. In at least one modality, the actuation axis coincides with, or is substantially coaxial with, the longitudinal axis of the LT-LT tool. In this way, the actuation axis does not transversely intersect the longitudinal axis. In other embodiments, the actuation axis can be substantially parallel to the longitudinal axis. For ease of assembly and fabrication, the 2040 actuation disc is manufactured in two 2040A parts that can be fixed together by screws, snap fit, adhesive etc. When mounted, the 2040 actuation disc has a first set of 2042 actuation threads that are configured in a first direction for threaded engagement with a first set of 2060 thread nut. In addition, the 2040 actuation disc also has a second set of actuation threads 2044 that are configured in a second direction that differs from the first direction. For example, the first 2042 threads may comprise "straight threads" and the second 2044 threads may comprise "left threads" or visa versa. The second threads 2044 are adapted to threadably engage the second set of thread nuts 2070.
[00182] In several embodiments, the first set of threaded nut 2060 comprises a first disk 2062 that has first threads 2064 formed in it. The first disc 2062 is supported on a knife tube 1800 by a first bearing pad 2066. The first bearing pad 2066 facilitates the movement of the first disc 2062 in relation to the knife tube 1800. Similarly, the second set of nut threaded 2070 comprises a second disk 2072 having second threads 2074 formed therein. The second disc 2072 is supported on the knife tube 1800 by the second bearing pad 2076 which facilitates the movement of the second disc 2072 in relation to the knife tube 1800. The first and second discs 2062, 2072 are also movably supported on track rails. upper and lower threads 2050, 2052 that are mounted on the 1905 separator columns molded in 1904 cable shells. See Figure 19. The upper and lower nut rails 2050, 2052 are used to prevent the first and second disks 2062, 2072 from rotating. with respect to the cable compartment and therefore, as the actuation disk 2040 is rotated in relation to the cable compartment, the first and second bearing pads 2066, 2076 move axially in the knife tube 1800 in different directions.
[00183] The first and second sets of articulation band 1150, 1170 are controlled by the rotation of the actuation disk 2040 in relation to the cable set 1900. To facilitate the application of these control movements, the first portion of structural band 1156 has a first clamp member configured to retain the first rolling cushion 2066 and the second portion of structural strip 1176 has a second clamp member configured to retain the second rolling cushion 2076. In addition, the articulation system 2000 in at least one form includes an elongated support beam 2080 that extends longitudinally within knife tube 1800 to provide lateral support for the first and second portions of structural strip 1156, 1176 within knife tube 1800. The beam of support 2080 can be manufactured from, for example, 400 or 300 grade stainless steel and is configured to facilitate axial movement d the first and second portions of structural band 1156, 1176 while offering lateral support to it.
[00184] Figures 15 and 16 illustrate the surgical instrument 1010 in a non-articulated position. That is, when the 1012 end actuator is in a non-articulated position, it is substantially and axially aligned on the longitudinal axis of the LT-LT tool. When in the "neutral" position, the first and second disks 2062, 2072 are spaced from each other. To provide the surgeon with an indication of when the articulation system 2000 is stopped in the neutral position, a 2090 retainer assembly is mounted inside the cable compartment. The retainer assembly 2090 inside the compartment is adapted to engage the recess (not shown) in the central part portion 2041 of the actuation disk 2040. See Figure 19. The retainer assembly 2090 is configured to engage the recess when the actuation disk 2040 is in a neutral position. When the 2090 keeper engages the recess, the surgeon may receive a tactile and / or audible indication.
[00185] The articulation system 2000 can articulate the end actuator 1012 around the flexible neck assembly 1110 as follows. First, the surgeon rotates the articulation actuation disk 2040 in a first rotating direction that causes the first and second disks 2062, 2072 to move towards each other. As the first disk 2062 moves in the proximal direction "PD", the first set of articulation strips 1150 is pulled in the proximal direction "PD" by virtue of the first cleat feature 2017 which is coupled to the first 2066 rolling pad. Similarly, as the second disc 2072 moves in the distal direction "DD", the second set of articulation strips 1170 is pushed in the distal direction "DD" by virtue of the second clamp feature 2027 which is coupled to the second cushion bearing 2076. This action of the first and second articulation strip assemblies 1150, 1170 causes the end actuator 612 to articulate in the first articulation direction "FD" due to the interconnection of the first and second articulation strips 1150, 1170 with the end actuator 1012. To articulate the end actuator in the second pivoting direction "SD", the user simply rotates the 2040 pivoting actuation disc in a second rotating direction that is opposite to the first rotating direction.
[00186] As indicated above, the articulation system 2000 in at least one form also includes an elongated support beam 2080 that extends longitudinally within knife tube 1800 to provide lateral support for the first and second portions of structural range 1150 and 1170 in knife tube 1800. The support beam 2080 can be manufactured from, for example, grade 400 or 300 stainless steel and is configured to facilitate axial movement of the first and second portions of structural band 1156, 1176 at the same time time it offers lateral support to it. In addition, the left and right segments 1110R, 1110L of the flexible neck assembly 1110, when joined together, form a passage 1118 to receive a cutting bar assembly 1180. In various forms, the cutting bar assembly 1180 includes a portion of distal cutting bar 1182 which includes an upper cutting bar 1184 and a lower cutting bar 1186 which are attached to a fabric cutting head 1190. The upper cutting bar 1184 is attached to a top portion 1192 of the cutting head of fabric 1190 and the lower cutting bar 1186 is attached to a lower portion 1194 of the cutting head of fabric 1190. The upper cutting bar 1184 and the lower cutting bar 1186 are configured to flex as the flexible neck assembly 1110 flexes.
[00187] As will be discussed in more detail below, in at least one mode, the axial advance and retraction of the 1180 cutter bar assembly can be controlled, for example, by manually activating a trigger trigger that is sustained so operational in cable assembly 1900. As can be seen in Figure 19, a connector element 1790 is coupled to the proximal end 1183 of the distal portion of the cutter bar 1182. In at least one embodiment, for example, the connector element 1790 is attached to the proximal end 1787 of the distal portion of the cutting bar 1182 and has a proximally hinged clamping feature 1792 that is configured to be coupled to a distal end 1802 of the hollow knife tube 1800. The hollow knife tube 1800 extends through the external stem segment 1300 and for the cable assembly 1900 and is attached to the carriage assembly 1810. In various embodiments, the carriage assembly 1810 comprises a flanged carriage cushion 1812 that is snap-fit and a portion of the knife tube 1800. The carriage assembly 1810 additionally comprises a firing carriage 1814 which has a concave portion formed therein to extend over carriage cushion 1812 between the flanges of cushion 1813. At least at least one shape, the firing carriage 1814 also has a pair of portions extending laterally 1816, each having a support flap 1818 formed in place. The support flaps 1818 are configured to be slidably received in a corresponding sliding passage (not shown) formed in the cable compartment 1904. This arrangement allows the firing carriage 1814 to move axially within the cable assembly 1900 and thus apply axial actuating movements to knife tube 1800 while allowing knife tube 1800 to rotate about the longitudinal axis of the LT-LT tool in relation to firing carriage 1814, as nozzle assembly 1770 is rotated .
[00188] In at least one mode, actuation movements can be applied manually to the firing carriage 1814 by a firing trigger assembly 1820 that is pivotally supported in the 1900 cable assembly. The firing trigger assembly 1820 includes a trigger firing plate 1822 which has a fixing plate 1824 that is configured to interface operationally with a pair of actuation plates 1826. As can be seen in Figure 19, the fixing plate 1824 is located between the actuation plates 1826 and is fastened pivoting mode by a first pivot pin 1828 which extends through slots 1830 in the actuation plates 1826 and through a hole 1825 in the fixing plate 1824. A second pivot pin 1832 is received inside or is supported by the mounting in the cable shells 1904 and extends between the holes 1834 in the actuation plates 1826. Each of the actuation plates 1826 has a pin 1836 that extends into a pocket or opening corresponding length 1815 on the firing carriage 814. This arrangement facilitates the application of axial actuating movements to the knife tube 1800 by rotating the firing trigger 1822 in relation to the cable compartment 1900. As the firing trigger 822 is pivoted towards to the pistol grip handle 1908 of the cable compartment 1900, the firing carriage 1814 is driven in the distal direction "DD". As the firing trigger 1822 is pivoted away from the pistol grip handle 1908 of the cable compartment 1900, firing carriage 1814 pulls knife tube 1800 in the proximal "PD" direction.
[00189] Various modalities of the surgical instrument 1010 may also include a locking system 1840 which includes a locking trigger 1842 which is pivotally coupled to the cable compartment 1900. Locking trigger 1842 includes a portion of the locking bar which is configured to operationally engage a locking element 1846 which is pivotally attached to the fixing plate 1824 of the trigger trigger 1822 by pin 1849. A more detailed discussion of the operation of the locking system 1840 can be seen in the order publication US Patent No. US 2012/0074200 A1.
[00190] The performance of the end actuator 1012 will now be explained. When holding the 1908 pistol grip portion of the 1900 cable assembly, the surgeon can apply a closing motion to the anvil assembly 1020 of the end actuator 1012 by applying an actuating force to the trigger trigger 1822. Such action results in application of an actuation movement to the firing carriage 1814 by the actuation plates 1826 which ultimately results in the displacement of the knife tube 1800 in the distal direction "DD". As knife tube 1800 advances in the "DD" distal direction, the 1180 cutting bar assembly is likewise driven in the "DD" distal direction. According to the cutting bar assembly 1180 and, more particularly, the fabric cutting head 1190, it is driven in the distal direction "DD", the upper flap portions 1196 on the fabric cutting head 1190 come into contact with the inclined surfaces 1025 on the anvil body 1021 to initiate the application of a closing movement to the anvil assembly 1020. The additional application of the actuation force to the trigger trigger 1822 results in additional axial displacement of the knife tube 1800 and the fabric cutting head 1090 This action further moves the anvil assembly 1020 towards the elongated jaw groove 1014. When the trigger trigger 1822 is pivoted towards the pistol grip portion 1908 of the cable assembly 1900, the locking element 1848 is also pivoted counterclockwise "CCW" around pin 1849. At that point, the fabric cutting head 1190 is prevented from moving further in the "DD" distal direction due to the locking system 1840. In this way, the surgeon can move the anvil assembly 1020 to capture and manipulate the tissue on the end actuator 1012 without the risk of actually "firing" the end actuator 1012 (ie, or cutting the tissue and forming the staples) .
[00191] When the surgeon wants to cut the tissue and form staples, a second form of action is applied to the locking trigger 1842. When the locking trigger 842 is compressed, the portion of the locking bar 1844 pivots to a forward position that allows as soon as the locking element 1848 continues to pivot in the counterclockwise direction, as the surgeon continues to apply the actuation force to the trigger 1822. This action of the trigger trigger 1822 results in the axial displacement of the cutting head of fabric 1190 through the anvil assembly 1020 and the elongated jaw groove 1014. At that point, the upper flap portions 1196 and the lower floor 1198 on the fabric cutting head 1190 serve to space the anvil assembly 1020 in relation to the elongated jaw 1014 so that staples 32 in staple cartridge 30 are formed on the fabric on each side of the fabric cut line.
[00192] After completing the cutting and stapling process, trigger trigger 1822 can be released. A return spring (not shown) attached to trigger trigger 1822 returns trigger trigger 1822 to the unacted position. Alternatively, the user can use the trigger hook feature to "pull" the trigger to an open position if no spring is used. As the trigger trigger 1822 moves in the direction of the "CW" clockwise direction, the trigger carriage 1814 moves in the proximal direction "PD" which also moves the cutting bar assembly 1180 in the proximal direction "PD". As the fabric cutting head 1190 returns to its initial position, the upper tabs 1196 on the fabric cutting head 1190 contact an arcuate opening surface 1027 at the bottom of the anvil cover 1023 as shown in Figure 18. The continued movement of the fabric cutting head 1190 in the proximal direction "PD" causes the anvil assembly 1020 to pivot open through its contact with the arched surface 1027.
[00193] Surgical instrument 1010 also provides advantages over previous surgical instruments. For example, the unique and innovative floating anvil arrangement is capable of automatically adjusting the anvil gap between the lower surfaces of the anvil and the staple cartridge or elongated groove. In this way, the floating anvil arrangement can automatically compensate for different thicknesses of tissue while allowing the lower staple-forming surface (s) of the anvil to remain parallel to the staple cartridge and the elongated channel. This is all achieved without sacrificing the stability of the anvil.
[00194] Figures 20 to 26 represent another surgical instrument 3010 that is capable of practicing several exclusive benefits of the present invention. The 3010 surgical instrument is designed to manipulate and / or actuate various shapes and sizes of 3012 end actuators that are operationally attached to a 3100 elongated stem assembly of the surgical instrument. In the represented embodiment, for example, the end actuator 3012 comprises a surgical stapling device that has jaws 3013 and 3015 that can be opened and closed. More specifically, end actuator 3012 includes an elongated channel 3014 that forms a lower jaw 3013 of end actuator 3012. See Figures 21 and 22. In the illustrated arrangement, elongated channel 3014 is configured to operationally support a staple cartridge 30 of the type and construction described here. For example, the surgical staple cartridge includes a cartridge body 31 that operationally supports a plurality of unformed surgical staples 32 therein. The elongated groove 3014 also movably supports a set of fixed anvil 3020 that functions as an upper jaw 3015 of the end actuator 3012.
[00195] In various implementations, the end actuator 3012 is configured to be coupled to a 3100 elongated stem assembly that protrudes from a 3400 cable assembly or compartment. See Figure 20. The 3400 cable assembly can be similar to one of the cable assemblies described herein and / or in US Patent Application Publication No. US 2012/0074200 A1 except for the differences discussed in the present invention.
[00196] With reference to Figure 23, the elongated channel 3014 can comprise an elongated vat 3016 which is configured to removably support the surgical staple cartridge 30 therein. In various implementations, for example, the elongated channel 3014 can be manufactured from, for example, stainless steel series 300 and 400, 17-4 and 17-7, titanium etc., and can be formed with spaced side walls 3018. The body 31 of the staple cartridge 30 is dimensioned to be removably supported in the elongated groove 3014, as shown, so that each staple 32 inside it is aligned with the corresponding staple forming pockets in the anvil assembly 3020 when the assembly the anvil 3020 is actuated to form contact with the staple cartridge 30. The elongated channel 3014 may also include a proximal end 3200 that includes a pair of spaced sidewalls 3202. In at least one implementation, the end actuator 3012 it is configured to be articulated with respect to the 3100 elongated stem assembly around an articulation and AA pivot axis around which the anvil assembly 3020 is pivoted with respect to the along groove ada 3014. The elongated stem set 3100 defines a longitudinal axis of the LT-LT tool. The articulation and pivot axis A-A are transversal to the longitudinal axis of the LT-LT tool. The 3100 elongated stem assembly comprises a hollow outer stem 3300 and serves to function as the stem back of the 3100 elongated stem assembly. The proximal end of the outer stem 3300 can be rotationally supported by the 3400 cable assembly so that the physician can selectively rotate the elongated stem assembly 3100 and the end actuator 3012 fixed to it by the longitudinal axis of the LT-LT tool. For example, the proximal end of the elongated stem assembly can be operationally coupled to a 3250 nozzle assembly that is pivotally supported on the 3400 cable assembly. The rotation of the 3250 nozzle assembly with respect to the 3400 cable assembly (represented by the "R" arrow) will result in a rotation of the 3100 elongated stem assembly, as well as the 3012 end actuator coupled to them. See Figure 20.
[00197] Again with reference to Figure 23, the distal end 3302 of the outer stem 3300 is formed with a shackle arrangement 3304 comprising a pair of spaced securing tabs 3306. Each securing tab 3306 has a mounting hole 3308 in it which is adapted to receive a corresponding pivot pin 3204 which is formed on each vertical side wall 3202. In this way, the elongated channel 3014 is selectively pivoting or pivotable on the pivot axis AA with respect to the 3100 elongated stem assembly. Anvil portion 3020 includes a distal anvil portion 3022 and a proximal anvil assembly portion 3030. The distal anvil portion 3022 can, for the most part, be substantially coextensive with the portion of the elongated groove 3014 that supports the staple cartridge 30 and is manufactured, for example, from stainless steel series 300 & 400, 17-4 & 17-7, titanium, etc. The distal anvil portion 3022 comprises two spaced arms 3024 projecting distally from the distal anvil portion 3030 to define an elongated slot 3026 with each other. Each of the spaced anvil arms 3024 has a staple-forming bottom surface generally identified as 3028 which has a plurality of staple-forming pockets (not shown) formed therein.
[00198] The anvil mounting portion 3030 has a pair of mounting holes 3032 (only one is shown in Figure 23) which are pivotally adapted to receive the corresponding pivot pins 3204 protruding from the side walls 3202 of the end proximal 3200 of elongated groove 3014. This arrangement serves to pivotally mount the anvil set 3020 in the elongated groove 3014 for selective pivoting displacement on the pivot axis AA between an open position (Figures 24 and 25) and a closed position ( Figures 21, 22 and 26).
[00199] The articulation of the end actuator 3012 on the pivot axis AA as well as the action of the anvil set 3020 between an open and closed position can be controlled by a single trigger system, generally referred to as 3500. In at least In one implementation, for example, the 3500 firing system includes a 3510 actuation pivot that is movably supported between the vertical side walls 3202 of the elongated channel 3014. The 3510 actuation pivot includes a distal cam surface 3512 and a surface of proximal cam 3514. The distal cam surface 3512 is configured to interface operationally with a distal anvil pin projecting internally 3034 protruding from the anvil mounting portion 3030. The proximal cam surface 3514 is configured to interface operationally with a proximal anvil pin projecting internally 3036 which also protrudes internally from the anvil mounting portion 3030. As can be seen in Figure 23 the distal anvil pin 3034 extends internally through the corresponding elongated distal slit 3206 in the vertical side walls 3202 of the proximal end 3200 of the elongated channel 3014. Similarly, the proximal anvil pin 3036 extends internally through corresponding elongated slits 3208 in the vertical side walls 3202 of the proximal end 3200 of the elongated channel 3014.
[00200] The 3500 firing system can be controlled, for example, by a closing trigger arrangement on a 3400 cable assembly of the type disclosed in US Patent Application Publication No. 2012/0074200 A1. For example, the 3500 firing system can include a 3520 actuation bar that is movably coupled to the 3510 actuation pivot. The 3520 actuation bar can have, for example, a 3522 connecting ball element formed at its distal end which is received in a rotating manner in a semicircular groove 3516 in the actuation pivot 3510. This arrangement allows the actuation pivot 3510 to pivot or otherwise move in relation to the actuation bar 3520. Other methods for mobile coupling of the actuation bar actuation 3520 to actuation pivot 3510 can also be used. The actuation bar 3520 can extend through the external rod 3300 and be operationally coupled to, for example, the closing carriage arrangement revealed in the published patent application, so that the actuation of trigger 440 will result in axial displacement of the actuation bar 3520 inside the outer stem 3330. In various implementations, a series of support collars 3530, 3532, 3534 can be provided on the outer stem 3300 to provide support for the 3520 actuation bar inside the outer stem 3300.
[00201] In use, the 3012 end actuator is articulated in a desired position before closing the 3020 anvil assembly. Of course, if the 3012 end actuator is to be inserted into the patient through a trocar or other opening, the doctor can move the anvil set 3020 to the closed position (Figure 21) without pivoting the end actuator 3012 so that the end actuator 3012 is coaxially aligned with the elongated stem set 3100. The doctor manipulates trigger 440 to position the pivot actuation 3510 so that cam surfaces 3512 and 3514 interact with pins 3034, 3036 to result in closing the anvil assembly 3020 without pivoting the end actuator 3012. After the end actuator 3012 has been inserted through the trocar or opening, the physician can actuate trigger 440 to move actuation pivot 3510 to the position shown in Figure 24. When in that position, actuation pivot 3510 causes the set of b igorna 3520 move to the open position without being articulated. The physician can then articulate the end actuator 3012 around the pivot axis AA in relation to the elongated stem assembly 3100 by further activating the trigger 440 to move the actuating pivot 3510 to the position shown, for example, in Figure 25 As can be seen in the Figure, end actuator 3012 pivoted in a first "FD" direction which is the same general direction in which the 3020 anvil assembly moves when it moves from the closed to the open position (called in the present invention "OD direction"). If desired, the user can actuate trigger 440 to cause end actuator 3012 to move in a second direction "SD" which is the same general direction in which the anvil set 3020 moves when it moves from the open position to the closed position (called in the present invention "closing direction" CD "). After the user has positioned the 3012 end actuator in the desired position, the user additionally acts on the trigger 440 to manipulate the actuation pivot to the position illustrated in Figure 26 to staple the target tissue "T" between the anvil set 3020 and the staple cartridge 30.
[00202] Surgical instrument 3010 additionally includes a 3600 cutter bar assembly that can be attached to the firing bar and firing rack of the present invention and / or described in US Patent Application Publication No. US 2012 / 0074200 A1, so that it can be controlled by the actuation of the secondary trigger 460. In various embodiments, the cutter bar assembly 3600 may comprise an upper bar segment 3602 and a lower segment 3604. Such an arrangement may allow the bar assembly cut 3600 flex as end actuator 3012 is articulated, while remaining sufficiently rigid to be driven distally through stem set 3100. In the embodiment shown, the upper and lower cutter bar segments 3602 and 3604 are each fixed to a cutting head 3610. In the configuration shown, the cutting head 3610 includes a vertically oriented body portion 3612 having an upper portion 3615 and a portion bottom 3617. A bottom floor 3614 is formed in the bottom portion 3617 or attached thereto. Similarly, an upper flap 3616 is formed in or otherwise attached to the upper portion 3615 of the vertically oriented body portion 3612. Furthermore, as can be seen in Figure 23, the vertically oriented body portion 612 additionally includes a 3620 fabric cutting edge.
[00203] Referring to Figure 23, the vertically oriented body portion 3612 extends through a longitudinally extending slit 3210 in the elongated groove 3014 and the longitudinally extending slit 3026 in the anvil set 3020. When assembled, the portion upper part 3615 of the cutting head 3610 extends through a proximal upper opening 3031 in the anvil assembly portion 3030 of the anvil assembly 3020. Thus, when the cutting head 3610 is advanced distally, the upper flap portions 3616 slide in the anvil arms 3024. Similarly, the bottom floor 3614 projects through a lower opening 3212 in the elongated groove 3014, so that it slides below the elongated groove as the cutting head 3610 is distally advanced. As the cutting head 3610 advances distally, the cutting edge 3620 cuts through the stapled tissue in the end actuator 3012. The surgical staple cartridge 30 is crushed between the anvil set 3020 and the elongated groove 3014 thus causing the staples 32 held therein are formed on both sides of the tissue cut line as they are placed in contact with the staple forming bottom of the anvil assembly 3020. After the cutter head 3610 has been advanced to the distal end of the actuator end 3012, the user retracts the cutting head 3610 to the starting position in the manner discussed in the present invention and the trigger 440 is actuated to open the anvil assembly 3020 to release the staple cartridge and stapled tissue.
[00204] As discussed in detail above, since the articulation axis is also the axis on which the anvil pivots, the surgeon has a more reliable reference structure with respect to the location of the pivot axis, when seeing the anvil of the cutter through the camera. In other words, when using the end actuator arrangement of the surgical instrument 10, the surgeon can determine where the elongated channel will pivot in relation to the elongated rod by seeing where the anvil is pivotally mounted on the elongated channel.
[00205] Figures 27 to 35 illustrate another 4010 surgical instrument arrangement that can employ various components of other surgical instruments described here, except for the differences discussed below. The 4010 surgical instrument is designed to manipulate and / or actuate various shapes and sizes of 4012 end actuators that are operationally attached to a 4100 elongated stem assembly of the surgical instrument. In the represented embodiment, for example, the end actuator 4012 comprises a surgical stapling device that has jaws 4013 and 4015 that can be opened and closed. More specifically, end actuator 4012 includes an elongated groove 4014 that forms a lower jaw 4013 of end actuator 4012. See Figure 28. In the illustrated arrangement, elongated groove 4014 is configured to hold a staple cartridge 30 and also supports movable mode an anvil set 4020 that functions as an upper jaw 4015 of end actuator 4012.
[00206] In various implementations, the end actuator 4012 is configured to be coupled to a 4100 elongated stem assembly that protrudes from a 4400 cable assembly or compartment. See Figure 27. The 4400 cable assembly can be similar to one of the cable assemblies described herein and / or in US Patent Application Publication No. US 2012/0074200 A1 except for any differences discussed below. Alternative modalities, however, can be used with robotic systems, and acted on by them, as was discussed earlier in this document.
[00207] With respect to Figures 28 and 29, the elongated channel 4014 may comprise an elongated bowl 4016 which is configured to removably support the surgical staple cartridge 30 therein. In various implementations, for example, the elongated channel 3014 can be manufactured from, for example, stainless steel series 300 and 400, 17-4 and 17-7, titanium etc., and can be formed with 4018 spaced sidewalls. The body 31 of the staple cartridge 30 is dimensioned to be removably supported in the elongated groove 3014, as shown, so that each staple 32 inside it is aligned with the corresponding staple forming pockets in the anvil set 4020 when the set anvil 4020 is actuated to form contact with the staple cartridge 30. The elongated groove 4014 may also include a proximal end 4200 that includes a pair of side walls 4202 that has a top flap 4203 that protrudes internally from from there to define a gap 4205 between them. The side walls 4202 are coupled by a support bar 4207 which extends between them. See Figures 29, 31 and 32.
[00208] In at least one implementation, the elongated groove 4014 is configured to be moved or pivoted in relation to the elongated stem assembly 4100 and the anvil assembly 4020 around a pivot axis AA around which the anvil assembly 4020 is also pivotally mounted. The 4100 elongated shank assembly defines a longitudinal axis of the LT-LT tool. The pivot axis A-A is transversal to the longitudinal axis of the LT-LT tool. The 4100 elongated stem assembly comprises a 4300 hollow outer stem and serves to function as the stem back of the 4100 elongated stem assembly. The proximal end of the 4300 external stem can be rotationally supported by the 4400 cable assembly so that the physician can selectively rotate the elongated stem assembly 4100 and the end actuator 4012 fixed to it by the longitudinal axis of the LT-LT tool.
[00209] Again with reference to Figure 29, the distal end 4302 of the outer stem 4300 is formed with a shackle arrangement 4304 comprising a pair of spaced fixing tabs 4306. Each fixing tab 4306 has a mounting hole 4308 in it which is adapted to receive a corresponding 4310 pivot pin that defines the AA pivot axis. The pivot pins 4310 also extend through corresponding openings 4210 in the vertical side walls 4202 of the proximal mounting end 4200 of the elongated channel 4014. Thus, the elongated channel 4014 is selectively pivoting or pivotable about the pivot axis AA with respect to to the elongated rod assembly 4100 and the anvil set 4020. The anvil set 4020 includes a distal anvil portion 4022 and a proximal anvil mounting portion 4030. The distal anvil portion 4022 can, for the most part, be substantially coextensive with the elongated channel portion 3014 that supports the staple cartridge 30 and is made, for example, of stainless steel series 300 & 400, 17-4 & 17-7, titanium, etc. The distal anvil portion 4022 comprises two spaced arms 4024 protruding distally from the distal anvil portion 4030 to define an elongated slit 4026 with each other. Each of the spaced anvil arms 4024 has a lower staple forming surface generally identified as 4028 that has a plurality of staple forming pockets (not shown) formed therein. The anvil mounting portion 4030 has a pair of mounting holes 4032 which are adapted to pivotally receive the corresponding pivot pins 4310. This arrangement serves to pivotally mount the anvil assembly 4020 on the external stem 4300 for pivoting displacement selective around the pivot axis AA between an open position (Figures 32 and 33) and a closed position (Figures 28, 30 and 31) with respect to the elongated channel set 4014.
[00210] The initial closing of the anvil set 4020 with respect to the elongated channel set 4014 and the surgical staple cartridge 30 operationally supported therein can be accomplished through a unique and innovative closing system, generally referred to as 4110. The 4110 closure system can also be referred to in the present invention as the "second jaw closure system" In one implementation, the 4110 closure system includes an 4112 anvil closure rod that has a proximal end that can be operationally attached to the trolley. closure on cable assembly 4400 in the various ways discussed in the present invention and also described in more detail in US Patent Application Publication No. US 2012/0074200 A1. For example, the proximal end of stem 4112 may have a flange (not shown) that is configured to swivel to a closing carriage that is operationally supported between compartment assembly 4400. In this way, triggering the trigger 440 will result in the axial advance of the closing rod of the anvil 4112 on the external stem 4300. This arrangement also allows the elongated stem assembly 4100 and the end actuator 4012, which is operationally coupled to it, to be selectively rotated about the axis longitudinal of the LT-LT tool in relation to the 4400 housing assembly. The anvil closure rod 4112 can also be called "second jaw actuation bar" in the present invention.
[00211] With reference again to Figure 29, the distal end 4118 of the anvil closure rod 4112 is configured to be attached to an anvil closure link 4120. The anvil closure link 4120 is pivotally attached to a slider of the anvil pin 4122 by a pin 4123. The anvil pin slider 4122 includes two spaced side walls 4124 that define a space 4125 between them which is configured to receive a portion of the fabric cutting head 4610, as will be discussed further in more details below. An anvil cam pin 4034 is mounted on the anvil mounting portion 4030 and extends through the elongated slots 4208 in the vertical side walls 4202 of the proximal end 4200 of the elongated channel 4014, as well as in the cam slits 4126 provided through the side walls. Anvil pin slider 4124 4122. Figure 32 illustrates the positions of the anvil slider 4122 and the anvil pin 4034 when the anvil set 4020 is in the open position. To move the anvil set 4020 to a closed position in relation to the elongated groove set 4014 (Figure 31), the doctor can actuate the trigger 440 that activates the closing rod of the anvil 4112 in the distal direction "DD". Such movement of the closing rod of the anvil 4112 in the distal direction also moves the anvil pin slider 4122 in the distal direction "DD". As the anvil pin slider 4122 moves in the distal direction, the oscillating action of anvil pin 4034 in slots 4126 and 4208 oscillates the anvil set 4020 in the "CD" closing direction to the closed position, as shown in Figure 31. The movement of the closing rod of the anvil 4112 in the proximal direction "PD" will cause the anvil set 4020 to move in the direction of opening "OD".
[00212] In various arrangements, the end actuator 4012 can be configured to be selectively articulated in relation to the longitudinal axis of the LT-LT tool. In other words, the elongated channel set 4014 can be selectively pivotable or movable with respect to the anvil set 4020. As described above, the elongated channel 4014 is pivotally coupled to the distal end 4302 of the outer tube 4300 by pivot pins 4310 Such a fixing arrangement allows the elongated end channel assembly 4014 to articulate in a first "FD" direction around the articulation and pivot axis AA which is essentially the same direction in which the anvil assembly 4020 moves when the anvil set 4020 is moved from a closed position to an open position (the anvil opening direction "OD"). Such an arrangement additionally facilitates articulation or movement in a second "SD" articulation direction which is essentially the same direction in which the 4020 anvil assembly moves from an open position to a closed position (the anvil closing direction "CD" ). To facilitate such movement of the elongated channel set 4014 with respect to the anvil set 4020, a reciprocal hinge rod 4150 is employed. The 4150 pivot rod can also be called "first jaw actuation bar" in the present invention. More specifically, and with reference to Figure 29, the articulation rod 4150 is dimensioned to be received in a movable way with the external tube 4300 and has a distal end 4152 that is pivotally fixed to a pair of 4160 articulations. hinge 4160 are pivotally attached to the proximal portion of the elongated channel 4014 by a pivot pin 4161. As can be seen in Figure 34, a proximal end 4154 of the hinge rod 4150 has a hinge rack 4156 formed there that performs interface drive with a joint control system 200 of the type previously described in this document. As indicated above, the joint control system 200 can also be referred to in the present invention as the "first jaw closure system". The ratchet rotation of the actuator 210 of the articulation transmission 200 causes the elongated groove assembly 4014 to be articulated in the first and second directions in relation to the anvil assembly 4020. Figures 28, 30, 31 and 31 illustrate the elongated groove assembly 4014 in a non-articulated position. When the drive gear 240 in the hinge body 220 of the hinge transmission 200 is rotated to thereby push the hinge rod 4150 in the distal direction "DD", the elongated channel assembly 4014 will move in the first hinge direction "FD "in relation to the anvil set 4020 as shown in Figure 33. When the drive gear 240 in the hinge body 220 of the hinge transmission 200 has been rotated to thereby pull the hinge rod 112 in the proximal direction" PD ", the elongated channel set 4014 will pivot in a second "SD" direction in relation to the anvil set 4020. The second "SD" direction is the same as the closing direction "CD". See Figure 33.
[00213] Surgical instrument 4010, as shown in Figure 27, may also include a firing system of the type described here and / or in the publication of US patent application No. US 2012/0074200 A1 that can be controlled by the trigger actuation 460. Referring to Figure 34, the firing rack 500 is coupled to the firing rod 530 which is attached to the proximal end of a 4600 cutter bar assembly. In various forms, the 4600 cutter bar assembly includes a distal cutting bar portion 4602 which includes an upper cutting bar 4604 and a lower cutting bar 4606 which are attached to an I 4610 beam cutting head. The upper cutting bar 4604 and the lower cutting bar 4606 are configured to flex as the 4012 end actuator is pivoted. As can be seen in Figure 29, for example, the I-beam cutting head 4610 includes a vertically oriented body portion 4612 that has a bottom floor 4614 and an upper flap 4616 formed therein. A cutting edge of fabric 4620 is formed on the vertically oriented body portion 4612.
[00214] Still with reference to Figure 29 the vertically oriented body portion 4612 extends through a longitudinally extending slot 4704 in the elongated channel 4014 and the longitudinally extending slot 4026 in the distal anvil portion 4024. The anvil portion distal 4024 additionally has a bowl 4025 formed on the upper surface for slidingly receiving the upper flap 4616 therein. The distal end of the upper flap 6616 can be angled to interface with the angled surfaces 4027 formed on the anvil arms 4024 of the distal anvil portion 4022. The flexible firing bars 4604, 4606 extend through the elongated stem assembly 4100 to be coupled to a distal end portion 532 of a firing rod 530 by a coupling element 650. As discussed above, triggering the trigger 460 will result in axial advancement of the firing rod 530 in the elongated rod assembly 4100 to apply firing movements and retraction to the 4600 cutter bar assembly.
[00215] The operation of the 4010 surgical instrument will now be described. To start the closing process, a first movement is applied to the trigger assembly 430. That is, the trigger assembly 430 is initially pivoted towards the pistol grip 406. This pivoting action is used to activate the closing car in the distal direction. "DD". This distal movement of the closing carriage also advances the anvil 4112 closing bar axially in the distal direction "DD". As the anvil closing rod 4112 moves distally, the closing link 4120 moves the anvil pin slider 4122 distally. As the anvil pin slider 4122 moves distally, the anvil set 4020 is pivoted to the closed position by means of the oscillation interaction of the anvil pin 4034 within slots 4208 and 4126. See Figure 31. In the various ways discussed in present invention, if the surgeon simply wants to pick and manipulate the tissue before stapling it between the anvil set 4020 and the surgical staple cartridge 30, the trigger set 430 can be pivoted to open and close the 4020 anvil set without fully pivot trigger assembly 430 to the fully closed position. After the trigger assembly 430 has been initially and completely compressed to the closed position, the anvil assembly 4020 will be retained in the locked position or stapled by the locking lock assembly, which prevents proximal movement of the closing carriage, as discussed above . In order to activate the cutter bar assembly 4600 in the distal position through the stapled tissue on end actuator 4012, the surgeon pivots the primary trigger 440 again towards the pistol grip 406 of the compartment set 400. As the primary trigger 440 is pivoted , the firing rack 500, the firing rod 530 and the cutting bar assembly 4600 are driven in the distal direction "DD". As the 4600 cutting bar assembly is driven in the distal direction, the 4610 cutting head also moves distally. As the cutting head 4610 moves distally, the angled surface on the upper flap 4616 moves upward through the angled surface 4027 on the distal anvil portion 4022 by moving the floating distal anvil portion 4022 in the downward "D" direction. As the distal anvil portion 4022 is driven towards the stapled tissue and staple cartridge 30, the action of stapling or crushing causes the staples to form against the bottom of the distal anvil portion 4022. cutting head 4610 is driven distally through end actuator 4012, the cutting surface of fabric 4620 cuts through the stapled fabric while forming the staples in the staple cartridge that are located on both sides of the cutting fabric. After the 4600 cutter bar assembly has been triggered through the stapled tissue on end actuator 4012, the surgeon then releases the primary trigger 440 to thereby allow the primary trigger 440 to pivot to its unactivated position under the tension of the spring. firing. When the primary trigger 440 pivots back to the starting position, the firing rack 500, firing rod 530 and cutting bar assembly 4600 are dragged back proximally to their respective starting positions. The end actuator 4012 remains in its stapled position, as shown in Figure 31. The anvil set 4020 can then be unlocked and moved to the open position, as discussed above.
[00216] As discussed in detail above, since the articulation axis is also the axis on which the anvil pivots, the surgeon has a more reliable reference structure with respect to the location of the pivot axis, when seeing the anvil of the cutter through the camera. In other words, when using the end actuator arrangement of the surgical instrument 10, the surgeon can determine where the elongated channel will pivot in relation to the elongated rod by seeing where the anvil is pivotally mounted on the elongated channel.
[00217] The 4010 surgical instrument also employs separate control systems to move the jaws of the end actuator 4013 and 4015. For example, the physician may decide to move or articulate the lower jaw 4013 (elongated groove 14) around the pivot axis AA towards the upper jaw 4015, or away from it, without acting on the upper jaw 4015 (anvil set 4020). This can be achieved by actuating the joint control system 200 without activating the closing system 4110. In this way, the elongated channel 4014 can be selectively pivoted around the pivot axis AA while the anvil set 4020 is in a position closed or open. Similarly, the anvil set 4020 can be actuated or moved without moving the elongated channel 4014 by activating the closing system 4110 without acting on the joint control system 200. Such a unique and innovative arrangement provides the physician with more flexibility when positioning the jaws of the end actuator inside the patient.
[00218] Figures 36 to 42 represent another 5010 surgical instrument that is capable of practicing several exclusive benefits of the present invention. The 5010 surgical instrument is designed to manipulate and / or actuate various shapes and sizes of 5012 end actuators that are operationally attached to a 5100 elongated stem assembly of the surgical instrument. In the represented embodiment, for example, the 5012 end actuator comprises a surgical stapling device that has 5013 and 5015 jaws that can be opened and closed. More specifically, the end actuator 5012 includes an elongated groove 5014 that forms a lower jaw 5013 of the end actuator 5012. See Figure 37. In the illustrated arrangement, the elongated groove 5014 is configured to operationally support a clamp cartridge 30 of type e construction described here. For example, the surgical staple cartridge includes a cartridge body 31 that operationally supports a plurality of unformed surgical staples 32 therein. The elongated channel 5014 also movably supports a fixed anvil 3020 which functions as an upper jaw 5015 of the end actuator 5012.
[00219] In various implementations, the 5012 end actuator is configured to be coupled to a 5100 elongated stem assembly that protrudes from a 5400 cable assembly or compartment. See Figure 36. The 5400 cable assembly can be similar to one of the cable assemblies described herein and / or in US Patent Application Publication No. US 2012/0074200 A1 except for the differences discussed below.
[00220] With reference to Figure 38, the elongated channel 5014 may comprise an elongated bowl 5016 which is configured to removably support the surgical staple cartridge 30 therein. In various implementations, for example, the elongated channel 5014 can be manufactured from, for example, stainless steel series 300 and 400, 17-4 and 17-7, titanium etc., and can be formed with 5018 spaced sidewalls. The body 31 of the staple cartridge 30 is dimensioned to be removably supported in the elongated groove 5014, as shown, so that each staple 32 inside it is aligned with the corresponding staple forming pockets on the anvil 5020 when the anvil 5020 is actuated to form contact with the staple cartridge 30. The elongated channel 5014 may also include a proximal end 5200 that includes a pair of spaced side walls 5202 and 5204. Each side wall 5202, 5204 has a hole 5205, 5207 respectively through them for fixing the 5100 elongated stem assembly by corresponding pivot pins 5310R and 5310L.
[00221] In at least one implementation, for example, the end actuator 5012 is configured to be articulated in relation to the elongated stem assembly 5100 around a joint and an AA pivot axis around which the anvil assembly 5020 it is pivoted with respect to the elongated groove 5014. The elongated shank assembly 5100 defines a longitudinal axis of the LT-LT tool. The articulation and pivot axis A-A are transversal to the longitudinal axis of the LT-LT tool. The 5100 elongated stem assembly comprises a hollow outer stem 5300 and serves to function as the stem back of the 5100 elongated stem assembly. The proximal end of the 5100 elongated stem can be rotationally supported by the 5400 cable assembly so that the physician can selectively rotate the elongated stem assembly 5100 and the end actuator 5012 attached to it around the longitudinal axis of the LT-LT tool. For example, the proximal end of the elongated stem assembly 5100 can be operationally coupled to a 5250 nozzle assembly that is pivotally supported on the 5400 cable assembly. The rotation of the 5250 nozzle assembly relative to the 5400 cable assembly (shown by the "R" arrow) will result in a rotation of the elongated stem assembly 5100, as well as the end actuator 5012 coupled to them. See Figure 36.
[00222] Again with reference to Figure 38, the distal end 5302 of the outer stem 5300 is formed with a shackle arrangement 5304 comprising a pair of spaced fixing tabs 5306R and 5306L. Each fixing tab 5306R, 5306L has a mounting hole 5308R, 5308L respectively there that is adapted to receive a corresponding pivot pin 5310R and 5310L, respectively. In this way, the elongated groove 5014 is selectively pivoting or pivoting on the AA pivot axis with respect to the elongated shank assembly 5100. The anvil set 5020 includes a distal anvil portion 5022 and a proximal anvil assembly portion 5030. A Distal anvil portion 5022 can, for the most part, be substantially coextensive with the portion of the elongated groove 5014 that supports the staple cartridge 30 and is manufactured, for example, from 300 & 400, 17-4 & 17- series stainless steel 7, titanium, etc. The distal anvil portion 5022 comprises two spaced portions 5024 protruding distally from the distal anvil portion 5030 to define an elongated slot 5026 between them. Each of the spaced anvil portions 5024 has a staple-forming bottom surface generally identified as 5028 which has a plurality of staple-forming pockets (not shown) formed therein. The anvil mounting portion 5030 includes a right mounting wall 5032 and a left mounting wall 5034. Each mounting wall 5032 and 5034 has a mounting hole 5036 extending through it that is adapted to pivotally receive the corresponding 5310R, 5310L pivot pins. Such an arrangement serves to pivotally mount the anvil assembly 5020 in the elongated channel 5014 for selective pivoting displacement around the pivot axis A-A between an open position and a closed position.
[00223] The anvil set 5020 is selectively movable between the open and closed positions by means of a 5110 bar. The anvil bar 5110 can be coupled to a closing carriage of the type described here and / or in the publication of a patent application US No. 2012/0074200 A1, so that the actuation of a trigger mounted on the cable assembly will result in axial movement of the anvil bar 5110 within the elongated stem assembly 5100. The anvil bar 5110 is configured to clamp movable to an actuator cam 5510 that is pivotally seated on an anvil pin 5038 that protrudes internally from the left mounting wall 5034 of the anvil mounting portion 5030. See Figures 39 and 40. As can be seen in Figure 41 , for example, anvil pin 5034 is pivotally received within a corresponding cam slot 5512 within actuator cam 5510. The distal end 5112 of anvil bar 5110 is pivotally attached to actuator cam 5510 by a pin ivô 5114 defines an actuation axis of anvil B-B. See Figure 40.
[00224] The 5012 end actuator can also be pivotable or rotatable with respect to the elongated stem assembly 5100 around the pivot axis AA through a pivot system of the type described herein and / or in the publication of US patent application N US ° 2012/0074200 A1. The articulation system can be used to axially actuate the 5150 pivot bar which is pivotally coupled to the actuator cam 5510. With reference to Figures 38 and 39, for example, the distal end 5152 of the 5150 pivot bar is mounted so rotating on a central pin 5514 that protrudes from the actuator cam 5510. The central pin 5514 has a cavity 5516 in it to rotatively receive a channel pin that projects internally 5209 for selective rotation in relation to the same on the DC channel axis. See Figure 40.
[00225] Figures 41 and 42 illustrate the portion of the end actuator 5012 in a neutral or non-articulated position with the anvil set 5020 thereof in an open position. When the user wants to close the 5020 anvil assembly, the 5110 anvil stem advances distally in the "DD" distal direction. Movement of the anvil stem 5110 in the distal direction causes the actuator cam 5510 to interact with the anvil pin 5038 to rotate the anvil assembly 5020 to a closed position around the pivot axis A-A. When the physician wishes to articulate the 5012 end actuator, the 5150 pivot rod is moved axially inside the elongated rod 5100. The movement of the pivot rod in the distal direction "DD" will cause, for example, the 5012 end actuator pivot in a first "FD" direction which is essentially the same direction in which the 5020 anvil assembly moves from a closed to an open position (referred to in the present invention as the "OD" opening direction). Movement of the pivot rod in a proximal "PD" direction will cause the end actuator 5012 to pivot in a second "SD" direction around the pivot axis AA which is essentially the same direction in which the 5020 anvil assembly is located. moves when it moves from an open position to a closed position (referred to in the present invention as the "CD" closing direction).
[00226] As can also be seen in Figures 38 and 39, surgical instrument 5010 additionally includes a cutting bar assembly 5600 that can be attached to the firing bar and firing rack of the present invention and / or described in the publication US patent application 2012/0074200 A1, so that it can be controlled by operating the secondary trigger in the various ways described here 460. The cutter bar assembly 5600 may comprise a cutter bar 5602 that can flex depending on the actuator of end 5012 is hinged while remaining sufficiently rigid to be driven distally through stem assembly 5100. In the embodiment shown, the cutting bar 5602 is connected to a cutting head 5610. In the configuration shown, the cutting head 5610 includes a portion vertically oriented body 5612 having an upper portion 5615 and a lower portion 5617. A bottom floor 5614 is formed in the lower portion 5617 or attached thereto. Similarly, an upper flap 5616 is formed in or otherwise attached to the upper portion 5615 of the vertically oriented body portion 5612. In addition, as can be seen in Figures 38 and 39, the vertically oriented body portion 5612 includes, in addition, a fabric cutting edge 5620. The vertically oriented body portion 5612 extends through a longitudinally extending slot 5210 in the elongated groove 5014 and the longitudinally extending slot 5026 in the anvil set 5020. Thus, when the cutting head 5610 is advanced distally, the upper flap portions 5616 slide on the anvil arms 5024. Similarly, the bottom floor 5614 projects through a lower opening in the elongated channel 5014 so that it slides below the channel elongated 5014 as the cutting head 5610 is advanced distally. As the cutting head 5610 advances distally, the cutting edge 5620 cuts through the tissue stapled to the end actuator 5012. The surgical staple cartridge 30 is crushed between the anvil assembly 5020 and the elongated groove 5014 thus causing the staples 32 held therein are formed on both sides of the tissue cut line as they are placed in contact with the staple forming bottom of the anvil assembly 5020. After the cutter head 5610 has been advanced to the distal end of the actuator end 5012, the user retracts the cutting head 5610 to the starting position in the manner discussed in the present invention and the trigger is actuated to open the anvil assembly 5020 to release the staple cartridge and stapled tissue.
[00227] As discussed in detail above, since the articulation axis is also the axis on which the anvil pivots, the surgeon has a more reliable reference structure with respect to the location of the pivot axis, when seeing the anvil of the cutter through the camera. In other words, when using the end actuator arrangement of the surgical instrument 10, the surgeon can determine where the elongated channel will pivot in relation to the elongated rod by seeing where the anvil is pivotally mounted on the elongated channel.
[00228] In several implementations, when using surgical end actuators of the types described here, the end actuator is configured to be coupled to a set of elongated stem that protrudes from a compartment. The compartment may comprise a manually maneuverable cable arrangement or may, for example, comprise a portion of a robotic system or another arrangement of an automated control system. The end actuator and the elongated stem can typically be introduced to the surgical site on the patient through a trocar tube or a working channel in another form of instrument access. In at least some surgical procedures, it is desirable and effectively, sometimes even necessary, to limit the size of the trocar tubes / access tubes that are employed. This limits the size of the end actuator and the elongated stem arrangements that can be employed. For example, if a trocar is used that has an opening of 5 mm in diameter through the trocar tube, the end actuator, as well as the elongated stem, need to be dimensioned to allow them to pass through the opening. When employing cutting edge actuators and staplers that essentially comprise jaws that are mobile between the open and closed positions, the doctor passes the end actuator through the trocar when the jaws are in their closed position. Typically, when the jaws are in their fully closed position, the end actuator is in its smallest cross-sectional shape to facilitate such insertion through the tube or access opening. After the end actuator has been passed through the tube or opening, the doctor can then open the jaws to secure and manipulate the target tissue. After the target tissue is properly positioned between the jaws, the doctor can have the jaws close or staple the tissue in preparation to fire the instrument (that is, by having the instrument cut and staple the tissue). In this way, the size of the end actuator that can be used to complete the surgical procedure can necessarily be limited by the size of the access opening or the access tube through which it must pass. Such limitations can become problematic, however, in cases where the mandibles cannot sufficiently accommodate the target tissue due to the thickness of the target tissue to be cut and stapled. In some applications, for example, the tissue may be compressed too much by the jaws if the tissue is thicker than expected.
[00229] Over the years, a variety of end actuator arrangements have been developed to effectively accommodate various fabric thicknesses. For example, US Patent No. 7,665,647 entitled SURGICAL CUTTING AND STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUE COMPRESSION, and issued on February 23, 2010, the description of which is incorporated herein in its entirety by reference, reveals head configurations cutting patterns called "E-beam" arrangements that are configured to limit the amount of compression applied to the fabric as the E-beam is fired by the end actuator. While effective, there is a need for an end actuator that has a fully closed height that is less than a closed "operating height" or "clamp height" when stapling the fabric.
[00230] Figures 43 to 46 illustrate a cutting beam assembly 6610 that can be used with several 6012 end actuators of the type, for example, described here, as well as disclosed in US patent No. 7,665,647. As can be seen in Figures 43 and 44, the cutting beam assembly 6610 can include a firing bar 6620 that has a proximal portion 6622 that is attached to a cutting beam head 6630 that translates into a 6670 staple cartridge See Figures 45 and 46. The distal cutting beam head 6630 can also be called a "firing element". The 6670 staple cartridge may comprise a staple cartridge of the type disclosed in US Patent No. 7,665,647 and be configured to be operationally supported on the elongated channel 6014 of the end actuator 6012. As discussed therein, the 6670 staple cartridge includes a series of 6642 clamp actuators that operationally support the 6674 surgical clamps therein. The 6672 actuators are driven upwards towards the anvil 6020, as an intravenous slide 6676 is advanced distally through the 6670 staple cartridge.
[00231] Referring to Figures 43 and 44, the distal cutting beam head 6630 includes a body portion 6632 that is attached to the proximal portion 6622 of the firing bar 6620. The firing bar 6622 can be actuated by any of the provisions described herein including those firing arrangements disclosed in US Patent No. 7,665,647. As can be seen in these Figures, the body portion includes an upper portion 6640 and a lower portion 6650. The upper portion 6640 includes a flexible extension arm 6642 that protrudes from the lower portion 6650. Essentially, the extension arm 6642 comprises a beam arrangement of the cantilever type which includes a nose projecting 6644 distally and which includes pins or upper flaps 6645 projecting laterally from there. The upper portion 6640 additionally includes a lower flap portion 6646 that includes a distally protruding lower nose portion 6647 and a proximally protruding hook, bumper or clip formation 6648 that is designed to engage a body of complementary hook 6654 formed in the lower portion 6650, as shown in Figure 44. As can be seen more particularly in Figures 43 and 44, a cutting surface 6649 is provided in a movable upper portion 6640 and is oriented so that it is located close to the end of the upper nose 6644, and the end of the lower nose portion 6647 so that a tissue capture pocket 6659 is established between the upper nose 6644 and the lower nose 6647. Such a pocket 6659 allows the tissue to be captured therein in position distal to the cutting surface 6649. As can be seen from the references to Figures 43 and 44, the cutting surface 6649, as well as the nose portion upper iz 6644 and the upper flaps 6645, move as a unit (for example, they move together) in relation to the lower portion 6650 of the cutting beam head 6630. As will be discussed further in detail below, such an arrangement allows the head 6630 cutting beam head assumes a compressed state, which facilitates the passage of the 6630 cutting beam head through, for example, an access opening or a trocar door that has something similar to a limited cross-sectional area, when while it is capable of accommodating various thicknesses of tissue when the end actuator has exited through the opening and has been stapled to the tissue in preparation for firing.
[00232] The lower portion 6650 of the cutting beam head 6630 additionally includes lower floor flaps 6652 that project laterally from the lower portion 6650. As can be seen in Figures 45 and 46, the elongated groove 6014 includes an elongated slot 6016 which corresponds to an elongated slot 6678 in the staple cartridge 6670 to accommodate the body portion 6632 of the cutting beam head 6630. The elongated channel additionally has a channel rail 6018 which is configured to receive the lower floor flaps 6652. Similarly, the anvil assembly 6020 includes an elongated slot 6022 that accommodates the body portion 6632 and an upper anvil track 6024 that accommodates the upper flaps 6645 there.
[00233] Figure 43 illustrates the cutting beam head 6630 in its compressed state. The maximum total height of the cutting beam head in this compressed state is represented by "H1". Figure 44 illustrates the cutting beam head 6630 in its state of maximum uncompressed height. The maximum total height of the cutting beam head in this uncompressed state is represented by "H2". It will be understood that the total height of the E 6630 beam can vary between H1 and H2 depending on the state of the cutting beam head. With reference now to Figure 45, the end actuator 6012 is illustrated in its most compact cross-sectional state which can be referred to in the present invention as its insertion or position state. The total height (or diameter) of the 6012 end actuator is represented in Figure 45 by "E1". This would be the state, for example, in which the end actuator 6012 can be inserted through an access opening or a trocar door. After the 6012 end actuator has been inserted through the trocar opening or door to the surgical site, the physician can open and close the 6020 anvil assembly as needed to secure and manipulate target T tissue. After the T tissue has been captured between the anvil set 6020 and the staple cartridge 6670, the physician can lock the anvil set 6020 in the closed position in the various ways described herein or in other known ways. The unique and innovative 6630 cutting beam head allows the total height of the 6012 end actuator to increase to accommodate various thicknesses of tissue and or different surgical staple cartridges that have different lengths / sizes of staples / fasteners. Figure 46 illustrates target tissue T after it has been "completely stapled" to end actuator 6012 and end actuator 6012 has been fired to cut and puncture tissue T. The total height of end actuator 6012 is represented by " E2 ". Such a beam head arrangement is capable of assuming a compressed insertion height for insertion into the surgical site and then automatically reconfiguring to a firing height. Such a configuration is achieved by the extension arm 6642 which acts as a spring and which is normally forced into its decompressed state as shown in Figure 44. In this way, the 6630 cutting beam head has a range of operating heights extending between H1 and H2. This range can be represented by "H3" and can be equal to the distance between the lower edge of the 6642 extension arm and the upper maximum edge of the 6636 hook body portion. See Figure 44.
[00234] Figures 47 to 54 represent another surgical instrument 7010 that is capable of practicing several exclusive benefits of the present invention. The surgical instrument 7010, shown in Figure 47, comprises a compartment 7020, which consists of a handle 7022, configured to be held, manipulated and acted by a doctor. Cable 7022 may comprise a pair of interconnectable compartment segments 7024 and 7026 that can be interconnected by screws, inserts, adhesives, etc. As this Detailed Description proceeds, however, it will be understood that the various unique and innovative arrangements of the various forms of stem arrangements and end actuator arrangements described herein can also be employed effectively in connection with surgical systems such as those robotic systems and arrangements described in US patent application serial number 13 / 536,323 entitled ROBOTICALLY POWERED SURGICAL DEVICE WITH MANUALLY ACTUATABLE REVERSING SYSTEM, and filed on June 28, 2012, the disclosure of which is incorporated herein in its entirety for reference.
[00235] As can be seen in Figure 48, the 7100 surgical end actuator can comprise an elongated groove 7102 that is configured to receive a 7110 surgical clamp cartridge there. The surgical clamp cartridge 7110 may include a cartridge body 7112 that has an elongated slot centrally arranged 7114 therein. The cartridge body 7112 may also include rows of clamp pockets 7116 which are located on each side of the elongated slot 7114 and which are configured to hold surgical clamps 7120 there. The elongated groove 7102 can additionally operationally support a "firing element" in the form of a fabric cutting element or knife set 7150. Knife set 7150 is configured to move axially in slot 7114 in cartridge body 7112 when the cartridge body 7112 has been installed in the elongated groove 7102. The knife assembly 7150 can be configured with a cutting edge of fabric 7152 that is centrally arranged between a lower floor 7154 and an upper floor or flap 7156. In one arrangement Preferably, the 7150 knife set has the same construction and characteristics as the 6610 shaving head set described in detail above. As will be discussed in more detail below, the 7150 knife assembly is configured to be axially driven within the elongated groove 7102 and the surgical clamp cartridge 7110 in response to movements applied to it by a 7300 trigger drive system.
[00236] As can also be seen in Figure 48, the end actuator 7100 can additionally include an anvil assembly 7130 that is supported for movement in relation to the elongated groove 7102. The anvil assembly 7130 can be movable with respect to the cartridge 7110 surgical clamp, for example, in response to "actuating movements" that may comprise, for example, opening and closing movements that are transferred there from a 7200 closing drive system. In one arrangement, for example, the anvil assembly 7130 includes an anvil body portion 7132 that has a fastener forming surface 7134 formed at the bottom of it. The fastener forming surface 7134 may comprise a series of training pockets (not shown) comprising the 7120 surgical fasteners held in the 7110 surgical fastener cartridge. As the legs of the 7120 surgical fasteners are triggered to contact the pockets of the 7120 surgical fastener. corresponding formation on the 7130 anvil set, they are formed in a desired tissue retention configuration. The anvil assembly 7130 may also include an anvil assembly portion 7136 that has a pair of trunnions 7138 protruding from there that are received into the slots of the corresponding trunnions 7610 formed in a U-shaped control insert 7602 that it is movably supported on a proximal mounting portion 7104 of elongated groove 7102. In various arrangements, surgical clamps 7120 are driven out of their respective clamp pockets 7116 on the surgical clamp cartridge 7110 by corresponding slide sets 7160 and 7170 which are movably supported within the elongated channel 7102 and are movable in response to the firing movements applied there, by the 7300 firing drive system.
[00237] As indicated above, the anvil set 7130 is also responsive to actuation movements in the form of opening and closing movements that are applied to them by a 7200 closing drive system. Various details related to certain aspects of construction and operation of the closing drive system 7200 can be found in US patent application serial number 13 / 803,097, filed on March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, the description of which is incorporated herein by reference . As discussed in that reference and as shown in Figure 49 in the present invention, the closing drive system 7200 includes a closing trigger 7202 that is configured to cooperate with the closing release assembly 7220 that is pivotally coupled to a frame 7030 In at least one way, the closing release assembly 7220 may comprise a release button assembly 7222 that can be rotated in a counterclockwise direction by a release spring (not shown). As the physician compresses the closing trigger 7202 from its unacted position towards the pistol grip portion 7028 of the cable 7022, the closing release assembly 7220 serves to lock the closing trigger 7202 in the fully actuated position. When the physician wishes to unlock the closing trigger 7202 to allow it to be forced into the unacted position, the physician simply pivots the closing release button assembly 7220 to cause it to disengage from the closing trigger arrangement and thus, allow the closing trigger 7202 to pivot back to the unacted position. Other arrangements for locking and releasing the closing trigger can also be employed.
[00238] With reference to Figures 49 and 50, the closing drive system 7200 may additionally comprise a segment of the proximal closing tube 7210 that has a proximal end 7212 that is adapted to be rotationally coupled to a fixing clamp of the tube closing 7230. The proximal end 7212 of the segment of the proximal closing tube 7210 is configured to be received inside a cradle 7232 (Figure 49) in the fixing claw of the closing tube 7230 to allow relative rotation with respect to them. The segment of the proximal closing tube 7210 can be rotationally attached to the fixing claw of the closing tube 7230 by a U-shaped connector (not shown) that is configured to be received in an annular slot 7214 at the proximal end 7212 of the segment of the proximal closing tube 7210 and being seated in a slot 7234 (Figure 49) in the fixing clamp of the closing tube 7230. This arrangement serves to rotatively couple the segment of the proximal closing tube 7210 to the fixing claw of the closing tube 7230, so that the segment of the proximal closing tube 7210 can rotate with respect to it. More specifically, such an arrangement facilitates the manual rotation of an elongated stem set 7050 with respect to the 7022 handle around the longitudinal axis of the "LT-LT" tool defined by an elongated stem set 7050 to allow the physician to rotate the end actuator surgical 7100 in the manner represented by the arrow "R" in Figure 47.
[00239] In various arrangements, the fixing clamp of the closing tube 7230 is movably mounted on a proximal hinge tube 7402 of a 7400 hinge system, which will be discussed in further detail below. Such an arrangement allows the clamping tube 7230 claw to move axially in the proximal hinge tube 7402 in response to the action of the closing trigger 7202. In particular, the clamping tube 7230 claw can be pivotally coupled to a closing trigger 7202 by a closing link bar 7240. See Figure 49. This way, when the doctor pivots the closing trigger 7202 inwards towards the pistol grip portion 7028 of the cable 7022, the clamping claw of the closing tube 70230 will be advanced in the distal direction "DD". When the trigger trigger 7202 returns to the non-actuated position, the clamping clamp of the closing tube 7230 will be advanced proximally ("PD" direction) on the proximal articulation tube 7402 to an initial position.
[00240] The closing drive system 7200 may also include an intermediate tube segment 7250 that is configured to secure the distal end 7218 of the segment of the proximal closing tube 7210. As can be seen in Figure 50, the segment of intermediate tube 7250 may include a flexible hinge portion 7260 and a fixation stem portion 7252. The fixation stem portion 7252 can be sized to extend into the distal end 7218 of the proximal closing tube segment 7210 in an engagement by friction with the same. The flexible hinge portion 7260 can be integrally formed with the clamping rod portion 7252 and include a hinge back 7262 that includes proximal end portions 7264 (only one can be seen in Figure 50) that are configured to receive in corresponding notches 7219 at the distal end 7218 of the proximal closing tube segment 7210 and the intermediate tube segment 7250. The intermediate tube segment 7250 can be fixed non-rotatable (that is, fixed to prevent relative rotation between these components) to the segment of the 7210 proximal closing tube using, for example, screws, retainers, adhesives, etc.
[00241] The closing drive system 7200 may also include a segment of the distal closing tube 7280 which is configured to engage axially and applying opening and closing movements to the anvil assembly 7130. The segment of the distal closing tube 7280 can be attached to a distal end of 7250 intermediate tube segment for axial displacement therewith. The hinge back 7262 can also include distal end portions 7266 which are configured to be received in corresponding notches 7284 at the proximal end 7282 of the distal closing tube segment 7280 to prevent relative rotation between the distal closing tube segment 7280 and the intermediate tube segment 7250. See Figure 50. The proximal end 7282 of the distal closing tube segment 7280 can internally extend fixing tabs 7286 which are adapted to be folded into corresponding notches 7266 in the segment of the intermediate tube segment 7250 See Figure 50. This arrangement serves to facilitate the attachment of the segment of the distal closing tube 7280 to the segment of intermediate tube 7250 for axial displacement there.
[00242] The segment of the distal closing tube 7280 is configured to apply opening and closing movements to the anvil assembly 7130. The mounting portion of the anvil 7136 can be formed with an anvil flap 7142. The distal end 7288 of the segment of the anvil distal closure tube 7280 has an internally extending flap 7290 formed there that is configured to interact with anvil flap 7142. For example, when the segment of distal closure tube 7280 is in the open position, the actuation flap 7290 is in traction contact with the anvil flap 7142 which serves to pivot the anvil assembly 7130 to the open position.
[00243] The operation of the closing drive system 7200 will now be described. The anvil assembly 7130 can be moved relative to the surgical clamp cartridge 7110 by turning the closing trigger 7202 towards the pistol grip portion 7028 of the handle 7022, or in the opposite direction. In this way, actuation of the closing trigger 7202 causes the segment of the proximal closing tube 7210, the intermediate tube segment 7250 and the segment of the distal closing tube 7280 to move axially in the distal direction "DD" to contact the end wall 7144 of the anvil body portion 7132 to pivot or otherwise move the anvil assembly 7130 towards the surgical clamp cartridge 7110. The physician can seize and manipulate the tissue between the anvil assembly 7130 and the clamp cartridge 7110 by opening and closing the anvil assembly 7130. When the target tissue is captured between the anvil assembly 7130 and the clamp cartridge 7110, the clinician can pivot the closing trigger 7202 to the fully actuated position in which it is locked in place to fire.
[00244] Again with reference to Figure 49, the structure 7030 can also be configured to support the trigger drive system 7300 which is configured to apply the trigger movements to the corresponding portions of the elongated shank assembly 7050 and finally to the knife assembly 7150 and slider assemblies 7160, 7170. As can be seen in Figure 49, the 7300 firing drive system can employ an electric motor 7302, which is supported on the gripping portion 7028 of cable 7022. In several ways, the motor 7302 can be a brushed DC motor with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 7302 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable electric motor. A 7304 battery (or "power source" or "battery pack"), such as a Li ion battery, for example, can be attached to the 7022 cable to supply power to a 7306 control circuit pack and , finally, to the 7302 engine.
[00245] The 7302 electric motor may include a rotating rod 7308 that connects operably with a 7310 gear reducer assembly that is mounted in gear engaged with a set, or rack, of 7322 drive teeth on a movable drive element longitudinally 7320. The gear reducer assembly 7310 may include, among other things, a housing and an output pinion gear 7314. In certain embodiments, the output pinion gear 7314 can be directly engaged operably with the drive element longitudinally movable 7320 or, alternatively, operably engaged with the drive element 7320 by means of one or more intermediate gears. In use, the 7302 electric motor can move the drive element in the distal direction, as indicated by the "DD" arrow, and / or in the proximal direction, indicated by the "PD" arrow, depending on the direction in which the 7302 electric motor rotates. . For example, a voltage polarity supplied by the battery is capable of operating the 7302 electric motor clockwise, and the voltage polarity applied to the electric motor by the battery can be reversed in order to operate the 7302 electric motor counterclockwise. . When the 7302 electric motor is rotated in one direction, the drive element 7320 will be driven axially in the distal "DD" direction. When the 7302 motor is driven in the opposite rotating direction, the drive element 320 will be driven axially in a proximal "PD" direction. The 7022 cable may include a switch that can be configured to reverse the polarity applied to the 7302 electric motor by the battery. Cable 7022 may also include a sensor that is configured to detect the position of the mobile drive element 7320 and / or the direction in which the mobile drive element 7320 is being moved.
[00246] The actuation of the 7302 motor can be controlled by a trigger trigger 7330, pivotally supported by the cable 7022. The trigger trigger 7330 can be pivoted between an unacted position and an acted position. The 7330 trigger can be forced into the position not actuated by a spring (not shown) or other traction arrangement, so that when the doctor releases the 7330 trigger, it can be pivoted or otherwise can return to the position not actuated by the spring or polarization arrangement. In at least one way, the 7330 firing trigger can be positioned "externally" to the closing trigger 7202 as discussed in more detail in US patent application Serial No. 13 / 803.097 which was previously incorporated for reference and in its entirety to the present document. In at least one way, a safety button on the 7332 firing trigger can be pivotally mounted on the closing trigger 7202. The safety 7332 button can be positioned between the 7330 firing trigger and the closing trigger 7202 and have a articulated arm (not shown) protruding from it. When the closing trigger 7202 is in the non-actuated position, the 7332 safety button is contained in the cable compartment, where the doctor cannot readily access it or move it between the safety position, which prevents the trigger from operating. firing 7330, and the firing position, in which the 7330 firing trigger can be fired. As the doctor presses the closing trigger 7202, the safety button 7332 and the trigger trigger 7330 are pivoted downwards, in a position where they can be manipulated by the doctor.
[00247] As indicated above, in at least one way, the longitudinally movable drive element 7320 has a tooth rack 7322 formed thereon for the engagement engaged with the corresponding drive gear of the gear reducer assembly 7310. At least one shape it can also include a manual actuation "ejection" set configured to allow the physician to manually retract the 7320 longitudinally movable drive element in the event that the engine is disabled. U.S. Patent Application Serial No. 13 / 803,097 contains more details of a form of ejection assembly that can be employed. US patent application publication No. US 2010/0089970 also features "ejection" provisions and other components, arrangements and systems that can also be employed with the various instruments disclosed herein. US patent application Serial No. 12 / 249,117, entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, now publication of US patent application No. 2010/0089970, is incorporated in its entirety by reference.
[00248] Referring to Figure 50, various forms of elongated stem assembly 7050 may include a firing element assembly 7060 that is sustained for axial displacement in the 7400 pivot stem assembly that essentially functions as a frame or stem back. The firing element assembly 7060 may further include a proximal firing rod 7062 which has a proximal end portion 7064 which is configured to be pivotally received in a distal cradle 7326 provided at a distal end 7324 of the mobile actuator 7320 Such an arrangement allows the proximal firing rod 7062 to rotate with respect to the mobile drive element 7320 while also moving axially with it. The proximal firing rod 7062 may further have a slit 7068 formed at its distal end to receive a proximal end 7072 of a flexible distal firing rod assembly 7070 therein. See Figure 50. As can be seen in the Figure, the proximal end 7072 of the distal firing rod set 7070 can be received in the slot 7068 in the distal firing rod 7062 and can be attached to it with a pin 7073.
[00249] The 7070 distal firing rod assembly can include a 7074 central firing beam that is located between a 7076 right sliding drive beam and a 7078 left sliding driving beam. The 7074 central firing beam and 7076 driving beams , 7078 can, for example, each be manufactured from metal, which facilitates the axial actuation of the 7160, 7170 slide sets on the 7100 surgical end actuator while also facilitating their flexing when the 7100 end actuator is hinged . In at least one arrangement, the central drive beam 7074, the right slide drive beam 7076 and the left slide drive beam 7078 can extend through a slot 7146 in the anvil mounting portion 7136. The right slide drive beam 7076 corresponds to the right slide set 7160 and the left slide drive beam 7078 corresponds to the left slide set 7170 mobilely supported in the elongated groove 7102. Axial movement of the right slide drive beam 7076 and the left slide drive beam 7078 will result in the axial advance of the right and left slide assemblies 7160, 7170, respectively, inside the elongated groove 7102. As the right slide assembly 7160 is advanced axially in the elongated groove 7102, it drives the 7120 surgical fasteners supported on the 7112 cartridge body on the right side of the slot 7114 out of their respective pockets 7116 and according to the c the left slide assembly 7170 is axially advanced in the elongated groove 7102, it activates the surgical clips 7120 held on the body of the cartridge 7112 on the left side of the slot 7114 out of their respective pockets 7116.
[00250] The central firing beam 7074 has a distal end 7080 that can be configured to be received within a slot provided in the body portion 7155 of the knife assembly 7154 and retained there by, for example, a friction fit, adhesive , welding, etc. In at least one shape, the elongated groove 7102 is formed with a right vertical wall 7107 and a left vertical wall 7108 that define a centrally arranged groove 7109. After knife assembly 7150 has been inserted into the bottom window in elongated groove 7102, the body portion 7151 of knife assembly 7150 can be inserted into the groove in groove 7109 and be advanced proximally into elongated groove 7102 to be coupled with the distal end 7080 of central firing beam 7074. A lower groove cover 7111 can be attached to the bottom of the elongated channel 7102 to prevent tissue, body fluids, etc. enter the elongated groove 7102, which can hinder the movement of the knife assembly 7150 in it.
The surgical instrument 7010 may also include a 7400 hinge system of the type described in detail in U.S. Patent Application Serial No. 13 / 803,097. In one implementation, for example, the 7400 pivot system includes a 7430 pivot stem assembly that can be controlled by a 7460 pivot control system. In one form, for example, the 7430 pivot stem assembly can include a right pivot rod segment 7440 and a left pivot rod segment 7450. The right pivot rod segment 7440 includes a proximal end 7442 that has a right pass segment 7444 formed therein. Similarly, the left hinge rod segment 7450 includes a proximal end portion 7452 that has a left passage segment 7454 formed therein. When the right pivot rod segment 7440 and the left pivot rod segment 7450 are installed in the closing tube segment 7210, they form the 7430 pivot rod assembly. The right passage segment 7444 and the left passage segment 7454 cooperate to receive a portion of the proximal firing rod 762 there. The 7440 right pivot rod segment and the 7450 left pivot rod segment can be, for example, composed of a plastic, specifically an amorphous polyamide reinforced with glass fiber, marketed under the trade name Grivory GV-6H by EMS -American Grilon.
[00252] Still referring to Figure 50, the 7430 pivot rod assembly may comprise a right pivot band 7490 and a left pivot band 7500. In one form, a portion of the proximal end 7492 of the right pivot band 7490 can be attached to the distal portion 7448 of the right pivot rod segment so that the distal portion 7494 of the right pivot band 7490 protrudes out of the right passage 7449 thereof. The proximal end portion 7492 of the right articulation band 7490 can include holes or cavities 7493 that are configured to receive the corresponding shoulders (not shown) in the right articulation stem segment 7440 to facilitate attachment of the right articulation band 7490 to the segment 7440 right pivot nail. Similarly, the proximal end portion 7502 of the left pivot band 7500 may include holes or cavities 7503 that are configured to receive projections (not shown) in the distal portion 7458 of the left pivot nail segment. 7450 to facilitate the attachment of the left articulation band 7500 to the segment of the left articulation stem 7450. The articulation bands 7490 and 5700 can be composed of a metal, advantageously fully resistant stainless steel 301 or its equivalent. The distal end of the left pivot band 7500 may have a left hook portion 7506 that is adapted to be coupled to a left clamping portion 7507 of the elongated groove 7102. Similarly, the distal end of the right pivot band 7494 has a right hook portion 7496 for attachment to a right attachment portion 7497. As discussed in detail in US patent application serial number 13 / 803.097, when the physician intends to articulate end actuator 7100 to the right in relation to the axis the LT-LT tool, the doctor simply turns the 7.570 joint control knob in the appropriate direction.
[00253] The surgical instrument 7010 can be used in a minimally invasive procedure where it is inserted through a trocar port that has been installed on a patient. In such applications, it is generally advantageous to minimize the cross-sectional shape of the end actuator during insertion into the patient, in order to minimize the size of the trocar port to be used. The smallest cross-sectional configuration that the 7100 end actuator can adopt is achieved when the upper jaw or anvil assembly 7130 is in its "first insertion position" in relation to the surgical staple cartridge 7110 installed in the elongated groove 7102. Thus, to facilitate insertion of the 7100 end actuator through the trocar port, the cross-sectional area or projection area is dimensioned in relation to the cross-sectional dimension of the door opening in the trocar port to allow the end actuator 7110 slide past it.
[00254] In at least one implementation, the 7100 end actuator employs an active anvil control system 7600 that is configured to allow the 7130 anvil assembly to move to the first insertion position to enable the 7100 end actuator is inserted through the trocar port and then, after the 7100 end actuator has passed through the trocar port, it allows the 7130 anvil assembly to assume an operational configuration for stapling the tissue. Referring to Figures 48 and 51 to 54, a form of control system for the anvil 7600 includes a U-shaped control insert 7602 that is movably supported in the elongated groove 7102 and is attached to a control bar 7604. A control bar 7604 extends through the elongated stem assembly 7050 and is movably supported for axial displacement there. The control bar 7604 can be attached to a movable actuator slider 7606 or other arrangement of the actuator supported on the cable assembly. See Figure 47. Moving the 7606 actuator slider in the "DD" distal direction will cause the 7604 control bar to move in the "DD" distal direction. Similarly, moving the 7606 actuator slider in the "PD" proximal direction will cause the 7604 control bar to move in the "DD" proximal direction.
[00255] As can be seen in Figure 48, the control insert in the shape of U 7602 is formed with two vertical walls 7608, in which each one has a trunnion slit more or less in the shape of L 7610 there. More specifically, each trunnion slot 7610 has a vertical slot portion 7612 and a horizontal slot portion 7614. Trunnion slots 7610 are sized to movably receive an anvil sleeve 7138 there. Figure 51 illustrates the 7130 anvil assembly in its first insertion position. As seen in that Figure, for example, the 7130 anvil set is being inserted through a distal end portion of a 7630 trocar port. To enable the 7130 anvil set to assume that insertion position, the doctor moves the control bar 7604 in the distal direction "DD" to cause the anvil sleeves 7130 to be retained in the horizontal slot portions 7614, as shown. When in that position, the anvil mounting portion 7136 is in its lowest position in the elongated groove 7102.
[00256] The elongated groove 7102 is equipped with an elastic "traction means" 7620 which serves to force the anvil body portion 7132 away from the elongated groove 7102. In various embodiments, the elastic traction means 7620 can comprise any shape of resilient element (s) and / or spring (s) which are attached directly to the elongated channel 7102. For example, in the arrangement shown, the traction means comprise strips of compressible or elastic foam material 7622 fixed over the sides of the elongated groove 7102. When the anvil assembly 7130 is inside the trocar port 7630, the foam strips 7622 will be compressed as shown in Figure 51. After the end actuator 7100 has passed through the trocar port 7630, the physician you can move the control bar 7604 in the proximal direction "PD", so that the control insert 7602 is also moved proximally to the position shown in Figure 52. In this position, the foam strips 7622 force the anvil assembly 7130 upward (represented by the "U" arrow in Figure 52) to a "primary open position" thereby causing the anvil trunnions 7138 to move to the upper end of the vertical trunnion slots 7612 as shown. When the anvil set 7130 is in that "primary open position", the physician can then actuate the closing trigger to move the distal closure tube 7280 in the proximal direction "PD" to cause the anvil set 7130 to move to a "fully open position", as shown in Figure 53. After the physician has positioned the target tissue between the anvil set 7130 and the staple cartridge 7110, the anvil set 7130 can be closed using the closing trigger 7202 to move the 7130 anvil assembly to the closed or fully stapled position shown in Figure 54.
[00257] Figures 55 and 56 illustrate a passive anvil 7650 control arrangement that is configured to allow the 7130 anvil assembly to move to the first insertion position for insertion through a 7630 hollow trocar port and then , after the end actuator 7100 has passed through the hollow trocar port 7630 to be forced into a "primary open position" in which further actuation movements can be applied to the anvil assembly 7130 for the acquisition and stapling of the target tissue. In this arrangement, for example, the control arrangement of the anvil 7650 includes a U-shaped control insert 7652 that is movably supported in the elongated groove 7102 for vertical displacement therein. A form of control insert 7652 is illustrated in Figure 57. As can be seen in that Figure, the control insert includes a pair of vertical side walls 7654 that are spaced from each other and connected by an upper bar 7655. Each vertical side wall it has an arched trunnion slot 7656 in it. Again with reference to Figures 55 and 56, the control insert 7652 is movable in relation to the elongated groove 7102 along an insertion axis "IA-IA" that is transversal to the longitudinal axis of the tool "LT-LT" which is defined by the elongated stem assembly 7050. The control insert 7652 can interface movably with the vertically extending guide ribs 7660 formed in the elongated groove 7102 to guide the control insert 7652 as it moves up and down along the insertion axis IA-IA between a first lower position, which corresponds to the insertion position of the anvil set 7130, and a second upper position, which corresponds to the "primary open position", in which the actuation movements can be applied to the anvil assembly 7130. As can be seen in Figures 55 and 56, the anvil sleeves 7138 are received inside the 7656 trunnion slots. The traction means of the control element 7662 is provided between the insert control 7652 and the elongated groove bottom 7102 to force the control insert 7652 in the upward direction "U" to the second most upper position. As shown in Figure 55, the traction means of the control element 7662 comprises a spring bundle 7664. However, other traction materials, elements, springs, materials, etc. can be employed.
[00258] Figure 55 illustrates the end actuator 7100, in which the upper jaw or anvil assembly 7130 is in the insertion position, as it is inserted through the trocar port 7630. As can be seen in that Figure, the control insert 7652 is compressed inside its lowest position in the elongated groove 7102, here called the first position. After the end actuator 7100 has been inserted through the trocar port 7630, the "traction means" 7620 serves to force the anvil body portion 7132 away from the elongated groove 7102 to the primary open position, as shown in Figure 56. As can be seen in that Figure, when the anvil assembly 7130 is in that position, the springs 7664 force the control insert 7652 to its highest position, or second position, and the doctor can then operate the locking system to apply an actuating motion to the anvil assembly 7130 to move the anvil assembly 7130 relative to the elongated groove 7102 to a fully open position to receive the target tissue between them. The physician can then operate the locking system again to move the anvil assembly to the fully stapled position where the end actuator is ready to fire.
[00259] Figures 58 and 59 illustrate another configuration of anvil control that facilitates the initial positioning of the anvil set in a first fully compressed insertion position, in which the 7720 end actuator can be inserted through the trocar port and, then, after the end actuator 7100 has passed through the trocar door, it allows the anvil set 7730 to assume a primary open position whereby applying an actuating motion to the anvil set 7730 can cause the anvil set 7730 move to a fully open position. As shown in those Figures, the 7720 end actuator is coupled to a 7710 surgical instrument of the types and construction disclosed herein. The anvil set 7730 may be similar in construction to the other anvil sets disclosed herein. For example, the anvil assembly 7730 may include an anvil body portion 7732 and an anvil mounting portion 7736 that has a pair of 7738 trunnions protruding from there, as well as a vertical anvil flap 7742. The anvil flap 7742 is configured to interact with the actuation tab 7290 of the segment of the distal closing tube 7280 and has been described in this document in several ways.
[00260] As can be seen in Figures 58 and 59, the 7720 end actuator includes an elongated groove 7721 which is similar in construction and operation to the other elongated groove arrangements described here. The elongated groove 7721 is configured to operationally support a surgical staple cartridge therein and includes a proximal mounting portion 7722 comprising two vertical wall portions 7723, each of which has a 7724 trunnion slot therein. In at least one implementation, each trunnion slot 7724 has a distal portion 7726 that allows the trunnions to be parked therein during the initial insertion process. Each trunnion slot 7724 additionally has an arcuate portion 7727 which facilitates the displacement of trunnions 7738 during the opening and closing of the 7730 anvil assembly.
[00261] In various implementations, the traction means 7750 are provided in portions of the lower side 7733 of the anvil body portion 7732, as well as on the sides of the elongated groove 7721 and / or in the portions of the surgical staple cartridge. For example, the traction elements 7752 can be provided in the anvil body portion 7732 in an arrangement confronting the traction elements 7756 in the elongated groove 7721. Traction means 7752, 7754 can comprise any form of resilient elements and / or springs. For example, in the arrangement shown, the traction means comprises strips of compressible or elastic foam material. When the anvil set 7730 is inside the trocar port 7630, the pull elements 7752, 7754 will be compressed, as shown in Figure 58. After the end actuator 7720 has passed through the trocar port 7630, the pull elements 7752 , 7754 force the anvil set 7730 upward to a "primary open position", as shown in Figure 59. When the anvil set 7730 is in that "primary open position", the physician can then actuate the closing trigger to move the distal closing tube 7280 in the proximal "PD" direction to cause the 7730 anvil assembly to move to a "fully open position". After the physician has positioned the target tissue between the 7730 anvil set and the staple cartridge, the 7730 anvil set can be moved to the closed or fully secured position. The amount of resistance and tensile forces generated by the traction elements can be changed using different traction elements having different durometers or spring elements with different spring compression characteristics. Another method is to change the geometry of the traction elements. Figures 60 and 61 represent different traction element configurations 7752 ', 7754' (Figure 60) and 7752 ", 7754" (Figure 61).
[00262] Figures 62 and 63 illustrate the use of the 7720 end actuator with an alternative distal closing tube arrangement 7280 'which is essentially identical to the distal closing tube 7280, except that the pull element 7292 is mounted on the flap. actuation that extends internally 7290. In the illustrated embodiment, the traction element 7292 comprises a semieliptic spring. It will be understood, however, that the traction element could comprise an elastic material which is fixed, for example, to the mounting portion of the anvil 7736 (distal from the anvil flap 7742). Figure 62 illustrates the 7720 end actuator in the insertion position, as it is inserted through the 7630 trocar port. As can be seen in this Figure, the 7732 anvil body portion is compressed in its lowest position with respect to the groove elongated 7102 by a portion of trocar 7630 which also places a pulling force or movement on the pulling element 7292. After the end actuator 7100 has been inserted through the trocar port 7630, the pulling element 7292 forces the body portion of anvil 7132 in the direction away from the elongated groove 7102 to the primary open position, as shown in Figure 63. The physician can then operate the closing system again to move the anvil assembly 7730 to the fully stapled position where the end actuator is ready to fire.
[00263] Figure 64 illustrates an exemplary 7810 surgical instrument that may include a 7820 compartment, a 7850 elongated stem assembly that protrudes operatively from the 7820 compartment and that is operatively coupled to a 7900 surgical end actuator. The 7810 surgical instrument, shown in Figure 64 comprises a compartment 7820, which consists of a cable 7822, configured to be held, handled and operated by a physician. As the present Detailed Description progresses, however, it will be understood that the various unique and innovative arrangements of the various forms of rod arrangements and end actuator arrangements disclosed in the present invention can also be effectively employed in conjunction with robot-controlled surgical systems. . Accordingly, the term "compartment" can also encompass a compartment or similar portion of a robotic system that otherwise accommodates or supports at least one drive system configured to generate and apply at least one control motion that can be used to act on various forms of surgical end actuators attached to them. The term "structure" can refer to a portion of a hand held surgical instrument. The term "structure" can also represent a portion of a robot-controlled surgical instrument and / or a portion of the robotic system that can be used to operably control the surgical instrument. For example, US patent application serial number 13 / 536,323, entitled ROBOTICALLY-POWERED SURGICAL DEVICE WITH MANUALLY ACTUATABLE REVERSING SYSTEM, filed on June 28, 2012, the description of which is incorporated herein in its entirety for reference, reveals various robotic system arrangements that can also be effectively employed. In addition, as will be discussed in further detail below, the 7810 surgical instrument, represented in at least some of the attached drawings, employs a motor to generate control movements to actuate various components and features of the surgical end actuator. As the Detailed Description proceeds, however, those skilled in the art will understand that certain features and advantages of the present invention can also be obtained effectively in connection with surgical instruments that are equipped with manually generated actuation and control movements (ie, not generated). per engine).
[00264] As shown in Figures 64 and 66, cable 7822 can comprise a pair of interconnectable compartment segments 7824, 7826 that can be interconnected by screws, snap-fit features, adhesive, etc. As used herein, the term "snap-fit feature" includes, but is not limited to, for example, a tab that has a protrusion that is configured to retain a corresponding locking portion of another component. Such features may be designed to releasably engage the locking portion or may not be designed or intended to be removed. In the illustrated arrangement, the cable compartment segments 7824 and 7826 cooperate to form a 7828 pistol grip portion that can be held and manipulated by the physician. As will be discussed in more detail below, the 7822 cable operably supports a plurality of drive systems or control systems, which are configured to generate and apply various control movements to the corresponding component portions of the elongated stem assembly 7850 that is operably attached to the 7900 surgical end actuator. In the illustrated embodiment, the 7900 surgical end actuator is configured to cut and secure the tissue, for example.
[00265] Figure 65 illustrates a form of 7900 surgical end actuator that can be employed. As can be seen in that Figure, the 7900 surgical end actuator may comprise an elongated groove 7902 which is configured to receive a 7910 surgical clamp cartridge therein. The surgical clamp cartridge 7910 can include a cartridge body 7912 that has an elongated slot centrally arranged 7914 therein. The cartridge body 7912 may also include rows of pocket pockets 7916 which are located on each side of the elongated slot 7914 and which are configured to hold surgical clamps 7920 there. The elongated groove 7902 can additionally operationally support a fabric cutting member or knife assembly 7950 in it which is configured to move axially in slot 7914 in cartridge body 7912 when installed in elongated groove 7902. The knife set 7950 can be configured with a fabric cutting edge 7952 that is centrally arranged between a lower floor 7954 and an upper floor or flap 7956. As will be discussed in more detail below, the knife set 7950 is configured to be driven axially within the groove elongated 7902 and surgical clamp cartridge 7910 in response to movements applied to it by an 8100 trigger drive system.
[00266] As can also be seen in Figure 65, end actuator 7900 can additionally include an anvil assembly 7930 that is movably supported in the elongated groove 7902. Anvil assembly 7930 can be movable with respect to the clamp cartridge surgical 7910, for example, in response to the opening and closing movements that are transferred there from an 8000 closing drive system. In other arrangements, however, the anvil assembly can be fixed and the surgical clamp cartridge can be configured to move with respect to the anvil assembly by applying closing movement to it. In one arrangement, for example, anvil assembly 7930 includes an anvil body portion 7932 that has a fastener-forming surface 7934 formed at the bottom of it. The fastener forming surface 7934 may comprise a series of training pockets (not shown) comprising the 7920 surgical fasteners held in the 7910 surgical fastener cartridge. As the legs of the 7920 surgical fasteners are triggered to contact the pockets of the surgical fastener. corresponding formations in the 7930 anvil set, they are formed in a desired tissue retention configuration. Anvil assembly 7930 may also include an anvil mounting portion 7936 which has a pair of trunnions 7938 protruding from there which are received into the slots of the corresponding trunnions 7906 formed into a proximal mounting portion 7904 of the elongated groove 7902 In various arrangements, surgical clamps 7920 are driven out of their respective clamp pockets 7916 into the surgical clamp cartridge 7910 by corresponding slider assemblies 7960 and 7970 that are movably supported within the elongated groove 7902 and are movable in response to the firing movements applied there, by the 8100 firing drive system.
[00267] With reference now to Figure 66, cable 7822 may also include a structure 7830 that operationally supports various components of the closing drive system 8000 and the trigger drive system 8100. In at least one way, the system closing drive 8000 can include an actuator in the form of a closing trigger 8002, pivotally supported by frame 7830. closing trigger 8002 can be pivotally supported by frame 7830, so that when the doctor picks up the pistol grip portion 7828 of the cable 7822, the closing trigger 8002 is easily pivoted from an initial position, or not acted, to an acted position and, more particularly, to a completely compressed position, or fully acted position. The closing trigger 8002 can be pulled to the deactivated position by a spring or other traction arrangement (not shown). Various details related to certain aspects of the construction and operation of the 8000 closing drive system can be found in US patent application serial number 13 / 803.097, filed on March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, whose description is hereby incorporated by reference. As discussed in that reference and as shown in Figure 66 in the present invention, lock trigger 8002 can be configured to cooperate with lock release assembly 8020 which is pivotally coupled to a 7830 frame. closing release assembly 8020 may comprise a release button assembly 8022 that can be rotated in a counterclockwise direction by a release spring (not shown). As the physician compresses the closing trigger 8002 from its unacted position towards the 7828 pistol grip portion of the cable 7822, the closing release assembly 8020 serves to lock the closing trigger 8002 in the fully actuated position. When the physician wishes to unlock the closing trigger 8002 to allow it to be forced into the unacted position, the physician simply pivots the closing release button assembly 8020 to cause it to disengage from the closing trigger arrangement and thus, allow the closing trigger 8002 to pivot back to the unacted position. Other arrangements for locking and releasing the closing trigger can also be employed.
[00268] With reference to Figures 66 and 67, the closing drive system 8000 may additionally comprise a segment of the proximal closing tube 8010 that has a proximal end 8012 that is adapted to be rotationally coupled to a fixing clamp of the pipe closing 8030. The proximal end 8012 of the segment of the proximal closing tube 8010 is configured to be received inside a cradle 8032 (Figure 66) in the clamping jaw of the closing tube 8030 to allow relative rotation with respect to them. The 8010 proximal closing tube segment can be rotationally attached to the 8030 closing tube fixing jaw by an 8036 U-shaped connector that is configured to be received in an 8014 annular slot at the 8012 proximal end of the closing tube segment proximal 8010 and be seated in a slit 8034 (Figure 66) in the fixing clamp of the closing tube 8030. This arrangement serves to rotatably couple the segment of the proximal closing tube 8010 to the fixing claw of the closing tube 8030, in a so that the segment of the proximal closing tube 8010 can rotate with respect to it. More specifically, such an arrangement facilitates the manual rotation of a 7850 elongated stem assembly with respect to the 7822 handle around the longitudinal axis of the "LT-LT" tool defined by a 7850 elongated stem assembly to allow the physician to rotate the end actuator surgical 7900 in the manner represented by the "R" arrow in Figure 64.
[00269] In various arrangements, the clamping jaw of the closing tube 8030 is movably mounted on a proximal articulation tube 8202 of an articulation system 8200, which will be discussed in further detail below. Such an arrangement allows the clamping tube clamp 8030 to move axially in the proximal articulation tube 8202 in response to the actuation of the closing trigger 8002. In particular, the clamping clamp of the closing tube 8030 can be pivotally coupled to a closing trigger 8002 by a closing link bar 8040. See Figure 66. This way, when the doctor pivots the closing trigger 8002 inwards towards the 7828 pistol grip portion of the 7822 handle, the clamping claw of the closing tube 8030 will be advanced in the distal direction "DD". When the trigger trigger 8002 returns to the unacted position, the clamping clamp of the closing tube 8030 will be advanced proximally (direction "PD") on the proximal articulation tube 8202 to an initial position.
[00270] The closing drive system 8000 may also include an intermediate flexible pipe segment 8050 that is configured to attach to the distal end 8018 of the proximal closing pipe segment 8010. As can be seen in Figure 68, the intermediate tube segment 8050 may include a flexible hinge portion 8060 and a portion of the clamping rod 8052. The portion of the clamping rod 8052 may be sized to extend into the distal end 8018 of the proximal closing tube segment 8010 in a friction coupling with it. The flexible hinge portion 8060 can be integrally formed with the clamp shank portion 8052 and include a hinge back 8062 that includes the proximal end portions 8064 (only one can be seen in Figure 5) that are configured to be received in corresponding notches 8019 at the distal end 8018 of the proximal closing tube segment 8010 and the intermediate tube segment 8050. The intermediate tube segment 8050 can be fixed non-rotatable (that is, fixed to prevent relative rotation between these components) to the 8010 proximal closing tube segment using, for example, screws, retainers, adhesives, etc.
[00271] The closing drive system 8000 can also include a segment of the distal closing tube 8080 that is configured to engage axially and applying opening and closing movements to the anvil assembly 7930. The segment of the distal closing tube 8080 can be attached to a distal end of 8050 intermediate tube segment for axial displacement therewith. The hinge back 8062 may also include portions of distal end 8066 that are configured to be received in corresponding notches 8084 at the proximal end 8082 of the segment of the distal closing tube 8080 to prevent relative rotation between the segment of the distal closing tube 8080 and the intermediate tube segment 8050. See Figure 68. The proximal end 8082 of the distal closing tube segment 8080 can internally extend securing tabs 8086 which are adapted to be folded into corresponding notches 8067 in the segment of the intermediate tube segment 8050 See Figure 68. This arrangement serves to facilitate the attachment of the segment of the distal closing tube 8080 to the segment of intermediate tube 8050 for axial displacement there.
[00272] The 8080 distal closing tube segment is configured to apply opening and closing movements to the anvil assembly 7930. As can be seen in Figure 70, a shape of the mounting portion of the anvil 7936 can be formed with a groove 7940 which defines an anvil flap 7942. As can be seen in Figures 69 and 71, the distal end 8088 of the segment of the distal closing tube 8080 has an internally extending flap 8090 formed there that is configured to interact with the flap anvil 7942. For example, when the segment of the distal closing tube 8080 is in the open position (Figures 69 and 71), the actuation flap 8090 is in traction contact with the anvil flap 7942 that serves to pivot the set of anvil 7930 to the open position. As shown in Figure 72, when anvil assembly 7930 is in an open position, trunnions 7938 are located at the bottom of trunnion slots 7906 in the proximal mounting portion 7904 of elongated groove 7902. When the distal closure tube segment 8080 advances distally, the distal end 8088 contacts the vertical end wall 7944 on the anvil body 7932 to cause the anvil assembly 7930 to pivot or otherwise move toward the 7910 surgical clamp cartridge. assembled, the 7938 trunnions each extend into a corresponding 8092 opening in the 8080 distal closure tube segment. See Figure 69.
[00273] The operation of the closing drive system 8000 will now be described. The anvil assembly 7930 can be moved relative to the surgical clamp cartridge 7910 by rotating the closing trigger toward and against the 7828 pistol grip portion of the 7822 handle. In this way, triggering the closing trigger 8002 causes the proximal closing tube segment 8010, the intermediate tube segment 8050 and the distal closing tube segment 8080 to move axially in the distal direction "DD" to contact the end wall 7944 of the anvil body portion 7932 to pivot or otherwise move the anvil 7930 towards the surgical clamp cartridge 7910. The physician can seize and manipulate the tissue between the anvil assembly 7930 and the cartridge clamp 7910 opening and closing the anvil assembly 7930. When the target tissue is captured between the anvil assembly 7930 and the clamp cartridge 7910, the clinician can pivot the closing trigger 8002 to the fully actuated position in which it is locked in place to fire.
[00274] As indicated above, the 7830 structure can also be configured to support the 8100 trigger drive system which is configured to apply the trigger movements to the corresponding portions of the 7850 elongated shank assembly and finally to the 7950 knife assembly and the slide assemblies 7960, 7970. As can be seen in Figures 64 and 73, the trigger drive system 8100 can employ an electric motor 8102, which is supported on the gripping portion 7828 of cable 7022. In various forms, the motor 8102 it can be a brushed DC motor with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 302 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable electric motor. An 8104 battery (or "power source" or "battery pack"), such as a Li-ion battery, for example, can be attached to cable 22 to supply power, to a set of 8106 control circuit board and , finally, to the 8102 engine. Figure 66 illustrates an 8105 battery pack compartment, which is configured to be releasably mounted on the 7822 cable to provide control power to the 7810 surgical instrument. Multiple battery cells connected in series can be used as a power source to power the 8102 engine. In addition, the power source can be replaceable and / or rechargeable.
[00275] As described above with respect to various other forms, the 8102 electric motor may include a rotating rod 8108, which, operably, interfaces with a gear reducer assembly 8110, which is in gear engaged with a set, or rack, with drive teeth 8122 on a longitudinally movable drive element 8120. The gear reducer assembly 8110 can include, among other things, an 8112 housing and an output pinion gear 8114. See Figure 10. In certain embodiments, the output pinion gear 8114 can be directly engaged operably with the longitudinally movable drive element 8120 or, alternatively, operably engaged with the drive element 8120 via one or more intermediate gears 8116. The intermediate gear, in at least one of these modalities, can be engaged in gear with the set, or rack, of defined driving teeth 8122 s on drive element 8120. In use, electric motor 8102 can move the drive element distally, as indicated by the arrow "DD", and / or proximally, indicated by an arrow "PD", depending on the direction in which the 8102 electric motor rotates the idler gear. In use, a voltage polarity provided by the battery is capable of operating the 8102 electric motor clockwise, and the voltage polarity applied to the electric motor by the battery can be reversed in order to operate the 8102 electric motor counterclockwise. . When the 8102 electric motor is rotated in one direction, the drive element 8120 will be driven axially in the distal "DD" direction. When motor 8102 is driven in the opposite rotating direction, drive element 8120 will be driven axially in a proximal "PD" direction. The 7822 cable may include a switch that can be configured to reverse the polarity applied to the 8102 electric motor by the battery. The 7822 cable may also include a sensor that is configured to detect the position of the mobile drive element 8120 and / or the direction in which the mobile drive element 8120 is being moved.
[00276] The actuation of motor 8102 can be controlled by a trigger trigger 8130, pivotally supported by cable 7822. The trigger trigger 8130 can be pivoted between an unacted position and an acted position. The trigger trigger 8130 can be forced into the position not actuated by a spring (not shown) or other traction arrangement, so that when the doctor releases the trigger trigger 8130, it can be pivoted or otherwise can return to the position not actuated by the spring or polarization arrangement. In at least one form, the trigger trigger 8130 can be positioned "externally" to the closing trigger 8002 as discussed in more detail in US patent application Serial No. 13 / 803.097 which was previously incorporated for reference and in its entirety to the present document. In at least one way, a trigger safety button 8132 can be pivotally mounted on the closing trigger 8002. The safety button 8132 can be positioned between the trigger 8130 and the closing trigger 8002 and have a articulated arm (not shown) protruding from it. When the closing trigger 8002 is in the non-actuated position, the safety button 8132 is contained in the cable compartment, where the doctor cannot readily access it or move it between the safety position, which prevents the activation of the trigger. trigger 8130, and the trigger position, at which the trigger 8130 can be fired. As the doctor presses the closing trigger 8002, the safety button 8132 and the trigger trigger 8130 are pivoted downwards, in a position where they can be manipulated by the doctor.
[00277] As indicated above, in at least one way, the longitudinally movable drive element 8120 has a toothed rack 8122 formed thereon for the engagement engaged with the corresponding drive gear of the gear reducer assembly 8110. At least one shape it can also include a manual actuation "ejection" set configured to allow the physician to manually retract the 8120 longitudinally movable drive element in the event that the motor is disabled. U.S. patent application Serial No. 13 / 803,097 contains more details of a form of ejection assembly that can be employed. US patent application publication No. US 2010/0089970 also features "ejection" provisions and other components, arrangements and systems that can also be employed with the various instruments disclosed herein. US patent application Serial No. 12 / 249,117, entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, now publication of US patent application No. 2010/0089970, is hereby incorporated in its entirety, as a reference in its entirety.
[00278] Referring to Figures 67 and 68, various forms of elongated stem assembly 7850 may include a firing element assembly 7860 that is sustained for axial displacement in the joint stem assembly 8230 that is part of the joint system 8200 and which essentially functions as a structure or back of the stem. The firing element assembly 7860 may further include a proximal firing rod 7862 having a proximal end portion 7864 that is configured to be pivotally received in a distal cradle 8126 provided at a distal end 8124 of the movable driving element 8120 Such an arrangement allows the proximal firing rod 7862 to rotate with respect to the mobile actuating element 8120 while also moving axially with it. The proximal firing rod 7862 may further have a slot 7868 formed at its distal end 7866 to receive a proximal end 7872 of a flexible distal firing rod assembly 7870 therein. See Figure 68. As can be seen in the Figure, the proximal end 7872 of the distal firing rod assembly 7870 can be received in slot 7868 in the distal firing stem 7862 and can be attached to it with a pin 7873.
[00279] The distal firing rod assembly 7870 may include a central firing beam 7874 which is located between a right sliding drive beam 7876 and a left sliding driving beam 7878. The central firing beam 7874 and the driving beams 7876 .7878 can, for example, each be made from metal, which facilitates the axial actuation of the 7960, 7970 slide sets on the 7900 surgical end actuator while also facilitating their flexing when the 7900 end actuator is hinged , as will be discussed in more detail below. In at least one arrangement, the central drive beam 7874, the right slide drive beam 7876 and the left slide drive beam 7878 can extend through a slot 7946 in the anvil mounting portion 7936. The right slide drive beam 7876 corresponds to the right slide set 7960 and the left slide drive beam 7878 corresponds to the left slide set 7970 mobilely supported in the elongated groove 7902. Axial movement of the right slide drive beam 7876 and the left slide drive beam 7878 will result in the axial advance of the right and left slider assemblies 7960, 7970, respectively, inside the elongated groove 7902. As the right slider assembly 7960 is advanced axially in the elongated groove 7902, it activates the surgical clamps 7920 supported on the 7912 cartridge on the right side of slot 7914 out of their respective pockets 7916 and as per the c the left slide assembly 7970 is axially advanced in the elongated groove 7902, it activates the surgical clips 7920 held on the body of the cartridge 7912 on the left side of the slot 7914 out of their respective pockets 7916.
[00280] The central firing beam 7874 has a distal end 7880 that can be configured to be received inside a slot 7951 provided in the knife assembly 7954 and retained there by, for example, a friction fit, adhesive, welding, etc. . A bottom window 7905 can be formed at a distal end 7903 of the elongated groove 7902 to enable the knife assembly 7950 to be inserted through it. In at least one shape, the elongated groove 7902 is formed with a right vertical wall 7907 and a left vertical wall 7908 that define a centrally arranged groove in the channel 7909. After the knife assembly 7950 has been inserted into the bottom window 7905 in the elongated channel 7902, the body portion 7951 of the knife assembly 7950 can be inserted into the slot of the channel 7909 and advanced proximally in the elongated channel 7902 to be coupled with the distal end 7980 of the central firing beam 7874. A channel cover bottom 7911 can be attached to the bottom of the elongated channel 7902 to prevent tissue, body fluids, etc. enter the elongated groove 7902, which can hinder the movement of the 7950 knife assembly in it.
[00281] In one form, the anvil set 7930 can be installed in the elongated groove 7902 as follows. To begin the installation process, the anvil assembly 7930 is positioned over the elongated groove 7902 so that the trunnions 7938 can be inserted into indentations 7913 in the proximal mounting portion 7904 of the elongated groove 7902, which allows the 7938 trunnions to enter in the trunnion slots 7906 corresponding to 7906 in the elongated groove 7902. See Figure 65. This installation can be done before the segment of the distal closing tube 8080 has been fixed in the segment of the intermediate tube 8050 or after the segment of the distal closing tube 8080 has been moved sufficiently proximally to allow the anvil to be positioned in such a way. Since trunnions 8038 are received within their respective trunnion slots 7906, the segment of the distal closing tube 8080 can be moved to the position shown in Figures 71 and 72 where the segment of the distal closing tube 8080 holds the trunnions 7938 in their respective trunnion slots 7906 and the actuation tab 8090 is in traction contact with the anvil flap 7942 which serves to pivot the anvil assembly 7930 to the open position. When in this position, each 7938 trunnion projects into a corresponding opening 8092 in the segment of the 8080 distal closing tube. See Figure 69. As shown in Figures 65 and 71, when the anvil assembly 7930 is in an open position, the upper end the knife assembly 7950 enters a window 7933 in the anvil body portion 7932. Such a window 7933 provides a distance for the anvil assembly 7930 to be moved to the closed positions while the knife assembly 7950 remains in the non acted upon. After the anvil assembly 7930 has been installed with the knife assembly 7950 in place, an anvil cover 7935 can be attached to the anvil body 7934 to prevent tissue, body fluids, etc. into the anvil body 7934, which can hinder the movement of the 7950 knife assembly in it. As knife assembly 7950 advances distally on end actuator 7900, upper flap 7956 of knife assembly 7950 engages with projections on the anvil body and the lower floor 7954 engages portions 7915 of elongated groove 7902 and serves to retain the assembly anvil 7930 in the closed position and essentially maintain the spacing between the anvil assembly 7930 and the clamp cartridge 7910.
[00282] Figures 70A and 70B illustrate an alternative distal closing tube arrangement 8080 'that can work with an anvil set 7930' that can be substantially identical to the anvil set 7930, except that the anvil set 7930' does not have the anvil flap. In such an arrangement, for example, each journal 7938 extends into a corresponding opening 8092 'in the segment of the distal closing tube 8080'. The segment of the distal closing tube 8080 'additionally includes a breathing flap 8094 which extends internally and protrudes inwardly to contact the corresponding anvil sleeve 7938. When the segment of the distal closing tube 8080'is pulled in the proximal direction "PD", each breathing flap 8094 comes into contact with the corresponding trunnion 7938 to cause the trunnion to move downward in its corresponding trunnion slot 7906 in the groove elongated 7902 to rotate or otherwise move the anvil assembly 7930 'to open positions. Figure 70C illustrates yet another arrangement of distal closing tube 8080 "in which the actuation tab is formed by a notch 8090" in the segment of distal closing tube 8080 "for interaction with anvil flap 7942 in the manner described above.
[00283] Figure 70D illustrates an alternate anvil set 7930 "in which the anvil flap 7942'is removably attached to the mounting portion of the anvil 7936. In one arrangement, for example, the anvil flap 7942'is configured with a snap-fit flap 7943 arranged to retain an opening 7941 in the anvil mounting portion 7936 retentively. The anvil assembly 7930 "may otherwise be the same anvil assembly 7930 described above and be open and similarly closed by the segment of the distal closing tube 8080. Figure 70E illustrates yet another set of anvil 7930 "in which the anvil flap is formed by a screw 7948 'which is removably fixed to the mounting portion of the anvil 7936 Such removable anvil screw / flap arrangements can facilitate installation of the 7930 "anvil assembly.
[00284] Referring to Figures 67 and 68, a form of joint system 8200 includes a joint rod assembly 8230 that can be controlled by a joint control system 8260. In one form, for example, the joint assembly hinge rod 8230 may include a right hinge rod segment 8240 and a left hinge rod segment 8250. The right hinge rod segment 8240 includes a proximal end 8242 that has a right through segment 8244 formed therein. Similarly, the left hinge rod segment 8250 includes a proximal end portion 8252 that has a left passage segment 8254 formed therein. When the right pivot rod segment 8240 and the left pivot rod segment 8250 are installed on the closing tube segment 8010, they form the 8230 pivot rod assembly. The right passage segment 8244 and the left passage segment 8254 cooperate to receive a portion of the proximal firing rod 7862 there. The 8240 right hinge rod segment and the 8250 left hinge rod segment can be, for example, composed of a plastic, specifically an amorphous polyamide reinforced with fiberglass, marketed under the trade name Grivory GV-6H by EMS -American Grilon.
[00285] In various arrangements, for example, the articulation control system 8260 may include a nozzle assembly 8262 that is supported for rotational displacement with respect to the cable 7822. As can be seen in Figure 67, the nozzle assembly 8262 may comprise an upper nozzle segment 8264 and a lower nozzle segment 8266 which are attached together by a series of fasteners (for example, screws) 8268. The upper nozzle segment 8264 can be configured to pivot a control knob hinge 8270 on it. In one arrangement, for example, the hinge control button 8270 extends through an opening (not shown) in the upper nozzle segment 8264 and is coupled to a hinge gear element 8272 by screws 8274. The hinge gear element hinge 8272 may include a hinge sprocket gear 8276 that extends into an opening 8016 in the proximal end portion 8012 of the proximal closing tube segment 8010. As can be seen in Figure 67, the hinge system 8200 additionally includes , a right-hand tube adapter 8278 and a left-hand tube adapter 8280. The right-hand tube adapter 8278 has a right recess 8279 formed there that is adapted to receive a right-hand cam 8246 formed at the proximal end 8242 of the 8240 right pivot rod segment. Similarly, the 8280 left pivot tube adapter includes a left indentation 8282 which is adapted to engage a left adapter shoulder 8256 formed at the proximal end 8252 of the left pivot rod segment 8250. The right pivot tube adapter 8278 additionally has a series of right pivot drive gears 8281 that are configured to interlocking with the 8276 hinge sprocket gear. The left hinge tube adapter 8280 has a series of 8284 left hinge drive gears formed there that are adapted to interleave with the 8276 hinge sprocket gear. way, when the articulation control knob 8270 is rotated around the CA-CA control axis, which is transverse to the longitudinal axis of the LT-LT tool with respect to the 7822 cable (Figure 64), the left articulation rod segment 8250 is, for example, driven axially in the "DD" distal direction between the 8010 proximal closing tube segment and the sec right articulation rod 8240 is simultaneously and axially driven in the proximal direction "PD".
[00286] Still referring to Figure 68, the hinge rod assembly 8230 may comprise a right hinge band 8290 and a left hinge band 8300. In one form, a portion of the proximal end 8292 of the right hinge band 8290 may be attached to the distal portion 8248 of the right pivot rod segment so that the distal portion 8294 of the right pivot band 8290 protrudes out of the right passage 8249 thereof. The proximal end portion 8292 of the right pivot band 8290 may include holes or cavities 8293 that are configured to receive the corresponding shoulders (not shown) in the right pivot rod segment 8240 to facilitate attachment of the right pivot band 8290 to the segment right pivot nail 8240. Similarly, the proximal end portion 8302 of the left pivot band 8300 can include holes or cavities 8303 that are configured to receive projections (not shown) in the distal portion 8258 of the left pivot nail segment 8250 to facilitate the attachment of the left articulation band 8300 to the segment of the left articulation rod 8250. The articulation bands 8290 and 8300 can be composed of a metal, advantageously fully resistant stainless steel 301 or its equivalent.
[00287] Referring now to Figures 75 to 78, as briefly discussed above, the intermediate tube segment 8050 may have a clamping rod portion 8052 and a flexible hinge portion 8060. In various arrangements, the intermediate pipe segment 8050 can be manufactured, for example, from rigid thermoplastic polyurethane marketed as ISOPLAST grade 2510 by the Dow Chemical Company and includes a vertically extending hinge back 8062 centrally arranged. The hinge back 8062 includes a proximal back end 8064 and a distal back end 8066 that facilitate attachment of the proximal closing tube segment 8010 and the distal closing tube segment 8080 respectively, as discussed above. The hinge back 8062 additionally includes a component or knife slot 8070 centrally arranged to facilitate the passage of various control components through it. In the illustrated arrangement, the slit 8070 movably supports the central firing beam 7874, the right driving beam 7876 and the left driving beam 7878. In various forms, the centrally arranged slit 8070 is substantially involved to slow or prevent infiltration of bodily fluids and tissue in it that can otherwise hinder the movement of component control by passing through it in a functional way.
[00288] As can be seen particularly in Figure 78, the flexible hinge portion 8060 includes a plurality of right ribs 8310 and a plurality of left ribs 8320 that can be integrally formed with the joint back 8062 and can project laterally to from the same. In various forms, for example, each rib 8310 may comprise a rib body portion 8312 that is spaced from the hinge back 8062 by a corresponding right rib neck portion 8316. Similarly, each left rib 8320 can comprise a left rib body portion 8322 that is spaced from the joint back 8062 by a left rib neck portion 8326. As can be seen in Figure 76, the rib body portions left and right 8312 and 8322 have an arcuate shape to provide a flexible hinge portion 8060 of the intermediate tube segment 8050 with a substantially circular cross-sectional shape. Such a shape can facilitate the passage of the 8050 intermediate tube segment through a circular passage such as, for example, an appropriately sized trocar.
[00289] In various arrangements, each of the right ribbed neck portions 8016 serves to define a right articulation passage 8318 to movably receive the right articulation strip 8290 through them. The right hinge band 8290 can extend through the right hinge passage 8318 and be coupled to the proximal mounting portion 7904 of the elongated groove 7902. For example, the distal end 8294 of the right hinge band 8290 may have a right hook portion. 8296 which is adapted to be coupled to a right fixing portion 8297 of the elongated groove 7902. See Figure 65. Similarly, each of the left rib neck portions 8326 serves to define a left articulation passage 8328 to receive in a the left articulation band 8300 movable through them. The left pivot band 8300 can extend through the left pivot passage 8328 and be coupled to the proximal mounting portion 7904 of the elongated groove 7902. For example, the distal end 8304 of the left pivot band 8300 may have a left hook portion. 8306 which is adapted to be coupled to a left fixing portion 8307 of the elongated channel 7902.
[00290] A method for operating the 8200 articulation system will now be described. When the doctor wants to articulate the 7900 end actuator to the right with respect to the longitudinal axis of the LT-LT tool (the right direction is represented by the "RD" arrow in Figure 78), the doctor simply turns the 8270 joint control knob in the appropriate direction. For example, turning the 8270 control knob in a clockwise direction (when viewed from above) causes the left pivot band to be pushed in the distal "DD" direction and the right 8290 pivot band is pulled in the proximal direction " PD ", which serves to apply a pivot movement to the elongated channel 102. As the pivot movement is applied to the elongated channel 7902, the flexible pivot portion 8060 flexes to accommodate the movement of the 7900 surgical end actuator in the direction" right". Conversely, if the physician wishes to articulate the 7900 end actuator in the left "LD" direction, the physician simply turns the 8270 control knob counterclockwise, which causes the 8290 right pivot band to be pushed in the direction distal "DD" and the left articulation band 8300 is pulled in the proximal direction "PD", thus causing the 7900 surgical end actuator to move to the left. The 7900 end actuator can also be articulated by a robotic system (not shown) that is configured to apply control movements to the articulation bands 8290, 8300.
[00291] By applying the articulation movements described above for the surgical end actuator 7900, it may be desirable to avoid twisting or torqueing the flexible joint portion 8060 of the 8050 intermediate tube segment. possibility to hinder or, in cases of severe torsion, completely stop the operation of the central firing beam 7874 and the left and right sliding drive beams 7876, 7878. To avoid this problem, the right and left ribs 8310, 8320 can be configured exclusively to avoid twisting the ribs.
[00292] In at least one arrangement, for example, each 8312 rib body has lateral ends that are arranged in a confrontational relationship, and spaced with the lateral ends of the rib body of the adjacent ribs. Again with reference to Figure 78, for example, the right rib body 8312 of each rib 8310 has a first right lateral end 8313 and a second right lateral end 8314. With the exception of the most proximal right rib 8310P and the right most distal rib 8310D, the first right lateral end 8313 of a right rib 8310 is in contact relationship with the second right lateral end 8314 of an adjacent right rib 8310. When the flexible hinge portion 8060 of the intermediate pipe segment 8050 is not hinged (for example, example, the flexible hinge portion 8060 is substantially axially aligned on the longitudinal axis of the LT-LT tool), the first right lateral end 8313 of each right rib 8310 is spaced from the second right lateral end 8314 of the adjacent right rib 8310 by a right rib spaced 8315. In the arrangement shown in Figure 78, for example, all nervous spaces A 8315 right has substantially the same space with "SWR". Similarly, the rib body 8322 of each left rib 8320 has a first left lateral end 8323 and a second left lateral end 8324. With the exception of the most proximal left rib 8320P and the left most distal rib 8320D, the first lateral end left 8323 of a left rib 8320 is in contact relationship with the second left lateral end 8324 of an adjacent left rib 8320. When the flexible hinge portion 8060 of the intermediate pipe segment 8050 is not hinged, the first left lateral end 8323 of each left rib 8320 is spaced from the second left side end 8324 of the adjacent left rib 8320 by a spaced left rib 8325. In the arrangement shown in Figure 78, for example, all left rib spaces 8325 have substantially the same space with "SWL" . In at least one form, the widths of the right rib spaces SWR are substantially the same as the widths of the left rib spaces SWL. However, the widths of the right and left rib spaces may differ from one another.
[00293] Still with reference to Figure 78, each rib can be provided with a torsion prevention configuration, generically referred to as 8330. In at least one arrangement, for example, an 8332 anti-torsion protrusion can be formed at each of the first ends right sides 8313 of the bodies of the right rib 8312 and at each of the first left side ends 8323 of each of the bodies of the left rib 8322. Each protrusion protrusion 8332 corresponds to a recess with a substantially complementary shape 8334 formed in the rib that is immediately adjacent and in a coping relationship with him. Figure 77 illustrates this arrangement on the left ribs 8320. In at least one arrangement, the right ribs 8310 employ an identical configuration. In at least one form, the 8332 protrusions can be substantially aligned along a lateral axis. That is, the protrusions 8332 formed on the right ribs 8310 can be substantially aligned along a right lateral axis RLA-RLA on the right side of the joint back 8062 and the protrusions 8332 formed on the left ribs 8320 can be substantially aligned on the left side of the articulation dorsum 8062 along a left lateral axis of ALL-ALL. When the flexible portion 8060 is not articulated, the right lateral axis RLA-RLA, the left lateral axis LLA-LLA and the longitudinal axis of the LT-LT tool can be substantially parallel to each other. As can be seen in Figure 78, the right lateral axis RLA-RLA and the left lateral axis LLA-LLA are spaced from the longitudinal axis of the LT-LT tool.
[00294] As the flexible hinge portion 8060 is hinged in the "RD" right direction, at least some of the protrusions 8332 in the right ribs 8310 will frictionally engage a portion of a corresponding recess 8332 in an adjacent right rib 8310 to avoid twisting of the flexible portion 8060. Similarly, as the flexible joint portion 8060 is pivoted in the left "LD" direction, at least some of the protrusions 8332 in the left ribs 8320 will engage a portion of the recess 8332 in an adjacent rib 8320 in an adjacent "twist prevention orientation" to prevent twisting of flexible portion 8060. This orientation / engagement between protrusion 8332 and the bottom of cavity 8334 on an adjacent left rib 8320, for example, is illustrated in Figure 79. As can be seen in that Figure, in that example, the first left side end 8323 of a second rib 8320 is in contiguous contact with the second left side end 8324 from an adjacent left rib 8320 to thereby prevent or delay the twisting of the flexible portion 8060 of the intermediate pipe segment 8050.
[00295] Several alternative anti-torsion provisions are also contemplated. For example, anti-torsion features may not provide, for example, the four most proximal ribs. In still other arrangements, the features may be provided in a plurality of ribs that comprise a central area of the flexible segment, but not in the most proximal and most distal ribs. In other arrangements, the anti-torsion features can be used on alternating pairs of ribs along the length of the flexible segment. For example, the most proximal pair of adjacent ribs may have anti-torsion capabilities; so the next rib or ribs (distal to the anterior ribs) may not have anti-torsion features, and the next ribs (distal to them) may have torsion features, and so on. These alternative arrangements can be applied only to the ribs on one side of the back of the joint or they can be applied to the ribs on both sides of the back of the joint. By changing the number, location and / or spacing of the ribs with the anti-torsion features, as well as the spacing widths between the ribs (with and without anti-torsion features), as well as the geometric shape of the joint back, you can advantageously adjust the total flexibility of the flexible segment, gave degree of articulation, its degree of articulation and the degree of hardness and its rate of articulation.
[00296] With reference to Figures 75 and 76, in the illustrated arrangement the articulation back 8062 is elongated and has a height, generically called "H". In at least one arrangement, the height "H" is substantially consistent with the length "L" of the joint back 8062. In addition, the joint back 8062 can taper downwards from the portion of the proximal end 8064 to the portion the distal end 8066. More specifically, as can be seen in Figure 75, the proximal end portion 8064 has a proximal width "PW" and the distal end portion 266 has a distal width "DW". In an illustrated embodiment, the "PW" is greater than the distal width "DW" and the width of the joint back 8062 gradually tapers (as opposed to height) from the proximal end 8064 to the distal end 8066 along the length " L ". Such a tapered joint back arrangement additionally serves to delay torsion during the articulation of the surgical end actuator while facilitating the increased articulation of the distal end of the flexible portion 8060 in relation to the proximal end of the flexible portion 8060 and while facilitating the mobile passage of several control components (e.g., the central firing beam 7874, the right sliding drive beam 7876, the left sliding driving beam 7878, etc.) in it.
[00297] Additionally, in an arrangement, when the flexible portion 8060 is in a flexed or non-articulated position, all spaces in the right rib 8315 and spaces in the left rib 8325 have the same initial width. Thus, in this configuration SWR = SWL. Figures 80 and 81 illustrate another intermediate tube segment 8050 'which can be substantially identical to the intermediate tube segment 8050 described above, except that the right rib spaces 8315 and the left rib spaces 8325 decrease in magnitude, going from the proximal end from the flexible hinge portion 8060 'to the distal end of the flexible hinge portion 8060'. That is, the most proximal right rib space 8315P'is the widest right rib space and the most distal right rib space 8315D'is the narrowest right rib space, with right rib spaces 8315 'successively narrower in the "DD" distal direction. Similarly, the most proximal left rib space 8325P'is the widest left rib space and the most distal left rib space 8325D'is the narrowest left rib space, with the left rib spaces 8325 'being successively narrower in the distal direction. In such an arrangement, when joint movement is applied to the surgical end actuator, the flexible portion 8060 will have a faster rate of flexion at its distal end. That is, the distal portion of the flexible segment 8060 'will flex or articulate at a rate that is greater than the rate at which another portion of the 8060 "that is proximal to the distal segment will articulate by applying a joint motion to the actuator. In other words, the relative movement between the ribs at the distal end will stop before the relative movement between the proximal ribs stops because the spaces between the distal ribs are smaller than the spaces between the proximal ribs. the widths of the left and right rib spaces 8315 'and 8325' that are laterally aligned with each other can be equal in magnitude. Such arrangements of width of the rib space can enable the flexible hinge portion 8060 'to take on a substantial shape in " U ", if desired. See, for example, Figure 82. It will be understood, however, that several other provisions of width, sizes and settings of phen da can be used to obtain a desired amount / range of articulation, while preventing inadvertent twisting of the intermediate tube around the longitudinal axis of the tool.
[00298] Figure 83 represents another surgical instrument 8410 that is capable of practicing several exclusive benefits of the present invention. The 8410 surgical instrument is designed to manipulate and / or actuate various shapes and sizes of 8412 end actuators that are operationally attached to an 8500 elongated stem assembly of the surgical instrument. In the represented embodiment, for example, the end actuator 8412 comprises a surgical stapling device that has jaws 8413 and 8415 that can be opened and closed. More specifically, end actuator 8412 includes an elongated channel 8414 that forms a lower jaw 8413 of end actuator 8412. See Figure 84. In the illustrated arrangement, elongated channel 8414 is configured to hold an 8430 clamp cartridge and also supports movable mode an anvil 8420 which functions as an upper jaw 8415 of end actuator 8412.
[00299] With reference now to Figures 84 and 85, the anvil 8420 may have a mounting portion 8422 that protrudes from its proximal end 8421. The mounting portion 8422 may have side mounting holes 8424 through it that allow that the mounting portion 8422 is pivotally fixed to a vertical pivot projection 8417 formed in the elongated groove 8414 by an anvil pin 8418. The anvil 8420 can be selectively "moved" towards the surgical staple cartridge 8430 mounted in the groove elongated 8414 by axially advancing a segment of the distal closing tube 8590 in the distal direction "DD" as will be discussed in more detail below. In various implementations, for example, a first anvil actuating element in the form of an anvil cam pin 8419 can extend through a cam slot 8423 provided in the mounting portion of the anvil 8422. Cam pin 8419 is mounted in holes 8591 provided in the segment of the distal closing tube 8590 so that movement of the segment of the distal closing tube 8590 in the distal and proximal directions will result in the movement of the cam pin 8419 in the cam slot 8423. In addition, the the segment of the distal closing tube 8590 may further include a second anvil actuating element in the form, for example, of an 8593 actuating pin which is positioned to interact with an angled actuating surface 8425 formed at the proximal end of the mounting portion anvil 8522. Figures 89 to 91 illustrate anvil 8420 in the open position. The anvil 8420 can be moved to a closed position by moving the segment of the distal closing tube 8590 in the distal "DD" direction. The movement of the segment of the distal closing tube 18590 in the distal direction "DD" causes the first cam pin 8419 to move in the cam slot 8423 in the mounting portion of the anvil 8422 which in this way causes the anvil 8420 to pivot in around the anvil pin 8418 to the closed position as shown in Figures 86 to 88. To return the anvil 20 to the open position (Figures 89 to 91), the segment of the distal closing tube 8590 is moved in the proximal direction "PD" , which causes the first cam pin 8419 to move in the cam slot 8423 in an opposite direction and swing the anvil 8420 to the open position. Such a closing tube arrangement differs from previous closing tube arrangements in that the distal end of the closing tube segment is configured to contact the anvil and pivot to a closed position. The use of the present cam pin arrangements does not require the use of an anvil that has a more robust portion configured for the actuation contact with the segment of the closing tube.
[00300] In various arrangements, the 8412 end actuator can be configured to be selectively articulated around a longitudinal axis of the LT-LT tool that is defined by the 8500 elongated stem assembly. For example, the 8500 elongated stem assembly can include a flexible neck assembly 8510 that allows the end actuator 8412 to pivot in a first "FD" direction which is essentially the same direction in which the anvil 8420 moves when the anvil 8420 is moved from an open position to a position closed (from this point onwards in this document called the anvil closing direction "CD"). See Figures 86 and 90. The flexible neck assembly 8510 will additionally facilitate the articulation of the end actuator 8412 in a second "SD" articulation direction which is essentially the same as the direction in which the anvil moves from a closed position to an open position (hereinafter referred to in this document as the "OD" anvil opening direction). See Figures 86, 89 and 90.
[00301] Several flexible neck sets are described in Provisional Patent Application No. Serial 61 / 386,117, filed on September 24, 2010, all of which is incorporated herein by reference. Other flexible neck sets are revealed in US Patent Application Publication No. US 2012/0074200 A1, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR, filed on September 23, 2011, all the disclosure of which is incorporated herein by way of reference. The flexible neck assembly 110 can, for example, be composed of a rigid thermoplastic polyurethane marketed as ISOPLAST grade 2510 by the Dow Chemical Company. The flexible neck assembly 8510 can have a flexible neck segment 8511 comprising a first portion or a portion of the upper flexible neck 8512 and a second portion of the lower flexible neck 8514. These neck portions 8512 and 8514 can be separated by a portion longitudinal rib 8516. Each neck portion 8512, 8514 may have a plurality of neck ribs 8518 that are essentially configured as semicircular discs that together form, in general, a cylindrical configuration. An upper slot 8520 extends through each neck rib 8518 of the first portion, or upper portion, of the upper flexible neck 8512 to form a passage through the first flexible neck portion 8512 to receive a first set of flexible transmission band 8550 through the same. Similarly, a lower slot 8521 extends through each neck rib 8518 in the second portion, or lower portion, of flexible neck 8514 to form a passageway to receive a second set of flexible transmission band 8570 therethrough. See, for example, Figure 86. The flexible neck assembly 8510 can include guide surfaces 8524 (only one can be seen in Figure 92) that extend proximally from the flexible neck segment 8511 to support the reciprocating movement of the 8550, 8570 flexible transmission range assemblies.
[00302] As can be seen in Figure 92, the first set, or upper set, of 8550 transmission band may include a first 8552 transmission band and the second 8570 transmission band set may include a second 8572 transmission band. In addition, the first transmission band 8550 may have a first elongated structural portion 8554 and the second transmission band 8570 may have a second elongated structural portion 8574. When the first and second transmission bands 8550, 8570 are brought into contact with one another. the other during the assembly of the instrument, they form an elongated cylinder that has a longitudinal cavity 8560 that extends concentrically through it to receive operationally receive a firing rod 530 through it. See Figures 93 and 94. The first structural portion 8554 of the first transmission strip 8552 has a first articulation rack 8556 formed therein and the second structural portion 8574 of the second transmission strip 8572 has a second articulation rack 8576 formed thereon. which, as will be discussed in more detail below, interface with an 8600 hinge transmission assembly.
[00303] Again with reference to Figure 92, the first transmission strip 8552 may have a first portion of outer reinforcement strip 8557 that extends distally from the first structural portion 8554. Similarly, the second transmission strip 8572 may have a second portion of outer reinforcement strip 8577 that extends distally from the second structural portion 8576. Each portion of outer reinforcement strip 8557 and 8577 may have a plurality of fixing pieces 8562 for securing the first and second the second inner articulation strips 8558 and 8578 therein. For example, the first drive band 8552 has a first inner link band 8558 attached to it and the second drive band 8572 has a second inner link band 8578 attached to it. The first and second transmission strips 8552, 8572 can be composed of a plastic, specifically, an amorphous polyamide reinforced with glass fiber, sold commercially under the trade name Grivory GV-6H from EMS-American Grilon. In contrast, the inner pivot strips 8558, 8578 of the driveline assembly can be composed of a metal, advantageously making fully resistant stainless steel 301 or its equivalent. The fixing lugs 8562 on the outer reinforcement strip portions 8557, 8577 of the transmission strips 8552, 8572, respectively, are received and secured by a plurality of projection holes 8564 in the corresponding inner pivot strip 8558, 8578. See Figure 92 .
[00304] In at least one implementation, the proximal end of the 8414 elongated cartridge groove is provided with a pair of upper and lower strip connector handles 8450. See Figures 84 and 86 to 88. These strip connector ears 8450 they are inserted into and through connection loops 8559, 8579 at the distal end of the inner pivot strips 8558, 8578, respectively. In this way, the cartridge groove 8414 is coupled to the inner pivot strips 8558, 8578 of the flexible neck assembly 8510. Specifically, the reciprocation of the first and second flexible stripe sets 8550, 8570 in opposite directions causes the strips inner hinges 8558, 8578 received in the upper and lower slots 8520 and 8521 in the flexible neck segment 8511 reciprocate in a similar manner. During the reciprocation of the inner articulation strips 8558, 8578, in particular, when the first stripe 8558 is moved proximally together with the second stripe 8578 in movement in the distal position, the first and second portions of flexible neck 8514, 8516 are they flex when the neck ribs 8518 of the first flexible neck portion 8514 move towards each other and the neck ribs 8518 of the second portion of the flexible neck rib 8516 concurrently move away from each other. The coupling of the inner pivot strips 8558, 8578 to the portions of the outer reinforcement stripe 8557, 8577 of the transmission strips 8552, 8572, respectively, prevents the inner pivot strips 8558, 8578 from being buckled between the adjacent neck ribs.
[00305] In various arrangements, the segment of the distal closing tube 8590 is slid over the channel guide 8528 of the flexible neck assembly 8510. The proximal end 8591 of the segment of the distal closing tube 8590 has a pair of diametrically opposed slots 8592 (only one can be seen in Figures 83 and 92) to receive the projections distally projecting 8513 projecting from the flexible neck portion 8511 to prevent rotation of the distal closing tube segment 8590 relative to the flexible neck portion 8511. In various embodiments, the 8590 distal closing tube segment can be retained in the 8528 channel guide by a retaining tab (not shown) that extends into the fastener hole (not shown) in the 8528 channel guide. , other fastener arrangements can be employed, for example. This arrangement causes the 8590 distal closing tube segment to move axially with the flexible neck assembly 8510.
[00306] The movement of the first and second transmission tracks 8552, 8572 can be controlled by an articulation transmission 8600. The component parts of a form of articulation transmission assembly 8600 are illustrated in Figure 92. In one form, the assembly hinge transmission 8600 may include an actuator 8610, a hinge body 8620 and a nozzle 8650 (Figures 83 and 94). The pivoting movement of the 8610 actuator causes the corresponding rotation of the articulation body 8620 inside the nozzle 8650. The first and second elongated transmission strips, 8552 and 8572, consequently reciprocate axially in opposite directions parallel to the LT-LT longitudinal axis of the stem assembly elongated 100 to cause remote articulation of end actuator 8412.
[00307] Still with reference to Figure 92, the articulation body 8620 has a platform 8622 which consists of the first and second spaced and semicircular halves 8624, 8626 of the platform. The platform halves are mutually opposite and essentially represent mirror images of each other. The first and second halves of platform 8624, 8626 protrude from their surfaces mutually opposite the first and second holders 8625, 8627, respectively. Each half of the 8624 platform, 8626 has a set of 8628 platform teeth spaced about 180 degrees from the platform teeth set on the other half of the platform. The hinge body 8620 has a pair of rotation stops 8630 that protrude from its surface as well as a pair of finger recesses 8632. A drive gear 8640 protrudes laterally from the hinge body 8622. The hinge gear drive 8640 has an enlarged opening 8642 through it and a side pivot 8644. Inside the enlarged opening 8642 of the drive gear 8640, there is a hole in the firing rod (not shown) for receiving a firing rod 8930 through the even allowing the application of a firing motion to the 8412 end actuator. The 8640 drive gear is configured to engage the first and second drive racks 8556, 8576, respectively to effect the desired reciprocating movement of the first and second transmission strips 8552 , 8572. See Figure 94.
[00308] The nozzle 8650 of the hinge transmission assembly 8600 may include a nozzle structure 8652. The nozzle structure 8652 may have an axial orifice 8654 through it which facilitates the passage of the first set of 8550 transmission strip and the second 8570 drive range assembly as well as 8930 firing rod and other operating components of the 8410 instrument, including the proximal end 8706 of a proximal 8700 outer rod segment. See Figure 94. The nozzle structure 8652 can also have a groove of frame 8656 and flange 8658 for rotationally securing the nozzle body 8652 to an 8800 housing. In various forms, a housing for the 8660 holder comprises a portion of the nozzle frame 8652. See Figure 95. An annular matrix of the retainer teeth ( (not shown) is formed inside the retainer compartment 8660. One floor of the retainer compartment is spaced from the teeth of the retainer. The floor may have a pair of projections that interact within the 8630 rotation stops of the 8620 hinge body to limit the degree of rotation. When the hinge body 8620 is inserted into the retainer housing 8660, the base of the hinge body 8620 is supported on the floor in the retainer housing 8660, and the teeth of the 8628 platform of the first and second platform halves, 8624, 8626 are aligned for engaging the retaining teeth of the retainer teeth 8660. A spring element 8668 is held within the pivot body to force the teeth of the 8628 platform to engage with the retaining teeth.
[00309] Again with reference to Figure 92, the actuator 8610 can consist of a lever arm 8612, a cap 8614 and a pair of retaining fingers 8616. The lever arm 8612 is mounted on top of the cap 8614. The pair of fingers 8616 retainer protrudes laterally from the bottom side of the 8614 cover. Each of the 8616 retaining fingers has a retaining clip. The retaining fingers 8616 are received within the finger recesses 8632 of the hinge body 8620. The first and second retainers 8625, 8627, on the platform halves of the hinge body are inserted into a slit depression within the underside of the lid circular 8614. Advantageously, each of the three significant components of the articulation transmission assembly, namely, actuator, articulation body and nozzle, can be injection molded components. Such components, for example, can be manufactured from amorphous polyamide reinforced with fiberglass, marketed under the trade name Grivory GV-4H by EMS-American Grilon 150.
[00310] The ratchet rotation of the 8610 actuator causes the articulation of the end actuator 8412 in the first and second direction in relation to the longitudinal axis of the LT-LT tool. Figure 86 illustrates end actuator 8412 in a non-articulated position in continuous lines and exemplary articulation bands in dashed lines. When the drive gear 8640 in the hinge body 8620 of the hinge transmission 8600 is rotated to thereby drive the first set of transmission band 150 distally in the "DD" direction and the second set of transmission band 8570 proximally in the direction proximal "PD", the 8412 end actuator will pivot in the first pivoting direction "FD" in relation to the longitudinal axis of the LT-LT tool. When the drive gear 8640 in the hinge body 8620 of the hinge transmission 8600 has been rotated to thereby drive the second set of hinge strips 8570 in the distal direction "DD" and the first set of hinge strips 8550 in the direction proximal "PD", the 8412 end actuator will pivot in a second "SD" direction in relation to the LT-LT longitudinal axis.
[00311] As can be seen in Figure 93, the elongated stem assembly 8500 additionally includes a segment of the proximal external axis 8700 that is attached to the flexible neck assembly 8510. The segment of the proximal external axis 8700 is substantially rigid and can be fixed to the flexible neck portion 8511 of the flexible neck assembly 8510 by, for example, a snap fit, adhesive or other suitable fastener arrangement. As can be seen in Figure 94, in at least one embodiment, the distal end 8702 of the proximal outer axis segment 8700 has a pair of opposing notches 8704 in it that are adapted to receive corresponding lugs 8515 protruding from the portion of the flexible neck 8511, so that the rotation of the proximal external axis segment 8700 results in the rotation of the flexible neck assembly 8510 and, finally, the end actuator 8412.
[00312] Still with reference to Figure 92, the proximal external axis segment 8700 has a proximal end 8706 which has a slit 8708 to receive the drive gear 8640 through it, so that the proximal external axis segment 8700 can be move axially with respect to it. In addition, the proximal end 8706 of the proximal 8700 external axis segment has a 8710 flange formed therein that facilitates the rotational fastening to a 8820 closing carriage of an actuation system that is operationally supported in the 8800 housing assembly. closing car and drive system may be the same or of types, constructions and operations similar to those of the closing car and drive system described in the publication of US Patent Application No. US 20120074200 A1, which has been incorporated herein by reference in your totality.
[00313] With reference now to Figure 96, the closing cart 8820 can comprise two segments of cart 8822 (only one is illustrated) that are interconnected by adhesive, coupling features, screws, etc. As used herein, the term "engaging feature" includes, but is not limited to, for example, a tab having a protrusion that is configured to retain a corresponding engaging portion of another component. Such features may be designed to releasably engage the locking portion or may not be designed or intended to be removed. In at least one form, the closing carriage 8820 has a distal end 8824 which has a groove arrangement 8826 which is adapted to receive the flanged end 8710 of the proximal outer stem segment 8700. This arrangement serves to secure the proximal end 8706 of the proximal outer shaft segment 8700 to the 8820 closing carriage while facilitating its selective rotation of the proximal outer shaft segment 8700 to the 8820 closing carriage. Therefore, the elongated stem assembly 8500 and the end actuator 8412 which is operationally coupled to it can be selectively rotated about the longitudinal axis of the LT-LT tool in relation to the 8800 housing assembly.
[00314] In various implementations, the 8800 compartment assembly comprises a pistol-shaped cable compartment that can be manufactured in two or more parts for assembly purposes. For example, compartment assembly 8800, as shown, comprises a right wrapping element 8802 and a left wrapping element 8804 (Figure 83), which are molded or otherwise manufactured from a polymer or plastic material and are designed to if they match. These housing elements 8802 and 8804 can be attached to each other by snap-fit features, dowels and sockets molded or otherwise formed there and / or by adhesive, screws, etc. When assembled, the 8800 compartment assembly movably supports the 8820 closing carriage for selective axial displacement of the carriage in response to actuation movements from the trigger, generically designated as 8830. As the Detailed Description proceeds, however, it will be understood that the various unique and innovative aspects and attributes of the various implementations of the present invention can be effectively achieved when employed with robotically controlled systems or, otherwise, remotely controlled. Accordingly, the term "compartment" or "compartment assembly" can also encompass a compartment or similar portion of a robotic system that houses or sustains in any way at least one drive system configured to generate and apply at least one control movement. that can be used to act on various forms of surgical end actuators attached to them. For example, various implementations of the surgical instruments described herein can be used in connection with these robotic systems disclosed in US patent application Serial No. 13 / 536,323, entitled ROBOTICALLY POWERED SURGICAL DEVICE WITH MANUALLY ACTUATABLE REVERSING SYSTEM, deposited on June 28, 2012, whose full description is hereby incorporated by reference.
[00315] The trigger assembly 8830 may, for example, comprise a primary trigger 8840 and a secondary trigger 8860. Primary and secondary triggers 8840 and 8860 are pivotally seated in a pivot pin assembly 8831 formed in the housing assembly 8800, so that triggers 8840 and 8860 can essentially move relative to each other. Such an arrangement allows the 8830 trigger assembly to pivot in relation to the 8800 housing assembly on a PA-PA pivot axis. See Figure 96. The primary drive 8840 has an elongated gripping primary drive blade 8842 that protrudes from the primary steering portion 8844 that has a trigger rack 8846 formed therein. In one embodiment, the secondary trigger 8860 has a secondary trigger blade 8862 that protrudes from a secondary drive portion 8864 as discussed in greater detail which is pivotally seated on the 8831 pivot pin assembly. The steering portion primary 8844 has a slit 8848 which is adapted to receive the secondary drive portion 8864 of the secondary trigger 8860 there when the primary trigger paddle 8842 is pivoted toward the pistol grip portion 8806 of the 8800 housing assembly. This arrangement essentially allows the secondary drive 8860 to "nest" inside the primary drive 8840 during actuation. As will be discussed in detail below, the secondary drive 8860 is actuated pivotally by turning the primary drive 8840. Thus, in other modalities, the secondary drive 8860 may not feature the secondary drive blade 8842. In several ways, the 8830 trigger assembly can be forced into position not actuated by a trigger spring (not shown).
[00316] As can be seen in Figure 96, the secondary drive portion 8864 of the secondary trigger 8860 may have a closing gear segment 8866 formed therefrom that is configured to engage with a gear rack of the 8823 carriage formed on the side bottom of the 8820 closing carriage. Thus, when the secondary trigger 8860 is pivoted towards the pistol grip 8806, the 8820 closing carriage is actuated in the distal direction "DD".
[00317] In several implementations, the 8810 actuation system additionally includes an 8870 actuation bar. The 8870 actuation bar has a first 8872 actuating rack formed in it that is configured for gear engagement with the primary gear segment 8846 in the primary drive 8840. Thus, when the primary gear segment 8846 is in gear engagement with the first 8872 actuating rack, the 8870 actuating bar is pushed in the "DD" distal direction when the 8840 primary actuator is rotated towards the handle of the 8806 pistol. The 8870 actuating bar has a second 8874 actuating rack formed on it configured for engagement with the 8884 clutch teeth on a 8882 clutch rod of an 8880 clutch assembly. In various embodiments, the clutch shaft 8882 is pivotally supported inside the 8800 housing assembly and is also laterally movable therein. The clutch shaft 8882 has a central portion 8886 which has a plurality of spaced teeth 8888 which are configured to directionally engage the tooth openings 8892 on a drive gear 8890 which is pivotally supported on the clutch shaft 8882. The gear gear The 8890 drive has an 8894 drive gear segment in it that is adapted for engagement with the 8900 firing rack that is movably supported in the 8800 housing assembly.
[00318] Various embodiments of the 8880 clutch assembly may additionally comprise a 8910 clutch plate which is slidably seated on a 8849 clutch pin provided in the primary steering portion 8844 of the primary trigger 8840. The 8849 clutch pin can be received movably within a vertical slot 8912 in the clutch plate 8910. The clutch plate 8910 also has a clutch arm that extends in the distal position 8914 which is adapted to engage a chamfer plate 8889 formed on the clutch shaft 8882. In addition, the clutch spring 8920 is used to tilt the clutch shaft 8880 laterally, so that the teeth 8888 on the clutch shaft 8882 are brought into engagement with the openings of teeth 8892 on the drive gear 8890.
[00319] As can be seen in Figures 92 and 96, the 8900 firing rack is coupled to the 8930 firing rod which is attached to the proximal end of a 8970 cutter bar assembly. In various embodiments, the cutter bar assembly 8970 may comprise an upper bar segment 8971 and a lower segment 8972. Such an arrangement may allow the 8970 cutter bar assembly to flex as the end actuator 8412 is pivoted, while remaining sufficiently rigid to be driven distally through the 8500 stem assembly In the embodiment shown, the upper and lower cutter bar segments 8971 and 8972 are each attached to an "E-beam" 8973 cutting head. In the configuration shown, the E-beam 8973 cutting head includes a portion vertically oriented body 8974 having an upper portion 8975 and a lower portion 8976. A bottom floor 8977 is formed in the lower portion 8976 or attached thereto. In alternative embodiments, the bottom floor can essentially comprise lower flaps extending laterally that project laterally from the lower portion. Similarly, at least one upper tab 8977 is formed in the upper portion 8975 or otherwise attached thereto, of the vertically oriented body portion 8974. In addition, as can be seen in Figure 84, the vertically oriented body portion 8974 additionally includes at least a 8978 intermediate flap portion (only one is shown) as well as a 8979 fabric cutting edge.
[00320] Referring to Figure 84 the vertically oriented body portion 8974 extends through a longitudinally extending slit 8980 in the elongated groove 8414 and a longitudinally extending slit 8981 in the anvil 8420. When assembled, the elongated channel portions 8414 are received between the bottom of the bottom floor 8977 and the intermediate flap portion 8978. The upper flap portion 8977 'is arranged to be received between the anvil 8420 above the 8982 portions of the anvil 8420 that defines the anvil slit 8981 To facilitate assembly, the anvil 8420 can be provided with a movable anvil cover 8983 and the elongated groove 8414 can be provided with a removable channel cover 8984. Once assembled, the anvil cover 8983 and the channel cover 8984 can be installed to prevent tissues, body fluids, etc. enter the anvil 8420 and the elongated channel 8414, respectively, which can impair the operation of the 8973 shaving head.
[00321] In various arrangements, each 8430 staple cartridge includes a 8431 cartridge body that has a 8985 slide assembly operably supported therein. Slider assembly 8985 may have a mounting portion 8986 that is configured to extend into a slit slot 8987 formed in the vertically oriented body portion 8974 of the 8973 cutting head. See Figures 84 and 86. Slider assembly 8985 can be configured with 8988 wedges that are arranged to contact the 8989 clamp actuators that are operationally supported within the 8430 clamp cartridge. The 8989 clamp drivers can hold one or more 8990 clamps therein in a manner known in the art . As the 8985 sliding support assembly is driven in the "DD" distal direction through the 8430 staple cartridge, the 8988 wedges drive the 8989 actuators upward in the 8430 cartridge in a manner known in the art. The 8989 upward actuators drive the clamps 8990 so that they come into contact with a clamp-forming bottom surface of the 8420 anvil assembly. The bottom surface may, for example, include clamp forming pockets that correspond to each clamp.
[00322] The 8412 end actuator can also employ a shaving head locking system, commonly referred to as 8991, which serves to prevent distal advancement of the 8973 shaving head when a new 8430 staple cartridge is not present inside the groove elongated 8414. In at least one arrangement, for example, the cutting head locking system 8991 can comprise a locking spring 8992 which is mounted on the bottom of the elongated channel 8414. Locking spring 8992 can be configured to contact with the bottom floor 8977 of the 8973 shaving head assembly when the 8974 shaving head assembly is in the home position. See Figures 86, 88 and 91. An opening 8993 can be provided through the bottom of the elongated channel 8414 so that, when in this position, the locking spring 8992 forces the bottom floor 8977 so that it interferes with the bottom of the elongated groove 8414. Thus, when the bottom floor 8977 is in this position, if the physician attempts to advance the 8973 shaving head distally through the elongated groove 8414, the bottom floor portion 8977 will come into contact with the elongated groove portion 8414 to prevent such an advance of the 8973 cutting head. When an 8430 cartridge has been properly installed with the elongated groove 8414, the 8986 mounting portion of the 8985 slide assembly extends into the 8987 slide slot and serves to move the assembly cutting head 8973 in a position where the floor portion 8977 is moved out of the interference contact with the bottom of the elongated groove 8414. When in this position, the cutting head assembly 8973 is It is free to be advanced distally through the elongated channel 8414. This arrangement serves to prevent the physician from inadvertently firing the end actuator when a new cartridge is not present, which could otherwise result in cutting the tissue, but not in your stapling. As the cutting head 8973 is distally advanced, the bottom floor 8977, the intermediate flap portions 8978 and the upper flap 8977 "cooperate to orient the anvil 8420 with respect to the staple cartridge platform in a desired spaced relationship. A distally shown fabric cutting edge 8979, which is between the upper flap 8977 'and the intermediate flap portions 8978, cuts the stapled fabric while causing staples 8990 inside the staple cartridge 8430 to be formed in the stapled fabric inside the 8412 end actuator.
[00323] As can be seen in Figure 84, the upper firing bar 8971 is connected to the upper end portion 8975 and the lower firing bar 8972 is spaced from the upper firing bar 8971 and is attached to the lower end portion 8976 of the cutting head 8973 vertically extending 8974. This arrangement serves to transmit the firing movements to the upper and lower portions of the cutting head 8973 in an equivalent manner to facilitate the aligned movement of the cutting head through the anvil 8420, the surgical clips 8430 and elongated channel 8414. In various arrangements, for example, the upper firing bar 8971 can be attached to the upper end portion directly behind the upper flap (s) 8977 'so that the the upper firing bar 8971 is essentially aligned with the point (s) from which the upper flap (s) 8977 'protrudes (m) laterally from the upper and end portion 8975. Similarly, the lower firing bar 8972 can be attached to the lower end portion 8976 directly behind the bottom floor 8977 or the point (s) from which the side flaps projecting laterally protrude laterally from the lower end portion 8976 so that the lower firing bar 8972 is axially aligned with it. The lower and upper firing bars 8971, 8972 can be welded to the 8974 vertical extendable portion at these locations. For example, welds can be applied to the firing bars on one side or on both sides of the firing bars. In at least one implementation, the upper and lower firing bars 8971, 8972 are not directly attached to each other. The portions of the lower and upper firing bars 8971, 8972 extending through the elongated stem assembly 8500 to be coupled to a distal end portion 8932 of the firing stem 8930 are held in a contiguous orientation with each other. The proximal ends of the upper and lower firing bars 8971, 8972 can be attached to the distal end portion 8932 of the firing bar 8930 by a coupling element 8994. See Figure 92. As will be discussed in more detail below, the firing rod 8930 facilitates the application of the firing movements and the retraction in the cutter bar assembly 600 by the firing actuation system 8810. In at least one implementation, the mounting portion of the anvil 8422 has a wedge-like formation 8427 in it that serves to separate the upper firing bar 8971 and the lower firing bar 8972 as the cutter bar 8970 is activated in the distal direction "DD". See, for example, Figure 91.
[00324] In various arrangements, the 8930 firing rod extends through the 8940 closing pad that is mounted inside the 8800 bay assembly. In at least one form, a pair of 8807 mounting studs protrudes from the cable cases 8802, 8804 and extends through corresponding slots in the closing cart 8820 to be received in a retaining slot in the 8840 cushion. The closing spring 8950 which is attached to a retaining clip 8952 is seated in the closing cushion 8940. The spring closure 8950 extends between the frame of the nozzle 8652 and an inner wall 8825 in the closing carriage 8820. Thus, the closing spring 8950 serves to tilt the closing carriage 8820 in the proximal direction "PD".
[00325] Various modalities may also include a release locking lock assembly 8960 that connects with the closing cart 8820 to selectively retain the closing cart 8820 in its most distal closed or stapled position. In at least one way, the locking lock assembly 8960 includes a locking button 8962 that is pivotally supported in the 8800 lock assembly. Locking button 8862 has a locking arm 8964 that is configured to be in a boundary position with a locking protrusion 8826 formed in the closing carriage 8820 when the button 8962 is in a locked position. In addition, the locking arm 8964 has a tab 8966 formed on it which is configured to lock releasably with the locking clip 8902 at the proximal end of the 8900 firing rack. 8962 in a locked position.
[00326] The operation of the 8410 surgical instrument will now be described. Figure 89 to 91 illustrates the jaws 8413 and 8415 of the end actuator 8412 in an open position. When the end actuator 8412 is in an open position, the lock arm 8964 is located at the top of the locking projection 8826 formed in the closing carriage 8820, so that the clip 8966 of the lock arm 894 is in locking engagement with locking latch 8902 on firing rack 8900. Thus, when in its initial position, the 8790 cutter bar assembly cannot be inadvertently actuated. The 8910 clutch plate, as well as the closing carriage, are each in their most close unacted positions. When in these positions, the clutch steering chamfer 8889 on the clutch stem 8882 is in contact with the portion of the closing carriage 8820, which prevents the clutch stem 8882 from moving laterally in gear engaged with the drive gear 8890 under the 8920 clutch spring pull.
[00327] To start the closing process, a first movement is applied to the 8830 trigger assembly. That is, the 8830 trigger assembly is initially pivoted towards the 8806 pistol grip. This pivoting action is used to direct the closing car. 8820 in the distal direction "DD" due to the gear engagement between the 8866 closing gear segment on the secondary drive 8860 and the 8823 carriage rack formed on the underside of the 8820 closing carriage. Such a distal movement of the 8820 closing carriage also advances axially the proximal external nail segment 8700 and the segment of the distal closing tube 8590 in the distal direction "DD". As the segment of the distal closing tube 8590 moves distally, pin 8419 extending through slots 8423 in the anvil mounting portion 8422 moves from the position shown in Figures 90 and 91 to the position shown in Figures 86 to 88 for pivot anvil 8420 to the closed position. If the surgeon simply wants to seize and manipulate the tissue before stapling it between the 8420 anvil and the 8430 surgical staple cartridge, the 8830 trigger assembly can be pivoted to open and close the 8420 anvil without fully pivoting the 8830 trigger assembly to the fully closed position.
[00328] Those skilled in the art will understand that when the 8830 actuator assembly is rotated towards the 8806 pistol grip, the 8870 actuation bar will necessarily also be distally directed due to the gear engagement between the primary gear segment 8846 on the 8840 primary drive and the first 8872 actuating rack on the 8870 actuating bar. The distal movement of the 8870 actuating bar will also result in the application of a rotating actuating motion to the 8882 clutch shaft due to the gear engagement between the clutch teeth 484 on the 8882 clutch shaft and the second 8874 actuating rack on the 8870 actuating bar. However, this rotary motion is not applied to the 8890 drive gear because the 8914 clutch arm of the 8910 clutch plate, in contact with clutch steering chamfer 8889 on clutch shaft 8882, prevents axial movement of clutch shaft 8882 in gear engagement with the 8890 drive gear. In this way, the 8882 clutch shaft rotates freely in relation to the 8890 drive gear. Consequently, the 8880 clutch assembly automatically prevents the 8900 trigger rack from being activated during the initial actuation of the 8830 drive assembly. .
[00329] After the trigger assembly 8830 has been initially and completely compressed to the closed position, the anvil 8420 will be held in the stapled position or locked by the locking assembly of the 8960 lock, which prevents the proximal movement of the 8820 locking carriage. To drive the 8970 cutter bar assembly distally through the tissue stapled to the 8412 end actuator, the surgeon pivots the primary trigger 8840 again towards the pistol grip 8806 of the 8800 bay assembly. As the primary trigger 8840 is pivoted , the firing rack 8900, the firing rod 8930 and the cutting bar assembly 600 are actuated in the distal direction "DD". After the 8970 cutter bar assembly has been driven through the tissue stapled to the 8412 end actuator, the surgeon then releases the primary trigger 8840 to allow the primary trigger 8840 to pivot to its unactivated position under the pull of the spring. firing 8832. When the primary trigger 8840 pivots back to the starting position, the firing rack 8900, firing rod 8930 and cutter bar assembly 8970 are dragged back proximally to their respective starting positions. The end actuator 12 remains in its stapled position, as shown in Figure 88. As can also be seen in that Figure, the 8985 slide assembly remains at the distal end of the 8430 cartridge while the 8970 cutter bar assembly is returned to the initial.
[00330] To unlock the 8820 closing carriage and the 8860 secondary actuator, the surgeon presses the 8962 locking button. When the 8962 locking button is compressed, the 8964 locking arm is pivoted out of the coupling that is contiguous with the locking projection 8826 on the closing carriage 8820. Additional details regarding the operation of the closing and firing systems can be found in US Patent Application Publication No. 2012/0074200 which is hereby incorporated by reference, in its entirety, for reference. . When the 8820 closing carriage moves proximally, the proximal outer axis segment 8700, the flexible neck assembly 8510, and the tube segment of the 8590 distal closure system are extracted proximally. As the segment of the distal closing tube 8590 moves proximally, stem 8419 moves proximally into slot 8423 in the anvil mounting portion 8422 to move anvil 8420 to an open position.
[00331] As can be seen from the foregoing, the various surgical instruments disclosed here allow the physician greater maneuverability and several other advantages that are not available when using previous surgical instruments that are configured to cut and secure the tissue. For example, in several implementations disclosed in this document, the end actuator is selectively articulated in the same directions in which the jaws are movable with each other. In other words, the jaws of the surgical end actuator are forced to move in a plane. In several implementations disclosed in the present disclosure, the end actuator is also able to move in this same plane. Front end actuators are commonly forced to move in planes that differ from the plane in which the jaws move.
[00332] Another advantage provided by many of the present implementations is the use of a firing bar that comprises at least one upper firing bar and at least one lower firing bar that form a laminated structure. The upper and lower bars may, at some point, be attached to each other or they may not be attached, but only contiguous with each other. In each of these arrangements, the upper bar is attached to an upper end of the cutting head and the lower bar can be attached to the lower head so that they are spaced apart at their points of attachment to the cutting head. Such an arrangement serves to provide a more stable shaving head arrangement that may be less likely to twist and / or lock during actuation. In addition, the cutting head can be equipped with upper flange (s) that project (s) laterally and that engage (an) the portion of the anvil and the lower flap (s) that engage (m) ) the elongated channel. The upper firing bar can be attached directly behind the point where the upper tabs are attached so that it is axially aligned with it. Similarly, the lower firing bar can be attached directly behind the point where the upper tabs are attached so that it is axially aligned with it. Such axial alignment facilitates the transfer of actuation or actuation movements to the cutting head at the points where the cutting head engages the anvil and the elongated groove, which can additionally prevent deformation and / or twisting of the cutting head during actuation. .
[00333] The various provisions of surgical instruments disclosed in the present disclosure that employ tissue cutting and staple firing systems, jaw opening and closing systems and articulation systems that employ components that are essential and axially reciprocal during performance can be actuated by manually generated actuation movements, for example, the trigger systems can be housed in a cable that includes trigger arrangements that are configured to generate the actuation movements when the doctor manipulates the triggers. It will be understood, however, that such actuation movements can similarly be generated by motors that are supported on the cable or are supported or comprise a portion of the robotic system. Thus, several surgical instruments disclosed in the present disclosure should not be limited to use only in connection with portable compartments and manually generated actuation movements.
[00334] Surgical instruments equipped with an engine are revealed in US patent application publication No. 2009/0090763 A1, entitled POWERED SURGICAL STAPLING DEVICE to Zemlok et al. (hereinafter "Zemlok '763'"), the entire description of which is incorporated herein as a reference. Surgical instruments equipped with a motor are also revealed in US patent application publication No. 2011/0278344 A1, entitled POWERED SURGICAL INSTRUMENT for Zemlok et al. (hereinafter "Zemlok '344'"), now US patent No. 8,201,721, the entire description of which is incorporated herein by reference. Figure 97 illustrates a surgical instrument equipped with a 9010 engine which, in many ways, can be similar to surgical instruments (including various features, components and subcomponents thereof) revealed in, for example, Zemlok '763 and / or Zemlok' 344, which were each incorporated here in full, as a reference. Likewise, the 9010 surgical instrument may be similar to the surgical instruments disclosed in US patent application Serial No. 13 / 974,205, filed on August 23, 2013, entitled ATTACHMENT PORTIONS FOR SURGICAL INSTRUMENT ASSEMBLIES for Shelton et al., Being its full description incorporated herein by way of reference. The surgical instrument 9010 shown in Figure 97 includes a compartment 9012 that has a portion of cable 9014 to facilitate manual manipulation and operation of the instrument. Accordingly, the term "compartment" as used here can encompass a portable or otherwise hand-manipulated arrangement. However, the term "compartment" can also encompass portions of an automatic surgical instrument system such as a robotically controlled system that is not designed to be portable, but is otherwise manipulated and can be activated by various components, portions and / or activators of the system. For example, various implementations of the surgical instruments described herein can be used in connection with these robotic systems disclosed in US patent application serial number 13 / 536,323, entitled ROBOTICALLY POWERED SURGICAL DEVICE WITH MANUALLY ACTUATABLE REVERSING SYSTEM, filed on June 28, 2012, whose full description is hereby incorporated by reference. In addition, the coupling arrangements and the end actuator arrangement disclosed in the present invention can also be effectively employed with portable surgical instruments not equipped with an engine. Accordingly, the end actuator arrangements and coupling arrangements disclosed in the present invention should not be limited to use in connection with instruments equipped with a motor, whether portable instruments or otherwise, automated.
[00335] An elongated stem set 9116 in the form of an endoscopic portion emerges from compartment 9012 and is configured for operable fixation to a surgical end actuator that is constructed to perform at least one surgical procedure in response to triggering motion applications on it . The surgical end actuator may comprise a device configured to cut and staple tissue as a 9020 "loading unit" as shown in Figures 98 to 105. Surgical end actuators, such as the 9020 loading unit, for example, can be attached reliably to the elongated stem assembly 9116 of the surgical instrument equipped with a 9010 engine, as described in more detail here.
[00336] Figures 98 to 105 illustrate an exemplary form of the end actuator or loading unit 9020 that can be used with the 9010 surgical instrument. As can be seen in Figure 100, the loading unit 9020 includes an 9220 anvil set which is supported for pivoting displacement in relation to a 9240 conductor which operationally supports a 9260 staple cartridge inside. The 9260 staple cartridge may comprise a surgical staple cartridge that is designed to be "implanted" in the patient. For example, the 9260 implantable surgical staple cartridge may comprise any of the various surgical staple cartridge provisions disclosed in US Patent Application Publication No. 2012-0080484, filed September 30, 2010, entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM, the full description of which is hereby incorporated by reference. In at least one implementation, for example, the 9260 staple cartridge includes a body portion 9261 consisting of a compressible hemostatic material such as oxidized regenerated cellulose ("ORC") or a bioabsorbable foam, on which rows are supported. of unformed metal clamps. In at least some ways, in order to prevent the clamp from being affected and the hemostatic material from being activated during the insertion and positioning process, the entire cartridge can be coated or wrapped in a biodegradable film, such as a polydioxanone film, sold under the trademark PDS.RTM, or with a polyglycerol sebacate film (PGS) or other biodegradable films formed from PGA (polyglycolic acid, marketed under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid) , PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, marketed under the trademark Monocryl) or a compound of PGA, PCL, PLA, PDS that would be waterproof until broken. The body 9261 of the staple cartridge 9260 is dimensioned to be removably supported on the conductor 9240, as shown, so that each staple inside it is aligned with the corresponding staple forming pockets in the anvil assembly 9220.
[00337] The anvil set 9220 has a pair of trunnions 9221 formed therein that are adapted to be received into slots in the trunnion 9242 at a proximal end 9241 of conductor 9240 so that the anvil set 9220 can move or pivot between an open position and a closed position in relation to the 9240 conductor around the axis of the ANV-ANV pivot. The pivot axis of the ANV-ANV anvil is transversal to the tool axis extending longitudinally LA-LA defined by the elongated shank set 9116. When the anvil set 9220 is pivoted from an open position to the closed position, the set of anvils anvil 9220 moves in a closed "CD" direction around an ANV-ANV anvil pivot axis. On the other hand, when the anvil set 9220 moves from a closed position to the open position, the anvil set 9220 moves in an open "OD" direction around an ANV-ANV anvil pivot axis.
[00338] The loading unit 9020 employs a unique and innovative 9270 articulation joint that facilitates the 9240 conductor articulation and the 9220 anvil assembly to pivot around an "AA-AA" articulation axis that is transverse to the longitudinal axis of the "LA-LA" tool. For example, the loading unit 9020 may include an end actuator compartment 9400 that is configured to be received within an outer shell 9450. The distal end 9402 of end actuator compartment 9400 may have a shackle 9404 formed therein. two flaps protruding distally 9406. Each flap 9406 has a pivot hole 9408 formed therein that is adapted to receive a corresponding pivot pin 9274 formed therein in a pivot ball assembly 9272. See Figure 100. The ball assembly hinge 9272 can be affixed to the proximal end 9241 of conductor 9240, for example, by welding or other suitable gripping arrangement. As will be discussed in more detail below, when assembled, conductor 9240 and anvil assembly 9220 can selectively articulate as a unit around the axis of the AA-AA joint in a first "FD" direction which is the same direction as the direction of anvil closing "CD" and in a second direction "SD" which is the same as the anvil opening direction "OD". See Figure 105.
[00339] Still with reference to Figure 100, the end actuator compartment 9400 can be provided with a channel 9410 for slidingly receiving the articulation connection means 9420 there. The hinge link 9420 includes a proximal end portion 9422 and a distal end 9424. Firmly attached to the distal end portion 9424 is a hinge tube 9426. The hinge tube 9426 can comprise a hollow tube and be fixed to the distal end 9424 through, for example, soldering or other suitable means. As can be seen in Figure 102, the hinge tube 9426 can have a series of hinge teeth 9428 formed therein that are configured to engage by gear the sets of teeth of the distal hinge 9276 formed in the hinge sphere 9272. Thus, the movement of the articulation link 9420 in the distal direction "DD" will cause the conductor 9240 and the anvil assembly 9220 to pivot in the first direction "FD" around the articulation axis AA-AA. On the other hand, the movement of the articulation link 420 in the proximal direction "PD" will cause the conductor 9240 and the anvil assembly 9220 to pivot as a unit in the second direction "SD" around the articulation axis AA-AA. The articulation link 9420 and the articulation tube 9426 can be called collectively in the present invention the articulation link assembly 9425. See Figure 100.
[00340] The 9020 loading unit can also be equipped with a 9460 drive assembly that is configured to move axially through the 9400 end actuator housing. In at least one implementation, the 9460 drive assembly includes a beam assembly drive 9461 which includes an upper drive beam 9462 and a lower drive beam 9464 that are attached to a cutting head 9470. The cutting head 9470 can include a body portion 9471 that has a fabric cutting edge 9472 formed in the same. An upper portion 9473 of the body portion 9471 has an upper flap 9474 formed therein. A bottom floor or flap 9476 is formed in a lower portion 9475 of the body portion 9471. The vertically oriented body portion 9471 extends through a longitudinally extending slit 9245 in conductor 9240 and a longitudinally extending slit 9222 in the anvil assembly 9220. When assembled, the bottom floor 9476 is configured to slide along the bottom of the conductor 9240. The upper flap portion 9474 is arranged to be slidably received within an elongated channel 9223 formed in the anvil assembly 9220.
[00341] As can be seen in Figure 100, the upper firing bar 9462 is connected to the upper end portion 9473 and the lower firing bar 9464 is spaced from the upper firing portion 9462 and is attached to the lower end portion 9475 of the portion vertically extending 9471 of the cutting head 9470. This arrangement serves to transmit the firing movements to the upper and lower portions of the cutting head 9470 in an equivalent manner to facilitate the aligned movement of the cutting head 9470 through the anvil assembly 9220 , the staple cartridge 9260 and the conductor 9240. In various arrangements, for example, the upper firing bar 9462 can be attached to the upper end portion 9473 directly behind the upper flap (s) 9474 such that the upper firing bar 9462 is essentially aligned with the point (s) from which the upper flap (s) 9474 project (s) laterally from the upper and end portion 9473. D and similarly, the lower firing bar 9464 can be attached to the lower end portion 9475 directly behind the bottom floor 9476 or the point (s) from which the side flaps projecting laterally protrude laterally from the lower end 9475 such that the lower firing bar 9464 is axially aligned with it. The lower and upper firing bars 9462, 9464 can be welded to the vertical extendable portion 9471 at these locations. For example, welds can be applied to the firing bars on one side or on both sides of the firing bars. As the cutting head 9470 is distally driven in the "DD" distal direction, the anvil set 9220 is closed by pivoting between the upper flap (s) 9474 and the lower flap (s) or standing 9476. The additional feed on the 9470 shaving head assembly causes the 9260 surgical staple cartridge to be crushed between the 9220 anvil assembly and the 9240 conductor, thereby forming the surgical staples supported therein in both sides of the fabric cut line as they are brought into contact with the staple-forming bottom of the 9220 anvil assembly. After the 9470 cutting head assembly has been advanced to the distal end of the 9240 conductor, the user retracts the cutting head assembly 9470 to the home position so that the anvil assembly 9220 can be opened to release the 9260 staple cartridge and stapled fabric. In an implementation, for example, the upper flap (s) 9474 are configured to interact with the upper surface of the anvil assembly 9220 to swing or pivot the anvil assembly 9220 back to the open position. In alternative arrangements, a spring or other pulling element (not shown) can be used to force the anvil assembly 9220 to the open position when the cutting head assembly 9470 is in an initial position.
[00342] The drive beam assembly 9460 may also include a proximal latch element 9467 that includes a pair of latch fingers 9468 that are configured to operably engage a distal end 9522 of the firing rod 9104, as will be discussed in more detail in the present disclosure. As can be seen in Figure 100, for example, the proximal engaging element 9467 is pivotally coupled to the lower and upper firing bars 9462, 9464 to facilitate articulation and flexion during articulation of conductor 9240 around the axis of AA-AA joint without connection of the drive beam assembly 9461. In at least one implementation, for example, the proximal coupling element 9467 is pivotally coupled to the lower and upper firing bars 9462, 9464 by a pair of links of the pivot 9466. Such links 9466 allow the upper firing bar 9462 to pivot in relation to the proximal engagement element 9467 independently of the lower firing bar 9464 and vice versa.
[00343] As can be seen in Figure 97, the surgical instrument 9010 can include a motor 9100 that is configured to generate rotating actuation movements that can be used, for example, to apply firing movements to the loading unit 9020 as will be discussed with more details below. In at least one way, for example, the 9100 motor is configured to apply rotary activation movements to the trigger element assembly, generally referred to as 9082. In one embodiment, for example, the trigger element 9082 assembly includes a drive 9102 which is swiveled inside compartment 9012 and has an internal thread (not shown) formed in it. A proximal threaded portion of a firing element or firing rod 9104 is supported on the threaded engagement with the driving tube 9102 so that the rotation of the firing tube 9102 results in the axial movement of the firing rod 9104. The firing rod 9104 can connect to the inside of the 9460 drive assembly on the 9020 loading unit. As discussed in more detail in the aforementioned Zemlok '763 and Zemlok' 344 incorporated here, the drive tube 9102 rotates in a first direction (for example, example, counterclockwise) causes trigger rod 9104 to advance drive assembly 9460 in the distal direction.
[00344] As can be seen in Figure 97, surgical instrument 9010 may include a joint system generally referred to as 9109. However, surgical instrument 9010 may include several other joint system arrangements disclosed in detail here. In at least one way, the hinge system 9109 can include a hinge mechanism 9110 that includes a hinge motor 9112 and a hinge button 9114. The hinge motor 9112 can be activated by a powered hinge key 9116 or by rotation of the manual articulation knob 9114. Activation of the articulation motor 9112 serves to rotate a articulation gear 9118 of the articulation mechanism 9110. The actuation of the articulation mechanism 9110 can cause the end actuator (for example, the cartridge / anvil of the loading unit 9020) moves from its first position, where its axis is substantially aligned with the longitudinal axis of the "LA-LA" tool of the elongated stem assembly 9116 to a position where the axis of the actuator of The end is arranged at an angle to the longitudinal axis of the "LA-LA" tool of the elongated stem assembly around, for example, the "AA-AA" pivot axis. Further discussion of the various aspects of the 9110 hinge mechanism can be found in Zemlok '763, which was previously incorporated here in full, by way of reference. In addition, US patent No. 7,431,188 entitled SURGICAL STAPLING APPARATUS WITH POWERED ARTICULATION, with its description incorporated here in its entirety for reference, reveals articulated end actuators equipped with a motor that can be used in connection with a 9010 surgical instrument Those skilled in the art will understand, however, that the unique and innovative coupling arrangements disclosed in the present disclosure can also be effectively used with manually operated (i.e., non-powered) articulation systems that are known in the art.
[00345] In several modalities, the surgical instrument can include at least one motor, which can apply firing movements to the loading unit 9020 and / or articulation movements to the 9109 articulation system, as described here in more detail. The 9100 engine can, for example, be powered by a 9200 power source of the type described in more detail in Zemlok '763. For example, the 9200 power source may comprise a rechargeable battery (for example, based on lead, nickel or lithium-ion, etc.). It is also envisioned that the 9200 power source may include at least one disposable battery. The disposable battery can, for example, be between about 9 volts and about 30 volts. However, other power supplies can be used. Figure 97 illustrates an example in which the power source 9200 includes a plurality of battery cells 9202. The number of battery cells 9202 employed may depend on the current load requirements of the 9010 instrument.
[00346] With reference to Figure 97, a power source, for example the power source 9200, can provide power for the operation of the surgical instrument 9010. For example, the power source 9200 can provide power for an engine such as, for example , the 9100 motor to cause the drive tube 9102 to rotate in a first direction and finally the axial advance of the firing rod 9104 that drives the 9460 drive assembly distally through the loading unit 9020. Alternatively, the power source 9200 can supply power to the 9100 motor to cause the drive tube 9102 to rotate in a second direction opposite the first direction and finally the axial retraction of the trigger rod 104 which can move the drive beam 9060 proximally to its initial and / or standard position .
[00347] Surgical end actuators, such as a disposable 9020 loading unit, for example, can be operationally coupled to the 9116 elongated stem assembly of the surgical instrument equipped with motor 10 (Figure 1). In various embodiments, the surgical instrument 9010 may include an elongated stem assembly 9116, which can engage the loading unit 9020, for example. In various embodiments, a 9115 coupling assembly that includes a rotating coupling collar 9500, for example, can releasably lock the loading unit 9020 in relation to the elongated stem assembly 9116. In addition, in various embodiments, rotation of the 9500 coupling collar can facilitate the attachment and / or alignment of a firing assembly and / or a hinge assembly, as described here. In various embodiments, the loading unit 9020 can include a distal fixing portion 9480 and the elongated stem assembly 9116 can include an outer tube 9030 and a distal fixing portion 9032. The distal fixing portion 9480 of the loading unit 9020 can receive the distal fixing portion 9032 of the stem assembly 9116 when the loading unit 9020 is attached to the elongated stem assembly 9116 (Figure 107). In addition, the rotating coupling collar 9500 can be positioned around the distal attachment portion 9032 of the stem assembly 9116, so that the distal attachment portion 9480 of the loading unit 9020 can also be positioned within the rotating coupling collar 9500. The rotating coupling collar 9500 can be attached to the elongated stem assembly 9116 and / or to the proximal fixing portion 9480 and, in certain embodiments, can be swiveled to the distal fixing portion 9032 of the stem assembly 9116, for example. In certain embodiments, a proximal attachment portion of the stem assembly 9116 can receive a distal attachment portion 9480 of the loading unit 9020 when the loading unit 9020 is attached to the stem assembly 9116. In addition, in certain embodiments, a collar 9500 coupling can be swiveled to the 9020 loading unit.
[00348] With reference to Figures 106 and 107, as the loading unit 9020 moves between an unsecured position and a stapled position in relation to the elongated stem assembly 9116 of the surgical instrument 9010, the loading unit 9020 can move along a longitudinal axis of the LA-LA tool, as defined by the elongated stem assembly 9116. The distal attachment portion 9480 of the loading unit 9020 can be inserted into the distal attachment portion 9032 of the elongated stem assembly 9116 as the loading unit 9020 moves from the unsecured position to the stapled position. For example, the loading unit 9020 can move in the proximal direction "PD" (Figure 107) when the loading unit 9020 is moved between the unsecured position and the stapled position. In certain embodiments, a groove and slit engagement between the distal fixing portion 9480 and the distal fixing portion 9032 can guide the loading unit 20 along the longitudinal axis LA-LA defined by the elongated stem assembly 9116. Referring primarily to the Fig. 110, the distal fixing portion 9480 may include a guide rail 9482. In addition, with reference mainly to Fig. 112, the distal fixing portion 9032 may include a guide slot 9034. The guide slot 9034 can be sized and structured to receive and guiding the guide rail 9482 as the proximal fixing portion 9480 of the loading unit 9020 is inserted into the distal fixing portion 9032 of the elongated stem assembly 9116. For example, the guide slot 9034 may comprise a longitudinal slot and the rail Guide 9482 may comprise a longitudinal ridge, for example. In certain embodiments, the guide slot 9034 and the guide rail 9482 can prevent the loading unit 9020 from twisting and / or turning in relation to the longitudinal axis of the LA-LA tool.
[00349] Referring primarily to Figure 106, the distal fixation portion 9480 may include a first alignment symbol 9484, such as a first arrow, for example, and the elongated stem assembly 9116 and / or the coupling collar 9500 may include a second 9502 alignment symbol, such as a second arrow, for example. The alignment of the first and second alignment symbols 9484, 9502 can align the guide rail 9482 and the guide slot 9034, which can facilitate the attachment of the distal fixation portion 9480 to the distal fixation portion 9032. As described here, the translation of the loading unit 9020 along a longitudinal path towards the elongated stem assembly 9116 can reliably lock the loading unit 9020 in relation to the elongated stem assembly 9116. In such embodiments, the rotation of the loading unit 9020 in in relation to the 9116 elongated stem assembly may not be required to secure the 9020 loading unit in relation to the 9116 elongated stem assembly. In fact, the rotation of the 9020 loading unit in relation to the 9116 elongated stem assembly may be restricted and / or avoided by a groove and slit engagement between the distal fixing portion 9032 and the fixing portion 9480, as described herein. In various embodiments, the coupling collar 9500 can rotate with respect to the loading unit 9020 and / or the elongated stem assembly 9116 to releasably lock the loading unit 9020 to the elongated stem assembly 9116. For example, as described herein , the 9500 coupling collar can rotate from an initial orientation (Figure 120) towards a secondary orientation (Figure 121) and then return towards the initial orientation (Figure 124) to lock the 9020 loading unit to the stem assembly elongated 9116.
[00350] Referring mainly to Figures 110 and 111, the proximal portion 9480 of the loading unit 9020 may include a key or rotation rib 9486. As the loading unit 9020 is moved in the "PD" direction (Figure 106) between an unsecured position (Figure 106) and a stapled position (Figure 107), the rotation switch 9486 can affect the rotation of the 9500 coupling collar. For example, the rotation switch 9486 can rotate and / or force the 9500 coupling in direction B (Figure 107) from initial to secondary orientation. The distal fixation portion 9480 can be inserted into the distal fixation portion 9032 when the coupling collar 9500 is forced into the secondary orientation. In addition, when the distal fixation portion 9480 is fully inserted into the distal fixation portion 9032, the rotation key 9486 can allow the coupling collar 9500 to rotate in the C direction (Figure 107) of the secondary orientation toward the initial orientation. As used here, the term "fully inserted" as used in connection with the loading unit 9020 coupling for the elongated stem assembly 9116 means that the distal fixing portion 9480 of the loading unit 9020 has been fully inserted by snapping or operating engagement with the distal fixing portion 9032 of the elongated stem assembly 9116. Direction C can be opposite direction B, for example. As described here, when coupling collar 9500 returns to the initial orientation, coupling collar 9500 can lock distal attachment portion 9480 with respect to distal attachment portion 9032. Referring to Figures 110 and 111, the rotation key 9486 may include a rotation ramp 9488 at the proximal end thereof. The rotation ramp 9488 can engage an element of the stem assembly 9116 to rotate the 9500 rotation coupling collar, for example.
[00351] In various embodiments, the rotation ramp 9488 can affect the rotation of a firing rod 9104 positioned within the elongated rod assembly 9116. For example, with reference mainly to Figures 115 to 118, firing rod 9104 can include a firing rod rotor 9600 which can extend radially out of firing rod 9104. Rotation ramp 9488 of rotating switch 486 can engage firing rotor 9600 when loading unit 9020 is inserted into the assembly elongated stem 9116. In various embodiments, the rotation ramp 9448 can rotate the firing rod rotor 9600, which can rotate firing rod 9104. For example, firing rod 104 and firing rod rotor 9600 can rotate in direction B between a first orientation (Figure 121) and a second orientation (Figure 122). Also with reference to Figures 115 to 118, the firing rod 9104 can be engaged with the rotating coupling collar 9500. For example, the rotating coupling collar 9500 may include a rotor groove 9502, which can be structured and sized to receive and / or maintain the firing rod rotor 9600. The firing rod rotor 9600 can be secured by the groove of the rotor 9600, so that the rotation of the firing rod rotor 9600 rotates the rotating coupling collar 9500. In such cases modalities, the insertion of the loading unit 9020 in the elongated stem assembly 9116 can affect the rotation of the rotating coupling collar 9500 in direction B (Figure 122) by rotating the rotating stem 9600 in direction B, for example.
[00352] Referring mainly to Figures 112 and 113, the distal fixation portion 9032 can include a rotation key slot 9510 which can receive the rotation key 9486 when the distal fixation portion 9480 is inserted into the distal fixation portion 9032 In various embodiments, the rotating key slot 9510 may include a clearance notch 9512 for receiving the rotor of the firing rod 9600. For example, the rotating ramp 9488 at the proximal end of the rotating switch 9486 can rotate the rotor of the firing rod 9600 for the second orientation and clearance slot 9512 (Figure 122). The rotation key 9486 can continue to move along the slot of the rotation key 9510 when the loading unit 9020 is inserted into the elongated stem assembly 9116. In addition, when the distal end 9490 of the rotation key 9486 moves if in addition to the firing rod rotor 9600, the firing rod rotor 9600 can rotate back to the first orientation (Figure 126), which can correspondingly rotate the rotating coupling collar 9500 back to the initial orientation of the same.
[00353] In various embodiments, the 9500 rotating coupling collar can be forced in the initial orientation with respect to the elongated stem assembly 9116 and / or the distal fixing portion 9032. For example, a 9514 spring can force the 9500 coupling collar in the initial orientation. The spring 9514 can include a proximal end 9516 that can be attached to the elongated stem assembly 9116 and a distal end 9550 that can be attached to the coupling collar 9500. For example, the proximal end 9516 of the spring 9514 can be retained in a proximal spring slot 9556 (Figure 119) of stem assembly 9116 and the distal end 9550 of spring 9514 can be retained in a distal spring slot 9552 (Figure 114) of the swivel coupling collar 9500, for example. In such embodiments, the rotation of the coupling collar 9500 can displace the distal end 9550 of the spring 9514 with respect to the proximal end 9516 of the spring 9514, which can generate torsional force. Consequently, the 9500 coupling collar can resist rotation from the initial orientation to the secondary orientation and, when the coupling collar is rotated to the secondary orientation, the 9514 spring can force the 9500 coupling collar back to the initial orientation. Since the 9600 firing rod rotor is engaged with the 9500 coupling collar, spring 9514 can also force firing rod 9104 toward its first orientation.
[00354] In various embodiments, the swivel collar 9500 may include a locking holder 9518 that releasably locks loading unit 9020 to the elongated stem assembly 9116. Referring primarily to Figure 114, locking holder 9518 can extend radially into the inner perimeter of the swivel coupling collar 9500. In various embodiments, locking holder 9518 can extend into a retaining slot 9520 (Figure 112) in the distal fixing portion 9032. Referring mainly to Figure 112 , the retainer slot 9520 can form a notch in the guide slot 9034. In various embodiments, the retainer slot 9520 can extend from the guide slot 9034 and can be perpendicular or substantially perpendicular to the guide slot 9034, for example. In addition, locking holder 9518 can move along locking slot 9520 when the rotating coupling collar 9500 rotates between the initial orientation and the secondary orientation with respect to the elongated stem assembly 9116.
[00355] In various embodiments, locking holder 9518 can engage distal fixing portion 9480 of loading unit 9020 to lock loading unit 9020 with respect to elongated stem assembly 9116. For example, referring again to Figure 110 , the distal fixing portion 9480 may include the guide rail 9482, which may have a locking notch 9489 defined therein. Locking notch 9489 can be structured and dimensioned to receive locking holder 9518 of rotating coupling collar 9500 when loading unit 9020 is fully inserted into the distal fixing portion 9032. For example, when the distal fixing portion 9480 is fully inserted into the distal fixing portion 9032, the locking notch 9489 of the distal fixing portion 9480 can be aligned with the retainer slot 9520 of the distal fixing portion 9032. Consequently, the locking holder 9518 can slide along the slot of the holder 9520 in the distal fixation portion 9032 and in the locking notch 9489 in the distal fixation portion. In addition, locking holder 9518 can be tilted towards engagement with locking notch 9489 by torsion spring 9514. For example, after firing rod rotor 9600 releases distal end 9490 from rotation switch 9486, the firing rod 9104 can be forced back to the first orientation and the rotating coupling collar 9500 can be forced back in the direction of the initial orientation by the torsion spring 9514. In addition, when the 9500 coupling collar is rotated from the secondary orientation back to the initial orientation, the locking holder 9518 of the same can be aligned and engaged with the locking notch 9489 on the guide rail 9482.
[00356] In several modalities, the rotation of the 9500 coupling collar can facilitate the fixation and / or the alignment of a firing set. For example, firing rod 9104 can extend between a proximal end 9524 and a distal end 9522. Proximal end 9524 can have a rotating joint, which can allow rotation of firing rod 9104 between the first configuration and the second configuration. In addition, the distal end 9522 may have a coupler for securing the proximal engaging element 9467 of the drive beam assembly 9461 to the firing rod 104. Rotating the firing rod 9104 can facilitate the attachment of the proximal engaging element 9467. For example, as the coupler at the distal end 9522 of the firing rod 9104 rotates, the distal end 9522 is operationally coupled to the proximal engaging element 9467. In certain embodiments, the coupler may include a bayonet mount, which can engage a corresponding bayonet receiver of the cutting element in the loading unit 9020. With reference mainly to Figures 108 and 109, the firing assembly may additionally include a sleeve 9526 positioned around the firing rod 9104 between the proximal end 9524 and the distal end 9522, for example.
[00357] In various embodiments, when firing rod 9104 rotates within the elongated rod assembly 9116, firing rod 9104 can rotate in alignment with a firing rod slot 528 in loading unit 9020. For example, the rotor of the firing rod 9600 can be aligned with the slot of the firing rod 9528 when the loading unit 9020 is fully inserted and attached to the elongated stem assembly 9116. However, in various embodiments, when the loading unit 9020 is only partially inserted in the elongated stem assembly 9116, the firing rod rotor 9600 can be rotated, using the rotation key 9486, out of alignment with the firing rod slot 9528. In other words, the firing rod rotor 9600 can be aligned with the trigger rod slot 9482 when the trigger rod 9104 is in the first orientation and may not be aligned with the slot of the trigger rod 9482 when the trigger rod 9104 rotates in d direction to the second orientation. In such embodiments, when the loading unit is only partially inserted into the elongated stem assembly 9116 and / or before the loading unit 9020 is releasably locked to the elongated stem assembly 9116 by the rotating coupling collar 9500, the firing of the firing rod rotor 9600 can be blocked by the distal fixing portion 9480. The integration of firing rod 9104 and coupling collar 9500 can ensure that the loading unit 9020 is securely attached to the elongated rod assembly 9116 before the firing rod 9104 can fire and / or advance. For example, the surgical instrument may be unable to fire until the cutting element on loading unit 9020 is coupled to firing rod 9104 and / or until firing rod 9104 is properly aligned within the elongated rod assembly 9116, for example. example.
[00358] In certain embodiments, rotation of the 9500 collar can facilitate the attachment and / or alignment of a 9530 hinge assembly. Referring primarily to Figures 108 and 109, the 9530 hinge assembly may include a proximal hinge bar 9538, a distal pivot bar 9420 and a 9532 pivot connector. In addition, stem assembly 9116 can include a proximal pivot bar slot 9534 and the loading unit 9020 can include a distal pivot bar slot 9410, for example. In certain embodiments, the proximal pivot bar 9538 can be aligned with the slot of the proximal pivot bar 9534 and the distal pivot bar 9420 can be aligned with the slot of the distal pivot bar 410. Now with reference to Figures 114, the hinge connector 9532 can be housed in the swivel coupling collar 9500. For example, the swivel coupling collar 9500 can include a hinge connector slot 9536 and the hinge connector 9532 can be positioned movably within it.
[00359] In various embodiments, again with reference to Figures 108 and 109, the proximal pivot bar 9538 may have a proximal notch 9540 and the distal pivot bar 9420 may have a distal notch 9423. In addition, the 9532 pivot connector may include a proximal joint shoulder 9533 and a distal joint shoulder 9540. The proximal joint shoulder 9533 can be retained in the proximal notch 9540 of the proximal joint bar 9538. In certain embodiments, the distal articulation shoulder 9535 can engage the distal notch 9423 of the distal pivot bar 9420 is operational. As described here, the swivel coupling collar 9500 can rotate between the initial configuration and the secondary configuration. As the coupling collar 9500 rotates, the 9532 hinge connector housed in it can also rotate with respect to the longitudinal axis defined by the 9116 stem assembly. In several embodiments, the 9533 hinge connector proximal hinge 9533 can remain positioned in the proximal notch 9540 of the proximal pivot bar 9538 as the pivot connector 9532 rotates. In addition, the shoulder of the distal hinge 9535 of the hinge connector 9532 can move in engagement with the distal notch 9423 of the distal hinge bar 9420 as the hinge connector 9532 rotates with the coupling collar 9500 from the secondary orientation to the initial orientation. For example, when loading unit 9020 is fully inserted into stem 9488, distal notch 9423 of distal pivot bar 9420 can be aligned with the distal pivot shoulder 9533 of pivot connector 9532. In such embodiments, when the swivel collar 9500 rotates back to the initial configuration, the distal pivot shoulder 9533 can slide into the distal notch 9423 of the distal pivot bar 9420. When the distal pivot shoulder 9533 is positioned at the distal notch 9423, the 9530 pivot assembly can be fully mounted.
[00360] Referring mainly to Figure 113, in various embodiments, the slot of the proximal articulation bar 9534 may include a first clearance 9542 and a second clearance 9544. The proximal and distal articulation shoulders 9533, 9535 of the articulation connector 9532 can extend to the first and second clearances 942, 9544, respectively. In certain embodiments, the first and second clearances 9542, 9544 may provide a space for the proximal and distal joint shoulders 9533, 9535 to move as the collar 9500 rotates and / or as the joint 9530 pivots , for example.
[00361] Now with reference to Figures 119 to 126, to connect the loading unit to the elongated rod assembly 9116 of the surgical instrument, a user can align the alignment symbols 9484 of the loading unit 9020 with the alignment symbols 9502 of the set elongated stem 9116 and / or the 9500 coupling collar (Figure 119). While maintaining the alignment of the alignment symbols 9484, 9502, the user can move the loading unit 9020 relative to the elongated stem assembly 9116 along the LA-LA longitudinal axis. The user can move the loading unit 9020 along a straight or substantially straight path and, in various embodiments, does not need to rotate the loading unit in relation to the 9116 elongated stem assembly, for example. Referring mainly to Figure 121, the loading unit 9020 can continue to translate in relation to the elongated stem assembly 9116 and the guide rail 9482 of the distal fixing portion 9480 can fit into the guide slot 9034 (Figure 112) in the portion of distal fixation 9032 of the elongated shank assembly 9116. As the distal fixing portion 9480 moves to the distal fixing portion 9032, the guide slot 9034 can guide the guide rail 9482 and can maintain the alignment of the alignment symbols 9484, 9502, for example. In other words, the guide slot 9034 and the guide rail 9482 can prevent rotation of the loading unit 9020 with respect to the longitudinal axis of the elongated stem assembly 9116. Referring mainly to Figure 120, the proximal articulation shoulder 9533 of the connector pivot 9032 can extend to the first gap 9542 and can be positioned at the proximal notch 9540 of the proximal pivot bar 9420 and the distal pivot shoulder 9535 of the pivot connector 9032 can extend through the second gap 9544, for example.
[00362] With reference mainly to Figure 122, when the distal fixation portion 9480 is inserted into the proximal fixation portion 9032, the ramp of the rotation switch 9488 of the rotation switch 9486 may be in contiguity with the rotor of the firing rod 9600 The rotary switch ramp 9488 can guide and / or direct the rotor of the firing rod 9600 to the clearance slot 9512 extending from the slot of the rotating switch 9510. In addition, as the rotor of the firing rod 9600 moves to clearance slot 9512, firing rod 9104 can rotate in direction B. Firing rod 9104 can rotate from first orientation to second orientation. Such rotation of the firing rod 9104 can facilitate the attachment of the distal end 9522 of the firing rod 9104 with the proximal engagement element 9467 which is pivotally coupled to the driving beam assembly 9461. In addition, the rotation of the rotor of the rod firing 9600 can rotate coupling collar 9500 in direction B via the engagement between the rotating stem 9600 and the groove rotor 9600 on coupling collar 9500. Coupling collar 9500 can rotate from the initial orientation for secondary guidance, for example. In addition, locking holder 9518 can move along the slot of holder 9520 in stem assembly 9116 as the coupling collar 9500 rotates. Additionally, the rotation of the 9500 coupling collar can rotate the distal end 9550 of the 9514 spring because the distal end 9550 of the 9514 spring can be retained in the gap of the distal spring 9552 (Figure 114) in the 9500 coupling collar. The displacement of the distal end 9550 relative to the distal end 9516 can generate a torsional elastic return force that can force the coupling collar 9500 from the secondary orientation towards the initial orientation, for example, and can force the firing rod 9104 from the second orientation towards the first guidance, for example.
[00363] With reference mainly to Figure 123, as the coupling collar 9500 rotates towards the secondary orientation, the proximal joint shoulder 9533 can remain engaged with the proximal notch 9540 on the proximal joint bar 9538. In addition, the distal pivot shoulder 9535 can rotate so that distal pivot shoulder 9535 provides clearance for the distal pivot bar 9420 of the loading unit 9020. Referring to Figure 124, the loading unit 9020 can be fully inserted into the assembly elongated stem 9116 when coupling collar 9500 and hinge connector 9532 positioned on it are rotated to secondary orientation. In various embodiments, the distal pivot bar 9420 can release the shoulder of the distal pivot 9535 from the pivot connector 9532 when the pivot connector 9532 is rotated to the secondary orientation. In addition, the distal hinge shoulder 9535 can be pivotally aligned with the distal notch 9423 on the hinge connector 9532. Still referring to Figure 124, when the loading unit 9020 is fully inserted into the elongated stem assembly 9116, the firing rod rotor 9600 can release distal end 9490 from rotation switch 9486.
[00364] Now with reference to Figure 125, the firing rod rotor 9600 can rotate in the C direction when the distal end 9490 of the rotating switch 9486 passes beyond the firing rod rotor 9600. For example, the rod rotor trigger 9600 can rotate in the C direction of the second orientation towards the first orientation. In addition, the rotation of the 9600 firing rod rotor can affect the rotation of the 9500 coupling collar in direction C of the secondary orientation towards the initial orientation. In various embodiments, the spring 9514 can tilt the firing rod 9104 towards its first orientation and the collar 9500 towards its initial orientation. For example, the firing rod rotor 9600 may be positioned in the groove of the firing rod rotor 9602 (Figure 114) on the coupling collar 9500 so that the rotation of the firing rod rotor 9600 rotates the collar 9500. Due to the alignment of the shoulder of the distal joint 9535 of the joint connector 9532 and of the distal notch 9423 of the distal joint bar 9420, the joint connector 9532 can rotate as the coupling collar 9500 rotates and the shoulder of the distal joint 9535 can rotate to the engagement with the distal notch 9423. The hinge assembly 9530 can be mounted when the shoulder of the distal hinge 9535 engages the distal notch 9423. In addition, as the rotor of the firing rod 9600 rotates in the C direction, the distal end 9522 of firing rod 9104 can rotate in the C direction, which can facilitate the attachment of the proximal engaging element 9467 of the drive beam assembly 9461 to the distal end 9522 of firing rod 9104.
[00365] Now with reference to Figure 126, rotation of collar 9500 can also rotate locking holder 9518 of coupling collar 9500 to locking notch 9489 on guide rail 9482 of distal fixing portion 9480. For example, when loading unit 9020 is fully inserted into the elongated stem assembly 9116, locking notch 9489 can be aligned with the slot of the detent 9520, so that the detent lock 9518 can rotate through the detent slot 9520 and into the notch of the detent lock 9489. As described here, spring 9514 can force coupling collar 9500 to rotate in direction C (Figure 125) after firing rod rotor 9600 releases distal end 9490 of rotation switch 9486. Still referring to Figure 126, when the firing rod rotor 9600 rotates in the C direction, the firing rod rotor 9600 can move into alignment with the slot of the firing rod 9528 in the loading unit 9020. Alignment d the firing rod rotor 9600 with the firing rod slot 9528 can allow firing rod 9104 to be advanced distally to fire the loading unit 9020, for example.
[00366] As described here, the swivel coupling collar 9500 can releasably lock the loading unit 9020 in relation to the elongated stem assembly 9116. In addition, rotation of the coupling collar 9500 can facilitate attachment and / or simultaneous alignment of the hinge assembly 9530, as well as the fixing and / or alignment of the firing rod 9104 with a cutting head assembly on the loading unit 9020, for example. In addition, rotation of the coupling collar 9500 can also simultaneously unlock the loading unit 9020 elongated stem assembly 9116, disconnect the hinge assembly 9530 and / or disconnect the firing stem 104 from the cutting element in the loading unit 9020. For example, when the coupling collar 9500 is rotated again from the initial orientation towards the secondary orientation, the locking holder 9518 can disengage the locking notch 9489 on the distal fixing portion 9480. Consequently, the distal fixing portion 9480 can be withdrawal of the distal fixation portion 9032 along the longitudinal axis defined by the elongated stem assembly 9116, for example. In various embodiments, loading unit 9020 can be released from elongated stem assembly 9116 without rotating loading unit 9020 relative to elongated stem assembly 9116. However, coupling collar 9500 can rotate with respect to elongated stem assembly 9116, which can disconnect the distal pivot bar 9420 from the pivot connector 9532 on the coupling collar 9500 and can disconnect the firing rod 9104 from the cutting element or drive beam assembly on the loading unit 9020, for example.
[00367] Thus, as can be seen from the foregoing, at least one type of surgical instrument of the present invention includes a surgical end actuator comprising a lower jaw and an upper jaw. In one implementation, the upper jaw comprises a proximal portion of the upper jaw that is pivotally coupled to the lower jaw for selective pivoting displacement relative to it around a pivot axis between the open and closed positions, by applying closing and opening movements in the proximal upper jaw; A distal portion of the upper jaw can be movably coupled to the proximal portion of the upper jaw and is supported for parallel movement towards, and in the opposite direction, the lower jaw when the proximal portion of the upper jaw is in the closed position. A firing element can be operationally supported for operable displacement within the surgical end actuator with respect to the upper and lower jaws when the proximal upper jaw portion is in a closed position and firing movements are applied to the firing element.
[00368] In at least one implementation, the surgical instrument can employ a locking system that is configured to not only prevent the triggering system from acting, or, in other words, advance the cutting head through the elongated channel when a cartridge does not is present, but also to prevent the actuation of such a firing system, unless a new cartridge has been properly supported in the elongated channel. In such implementations, each new cartridge has a slide assembly held in the home position. When the cartridge has been correctly installed inside the elongated groove, the slider assembly connects with the locking system to allow the cutting head to be advanced distally through the cartridge. However, if a used cartridge was inadvertently installed in the elongated groove, the locking system will prevent the actuation of the cutting head, because the slider assembly will be located at the distal end of the cartridge, therefore, it will not be possible to connect with the locking system. Such a system will prevent the triggering system from acting again if the doctor fails to replace a used cartridge and tries to actuate the triggering system.
[00369] In at least one other implementation, a surgical instrument is provided that comprises an elongated stem set and a surgical end actuator that includes an elongated channel that is coupled to the elongated stem set. A surgical staple cartridge can be operationally supported in the elongated groove. The end actuator may additionally comprise an anvil assembly that includes a proximal anvil portion that is pivotally coupled to the elongated groove around a pivot axis. The proximal anvil portion is selectively movable between the open and closed positions by applying opening and closing movements. The anvil assembly may additionally comprise a distal anvil portion that is slidably coupled to the proximal anvil portion, so that when the proximal anvil portion is in a closed position, the distal anvil portion is movable with respect to it, while remaining parallel to the elongated channel. A trigger element can be operationally supported to perform the operable movement on the surgical end actuator by applying trigger and retraction movements to it. A firing system can be configured to selectively apply firing and retraction movements to the firing element. The instrument may also include a closing system to apply the opening and closing movements to the proximal portion of the anvil.
[00370] The devices described here can be designed to be discarded after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing specific parts and subsequent reassembly. In particular, the device can be disassembled and any number of specific parts or parts of the device can be selectively replaced or removed, in any combination. By cleaning and / or replacing specific parts, the device can be reassembled for subsequent use at the reconditioning facility or by a surgical team, immediately before a surgical procedure. Those skilled in the art will understand that the reconditioning of a device can use a variety of techniques to disassemble, clean / replace and reassemble. The use of such techniques and the resulting reconditioned device are within the scope of the present application.
[00371] In connection with another implementation, a surgical instrument is provided that includes an elongated shank set that defines a longitudinal axis of the tool. The instrument additionally includes a surgical end actuator that has an elongated groove that is movably coupled to the elongated stem assembly for selective pivoting displacement around a pivoting axis that is transversal to the longitudinal axis of the tool through the application of articulation movements there. The elongated channel can be configured to operationally support a surgical staple cartridge. An anvil set is pivotally coupled to the elongated channel for selective pivoting displacement in relation to it, between the open and closed positions around said pivoting axis by applying closing and opening movements to it.
[00372] Preferably, the invention described here will be processed before surgery. First, a new or used instrument is obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and the instrument are then placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays or high-energy electrons. The radiation kills bacteria on the instrument and the container. The sterile instrument can then be stored in a sterile container. The sealed container keeps the instrument sterile until it is opened in the medical unit.
[00373] Any patent, publication or other disclosure material, in whole or in part, that is taken as incorporated by reference to the present invention, is incorporated into the present invention only to the extent that the incorporated materials do not conflict with existing definitions, statements or other disclosure materials presented in this disclosure. Accordingly, and to the extent necessary, the disclosure as explicitly presented herein replaces any conflicting material incorporated by reference into the present invention. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other disclosure materials contained herein, will be incorporated here only insofar as there is no conflict between the material embedded and existing disclosure material.
[00374] Although this invention has been described as having exemplary designs, the present invention can be further modified within the spirit and scope of the disclosure. It is intended, therefore, that this application will cover any variations, uses or adaptations of the invention with the use of its general principles. In addition, this application is intended to cover those deviations from the present disclosure that may occur with known or customary practice in the technique to which this invention is related.

权利要求:
Claims (20)
[0001]
1. Surgical cutting and stapling instrument, comprising: a surgical end actuator (12; 1012; 3012; 4012; 5012) comprising: an elongated groove (14; 1014; 3014; 4014; 5014) configured to support so a surgical staple cartridge is operational in it; an anvil (20; 1020; 3020; 4020; 5020) supported in relation to the elongated groove, so that the anvil is configured to move in the opposite direction of the elongated groove; and a firing element (610; 1190; 3610; 4610; 5610) operationally supported for selective axial displacement through the surgical staple cartridge and the surgical cutting and stapling instrument still comprises: means to selectively move the anvil in relation to the elongated channel; and means for applying firing movements to the firing element to move the firing element within the surgical staple cartridge, characterized by the fact that the elongated groove is configured to move towards, and in the opposite direction of, the anvil, and in that the cutting and stapling surgical instrument still comprises means to selectively move the elongated channel in relation to the anvil.
[0002]
2. Surgical cutting and stapling instrument, according to claim 1, characterized by the fact that the elongated channel is configured to be pivotally coupled to an elongated stem set (100; 1100; 3100; 4100; 5100) in around a pivot axis and the anvil is pivotally supported in relation to the elongated channel for selective pivoting displacement in relation to the elongated channel around the pivot axis.
[0003]
3. Surgical cutting and stapling instrument, according to claim 1 or claim 2, characterized by the fact that the firing element comprises a tissue cutting head (1190, 4610) configured for axial displacement through the staple cartridge surgical, so that by applying one of the firing movements to it, the firing element moves the anvil to the deformable engagement with the surgical staple cartridge to form the surgical staples in it.
[0004]
4. Surgical cutting and stapling instrument, according to claim 1, characterized by the fact that the means to selectively move the elongated channel in relation to the anvil comprise a first jaw closure system that interfaces operationally with the elongated channel and configured to selectively move the elongated channel in relation to the anvil; wherein the means for electively moving the anvil relative to the elongated groove comprises a second jaw closure system that interfaces operatively with the anvil and configured to selectively move the anvil relative to the elongated groove; and wherein the means for applying firing movements to the firing element comprises a firing system that interfaces operatively with the firing element and configured to apply firing movements to the firing element to move the firing element within the cartridge of surgical staples.
[0005]
5. Surgical cutting and stapling instrument, according to claim 4, characterized by the fact that the first jaw closure system is configured to move a portion of the elongated channel in the direction, and in the opposite direction, of a corresponding portion of the anvil.
[0006]
6. Surgical cutting and stapling instrument, according to claim 5, characterized by the fact that the second jaw closure system is configured to move the corresponding portion of the anvil towards, and in the opposite direction, the portion of the elongated groove .
[0007]
7. Surgical cutting and stapling instrument according to any one of claims 4 to 6, characterized by the fact that the elongated channel is articulated coupled to a set of elongated rod around a pivoting axis and in which the anvil it is supported in an articulated manner in relation to the elongated channel for selective articulated displacement in relation to the elongated channel around the pivoting axis.
[0008]
8. Surgical cutting and stapling instrument according to any of claims 4 to 7, characterized in that the firing element comprises a tissue cutting head configured for axial displacement through the surgical staple cartridge, so that , by applying one of the firing movements on it, the firing element moves the anvil towards the elongated groove and separates the tissue trapped between the surgical staple cartridge supported on the elongated groove and the anvil.
[0009]
9. Surgical cutting and stapling instrument according to claim 8, characterized by the fact that the surgical staple cartridge comprises a bioabsorbable cartridge body (31) that operationally supports a plurality of surgical staples (32) in the same .
[0010]
10. Surgical cutting and stapling instrument, according to claim 7, characterized by the fact that it still comprises a handle (400; 1900; 3400, 4400, 5400) that operationally supports the portions of each of the first jaw closure, the second jaw closure system and the firing system in which the elongated stem assembly is operatively coupled to the surgical end actuator to transfer the first jaw control movements from the first control system from the jaw to the elongated groove, the second jaw control movements of the second jaw control system to the anvil and the firing movements of the firing system to the firing element.
[0011]
11. Surgical cutting and stapling instrument, according to claim 10, characterized by the fact that the first jaw control system comprises a first jaw actuating bar (150; 4150) movably supported by the elongated stem assembly for the selective axial displacement in response to the actuation of the first jaw closure system, with the first jaw actuating bar operationally interconnecting the elongated channel and the second jaw control system comprising a second jaw actuating bar (112 ; 4112) mobilely supported by the elongated stem assembly for selective axial displacement in relation to the first jaw actuating bar in response to the actuation of the second jaw closing system, with the second jaw actuating bar interconnecting in an operational way with the anvil.
[0012]
12. Surgical cutting and stapling instrument, according to claim 9, characterized by the fact that the firing element comprises a tissue cutting head configured for axial displacement through the surgical staple cartridge, so that, by means of application of one of the firing movements on the tissue cutting head, the tissue cutting head moves the anvil in a deformable engagement with the bioabsorbable cartridge body to form surgical staples supported therein, and separate the stapled tissue between the anvil and the cartridge of surgical staples.
[0013]
13. Surgical cutting and stapling instrument, according to claim 7, characterized by the fact that it still comprises a compartment that operationally supports portions of each one of the first jaw closure system, the second jaw closure system and the firing system therein, and since the elongated stem assembly is operationally coupled to the surgical end actuator to transfer the first jaw control movements from the first jaw control system to the elongated channel, the second movements jaw control of the second jaw control system for the anvil and the firing movements of the firing system for the firing element.
[0014]
14. Surgical cutting and fixation instrument, according to claim 1, characterized by the fact that it comprises: a compartment; an elongated stem assembly operably coupled to the compartment, wherein the elongated channel and anvil are movably coupled to a distal end of the elongated stem assembly; wherein the means for selectively moving the elongated channel in relation to the anvil comprises: a first jaw closure system operably supported by the compartment; a first jaw actuating bar, operationally supported by the elongated rod assembly and which operationally interconnects the elongated channel and the first jaw closure system, so that the performance of the first jaw closure system causes the elongated channel moves in relation to the anvil; wherein the means for electively moving the anvil relative to the elongated groove comprises: a second jaw closure system operably supported by the compartment; a second jaw actuating bar, operationally supported by the elongated rod assembly and which operationally interconnects the anvil and the second jaw closure system, so that the actuation of the second jaw firing system causes the anvil move in relation to the elongated channel; wherein the means for applying firing movements to the firing element to move the firing element within the surgical staple cartridge comprises: firing system operatively supported by the compartment and operably interconnecting the firing element, so that the actuation of the firing system causes the firing element to move axially in relation to the elongated channel and the anvil.
[0015]
15. Surgical cutting and fixing instrument, according to claim 14, characterized by the fact that the elongated channel and the anvil are pivotally coupled to the elongated stem set for pivoting displacement in relation to them, around a common axis.
[0016]
16. Surgical cutting and fixing instrument, according to claim 14 or claim 15, characterized by the fact that the compartment comprises a handle.
[0017]
17. Surgical cutting and fixing instrument according to any one of claims 14 to 16, characterized by the fact that the first jaw closure system is configured to move a portion of the elongated channel in the direction, and in the opposite direction, of a corresponding portion of the anvil.
[0018]
18. Surgical cutting and fixing instrument, according to claim 11, characterized by the fact that the second jaw closure system is configured to move the corresponding portion of the anvil towards, and in the opposite direction, the portion of the elongated groove .
[0019]
19. Surgical cutting and fixing instrument, according to claim 18, characterized by the fact that the firing element comprises a tissue cutting head configured for axial displacement through the surgical end actuator, so that, by means of the application of one of the firing movements to it, the firing element moves the anvil towards the elongated groove and separates the stapled tissue between the surgical staple cartridge supported on the elongated groove and the anvil.
[0020]
20. Surgical cutting and fixing instrument, according to claim 19, characterized by the fact that the surgical staple cartridge comprises a bioabsorbable cartridge body that operationally supports a plurality of surgical staples in it.

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同族专利:

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公开号 | 公开日

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EP2889010A1|2015-07-01|

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US9839428B2|2017-12-12|

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MX2016008379A|2017-01-09|

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RU2016130045A|2018-01-30|

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EP2889010B1|2017-05-10|

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US20150173746A1|2015-06-25|

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US20180110517A1|2018-04-26|

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PL2889010T3|2017-09-29|

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CN106061404A|2016-10-26|

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US11123065B2|2021-09-21|

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JP2017501806A|2017-01-19|

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CN106061404B|2018-12-04|

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WO2015100002A1|2015-07-02|

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JP6495293B2|2019-04-03|

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US20220054129A1|2022-02-24|

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RU2684353C2|2019-04-08|

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RU2016130045A3|2018-07-03|

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法律状态:
2020-03-03| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-12-08| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-02-23| 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 09/12/2014, 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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US14/138,485|2013-12-23|

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US14/138,485|US9839428B2|2013-12-23|2013-12-23|Surgical cutting and stapling instruments with independent jaw control features|

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