SURGICAL STAPLER WITH ACTUATORS ACTIVATED INDEPENDENTLY TO PROVIDE VARIED CLIP HEIGHTS

专利摘要:
The present invention relates to an apparatus that includes a body assembly, a drive shaft assembly and an end actuator. The drive shaft assembly includes an outer sheath and a motorized drive mechanism. The body assembly is configured to drive the drive mechanism. The end actuator includes a clamp platform, an anvil, a first clamp driver and a second clamp driver. The first staple driver is configured to fire a first annular matrix of staples from the plurality of staples against the anvil to deform the first annular matrix of staples at a first height of compressed staple. The second staple driver is configured to fire a second annular matrix of staples from the plurality of staples against the anvil to deform the second annular matrix of staples at a second height of compressed staple independently of the first staple driver. The first height of compressed clamp and the second height of compressed clamp are different.
公开号:BR112019026543A2
申请号:R112019026543-0
申请日:2018-05-23
公开日:2020-06-23
发明作者:D. Auld Michael；Michael D. Auld；E. Swensgard Brett；Brett E. Swensgard；Posada Sol；Sol Posada；J. Vendely Michael；Michael J. Vendely；E. Shelton Frederick Iv；Frederick E. Shelton Iv
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] In some cases, endoscopic surgical instruments may be preferred over traditional open surgery devices, as a smaller incision can reduce recovery time and complications in the postoperative period. Consequently, some endoscopic surgical instruments may be suitable for placing a distal end actuator in a desired surgical site through the trocar cannula. These distal end actuators can engage the tissue in various ways to obtain a diagnostic or therapeutic effect eg endocutter, claw, cutter, stapler, clip applicator, access device, drug delivery device / gene therapy and device for applying energy through the use of ultrasonic vibration, RF, laser, etc. Endoscopic surgical instruments may include a drive shaft between the end actuator and a handle portion, which is handled by the clinician. Such a drive shaft can enable insertion to a desired depth and rotation around the longitudinal geometric axis of the drive shaft, thus facilitating the positioning of the end actuator on the patient. The positioning of an end actuator can be further facilitated by the inclusion of one or more joints or articulation features, allowing the end actuator to be selectively articulated or otherwise deflected in relation to the longitudinal geometric axis of the drive.
[0002] [0002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers attach layers of fabric, cut through the layers of fabric attached, and insert staples into the fabric layers to substantially seal the cut layers of fabric together, close to their cut ends. Surgical staplers for example only are disclosed in US patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", granted on February 21, 2006; US Patent No. 7,380,696, entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism", issued on June 3, 2008; US Patent No. 7,404,508, entitled "Surgical Stapling and Cutting Vice," issued July 29, 2008; US Patent No. 7,434,715, entitled "Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout", issued October 14, 2008; US Patent No. 7,721,930, entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010; US Patent No. 8,408,439, entitled "Surgical Stapling Instrument with An Articulating End Effector", issued April 2, 2013; and in US patent no.
[0003] [0003] Although the surgical staplers mentioned above are described as being used in endoscopic procedures, such surgical staplers can also be used in open procedures and / or other non-endoscopic procedures. Just as an example, a surgical stapler can be inserted through a thoracotomy and, thus, between the patient's ribs, to reach one or more organs in a thoracic surgical procedure that does not use a trocar as a conduit for the stapler. Such procedures may include the use of a stapler to cut and close a blood vessel that reaches the lung. For example, vessels that go to an organ can be cut and closed by a stapler before the organ is removed from the chest cavity. Naturally, surgical staplers can be used in many other scenarios and procedures.
[0004] [0004] Examples of surgical staplers that may be particularly suitable, or used through a thoracotomy are disclosed in US Patent Application Publication No. 2014/0243801, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks ", published on August 28, 2014; US Patent Application Publication No. 2014/0239041, entitled "Lockout Feature for Moveable Cutting Member of Surgical Instrument", published on August 28, 2014; US Patent Application Publication No. 2014/0239038, entitled "Surgical Instrument with Multi-Diameter Shaft", published on August 28, 2014; and US Patent Application Publication No. 2014/0239044, entitled "Installation Features for Surgical Instrument End Effector Cartridge", published on August 28, 2014. Disclosure of each of the aforementioned US Patent Applications is incorporated into the present invention. as a reference.
[0005] [0005] Although several surgical instruments and systems have been developed and used, it is believed that nobody before the inventors has developed or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS
[0006] [0006] Although the specification concludes with claims that specifically indicate and distinctly claim this technology, it is believed that this technology will be better understood from the following description of certain examples, taken in conjunction with the accompanying drawings, in which figures equal reference points identify equal elements, and in which:
[0007] [0007] Figure 1 represents a perspective view of an exemplary surgical instrument including an interchangeable drive shaft set and a handle set;
[0008] [0008] Figure 2 represents a perspective view of the instrument in Figure 1, showing the drive shaft assembly disassembled from the instrument handle assembly;
[0009] [0009] Figure 3 represents a partial perspective view of the instrument of Figure 1, showing the drive shaft assembly disassembled from the instrument handle assembly;
[0010] [0010] Figure 4A represents a side elevation view of a proximal portion of the Figure 1 instrument, with a closing trigger in a first pivoting position and a firing trigger in a first pivoting position;
[0011] [0011] Figure 4B represents a side elevation view of a proximal portion of the instrument in Figure 1, with the closing trigger in a second pivoting position and the trigger in a second pivoting position;
[0012] [0012] Figure 4C represents a side elevation view of a proximal portion of the instrument in Figure 1, with the closing trigger in the second pivoting position and the trigger in a third pivoting position;
[0013] [0013] Figure 5 represents a perspective view of a proximal portion of the instrument of Figure 1, with the battery removed from the handle assembly;
[0014] [0014] Figure 6 represents a side elevation view of an array of axis sets of alternative drives that can be used with the instrument of Figure 1;
[0015] [0015] Figure 7 represents a cross-sectional view of the handle assembly of Figure 1, taken along line 7-7 of the
[0016] [0016] Figure 8 represents a perspective view of an interchangeable drive shaft assembly of the circular stapler that can be used with the handle assembly of Figure 1 to replace the interchangeable drive shaft assembly of Figure 1;
[0017] [0017] Figure 9 represents another perspective view of the interchangeable drive shaft assembly of the Figure 8 circular stapler;
[0018] [0018] Figure 10 represents a perspective view of an anvil assembly of the interchangeable drive shaft assembly of the circular stapler of Figure 8;
[0019] [0019] Figure 11 represents a perspective view of the distal end of a drive shaft assembly and of an interchangeable drive shaft assembly of Figure 8 circular stapler;
[0020] [0020] Figure 12 represents an exploded side view of the interchangeable drive shaft assembly of the Figure 8 circular stapler;
[0021] [0021] Figure 13 represents an exploded perspective view of the end actuator of Figure 11 and the distal end of the drive shaft assembly of Figure 11;
[0022] [0022] Figure 14 represents a top plan view of a platform member of the end actuator of Figure 11;
[0023] [0023] Figure 15 represents a perspective view of the platform member of Figure 14;
[0024] [0024] Figure 16 represents an exploded perspective view of a stapling and cutting assembly of the end actuator of Figure 11;
[0025] [0025] Figure 17 represents a perspective view of an external staple driver of the stapling and cutting assembly of Figure 16;
[0026] [0026] Figure 18 represents a perspective view of an internal staple driver assembly of the stapling and cutting assembly of Figure 16;
[0027] [0027] Figure 19 represents an exploded perspective view of the clip driver assembly Figure 18;
[0028] [0028] Figure 20 represents a perspective view of a blade set of the stapling and cutting set of Figure 16;
[0029] [0029] Figure 21 represents an exploded perspective view of the blade assembly of Figure 20;
[0030] [0030] Figure 22 represents a perspective view of the distal portion of the drive shaft assembly of Figure 11;
[0031] [0031] Figure 23A represents a cross-sectional side view of an external wrap of the drive shaft assembly of Figure 11 aligned to couple with a distal compartment of the drive shaft assembly, taken along line 23-23 of Figure 22;
[0032] [0032] Figure 23B represents a side view in cross section of the external envelope of Figure 23A coupled with the distal compartment of Figure 23A, taken along line 23-23 of Figure 22;
[0033] [0033] Figure 24 shows a top plan view of the distal compartment of Figure 23A;
[0034] [0034] Figure 25 represents a perspective view of the interchangeable drive shaft assembly of the Figure 8 circular stapler, in which the end actuator of Figure 11, the outer wrapper of Figure 23A, and the distal compartment of Figure 23A are omitted for the sake of clarity;
[0035] [0035] Figure 26 represents a perspective view of a proximal compartment of the fixation of the interchangeable circular stapler and of a proximal end of the drive shaft assembly of Figure 11, in which the outer wrapper of Figure 23A is omitted for the purposes of clarity;
[0036] [0036] Figure 27 represents an exploded perspective view of the interchangeable drive shaft assembly of the circular stapler of Figure 8, where the end actuator of Figure 11, the outer wrapper of Figure 23A, and the distal compartment of Figure 23A are omitted for the sake of clarity;
[0037] [0037] Figure 28 represents a perspective view of a clutch assembly of the interchangeable drive shaft assembly of the circular stapler of Figure 8;
[0038] [0038] Figure 29 represents an exploded perspective view of the clutch assembly of Figure 28;
[0039] [0039] Figure 30 shows a perspective view of a reciprocating translation element of the clutch assembly of Figure 28;
[0040] [0040] Figure 31 shows another perspective view of the translational reciprocating element of Figure 30;
[0041] [0041] Figure 32 represents a perspective view of the reciprocating translation element of Figure 30 coupled with a translation tube of the clutch assembly of Figure 28;
[0042] [0042] Figure 33 represents an exploded perspective view of a rotary shifter of the clutch assembly of Figure 28, an intermediate trigger drive shaft of the drive shaft assembly of Figure 11, and a drive arm of the drive shaft assembly. drive;
[0043] [0043] Figure 34 represents a perspective view of the rotary shifter of Figure 33;
[0044] [0044] Figure 35 represents another perspective view of the rotary shifter of Figure 33;
[0045] [0045] Figure 36A represents a perspective view in cross section of the clutch assembly of Figure 28, taken along line 36-36 of Figure 28, in which the rotary displacer of Figure 33 is engaged with the drive arm of Figure 33, while the intermediate firing drive axis of Figure 33 is in a first longitudinal position;
[0046] [0046] Figure 36B represents a perspective view in cross section of the clutch assembly of Figure 28, taken along line 36-36 of Figure 28, where the rotary displacer of Figure 33 is disengaged from the drive arm of Figure 33 , while the intermediate trigger drive axis of Figure 33 is in a first longitudinal position;
[0047] [0047] Figure 36C represents a perspective view in cross section of the clutch assembly of Figure 28, taken along line 36-36 of Figure 28, where the rotary displacer of Figure 33 is disengaged from the drive arm of Figure 33 , while the intermediate firing drive axis of Figure 33 is in a second longitudinal position;
[0048] [0048] Figure 37 represents a perspective view of a trocar set of the drive shaft assembly of Figure 11;
[0049] [0049] Figure 38 represents a perspective view of a longitudinal locking set of the trocar set of Figure 37;
[0050] [0050] Figure 39 represents an exploded perspective view of the longitudinal locking assembly of Figure 38;
[0051] [0051] Figure 40 shows a perspective view of a web coupling body of the longitudinal locking assembly of Figure 38;
[0052] [0052] Figure 41 represents a bottom plan view of the band coupling body of Figure 40;
[0053] [0053] Figure 42 represents a perspective view of a fixed body of the longitudinal locking assembly of Figure 38;
[0054] [0054] Figure 43 represents another perspective view of the fixed body of Figure 42;
[0055] [0055] Figure 44A represents a cross-sectional view of the longitudinal locking assembly of Figure 38, taken along line 44-44 of Figure 38, in which the longitudinal locking assembly is in a locked configuration and the drive arm of the Figure 33 is in a first longitudinal position;
[0056] [0056] Figure 44B represents a cross-sectional view of the longitudinal locking assembly of Figure 38, taken along line 44-44 of Figure 38, in which the longitudinal locking assembly is in an unlocked configuration and the drive arm of the Figure 33 is in a second longitudinal position;
[0057] [0057] Figure 44C represents a cross-sectional view of the longitudinal locking assembly of Figure 38, taken along line 44-44 of Figure 38, where the longitudinal locking assembly is in the unlocked configuration and the drive arm of Figure 33 is in a third longitudinal position;
[0058] [0058] Figure 44D represents a cross-sectional view of the longitudinal locking assembly of Figure 38, taken along line 44-44 of Figure 38, where the longitudinal locking assembly is in a locked configuration and the drive arm of the Figure 33 is in the third longitudinal position;
[0059] [0059] Figure 45 shows a perspective view of a reciprocating drive assembly of the drive shaft assembly of Figure 11;
[0060] [0060] Figure 46 represents another perspective view of the reciprocating drive assembly of Figure 45;
[0061] [0061] Figure 47 represents a bottom plan view of a reciprocating drive assembly of Figure 45;
[0062] [0062] Figure 48 represents an exploded perspective view of a distal end of the reciprocating drive assembly of Figure 45;
[0063] [0063] Figure 49A represents a side elevation view of a portion of the anvil assembly of Figure 10 inserted into an anatomical passage of a patient, and a portion of the driving shaft assembly of Figure 11 inserted into a second passage anatomical gem, with the drive shaft set and the anvil set aligned in preparation for coupling with each other;
[0064] [0064] Figure 49B represents a side elevation view of a portion of the anvil assembly of Figure 10 inserted into an anatomical passage of a patient, and a portion of the driving shaft assembly of Figure 11 inserted into a second passage. anatomical gem, with the trocar set in Figure 37 being attached to the anvil set, and the anvil set being in a first position;
[0065] [0065] Figure 49C represents a side elevation view of a portion of the anvil assembly of Figure 10 inserted into an anatomical passage of a patient, and a portion of the driving shaft assembly of Figure 11 inserted into a second passage. anatomical part, the trocar set in Figure 37 is attached to the anvil set, and the anvil set is moved to a second position to capture portions of the first anatomical pass and the second anatomical pass between the set of anvils. anvil and the drive shaft assembly;
[0066] [0066] Figure 50A represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of the assembly the reciprocating drive of Figure 45 is in a first rotational position aligned with the external clamp driver of Figure 17, with the external clamp driver being in a pre-triggered position;
[0067] [0067] Figure 50B represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of Figure 50A is in a first rotational position aligned with the external staple driver of Figure 17, the external staple driver being in a triggered position as the first distal position;
[0068] [0068] Figure 50C represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of Figure 50A is in a second rotational position aligned with the internal staple trigger assembly in Figure 18, with the internal staple trigger being in a pre-triggered position;
[0069] [0069] Figure 50D represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of Figure 50A is in the second rotational position aligned with the internal staple driver assembly of Figure 18, the internal staple driver assembly being in a triggered position as the first distal position;
[0070] [0070] Figure 50E represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, where the driving member of Figure 50A is in a third rotational position aligned with the blade set in Figure 20, the blade set being in a pre-triggered position;
[0071] [0071] Figure 50F represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, where the driving member of Figure 50A is in the third rotational position aligned with the blade set in Figure 20, with the blade set in a triggered position;
[0072] [0072] Figure 50G represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, where the driving member of Figure 50A is in the third rotational position aligned with the blade set of Figure 20, the blade set being in a post-triggered position;
[0073] [0073] Figure 51A represents a cross-sectional side view of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted into an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a second anatomical passageway for a patient, in which the tissue of the first and second anatomical passages is captured between the anvil assembly and the assembly drive shaft in preparation to form an anastomosis;
[0074] [0074] Figure 51B represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted within an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a second pass
[0075] [0075] Figure 51C represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted into an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a patient's second anatomical passage, in which the tissue of the first and second anatomical passages is captured between the anvil assembly and the set of axis, where the external staple driver of Figure 17 has staples driven through the first and second anatomical passages to help form an anastomosis;
[0076] [0076] Figure 51D represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted into an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a second anatomical passageway for a patient, in which the tissue of the first and second anatomical passages is captured between the anvil assembly and the assembly drive shaft, where the internal clamp driver assembly of Figure 18 is in the triggered position;
[0077] [0077] Figure 51E represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted within an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a second anatomical passageway for a patient, in which the tissue of the first and second anatomical passages is captured between the anvil assembly and the assembly drive shaft, in which the internal staple driver assembly of Figure 18 has staples driven through the first and second anatomical passages to help form an anastomosis;
[0078] [0078] Figure 51F represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted within an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a second anatomical passageway for a patient, in which the tissue of the first and second anatomical passages is captured between the anvil assembly and the assembly drive shaft, where the clamp assembly of Figure 20 is in the triggered position;
[0079] [0079] Figure 51G represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted into an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted into a patient's second anatomical passage, in which the tissue of the first and second anatomical passages is captured between the anvil assembly and the set of axis, on which the blade set of Figure 20 cut and removed the fabric inside the driven clips of Figure 51C and Figure 51E;
[0080] [0080] Figure 51H represents a side view in cross section of the anvil set of Figure 10, taken along line 51- 51 of Figure 9, with the anvil set inserted within an anatomical passage of a patient , and a portion of the drive shaft assembly of Figure 11 inserted within a second anatomical passage of a patient, in which the anvil assembly is actuated distally from the newly stapled and cut tissue;
[0081] [0081] Figure 511 represents a cross-sectional side view of the newly formed anatomical passage, with the anvil assembly of Figure 10 and the drive shaft assembly of Figure 11 removed, leaving a newly formed anastomosis between the first anatomical passage of a patient and the second anatomical passage of a patient;
[0082] [0082] Figure 52A represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of the assembly the reciprocating drive of Figure 45 is in a first rotational position aligned with the external clamp driver of Figure 17, with the external clamp driver being in a pre-triggered position;
[0083] [0083] Figure 52B represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of the assembly the reciprocating drive of Figure 45 is in a first rotational position aligned with the external clamp driver of Figure 17, with the external clamp driver being in a triggered position in a second distal position;
[0084] [0084] Figure 53A represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of the assembly the reciprocating drive of Figure 45 is in a first rotational position aligned with the external clamp driver of Figure 17, with the external clamp driver being in a pre-triggered position;
[0085] [0085] Figure 53B represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of the assembly the reciprocating drive of Figure 45 is in a first rotational position aligned with the external clamp driver of Figure 17, with the external clamp driver being in a triggered position in a third distal position;
[0086] [0086] Figure 54A represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of Figure 50A is in a second rotational position aligned with the internal staple trigger assembly in Figure 18, with the internal staple trigger being in a pre-triggered position;
[0087] [0087] Figure 54B represents a side elevation view of a portion of the drive shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the drive member of Figure 50A is in the second rotational position aligned with the internal clamp driver set in Figure 18, with the internal clamp driver set in a triggered position in a second distal position;
[0088] [0088] Figure 55A represents a side elevation view of a portion of the shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the driving member of Figure 50A is in a second rotational position aligned with the internal staple trigger assembly in Figure 18, with the internal staple trigger being in a pre-triggered position;
[0089] [0089] Figure 55B represents a side elevation view of a portion of the drive shaft assembly of Figure 11 and the end actuator of Figure 11, with certain portions omitted for clarity, in which the drive member of Figure 50A is in the second rotational position aligned with the internal clamp driver set in Figure 18, with the internal clamp driver set in a triggered position in a third distal position;
[0090] [0090] Figure 56 represents a side elevation view of the external staple driver assembly of Figure 17 or the internal staple driver assembly of Figure 18 in a triggered position, in which the fabric of a first and a second passage anatomical features of a patient are captured between the anvil and the drive shaft assembly, where the internal staple driver assembly or the external staple driver assembly is in the pre-released position;
[0091] [0091] Figure 57 represents a side elevation view of the external staple driver assembly of Figure 17 or the internal staple driver assembly of Figure 18 in a triggered position, in which the fabric of a first and a second passage anatomical features of a patient are captured between the anvil and the drive shaft assembly, where the internal staple driver assembly and or external staple driver assembly is in the first distal position shown in Figures 50B or 50D;
[0092] [0092] Figure 58 represents a side elevation view of the external staple driver assembly of Figure 17 or the internal staple driver assembly of Figure 18 in a triggered position, in which the fabric of a first and a second passage anatomical features of a patient are captured between the anvil and the drive shaft assembly, where the internal staple driver assembly or the external staple driver assembly is in the second distal position shown in Figures 52B or 54B;
[0093] [0093] Figure 59 represents a side elevation view of the external staple driver assembly of Figure 17 or the internal staple driver assembly of Figure 18 in a triggered position, in which the fabric of a first and a second passage A patient's anatomical anatomy is captured between the anvil and the drive shaft assembly, where the internal staple driver assembly or the external staple driver assembly is in the third distal position shown in Figures 53B or 55B;
[0094] [0094] Figure 60 represents a flowchart of an exemplary firing process that can be used by the cable assembly of Figure 1 in combination with the interchangeable circular stapler drive shaft assembly of Figure 8, where a variable clamp compression height can be selected;
[0095] [0095] Figure 61A represents a side elevation view of a portion of the alternate drive shaft assembly, with certain portions omitted for the sake of clarity, where the drive member of Figure 50A is in a first rotational position aligned with the external staple driver in Figure 17, the external staple driver being in a pre-triggered position;
[0096] [0096] Figure 61B represents a side elevation view of a portion of the drive shaft assembly of Figure 61A, with certain portions omitted for clarity, where the driving member of Figure 50A is in a first rotational position aligned with the external clamp trigger in Figure 17, the external clamp trigger being in a triggered position;
[0097] [0097] Figure 61C represents a side elevation view of a portion of the drive shaft assembly of Figure 61A, with certain portions omitted for clarity, where the driving member of Figure 50A is in a second rotational position aligned with the the internal staple driver assembly in Figure 18, the internal staple driver being in a pre-triggered position;
[0098] [0098] Figure 61D represents a side elevation view of a portion of the drive shaft assembly of Figure 61A, with certain portions omitted for clarity, where the driving member of Figure 50A is in a second rotational position aligned with the the internal staple driver assembly in Figure 18, the internal staple driver assembly being in a triggered position;
[0099] [0099] Figure 61E represents a side elevation view of a portion of the drive shaft assembly of Figure 61A, with certain portions omitted for clarity, where the drive member of Figure 50A is in a third rotational position there - combined with the blade set in Figure 20, the blade set being in a pre-triggered position;
[0100] [0100] Figure 62A represents a cross-sectional side view of an exemplary alternative circular stapler end actuator, with a staple driver and a platform member in a proximal position; and
[0101] [0101] Figure 62B shows a side cross-sectional view of the end actuator of Figure 62A, with the clamp driver and the platform member in a distal position.
[0102] [0102] The drawings are not intended to be limiting in any way and it is envisaged that various modalities of technology can be implemented in a variety of other ways, including those not necessarily represented in the drawings. The attached drawings that form part of the specification illustrate various aspects of the present technology and, together with the description,
[0103] [0103] The following description of certain examples of the technology should not be used to limit its scope. Other examples, resources, aspects, modalities and advantages of the technology will become evident to those versed in the technique from the following description, which is given by way of illustration, one of the best ways contemplated to implement the technology. As will be understood, the technology described here is capable of other different and obvious aspects, all without disregarding the technology. Consequently, drawings and descriptions should be considered as illustrative and not restrictive in nature.
[0104] [0104] It is further understood that any one or more of the teachings, expressions, modalities, examples etc. here described can be combined with any one or more of the other teachings, expressions, modalities, examples etc. which are described in the present invention. The teachings, expressions, modalities, examples etc. described below should not be seen in isolation from each other. Various suitable ways in which the teachings of the present invention can be combined will become readily apparent to those skilled in the art in view of the teachings of the present invention. These modifications and variations are intended to be included in the scope of the appended claims.
[0105] [0105] For clarity of description, the terms "proximal" and "distal" are defined here in relation to an operator or other operator who holds a surgical instrument that has a distal surgical end actuator. The term "proximal" refers to the position of an element closer to the operator or another operator, and the term "distal" refers to the position of an element closer to the surgical end actuator of the surgical instrument and more distant from the operator or the other operator. Although the surgical instruments described here comprise motorized implements for cutting and stapling, it will be observed that the configurations described here can be used with any suitable type of electrical surgical instrument, such as cutters, tweezers, staplers, RF cutters / coagulators, cutters ultrasonic pain / coagulators and laser cutters / coagulators, for example. |. Overview of exemplary surgical instrument
[0106] [0106] Figure 1 represents a motor-driven surgical cutting and clamping instrument 10 that includes a handle assembly 11 and a removable drive shaft assembly 16. In some versions, the handle assembly 11 and the shaft assembly of drive 16 is each supplied as single use disposable components. In some other versions, the handle assembly 11 and the drive shaft assembly 16 are each supplied as reusable components. As another illustrative example, the drive shaft assembly 16 can be supplied as a single-use disposable component, while the handle assembly is provided as a reusable component. Various suitable ways in which reusable versions of the handle assembly 11 and the drive shaft assembly 16 can be modified and coupled will become apparent to those skilled in the art based on the teachings of the present invention.
[0107] [0107] The handle assembly 11 of the present example includes a compartment 12, a closing trigger 32 and a trigger trigger 33. At least a portion of the compartment 12 forms a handle 14 that is configured to be held, handled and actuated by the doctor. The compartment 12 is configured for operational fixation to the drive shaft assembly 16, which has a surgical end actuator 18 operationally coupled to it. As described below, end actuator 18 is configured to perform one or more surgical tasks or procedures. In particular, the end actuator 18 of the example shown in Figure 1 is operable to perform a surgical cutting and stapling procedure, similar to a conventional end cutter end actuator, although this is only an illustrative example.
[0108] [0108] Figure 1 illustrates a surgical instrument 10 with the interchangeable drive shaft assembly 16 operationally coupled to the handle assembly 11. Figures 2 and 3 illustrate the attachment of the interchangeable drive shaft assembly 16 to the cable housing 12 Cable 14 includes a pair of interconnectable cable compartment segments 22, 24 that can be interconnected by screws, plug-in features, adhesive, etc. In the illustrated arrangement, the cable compartment segments 22, 24 cooperate to form a pistol grip portion 26 that can be held and handled by the physician. As will be discussed in greater detail below, cable 14 operationally supports a plurality of drive systems in it, which are configured to generate and apply various control movements to the corresponding portions of the interchangeable drive shaft assembly 16 which is operationally attached to the same. As will be discussed in more detail below, the triggers 32, 33 are pivoting towards the pistol grip portion 26 to activate at least some of the drive systems on the handle 14.
[0109] [0109] At least some of the drive systems in the handle assembly 11 are driven by a motor 118, which is shown schematically in Figure 5. In the present example, the motor 118 is located in the grip portion of the gun 26, although it should be understood that the motor 118 can be located in any other suitable position. The 118 engine receives power from a battery
[0110] [0110] As also shown schematically in Figure 5, a control circuit 117 is contained in cable 14. Only by way of example, control circuit 117 can comprise a microcontroller and / or several other components, as will be evident to the versed in the technique, in view of the teachings of the present invention. Control circuit 117 is configured to store and execute control algorithms to drive motor 118. As also shown in Figure 5 and Figure 7, cable 14 includes an encoder 115 in communication with control circuit 117. The encoder 115 is configured to read a plurality of markings 85 located on longitudinal drive member 86. Each mark 85 is associated with a corresponding longitudinal position of longitudinal drive member 86. Additionally, as mentioned above, motor 118 is operable to actuate the longitudinal drive member 86. For example, as the motor 118 rotates, the motor 118 can rotate an idle gear 119, which in turn can intertwine with the teeth 88 of the longitudinal drive member 86 , so I touch the longitudinal drive member 86 in a linear direction. Therefore, as motor 118 drives longitudinal drive member 86, encoder 115 can read the markings 85 on longitudinal drive member 86 to track and determine the longitudinal position of longitudinal drive member 86. The encoder
[0111] [0111] Although in the present example, encoder 115 and markings 85 are used to determine the longitudinal position of the longitudinal drive member 86, any other suitable components can be used to track and determine the longitudinal position. longitudinal drive member 86. As a further example only, a stepper motor can be used to drive longitudinal drive member 86 in a way that provides precise control of the longitudinal position of the longitudinal drive member 86.
[0112] [0112] Control circuit 117 is also configured to trigger a graphical user interface 116, which is located at the proximal end of the handle assembly 11. In some versions, control circuit 117 is configured to receive and process one or more signals from the drive shaft assembly 16. Only by way of example, control circuit 117 can be configured and operated in accordance with at least some of the teachings of US patent publication No. 2015/0272575, entitled "Surgical Instrument Comprising a Sensor System", published on October 1, 2015, the description of which is incorporated herein by reference. Other suitable ways in which the control circuit 117 can be configured and operated will be apparent to those skilled in the art in view of the teachings of the present invention.
[0113] [0113] As can be seen better in Figure 3, a structure 28 of the cable 14 operationally supports a plurality of drive systems. In this particular example, structure 28 operationally supports a "first" drive system or a closing drive system, generally designated as 30, which can be used to apply closing and opening movements to the interchangeable drive shaft assembly 16 which is operationally fixed to it. Also in this particular example, the closing drive system 30 includes an actuator in the form of a closing trigger 32 that is pivotally supported by structure 28. More specifically, the closing trigger 32 is pivotally coupled to the compartment 14 by a pin (not shown). Such an arrangement allows the closing trigger 32 to be handled by a physician so that when the physician holds the pistol grip portion 26 of the handle 14, the closing trigger 32 can be easily pivoted from a starting position or "not actuated" (Figure 4A) towards the pistol grip portion 26 to an "acted" position; and more particularly, to a fully compressed or fully actuated position (Figure 4B). The closing trigger 32 can be moved to the non-spring loaded position or other displacement arrangement (not shown).
[0114] [0114] In the present example, the closing drive system 30 additionally includes a closing hinge assembly 36, which is pivotally coupled to the closing trigger
[0115] [0115] Still with reference to Figures 1 to 3, the first closing link (not shown) is configured to cooperate with a closing release assembly 44 that is pivotally coupled to the structure 28. In at least one For example, the closing release assembly 44 has a release button assembly 46 with a distal projecting tongue (not shown) formed thereon. The release button assembly 46 can be pivoted counterclockwise by a release spring (not shown). As the doctor presses the closing trigger 32 from its unacted position towards the pistol grip portion 26 of the handle 14, the first closing link (not shown) pivots up to a point where a tongue locking mechanism (not shown) falls into a retaining hitch with the first closing link (not shown), thus preventing the closing trigger 32 from returning to the unacted position. In this way, the closing release assembly 44 serves to lock the closing trigger 32 in the fully actuated position.
[0116] [0116] When the physician wishes to unlock the closing trigger 32 from the actuated position to return to the unactivated position, the physician simply pivots the closing release button assembly 46 by pressing the closing release button assembly 46 distally, so that the locking tab (not shown) is moved out of the engagement with the first closing link (not shown). When the locking tab (not shown) has been moved out of the engagement with the first closing link (not shown), the closing trigger 32 can return to the unacted position in response to a resilient displacement forcing the closing trigger
[0117] [0117] The interchangeable drive shaft assembly 16 additionally includes a hinge joint 52 and a hinge lock (not shown) that can be configured to reliably retain end actuator 18 in a desired position relative to to a longitudinal axis of the drive shaft assembly 16. In the present example, the pivot joint 52 is configured to allow the end actuator 18 to be laterally offset away from the longitudinal axis of the axis assembly drive 16, as is known in the art. Only by way of example, end actuator 18, hinge joint 52 and hinge lock (not shown) can be configured and operable in accordance with at least part of the teachings of US Publication No. 2014/0263541, entitled "Articulatable Surgical Instrument Awarding an Articulation Lock", published on September 18, 2014.
[0118] [0118] In the present example, the articulation in the articulated joint 52 is motorized through the motor 118, based on the operator control input through an articulation control oscillator 112 in the handle assembly 11. Only as an example, when the operator presses on the upper portion of the articulation control oscillator 112, the end actuator 18 can laterally pivot to the right (visualization instrument 10 from above) 52 on the articulated joint; and when the operator presses on the lower portion of the articulation control oscillator 112, the end actuator 18 can laterally pivot to the left (viewing instrument from above) 52 on the articulated joint. In some versions, the other side of the handle assembly 11 includes another joint control oscillator 112. In such versions, the joint control oscillator 112 on the other side of the handle assembly 11 can be configured to provide the rotation of end actuator 18 in directions opposite to those mentioned above in response to the upper actuation of the control joint oscillator 112 and the lower actuation of the joint control oscillator 112. For example, the control oscillator joint 112 and the rest of the features that provide the motorized joint of the end actuator 18 on the joint 52 can be configured and operable according to at least some of the teachings in US publication 2015/0280384, entitled "Surgical Instrument Comprising a Rotatable Shaft ", published on October 1, 2015, the description of which is incorporated herein by reference. Other suitable ways in which the articulation control oscillator 112 and the rest of the characteristics that provide the motorized articulation of the end actuator 18 in the articulated joint 52 can be configured and operated will be evident to those skilled in the art in view of the teachings of the present invention.
[0119] [0119] The end actuator 18 of the present example comprises a lower jaw in the form of an elongated groove 48 which is configured to operationally support a staple cartridge within it. The end actuator 18 of the present example additionally includes an upper jaw in the form of an anvil 50 which is pivotally supported in relation to the elongated channel 48. The interchangeable drive shaft assembly 16 additionally includes a proximal compartment or nozzle 54 comprised of nozzle portions 56, 58; and a closing tube 60 that can be used to close and / or open the anvil 50 of the end actuator 18. The drive shaft assembly 16 also includes a reciprocating closing element 62 that is slidably supported within a chassis 64 of a drive axis 16 such that the reciprocating closing element 62 can be axially moved relative to the chassis 64. The reciprocating closing element 62 includes a pair of proximally projecting hooks 66 that are configured for fixing to the fixing pin 42 which is fixed to the second closing link 38. An unseen proximal end of the closing tube 60 is coupled to the reciprocating closing element 62 for relative rotation with respect to it, although the coupling of the closing tube closing 60 with reciprocating closing element 62 provides that the closing tube 60 and the reciprocating closing element 62 will translate longitudinally with each other. A closing spring (not shown) is seated on the closing tube 60 and serves to move the closing tube 60 in the proximal direction PD, which can serve to pivot the closing trigger 32 to the unacted position when the drive shaft assembly 16 is operationally coupled to cable 14.
[0120] [0120] In the present example, the hinge joint 52 includes a double pivot closure sleeve assembly 70. The double pivot closure sleeve assembly 70 includes an end actuator closure sleeve assembly 72 for engaging a flap opening on the anvil 50 in the various ways described in US Publication No. 2014/0263541, the description of which is incorporated herein by way of reference. The double pivot locking sleeve assembly 70 is coupled with the closing tube 60 so that the double pivot closing sleeve assembly 70 translates with the closing tube 60 in response to the pivoting movement of the closing trigger 32, even when the pivot joint 52 is in an articulated state (i.e., when the end actuator 18 is pivotally deflected laterally in the direction opposite the longitudinal axis of the drive shaft assembly 16 at the pivot joint 52). In addition, the engagement of the end actuator closure sleeve assembly 72 with the anvil 50 provides pivoting movement of the anvil 50 towards the staple cartridge 20 in response to the distal translation of the end closure sleeve assembly. double pivot 70 and closing tube 60; and the pivoting movement of the anvil 50 away from the staple cartridge in response to the proximal translation of the double pivot locking sleeve assembly 70 and the closing tube 60. Although the drive shaft assembly 16 of the present example includes a pivot joint 52, other interchangeable drive shaft assemblies may not have pivot capabilities.
[0121] [0121] As shown in Figure 3, the chassis 64 includes a pair of tapered fastening portions 74 formed therein that are adapted to be received within corresponding slot slots 76 formed within a flange portion. distal fastening 78 of the structure 28. Each slot 76 can be tapered or generally V-shaped to seat the fastening portions 74 thereon. A drive shaft fixation pin 80 is formed on the proximal end of an intermediate firing drive shaft 82. Thus, when the interchangeable drive shaft assembly 16 is coupled to the cable 14, the drive pin drive shaft fixing 80 is received in a firing drive shaft fixing cradle 84 formed at a distal end of a longitudinal drive member 86. When the driving shaft fixing pin 80 is received in the driving cradle coupling of the trigger drive shaft 84, the intermediate drive shaft 82 will travel longitudinally with the longitudinal drive member 86. When the intermediate drive shaft 82 travels distally, the drive shaft of intermediate trigger 82 drives the end actuator
[0122] [0122] Figures 4A to 4C show the different states of the handle set 11 during the different actuation states of the end actuator 18. In Figure 4A, the handle set 11 is in a state where the closing trigger 32 is in an unactivated pivot position and the trigger trigger 33 is in an unactivated pivot position. At this stage, the end actuator 18 is in an open state where the anvil 50 is pivoted out of the staple cartridge 20.
[0123] [0123] In Figure 4B, the handle assembly 11 is in a state where the closing trigger 32 is in an actuated pivoting position. As noted above, the closing trigger 32 will be locked in this position until the operator activates the release button assembly 46. At this stage, the end actuator is in a closed position but not triggered where the anvil 50 is pivoted towards the staple cartridge 20, so that the fabric is being compressed between the anvil 50 and the cartridge 20. However, the firing drive shaft 82 has not yet been driven distally to actuate the staples of the staple cartridge 20, and the knife at the distal end of the firing drive shaft 82 has not yet separated the fabric between the anvil 20 and the staple cartridge 20. It should be noted that the firing trigger 33 is in a pivoting position partially actuated in Figure 4B , due to the travel of the closing trigger 32 from the unactivated pivot position to the actuated pivot position. However,
[0124] [0124] In Figure 4C, the handle assembly is in a state where the closing trigger 32 remains in the actuated pivot position, and the trigger trigger 33 has been pivoted to an actuated pivot position. This actuation of the trigger trigger 33 activates the motor 118 to drive the longitudinal drive member 86 longitudinally, which in turn drives the drive drive drive shaft 82 longitudinally. The longitudinal movement of the trigger drive shaft 82 results in the clamps of a staple cartridge 20 being driven into the compressed tissue between the bib 50 and the staple cartridge 20; and additionally results in cutting the compressed tissue between the anvil 50 and the staple cartridge 20. In some versions, an additional safety trigger is provided. For example, the additional safety trigger can prevent trigger trigger 33 from firing until the safety trigger is triggered. In other words, after the state shown in Figure 4B has been reached, when the operator is ready to activate the trigger trigger 33, the operator must first activate the safety trigger and then activate the trigger trigger 33. The presence of a safety trigger can prevent inadvertent trigger trigger 33.
[0125] [0125] It should also be understood that, in the present example, the drive of the anvil 50 towards the staple cartridge 20 is provided through purely mechanical couplings between the closing trigger 32 and the anvil 50, so that the motor 118 is not used to act on anvil 50. It should also be understood that, in the present example, the actuation of the trigger drive shaft 82
[0126] [0126] In the present example, the handle set 11 also includes a "start" button 114. Just as an example, when the anvil 50 is in a closed position, the "start" button 114 can be operable to activate the engine 118 to retract drive member 86 proximally to a more proximal "start" position. In addition, or as an alternative, when the anvil 50 is in an open position, the "start" button 114 can be operable to activate the motor 118 to activate the articulation joint 52 to reach an un-articulated state, so that the end actuator 18 is aligned coaxially with the drive shaft assembly 16. In addition, or as an alternative, the "home" button 114 can activate the graphical user interface button 116 to return to a "home" screen . Other suitable operations that can be provided in response to the activation of the "start" button 114 will be evident to those skilled in the art in view of the teachings of the present invention.
[0127] [0127] The drive shaft assembly 16 of the present example includes a locking system for removably coupling the drive shaft assembly 16 to the handle assembly 11 and, more specifically, to the frame 28. Just as an example, this locking system can include a locking fork or other type of locking member that is movably attached to the chassis 64. As shown in Figure 3, such locking fork can include two locking pins that protrude proximally 96 which are configured for releasable engagement with the corresponding locking retainers or locking grooves 98 in frame 28. In some versions, the locking fork is tilted proximally by a resilient member (for example, a spring, etc.). The locking fork can be actuated by a locking button 100 that is slidably mounted on a locking actuator assembly 102 that is mounted on chassis 64. Locking button 100 can be forced in a proximal direction in relation to the locking fork. The locking fork can be moved to an unlocked position by pressing the locking button 100 in the distal direction, which also causes the locking fork to pivot out of the retaining engagement with frame 28. When the fork The locking pin is in a "retention slot" with frame 28, the locking pins 96 are seated in a retentive manner within the corresponding locking retainers or grooves 98. Just as an additional example,
[0128] [0128] To initiate the coupling process between the drive shaft assembly 16 and the handle assembly 11, the physician can position the frame 64 of the interchangeable drive shaft assembly 16 above or adjacent to the frame 28 so that the tapered clamping portions 74 formed in the chassis 64 are aligned with the slot slots 76 in the frame 28. The physician can then move the drive shaft assembly 16 along an installation geometry axis IA that it is perpendicular to the longitudinal axis of the drive shaft assembly 16 to seat clamping portions 74 in "operating engagement" with the corresponding groove receiving slots 76. In doing so, the driving shaft clamping pin 80 on the shaft intermediate trigger drive 82 will also be seated in the cradle 84 on the longitudinally movable drive member 86 and the pin 42 portions in the second locking link 38 will be seated on the corresponding hooks 66 in the mobile closing element 62. As used here, the term "operational coupling" in the context of two components means that the two components are sufficiently coupled to each other so that, through application of a movement of action to them, the components can carry out their intended action, function and / or procedure.
[0129] [0129] As discussed above, at least five systems of the interchangeable drive shaft assembly 16 can be operatively coupled to at least five corresponding systems of the cable 14. A first system comprises a frame system that couples and / or aligns the structure or the central column of the drive shaft assembly 16 with the structure 28 of the cable 14. A second system is the locking system that reliably locks the drive shaft assembly 16 to the cable 14.
[0130] [0130] A third system is a closing drive system 30 that can operationally connect the closing trigger 32 of the cable 14 and the closing tube 60 and the anvil 50 of the drive shaft assembly 16. As outlined above, the reciprocating closing element 62 of the drive shaft assembly 16 engages with pin 42 on the second closing link 38. Through the closing drive system 30, the anvil 50 pivots towards the staple cartridge 20 and in the opposite direction based on a pivoting movement of the closing trigger 32 in the direction of the pistol handle 26 and in the opposite direction.
[0131] [0131] A fourth system is a linkage and a trigger drive system that operationally connects a trigger trigger 33 of cable 14 to the intermediate trigger drive shaft 82 of the drive shaft assembly 16. As outlined above , the drive shaft fixing pin 80 operationally connects to the cradle 84 of the longitudinal drive member 86. This fourth system provides motorized actuation of both the articulated joint 52 and the clamp cartridge 20, depending on the pivoting position of the trigger closing 32. When the closing trigger 32 is in an unactivated pivoting position, the fourth system operationally connects to the articulation control oscillator 112 with the articulation joint 52, thus providing a motorized pivoting deflection of the actuator. end 18 towards the longitudinal geometric axis and in the opposite direction from the drive shaft assembly 11 on the articulated joint 52. When the closing trigger nment 32 is in an actuated pivoting position, the fourth system optionally connects the trigger trigger 33 to the staple cartridge 20, resulting in the stapling and cutting of the tissue captured between the anvil 50 and the staple cartridge 20 in response to trigger trigger action 33.
[0132] [0132] A fifth system is an electrical system that can signal to a control circuit 117 on cable 14, in which the drive shaft assembly 16 has been operationally coupled to cable 14 to conduct power and / or communicate signals between the drive shaft assembly 16 and cable 14. In the present example, and as shown in Figure 3, drive shaft assembly 16 includes an electrical connector 106 that is operationally mounted on a drive shaft circuit board. drive (not shown). Electrical connector 106 is configured for coupling paired with a corresponding electrical connector 108 on a cable control board (not shown). Additional details regarding circuit and control systems can be found in US Publication No. 2014/0263541, the description of which is incorporated herein by reference, and / or US Publication No. 2015/0272575, the description of which is incorporated herein reference title.
[0133] [0133] As noted above, the handle set 11 of the present example includes a graphical user interface 116. Only by way of example, the graphical user interface 116 can be used to display various information about the operational status of the ba - it would have 110, the operating state of the end actuator 18, the operating state of the articulated joint 52, the operating state of the triggers 32,
[0134] [0134] The handle set 11 can be configured for use in connection with interchangeable drive shaft assemblies that include end actuators that are adapted to support different sizes and types of clamp cartridges, have different lengths, sizes and drive shaft types. Just by way of example, Figure 6 shows several types of drive shaft assemblies 16, 120, 130, 140 that can be used with the handle assembly 11. In particular, Figure 6 shows a drive shaft assembly. driving a circular stapler 120 with an end actuator 122 which is operable to perform a circular stapling operation (for example, end-to-end anastomosis); a linear stapler drive shaft assembly 130 with an end actuator 132 that is operable to perform a linear stapling operation; and a second cutter drive shaft assembly 140 with an end actuator 142 that is operable to perform the same type of stapling and cutting operation as end actuator 18. However, in this example, the end shaft assembly drive 140 is shorter than the drive shaft assembly 16, the drive shaft assembly 140 has a smaller diameter than the drive shaft assembly 16, and the end actuator 142 is smaller than the end actuator
[0135] [0135] It should also be understood that control circuit 117 can be configured to detect the type of drive shaft assembly 16, 120, 130, 140 coupled with the handle assembly
[0136] [0136] In addition, the handle assembly 11 can also be used effectively with a variety of other interchangeable drive shaft assemblies including those assemblies that are configured to apply other movements and types of energy, such as RF radio frequency, ultrasonic energy and / or movement to end actuator arrangements adapted for use in various applications and surgical procedures. In addition, end actuators, drive shaft assemblies, cables, surgical instruments and / or surgical instrument systems can use any suitable fastener, or fasteners, to fasten tissue. For example, a fastener cartridge comprising a plurality of fasteners stored therein removably can be removably inserted into and / or attached to the end actuator of a drive shaft assembly. Various examples of such cartridges are disclosed in various references that are cited in the present invention.
[0137] [0137] The various driveshaft sets 16 disclosed here can employ sensors and various other components that require electrical communication with control circuit 117 in the handle assembly 11. Electrical communication can be provided via electrical connectors coupling 106, 108. Only as an example, such sensors and other components can be constructed and operable in accordance with at least some of the teachings of US publication No. 2015/0272575, the description of which is incorporated herein by way of reference. In addition or alternatively, instrument 10 can be constructed and operable according to at least some of the teachings of any of the various other references that are cited in the present invention.
[0138] [0138] It will also be understood that various teachings disclosed in the present invention can also be effectively employed together with robotically controlled surgical systems. In this way, the term "compartment" or "body" can also include a compartment, body or similar portion of a robotic system that houses or otherwise operationally supports at least one drive system that is configured to generate and apply at least one control movement that could be used to act on the interchangeable drive shaft assemblies shown here and their corresponding equivalents. The term "structure" can refer to a portion of a hand held surgical instrument. The term "structure" can also represent a portion of a robotically controlled surgical instrument and / or a portion of the robotic system that can be used to operationally control a surgical instrument. By way of example only, the interchangeable drive shaft assemblies disclosed herein can be employed with various robotic systems, instruments, components and methods disclosed in US patent application No. 9,072,535, entitled "Surgical Stapling Instruments with Rotatable Staple Deployment Arrangements ", granted on July 7, 2015, the description of which is incorporated herein by reference. Il. Exemplary circular stapler fixation with independent stapling and cutting chambers
[0139] [0139] As described above, the handle assembly 11 can be configured for use in conjunction with the interchangeable drive shaft assemblies that include various end actuators, such as the circular stapler drive shaft assembly 120 and the end actuator 122 to form an end-to-end anastomosis. For example, in some surgical procedures (for example, colorectal, bariatric, thoracic, etc.), portions of a patient's digestive tract (for example, the gastrointestinal and / or esophageal tract, etc.) can be cut and removed for eliminate unwanted tissue or for other reasons. Once the tissue is removed, the remaining portions of the digestive tract can be coupled in an end-to-end anastomosis using a circular stapler similar to the circular stapler drive shaft assembly 120 and the end actuator 122 The end-to-end anastomosis can provide a substantially unobstructed flow path from one portion of the digestive tract to the other portion of the digestive tract, without also providing any type of leak at the anastomosis site.
[0140] [0140] For example, a circular stapler can be operable to attach layers of fabric, direct staples through the fabric layers, and cut through the fabric layers to substantially seal the fabric layers together near the edges. tremors separated from the tissue layers, thus joining two separate ends of an anatomical lumen together. In particular, the circular stapler can separate the excess tissue, which is inside an annular matrix of staples in an anastomosis, to provide a substantially smooth transition between the sections of anatomical lumen that are joined in the anastomosis.
[0141] [0141] In some cases, when using a circular stapler to form an end-to-end anastomosis, the
[0142] [0142] For example, staple formation can be negatively affected by initially triggering an annular row of staples through the fabric while simultaneously cutting excess tissue. For example, when an initial row of staples is forming simultaneously while cutting excess fabric, the stapled fabric may start to move due to the forces absorbed from cutting excess fabric before the staples are formed completely. The movement of the stapled tissue before the total formation of an initial row of staples can adversely affect the quality of an end-to-end anastomosis. Therefore, it may be desirable to fire a first row of clips into the fabric before separating the excess fabric. Firing a first row of staples into the tissue before cutting the tissue can prevent unwanted movement of the stapled tissue prior to the completion of staple formation, which can increase the integrity of staple formation in an anastomosis. end to end.
[0143] [0143] Additionally, the formation of staples can be negatively affected by the simultaneous activation of multiple rows of annular staples to form an end-to-end anastomosis. Therefore, it may also be desirable to fire a first annular row of staples into the fabric, then fire a row, or rows, additional annular staples into the fabric sequentially before separating the excess fabric. Alternatively,
[0144] [0144] It may therefore be desirable to have a circular stapler capable of independently firing annular rows of staples, and / or independently firing a blade set to cut excess tissue.
[0145] [0145] Figures 8 and 9 show an exemplary interchangeable circular stapler fixture 150 that can be readily incorporated into the handle assembly 11 in place of the drive shaft assembly 16 and end actuator 18 described above. As will be described in more detail below, the handle set 11 and the interchangeable circular stapler fixture 150 are configured to mate with each other so that the fixation of the circular stapler 150 can perform an anastomosis from end to end by independently activating multiple annular arrays of rows of staples, as well as independently cutting excess fabric after at least a first row of staples is formed. In particular, the first drive system 30 and the longitudinal drive member 86 are configured to generate and apply various control movements to the corresponding portions of the interchangeable circular stapler fixture 150 in accordance with the above descriptions, so that a physician can selectively control portions of the interchangeable circular stapler fixture 150 through the handle assembly 11 to form an end-to-end anastomosis.
[0146] [0146] Interchangeable circular stapler fixture 150 includes a drive shaft assembly 156 and an end actuator
[0147] [0147] As noted above, end actuator 158 includes anvil 600, a platform member 640, and a stapling and cutting assembly 700. As can best be seen in Figure 10, the anvil 600 of the present example comprises a head 602 and a rod 614. The head 602 includes a proximal surface 604 that defines an external annular matrix of staple forming pockets 606 and an internal annular matrix of staple forming pockets 608. The staple forming pockets 608 are configured to deform the staples 702 as staples 702 are pushed into staple forming pockets 606, 608. For example, each staple forming pocket 606, 608 can deform a staple generally "U" shaped 702 to a "B" shape "as is known in the art. The proximal surface 604 ends at an inner edge, which defines an outer contour of an annular recess 612 surrounding the stem 614. As will be described in more detail below, the outer annular matrix of the staple forming pockets 606 is configured to receive the staples 702 from a selected portion of the stapling and cutting assembly 700 while the internal ring matrix of staple forming pockets 608 is configured to receive staples 702 from a selected portion of the stapling and cutting assembly 700.
[0148] [0148] The stem 614 defines an orifice 616 and a pair of side openings 618. Orifice 616 is opened at a proximal end of the stem 614 to receive a distal end of the trocar assembly
[0149] [0149] As can best be seen in Figures 13 to 15, the platform member 640 includes a distally displayed platform surface 642 and a plurality of protrusions 648 for seizing tissue. The platform member 640 also defines an inner diameter 646, an external concentric annular matrix of staple openings 606, and an internal concentric annular matrix of staple openings 645. The platform member 640 is fixed to the end distal compartment 260. In addition, the platform member 640 houses a plurality of staples 702 in both staple openings 644, 645. Staple openings 644, 645 are configured to align with staple forming pockets 606 , 608 respectively when the anvil 600 and the platform member 640 compress the tissue between the proximal surface 604 and the platform surface distally presented
[0150] [0150] As can be seen better in Figure 11, and as will be described in greater detail below, the inner diameter 646 is dimensioned to receive a blade member 712 from the stapling and cutting set 700, so that the cutting member blade 712 can cut excess tissue within the inner diameter limits
[0151] [0151] As best seen in Figure 16, the stapling and cutting assembly 700 includes a blade assembly 710, an external staple driver 750, and an internal staple driver set 770; all of which are slidably housed within the distal compartment 260 of the drive shaft assembly
[0152] [0152] As can best be seen in Figure 17, the external clamp trigger 750 includes an annular array of clamp actuators 752, three proximally displayed firing legs 754, each ending in a 756 actuator coupler. - external clamp pain 750 defines an orifice 758 designed to slide the internal clamp trigger assembly 770 slidingly. Clamp actuators 752 are each dimensioned to act within a respective clamp opening of the external concentric annular matrix of clamp openings 644 to drive clamps 702 against a respective clamp forming pocket of the external annular matrix of clamp forming pockets 606. As will be described in more detail below, the shooting legs are proximally shown 754 and the respective drive couplers 756 are positioned to selectively align with a portion of the reciprocating drive assembly 400, so that clamp actuators 752 can actuate clamps 702, regardless of blade assembly 710 and internal clamp driver assembly 770.
[0153] [0153] As can best be seen in Figures 18 and 19.0, the internal staple driver set 770 includes a plurality of internal staple actuator sections 780, each configured to be slidably housed between the respective defined sectors. by firing legs 754 of the external clamp driver
[0154] [0154] As best seen in Figures 20 and 21.0, the blade set 710 includes a cylindrical blade member 712 and an engagement ring 730. The cylindrical blade member 712 includes a distal cutting edge 714, a proximally presented surface. 716, and a flange 718. The cylindrical blade member 712 also defines an inner core path 720, a fabric cavity compartment 722, and a rotating cam slot 724. The inner core path 720 is sized to receive a core internal 262 of the distal compartment 260, while the tissue cavity compartment 722 is sized to receive the cut tissue, as will be described in more detail below. The rotating cam slot 724 is configured to fit with a spiral blade cam 280 on the inner core 262 of the distal compartment 260, so that the cylindrical blade member 712 rotates as the cylindrical blade member 712 is actuated. The proximally presented surface 716 and the flange 718 are configured to rotationally couple the coupling ring 730, so that the cylindrical blade member 712 can rotate relative to the coupling ring 730 while the blade assembly 710 acts.
[0155] [0155] The coupling ring 730 also includes three proximally presented firing legs 732 each ending in a trigger coupler 734. As will be described in more detail below, the proximally shown firing legs 732 and the respective trigger couplers 734 are positioned to selectively align with a portion of the reciprocating driver assembly 400, so that the cylindrical blade member 712 can separate excess tissue, regardless of the external staple driver 750 and the internal staple driver set
[0156] [0156] As will be described in more detail below, the selected portions of the proximal compartment 210 are configured to couple with the selected portions of the handle set 11 for operational engagement. The proximal compartment 210 includes a pair of mouthpiece portions 212, 214 that are substantially similar to the mouthpiece portions 56, 58 described above, with the differences described below.
[0157] [0157] The proximal compartment 210 also includes a reciprocating translation element 216 and a chassis 218 housed within portions of the nozzle 212, 214. Similar to the reciprocating closing element 62 described above, the reciprocating translation element 216 includes a pair of hooks that project proximally 220 that are configured for fixing to the fixing pin 42 that is fixed to the second closing link 38. Therefore, when properly engaged, the reciprocating translation element 216 is configured to translate in relation to the chassis 218 in response to the closing trigger 32 which moves between the unactivated pivot position (as shown in Figure 4A), and the driven pivot position (as shown in Figure 4B) according to the above description. As will be described in more detail below, the performance of the reciprocating translation element 216 is configured to actuate the clutch set 500 to selectively couple and uncouple the trocar set 300 from the intermediate trigger drive shaft 226.
[0158] [0158] Similar to chassis 64 described above, chassis 218 includes a pair of tapered fastening portions 222 formed therein which are adapted to be received within corresponding slot slots 76 formed within a portion of the fixing flange available. - such as 78 of structure 28. Each slot 76 can be tapered or have a generally V shape to seat the fixing portions 222 thereon. When the fixing portions 222 are properly placed inside the slot 76, the chassis
[0159] [0159] Additionally, the proximal compartment 210 includes a locking system for removably attaching the proximal compartment 210 to the handle assembly 11 and, more specifically, to the frame 28. In other words, while the fixing portions 222 avoid the longitudinal and rotational movement of the chassis 218 in relation to the structure 28, the locking system can prevent the chassis 218 from vertically sliding out of the slot slots 76 when properly coupled.
[0160] [0160] Just as an example, this locking system can include a locking fork or other type of locking member that is movably coupled to the chassis 218. As shown in Figures 9 and 28, this fork The locking pin may include two locking pins projecting proximally 228 which are configured for release with the corresponding locking catches or grooves 98 in the frame 28. The locking fork can be operated by a locking button 230 which is slidably mounted on chassis 218 and fixed to locking pins 228. As can be seen in Figure 28, locking button 230 and locking pins 228 are proximally displaced by means of a spring inclination 229, so that the locking pins 228 are pivoted relative to the chassis 218 around the pivot point 231 towards a locked proximal position. The locking fork can be moved to an unlocked position by pressing the locking button 100 in the distal direction, which also causes the locking fork to pivot out of the retaining engagement with frame 28. When the locking fork it is in "retaining engagement" with frame 28, locking pins 228 are seated in a retentive manner within the corresponding detent or locking grooves 98. Just as an additional example, the proximal compartment 210 can be removably attached to the handle assembly 11 in accordance with at least some of the teachings of US patent publication 2017/0086823, the description of which is incorporated herein by reference. cia; in accordance with at least some of the teachings of US patent publication 2015/0280384, the description of which is incorporated herein by reference; and / or in any other appropriate manner.
[0161] [0161] The chassis 218 additionally includes an electrical connector 232 which can be substantially similar to the electrical connector 106 described above. Therefore, electrical connector 232 can be operationally mounted on a drive shaft circuit board (not shown). Electrical connector 232 is configured to engage with a matching electrical connector 108 on a cable control board (not shown). Additional details regarding circuit and control systems can be found in US Publication No. 2014/0263541, the description of which is incorporated herein by reference, and / or Pub. US No. 2015/0272575, the description of which is incorporated herein - taken as a reference.
[0162] [0162] As mentioned above, the drive shaft assembly 156 further comprises an intermediate firing drive shaft 226 having a driving shaft securing pin 224 which is substantially similar to the intermediate firing drive shaft 82 having the drive shaft fixing pin 80 described above, respectively, with the differences described below. Therefore, the drive shaft fixation pin 224 is configured to be seated in the cradle 84 on the longitudinally movable drive member 86 when the drive shaft assembly 156 is properly coupled with the handle assembly 11. As will be described with more details below, the motor 118 is operable to drive the intermediate firing drive shaft 226 to act the trocar set 300 and a reciprocating drive set 400 according to the descriptions in the present invention.
[0163] [0163] To start the coupling process between the proximal compartment 210 of the drive shaft assembly 156 and the handle assembly 11, the doctor can position the chassis 218 of the proximal compartment 210 above or adjacent to the structure 28, so that tapered clamping portions 222 formed in the chassis 218 are aligned with slot slots 76 in the frame 28. The physician can then move the drive shaft assembly 156 along an installation geometry axis IA that is perpendicular to the longitudinal geometrical axis of the intermediate drive shaft assembly 226 to seat the clamping portions 222 in "operational engagement" with the corresponding groove receiving slots 76. In doing so, the clamping pin for the driving shaft 224 on the drive shaft intermediate trigger 226 will also be seated in cradle 84 on the longitudinally movable drive member 86 and the pin 42 portions in the second locking link 38 will be seated in corresponding hooks 220 on the translating reciprocating element 216.
[0164] [0164] When properly coupled, the nozzle portions 212, 214 are operable to rotate the end actuator 158 and selected portions of the drive shaft assembly 156 excluding the reciprocating translation element 216, the chassis 218, the lock 228, tilt spring 229, electrical connector 332, and locking button 230. In particular, nozzle portions 212, 214 can rotate end actuator 158 and selective portions of the drive shaft assembly 156 around the longitudinal geometric axis defined by the outer casing 240. Therefore, a physician can rotate the end actuator 158 and the drive shaft assembly 156 to a desired rotational orientation in preparation for an end-to-end anastomosis procedure .
[0165] [0165] Similar to the drive shaft assembly 16 discussed above, at least five interchangeable circular stapler fixing systems 150 can be operationally coupled to at least five corresponding cable systems 14. A first system comprises a structure that couples and / or aligns the structure or the central column of the drive shaft assembly 156 with the structure 28 of the cable 14, as described above. A second system is the locking system that reliably locks the drive shaft assembly 156 to the cable 14, as described above.
[0166] [0166] A third system is a first drive system that can operationally connect the closing trigger 32 of the cable 14 and the translational reciprocating element 216 of the proximal compartment 210. As mentioned above, and as described below, the third system can be used to actuate the clutch set 500 to selectively couple and uncouple the trocar set 300 from the intermediate trigger drive shaft 226.
[0167] [0167] A fourth system is a trocar and trigger drive system that operationally connects the control oscillator 112 and the trigger trigger 33 of the cable 14 with the intermediate firing drive shaft 226 of the drive shaft assembly 156 As outlined above, drive pin 224 securely connects cradle 84 with longitudinal drive member 86. This fourth system provides motorized actuation of the trocar set 300 or reciprocating drive member 400, depending on pivoting position of the closing trigger 32. As will be described in more detail below, when the closing trigger 32 is in an unactivated pivoting position (as shown in Figure 4A), the fourth system operationally connects the control oscillator
[0168] [0168] A fifth system is an electrical system that can signal to a control circuit on cable 14 that the drive shaft assembly 156 has been operationally engaged with cable 14 to conduct energy and / or communicate signals between the axis assembly drive 156 and cable 14.
[0169] [0169] Other ways of systems of the interchangeable drive shaft assembly 156 that can be operationally coupled to the corresponding systems in the cable 14 will be evident to those skilled in the art in view of the teachings of the present invention. C. External wrapping and distal compartment exemplifying the drive shaft assembly
[0170] [0170] As can best be seen in Figures 8, 9, 12, and from 22 to 23B, the drive shaft assembly 156 includes the outer casing 240 and the distal compartment 260. The outer casing 240 extends from a proximal portion 242 coupled to nozzles 212, 214, up to a distal portion 244 coupled to distal compartment 260. The outer casing 240 houses a portion of the intermediate firing drive shaft 226, the trocar assembly 300, the reciprocating drive assembly 400, and the clutch assembly 500. The distal compartment 260 houses the stapling and cutting assembly 700, a portion of the trocar assembly 300, and a portion of the reciprocating drive assembly 400.
[0171] [0171] The outer wrap 240 can be somewhat flexible so that a clinician can flex the outer wrap 240, portions of the trocar set 300, and portions of the reciprocating drive set 400 to a desired longitudinal profile to access a passageway anatomical target of a patient. As can best be seen in Figure 23A, the distal portion 244 of the outer envelope 240 defines a distal cutout 246. Additionally, the distal portion 244 of the outer envelope 240 includes a protrusion 248 configured to be in a boundary position against a proximal end of the distal compartment 260. As can best be seen in Figures 50A to 50G, the projection 248 defines a notch 250 configured to receive a proximally shown protrusion 278 of the distal compartment 260 to assist in coupling the distal compartment 260 and the outer casing 240.
[0172] [0172] The distal compartment 260 includes a distal compartment chamber 266 and a proximal compartment chamber 268. The distal compartment chamber 266 is configured to slide the clamp actuators 752, 772 from the trigger sections external clamp 750 and internal clamp driver 780, respectively, as well as the blade member 712 of the blade assembly
[0173] [0173] The distal compartment 260 includes an inner core 262 that extends from the chamber of the proximal compartment 268 into the chamber of the distal compartment 266. The interior of the inner core 262 defines a trocar path 264 sized to accommodate a sliding way a portion of the trocar set 300, so that the trocar set 300 can extend from the chamber of the proximal compartment 268 to and through the chamber of the distal compartment 266 to couple with, and act the anvil 600. The inner core 262 is attached to the interior of the proximal compartment chamber 268 by means of the coupling members 270. The coupling members 270, the proximal compartment chamber 268 and the inner core 262 also define the paths of the firing leg 272 which are dimensioned to allow firing legs 732, 752, 772 to actuate blade assembly 710, external staple driver 750, and internal staple driver set 770, respectively, inside the chamber of the distal compartment 266. In other words, the firing legs 732, 752, 772 can extend from the chamber of the distal compartment 266 to the chamber of the proximal compartment 268 through the trajectories of the firing legs 272.
[0174] [0174] The outer casing 240 and the distal compartment 260 are configured to couple together to define a drive assembly path 380. In particular, as shown between Figures 23A to 23B, the proximal compartment chamber 268 includes a first internal protrusion 274 and a second internal protrusion 276, both extending radially inward. When properly coupled, the first internal protrusion 274, the second internal protrusion 276, and the distal cutout profile 246 of the drive set define the path of the drive set 380. The path of the drive set 380 includes a first path of stapling 382, a second stapling path 384, and a blade actuation path 386, all connected to each other through a connection channel 388. Connection channel 388 is partially defined by a cam face 245 of the distal cutout 246 As will be described in more detail below, the cam face 245 of the drive set 380 path is configured to properly orient selected portions of the reciprocating drive set 400 based on a longitudinal position of the reciprocating drive set 400 to sequentially drive external staple driver 750, internal staple driver set 770, and blade set 71 0. D. Exemplary clutch assembly for the drive shaft assembly
[0175] [0175] As mentioned above, when properly coupled, motor 118 is operable to drive the intermediate trigger drive shaft 226 to act on the trocar set 300 or the reciprocating drive set 400, depending on the position of the closing trigger 32. In particular, when closing trigger 32 is in the non-actuated pivoting position (as shown in Figure 4A), the control oscillator 112 can activate motor 118 to drive the intermediate trigger drive shaft 226 , which can trigger the trocar set 300, regardless of the reciprocating drive set 400, in relation to the outer casing 240 and the distal compartment 260. When the lock trigger 32 is in the actuated pivoting position (as shown in Figure 4B), control oscillator 112 can no longer activate motor 118, but trigger trigger 33 can activate motor 118 to drive the intermediate trigger drive shaft 22 6, which in turn drives the reciprocating drive set 400, regardless of the trocar set 300, in a sequential firing motion to drive the individual portions of the stapling and cutting set 700, as will be described in more detail below.
[0176] [0176] As also mentioned above, and as will be described in more detail below, the drive shaft assembly 156 includes the clutch assembly 500, which is configured to selectively disengage the trocar assembly 300 from the drive shaft intermediate trigger 226, so that activation of the trigger trigger 33 allows the intermediate trigger drive shaft 226 to drive the reciprocating drive assembly 400 without triggering the trocar set 300. In particular, the trigger set 300 clutch 500 is configured to disengage the trocar assembly 300 from the intermediate firing drive shaft 226 in response to the pivoting movement of the closing trigger 32.
[0177] [0177] As can best be seen in Figures 27 and 37, the trocar set 300 includes a drive arm 322, a longitudinal locking set 320, a set of articulation band for the trocar 308 and a trocar 302 The trocar 302 includes a drive shaft 304 and a head 306. The head 306 is configured to selectively couple with the anvil 600, so that the trocar 302 can drive the anvil 600 towards and away from the platform member 640 to compress and release the fabric as described above, and as will be described in more detail below. The trocar band set 308 connects the drive shaft 304 of the trocar 302 with the longitudinal locking set 320. The trocar band set 308 is flexible enough to bend in response to a physician who flexes the longitudinal profile of the outer wrap 240 as described above.
[0178] [0178] The drive arm 322 includes a pair of distal locking arms 326. Additionally, the drive arm 322 defines a proximal clutch engagement notch 324. As will be described in more detail below, the engagement notch of clutch 324 is configured to selectively engage with the intermediate trigger drive shaft 226 through gear assembly 500 based on the pivoting position of the closing trigger 32, when properly engaged. As will also be described in more detail below, the distal engagement arms 326 are configured to act on the rest of the trocar set 300 when the clutch engagement notch 324 is selectively coupled to the intermediate firing drive shaft. 226 through clutch assembly 500.
[0179] [0179] The longitudinal locking set 320 can help lock the position of trocar 302 in relation to the distal compartment 260 and 240 to the external envelope when the drive arm 322 is stationary. In particular, the longitudinal locking assembly 320 can help to ensure that trocar 302, and anvil 600 in turn, remains stationary when clutch engagement notch 324 and intermediate trigger drive shaft 226 are no longer engaged.
[0180] [0180] As can be seen better in Figure 33, the intermediate firing drive shaft 226 defines a recess 234 and a distal slot 236. The recess 234 is dimensioned to be rotationally coupled with a rotary shifter 502 of the clutch assembly 500. In other words, the rotary displacer 502 can rotate with respect to the intermediate firing drive axis 226 around the longitudinal geometry axis defined by the intermediate firing drive axis 226, but the rotary displacer 502 is fixed longitudinally with axis intermediate trigger drive 226, so that the intermediate trigger drive shaft 226 can longitudinally drive the rotary shifter 502.
[0181] [0181] As can be seen best in Figure 47, the distal slot 236 houses a drive pin 405 of the reciprocating drive member 400. The distal slot 236 extends from an advance surface 237 to a retraction surface 238. The leading surface 237 and the retracting surface 238 may be in a boundary position against the drive pin 405 to advance or retract the reciprocating drive member 400, respectively. Therefore, the movement of the intermediate firing drive shaft 226 where the driving pin 405 is between the lead surface 237 or the retract surface 238, without touching, does not drive the reciprocating drive member 400. Therefore, the movement of the intermediate firing drive shaft 226 in which the driving pin 405 is not in a boundary position against the advancing surface 237 or the retracting surface 238 can be used to act independently of the trocar assembly 300 in relation to the member of reciprocating drive 400. In other words, the longitudinal length of the distal slit 236 can be dimensioned to the length of the displacement necessary to act the trocar set 300 to properly couple with, and retract, the anvil 600.
[0182] [0182] Figures 28 to 36C show the clutch assembly 500 as a whole or selected portions thereof. As best seen in Figure 29, the clutch assembly 500 includes a rotary shifter 502, a translatable compartment 510, a translatable tube 520, a U-shaped coupler 516, a wrapper 530, a key member 540 and a key member compartment 550. As will be described in more detail below, the translatable compartment 510 and the U-shaped coupler 516 can linearly drive the translatable tube 520 to rotate the displacer 502 to selectively engage and disengage the intermediate trigger activation 226 of the trocar set 300.
[0183] [0183] The translatable compartment 510 is attached to the translating reciprocating element 216. Therefore, the movement of the reciprocating translating element 216 results in the movement of the translatable compartment 510. The translatable compartment 510 defines an opening of the tube 512 and a cutout 514. The tube opening 512 can receive a proximal end of the translatable tube 520 while the cutout 514 is sized to couple with the U516-shaped coupler, so that the longitudinal movement of the translatable compartment 510 results in longitudinal movement of the U516-shaped coupler. The U-shaped coupler 516 defines an internal opening 518 dimensioned to receive a portion of the translatable tube 520 defining an external recess 524. The internal opening 518 of the U-shaped coupler 516 mates with the external recess 524 of the translatable tube 520, so that the translatable tube 520 can rotate about its longitudinal geometric axis in relation to the U-shaped coupler 516, but also so that the translatable tube 520 moves longitudinally with the U-shaped coupler. U 516. Therefore, the translation of the reciprocating translation element 216 and the translatable compartment 510 can longitudinally drive the U 516 coupler of the translatable tube 520. Additionally, the translatable tube 520 can rotate in relation to the coupling U-shaped painter 516 and the translatable compartment 510.
[0184] [0184] As described above, when properly coupled with the handle assembly 11, the reciprocating translation element 216 is configured to act longitudinally based on the pivoting position of the closing trigger 32. Therefore, the pivoting position of the closing trigger 32, when properly coupled with the interchangeable circular stapler fixing 150, can determine the longitudinal position of the translatable tube 520. In particular, when closing trigger 32 is in the pivoted position not actuated (as shown in Figure 4A), the translatable tube 520 will be in a proximal position as shown in Figure 36A. When the closing trigger 32 is in the actuated pivoting position (as shown in Figure 4B), the translatable tube 520 will be in a distal position (as shown in Figures 36B and 36C).
[0185] [0185] In addition to the external recess 524, the translatable tube 520 includes a distal cam surface 522. As will be described in more detail below, the translation of the translatable tube 520 from the proximal position to the distal position activates the distal cam surface 522 against the key member 540 and rotates the key member 540 and the rotary shifter 502 to uncouple the trocar assembly 300 from the intermediate firing drive shaft 226. The tilt spring 526 is housed around the translatable tube 526 between a distal end of the translatable compartment 510 and a proximally presented interior surface of the chassis 218. A tilt spring 526 pulls the translatable tube 526 towards the proximal position. Therefore, if a doctor pivots the closing trigger 32 from the actuated pivot position to the unactivated pivot position, according to the teachings above, the tilt spring 526 can force the translatable tube 520 from the distal position (as shown in Figure 36B) to the proximal position (as shown in Figure 36A).
[0186] [0186] The rotary shifter 502 includes a sector flange 504, coupling flanges 505, radial protrusions 506 defining a slot 508. Additionally, the rotary shifter 502 defines a through hole 509 that receives the intermediate firing drive shaft ary 226. Coupling flanges 505 swivelly engage rotary displacer 502 with intermediate drive shaft 226 through recess 234 of intermediate drive shaft 226. Key member 540 is slidably arranged inside the slot 508. The key member 540 also includes a laterally shown cam arm 542 which is housed within a slot of the circumferential key member 554 of the key member compartment 550.
[0187] [0187] Sector flange 504 is dimensioned to rotate in and out of the engagement with the clutch engagement notch 324 of the drive arm 322 of the trocar set 300, depending on the rotational position of the rotary displacer 502. When the flange of sector 504 is engaged with the drive arm 322 of the trocar set 300, the translation of the intermediate trigger drive shaft 226 will trigger the translation of the drive arm 322 of the trocar set 300, thus triggering the trocar set 300. When the sector flange 504 is not engaged with the drive arm 322 of the trocar set 300, translation of the intermediate firing drive shaft 226 will not trigger the position of the drive arm 322 or the trocar set 300.
[0188] [0188] The translatable tube 520 houses the casing 530, while the casing 530 houses the intermediate firing drive shaft 226 and the rotary shifter 502. The casing 530 defines a lateral opening 532, a first distal opening 534, and a second distal opening
[0189] [0189] A key member compartment 550 defines an opening of the tube 552 and the slot of the circumferential key member 554. The tube opening 552 slidily houses the translatable tube
[0190] [0190] Both the casing 530 and the key member compartment 550 are fixed longitudinally in relation to nozzles 212, 214 or to the proximal compartment 210. The casing 530 is also swiveled to nozzles 212, 214, so that the casing 530 may not rotate with respect to nozzles 212, 214 about the longitudinal geometry axis defined by the intermediate firing drive axis 226. The key member compartment 550 is pivotally coupled to nozzles 212, 214, so that the housing of the key member 550 can rotate with respect to nozzles 212, 214 about the longitudinal geometry axis defined by the intermediate firing drive shaft 226. However, the key member compartment 550 includes a spring of torsion 556 which interacts with an interior defined by nozzles 212, 214 to rotate the key member compartment 550 in a rotating manner to a first angled position (as shown in the Figures 28 and 36A). As will be described below, the torsion spring 556 allows the key member compartment 550 to force the key member 540 to rotate the displacer 502 back into engagement with the drive arm 322 when the translatable tube 520 moves from position distal (con-
[0191] [0191] Figures 36A to 36C show the exemplary use of the clutch assembly 500 to disengage the trocar assembly 300 from the intermediate firing drive shaft 226. Figure 36A shows the translational reciprocating element 216 and the translatable compartment 510 on proximal position. It should be understood, at this point, that the closing trigger 32 is in the pivoted position not actuated (as shown in Figure 4A). Therefore, a clinician can activate the control oscillator 112, so that the motor 118 can longitudinally drive the longitudinal drive member 86 and the intermediate trigger drive shaft 226. In the position shown in Figure 36A, the sector flange 504 of the rotary shifter 502 is engaged with the clutch hitch notch 324 of the drive arm 322. Therefore, if a doctor activates the oscillator control 112 to drive the longitudinal drive member 86 and the drive shaft intermediate trigger 226, the trocar set 300 will also act in relation to the outer casing 240 and the distal compartment 260. As mentioned above, the intermediate firing drive shaft 226 defines a distal slot 236 that houses the actuation pin 405 of the reciprocating drive set 400, so that the intermediate firing drive shaft 226 can act on the trocar set 300 over a length determined by the fen distal 236 without actuating the reciprocating drive member 400.
[0192] [0192] When a doctor no longer wishes to activate the trooper set 300, as when a clinician properly couples the trocar 302 with the anvil 600 and retracts the trocar 600 and the anvil 600 to properly compress the tissue, the doctor you can rotate the trigger trigger 32 to the actuated pivoting position (as shown in Figure 4B).
[0193] [0193] Then, a doctor can activate the trigger trigger 33, which can actuate the intermediate drive shaft 226 in relation to the trocar set 300 to drive the reciprocating drive set 400 according to the description below. As can be seen better in Figure 36C, the intermediate drive shaft 226 and the rotary displacer 502 act independently of the trocar set 300 due to the sector flange 504 being disengaged from the drive arm 322. Therefore, the intermediate drive shaft 226 can move longitudinally to be in a boundary position against the driving pin 405 of the reciprocating drive assembly 400 with the forward surface 237 and the retracting surface 238 to advance and retract the reciprocating drive assembly 400, respectively .
[0194] [0194] Once the reciprocating drive assembly 400 completes its firing cycle, as will be described in more detail below, the intermediate firing drive shaft 226 can return to the position shown in Figure 36B. The encoder 115 can communicate all the relative positions of the longitudinal drive member 86 and, therefore, of the intermediate trigger drive shaft 226, to the control circuit 117. Therefore, the control circuit 117 can instruct the motor 118 to drive longitudinal drive member 86 and intermediate drive drive shaft 226 to all suitable positions. For example, control circuit 117 can store the longitudinal position of the drive member 86 and the intermediate drive drive shaft 226 when the clinician pivots the closing trigger 32 from the unactivated pivot position (as shown in Figure 4A) to the unactivated pivot position (as shown in Figure 4B), thereby storing the position of the intermediate trigger drive shaft 226 in the position shown in Figure 36B.
[0195] [0195] A doctor may wish to regain control of the trocar set 300 to act on the anvil 600 away from a newly formed anastomosis, as will be described in more detail below. A physician can then rotate the closing trigger 32 from the actuation pivot position (as shown in Figures 4B to 4C), back to the unactivated pivot position (as shown in Figure 4A) according to the description above. With the closing trigger 32 in the pivot position not actuated, the reciprocating translation element
[0196] [0196] As mentioned above, the trocar set 300 includes a longitudinal locking set 320 that can help lock the position of the trocar 302 in relation to the distal compartment 260 and the outer casing 240 when the drive arm 322 is parked. nary. In particular, this can be useful to ensure that trocar 302 and anvil 600 have sufficiently compressed the tissue between the proximal surface 604 and the anvil 600 and the distally displayed platform surface 642 of the platform member 640 during the stapling and cutting process , as described in detail below.
[0197] [0197] As can best be seen in Figures 38 and 39, the longitudinal locking assembly 320 includes a drive arm 322, a longitudinally extending pin 328 fixedly fixed to a fixed body 330, a band coupling body 340 fixedly attached to the set of trocar actuation band 308, a first and a second plurality of locking members 350, 360 slidably coupled along pin 328, and a tilt member 370 disposed along the pin 328 between the first and second plurality of locking members 350, 360. As will be discussed in more detail below, the first and second plurality of locking members 350, 360 are forced against pin 328 to provide a force frictional rupture between the band coupling body 340 and the fixed body 330, thus helping to maintain the longitudinal position of the band coupling body 340, the actuation band set 308, and the trocar 30 2. As will be described in more detail below, the engagement arms 326 of the drive arm 322 are configured to be in a boundary position against the first or second plurality of locking members 350, 260 to compress the tilt member 370 , thereby reducing the frictional breaking force to accommodate the longitudinal movement of the band coupling body 340, the actuation band set 308, and the trocar 302.
[0198] [0198] The fixed body 330 provides a mechanical base for the longitudinal locking assembly 320. In particular, the fixed body 330 includes a wrap coupling arm 332 that fits with a hole in the outer wrap 340. Therefore, the fixed body 330 is fixed in relation to the outer casing 340. The fixed body 330 also defines a cutout pin cutout 334 sized to securely couple pin 328, so that pin 328 also acts as a mechanical base for the longitudinal locking assembly 320.
[0199] [0199] The band coupling body 340 includes a distal coupling arm 342, and a pair of side pin arms 344 each defining pin holes 346. Pin holes 346 are dimensioned to receive the slide pin 328, so that the band coupling body 340 can travel longitudinally along a path defined by pin 328. The distal coupling arm 342 is fixed to the actuation band set 308, so that the translation of the band coupling body 340 along the path defined by pin 328 leads to translation of the actuation band set 308 and the trocar 302. Additionally, the band coupling body 340 defines a recess 348 configured to accommodate a portion of the first and of the second plurality of locking members 350, 360. The recess 348 is at least partially defined by a pair of contact walls 345 configured to come into contact with potions from the first and second second plurality of locking members 350, 360.
[0200] [0200] The first and second plurality of locking members 350, 360 each include locking members 352, 362 having a central portion 354, 364 and a side portion 356, 366, respectively. The central portions 354, 364 are slidably arranged over pin 328, while the side portions 356, 366 extend into the recess 348 of the band coupling body 340. The locking arms 326 are positioned above and they tend laterally along pin 328 to house the central portion 354, 364 of the locking members 352, 362, respectively. As can be seen best in Figure 44A, when the first and second plurality of locking members 350, 360 are in the locked position, the tilt member 370 pushes the central portions 354, 364 away from each other. With the central portions 354, 364 tensioned away from each other, a frictional breaking force is provided to help maintain the longitudinal position of the web coupling body 340.
[0201] [0201] Figures 44A to 44D show the exemplary use of the longitudinal locking system 320. Figure 44A shows a longitudinal locking system 320 in the locked position, while the drive arm 322 and the band coupling body 340 they are in a first longitudinal position. As described above, a clinician can activate the engine 118 112 with the control oscillator 32 while the closing trigger is in the pivot position not actuated.
[0202] [0202] Motor 118 can longitudinally drive longitudinal drive member 86 and intermediate trip drive shaft 226, as shown in Figure 44B, which in turn is engaged with drive arm 322 through the assembly clutch 500 according to the above description. A latch arm 326 of drive arm 322 may be in a boundary position against the first or second plurality of locking members 350,
[0203] [0203] The reduction in frictional breaking force may allow the drive arm 322 to drive the first and second plurality of locking members 350, 360, so that the side portions 356, 366 of the locking members 352, 362 they can drive the band coupling body 340, the actuation band set 308, the trocar 302 also in the proximal direction, as shown in Figure 44C. In particular, the side portions 356, 366 can be in a boundary position against the contact walls 345 of the web coupling body 340 to drive the web drive body 340. When motor 118 stops the drive arm drive - ment 322 in accordance with the description above, the distal engagement arm 326 can stop contiguously against the central portions 364 of the second plurality of locking members 360. As a result, as shown in Figure 44D, the tilt member 370 it can once again space the first and second plurality of locking members 350, 360 away from each other to provide sufficient frictional breaking force in the locked position. F. Reciprocating drive set exemplifying the drive shaft set
[0204] [0204] As mentioned above, the reciprocating drive set 400 sequentially actuates the external staple drive 750, the internal staple drive set 770, and the blade set 710 to independently fire a first annular row of staples, a second annular row of staples, and then blade member 712 to cut excess tissue. Figures 45 to 48 show the reciprocating drive assembly 400.
[0205] [0205] Reciprocating drive assembly 400 includes a first portion of flexible center column 402, a second portion of flexible center column 404, and a driving member 420. The first portion of flexible center column 402 and the second flexible central column portion 404 are coupled together to form a trajectory for sliding the trocar assembly 300. The first portion of flexible central column 402 and the second portion of flexible central column 404 are also housed sliding into outer casing 240. The first portion of flexible central column 402 and the second portion of flexible central column 404 are sufficiently flexible to flex in response to a physician who flexes the longitudinal profile of outer envelope 240 as described above.
[0206] [0206] The proximal end of the first portion of flexible central column 402 includes drive pin 405 housed within distal slot 236 of the intermediate trigger drive shaft 226. As described above, the intermediate trigger drive shaft 226 is configured to drive the reciprocating drive assembly 400 through the contact between lead surface 237 or retraction surface 238 with drive pin 405. Although in the current example, the interaction between drive pin 405 and drive shaft - for intermediate 226 to activate the reciprocating drive assembly 400, any other suitable means can be used as would be evident to the person commonly skilled in the art in view of the teachings of the present invention.
[0207] [0207] The distal end of the first portion of flexible central column 402 includes a trocar cover 406. The trocar cover 406 defines a trajectory of trocar 412 that can additionally slide the trocar 302 in a sliding way. in Figure 48, the distal end of the trocar cover 406 includes a pair of flaps 408 and an annular face distally presented
[0208] [0208] The drive member 420 includes a ring 422 that defines an opening 424, with three drive forks 426 that extend distally from ring 422. Ring 422 can be housed between the flaps 408 and the annular face distally shown 410 to swivelly engage drive member 420 with trocar housing 406. As will be described in more detail below, drive forks 426 can selectively drive the corresponding firing legs 732, 754, 774 through interaction with the corresponding drive couplings 734, 756, 776 of the blade assembly 710, the external clamp driver 750, and the internal clamp drive sections 780, respectively. In addition, a drive fork 426 includes a guide pin 428 that extends radially outward from ring 422. As will be described in more detail below, the guide pin 428 is operable to travel the path of the drive assembly 380 defined by the outer casing 240 and the distal compartment 260 to pivotally align the drive forks 426 to drive the external clamp driver 750, the internal clamp drive set 770, or the blade set 710.
[0209] [0209] Figures 49A to 511 show the attachment of the interchangeable circular stapler 150 and the handle assembly 11 being used to perform an end-to-end anastomosis. Firstly, Figures 49A to 49C show the trocar 302 which mates with and retracts from the anvil 600 to compress the tissue from the ends of a first anatomical tubular structure T1 and a second anatomical tubular structure T2.
[0210] [0210] As shown in Figure 49A, the anvil 600 is positioned on the first tubular anatomical structure T1, while the outer casing 240 and the distal compartment 260 are positioned on the second tubular anatomical structure T2. In versions in which the tubular anatomical structures T1, T2 comprise sections of a patient's colon, the outer envelope 240 and the distal compartment 260 can be inserted through the patient's rectum. It should also be understood that the procedure depicted in Figures 49A to 51l is an open surgical procedure, although the procedure can instead be performed by laparoscopy. The various suitable ways in which the fixation of the interchangeable circular stapler 150 can be used to form an anastomosis in a laparoscopic procedure will be evident to those skilled in the art in view of the teachings presented here.
[0211] [0211] As shown in Figure 49A, the anvil 600 is positioned on the first anatomical tubular structure T1 so that the stem 614 protrudes from the open cut end of the first anatomical tubular structure T1. A purse-string suture (not shown) is provided over a middle region of nail 614 to generally secure the anvil position 600 on the first T1 tubular anatomical structure. Likewise, the distal compartment 260 is positioned in the second anatomical tubular structure T2, so that the trocar 302 protrudes from the open cut end of the second anatomical tubular structure T2. A purse-string suture (not shown) is provided around nail 304 to generally hold the position of the distal compartment 260 in the second anatomical tubular structure 12.
[0212] [0212] Then, the anvil 600 is attached to the trocar 302 by inserting the trocar 302 into an orifice 616, as shown in Figure 49B. As mentioned above, the anvil 600 can be attached to the trocar 302 by any suitable means as would be evident to a person skilled in the art in view of the teachings of the present invention, such as a snap closure that fits with the case. bezel 306 of trocar 302. The doctor can then retract trocar 302 and anvil 600 by the activated control oscillator 112, while the closing trigger 32 is in the non-actuated pivot position as shown in Figure 4A. As described above, the trocar set 330 can be engaged with the intermediate firing drive shaft 226 through the clutch assembly 500, so that the intermediate firing drive shaft 226 drives the trocar assembly 330 independently of the set reciprocating drive 400. In addition, the longitudinal locking set 320 can operate in accordance with the description above.
[0213] [0213] As shown in Figure 49C, this proximal retraction of the trocar 302 and the anvil 600 compresses the tissue of the anatomical tubular structures T1, T2 between the proximal surface 604 of the anvil 600 and the surface of the platform distally presented 642 of the limb. platform 640. As described above, encoder 115 can communicate with control circuit 117 to determine the longitudinal position of the intermediate drive shaft assembly 226. Control circuit 117 can use the longitudinal position of the drive assembly intermediate drive axis 226 to determine a gap distance d between the proximal surface 604 and the distally displayed platform surface 642. The control circuit 117 can then communicate this gap distance d to the doctor via the graphic interface user 116. Control circuit 117 can additionally calculate whether this span distance is sufficient to perform an end anastomosis the tip, and communicate this information to the clinician. Therefore, the physician can adjust the span distance d through the control oscillator 112 to capture an appropriate span distance d, and confirm the appropriate span distance d via the graphical user interface 116.
[0214] [0214] After the physician has properly adjusted the gap distance d using the graphical user interface 116, the physician can pivot the closing trigger 32 from the unactivated pivot position (as shown in Figure 4A) to the pivoted position actuated (as shown in Figure 4B). As described above, the clutch assembly 500 then disengages the trocar assembly 300 from the intermediate trigger drive shaft 226, so that the intermediate trigger drive shaft 226 can actuate the reciprocating drive assembly 400. At this point, a physician you can press the trigger 33 to start the firing sequence.
[0215] [0215] As mentioned above, the cam face 245 of the drive assembly path 380 is configured to properly guide the drive member 420 of the reciprocating drive assembly 400 with based on a longitudinal position of the drive assembly. reciprocating trigger 400 to sequentially drive external clamp trigger 750, internal clamp trigger set 770, and blade set 710. Figure 50A shows a drive member 420 in an initial pre-trigger position, or a first proximal position. The control circuit 117 can store the first proximal position for the purposes of instructing the motor 118 to properly drive the reciprocal drive assembly 400 in accordance with the description of the present invention. The guide pin 428 of the drive member 420 is initially located within the first stapling path 380 and distal to the cam face 245 in the first proximal position. The drive forks 426 are aligned with the corresponding drive couplers 756 of the external clamp driver 750.
[0216] [0216] Additionally, Figure 51A shows the tissue from the anatomical tubular structures T1, T2 between the anvil 600 and the platform member 640 in the pre-fired position. As can be seen in
[0217] [0217] After the physician activates the trigger trigger 33, the control circuit 117 can instruct the motor 118 to actuate the intermediate drive shaft 226 to drive the reciprocating drive assembly 400 from the first proximal position to a first distal position within the first stapling path 382, as shown in Figure 50B. Guide pin 428 is still within the first stapling path 382 but in the first distal position. The drive forks 426 actuate the corresponding firing legs 754 of the external clamp driver 750 distally. As can be seen in Figure 51B, clamp drivers 752 are actuated distally in response to drive forks 426 that act from the first proximal position to the first distal position. The staple actuators 752 of the external staple actuator 750 drive the staples 702 through the external concentric annular matrix of the staple opening 644 into the external annular matrix of the staple forming pockets 606, thereby stapling the tissue from the tubular anatomical structures T1, T2 between the anvil 600 and the platform member 640 together. At this point, the clamps 702 within the internal concentric ring matrix of the clamp opening 645 as well as the blade assembly have yet to be fired.
[0218] [0218] Then, as shown in Figure 50C, control circuit 117 can instruct motor 118 to actuate intermediate drive shaft 226 to drive reciprocating drive assembly 400 from the first distal position to a second proximal position. As the reciprocating drive assembly 400 moves from the first distal position to the second proximal position, the guide pin 428 moves through the first stapling path 382, into the connection channel 388. While the guide pin 428 moves through of the connection channel 388, the guide pin 428 comes into contact with the cam face 245. As described above, the drive member 420 is rotatably coupled with the trocar wrap
[0219] [0219] At this point, control circuit 117 can instruct motor 118 to rest for a predetermined amount of time to let the newly fired clips 702 form between the anatomical tubular structures T1, T2. This can provide time for the tissue to normalize as fluids are progressively squeezed during clamp formation. However, this is purely optional.
[0220] [0220] Then, as shown in Figure 50D, control circuit 117 can instruct motor 118 to actuate intermediate drive shaft 226 to drive reciprocating drive assembly 400 from the second proximal position to a second distal position within of the second stapling path 384. The second internal protrusion 276 includes a beveled edge proximally shown.
[0221] [0221] Then, as shown in Figure 50E, control circuit 117 can instruct motor 118 to actuate intermediate drive shaft 226 to drive reciprocating drive assembly 400 from the second distal position to a third proximal position. According to the reciprocating drive set 400 transferred from the second distal position to the third proximal position, the guide pin 428 travels through the second stapling path 384, into the connection channel 388. While the guide pin 428 transfer through connection channel 388, the guide pin 428 contacts the cam face 245. As described above, the drive member 420 is swivelly coupled with the trocar wrap
[0222] [0222] At this point, control circuit 117 can instruct motor 118 to rest for a predetermined amount of time to let the newly fired clips 702 form between the anatomical tubular structures T1, T2. This can provide time for the tissue to normalize as fluids are progressively squeezed during clamp formation. However, this is purely optional.
[0223] [0223] Then, as shown in Figure 50F, control circuit 117 can instruct motor 118 to actuate intermediate drive shaft 226 to drive reciprocating drive assembly 400 from the third proximal position to a third distal position within the path blade actuation 386. Drive forks 426 actuate the corresponding firing legs 732 of the blade assembly 730 distally. As can be seen in Figure 51F, blade member 712 is driven distally in response to drive forks 426 that act from the third proximal position to the third distal position. The distal cutting edge 714 of the blade assembly 710 cuts the tissue of the anatomical tubular structures T1, T2 in relation to the staples 702, thus removing excess tissue. At this point, all staples 702 were fired and blade set 710 cut and separated excess tissue.
[0224] [0224] Then, as shown in Figure 50G, control circuit 117 can instruct motor 118 to actuate intermediate drive shaft 226 to drive reciprocating drive assembly 400 from the third distal position back to the first initial proximal position . As shown in Figure 51G, blade assembly 710 can retract towards the pre-triggered position with excess tissue within the tissue cavity compartment 722.
[0225] [0225] With the intermediate drive shaft 226 back at the location required to drive the reciprocating drive assembly 400 to the first proximal position, control circuit 117 can then instruct motor 118 to drive the intermediate drive shaft 226 to the position where the sector flange 504 is longitudinally aligned with the clutch engagement notch 324 of the drive arm 322. A physician can then rotate the closing trigger 32 from the actuated pivoting position to the position pivot does not act in accordance with the teachings of the present invention. As described above, with the closing trigger 32 in the pivot position not actuated, clutch assembly 500 connects the intermediate firing drive shaft 226 with the trocar set 300. Therefore, a clinician can activate the control oscillator 112 to activate the trocar 302 distally, so that the tissue of the anatomical tubular structures T1, T2 between the proximal surface 604 of the anvil and the distally presented platform surface 642 of the platform member 640 is released, as shown in Figure 51H. Next, a doctor can remove the interchangeable circular stapler fixation 150 from the surgical site, leaving an anastomosis from end to end just formed, as shown in Figure 511.
[0226] [0226] In the present example, the reciprocating drive assembly 400 is configured to drive the external clamp driver
[0227] [0227] As mentioned above, the cam face 245 of the drive assembly trajectory is configured to properly orient the drive member 420 of the reciprocating drive assembly 400 based on the longitudinal position of the drive assembly reciprocating pain 400 to align the drive forks 426 with the corresponding members of the external clamp driver 450, the internal clamp driver assembly 470 and the blade assembly
[0228] [0228] Figures 61A to 61E show an alternative path of the drive set 980 that can be implemented in the drive shaft assembly 156 in place of the drive path 380 described above. The drive assembly 980 path includes a first stapling path 982, a second stapling path 984, a blade actuation path 986 and a connection channel 988, which are substantially similar to the first stapling path 382 , the second stapling path 384, and the blade actuation path 386, and the connection channel 388, respectively, with the differences described below. Therefore, the first stapling path 982 is configured to receive the guide pin 428 from the drive member 420 while the drive member 420 acts on the external staple driver 750. The second staple path 984 is configured
[0229] [0229] However, drive path 980 also includes a first stop channel 983, a second stop channel 985, a first stop member 910, a second stop member 920, a first capture 990, and a second catch 992. The first stop member 910 includes a cam member 912, a stop member 912, a lock 916, and a tilt member
[0230] [0230] As seen in Figure 61B, when the drive member 420 acts properly the external clamp driver 750, the guide pin 428 drives against the cam member 912 to distally drive the cam member 912, the cam member stop 914, and the lock
[0231] [0231] Next, the guide pin 428 can retract proximally, as shown in Figure 61C, to provide cam actuation against the cam face 945 to rotate and align with the second stapling path 984. The second member of stop 920 includes a cam member 922, a stop member 922, a lock 926 and a tilt member 928. Cam member 922 is slidably disposed within the second stapling path 984 unitarily attached to stop member 924 and lock 926. Stop member 924 is slidably disposed within the second stop channel 985. Tilt member 928 tilts tilt member 922 stop member 924 and lock 926 towards the position shown in Figure 61C. As can also be seen in Figure 61C, a proximal end of the stop member 924 is inside the connection channel 988 while the guide pin 428 is in the second proximal position, pre-triggered, that is, before the triggering of the internal clamp trigger 770. The proximal end of the stop member 924 within the connection channel 988 can prevent the guide pin 428 from accidentally rotating out of alignment with the second stapling path 984 before the drive member 420 acts. of external clamp actuator 770 according to the description above. Therefore, if a doctor accidentally tries to act proximally actuating member 920, so that the guide pin 428 tries to provide cam actuation against cam face 945, before actuation member 420 actuates the clamp driver assembly internal 770, the guide pin 428 will be interrupted by the contact of the proximal end of the stop member 924.
[0232] [0232] As seen in Figure 61D, when the drive member 420 acts properly on the external clamp driver 770, the guide pin 428 drives against the cam member 922 to distally drive the cam member 922, the cam member stop 924 and lock 926. At this point, stop member 924 slides into the second stop channel 985, so that the proximal end of stop member 924 no longer obstructs 988 the connection channel. Therefore, the guide pin 428 can now rotate past the stop member 924 towards the blade actuation path 986. Additionally, lock 926 is actuated distally to interact with capture 992. Lock 926 interacts with capture 992, so that the tilt member 928 can no longer tilt the proximal end of the stop member 924 into connection channel 918. Therefore, when the guide pin 428 is no longer in a boundary position against the cam member 922, cam member 922, stop member 924 and lock 926 will remain in the distal position shown in Figure 61D.
[0233] [0233] Next, the guide pin 428 can retract proximally, as shown in Figure 61E, to provide cam actuation against cam face 945 to rotate and align with the blade actuation path 986. The member drive unit 420 can then actuate the blade assembly 710 according to the above teachings. Ill. Exemplary use of the circular stapler fixed with variable compressed staple heights
[0234] [0234] In some cases, it may be desirable to optimize hemostasis between anatomical tubular structures T1, T2 connected through shot clips 702 as described above. Therefore, it may be desirable to adjust the compression height of the staple clip 702 fired against the anvil 600. It may be additionally desirable to independently adjust the compression height of the staple clip 702 corresponding to the external staple driver 750 and the internal clip driver assembly 770, respectively, or any other standard in which the clips are fired sequentially 702.
[0235] [0235] As described above, when the interchangeable circular stapler fixture 150 and cable assembly 11 are properly coupled, control circuit 117 can instruct motor 118 to drive longitudinal drive element 86 and drive shaft of intermediate trigger 226 of the interchangeable circular stapler fixture 150 to drive longitudinally the drive member guide pin 428 through the path of the drive set 380 in response to a doctor pressing the trigger trigger 33. Control circuit 117 can use information from encoder 115 and markings 85 to determine the longitudinal position of the longitudinal drive member 86, and therefore the intermediate trip drive shaft 226, to instruct the motor 118 on the proper positioning of the drive member 420.
[0236] [0236] Control circuit 117 can instruct motor 118 to drive reciprocating drive assembly 400 to actuate drive member 420 from a first proximal position (as shown in Figure 50A) to a first position distal (as shown in Figure 50B) to activate the clamps 702 corresponding to the external clamp trigger 750 through the compressed tissue T1, T2 against the anvil 600. When acting from the first proximal position to the first distal position, guide pin 428 runs within the first stapling route 382. Then, control circuit 117 can instruct motor 118 to drive reciprocating drive assembly 400 to drive drive member 420 from the first distal position to a second proximal position as shown in Figure 50C to align the drive forks 426 with the inner clip driver sections 780 of the inner clip driver assembly 770. The circ Control method 117 can then instruct motor 118 to drive reciprocating drive assembly 400 to drive drive member 420 from the second proximal position to the second distal position as shown in Figure 50D to drive clamps 702 corresponding to the internal staple drive set 770 through the compressed tissue T1, T2 against the anvil 600. When acting from the second proximal position to the second distal position, the guide pin 428 moves within the second stapling route 384.
[0237] [0237] Control circuit 117 can then instruct motor 118 to drive reciprocating drive assembly 400 to drive reciprocating drive assembly 420 from the second distal position to a third proximal position (as shown in
[0238] [0238] As will be described in more detail below, control circuit 117 can modify the longitudinal locations of the first and second distal positions that the motor 118 drives the drive member 420 forward, which in turn can determine the how far the clamps 702 are driven against the anvil 600. The compression height of the newly fired clamps 702 can be determined by how far the clamps 702 are driven against the anvil 600. The longest clamps 702 are driven against the anvil 600 that is, the more distal drive member 420 acts, the shorter the height compression of staples 702. On the other hand, the shorter staples 702 are driven against anvil 600 that is, the drive member the less distal 420 acts, the longer the compression height of the clamps 702. Therefore, the control circuit 117 can adjust the compression height 702 of the clamps fired by the external clamp driver 750 and the set of internal clip drive 770, adjusting the first and second distal positions of the drive member 420, respectively.
[0239] [0239] Figures 52A and 55B 420 show the drive member driving the external clamp driver 750 or the internal clamp drive set 770 for alternative distal positions h2, h3. Figures 50A and 50B and Figures 50C and 50D already show the external clamp driver 770 and the internal clamp drive set 770 being taken to the alternative distal position h1, respectively. In addition, Figures 56 to 59 show a single clamp 702 driven by clamp trigger 752, 772 of external clamp trigger 750 or internal clamp drive set 770, from a pre-triggered position Figure 56 against a clamp forming pocket external or internal 606, 608 to a position that corresponds to an alternative distal position h1, h2, h3.
[0240] [0240] As shown in Figure 56, slide lock 702 includes a cover 706 and two arms 704 that extend distally from cover 706. When fired, legs 704 are configured to flex against staple pockets 606, 608 to bend clips 702 into a substantial "B" shape.
[0241] [0241] Figures 50A and 50B and Figures 50C and 50D show the external clamp driver 750 or internal clamp drive set 770 adding to the alternative distal position h1, while Figure 57 shows the corresponding clamp in the shape of " B "702 formed from the clamp driver 752, 772 when the external clamp driver 750 or the internal clamp drive set 770 travels to the alternative distal position h1.
[0242] [0242] Figures 52A and 52B and Figures 54A and 54B show the external clamp driver 750 or the internal clamp driver set 770 driving the alternative distal position h2, while Figure 58 shows the "B" clamp. corresponding 702 formed from the clamp driver 752, 772 when the external clamp driver 750 or the internal clamp driver assembly 750 travels to the alternative distal position h2.
[0243] [0243] Figures 53A and 53B and Figures 55A and 55B show the external clamp driver 750 or the internal clamp driver set 770 driving the alternative distal position h3, while Figure 58 shows the "B" shaped clamp. correspondent 702 formed from clamp driver 752, 772 when external clamp driver 750 or internal clamp driver set 750 travels to the alternative distal position h3.
[0244] [0244] As can be seen, in Figures 52A to 55B, the alternative distal position h1 is distal compared to both alternative distal positions h2, h3; while the alternative distal position h3 is proximal compared to both alternative distal positions h1, h2; leaving the alternative distal position h2 between both alternative distal positions h1, h3. Therefore, when external clamp driver 750 or internal clamp driver set 770 is driven to the alternate distal position h1, as shown in Figure 57, legs 704 compress the maximum back toward crown 706, creating the smallest height of compressed clamp. When the external clamp driver 750 or external clamp driver set 770 is driven to the alternative distal position h2, as shown in Figure 58, legs 704 compress less compared to the alternative distal position h1, creating a height of more compressed clamp. And finally, when external clamp driver 750 or internal clamp driver set 770 is driven to the alternative distal position h3, as shown in Figure 59, legs 704 compress as little as possible compared to the alternative distal positions h1 , h2, creating the highest height of compressed clamp. Because the external clamp driver 750 and the internal clamp drive assembly 770 can be operated independently of each other, they can compress the corresponding clamps 702 at different heights of compressed clamp.
[0245] [0245] Figure 60 shows an exemplary process for adjusting the clip compression height 800 that can be used by control circuit 117 to modify the firing process control algorithm described above to change the first and second distal positions to any of the alternative distal positions h1, h2, h3, and thereby adjusting the compressed clamp height of the corresponding triggered clips 702. Although in the current example three alternative distal positions h1, h2, h3 are used, any suitable number of alternative distal positions can be used as would be evident to the person skilled in the art in view of the teachings in the present invention. For example, control circuit 117 can have five, ten, twenty, thirty, fifty alternative distal positions to choose from.
[0246] [0246] First, a doctor can capture tissue from a first T1 tubular anatomical structure and a second T1 tubular anatomical structure, as shown in Figures 49A to 49C, and as described above. As described above, control circuit 117 can communicate to a physician via the graphical user interface 116 when the gap distance "d" between the proximal surface and the distally presented platform 642 is adequate.
[0247] [0247] Control circuit 117 can then request input from the clip compression height to the Operator via a graphical user interface 116, so that control circuit 117 receives the clip compression height an 802 operator; and / or control circuit 117 can receive feedback from instrument 804 to indicate / recommend a suggested custom clip compression height 806 via graphical user interface 116, and then control circuit 117 can receive a confirmation of the suggested compression height of the clamp 808 through the operator of the graphical user interface 116. In other words, the control circuit 117 can provide a doctor with options for selecting his own customized compression height of the clamps or of a recommended custom clip compression height based on the instrument's feedback. It should be understood, as described above, that the custom clamp compression height may be different for the external clamp ring matrix, the internal clamp ring matrix, or any other suitable combination / pattern in which clamps 702 are independently fired.
[0248] [0248] The control circuit 117 can calculate a suggested custom clamp compression height based on any suitable information that would be evident to the person skilled in the art, in view of the teachings of the present invention. For example, control circuit 117 can calculate a suggested clamp compression height customized based on span distance "d", at load 118 to act on trocar set 300 to create that span distance "d", another entry in the control circuit 117 from the graphical user interface 116, such as the type of fabric being operated, among others.
[0249] [0249] Once the custom compression clamp height is received by control circuit 117, control circuit 117 can modify the triggering algorithm to change the first distal position and the corresponding second distal position with the heights of staple compression selected. With the first and second distal positions properly modified, the control circuit 117 is ready to receive the trigger command and start the firing sequence 810, as described above.
[0250] [0250] Once the firing sequence has started, the control circuit 117 can track the movement of the distal linear drive set 812 420 until the drive member reaches the first modified distal position. At this point, the clamps 702 of the external annular clamp matrix must be fired against anvil 600 to form the desired clamp compression at a height selected by the physician. Then, the control circuit 117 can reverse the linear movement of the reciprocating drive assembly 400 upon reaching the predetermined range of travel 814, as indicated by encoder 115, to the second proximal position. The control circuit 117 can repeat steps 812 and 814 with the second distal position to form the internal annular clamp matrix 702 at the desired clamp compression height selected by the physician.
[0251] [0251] Therefore, a physician may be able to choose a custom staple compression height for a first array of fired staples 702, and a second custom staple compression height for a second array of triggered 702 staples. IV. Exemplary circular circular stapler end actuator with travel platform member
[0252] [0252] In some cases, as the clamps leave the platform of a staple head assembly, the clamps may not form properly due to the lack of adequate lateral support when the clamps leave the platform. In the case of the platform member 640 described above, this issue can be resolved by the presence of protrusions 648 to seize the tissue, which can assist in orientation and laterally support the staples as the staples exit the platform member 640 towards the anvil 600 It may be desirable to provide additional lateral support to the staples, regardless of whether the 648 portions for seizing the tissue are included or not on the platform member. An example of alternative configuration to provide additional support for the clamps as the clamps come out of the platform member is described below.
[0253] [0253] Figures 62A and 62B show an exemplary alternative circular stapler end actuator 1000 that can be incorporated into a drive shaft assembly of the circular stapler, such as drive shaft assembly 120 or shaft assembly drive 156. The end actuator 1000 in this example comprises an anvil 1010 and a staple head assembly.
[0254] [0254] Stapling head assembly 1020 includes a distal compartment 1021, a platform member 1022, a staple trigger 1024 and a circular knife member 1026. Unless otherwise noted below, platform member 1022 is substantial. - cially similar to the platform member 640 described above. For example, platform member 1022 includes an upper surface 1042 that defines a plurality of staple openings, such as the staple openings 644, 645 described above. Unlike the platform member 640, the platform member 1022 in this example is configured to move in relation to the distal compartment, as described below.
[0255] [0255] The staple driver 1024 of this example comprises a plurality of staple drive members 1044 which are operable to drive the respective staples (not shown) through the staple openings of the platform member 1022, towards the staple forming pockets on the proximally facing surface 1012 of the anvil 1010. Unlike the example described above where a separate staple driver 750 and the staple drive set 770 are used to drive the staples in different annular rows in a sequence, the staple trigger 1024 of the present example is configured to activate the clamps in two annular rows simultaneously. Alternatively, the staple driver 1024 can drive one or at least three annular rows of staples. As another merely illustrative variation, end actuator 1000 may include more than one clamp drive feature, such as a combination of clamp driver 750 and clamp drive assembly 770.
[0256] [0256] In the present example, staple actuator 1024 is configured to engage platform member 1022 temporarily as staple actuator 1024 moves from a proximal position (Figure 62A) to a distal position (Figure 62B); and as the staple trigger 1024 moves from the distal position (Figure 62B) back to the proximal position (Figure 62A). When the staple driver 1024 is in the proximal position, all staples are completely recessed in relation to the upper surface 1042 of the platform member 1022. When the Staple Head assembly 1020 is actuated to cut the fabric and direct the staples Once through the fabric, the staple trigger 1024 will move distally through a first range of motion, a second range of motion and a third range of motion. As the clip actuator 1024 travels distally through the first movement range, the platform member 1022 remains stationary, and all the clips that are arranged on the clip drive members 1044 translate distally so that the distal portions of the Each clamp legs eventually protrude through the openings in the upper surface 1042 of the platform member
[0257] [0257] Depending on the staple actuator 1024, the platform member 1022 and the staples move together distally towards the anvil 1010 through the second movement range, the staples can begin to engage the staple forming pockets on the surface 1012 of the anvil 1010. This engagement can provide the initial formation of the staple legs. During this first formation of the clamp, the platform member 1022 can provide lateral support to the clamps to ensure that the clamps are all guided with the proper orientation towards their respective clamp-forming pockets on the 1010 anvil. platform member 1022 providing this initial orientation, the clamps can complete their formation during the third range of motion. As shown in Figure 62B, the clip drive members 1044 are located distally to the upper surface 1042 of the platform member 1022, so that all corresponding clips are also located distal to the upper surface 1042 of the platform member. platform 1022 at the end of the third range of motion.
[0258] [0258] After reaching the end of the third range of motion, the staple trigger 1024 can be retracted proximally back to the proximal position shown in Figure 62A. Along the way,
[0259] [0259] There are numerous structural features that can be employed to provide engagement between the clip driver 1024 and the platform member 1022, as the clip driver 1024 moves through the second movement range; and disengaging the staple trigger 1024 from the platform member 1022 as the staple trigger 1024 moves through the third range of motion. For example, the clip driver 1024 and the platform member 1022 can have complementary detent features that provide for this selective engagement. As another illustrative example, the clip driver 1024 and the platform member 1022 may have complementary features that provide interference or friction fit to provide selective engagement. Several suitable resources that can be used to provide such selective locking will be evident to those skilled in the art considering the teachings in this document. In addition, the distal compartment 1021 may include a protrusion feature or other feature that promotes disengagement between the clip driver 1024 and the platform member 1022 as the clip driver 1024 transitions from the second range of motion to the third range of motion.
[0260] [0260] The following examples refer to several non-exhaustive ways in which the teachings of the present invention can be combined or applied. The following examples are not intended to restrict coverage of any claims that may be made at any time in this application or in subsequent filings of this application. No rights waiver is intended. The following examples are provided for illustrative purposes only. It is envisaged that the various teachings of the present invention can be arranged and applied in several other ways. It is also contemplated that some variations may omit certain features mentioned in the examples below. Therefore, none of the aspects or resources mentioned below should be considered as of critical importance, unless the contrary is explicitly indicated at a later date, by the inventors or by a successor in the interest of the inventors. If any claims are made in this application or in subsequent filings related to this application that include additional resources in addition to those mentioned below, it should not be assumed that these additional resources have been added for any reason related to patentability.
[0261] [0261] Apparatus, the apparatus being characterized by comprising: a body assembly; (b) a drive shaft assembly comprising: (i) an outer sheath and (ii) a motorized drive mechanism slidably housed in the outer sheath, the body set being configured to drive the drive mechanism drive; (c) an end actuator, the end actuator comprising: (i) a clamp platform that defines a plurality of clamp openings that houses a plurality of clamps, with each clamp opening in the plurality of clamp openings houses a clamp, the clamp platform being attached to the drive shaft assembly, (ii) an anvil configured to deform the plurality of clamps, (iii) a first clamp driver coupled to the drive mechanism, the first being staple driver is configured to fire a first annular matrix of staples from the plurality of staples against the anvil to deform the first annular matrix of staples at a first height of compressed staple, and (iv) a second staple driver coupled to the mechanism the second clamp driver is configured to fire a second annular array of clamps from the plurality of clamps against the anvil for defo form the second annular matrix of clamps in a second height of compressed clamp independently of the first clamp driver, the first height of compressed clamp and the second height of compressed clamp being different. Example 2
[0262] [0262] Apparatus, according to Example 1, with the clamp platform hosting the plurality of clamps in an arched pattern. Example 3
[0263] [0263] Apparatus according to Example 2, the arcuate pattern comprising an outer annular row of staple openings and an inner annular row of openings for staples. Example 4
[0264] [0264] Apparatus of any one or more of Examples 1 to 3, in which the drive shaft assembly is configured to be removably coupled to the body assembly. Example 5
[0265] [0265] Apparatus, according to Examples 1 to 4, with the motorized drive mechanism being configured to drive the first clamp driver by a first feed length to form the first height of the compressed clamp, the maximum - drive mechanism is configured to drive the second clamp driver for a second feed length to form the second compressed clamp height, the first feed length and the second feed length being different.
[0266] [0266] Apparatus, according to Example 5, the actuation mechanism comprising a actuation fork presented distally, the actuation fork shown distally being configured to rotate from a first angular position to a second angular position.
[0267] [0267] Apparatus, according to Example 6, the drive fork being shown distally is configured to drive the first stapler driver in the first angular position, and the drive fork shown distally is configured to drive the second drive driver. stapler in the second angular position.
[0268] [0268] Apparatus, according to Example 7, the drive shaft assembly additionally defining a guide channel configured to rotate the drive fork presented distally based on a longitudinal position of the drive fork shown distally in relation to the outer sheath.
[0269] [0269] Apparatus, according to any of Examples 1 to 8, the body assembly comprising a control circuit configured to determine the first height of compressed clamp and the second height of compressed clamp.
[0270] [0270] Apparatus, according to Example 9, the body set additionally comprising a graphical user interface in communication with the control circuit, the graphical user interface being configured to receive a user action , the user input being configured to determine the first height of the compressed clamp and the second height of the compressed clamp.
[0271] [0271] Apparatus, according to Example 10, the graphical user interface being configured to present a recommended first compressed clamp height and a recommended second compressed clamp height.
[0272] [0272] Apparatus, according to any of Examples 9 to 11, the body set comprising a linear actuator configured to actuate the actuation mechanism.
[0273] [0273] Apparatus, according to Example 12, the body set comprising a sensor configured to determine the longitudinal position of the linear actuator.
[0274] [0274] Apparatus, according to any of Examples 12 to 13, the linear actuator being configured to move through a first reciprocating stroke to actuate the first clamp actuator distally, the linear actuator being configured to move through a second reciprocating stroke to drive the second clamp driver distally.
[0275] [0275] Apparatus according to Example 14, the end actuator additionally comprising an operable knife member for cutting the tissue, the linear actuator being additionally configured to move through a third reciprocating stroke to drive the knife member distally.
[0276] [0276] Apparatus, the apparatus being characterized by comprising: a body assembly comprising: (i) a motorized actuation member, (ii) a control circuit in communication with the motorized actuation member, (iii) and a position sensor in communication with the control circuit, the position sensor being configured to determine a position of the motorized drive member; and (b) a drive shaft assembly comprising: (i) a clamp platform defining at least one annular matrix of clamp openings, with each clamp opening in the plurality of clamp openings being associated with a clamp corresponding, (ii) a first clamp driver, the motorized actuation member being configured to drive the first clamp driver to fire a first clamp at a first height of the compressed clamp, and (ili) a second clamps, the motorized actuation member being configured to drive the second clamp actuator in a second height of compressed clamp, the first height of compressed clamp being different from the second height of compressed clamp. Example 17
[0277] [0277] Apparatus, according to Example 16, the control circuit being configured to generate the first height of compressed clamp and the second height of compressed clamp. Example 18
[0278] [0278] Apparatus, according to any of Examples 16 to 17, the control circuit being configured to generate the first height of compressed clamp and the second height of compressed clamp based on information from the position sensor. Example 19
[0279] [0279] Apparatus, according to any of Examples 16 to 18, with the modular drive shaft assembly comprising an intermediate drive shaft configured to selectively couple the motorized actuation member to the first clamp driver and the second clamp driver.
[0280] [0280] Apparatus, the apparatus being characterized by comprising: a motorized actuation member; (b) an end actuator comprising: (i) a first annular clamp matrix, (ii) a second annular clamp matrix, (ii) a first clamp driver, the motorized actuating member being configured to drive the first clamp trigger to trigger the first annular matrix of clamps at a first height of the compressed clamp, and (iii) a second clamp trigger, the motorized actuation member being configured to drive the second clamp trigger to firing the second ring matrix of clamps at a second height of compressed clamp, the first height of compressed clamp being different from the second height of compressed clamp; the motorized actuation element being operable to drive the second clamp actuator independently of the second clamp actuator in a sequence. Vl. General considerations
[0281] [0281] Any of the versions of the instruments described here may include several other features in addition to or instead of the features described above. By way of example only, any of the instruments described herein may also include one or more of the various resources disclosed in any of the various references that are incorporated herein by way of reference. It should also be understood that the teachings of the present invention can be readily applied to any of the instruments described in any of the other references cited in the present invention, so that the teachings of the present invention can be readily combined with the teachings of any of the references cited in the present invention in various ways. Other types of instruments to which the teachings of the present invention can be incorporated will be evident to those skilled in the art.
[0282] [0282] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8154USNP.0645301], entitled "Apparatus and Method to Determine End of Life of Battery Powered Surgical Instrument ", filed on the same date as this application, whose description is hereby incorporated by reference. Various suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [ower of attorney document END8154USNP.0645301] will be apparent to those skilled in the art in view of the teachings of the present invention.
[0283] [0283] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8155USNP.0645303)], entitled "Surgical Instrument with Integrated and Independently Powered Displays ", filed on the same date as this application, whose description is incorporated into the present invention by means of the reference. Various suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [ower of attorney document END8155USNP.0645303] will be apparent to those skilled in the art in view of the teachings of the present invention.
[0284] [0284] In addition to the previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8156US NP.0645305], entitled "Battery Pack with Integrated Circuit Providing Sleep Mode to Battery Pack and Associated Surgical Instrument "deposited on the same date as this application, the description of which is hereby incorporated by reference. Various suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [roxy document END8156USNP.0645305] will be apparent to those skilled in the art in view of the teachings of the present invention.
[0285] [0285] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8157USNP. 0645308], entitled "Battery Powered Surgical Instrument with Dual Power Utilization Circuits for Dual Modes", filed on the same date as this application, the description of which is incorporated into the present invention by reference. Various suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [ower of attorney document END8157USNP. 0645308] will be evident to those skilled in the art in view of the teachings of the present invention.
[0286] [0286] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8158USNP. 0645310], entitled "Powered Surgical Instrument with Latching Feature Preventing Removal of Battery Pack", deposited on the same date as the present application, whose description is incorporated by reference in this invention. Various suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [ower of attorney document END8158US NP.0645310] will be apparent to those skilled in the art in view of the teachings of the present invention.
[0287] [0287] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application no. [Power of attorney document
[0288] [0288] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8160USNP. 0645322], entitled "Powered Surgical Instrument with Independent Selectively Applied Rotary and Linear Drivetrains", deposited on the same date as this application, whose description is incorporated by reference into this invention. Various suitable forms according to which the teachings of the invention can be combined with the teachings of US patent application No. [roxy document END8160 USNP.0645322] will be apparent to those skilled in the art in view of the teachings of the present invention.
[0289] [0289] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8161USNP.0645357], entitled "Powered Circular Stapler with Reciprocating Drive Member to Provide Independent Stapling and Cutting of Tissue ", filed on the same date as the present application, the description of which is incorporated herein by reference. Several suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [ower of attorney document END8161USNP.0645357] will be apparent to those skilled in the art in view of the teachings of the present invention .
[0290] [0290] In addition to those previously mentioned, the teachings shown here can be readily combined with the teachings of US patent application No. [ower of attorney document END8162USNP. 0645359], entitled "Surgical Instrument Handle Associated with Feature to Clean Electrical Contacts at Modular Shaft Interface", filed on the same date as the present application, the description of which is incorporated herein by reference. Various suitable ways in which the teachings of the invention can be combined with the teachings of US patent application No. [roxy document END8162 USNP.0645359] will be apparent to those skilled in the art in view of the teachings of the present invention.
[0291] [0291] It should also be understood that any ranges of values mentioned here should be read as including the upper and lower limits of such ranges. For example, a strip expressed as in the range "between approximately 2.5 cm and approximately 3.8 cm (approximately 1.0 inch and approximately 1.5 inch)" should be read as including approximately 2.5 cm and approximately 3.8 cm (approximately 1.0 inch and approximately 1.5 inch), in addition to including values between those upper and lower limits.
[0292] [0292] It should be understood that any patent, publication or other description material that, in whole or in part, is said to be incorporated herein by reference, is incorporated herein only to the extent that the incorporated material does not enter in conflict with the definitions, statements or other description material presented in this description. Thus, and as necessary, the description as explicitly presented herein replaces any conflicting material incorporated into the present invention as a reference. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other description materials contained herein, will be incorporated here only to the extent that there is no conflict. between the embedded material and the existing description material.
[0293] [0293] Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in medical treatments and procedures assisted by robotics. Just as an example, several teachings of the present invention can readily be incorporated into a robotic surgical system such as the DA-VINCITY system from Intuitive Surgical, Inc., Sunnyvale, California, USA. Similarly, persons skilled in the art will recognize that various teachings of the present invention can be easily combined with various teachings from US Patent No. 6,783,524, entitled "Robotic Surgical Tool With Ultrasound Cauterizing And Cutting Instrument", published on 31 August 2004, the description of which is incorporated here as a reference.
[0294] [0294] The versions described above can be designed to be discarded after a single use or can be designed to be used multiple times. The versions can, in either or both cases, 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, some versions of the device can be disassembled and any number of parts or parts of the device can be selectively replaced or removed in any combination. With the cleaning and / or replacement of specific parts, some versions of the device can be reassembled for subsequent use in a reconditioning facility or by an operator immediately before a surgical procedure. Those skilled in the art will understand that the reconditioning of a device can use a variety of disassembly, cleaning / replacement and reassembly techniques. The use of these techniques, as well as the resulting refurbished device, are all within the scope of this application.
[0295] [0295] Just as an example, the versions described here can be sterilized before and / or after a procedure. In a sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and the device can then be placed in a radiation field, such as gamma radiation, X-rays or high-energy electrons, which can penetrate the container. Radiation can kill bacteria on the device and the container. The sterile device can then be stored in a sterile container for later use. The device can also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide or water vapor.
[0296] [0296] Having shown and described various modalities of the present invention, other adaptations of the methods and systems described herein can be carried out by means of suitable modifications by a person skilled in the art without departing from the scope of the present invention. . Several of these possible modifications have been mentioned, and others will become evident to those skilled in the art. For example, the examples, modalities, geometries, materials, dimensions, proportions, steps and the like discussed above are illustrative and are not mandatory. Consequently, the scope of the present invention must be considered in accordance with the following claims, and it must be understood that it is not limited to the details of structure and operation shown and described in the specification and drawings.

权利要求:
Claims (20)
[1]
1. Apparatus, characterized in that the apparatus comprises: (a) a body assembly; (b) a drive shaft assembly comprising: (i) an outer sheath, and (ii) a motorized drive mechanism slidably housed in the outer sheath, in which the body assembly is configured to drive the mechanism drive; (c) an end actuator, wherein the end actuator comprises: (i) a clamp platform that defines a plurality of clamp openings that accommodate a plurality of clamps, with each clamp opening of the plurality of openings for clamps it houses a clamp, in which the clamp platform is fixed to the drive shaft assembly, (ii) an anvil configured to deform the plurality of clamps, (iii) a first clamp driver coupled to the drive mechanism, wherein the first staple driver is configured to fire a first annular matrix of staples from the plurality of staples against the anvil to deform the first annular matrix of staples at a first height of compressed staple, and (iv) a second staple driver coupled to the drive mechanism, in which the second staple driver is configured to fire a second annular array of staple plugs against the anvil to deform the second annular matrix of clamps in a second height of compressed clamp independently of the first clamp driver, in which the height of the first compressed clamp and the second height of the compressed clamp are different.
[2]
Apparatus according to claim 1, characterized in that the staple platform accommodates the plurality of staples in an arcuate pattern.
[3]
Apparatus according to claim 2, characterized in that the arcuate pattern comprises an external annular row of staple openings and an internal annular row of staple openings.
[4]
4. Apparatus according to claim 1, characterized in that the drive shaft assembly is configured to be removably coupled to the body assembly.
[5]
5. Apparatus according to claim 1, characterized in that the motorized drive mechanism is configured to drive the first clamp driver by a first feed length to form the first height of the compressed clamp, in which the drive mechanism it is configured to drive the second clamp trigger by a second feed length to form the second compressed clamp height, in which the first feed length and the second feed length are different.
[6]
Apparatus according to claim 5, characterized in that the drive mechanism comprises a drive fork presented distally, wherein the drive fork shown distally is configured to rotate from a first angular position to a second position angular.
[7]
7. Apparatus according to claim 6, characterized in that the drive fork shown distally is configured to drive the first stapler driver in the first angular position, in which the drive fork shown distally is configured for drive the second stapler driver in the second angular position.
[8]
8. Apparatus according to claim 7, characterized in that the drive shaft assembly additionally defines a guide channel configured to rotate the drive fork shown distally based on a longitudinal position of the drive fork shown distally in relation to the outer sheath.
[9]
Apparatus according to claim 1, characterized in that the body assembly comprises a control circuit configured to determine the first height of compressed clamp and the second height of compressed clamp.
[10]
10. Apparatus according to claim 9, characterized in that the body assembly additionally comprises a graphical user interface in communication with the control circuit, in which the graphical user interface is configured to receive a user action, wherein the user input is configured to determine the first height of compressed clamp and the second height of compressed clamp.
[11]
11. Apparatus according to claim 10, characterized in that the graphical user interface is configured to have a recommended first compressed clamp height and a recommended second compressed clamp height.
[12]
Apparatus according to claim 9, characterized in that the body assembly comprises a linear actuator configured to actuate the actuation mechanism.
[13]
13. Apparatus according to claim 12, characterized in that the body assembly comprises a sensor configured to determine the longitudinal position of the linear actuator.
[14]
Apparatus according to claim 12, characterized in that the linear actuator is configured to move through a first reciprocating stroke to drive the first clamp actuator distally, wherein the linear actuator is configured to move through of a second reciprocating stroke to drive the second clamp driver distally.
[15]
Apparatus according to claim 14, characterized in that the end actuator further comprises a knife member operable to cut the fabric, wherein the linear actuator is additionally configured to move through a third reciprocating stroke for drive the knife member distally.
[16]
16. Apparatus, characterized in that the apparatus comprises: (a) a body assembly comprising: (i) a motorized actuation member, (ii) a control circuit in communication with the motorized actuation member, and (iii) a position sensor in communication with the control circuit, the position sensor being configured to determine the position of the motorized actuation member; and (b) a drive shaft assembly comprising: (i) a clamp platform that defines at least one annular array of clamp openings, wherein each clamp opening of the plurality of clamp openings is associated with a corresponding clamp, (ii) a first clamp driver, in which the motorized actuating member is configured to drive the first clamp driver to fire a first clamp at a first compressed clamp height, and (iii) a second clamp driver , wherein the motorized actuating member is configured to drive the second clamp driver to fire a first clamp at a second height of compressed clamp, where the first height of compressed clamp is different from the second height of compressed clamp.
[17]
17. Apparatus according to claim 16, characterized in that the control circuit is configured to generate the first height of compressed clamp and the second height of compressed clamp.
[18]
18. Apparatus according to claim 16, characterized in that the control circuit is configured to generate the first height of compressed clamp and the second height of compressed clamp based on information from the position sensor.
[19]
19. Apparatus according to claim 16, characterized in that the modular drive shaft assembly comprises an intermediate drive shaft configured to selectively couple the motorized actuation member to the first clamp driver and the second clamp driver .
[20]
20. Apparatus, characterized in that the apparatus comprises: (a) a motorized actuation member; and (b) an end actuator comprising: (i) a first annular clamp matrix, (ii) a second annular clamp matrix, (iii) a first clamp driver, in which the motorized actuating member is configured to drive the first clamp driver to fire the first ring clamp array at a first height of the compressed clamp, and (iv) a second clamp driver, in which the motorized actuating member is configured to drive the second clamp driver to fire the second annular matrix of clamps at a second height of compressed clamp, where the first height of compressed clamp is different from the second height of compressed clamp; wherein the motorized actuation element is operable to drive the second clamp driver independently of the second clamp driver in a sequence.

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同族专利:

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公开号 | 公开日

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WO2019002969A1|2019-01-03|

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法律状态:
2021-11-03| B350| Update of information on the portal [chapter 15.35 patent gazette]|

优先权:

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申请号 | 申请日 | 专利标题

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US15/634,620|US10828029B2|2017-06-27|2017-06-27|Surgical stapler with independently actuated drivers to provide varying staple heights|

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US15/634,620|2017-06-27|

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PCT/IB2018/053667|WO2019002969A1|2017-06-27|2018-05-23|Surgical stapler with independently actuated drivers to provide varying staple heights|

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