surgical instrument comprising a projector

专利摘要:
The present invention relates to a surgical stapler that comprises a projector configured to project, on a patient's tissue, an image that helps the user of the surgical stapler.
公开号:BR112020012208A2
申请号:R112020012208-4
申请日:2018-12-10
公开日:2020-11-24
发明作者:Frederick E. Shelton Iv；Jason L. Harris；David C. Yates
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] The present invention relates to surgical instruments and, in various arrangements, to surgical instruments for stapling and cutting, and staple cartridges for use with them, which are designed for stapling and cutting tissue. BRIEF DESCRIPTION OF THE DRAWINGS
[0002] [0002] Several characteristics of the modalities described here, together with their advantages, can be understood according to the description presented below, considered together with the attached drawings, as shown below:
[0003] [0003] Figure 1 is a perspective view of a surgical stapling instrument according to at least one modality;
[0004] [0004] Figure 2 is a cross-sectional view of the stapling instrument in Figure 1, taken along line 2-2 in Figure 1;
[0005] [0005] Figure 3 is a partial perspective view of a drive system for the surgical instrument of Figure 1;
[0006] [0006] Figure 4 is a plan view of the drive system of Figure 3;
[0007] [0007] Figure 5 is an elevation view of the drive system of Figure 3 illustrated in a first operational configuration;
[0008] [0008] Figure 6 is a side elevation view of the drive system of Figure 3 illustrated in the first operational configuration of Figure 5;
[0009] [0009] Figure 7 is a side elevation view of the drive system of Figure 3 illustrated in a second operational configuration;
[0010] [0010] Figure 8 is a partial perspective view of a surgical stapling instrument, according to at least one model;
[0011] [0011] Figure 9 is a partial perspective view of a surgical stapling instrument, according to at least one model;
[0012] [0012] Figure 10 is a partial perspective view of a handle housing of the stapling instrument of Figure 8;
[0013] [0013] Figure 11 is a perspective view of a battery, according to at least one modality;
[0014] [0014] Figure 12 is a perspective view of a handle of the stapling instrument of Figure 1;
[0015] [0015] Figure 13 is a partial perspective view of a surgical stapling instrument including a mesh, according to at least one modality;
[0016] [0016] Figure 14 shows a state control on the screen of Figure 13;
[0017] [0017] Figure 15 shows a speed control on the screen in Figure 13;
[0018] [0018] Figure 16 shows a fault limit control on the screen in Figure 13;
[0019] [0019] Figure 17 shows a direction control on the screen of Figure 13;
[0020] [0020] Figure 18 shows the screen of Figure 13 and the speed control of Figure 15;
[0021] [0021] Figure 19 shows the screen of Figure 13 and a speed control;
[0022] [0022] Figure 20 shows the screen of Figure 13 and a staple path control being used to change the staple trigger path of the stapling instrument;
[0023] [0023] Figure 21 shows the screen of Figure 13 and the control of the staple path of Figure 21 being used to control the staple trigger path of the stapling instrument;
[0024] [0024] Figure 22 shows the screen of Figure 13 and a control to interrupt the stapling instrument along the staple firing path;
[0025] [0025] Figure 23 shows a surgical instrument system including an external screen, or outside the stapling instrument, according to at least one modality;
[0026] [0026] Figure 24 shows a screen of a surgical stapling instrument, according to at least one modality;
[0027] [0027] Figure 25 shows the screen of Figure 24 that is used to change a staple firing path when creating a gastric sleeve during a stomach reduction procedure;
[0028] [0028] Figure 26 shows a joystick that is used to change a staple firing path on the screen in Figure 24;
[0029] [0029] Figure 27 shows the stapling instrument that is guided along a staple firing path;
[0030] [0030] Figure 28 shows a patient's stomach;
[0031] [0031] Figure 29 is a cross-sectional view of a patient's stomach;
[0032] [0032] Figure 30 is a cross-sectional view of a target inserted in the stomach of Figure 29;
[0033] [0033] Figure 31 is a cross-sectional view of a patient's stomach that is thinner than the stomach of Figure 29;
[0034] [0034] Figure 32 is a cross-sectional view of a target inserted in the stomach of Figure 31;
[0035] [0035] Figure 33 shows several anatomical features that can be mentioned during a gastric sleeve procedure;
[0036] [0036] Figure 34 is a partial elevation view of a surgical stapling instrument that includes a drive shaft, an end actuator, and a joint joint, according to at least one modality;
[0037] [0037] Figure 35 is a partial elevation view of the stapling instrument of Figure 34, which illustrates the end actuator in an articulated position;
[0038] [0038] Figure 36 is a bottom cross-sectional view of an end actuator of a surgical stapling instrument, according to at least one modality;
[0039] [0039] Figure 37 is a partial cross-sectional view of a surgical stapling instrument that comprises a tissue activation system, according to at least one modality;
[0040] [0040] Figure 38 is a partial cross-sectional view of the stapling instrument of Figure 37 that illustrates the tissue drive system engaged with a patient's tissue;
[0041] [0041] Figure 39 is a partial cross-sectional view of the stapling instrument of Figure 37 that illustrates the tissue drive system by pushing the patient's tissue in a first direction;
[0042] [0042] Figure 40 is a partial cross-sectional view of the stapling instrument of Figure 37, which illustrates the tissue drive system by pushing the patient's tissue in a second direction;
[0043] [0043] Figure 41 is a partial cross-sectional view of the stapling instrument of Figure 37 that illustrates the tissue drive system being disengaged from the patient's tissue;
[0044] [0044] Figure 42 is a partial perspective view of a drive system, which includes a synchronization mechanism, according to at least one modality;
[0045] [0045] Figure 43 illustrates the synchronization mechanism of Figure 42 that drives an end actuator drive system;
[0046] [0046] Figure 44 illustrates a drive system configured to reciprocally drive a plurality of drive system for the end actuator;
[0047] [0047] Figure 45 shows plots of two synchronized end actuator drivers;
[0048] [0048] Figure 46 is a table that illustrates the synchronization of four end actuator drivers;
[0049] [0049] Figures 47A to 47G illustrate the operational steps of a surgical stapling instrument, according to at least one modality;
[0050] [0050] Figure 48 is a table that illustrates the synchronization of the end actuator actuators of a surgical stapling instrument, according to at least one modality;
[0051] [0051] Figure 49 is a module for operating a surgical stapling instrument, according to at least one modality;
[0052] [0052] Figure 50 is a partial perspective view of an end actuator that includes a tissue drive system, according to at least one illustrated embodiment being extended;
[0053] [0053] Figure 51 is a partial perspective view of the tissue drive system of Figure 50 being retracted;
[0054] [0054] Figure 52 is a partial cross-sectional view of the end actuator of Figure 50 that illustrates the tissue drive system in an unlocked configuration;
[0055] [0055] Figure 53 is a partial cross-sectional view of the end actuator of Figure 50 that illustrates the tissue drive system in a lowered configuration;
[0056] [0056] Figure 54 is a partial cross-sectional view of the end actuator of Figure 50 illustrating the tissue drive system being extended;
[0057] [0057] Figure 55 is a partial cross-sectional view of the end actuator of Figure 50 that illustrates the teeth of the tissue drive system in a protruding configuration;
[0058] [0058] Figure 56 is a partial cross-sectional view of the surgical instrument of Figure 50 that illustrates the drive system being retracted;
[0059] [0059] Figure 57 is a partial perspective view of a tissue drive system, according to at least one mode;
[0060] [0060] Figure 58 is a partial perspective view of the tissue drive system of Figure 57 in an extended configuration;
[0061] [0061] Figures 59A to 59D illustrate the operational steps of a tissue drive system for a surgical stapling instrument, according to at least one modality;
[0062] [0062] Figures 60A to 60D further illustrate the operational steps of the tissue drive system of Figures 59A to 59D;
[0063] [0063] Figure 61 is a partial perspective view of a surgical stapling instrument, which includes a tissue activation system, according to at least one modality;
[0064] [0064] Figure 62 is a partial perspective view of the tissue drive system of Figure 61 in an extended configuration;
[0065] [0065] Figure 63 is a perspective view, in partial cross-section of a surgical stapling instrument that comprises a tissue activation system, according to at least one modality;
[0066] [0066] Figure 64 is a bottom plan view of the staple cartridge of Figure 63;
[0067] [0067] Figure 65 is a partial cross-sectional view of a surgical stapling instrument that includes a vacuum system, according to at least one modality;
[0068] [0068] Figure 66 is a partial detail view of a tissue drive system for the surgical instrument of Figure 65;
[0069] [0069] Figure 67 is a partial cross-sectional view of the stapling instrument of Figure 65 that illustrates the fabric being pulled into the end actuator of the stapling instrument;
[0070] [0070] Figure 68 is a partial detail view of the tissue drive system of Figure 66;
[0071] [0071] Figure 69 is a partial cross-sectional view of the stapling instrument of Figure 65 that illustrates the tissue being released;
[0072] [0072] Figure 70 is a partial cross-sectional view of a surgical stapling instrument, according to at least one modality;
[0073] [0073] Figure 71 is a partial cross-sectional view of the stapling instrument of Figure 70, which illustrates the first and second pedals for driving the stapling instrument in a retracted configuration;
[0074] [0074] Figure 72 is a partial cross-sectional view of the stapling instrument of Figure 70 that illustrates the first drive pedal in an extended position;
[0075] [0075] Figure 73 is a vacuum pipe of the stapling instrument of Figure 70 in fluid communication with the first drive foot;
[0076] [0076] Figure 74 is a perspective view of a surgical stapling instrument, according to at least one modality;
[0077] [0077] Figures 75A to 75D show operational steps of a surgical stapling instrument, according to at least one modality;
[0078] [0078] Figure 76 is a partial cross-sectional view of a surgical stapling instrument, according to at least one modality;
[0079] [0079] Figures 77A to 77D show the operational steps for directing the stapling instrument of Figure 76;
[0080] [0080] Figure 78 is an end view in cross section of a surgical stapling instrument, according to at least one modality;
[0081] [0081] Figure 79 is a partial elevation view of a surgical stapling instrument, according to at least one model, which comprises a tissue actuation;
[0082] [0082] Figure 79A illustrates the position of a tissue drive pedal corresponding to Figure 79;
[0083] [0083] Figure 80 is a partial elevation view of the stapling instrument of Figure 79, which illustrates the pedal being extended;
[0084] [0084] Figure 80A illustrates the pedal position of the tissue drive corresponding to Figure 80;
[0085] [0085] Figure 81 is a partial elevation view of the stapling instrument of Figure 79, which illustrates the pedal in an extended configuration;
[0086] [0086] Figure 81A illustrates the pedal position of the tissue drive corresponding to Figure 81;
[0087] [0087] Figure 82 is a partial elevation view of the stapling instrument of Figure 79, which illustrates the pedal being retracted;
[0088] [0088] Figure 82A illustrates the pedal position of the tissue drive corresponding to Figure 82;
[0089] [0089] Figure 83 is a partial cross-sectional view of the tissue binding of the stapling instrument of Figure 79;
[0090] [0090] Figure 84 illustrates the kinematics of tissue activation of the stapling instrument of Figure 79;
[0091] [0091] Figure 85 illustrates a cam capable of producing the kinematics of Figure 84;
[0092] [0092] Figure 86 is a perspective view of a cam capable of producing the kinematics of Figure 84;
[0093] [0093] Figure 87 is a partial perspective view of a surgical stapling instrument that includes a tissue activation, according to at least one modality;
[0094] [0094] Figure 88 shows a tissue activation of a surgical stapling instrument, according to at least one model;
[0095] [0095] Figure 89 shows the tissue drive of Figure 88 in an extended configuration;
[0096] [0096] Figures 90A to 90D show the operational steps of a surgical stapling instrument that includes a tissue drive, according to at least one modality;
[0097] [0097] Figures 91A to 91D show the operational steps of a surgical stapling instrument that includes a tissue drive, according to at least one modality;
[0098] [0098] Figure 92 shows a tissue activation of a surgical stapling instrument, according to at least one model;
[0099] [0099] Figure 93 shows the tissue drive of Figure 92 in an extended configuration;
[0100] [0100] Figure 94 is a partial cross-sectional perspective view of a surgical stapling instrument, according to at least one modality;
[0101] [0101] Figure 95 is a partial perspective view of a surgical instrument that comprises the tissue cutting member, according to at least one modality;
[0102] [0102] Figure 96 shows the fabric cutting member of Figure 95 being moved along a fabric cutting course;
[0103] [0103] Figure 97 is a perspective view of a surgical stapling instrument, according to at least one modality;
[0104] [0104] Figure 98 is a perspective view of a clamp, according to at least one embodiment;
[0105] [0105] Figure 99 is a partial perspective view of the clamps in Figure 98 being separated;
[0106] [0106] Figure 100 is a partial cross-sectional view of a staple firing system of the stapling instrument of Figure 97 that includes a staple firing chamber, according to at least one embodiment;
[0107] [0107] Figure 101 illustrates a clamp being fired by the clamp triggering system of Figure 100;
[0108] [0108] Figure 102 illustrates another staple being loaded into the staple firing chamber of Figure 100;
[0109] [0109] Figure 103 is an end view in bottom cross section of the stapling instrument of Figure 97;
[0110] [0110] Figure 104 is a partial cross-sectional perspective view of a surgical stapling instrument, according to at least one modality;
[0111] [0111] Figures 105A to 105D show the operational steps of the stapling system of Figure 104;
[0112] [0112] Figure 106 is a perspective view of a surgical stapling instrument, according to at least one modality;
[0113] [0113] Figure 107 is an exploded perspective view of a staple clip for use with the surgical stapling instrument of Figure 106;
[0114] [0114] Figure 108 is a plan view of a staple clip, according to at least one embodiment;
[0115] [0115] Figure 109 is an end view of the staple clip of Figure 108 positioned on a surgical stapling instrument;
[0116] [0116] Figure 110 is a perspective view of the staple clip of Figure 108;
[0117] [0117] Figure 111 is an end view of a staple clip, according to at least one modality, positioned on a surgical stapling instrument;
[0118] [0118] Figure 112 is a perspective view of the staple clip in Figure 111;
[0119] [0119] Figure 113 is an end view of a staple clip, according to at least one modality, positioned on a surgical stapling instrument;
[0120] [0120] Figure 114 is a perspective view of the clip clip of Figure 113;
[0121] [0121] Figure 115 is a partial plan view of a strip of staples in an unfolded configuration, according to at least one embodiment;
[0122] [0122] Figure 116 is an end view of the staple strip of Figure 115, in an unfolded configuration;
[0123] [0123] Figure 117 is an elevation view of the staple strip of Figure 115, in a folded configuration;
[0124] [0124] Figure 118 is a perspective view of the staple strip of Figure 115 being implanted;
[0125] [0125] Figure 119 is a perspective view of a group of clips, according to at least one modality;
[0126] [0126] Figure 120 is a partial perspective view of the group of staples in Figure 119 being loaded onto a surgical stapling instrument;
[0127] [0127] Figure 121 is a partial perspective view of a surgical stapling instrument, which comprises groups of implantable staples, according to at least one modality;
[0128] [0128] Figure 122 is a partial perspective view of a surgical stapling instrument that comprises a tissue drive, according to at least one modality;
[0129] [0129] Figure 123 is a partial perspective view of the stapling instrument of Figure 122 that illustrates the driver in an extended configuration;
[0130] [0130] Figure 124 shows a width in cross section of a distal head of the stapling instrument of Figure 122;
[0131] [0131] Figure 125 is a cross-sectional view of the tissue gripping surface of the tissue drive of Figure 122;
[0132] [0132] Figure 126 is an end view in cross section of a surgical stapling instrument that includes a tissue actuation, according to at least one modality, illustrated in an extended configuration;
[0133] [0133] Figure 127 is an end view in cross-section of the stapling instrument of Figure 126 that illustrates the actuation of tissue in a retracted configuration;
[0134] [0134] Figure 128 shows a trigger trigger for a surgical stapling instrument, according to at least one mode, illustrated in an untriggered configuration;
[0135] [0135] Figure 128A shows a tissue drive of the stapling instrument of Figure 128 in an extended configuration;
[0136] [0136] Figure 129 shows the trigger trigger of Figure 128 illustrated in a triggered configuration;
[0137] [0137] Figure 129A shows the tissue drive of Figure 128A in a retracted configuration;
[0138] [0138] Figure 130 shows the trigger trigger of Figure 128 illustrated in its non-triggered configuration;
[0139] [0139] Figure 130A shows the tissue drive of Figure 128A in its retracted configuration;
[0140] [0140] Figure 131 is a perspective view of a staple loading system for a surgical stapling instrument, according to at least one modality;
[0141] [0141] Figure 132 is a plan view of the clamp loading system of Figure 131;
[0142] [0142] Figure 133 is a partial elevation view of the clamp loading system in Figure 131;
[0143] [0143] Figure 134 is a partial cross-sectional view of the surgical instrument of Figure 131 illustrated in a non-triggered configuration;
[0144] [0144] Figure 135 is a partial cross-sectional view of the stapling instrument of Figure 131 illustrated in a triggered configuration;
[0145] [0145] Figure 136 is a partial cross-sectional view of the Figure 131 stapling instrument being retracted to its non-triggered configuration;
[0146] [0146] Figure 137 is a partial cross-sectional view of the surgical stapling instrument of Figure 131 illustrated in an untriggered configuration;
[0147] [0147] Figure 138 shows a staple pattern that can be produced by a surgical stapling instrument, according to at least one modality;
[0148] [0148] Figure 139 shows a staple pattern that can be produced by a surgical stapling instrument, according to at least one modality;
[0149] [0149] Figure 140 illustrates a surgical stapling instrument, according to at least one modality;
[0150] [0150] Figure 141 illustrates the operational steps that the stapling instrument in Figure 140 uses to manufacture and deploy staples;
[0151] [0151] Figure 142 shows a staple firing line in a patient's stomach;
[0152] [0152] Figure 143 shows a progression of staple shots, according to at least one modality;
[0153] [0153] Figures 144 to 146 illustrate the stapling instrument in Figure 1 being used during a surgical procedure;
[0154] [0154] Figure 147 illustrates a surgical stapling instrument, according to at least one modality being used during a surgical procedure;
[0155] [0155] Figure 148 is a partial elevation view of the surgical stapling system of Figure 147;
[0156] [0156] Figure 149 is a partial perspective view of the stapling instrument of Figure 147 in a first configuration;
[0157] [0157] Figure 150 is a partial perspective view of the stapling instrument of Figure 147 in a second configuration;
[0158] [0158] Figure 151 shows a potential result of a gastric sleeve procedure using the surgical stapling instruments disclosed here;
[0159] [0159] Figure 152 shows a guide inserted in a patient's stomach;
[0160] [0160] Figure 153 shows a guide that is used to define a staple firing path in the patient's stomach;
[0161] [0161] Figure 154 shows the guide in Figure 153 that is used to create a gastric sleeve during a gastric bypass procedure;
[0162] [0162] Figure 155 is a partial cross-sectional view of the guide in Figure 153;
[0163] [0163] Figure 156 is a partial perspective view of a guide, according to at least one modality illustrated with some components removed;
[0164] [0164] Figure 157 is a schematic drawing of the guide in Figure 153;
[0165] [0165] Figure 158 is a perspective view of a surgical stapling system comprising loadable staple cartridges, according to at least one modality;
[0166] [0166] Figure 159 shows certain operational components of the stapling system of Figure 158;
[0167] [0167] Figure 160 is an end view of a surgical stapling instrument that comprises a projector system that includes two lenses, according to at least one modality;
[0168] [0168] Figure 161 illustrates the stapling instrument of Figure 160 being used during a surgical procedure;
[0169] [0169] Figure 162 illustrates a surgical stapling system that includes a projector, according to at least one modality;
[0170] [0170] Figure 163 illustrates a surgical stapling system that comprises a vision system and a projection system, according to at least one modality;
[0171] [0171] Figure 164 illustrates a projector system of the stapling system of Figure 163 being used;
[0172] [0172] Figure 165 illustrates an image projected onto a patient's tissue, according to at least one modality;
[0173] [0173] Figure 166 illustrates a staple firing path projected onto a patient's tissue, according to at least one mode;
[0174] [0174] Figure 167 illustrates a surgical stapling instrument comprising a first projector configured to project a first part of a staple firing path on a patient's tissue and a second projector configured to project a second part of the firing path staples in the tissue of a patient, according to at least one modality;
[0175] [0175] Figure 168 is a partial elevation view of a surgical stapling instrument comprising an articulable end actuator, according to at least one modality;
[0176] [0176] Figure 169 is a partial elevation view of the surgical stapling system in Figure 168;
[0177] [0177] Figure 170 is a partial elevation view of a surgical stapling instrument comprising an articulable end actuator and a damper configured to reduce unintentional movement of the end actuator, according to least one modality;
[0178] [0178] Figure 171 is a partial elevation view of a surgical stapling instrument that includes an end actuator damper, according to at least one modality;
[0179] [0179] Figure 172 illustrates the stapling instrument of Figure 171 being used in a surgical procedure;
[0180] [0180] Figure 173 illustrates the stapling instrument of Figure 171 being used in a surgical procedure;
[0181] [0181] Figure 174 illustrates a staple firing path created by a surgical stapling instrument that comprises a longitudinal end actuator;
[0182] [0182] Figure 175 illustrates a staple firing path created by a surgical stapling instrument disclosed here;
[0183] [0183] Figure 176 illustrates a staple firing path created by a surgical stapling instrument that comprises a longitudinal end actuator;
[0184] [0184] Figure 177 illustrates a staple firing path created by a surgical stapling instrument disclosed here;
[0185] [0185] Figure 178 illustrates a staple firing path created by a surgical stapling instrument that comprises a longitudinal end actuator;
[0186] [0186] Figure 179 illustrates a staple firing path created by a surgical stapling instrument disclosed here;
[0187] [0187] Figure 180 is a perspective view of a surgical instrument handle, in accordance with at least one mode;
[0188] [0188] Figure 181 is a perspective view of the handle of the surgical instrument of Figure 180 enclosed in a sterile barrier;
[0189] [0189] Figure 182 is a partial cross-sectional view of the sterile barrier and a touchscreen of the handle of Figure 181;
[0190] [0190] Figure 183 is a plan view of the touch screen of Figure 182 that illustrates an electrode grid, with a plurality of pixels being activated; and
[0191] [0191] Figure 184 is a graph showing a relationship between the location of the active pixels in Figure 183 and the capacitance detected by the touchscreen in Figure 182.
[0192] [0192] Corresponding reference characters indicate corresponding parts through the various views. The exemplifications described herein illustrate various embodiments of the invention, in one form, and such exemplifications should not be considered to limit the scope of the invention in any way. DETAILED DESCRIPTION
[0193] [0193] The applicant for this application holds the following US Patent Applications that were filed on December 21, 2017, and which are each incorporated herein by reference in their respective totalities: - US Patent Application serial number 15 / 850.431, entitled CONTINUOUS USE SELF-PROPELLED STAPLING INSTRUMENT; - U.S. Patent Application Serial No. 15 / 850,461, entitled SURGICAL INSTRUMENT COMPRISING SPEED CONTROL; - U.S. Patent Application Serial No. 15 / 850,495, entitled STAPLE INSTRUMENT COMPRISING A FIRING PATH DISPLAY; - U.S. Patent Application Serial No. 15 / 850,480, entitled SELF-GUIDING STAPLING INSTRUMENT; - U.S. Patent Application Serial No. 15 / 850,522, entitled
[0194] [0194] The applicant for this application holds the following US Patent Applications that were filed on December 19, 2017, and which are each incorporated herein by reference in their respective totalities: - US Patent Application Serial No. 15 / 847,306, entitled
[0195] [0195] The applicant for this application holds the following US Patent Applications that were filed on December 15, 2017, and which are each incorporated herein by reference in their respective totalities: - Patent Application No. US serial number 15 / 843,485, entitled SEALED ADAPTERS FOR USE WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS; - U.S. Patent Application Serial No. 15 / 843,518, entitled END EFFECTORS WITH POSITIVE JAW OPENING FEATURES FOR
[0196] [0196] The applicant for this application holds the following US Patent Applications that were filed on June 29, 2017, and which are each incorporated herein by reference in their respective totalities: - US Patent Application Serial No. 15 / 636,829, entitled
[0197] [0197] The applicant for this application holds the following US Patent Applications that were filed on June 28, 2017, and which are each incorporated herein by reference in their respective totalities: - US Patent Application serial number 15 / 635,693, entitled SURGICAL INSTRUMENT COMPRISING AN OFFSET ARTICULA- TION JOINT; - U.S. Patent Application Serial No. 15 / 635,729, entitled SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYS-TEM RATIO; - U.S. Patent Application Serial No. 15 / 635,785, entitled SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYS-TEM RATIO;
[0198] [0198] The applicant for this application holds the following US Patent Applications that were filed on June 27, 2017, and which are each incorporated herein by reference in their respective totalities: - US Patent Application serial number 15 / 634,024, entitled SURGICAL ANVIL MANUFACTURING METHODS; - U.S. Patent Application Serial No. 15 / 634,035, entitled SURGICAL ANVIL ARRANGEMENTS; - U.S. Patent Application Serial No. 15 / 634,046, entitled SURGICAL ANVIL ARRANGEMENTS; - U.S. Patent Application Serial No. 15 / 634,054, entitled SURGICAL ANVIL ARRANGEMENTS; - U.S. Patent Application Serial No. 15 / 634,068, entitled SURGICAL FIRING MEMBER ARRANGEMENTS; - U.S. Patent Application Serial No. 15 / 634,076, entitled STAPLE FORMING POCKET ARRANGEMENTS; - U.S. Patent Application Serial No. 15 / 634,090, entitled STAPLE FORMING POCKET ARRANGEMENTS; - U.S. Patent Application Serial No. 15 / 634,099, entitled SURGICAL END EFFECTORS AND ANVILS; and - U.S. Patent Application Serial No. 15 / 634,117, entitled ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS.
[0199] [0199] The applicant for this application holds the following US Patent Applications that were filed on December 21, 2016, and which are each incorporated herein by reference in their respective totalities: - US Patent Application Serial No. 15 / 386,185, entitled
[0200] [0200] The applicant for this application holds the following US Patent Applications that were filed on June 24, 2016, and which are each incorporated herein by reference in their respective totalities: - US Patent Application Serial No. 15 / 191,775, entitled
[0201] [0201] The applicant for this application holds the following U.S. Patent Applications that were filed on June 24, 2016, and which are each incorporated herein by reference in their respective totalities:
[0202] [0202] The applicant for this application holds the following patent applications that were filed on April 1, 2016 and which are each incorporated herein by reference in their respective totalities: - Application for US Patent Serial No. 15 / 089,325, entitled METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM, now, publication of US Patent Application No. 2017/0281171; - U.S. Patent Application Serial No. 15 / 089,321, entitled MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY, now publication of U.S. Patent Application No. 2017/0281163; - U.S. Patent Application Serial No. 15 / 089,326, entitled SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD, now patent application No. 2017/0281172; - U.S. Patent Application Serial No. 15 / 089,263, entitled SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGU- RABLE GRIP PORTION, now publication of U.S. Patent Application No. 2017/0281165; - U.S. Patent Application Serial No. 15 / 089,262, entitled
[0203] [0203] The applicant for this application also holds the US Patent Applications identified below, which were filed on December 30, 2015, and which are each incorporated herein by reference in their respective totalities: - Application for US Patent Serial No. 14 / 984,488, entitled MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE IN POWERED SURGICAL INSTRUMENTS, now, publication of US Patent Application No. 2017/0189018; - U.S. Patent Application Serial No. 14 / 984,525, entitled
[0204] [0204] The applicant for this application also holds the US Patent Applications identified below, which were filed on February 9, 2016, which are each incorporated by reference in their respective totalities: - Patent Application US Serial No. 15 / 019,220, entitled
[0205] [0205] The applicant for this application also holds the US Patent Applications identified below, which were filed on February 12, 2016, which are each incorporated by reference in their respective totalities: - Patent Application US Serial No. 15 / 043,254, entitled
[0206] [0206] The applicant for the present application holds the following patent applications that were filed on June 18, 2015 and which are each incorporated by reference in their respective totalities: - Patent Application no. US serial number 14 / 742,925, entitled SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS, now US Patent Application Publication No. 2016/0367256; - U.S. Patent Application Serial No. 14 / 742,941, entitled
[0207] [0207] The applicant for this application holds the following patent applications that were filed on March 6, 2015 and which are each incorporated herein by reference in their respective totalities: - US Patent Application Serial No. 14 / 640,746, entitled POWERED SURGICAL INSTRUMENT, now US Patent No.
[0208] [0208] The applicant for the present application holds the following patent applications that were filed on February 27, 2015 and which are each incorporated herein by reference in their respective totalities: - Patent application serial number US 14 / 633,576, entitled
[0209] [0209] The applicant for this application holds the following patent applications that were filed on December 18, 2014 and which are each incorporated by reference in their respective totalities: - US Patent Application No. serial number 14 / 574.478, entitled SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULAT-
[0210] [0210] The applicant for this application holds the following patent applications that were filed on March 1, 2013 and which are each incorporated herein by reference in their respective totalities: - US Patent Application Serial No. 13 / 782,295, entitled Articulatable Surgical Instruments With Conductive Pathways For Signal Communication, now US Patent No. 9,700,309; - U.S. Patent Application Serial No. 13 / 782,323, entitled Rotary Powered Articulation Joints For Surgical Instruments, now U.S. Patent No. 9,782,169; - U.S. Patent Application Serial No. 13 / 782,338, entitled "Thumbwheel Switch Arrangements For Surgical Instruments", now publication of U.S. Patent Application No. 2014/0249557;
[0211] [0211] The applicant for the present application also holds the following patent applications that were filed on March 14, 2013 and which are each incorporated by reference in their respective totalities: - US Patent Application n Serial number 13 / 803,097, entitled
[0212] [0212] The applicant for this application also holds the following patent application that was filed on March 7, 2014 and is incorporated herein by reference in its entirety: - US Patent Application Serial No. 14 / 200,111, entitled CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, now US Patent No. 9,629,629.
[0213] [0213] The applicant for this application also holds the following patent applications that were filed on March 26, 2014 and which are each incorporated by reference in their respective totalities: - US Patent Application n Serial No. 14 / 226,106, entitled "POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS", now publication of US Patent Application No. 2015/0272582; - U.S. Patent Application Serial No. 14 / 226,099, entitled STERILIZATION VERIFICATION CIRCUIT, now U.S. Patent No.
[0214] [0214] The applicant for this application also holds the following patent applications that were filed on September 5, 2014 and which are each incorporated herein by reference in their respective totalities: - US Patent Application n Serial No. 14 / 479,103, entitled "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE", now publication of US Patent Application No. 2016/0066912; - U.S. Patent Application Serial No. 14 / 479,119, entitled
[0215] [0215] The applicant for this application also holds the following patent applications that were filed on April 9, 2014 and which are each incorporated herein by reference in their respective totalities: - US Patent Application n Serial number 14 / 248,590, entitled
[0216] [0216] The applicant for this application also holds the following patent applications that were filed on April 16, 2013 and which are each incorporated herein by reference in their respective totalities: - Provisional US Patent Application serial number 61 / 812.365, entitled "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR"; - U.S. Provisional Patent Application Serial No. 61 / 812,376, entitled "LINEAR CUTTER WITH POWER"; - U.S. Provisional Patent Application Serial No. 61 / 812,382, entitled "LINEAR CUTTER WITH MOTOR AND PISTOL GRIP"; - U.S. Provisional Patent Application Serial No. 61 / 812,385, entitled "SURGICAL INSTRUMENT HANDLE WITH MULTIPLE AC-TUATION MOTORS AND MOTOR CONTROL"; and - U.S. Provisional Patent Application Serial No. 61 / 812,372, entitled "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR".
[0217] [0217] Numerous specific details are presented to provide a complete understanding of the structure, function, manufacture and general use of the modalities described in the specification and illustrated in the attached drawings. Well-known operations, components and elements have not been described in detail, so as not to
[0218] [0218] The terms "understand" (and any form of understanding, such as "understands" and "who understands"), "have" (and any form of have, such as "has" and "has"), " include "(and any form of inclusion, such as" includes "and" that includes ") and" contain "(and any form of contain, such as" contains "and" that contains ") are unrestricted linking verbs. As a result, a surgical system, device or apparatus that "comprises", "has", "includes" or "contains" one or more elements has those one or more elements, but is not limited to having only those one or more elements. Likewise, an element of a surgical system, device or device that "comprises", "has", "includes" or "contains" one or more resources has those one or more resources, but is not limited to possess only those one or more resources.
[0219] [0219] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[0220] [0220] Several exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily understand that the various methods and devices disclosed in the present invention can be used in numerous surgical procedures and applications, including, for example, in relation to open surgical procedures. With the advancement of this Detailed Description, the reader will also understand that the various instruments disclosed here can be inserted into a body in any way, such as through a natural orifice, through an incision or perforation formed in fabric, etc. Functional portions or portions of the instrument's end actuator can be inserted directly into a patient's body or can be inserted via an access device that has a working channel through which the end actuator and shaft long drive of a surgical instrument can be advanced.
[0221] [0221] Various surgical instruments are revealed in the present invention that are configured to hold a patient's tissue. As discussed in greater detail below, such surgical instruments comprise an end actuator and a plurality of drive systems configured to perform various functions of the end actuator. Such drive systems may include an anvil drive system configured to hold the fabric within the end actuator, a staple trigger system configured to implant staples into the fabric, and / or a fabric cut system configured to cut the fabric, for example. Such drive systems may also include a pivot drive system configured to pivot the end actuator, a tissue drive system configured to move the end actuator relative to the fabric, and / or a clamp loading system configured to reload the end actuator with clamps, for example. As also discussed in more detail below, two or more of these drive systems can be optionally coupled to a common drive system so that they are operated in synchronization.
[0222] [0222] A stapling instrument 1000 is illustrated in Figure 1. The stapling instrument 1000 comprises a handle 1100, a set of drive shaft 1200 that extends from the handle 1100, and a plunger actuator. end 1300 extending from drive shaft assembly 1200. Grip 1100 comprises frame 1110 and gripping portions 1120 positioned on opposite sides of frame 1110. Grip 1100 additionally comprises a plurality of electric motors configured to operate the 1000 stapling instrument drive systems. Three 1130, 1140, and 1150 electric motors are shown, but the surgical instrument 1000 can include any suitable number of electric motors. Each electric motor is operationally coupled with a rotating output. For example, the 1130 electric motor is operationally coupled to a 1135 rotary outlet, the 1140 electric motor is operationally coupled to a 1145 rotary outlet, and the 1150 electric motor is operationally coupled to a 1155 rotary outlet. The 1100 handle additionally comprises 1160 batteries, for example, which supply power to electric motors 1130, 1140, and 1150. Referring to Figure 11, 1160 batteries comprise 18650 lithium batteries, for example, but can comprise any suitable battery. Referring mainly to Figure 12, batteries 1160 are positioned in a battery housing 1115 defined in the handle structure 1110, but can be stored in any suitable location. 1160 batteries are also configured to supply power to a control system
[0223] [0223] A handle 1100 'is illustrated in Figures 8 and 10. The handle 1100' is similar to the handle 1100 in many respects, most of which will not be discussed here for the sake of brevity. The handle 1100 'comprises a battery housing which is accessible through a door 1115'. Port 1115 'allows the batteries in the battery housing to be replaced. An 1100 "handle is illustrated in Figure 9. The 1100" handle is similar to the 1100 handle in many ways, most of which will not be discussed here for the sake of brevity. The 1100 "handle comprises a plug 1115" configured to supply power to the handle 1100 "from a generator and / or wall outlet, for example. In several cases, the handle 1100" can be powered from from an internal source, such as 1160 batteries, for example, and an external source, such as plug 1115 ", for example.
[0224] [0224] With reference again to Figure 1, the structure of the handle 1110 comprises a connector 1170; The drive shaft assembly 1200 comprises an outer housing 1210 that includes a drive shaft connector 1270 configured to engage with the handle connector 1170 to couple the drive shaft assembly 1200 to the handle 1100. The shaft connector actuator 1270 and handle 1170 comprise a rotating bayonet interconnect; however, any suitable interconnection can be used. The drive shaft assembly 1200 further comprises a rotary input 1235 configured to be operationally coupled with the rotary output 1135 when the drive shaft assembly 1200 is mounted on the handle.
[0225] [0225] In addition to the above, the external drive shaft housing 1210 additionally comprises a distal connector
[0226] [0226] In several cases, the drive shaft assembly 1200 and / or the end actuator 1300 comprises one or more electrically driven sensors and / or components. With reference to Figure 2, the stapling instrument 1000 comprises at least one electrical circuit that extends through the handle 1100, the drive shaft assembly 1200 and the end actuator 1300.
[0227] [0227] With reference again to Figure 1, the end actuator 1300 additionally comprises a distal head 1320 swivelly connected to the drive shaft portion 1310 around an articulation joint 1370. The end actuator 1300 it also comprises an articulation drive system configured to articulate the distal head 1320 with respect to the drive shaft portion 1310. The distal head 1320 comprises an anvil 1360 which is movable between an open position and a closed position. In use, the anvil 1360 is movable towards a compression surface of fabric 1325 by an anvil drive system to secure, or compress, the fabric within the end actuator 1300. As will be discussed in connection with the Figures 3 to 7 below, the tissue compression surface 1325 is defined in a tissue drive system that is configured to engage the patient's tissue and move the stapling instrument 1000 relative to the patient's tissue.
[0228] [0228] Referring mainly to Figure 3, the end actuator 1300 comprises a rotary drive shaft 1330 that is usable to selectively open the anvil 1360, operate the tissue drive system (Figures 4 to 6) to return the distal head 1320 to the patient's tissue, and close the anvil 1360 (Figure 7) before the stapling instrument 1000 performs a staple firing stroke. The drive shaft 1330 is driven by an electric motor and, in addition, the drive shaft 1330 is translatable between a first position in which a key 1332 extending from the drive shaft 1330 1332 is operatively coupled to the system of tissue drive (Figures 4 to 6) and a second position in which the 1332 key is operationally engaged with the anvil drive system (Figure 7). When the drive shaft 1330 is in its first position, the switch 1332 is positioned inside a slot of the switch 1333 defined in a drive gear 1331 of the fabric drive system. When the drive shaft 1330 is in its second position, key 1332 is positioned inside the slot of key 1363 defined in a drive collar 1361 of the anvil drive system.
[0229] [0229] With reference to Figures 4 to 6, the tissue drive system comprises a first pedal 1380a and a second pedal 1380b. Pedals 1380a, 1380b are extensible to engage patient tissue and then retractable to pull distal head 1320 from end actuator 1300 relative to patient tissue. The tissue drive system is configured to extend the first pedal
[0230] [0230] In addition to the above, the fabric drive system comprises a first gear train configured to transfer the rotation of the drive shaft 1330 to the first gear 1380a and a second gear train configured to transfer the rotation of the drive shaft 1330 for the second gear 1380b. The first gear train comprises a sprocket 1381a operatively interleaved with drive gear 1331, a transfer gear 1382a operably interleaved with gear 1381a, and a sprocket 1383a operationally interleaved with transfer gear 1382a, so that the rotation of the drive shaft 1330 is transferred to the sprocket 1383a. The first gear train additionally comprises a drive shaft gear 1384a operatively interleaved with the sprocket 1383a. With reference mainly to Figures 5 and 6, the drive shaft gear 1384a is fixedly mounted to a transfer drive shaft 1385a, so that a rotation of the sprocket 1383a is transferred to the transfer drive shaft 1385a.
[0231] [0231] The second gear train is similar to the first gear train in many ways except that the second gear train does not include a transfer gear between the two sprockets, as discussed below. The second gear train comprises a sprocket 1381b operationally interleaved with the drive gear 1331 and a sprocket 1383b operationally interspersed with the sprocket 1381b, so that the rotation of the shaft 1330 is transferred to the sprocket 1383b . The second gear train additionally comprises a drive shaft gear 1384b operatively interleaved with the sprocket 1383b. With reference mainly to Figure 5, the drive shaft gear 1384b is fixedly mounted to the transfer drive shaft 1385b, so that a rotation of the sprocket 1383b is transferred to the transfer drive shaft 1385b. The second gear train additionally comprises a bevel gear 1386b fixedly mounted to the transfer drive shaft 1385b, a side bevel gear 1387b operably interspersed with the bevel gear 1386b, and a pinion gear 1388b fixedly mounted to the gear side bevel 1387b, so that pinion gear 1388b rotates with side bevel gear 1387b. The pinion gear 1388b is operationally interleaved with a rack 1389b mounted to the second pedal 1380b that converts the incoming rotary movement to translational movement of the second pedal 1380b.
[0232] [0232] The presence of a transfer gear 1382a in the first gear train and the absence of a corresponding transfer gear in the second gear train causes the first pedal 1380a and the second pedal 1380b to move in opposite directions in response to the drive shaft rotation
[0233] [0233] After the 1300 end actuator has been properly moved in relation to the fabric by the tissue drive system, the 1330 drive shaft is moved longitudinally out of engagement with the tissue drive system and in input with the anvil drive system, as shown in Figure 7. In many cases, the rotation of the 1330 drive shaft can be stopped before it is disengaged from the tissue drive system. In other cases, the 1330 drive shaft can continue to rotate as it is disengaged from the fabric drive system and translated into engagement with the drive collar
[0234] [0234] Notably, the drive shaft 1330 extends along a longitudinal axis 1339 which is collinear with a longitudinal axis 1369 which extends through the driving shaft 1364 of the anvil drive system. Such an arrangement makes it possible for the drive shaft 1330 to be operatively connected to the driving rod 1334 through the drive collar 1361. In addition, particularly, the drive collar 1361 comprises a proximal flange 1367 and a distal flange 1368 extending from the drive collar. Flanges 1367 and 1368 act as stops that limit the longitudinal displacement of the anvil 1360 in the proximal and distal directions, respectively. As such, flanges 1367 and 1368 define the limits of the anvil opening and closing strokes
[0235] [0235] Again with reference to Figure 3, a longitudinal gap is present between the drive gear 1331 of the fabric drive system and the drive collar 1361 of the anvil drive system. As a result, a pause in operation may be present when the displacement between the woven drive system and the anvil drive system. A shorter span may result in shorter breaks while a longer span may result in longer breaks. Other modalities are foreseen in which no gap or a very small gap is present between the drive gear 1331 and the drive collar 1361 and, as a result, the operational break can be eliminated.
[0236] [0236] Again with reference to Figure 1, end actuator 1300 comprises a plurality of staple cartridges 1400 stored therein. The 1000 stapling instrument comprises a cartridge drive system configured to push a 1400 staple cartridge into the 1300 end actuator. As a result, the cartridge drive system can be used to reload the actuator end piece 1300 without having to remove the stapling instrument 1000 from the surgical site.
[0237] [0237] Again with reference to Figure 1, each 1300 end actuator is intended to be used many times as long as there are staples or staple cartridges stored in the 1300 end actuator. The drive shaft assembly 1200 is intended for more uses than a 1300 end actuator. As a result, a worn 1300 end actuator can be replaced with another 1300 end actuator without the need to replace the drive shaft assembly 1200. In at least one In this case, each end actuator 1300 is intended for 10 uses while the drive shaft set is intended for 100 uses, for example. The 1100 handle is designed for more uses than the 1200 drive shaft assembly and / or a 1300 end actuator. As a result, a used 1200 drive shaft assembly can be replaced without the need for replace the handle 1100. In at least one case, the drive shaft assembly 1200 is intended for 100 uses, while the handle 1100 is intended for 500 uses, for example.
[0238] [0238] As discussed above, the stapling instrument 1000 comprises a drive system configured to reciprocally open, or loosen, an anvil, create a relative movement between the end actuator and the patient's tissue, and then pinch - give the anvil again. Figures 42 and 43 illustrate an exemplary embodiment of another reciprocating drive system that could be used. The drive system 2800 comprises a rotary drive shaft 2830 and a drive gear 2831 mounted on the drive shaft 2830. The drive system 2800 additionally comprises a sprocket 2832 operatively interspersed with the drive gear 2831, so that the rotation of the drive shaft 2830 is transmitted to the sprocket 2832. The drive system 2800 additionally comprises a chamfer gear 2833 which is mounted and rotates with the sprocket 2832, a side chamfer gear 2834 operatively interspersed with the bevel gear 2833, and a sprocket 2835 operatively interspersed with a gear mounted on one face of the bevel gear 2834. The drive system 2800 additionally comprises a pinion gear 2836 which is fixedly mounted and rotates with the sprocket 2835, an output gear 2837 operatively interleaved with the pinion gear 2836, and a me 2838 which is fixedly mounted and rotates with the output gear 2837. As a result of the above, the rotation of the drive shaft 2830 rotates the cam 2838 which, as described below, is converted to the reciprocating motion of the drive shaft 2830.
[0239] [0239] In addition to the above, the drive system 2800 comprises a rotary displacement 2840 that includes a cam arm 2848 and a displacement arm 2849 that is rotatable around a pivot
[0240] [0240] Figure 44 illustrates another example of a reciprocating drive system. The 2900 drive system comprises a 2930 electric motor, a first 2940 drive system operationally coupled with the 2930 electric motor, and a second 2950 drive system operationally coupled with the 2930 electric motor. The 2930 electric motor comprises a 2931 rotary output drive shaft and 2932 drive gear mounted fixedly to the output drive shaft
[0241] [0241] The 2950 output drive system comprises a 2952 input gear operatively interleaved with the 2932 drive gear. The 2952 input gear is fixedly mounted to a 2953 drive shaft, so that the drive shaft drive 2953 rotate with input gear 2952. The second drive system 2950 additionally comprises a cylindrical cam 2954 which is slidably mounted on the drive shaft 2953 and which rotates with the drive shaft 2953. The cylindrical cam 2954 comprises a aperture 2955 defined in that it comprises a non-circular profile, for example, which is configured to transfer the rotation between the drive shaft 2953 and the cylindrical cam 2954, and still allow a relative translation between them. The cylindrical cam 2944 further comprises a cam slot 2959 defined around it that interacts with a cam pin 2919 mounted on a frame 2910 so that when the cylindrical cam 2954 is rotated, the cylindrical cam 2944 is also translated. The cylindrical cam 2954 is moved distally when the cylindrical cam 2954 is rotated in a first direction and moved proximally when the cylindrical cam 2954 is rotated in a second or opposite direction. The second drive system 2950 additionally comprises a drive shaft 2956 extending from the cylindrical cam 2954 which is configured to drive a second function of the end actuator.
[0242] [0242] When the 2930 electric motor of the 2900 drive system is rotated in a first direction, the first drive shaft 2946 is advanced distally and the second drive shaft 2956 is retracted proximally. Correspondingly, the first drive shaft 2946 is retracted proximally and the second drive shaft 2956 is advanced distally when the electric motor 2930 is operated in a second or opposite direction. Other modes are provided in which the drive shafts 2946 and 2956 are advanced distally at the same time.
[0243] [0243] With reference to Figures 92 and 93, a stapling instrument 4500 comprises a tissue drive 4590 that includes a first pedal 4580a and a second pedal 4580b. The first pedal 4580a comprises a tooth rack 4583a defined therein, the second pedal 4580b comprises a tooth rack 4583b defined therein, and the fabric drive 4500 additionally comprises a 4593 pinion gear in geared engagement. with racks 4583a and 4583b. The 4593 pinion gear rotates back and forth around a geometric axis to reciprocally extend and retract the 4580a and 4580b pedals and, as a result, trigger the stapling instrument in relation to a patient's tissue. The 4590 fabric drive additionally comprises a first 4592 actuator attached to the 4593 pinion gear in a 4591 pivot joint and a second 4594 actuator attached to the 4593 pinion gear in a pivot joint
[0244] [0244] As discussed above, the pedals 1380a and 1380b of the stapling instrument 1000 are extended and retracted along linear paths. In such cases, pedals 1380a and 1380b can slide over the fabric as they are being extended and then grab and pull the fabric as they are being retracted. Pedals 1380a and 1380b may comprise teeth extending from them that have profiles that facilitate the sliding of pedals 1380a and 1380b relative to the tissue when moved in one direction and which hold the tissue when moved in the opposite direction. In at least one case, the teeth are substantially triangular, for example, but comprise a shallow angle on one side and a steeper angle on the other side. In such cases, the shallow angle allows the first side to slide in relation to the fabric, while the steeper angle on the second side bites or grabs the fabric when the pedals 1380a and 1380b are retracted.
[0245] [0245] As discussed above, pedals 1380a and 1380b are driven along a linear path by racks 1389a and 1389b defined therein. In some cases, the linear movement of the pedals 1380a and 1380b can be firmly guided with little, fluctuation or deviation, if any, from the linear movement. In various embodiments, now with reference to Figures 88 and 89, the pedals of a tissue drive system may comprise one or more joints that provide at least an additional degree of freedom that allows the pedals to deviate from a purely linear path. The fabric drive system 4200 comprises a first pedal 4280a and a second pedal 4280b that are movably connected by a connection 4282. Connection 4282 is coupled to the first pedal 4280a in a pivot joint 4281a and the second pedal 4280b in a pivot joint 4281b. The pedals 4280a and 4280b are moved proximally and distally through an input 4290 that includes a drive shaft 4292 connected to connection 4282 in a pivot joint
[0246] [0246] As discussed above, the tissue stapling instruments disclosed herein that comprise a tissue triggering system are configured to trigger, or advance, through a patient's tissue as they staple and cut the patient's tissue along a staple firing path. In several cases, the thickness of the fabric may change along the length of the staple firing path. In other words, the fabric can increase and / or decrease the thickness in a forward and backward direction and / or a side-by-side direction. Again with reference
[0247] [0247] Now referring to Figure 87, a stapling instrument 4100 comprises a distal stapling head 4120 which, similarly to stapling instrument 1000, comprises a tissue drive system 4190 including pedals
[0248] [0248] Now with reference to Figures 37 to 41, a surgical instrument 2700 comprises a distal head 2720 that includes a stool 2760, a tissue trigger pedal 2780, and a tissue trigger 2790. The tissue trigger 2790 comprises a 2791 positioning rod fixed to the 2780 drive pedal on a 2781 pivot joint. The 2791 positioning rod is displaceable along a longitudinal geometric axis to engage (Figure 38) and disengage (Figure 41) the pedal of 2780 activation of the patient's T tissue. When the drive pedal 2780 is disengaged from the fabric and retracted into the distal head 2720, with reference to Figure 37, a distal tip 2785 of the drive pedal 2780 is positioned inside the distal head 2720 and does not extend from of the same. In addition, the 2780 actuation pedal is locked in position, or prevented from being rotated, when the 2780 actuation pedal is retracted into the distal head 2720. More specifically, the distal head 2720 comprises a control slot 2724 defined therein and the pedal 2780 comprises two control pins 2784 positioned slidably in the control slot 2724 which are configured to prevent the drive pedal 2780 from turning when the drive pedal 2780 is in its retracted position (Figures 37 and 41) and to enable the 2780 drive pedal to rotate when the 2780 drive pedal is in its engaged position (Figures 38 to 40), which is discussed below.
[0249] [0249] With reference to Figures 38 to 40, the activation pedal
[0250] [0250] Now with reference to Figures 78 to 85, a 3900 stapling instrument comprises a distal 3920 head that includes a 3950 staple firing system configured to staple a patient's tissue, an anvil 3960 configured to hold the tooth. - patient's acid against a 3925 tissue compression surface and deform the staples implanted by the 3950 staple firing system, and 3980 pedals configured to generate a relative movement between the distal head 3920 and the tissue when the anvil 3960 is in a non-attached position. The 3900 stapling instrument further comprises a 3990 fabric drive configured to extend and retract the 3980 pedals. Referring mainly to Figures 83 and 84, the 3990 fabric drive comprises a 3992 rotary drive shaft and a worm thread 3993 fixedly mounted to the drive shaft 3992 so that the worm gear 3993 rotates with the drive shaft
[0251] [0251] In addition to the above, with reference to Figures 79 to 82, the fabric drive 3990 additionally comprises a coupler bar 3996 comprising a first end slidably positioned in a 3999 cam slot (Figures 83 and 85 ) defined on a second side, or face, of the drive wheel
[0252] [0252] In addition to the above, the coupler bar 3996 comprises a longitudinal slot 3997 defined therein and the clamp head 3920 comprises a pin 3927 which extends into the longitudinal slot 3997, which cooperates to limit or restrict the movement of the 3996 coupler bar. Figures 84 and 85 map three corresponding positions, designated as 1, 2, and 3, along the cam slot 3999 and the firing motion path FM ("firing motion") . Position 1 corresponds to point P in Figure 79A, position 2 corresponds to point P in Figure 80A, and position 3 corresponds to point P in Figure 81A. In several cases, the 3990 fabric drive comprises a four-bar mechanism on which the 3980 pedals are raised when they are then extended. To facilitate this movement, each 3980 pedal comprises a 3981 slot defined therein, the side walls of which slide in relation to a 3921 pin that extends into the 3981 slot. The 3921/3981 slot arrangements enable the 3980 pedals translate and rotate during the tissue activation stroke cycle.
[0253] [0253] Figure 86 illustrates an alternative embodiment of a 4099 cam path comprising shields that prevent the 3996 coupler bar from receding into slot 3999. For example, the cam path 4099 comprises a first bulkhead 4091 corresponding to position 1 and Figure 79A and, after the 3996 bar coupler has passed that point, the 3996 coupler bar cannot recede beyond position 1. The path of cam 4099 comprises a second bulkhead 4092 which corresponds to position 2 and Figure 80A and, after coupler bar 3996 has passed that point, coupler bar 3996 cannot recede beyond position 2. Cam 4099 also comprises a third bulkhead 4093 which corresponds to position 3 and Figure 81A and, after the 3996 coupler bar has passed that point, the 3996 coupler bar cannot recede beyond the position
[0254] [0254] With reference to Figures 50 to 56, a stapling instrument 3100 comprises a distal head 3120 including an anvil 3160 and the fabric drive pedals 3180. With reference to Figure 50, the drive pedals 3180 are extensible to engage a patient's tissue and then, with reference to Figure 51, retractable to move the distal head 3120 relative to the patient's tissue. Each 3180 drive pedal comprises a rack, or an array, of 3193 teeth configured to engage the patient's tissue which is also movable between the extended and retracted positions. Figure 51 illustrates that teeth 3193 extend from drive pedals 3180 when drive pedals 3180 are being retracted from an extended position. More specifically, teeth 3193 protrude from the tissue compression surfaces 3125 defined on drive pedals 3180 when drive pedals 3180 are being retracted from their fully extended position. On the other hand, with reference to Figure 50, teeth 3193 do not protrude from the compression surfaces of fabric 3125 as the drive pedals 3180 are being extended, which allows the slide of the drive pedals 3180 in relation to the fabric of the patient while they are extended.
[0255] [0255] With reference to Figures 52 to 56, the stapling instrument 3100 comprises a fabric drive 3190 configured to extend and retract the 3180 drive pedals and also to extend and retract the teeth 3193. The drive fabric 3190 comprises an inlet bar 3191 which extends inwardly and is movable within a cavity 3181 defined in each pedal 3180. The inlet bar 3191 moves the actuation pedals 3180 through a winding, non-linear path that includes an elevated, retracted position (Figures 52 and 56), a lowered, retracted position (Figure 53), a lowered, extended position (Figure 54), and an elevated, extended position (Figure 55) . The entry bar 3191 comprises pins 3192 extending from it that extend into slots 3182 defined in the drive pedals 3180. As discussed in more detail below, the interaction between pins 3192 and the side walls of the slits 3182 transfers movement from the 3191 input bar to the drive pedals
[0256] [0256] When the input bar 3191 is in a fully retracted position, as shown in Figure 52, the 3191 drive bar positions the 3180 drive pedals in their raised, retracted position. In this position, teeth 3193 protrude through the windows 3183 defined on the drive pedals 3180. As the entry bar 3191 is moved out of its fully retracted position, with reference to Figure 53, pins 3192 interact with the side walls of the slits 3182 and by turning the 3180 drive pedals downwards by cam actuation. At such a point, the 3193 teeth no longer protrude through the 3183 windows. As the 3191 entry bar is moved further in the opposite direction from its completely retracted position, the 3191 entry bar begins to extend the pedals from drive 3180 as illustrated in Figure 54. Notably, teeth 3193 do not protrude through windows 3183 as drive pedals 3180 are extended.
[0257] [0257] Referring to Figures 57 to 59D, a stapling instrument 3200 comprises a distal stapling head 3220 that includes the tissue drive pedals 3270 that are extended outward and retracted inward along the same path for one tissue drive system, such as the tissue drive system of the 1000 stapling instrument, for example. That said, the stapling head 3220 additionally comprises side drive pedals 3280 that move with the drive pedals 3270 but can also move laterally in relation to the drive pedals 3270, as shown in Figures 57 and 58. As a result, the side drive pedals 3280 can be extended along a path, as shown in Figures 59A and 59B, extended laterally, and then retracted along a different path, as shown in Figures 59C and 59D. In addition, the 3270 and 3280 drive pedals can pull the distal head 3220 relative to the patient's tissue in two different directions, which provides greater control over the relative movement between the distal stapling head 3220 and the patient's tissue.
[0258] [0258] Referring mainly to Figures 57 and 58, the 3270 and 3280 drive pedals are rotationally coupled in pairs. Each pair comprises a 3260 actuator plate, a first 3272 connection hingedly connected to the 3270 drive pedal around a 3271 pivot pedal, and a second 3282 connection hingedly connected to the side drive pedal 3280 to the around a pivot 3281. When a downward force is applied to the actuator plate 3260, with reference to Figure 58, an actuator plate 3260 pushes a joint 3213 that swivels the first connection 3272 and the second connection 3282 , which causes the 3280 side pedal to move outward. In addition, the distal head 3220 restricts lateral movement of the 3270 actuation pedal and, as a result, the 3270 actuation pedal does not move laterally when the 3280 lateral actuation pedal extends laterally. However, with reference to Figures 60A to 60D, alternative modalities are provided in which the 3270 actuation pedal can also move laterally. In any case, a bias member, such as a torsion spring positioned on and / or attached to the 3213 linkage, for example, can retract the drive pedals laterally after the pushing force is removed from the plate. actuator 3260. Figures 59A to 59D show a sequence of steps that can be repeated by the surgical instrument 3200 to move the stapling instrument 3200 along a staple firing path. Figures 60A to 60D also show a sequence of steps that can be repeated by the surgical instrument 3200 to move the stapling instrument 3200 along a staple firing path.
[0259] [0259] Referring to Figures 61 and 62, a surgical instrument 3300 comprises a distal head 3320 and side pedals that are extendable 3380. The driving pedals 3380 are coupled to the distal head 3320 using flexible connectors 3375 and 3370 actuators. When a compressive force is applied to a 3370 actuator, the 3370 actuator is displaced and / or compressed which causes the 3375 connectors to extend laterally and push the corresponding 3380 drive pedal laterally. When the compressive force is removed from the 3370 actuator, the 3375 connectors resiliently contract and pull the 3380 drive pedal inward. The 3380 drive pedals can include tissue pressure features defined in them that are configured to push and / or pull the patient's tissue when the 3380 drive pedals are being moved laterally. As a result, the 3380 drive foot can create a relative movement between the 3320 distal head and the patient's tissue.
[0260] [0260] With reference to Figures 91A to 91D, a 4400 stapling instrument comprises a distal head 4420 that includes a 4440 fabric cutting drive, a 4450 staple trigger drive, and a fabric drive including 4480 pedals. Each pedal 4480 is rotatable mounted on the distal head 4420 around a pivot pin 4481 and is rotatable to drive the distal head 4420 in relation to the patient's tissue. Figure 91 illustrates the 4480 pedestals in a stowed position. Figure 91B illustrates pedals 4480 being extended. Figure 91C illustrates pedals 4480 in their fully extended position. Figure 91D illustrates pedals 4480 being retracted. When pedals 4480 are extended, pedals 4480 activate the distal head 4420 in relation to the patient's tissue. Notably, the 4480 pedals are synchronized so that they are extended and retracted together, and in such cases, the 4480 pedals can drive the distal head 4420 along a linear line, or at least substantially linear. That said, one of the 4480 pedals can be extended while the other 4480 pedal is retracted. In such cases, pedals 4480 can rotate distal head 4420 along a curved path.
[0261] [0261] With reference to Figures 76 and 77A to 77D, a stapling instrument 3800 comprises a distal head 3820 that includes a staple firing system 3850, an anvil 3860 and a tissue drive system. The drive system comprises a first pedal 3880a and a second pedal 3880b and is configured to selectively extend and retract pedals 3880a and 3880b to move the 3800 stapling instrument along a firing path (FP). "). The tissue drive system is configured to move, or advance, the 3800 stapling instrument along the trigger paths of linear and / or curved staples. With reference to Figures 77A and 77B, the tissue drive system is configured to simultaneously extend and retract the first pedal 3880a and the second pedal 3880b in an equal, or at least approximately equal, amount to move the distal firing head 3220 along a linear firing path. With reference to Figures 77C and 77D, the tissue drive system is also configured to extend and retract only one of the pedals 3880a and 3880b to rotate the distal trigger head 3220. For example, with reference to Figure 77C, the drive system of fabric can extend and retract the first pedal 3880a, while neither extending nor retracting the second pedal 3880b, to rotate the distal head 3820 in a first direction. Similarly, with reference to Figure 77D, the tissue drive system can extend and retract the second pedal 3880b, while neither extending nor retracting the first pedal 3880a, to rotate the distal head 3820 in a second direction.
[0262] [0262] As discussed above, the tissue drive system is configured to rotate the distal head 3820 of the 3800 stapling instrument by operating one of the pedals 3880a and 3880b, but not the other. Alternatively, the tissue drive system can be configured to rotate the distal head 3820 by extending one of the pedals 3880a and 3880b less than the other. The distal head 3820 could be gradually rotated in such cases. The tissue drive system can also be configured to rotate the distal head 3820 by moving the pedals 3880a and 3880b in opposite directions. In such cases, the distal head 3820 could follow small or narrow radii of curvature in the firing path of FP clips.
[0263] [0263] With reference to Figures 63 and 64, a 3400 stapling instrument comprises a distal head 3420 that includes a staple firing system 3450, an anvil 3460 and a tissue drive system. The fabric drive system comprises two drive wheels 3480 and a drive shaft 3481, which is pivotally supported by bezels 3482, which extend through openings defined in the center of the drive wheels
[0264] [0264] Referring to Figure 94, a 4600 stapling instrument comprises a distal head 4620 that includes a 4650 staple firing system, a 4660 anvil and a tissue drive system. The fabric drive system comprises driving two 4680 drive wheels that are each rotatably supported by a separate pin that extends through the center of the wheels. As a result, the 4680 drive wheels can be rotated independently. Each 4680 drive wheel comprises a matrix of teeth that extend around it that is in engagement with a drive shaft of an electric motor. In other words, the fabric drive system comprises two electric motors that are configured to rotate the 4680 drive wheels separately. Similar to the above, the drive teeth that extend around the 4680 drive wheels are also suitably configured to engage and secure the patient's tissue. In use, electric motors can be operated to rotate the 4680 drive wheels to create relative movement between the distal head 4620 and the patient's tissue and move the distal head 4620 along a staple firing path, as described in more details below.
[0265] [0265] In addition to the above, the fabric drive system is configured to rotate the 4680 drive wheels in the same direction at the same speed to move the distal head 4620 along a linear staple firing path. The fabric drive system is also configured to rotate the 4680 wheels in the same direction, but at different speeds, to rotate the distal head 4620 along a curved staple firing path. The distal head 4620 can make gradual turns in such cases. The fabric drive system is also configured to turn only one of the 4680 drive wheels, and at the same time not to turn the other 4680 drive wheel, to rotate the distal head 4620 along a suit.
[0266] [0266] The fabric drive system additionally comprises 4670 side add-on wheels that are positioned side by side with the 4680 drive wheels. Similar to the above, each 4670 side drive wheel is operationally coupled to a different electric motor. As a result, the 4600 stapling instrument's tissue drive system comprises four electric motors that are operated at the same time or at different times. The 4670 side drive wheels are operated independently of the 4680 drive wheels, although they could be operated at the same time as one or both 4680 drive wheels. In addition, the 4670 side drive wheels are operated independently one at a time. - lation to the other. Similar to the 4680 drive wheels, the fabric drive system is configured to rotate the 4670 side drive wheels together at the same speed, at different speeds, and / or in different directions to move the 4620 distal head over a staple trigger path. In addition, the fabric chucking system is configured to rotate any suitable combination of the 4670 and 4680 drive wheels in any suitable direction and at any suitable speed to move the 4600 stapling instrument along a path staple trigger function.
[0267] [0267] With reference to Figure 36, a stapling instrument 2600 comprises a distal head 2620 that includes a staple firing system 2650, an anvil 2660 and a tissue drive system. The fabric drive system comprises two drive wheels 2670 and two drive wheels 2680 that can be rotated independently, at the same time or at different times, to move the distal head 2620 along a staple firing path. Each drive wheel 2670 is rotatable about a 2671 axis and each drive wheel 2680 is rotatable about a 2681 axis; however, the 2671 geometry axes are not parallel to the 2681 geometry axes. In fact, the 2671 and 2681 geometry axes are orthogonal, but can be oriented in any suitable direction. The fabric drive system comprises four electric motors that are configured to rotate the 2670 and 2680 drive wheels separately; however, the fabric drive system can have any suitable number of electric motors to drive the 2670 and 2680 drive wheels. In use, the electric motors can be operated to rotate the 2670 and 2680 drive wheels to create movement relative between the distal head 2620 and the patient's tissue and move the distal head 2620 along a staple firing path.
[0268] [0268] Now with reference to Figures 75A to 75D, a 3700 stapling instrument comprises a distal head 3720 that includes a 3760 anvil and a tissue drive system that includes a 3780 tissue drive pedal. The 3700 stapling instrument is similar to the 1000 stapling instrument in many aspects, most of which will not be discussed here for the sake of brevity. The anvil 3760 is movable in relation to the pedal 3780 between a closed or stuck position (Figures 75A and 75D) and an open, or not stuck position (Figures 75B and 75C). While anvil 3760 is being opened, with reference to Figure 75B, the 3780 actuation pedal can be extended to engage and secure the fabric. With reference to the Figure
[0269] [0269] Now with reference to Figures 65 to 69, a 3500 stapling instrument comprises a 3520 distal head that includes a 3560 anvil and a tissue drive system including a 3570 vacuum feed line, two 3580 vacuum holders, and two 3590 gripper extenders. The 3570 vacuum feed line comprises a 3571 pipeline configured to provide a vacuum pressure differential to the two 3590 gripper extenders and two 3580 vacuum grippers. Each 3590 gripper extender comprises a pair of 3591 bellows in communication with the 3571 piping that contract and extend when a vacuum is communicated to the full internal space of the 3591 bellows. When the 3591 bellows contract, they extend the 3580 holders to the position shown in Figure 65. Each 3591 bellows is in fluid communication with a cavity
[0270] [0270] As discussed above, the extension of the 3580 holders corresponds to the application of a vacuum pressure differential to the fabric. When the 3570 vacuum feed line no longer provides a vacuum pressure differential for the 3591 bellows, the 3591 bellows expand and contract again resiliently and correspondingly retract the 3580 holders, as shown in the figure
[0271] [0271] Once positioned in the 3525 tissue chamber, the patient's tissue can be stapled and / or cut. The 3570 feed line does not provide a vacuum pressure differential during stapling and / or cutting operations as this can extend the 3580 grips and move the fabric. That said, the vacuum supply could be turned on during stapling and / or cutting operations if, for example, there was another way to keep the fabric in place. In any case, the anvil 3560 can then be reopened, the distal head 3520 can be moved relative to the tissue and the vacuum supply can be used to re-extend the 3580 tissue holders so that the process described above can be repeated, as shown in Figure 69.
[0272] [0272] With reference to Figures 70 to 73, a stapling instrument 3600 comprises a distal stapling head 3620 that includes a staple firing system 3650, an anvil 3660, a tissue cutting system 3640 and also a tissue gripping system that uses vacuum pressure differentials. The 3600 stapling instrument is similar to the 3500 stapling instrument in many respects, most of which will not be discussed here for the sake of brevity. That said, the tissue gripping system comprises two separate and distinct vacuum feed lines - a first feed line 3670a in communication with a first bellows 3690a which is in fluid communication with a second tissue drive pedal 3680a through a 3685a pedal tubing and also a second feed line 3670b in communication with a second bellows 3690b which is in communication with a second tissue drive pedal 3680b via a 3685b pedal tubing. The 3685a pedal tubing comprises an array of 3686 tubing openings that are in communication with the 3682 pedal openings defined in the first 3680a pedal and communicates a vacuum pressure differential to the 3682 pedal openings when a vacuum is supplied to the first line 3670a power supply. The 3685b pedal tubing comprises an array of 3686 tubing openings that are in communication with the 3682 pedal openings defined in the second pedal 3680a and communicates a vacuum pressure differential to the 3682 pedal openings when a vacuum is supplied to the second 3670a power line. The stapling instrument 3600 additionally comprises a control system configured to selectively apply a vacuum to the first supply line 3670a and the second supply line 3670b so that the first drive pedal 3680a and the second actuation pedal 3680b they can be selectively extended and retracted. In some cases, pedals 3680a and 3680b are synchronized and simultaneously extended and retracted together, while in other cases, pedals 3680a and 3680b are extended and retracted at different times.
[0273] [0273] An alternative modality of a 3600 'stapling instrument is illustrated in Figure 74. The 3600 stapling instrument is similar to the 3600 stapling instrument in many ways. That said, the instrument 3600 'comprises larger tissue drive pedals 3680' which have more vacuum holes 3682 defined therein compared to the tissue drive pedals 3680 of the stapling instrument 3600.
[0274] [0274] Now with reference to Figures 47A to 47G, a stapling instrument 3000 comprises a distal head 3020 that includes a staple firing system, an anvil closure system that includes an anvil 3060, a tissue drive that includes at least one 3080 drive pedal, and a 3070 fabric grip configured to release the fabric reliably. Referring to Figure 47A, the anvil 3060 is movable from a clamped position to a non-clamped position to loosen the patient's T tissue. Referring to Figure 47B, the tissue holder 3070 engages with the patient's T tissue to hold the tissue in place while the 3080 actuation pedal is extended, which is illustrated in Figures 47C and 47D. The tissue holder 3070 can be attached to the tissue as the anvil 3060 is being opened and / or after the anvil 3060 has been opened. In any case, with reference to Figure 47E, the tissue holder 3070 is disengaged from the tissue before the actuation pedal 3080 is retracted to pull the distal head 3020 in relation to the tissue and position the distal head 3020 in a new position along the staple firing path, as shown in Figure 47F. At such a point, with reference to Figure 47G, the patient's tissue is secured by the 3060 anvil and the staple firing system is operated to staple the tissue. At such a point, the cycle described above can be repeated.
[0275] [0275] As shown in Figures 47D to 47F, the 3080 drive pedal is in fluid communication with a vacuum source
[0276] [0276] Again with reference to Figure 78, the 3900 stapling instrument additionally comprises tissue holders
[0277] [0277] Figures 45, 46, 48 and 49 show the operational sequencing of a stapling instrument that could be used with a stapling instrument disclosed here, such as a stapling instrument 4000 and / or the stapling instrument 3900 discussed above, for example. The stapling instrument 4000 is similar to the other stapling instruments revealed here in many respects, most of which will not be discussed here for the sake of brevity. The stapling instrument 4000 comprises an anvil drive system 4060, a staple trigger system 4050, a fabric cut system 4040, a fabric hold system 4090, and a fabric drive system 4080 configured to move the stapling instrument 4000 in relation to the patient's tissue. Figure 49 shows the operational steps of the stapling instrument 4000, which occur in the order presented. For example, step 4003 follows step 4002 and step 4002 follows step 4001, and so on. That said, it should be understood that the adjacent operational steps can occur simultaneously, or with at least some amount of overlap, as illustrated in Figure 46 and discussed in greater detail below. In addition, the operating steps in Figure 49 can be rearranged in any suitable order.
[0278] [0278] Again with reference to Figure 49, operational step 4001 comprises loading a staple cartridge into the stapling instrument 4000 and / or pushing a staple cartridge into the pointer.
[0279] [0279] In addition to the above, operational step 4007 comprises forming the clamps against the anvil and operational step 4008 comprises implanting the 4040 fabric cutting system knife. Operational step 4007 occurs before operating step 4008, but steps 4007 and 4008 can occur at the same time or with a certain amount of overlap. Operational step 4009 comprises using the 4040 tissue cutting system to retract the knife and follows operational step 4008. Operational step 4010 comprises holding and holding the patient's tissue positioned within the end actuator of the stapling instrument 4000 using the 4090 tissue gripping system. Operational step 4011 involves loosening the anvil using the anvil drive system
[0280] [0280] In addition to the above, Figure 46 illustrates that certain operational steps can occur at the same time or with a certain amount of overlap. For example, step 4011 of opening the bib and step 4001 of loading a staple cartridge into position can occur at the same time or with at least some overlap. Similarly, the step 4002 and / or 4003 which comprises advancing the clamps into position within the clamp trigger 4050 can occur at the same time as, or with some overlap with, the step 4011 of opening the anvil, step 4010 of gripping the fabric with the system of gripping fabric 4090, step 4012 of extending the pedals of the fabric drive system 4080, step 4013 of releasing the fabric with the gripping system 4090, and / or the step 4014 retraction of the pedals of the 4080 fabric drive system, for example. In addition, step 4001 of reloading another staple cartridge into position within the stapling instrument 4000 can occur at the same time, or with some overlap with step 4008 of cutting the fabric and / or the step 4009 retraction of the fabric cutting knife.
[0281] [0281] In addition to the above, Figure 45 illustrates the actuation cycles of the anvil drive system 4060 and the anvil drive system 4080 of the stapling instrument 4000. The actuation cycles in Figure 45 are plotted in relation to time t, in which the O, or zero, marks on the horizontal time axes show the beginning of a cycle sequence of the stapling instrument 4000. With reference to the actuation cycle of the drive system with anvil 4060, the peak 4006 correlates with step 4006, discussed above, which comprises closing, or securing, the anvil in the fabric. Similarly, pause 4011 correlates with step 4011,
[0282] [0282] As discussed above, it may be desirable to perform certain operational steps of the 4000 stapling instrument sequentially and other operational steps at the same time. In some cases, however, it may not be desirable to perform certain operational steps at the moment. As such, the stapling instrument 4000 is configured to block certain drive systems and prevent them from being operated while other drive systems of the 4000 stapling instrument are being operated. Locks can include locks and / or electrical locks, for example. All stapling instrument drive systems 4000 are motorized and are in communication with the stapling instrument controller 4000 and, as such, the controller can be used to block the drive systems. The controller comprises a microprocessor, for example, which is configured to electronically block one or more drive systems
[0283] [0283] With reference to Figures 90A to 90D, a stapling instrument 4300 comprises a distal head 4320 that includes a clip trigger system 4350, an anvil drive system including an anvil 4360, and a tissue cutting system
[0284] [0284] As discussed above, pedals 4370a and 4380a are operationally coupled together so that they move together as a pair. They spin together as a pair, they hold together as a pair, and they drop together as a pair. Several alternative modes are provided in which only one of the pedals 4370a and 4380a moves to secure and detach the fabric; however, the 4370a and 4380a pedals would continue to rotate together as a pair. A second synchronized pair of pedals that includes the 4370b and 4380b pedals move in the same way as the first pair of pedals that include the 4370a and 4380a pedals and, as such, a discussion of their movement will not be repeated for the sake of brevity. That said, the movement of the first pair of pedals is synchronized with the movement of the second pair of pedals. More specifically, the second pair of pedals is extended at the same time that the first pair of pedals is extended, the second pair of pedals is attached to secure the fabric at the same time that the first pair of pedals is attached, the second pair of pedals is retracted at the same time as the first pair of pedals is retracted, and the second pair of pedals is released at the same time that the first pair of pedals is released. In certain instances, the movement of the first pair of pedals and the second pair of pedals is not synchronized, or completely synchronized. In at least one such example, the first pair of pedals is extended and retracted independently of the second pair of pedals to rotate the distal head 4320 along a curved clamp path.
[0285] [0285] As discussed above, the stapling instruments disclosed here are configured to staple a patient's tissue. They are also configured to cut the fabric. With reference to Figures 95 and 96, a stapling instrument 5000 comprises a distal head 5020 that includes a staple firing system, a fabric cutting system 5040 and an anvil 5060 configured to deform the staples implanted by the dis- - stop staples. The fabric cutting system 5040 comprises a cutting bar 5042 that includes a knife edge 5045 defined at the distal end 5044 thereof. In use, the cutting bar 5042 is laterally translatable through the distal head 5020 during a tissue cutting stroke. The fabric cutting stroke of the 5042 cutter bar extends between a first unacted position, shown in Figure 95, and a second acted position. During the tissue cutting stroke, the knife edge 5045 extends between a tissue compression surface 5025 and a tissue compression surface 5065 defined on the anvil 5060. The edge of the knife 5045 can also extend into the distal head 5020 and / or anvil 5060 during the tissue cutting stroke to ensure that the entire thickness of the tissue is transected.
[0286] [0286] In addition to the above, the distal head 5020 defines a longitudinal geometric axis of the HA head. During the fabric cutting stroke, the 5042 cutting bar moves orthogonally with respect to the longitudinal geometric axis of the HA head. The fabric cutting system 5400 additionally comprises a cutting actuator 5046 configured to engage the cutting bar 5042 and to move the cutting bar 5042 laterally. The cutting actuator 5046 comprises a distal end 5047 which includes an angled cam surface configured to engage a corresponding cam surface 5043 defined at the distal end 5044 of the cutting bar 5042. The cutting actuator 5046 can also be configured to push the 5042 cutter bar in any suitable manner. In other embodiments, the cutting bar 5042 can be moved without a cutting actuator 5046.
[0287] [0287] With reference to Figure 98, a stapling instrument 5100 comprises a distal head 5120 including a staple forming anvil 5160. The stapling instrument 5100 additionally comprises a staple feeding system 5190, an alignment system of staples 5180 clamps, and a 5150 clamp trigger system. The 5150 clamp trigger system comprises clamp actuators that are longitudinally movable 5151 to eject a set, or bundle, of 5130 clamps from the 5120 distal head during a firing stroke. of staples. Referring to Figures 99 and 100, each clamp 5130 may comprise a base 5131 and clamp legs 5132 extending from base 5131. With reference to Figures 100 and 101, the clamp actuators 5151 are configured to push the bases 5131 of the clamps 5130 to push the clamp legs 5132 against the formation pockets 5162 (Figure 97) defined on the anvil 5160 during the clamp firing stroke. At such a point, with reference to Figure
[0288] [0288] As described above, the 5100 stapling instrument is configured to deploy staples during each staple firing stroke. Referring to Figure 103, stapling instrument 5100 further comprises a 5140 tissue cutting knife configured to cut tissue during and / or after each staple firing stroke. The 5150 clamp firing system is configured to deploy a first group or grouping of three 5130 clamps positioned on a first side of a CP ("cutting path") created by the 5140 knife and a second group or grouping of three 5130 clamps positioned on a second side of the CP cutting path. The 5150 staple firing system deploys the first and second groups of staples at the same time; however, modalities are contemplated in which the first group is implanted before the second group of staples. Alternative modalities are provided in which a stapling instrument does not comprise a tissue cutting system, or the tissue cutting system of the stapling instrument can be deactivated. The staple feeding system 5190 and the staple alignment system 5180 cooperate to reposition another set of staples 5130 on the distal head 5120 after each staple firing stroke is performed so that another firing stroke is performed. staples can be performed. In many cases, the 5130 staples are reloaded during the fabric cutting course and / or after the fabric cutting course.
[0289] [0289] Referring mainly to Figures 97, 100, and 102, the 5190 clamp feed system comprises 5191 clamp pusher. Each 5191 clamp pusher is configured to push a 5130 clamp into a clamp cavity.
[0290] [0290] Staple actuators 5151 and staple pusher 5191 move in parallel, or at least substantially parallel to each other. Due to the design of the staple actuators 5151 and the staple pusher 5191, and / or other space restrictions, with reference to Figures 97 and 103, the staple instrument 5100 additionally includes a staple alignment system comprising 5180 clamp pushers that are configured to work with the 5191 clamp pushers to align the 5130 clamps with the 5151 clamp drivers. The 5191 clamp pushers push the 5130 clamps lengthwise and the 5180 clamp pushers push the clamps 5130 laterally.
[0291] [0291] With reference to Figures 104 to 105D, a stapling instrument 5200 comprises a distal head 5220 that includes a 5250 staple firing system configured to implant 5230 staples, a tissue cutting system and a 5260 anvil that includes formation pockets configured to deform the 5230 clamps. The 5250 clamp firing system comprises rotary actuators 5252 configured to move the side clamp actuators 5254 along linear, or at least substantially linear, lateral paths. Each rotary actuator 5252 comprises a cam 5253 configured to engage a bulkhead 5255 defined in the clamp actuators 5254 and move the actuators 5254 sideways, as shown in Figure 105B. The clamp firing system 5250 additionally comprises one or more springs 5224 positioned between the side clamp actuators 5254 and a frame 5222 of the distal head 5220. The springs 5224 are compressed as the clamp actuators 5254 are laterally slid by the actuators. rotating fans 5252 until cams 5253 disengage from bulkheads 5255 of actuators 5254 during continuous rotation of actuators 5252, as shown in Figure 105C. At this point, with reference to Figure 105D, springs 5224 resiliently return the side clamp actuators 5254 to their unacted positions.
[0292] [0292] Referring to Figures 104 and 105A, the 5250 clamp trigger further comprises longitudinal clamp actuators 5257 which are driven along the longitudinal path of clamp firing by side clamp triggers 5254. Each actuator side clamp 5254 comprises a drive cavity 5256 defined therein that receives a portion of a longitudinal clamp driver 5257 within it. More specifically, each longitudinal clamp driver 5257 comprises a cam portion positioned in a drive cavity 5256 which is driven longitudinally, as shown in Figure 105B, by a cam surface 5258 defined in the drive cavity 5256 when the clamp drivers 5254 are moved laterally. As a result of the above, the rotary movement of the 5252 rotary actuators is converted into the side translation of the 5254 side clamp actuators, which is converted into the longitudinal translation of the 5257 longitudinal clamp actuators. drives the 5230 clamps against the 5260 anvil to deform the 5230 clamps, as shown in Figure 105B. The longitudinal clamp actuators 5257 comprise cradles of clamps 5251 defined therein that are configured to support the 5230 clamps as the 5230 clamps are being deformed.
[0293] [0293] In addition to the above, with reference to Figure 105C, the lateral return movement of the clamp actuators 5254 retracts the longitudinal clamp actuators 5257 to their non-actuated positions. More specifically, the drive cavities 5256 additionally comprise a cam surface 5258 'configured to drive the longitudinal clamp drivers 5257 in an opposite direction until the clamp drivers 5257 have rotated.
[0294] [0294] As described above, connected staple columns can be used to supply and replenish the staple trigger system of a stapling instrument. In other cases, complete staple cartridges can be used to fill and replenish a staple firing system. With reference to Figure 106, a stapling instrument 5300 comprises a drive shaft 5310, a distal head 5320 and a pivot joint 5370 that swivelly connects the distal head 5320 to the drive shaft 5310. The stapling 5300 additionally comprises a plurality of staple cartridges 5330 "stored on drive shaft 5310 and a cartridge pushing system configured to push staple cartridges 5330" into the distal head 5320. After a 5330 "staple cartridge to be positioned on the distal head 5320, the clamps 5330 (Figure 107) contained in the clamp cartridge 5330 "can be separated and implemented by a clamp firing system, as discussed in more detail below. In several cases, the staple cartridge comprises a cartridge body that is broken and implanted with the staples, while in other cases the staples are ejected from the cartridge body and the cartridge body is not implanted.
[0295] [0295] In addition to the above, with reference to Figure 107, the 5330 "staple cartridge comprises a 5333 cartridge body including an opening defined therein. The opening includes a first side 5334 configured to receive and store a first group of staples 5330 and a second side 5335 configured to receive and store a second group of staples 5330. The first group of staples 5330 is implanted on a first side of a tissue incision path created by a knife cutting of the fabric and the second group of staples 5330 is implanted on a second side of the tissue incision path.The staples 5330 are additionally arranged in clusters 5330 'of three staples that are implanted together, although the staple clusters can include any suitable number of staples, five clamp clusters 5330 'are stored on the first side 5334 of the 5333 cartridge body and five clamp clusters 5330' are stored in the following on the 5335 side of the 5333 cartridge body, although any suitable number of collations can be used. A group of staples 5330 'is ejected on each side 5334 and 5335 of the cartridge body 5333 and deformed against an anvil 5360 during each staple firing stroke of the stapling system. In various alternative embodiments, the clamp groupings 5330 'can be sequentially deployed from the first and second sides 5334 and 5335.
[0296] [0296] In addition to the above, clamps 5330 of each group of clamps 5330 'are attached to each other by at least one adhesive; however, clamp bundles 5330 'are not attached to each other and are instead stored side by side in the 5333 cartridge body. In at least one alternative embodiment, the clamps in the adjacent clamp bundles are reliably fixed to each other. Now referring to Figure 108, the cartridge body 5333, for example, can be configured to releasably store a plurality of clamp groups 5430 'therein, each clamp group 5430' comprising three clamps. The three staples 5430 of each group of staples 5430 'are attached to each other by at least one 5435 adhesive, and also the clusters 5430' are attached to each other by at least one 5435 adhesive. the staple groups 5430 'are attached to each other to form a strip of staples 5430 ", one or more groups of staples 5430' being separated from the other groups of staples 5430 'to load the distal head 5320 with staples. Although the staple groupings of the modalities described above comprise three staples, a staple group can include any suitable number of staples including two staples, for example, or more than three staples.
[0297] [0297] With reference to Figures 109 and 110, a 5400 stapling instrument comprises a drive shaft 5410, a distal head, a staple loading system, a staple firing system, a fabric cutting system, a system anvil closure, and a system configured to move the distal head in relation to a patient's tissue. The stapling instrument 5400 additionally comprises the staple strip 5430 "of Figure 108 stored on the drive shaft 5410. The staple strip 5430" can be stored within the 5333 cartridge body, as described above, or it can be stored inside the drive shaft 5410 without the cartridge body. The staple strip 5430 "can comprise any suitable number of staples and / or groupings of staples. In at least one example, the staple strip 5430" comprises 588 staples, for example.
[0298] [0298] With reference to Figures 111 and 112, a 5500 stapling instrument comprises a drive shaft 5510, a distal head, a staple loading system, a staple firing system, a fabric cutting system, a system anvil closure and a system configured to move the distal head in relation to a patient's tissue. The stapling instrument 5500 additionally comprises a first staple strip 5530a "and a second staple strip 5530b" stored on the drive shaft 5510. Staple strips 5530a "and 5530b" are comprised of staples 5430 which are arranged in clusters 5430 '. The strips 5530a "and 5530b" are nested so that the bases of the 5430 clips are facing opposite directions.
[0299] [0299] With reference to Figures 113 and 114, a 5600 stapling instrument comprises a drive shaft 5610, a distal head, a staple loading system, a staple firing system, a fabric cutting system, a system anvil closure, and a system configured to move the distal head in relation to a patient's tissue. The stapling instrument 5600 additionally comprises a first staple strip 5630a "and a second staple strip 5630b" stored on the drive shaft 5610. Staple strips 5630a "and 5630b" are comprised of staples 5430 which are arranged in groups of 5430 'staples. The strips 5630a "and 5630b" are arranged side by side so that the bases of the 5430 clips are facing the same direction.
[0300] [0300] Again with reference to Figure 106, the stapling instrument 5300 comprises a system for pushing a 5330 "staple cartridge from the drive shaft 5310 into the distal head 5320. Notably, this cartridge pushing system pushes the 5330 "staple cartridges through the pivot joint 5370 into the distal head 5320. As a result, the size of the 5330" staple cartridges, and / or the 5330 staples,
[0301] [0301] The 5730 "staple strip is stored on a drive shaft of the 5700 stapling instrument. In its stored state, the 5730 'staple strip is flat, or at least substantially flat. More specifically, with Referring to Figures 115 and 116, the clamps 5730 are attached to the first carrier 5760 'so that they are flat with the first carrier 5760'. The clamping instrument 5700 additionally comprises a clamp feed system that includes a wheel drive wheel that is configured to push the staple strip 5730 'into the distal head of the 5700 stapling instrument. The drive wheel comprises an array of drive pins that extend around it that are configured to engage the openings 5762 of the first carrier
[0302] [0302] With reference to Figures 115 and 118, staple strips 5730 'and 5730 "are stored in a face-to-face arrangement so that the 5760' and 5760" carriers for staple strips 5730 'and 5730 "can be engaged and driven on opposite sides by the staple feeding system. As the staple strips 5730 'and 5730 "are fed into the distal head, referring to Figure 116, the staples 5730 are flexed down around the flaps 5761 'and 5761' 'of the strips 5730' and 5730 ", respectively. In at least one case, the structure of the distal head comprises cam surfaces configured to flex the clamps 5730 downwards. In such cases, the 5700 stapling instrument comprises one or more actuators configured to flex the clamps 5730 downward around a mandrel positioned under the flaps 5761 'and 5761 ", for example. Once moved to their downward positions, the 5730 clamps are separated from the strips of clamps 5730 'and 5730 ". In at least one case, the distal head structure comprises one or more shear surfaces, or knife edges , configured to separate clamps 5730 from flaps 5761 'and 5761 "according to clamp strips 5730' and 5730" are advanced into the distal head. In certain cases, the 5700 stapling instrument additionally comprises one or more scissors which are actuated to separate clamps 5730 from clamp strips 5730 'and 5730 ". In any case, the separate staples are then positioned to be implanted by the staple trigger system of the 5700 stapling instrument.
[0303] [0303] In addition to the above, the 5700 stapling instrument is configured to separate a group of staples from the 5730 'and 5730 "staple strips and then to advance the 5760' and 5760" carriers from the 5730 'and 5730 staple strips. "so that another set of staples can be separated from strips 5730 'and 5730". After the clamps 5730 have been separated from the 5760 'and 5760 "carriers, with reference to Figure 118, the empty, or removed, portions of the 5760' and 5760" carriers are fed back to the drive shaft of the instrument staple 5700. As a result, the movement that feeds new 5730 staples into the staple firing system also feeds the empty carriers 5760 'and 5760 "back into the drive shaft.
[0304] [0304] Referring to Figure 119, a grouping of clamps 5830 'comprises four clamps 5830 which are joined together by at least one 5835 adhesive. Each clamp 5830 comprises a base 5831 and two legs of clamp 5832 extending from of base 5831. Notably, legs 5832 are not coplanar with base 5831. Instead, base 5831 is present in a base plane and legs 5832 are present in a leg plane. The base plane is parallel, or at least substantially parallel, to the plane of the legs, although modalities are provided in which the base plane and the leg plane are not parallel. In either case, two of the clamps 5830 in the clamp assembly 5830 'are facing inward while two of the clamps 5830 are facing outward. A 5830 clamp faces outward when its base plane is closer to the center of the 5830 'clamp cluster than its leg plane. Correspondingly, a 5830 clamp faces inward when its leg plane is closer to the center of the 5830 'clamp assembly than its base plane.
[0305] [0305] In addition to the above, the 5830 'clamp bundle comprises two 5830 clamps located on a first side of a CL axis and two 5830 clamps located on a second side of the CL axis. The 5830 clamps on the first side of the 5830 'clamp bundle are connected by a first 5835 adhesive connector and the 5830 clamps on the second side of the 5830' clamp bundle are connected by a second 5835 adhesive connector. In addition, a 5830 clamp on the first side of the staple cluster 5830 'is connected to a 5830 staple on the second side of the staple cluster 5830' by a 5835 adhesive connector. That said, a staple cluster can comprise any suitable number of adhesive connectors. The 5835 adhesive connectors releasably hold the 5830 clamps together. The 5835 adhesive connectors are broken before the 5830 clamps are implanted in the patient's tissue; however, alternative modalities are foreseen in which the 5835 adhesive connectors are not broken before the 5830 clips are implanted in the patient's tissue. The 5835 adhesive connectors are comprised of biocompatible and / or bioabsorbable materials, such as bioabsorbable polymers, for example.
[0306] [0306] Referring to Figure 120, a 5900 stapling instrument comprises a drive shaft, a 5920 distal head, a staple feeding system, a staple firing system, a fabric cutting system, a system anvil closure and a drive system configured to move the 5920 distal head in relation to the patient's tissue. The distal head 5920 comprises a first staple cavity 5921 and a second staple cavity 5921. Each staple cavity 5921 is configured to store a cluster of staples 5930 ', or a column of staple assemblies 5930', in its interior. Each group of staples 5930 'comprises four 5930 staples, although it may include any suitable number of staples. Each clamp 5930 comprises a base 5931 and two legs of clamp 5932 extending from it. The base 5931 and the legs 5932 are coplanar, or at least substantially coplanar. The 5930 clips are releasably connected to each other by at least one adhesive.
[0307] [0307] In addition to the above, each cluster of clamps 5930 'comprises one or more 5935 guides. The 5935 guides are defined on the side sides of cluster 5930' and are configured to be received within notches 5925 defined in the clamp cavities.
[0308] [0308] With reference to Figure 121, a stapling instrument 6000 comprises, among other things, a drive shaft, a distal head 6020 that includes an anvil 6060 and a system for triggering staples. In this mode, the staple firing system loads the staples 6030 into the distal head 6020 and fires them by pushing them against the anvil 6060. The distal head 6020 comprises staple cavities 6021 defined therein that are configured to store and guide the 6030 clamps as they are pushed towards the 6060 anvil.
[0309] [0309] With reference to Figures 122 to 125, a 6100 stapling instrument comprises a drive shaft, a 6120 distal head, a staple loading system, a staple trigger system, an anvil drive system, a tissue gripping system, and a tissue drive system configured to move the 6120 distal head relative to the patient's tissue. The drive system for the 6100 stapling instrument comprises rotating pedals 6180 which, similarly to the above, are configured to hold a patient's tissue and pull the distal head 6120 relative to the tissue. Also similarly to the previously mentioned, the tissue gripping system is configured to hold the tissue as the 6180 pedals are extended and / or during any suitable time during the operation of the 6100 surgical instrument. Referring mainly to Figure 125, the tissue gripping system comprises a 6170 tissue gripper configured to engage a patient's tissue. The fabric clamp 6170 comprises a rectangular body 6172 and struts 6174 extending from the body 6172. The fabric clamp 6170 defines a surface engaging the fabric 6175 that is less than the thickness in cross section 6125 of the distal head 6120, which is illustrated in Figure 124. Due to the smaller area of the surface engaging the fabric 6175 compared to the thickness in cross section 6125, the fabric clamp 6170 can apply greater gripping pressure to the patient's tissue than the distal head 6120 could for a given clamping force. In at least one case, the surface of engagement with the fabric 6175 has an area that is about 25% of the thickness in cross section 6125.
[0310] [0310] With reference to Figures 126 to 137, a 6200 stapling instrument comprises a drive shaft, a distal head 6220, a clip trigger system 6250, a fabric cutting system, an anvil drive system and a tissue drive system configured to move the distal head 6220 relative to a patient's tissue. Referring to Figures 126 and 127, the tissue drive system comprises 6280 rotating pedals that are moved to an extended position (Figure 126) and then retracted (Figure 127) to secure the patient's tissue and move the 6220 distal head in relation to the fabric. Figure 128A also illustrates one of the 6280 pedals in its extended position. The 6280 pedals can be extended and then retracted at the same time to move the distal head 6220 along a linear path or extended and retracted separately to rotate the distal head 6220, but only one 6280 pedal is shown in Figure 128A for the purpose of illustration. Figure 128, which corresponds to Figure 128A, shows anvil 6260 in a state sufficiently secured so that anvil 6260 and pedals 6280 cooperate to secure the patient's tissue. In addition, Figure 128 shows an unformed clamp 6230 positioned in a clamp cavity 6221 defined in the distal head 6220 and the clamp firing system 6250 in an unstrung state.
[0311] [0311] Figure 129A, similar to Figure 127, shows the 6280 pedals in their stowed position. Figure 129, which corresponds to Figure 129A, shows the anvil 6260 in a completely clamped state and the clip trigger system 6250 in a triggered state. As shown in Figure 129, legs 6232 of clamp 6230 have been completely deformed in a B-shaped configuration; however, other deformed configurations of the 6230 clamp may be suitable. Now referring to Figures 131 and 133, the clamp firing system 6250 comprises a firing bar 6255 and a plurality of staples 6230 stored within the recesses 6252 defined on the sides of the firing bar 6255. A first column of clamps 6230 are stored on a first side of the firing bar 6255 and a second column of 6230 clamps is stored on a second side, or opposite side, of the firing bar 6255. Each of the recesses 6252 is defined by a proximal clamp cradle 6251 configured to push the base 6231 of the clamp 6230 there. Figure 134 shows two staples 6230 positioned in a staple cavity 6221 defined on distal head 6220 and the firing bar 6255 of the staple firing system 6250 in an untriggered state.
[0312] [0312] Again with reference to Figure 134, the sides of the staple cavity 6221 comprise recesses 6222 defined there. The sides of the staple cavity 6221 also comprise drag surfaces 6223 positioned between the recesses 6222. When the firing bar 6255 is pushed distally to fire a first group of staples 6230 positioned in the staple cavity 6221 during a first stroke of staple firing, the staples 6230 stored in the firing bar 6255 are pushed by the drag surfaces 6223. As the firing bar 6255 is retracted after the first firing stroke, with reference to Figure 136, the staples 6230 capture the drag surfaces 6223 so that the firing bar 6255 slides in relation to the 6230 clamps. In such examples, as a result, the 6230 clamps enter the next distal set of recesses 6252 defined in the firing bar 6255, thus presenting a new set of staples 6230 to be ejected from staple cavity 6221. Figures 130 and 130A show surgical instrument 6200 as it is being reopened upright to release the patient's tissue so that the distal head 6220 can be repositioned relative to the patient's tissue. After the distal head 6220 has been properly repositioned, with reference to Figure 137, the firing bar 6255 can be advanced distally to perform a second stroke of staple firing. This process can be repeated to deploy all 6230 staples stored in the 6255 firing bar.
[0313] [0313] The stapling instruments disclosed here can be configured to implant staples in a suitable staple pattern. Figure 138 shows an exemplary staple pattern comprising 6330 staples and 6330 'staples positioned on both sides of a 6340 fabric cut line. Each side of the 6340 fabric cut line comprises an internal row of staples 6330 facing the opposite side of the cut line 6340 and an outer row of staples 6340 facing towards the cut line 6340. Figure 139 shows another exemplary clamp pattern comprising the 6330 clamps, the 6330 clamps and the clamps 6430 ". Staples 6430" are arranged in rows on both sides of the 6340 fabric cut line. More specifically, staples 6430 "are arranged in rows of staples positioned between both sets of inner row 6330 and row 6330 'outer clamp.
[0314] [0314] With reference to Figures 140 and 141, a stapling instrument 6500 comprises a drive shaft 6510, a distal head 6520, and a pivot joint 6270 that swivelly connects the distal head 6520 to the drive shaft 6510. O stapling instrument 6500 further comprises a staple feeding system 6590 configured to produce and supply a continuous staple feeding 6530 to the distal head 6520. The staple feeding system 6590 comprises a coil 6592 operably coupled to an electric motor. The 6592 coil comprises a 6594 metal wire wrapped around a central core. The 6594 wire is comprised of stainless steel and / or titanium, for example. The 6594 wire is fed through a passage 6514 defined on the drive shaft 6510 and on the articulation joint 6570. In use, the motorized coil 6594 pushes the wire 6594 into the distal head 6520. As described in more detail below, the - distal head 6520 additionally comprises a forming mandrel configured to deform the 6594 wire in a 6530 clamp. The mandrel is driven by an electric motor and / or actuator, but can be actuated in any suitable manner. As also described in more detail below, the distal head 6520 comprises a knife, or shear member, configured to cut the 6594 wire. The shear member is driven by an electric motor and / or actuator, but can be acted in any appropriate manner. After clamp 6530 has been formed and separated from wire 6594, clamp 6530 can be implanted and deformed against an anvil 6560 of the stapling instrument
[0315] [0315] Referring to Figure 141, surgical instrument 6500 additionally comprises a clamp forming system 6580 configured to create 6530 clamps from wire 6594. The clamp forming system 6580 comprises a forming mandrel 6582 positioned in a cavity forming device 6522 defined on the distal head 6520. The clamping system 6580 additionally comprises a forming actuator 6584 configured to engage wire 6594 and deform wire 6594 within forming cavity 6522. At such a point, the Forming 6582 is used to cut the 6530 clamp from the 6594 wire. After the 6530 clamp has been implanted and / or moved out of the 6522 forming cavity, another 6530 clamp can be formed inside the 6522 cavity. Alternatively, a wire segment is cut from the 6594 metal wire before the wire segment is formed into a 6530 clamp. In any case, the 6530 clamp can comprise a configuration substantially U-shaped configuration, for example. Alternatively, the wire segment can be formed in a substantially V-shaped configuration. In addition, the 6500 stapling instrument can be configured to manufacture and deploy any suitable fastener, such as tacks and / or claws, for example.
[0316] [0316] With reference to Figures 158 and 159, a stapling instrument 7300 comprises a drive shaft 7310, a distal head 7320, and a pivot joint 7370 that pivotally connects the distal head 7320 to the drive shaft 7310. In In use, the 7300 stapling instrument is inserted into a P patient via a TC trocar. The TC trocar comprises a passage that extends through it that allows the distal head 7320 and a portion of the drive shaft 7310 to be inserted into the patient. In other cases, the 7320 distal head can be inserted into the patient through an open incision without a trocar. In any case, the 7300 stapling instrument is configured to deploy staples from a staple cartridge inserted in it. The drive shaft 7310 comprises a loading port 7312 which communicates with a cartridge passage, or channel, which extends through the drive shaft 7310, the pivot joint 7370 and the distal head 7320. In use, a cartridge of staples, such as the staple cartridge 7330 ', for example, is inserted into the drive shaft 7310 through the loading port 7312 and then pushed into the distal head 7320. The stapling instrument 7300 additionally comprises a pusher system of cartridge configured to push the staple cartridge 7330 'into the 7300 end actuator.
[0317] [0317] In several cases, in addition to the above, the 7330 'staple cartridges can be fed into the 7300 stapling instrument so that the 7300 stapling instrument can be operated continuously without having to be removed from the patient to be refilled . Each staple cartridge 7330 'has staples stored inside it that are a first size, such as an unstrung first height. In certain cases, it is desirable to create a staple line with all the staples having the same size, or height not triggered. Such cases can arise when the fabric being stapled has a substantially uniform thickness. In other cases, it is desirable to create a line of clamps with clamps having different sizes, or heights not fired. Such cases can arise when the fabric being stapled does not have a uniform thickness. For example, gastric tissue undergoing transection during a stomach reduction procedure generally does not have a consistent thickness. In such cases, a first staple cartridge 7330 'can be loaded into the stapling instrument 7300 which has staples with a first untapped height and a second staple cartridge 7330 "can be loaded into the stapling instrument 7300 with a second height The first unexplored height is greater than the second unexplored height, but the first unexplored height could be shorter than the second unexplored height. Similarly, a third 7330 "'staple cartridge can be loaded in the stapling instrument 7300 that has clamps with a third height not fired that is different from the first height not fired and the second height not fired.
[0318] [0318] In addition to the above, more than one staple cartridge can be loaded into the 7300 stapling instrument. Staple cartridges can be inserted into the stapling instrument
[0319] [0319] The loading door 7312 comprises an opening accessible from the outside of the drive shaft 7310, although loading door 7312 could be set on the handle of the stapling instrument 7300 or any other suitable location. In several cases, the 7300 stapling instrument may further comprise a door configured to cover the loading door 7312. In at least one case, the door can be sealed, when closed, to prevent or inhibit the entry of fluids and / or contaminants in the 7300 stapling instrument. In such cases, the 7310 drive shaft door and / or housing may comprise one or more seals.
[0320] [0320] Referring mainly to Figure 159, the stapling instrument 7300 comprises a system for removing a cluster of staples, such as staples 7330, for example, from the most distal staple cartridge. The stapling instrument
[0321] [0321] With reference to Figures 168 and 169, a stapling instrument 7900 comprises a drive shaft 7910, a distal head 7920, and a pivot joint 7970 that pivotally connects the distal head 7920 to the drive shaft 7910. Con - as described in more detail below, the distal head 7920 can be swiveled in any suitable direction. Similar to the above, the stapling instrument 7900 comprises a cartridge feeding system configured to feed staple cartridges 7930 'into the distal head 7920 through a cartridge pass 7914 that extends through the drive shaft - item 7910, from the articulation joint 7970 and the distal head 7920. Also similar to the above, the clamps 7930 are removed from the more distal clamp cartridge 7930 'and then fired against an anvil 7960. As described in more detail below, the 7900 stapling instrument further comprises an articulation drive system 7980 configured to articulate the distal head 7920.
[0322] [0322] In addition to the above, again with reference to Figures 168 and 169, the distal head 7920 is articulated in several directions in relation to the drive axis 7910. The drive axis 7910 extends along a geometric axis of the longitudinal drive axis LA and distal head 7920 extends along a geometrical axis of longitudinal head HA. The geometric axis of the HA head is aligned, or at least substantially aligned, with the geometric axis of the drive axis LA when the distal head 7920 is not articulated. When the distal head 7920 is pivoted, the geometric axis of the HA head is transverse to the geometric axis of the drive axis LA. Referring to Figure 168, the distal head 7920 is pivotable laterally, or in a side-to-side direction. In at least one such occurrence, the distal head 7920 is articulated in a strip that comprises about 15 degrees to a first side of the geometric axis of the drive axis LA and about 15 degrees to a second side of the geometric axis of the axis drive system, for example. The 7980 articulation drive system is configured to drive, or actively articulate, the distal head 7920 through this range of motion. The articulation drive system 7980 comprises a first side drive 7982 mounted on the distal head 7920 and a second side drive 7984 mounted on the distal head 7920 on the opposite side of the distal head 7920. In use, the first side drive 7982 is pushed and / or the second side actuator 7984 is pulled to articulate the distal head 7920 in a first direction. Correspondingly, the first driver 7982 is pulled and / or the second side driver 7984 is pushed to articulate the distal head 7920 in a second direction. In at least one case, the first side driver 7982 comprises a first guide wire and the second side driver 7984 comprises a second guide wire. Such guide wires are suitable for pulling the distal 7920 head.
[0323] [0323] Referring to Figure 169, the distal head 7920 is also pivotable in a forward and / or backward direction. In at least one of these cases, the distal head 7920 is pivotable within a range that comprises about 25 degrees in a backward direction and about 25 degrees in a forward direction, for example. In certain
[0324] [0324] In various modalities, the 7900 surgical instrument may comprise a lock configured to hold the distal head 7920 in the position that can be released to enable the distal head 7920 to move in relation to the drive shaft 7910. In several cases, the distal head 7920 can be passively articulated by pushing the distal head 7920 against the patient's tissue within the surgical site when the distal head 7920 is unlocked. The distal head 7920 could also be actively articulated when the distal head 7920 is unlocked. In any case, the distal head 7920 can then be locked in its hinged position after the distal head 7920 has been properly positioned. To return the distal head 7920 to its non-articulated position, the distal head 7920 can be unlocked and then realigned with the geometric axis of the LA drive axis. In at least one case, the 7900 stapling instrument comprises one or more springs configured to prop the distal head 7920 to its non-articulated position. In any case, the articulation lock can prevent, or at least inhibit, the retroaction of the distal head 7920 in response to external and / or internal forces and torques.
[0325] [0325] In addition to the above, the articulation joint 7970 of the stapling instrument 7000 allows the distal head 7920 to be articulated around one or more geometric axes. In several alternative modalities, the driving axis of a stapling instrument comprises a first articulation joint that allows a distal head to articulate around a first geometric articulation axis and a second articulation joint that enables that the distal head articulates around a second geometric axis of articulation. The first geometric axis of articulation and the second geometric axis of articulation extend on planes that are orthogonal, but that can extend on any transverse planes. In several cases, the first and second articulation joints are passively articulated. In some cases, the first and second articulation joints are actively articulated. In at least one case, the first articulation joint is actively articulated and the second articulation joint is passively articulated.
[0326] [0326] With reference to Figure 170, an 8000 stapling instrument comprises an 8080 damping system configured to control, or slow down, the distal head articulation 7920. The 8080 damping system comprises a first 8082 connection, a second connection 8084, and a buffer 8085. The first connection 8082 is attached to the distal head 7920 in an 8081 pivot. The first connection 8082 is also attached to the second connection 8084 in a pivot
[0327] [0327] With reference to Figure 171, a 8100 stapling instrument comprises an 8180 damping system configured to control, or slow down, the distal head articulation 7920. The 8180 damping system comprises an 8182 connection and a damper 8185. Connection 8182 is attached to the distal head 7920 in a pivot 8181. The first connection 8082 is flexible, thus allowing the 8180 damping system to accommodate the various articulation movements of the distal head 7920. The 8185 shock absorber comprises a mounted 8187 housing swiveling to the drive shaft 7910 and a damping means 8188 contained in a chamber defined in housing 8187. Connection 8182 comprises a piston 8186 defined at its proximal end which is positioned in the opening of the housing and configured to move through the damping means 8188 when the distal head 7920 is hinged. The damping medium 8188 flows through piston 8186 and / or around it, thus allowing, but delaying, the relative movement between 8186 and housing 8197. Correspondingly, the damping medium 8188 allows, but slows down, the movement of the distal head 7920 in relation to the drive shaft 7910. Sudden movements of the distal head 7920 can be difficult to control and / or anticipate by the physician and can cause the distal head 7920 to strike the patient's tissue . Damping medium 8188 can comprise any suitable medium, such as damping grease, for example.
[0328] [0328] With reference to Figure 172, the 8100 stapling instrument can be inserted into a P patient via a TC trocar and is mobile relative to target tissue T. To a certain extent, the TC trocar can be moved in in relation to patient P and, also to a certain extent, the 8100 stapling instrument can be moved in relation to the TC trocar. This movement, however, can cause the 7910 drive shaft to move through a wide range of angles. To keep the distal head 7920 aligned with the tissue as the distal head 7920 is advanced along the staple line, the distal head 7920 can be progressively pivoted backwards, for example. Referring to Figure 173, the distal head 7920 can be progressively pivoted forward and / or backward to keep the geometric axis of the distal head 7920 orthogonal, or at least substantially orthogonal, to the target tissue T. In some cases, the distal head 7920 is actively articulated by a pivoting drive system to adjust the angle between the distal head 7920 and the drive shaft 7910. In certain cases, the distal head 7920 is passively articulated by a system articulation drive to adjust the angle between the distal head 7920 and the drive shaft 7910. In such cases, the distal head 7920 can adaptively float to follow the staple firing path.
[0329] [0329] With reference to Figures 34 and 35, a stapling instrument 2500 comprises a drive shaft 2510, a distal head 2520, and a hinge joint 2570 that swivelly connects the distal head 2520 to the axis of drive 2510. The drive shaft 2510 extends along a geometric axis of the longitudinal drive axis LA and the distal head 2520 extends along a longitudinal geometric axis of the HA head. The geometry axis of the drive axis LA and the geometric axis of the HA head are aligned when the distal head 2520 is not articulated, as shown in Figure 34. With reference to Figure 35, the geometric axis of the HA head is transverse to the geometric axis of the drive shaft LA when the distal head 2520 is articulated. The clamping instrument 2500 additionally comprises a damping system 2580 configured to control, or slow down, the articulation of the distal head 2520. The damping system 2580 comprises a first connection 2581, a second connection 2582, and a damper
[0330] [0330] The damper 2585 comprises a housing mounted on the drive shaft 2510 and a damping means 2586 contained in a chamber defined in the housing. The second 2582 connection
[0331] [0331] A 2000 surgical instrument is illustrated in Figure 13 and is similar to the 1000 stapling instrument and / or other stapling instruments disclosed here in many respects, most of which will not be discussed here for the sake of brevity. The stapling instrument 2000 comprises a handle 2100 that includes a housing 2110, a handle 2120 and a screen 2130. Housing 2110 comprises a connector 2170 that is configured to connect a drive shaft assembly, such as a set of drive shaft 1200, for example, to the handle 2100. The handle 2100 additionally comprises a set of replaceable battery 2160 which is releasably attached to housing 2110 and positioned removably within a cavity 2115 defined in housing 2110. The battery pack 2160 supplies power to the screen 2130 and / or the driving systems contained within the handle 2100. As discussed in more detail below, the screen 2130 is configured to enable the user to control the operation of the surgical instrument 2000.
[0332] [0332] In addition to the above, the 2000 stapling instrument comprises a staple trigger system configured to apply a staple line to a patient's tissue and the screen 2130 comprises controls for assessing the state of the staple trigger system. Screen 2130 also includes controls for evaluating and / or changing the speed at which the 2000 stapling instrument is applying the staple line, the direction in which the staple line is being applied, and / or any performance limits that have been applied. met, exceeded, or are about to be exceeded, for example. Screen 2130 comprises a capacitive touch screen; however, any suitable screen can be used.
[0333] [0333] Referring mainly to Figure 14, screen 2130 comprises a 2140 state control. The 2140 state control comprises a 2141 window that includes a 2142 window header. The 2140 state control additionally comprises a window 2145 image set to show information regarding the fabric being stapled, the staple trigger path, and / or any other information the doctor may use to operate the 2000 stapling instrument. For example, the window image 2145 is configured to show the staple trigger path 2143 on which the staple instrument 2100 is currently moving and / or an alternative staple trigger path 2143 that could guide the staple path around certain anatomical features. in the patient's T tissue, such as a V blood vessel, for example. State control 2140 is a digital control and / or screen and is in signal communication with a 2000 stapling instrument controller.
[0334] [0334] Referring to Figure 17, screen 2130 additionally comprises a direction control 2190 that is configured to control the direction of the staple firing path. The direction control 2190 comprises a window 2191 that includes a window header 2192 and an image window 2195. The image window 2195 is configured to show the orientation of the distal head of the stapling instrument relative to an original initial orientation . The image window 2195 comprises a plurality of guidance lines 2194 that indicate certain direction angles, such as 15 degrees, 30 degrees, 45 degrees and, for example, with respect to the initial guidance line 2194 delimited as 0 degrees. The image window 2195 further comprises a needle 2193 which shows the orientation of the distal head of the stapling instrument in relation to the initial orientation of the stapling instrument. The 2190 direction control additionally includes a 2198 editing window which, when activated, allows the user to change the direction of the staple path by manipulating the 2193 needle. The 2190 direction control additionally comprises a 2199 save window which, once activated, it allows the user to save the input provided to the controller via the 2190 direction control. At such a point, the 2000 stapling instrument can move along its new orientation. The 2190 status control is a digital control and / or screen and is in signal communication with the 2000 stapling instrument controller.
[0335] [0335] Referring to Figure 15, the screen 2130 additionally comprises a speed control 2150 configured to control the speed at which the stapling instrument 2000 creates the staple path. The speed control 2150 comprises a window 2151 that includes a window header 2152 and an image window
[0336] [0336] Referring to Figure 16, screen 2130 additionally comprises a fault limit control 2180 that is configured to manage the fault limits of the 2000 stapling instrument as they arise. For example, a limit on the force required to execute a staple firing stroke can be used to establish a fault condition that requires user input. If the force required to execute a staple firing stroke exceeds the limit, the stapling instrument controller 2000 can alert the user via fault limit control 2180 and / or stop the stapling instrument 2000. Certain faults can ignored, or otherwise managed, by the user who can enable the 2000 stapling instrument to continue applying the staple line. Control of the fault limit 2180 allows the user to manage these faults. Other faults may not be ignored. In such cases, fault limit control 2180 is configured to show the user that the fault cannot be ignored and / or how to resolve the fault so that the stapling instrument 2000 can be operated continuously. The fault limit control 2180 comprises a window 2181 that includes a window header 2182 and an image window 2185. The fault limit control 2180 is a digital control and / or screen and is in signal communication with the controller. stapler instrument 2000.
[0337] [0337] Now going back to Figure 18, the stapling instrument
[0338] [0338] In addition to the above, again with reference to Figure 18, screen 2130 additionally comprises a first viewing window 2133 and a second viewing window 2134. Viewing windows 2133 and 2134 are positioned along the right side of the 2135 image window, but could be placed anywhere on the screen
[0339] [0339] As discussed above, the speed at which the staple trigger system and / or the tissue drive system of the stapling instrument 2000 is operated can be controlled by the control speed 2150 on screen 2130. In several cases, as discussed above, speed can be controlled manually, or by user input. In other cases, the stapling instrument controller 2000 can control the speed automatically. In such cases, the controller is configured to evaluate the properties of the fabric being stapled, such as its thickness and / or density, for example, and to adjust the speed of the staple firing system and / or the fabric trigger system accordingly. For example, if the controller determines that the tissue being stapled is thick, or is close to, at, or above a fabric thickness limit, the controller may slow the stapling instrument 2000. Similarly, the The controller can decelerate the speed of the 2000 stapling instrument if the controller determines that the fabric being stapled is dense, or is close to, or above, a fabric density limit, for example. Correspondingly, the controller can speed up the stapling instrument 2000 if the controller determines that the fabric being stapled is thin or less dense than usual, for example. In addition to the above, with reference to Figure 19, the speed control 2150 of the stapling instrument 2000 comprises an option for the user to select between an automatic speed control 2158 in which the stapling instrument 2000 controls the speed of the 2000 stapling instrument and a manual speed control 2159 in which the user controls the speed of the 2000 stapling instrument.
[0340] [0340] With reference to Figure 20, the 2200 stapling instrument comprises a 2230 fabric. The 2200 stapling instrument is similar to the 2000 stapling instrument in many aspects and the 2230 fabric is similar to the 2130 fabric in many respects. most of which will not be discussed in the present invention for the sake of brevity. Screen 2230 comprises a menu 2231 and a central window of image 2235. The central window of image 2235 shows an image of the patient's T tissue being stapled and a staple firing path 2243 along which the stapling instrument 2200 move. The staple firing path 2243 is shown as a series of actuations, or staple fires, 2244. Each projected act 2244 shows the path in which the T fabric will be cut and the positions in which the staple groups 2245 will be deployed in T tissue in relation to the tissue incision. The projected actuation 2244 closest to the distal head of the stapling instrument 2200 is highlighted in relation to the other projected actuations 2244 so that the user can differentiate between the next clamp fire and the subsequent projected clamp fire. Such enhancement may include a different color and / or brightness, for example, from the projected actuation 2244. In at least one case, the actuations shown 2244 of the staple firing path 2243 may be progressively less intense as they move away from the distal head of the 2200 stapling instrument.
[0341] [0341] In addition to the above, screen 2230 is additionally configured to show one or more alternative staple firing paths. For example, screen 2230 is configured to show an alternate staple trigger path 2243 'in the central window of image 2235. Similar to staple trigger path 2243, staple trigger path 2243' is shown as a series of actuations, or clamp shots, 2244 '. Each projected actuation 2244 'shows the trajectory in which the T-fabric will be cut and the positions in which the clusters of clamps 2245 will be implanted in the T-fabric. staple 2200 to edit the staple trigger path 2243 to create the alternate staple trigger path 2243 '. After the alternate staple firing path 2243 has been established, it can be saved and the stapling instrument 2200 can be operated to follow the alternate staple firing path 2243 '. As shown in Figure 20, the staple line control 2240 comprises an editable subcontrol 2241 and an actionable subcontrol to save 2242 to modify and save the staple trigger path as described above.
[0342] [0342] As described above, the staple trigger path 2243 can be modified into an alternative staple trigger path 2243 '. Staple firing path 2243 and alternative staple firing path 2243 'are shown in an image that overlaps the video image from the camera. Staple firing path 2243 and alternative staple firing path 2243 'are shown in the same image overlay or layer, but could be shown in different overlays, or layers, of images. In at least one of these cases, the clip trigger path 2243 is shown in a first overlay, or layer, of images and the alternate clip trigger path 2243 'is shown in a second overlay, or layer, of images , which is different from the first image overlay. The 2230 monitor screen is configured to receive an input command from the central window of the 2235 image that can drag the 2243 staple trigger path and / or the alternate staple trigger path 2243 'within the image overlay or overlap. . The 2230 monitor screen is configured to be responsive to the user's finger so that the staple trigger path can be modified by dragging the user's finger. Referring to Figure 21, the 2230 monitor screen is additionally configured to be responsive to a 2220 pen, for example.
[0343] [0343] As discussed above, screen 2230 can be configured to show the current or desired staple trigger path and one or more alternative staple trigger paths. The stapling instrument controller 2200 is configured to generate one or more alternative staple firing paths and display these alternate staple firing paths on the 2230 screen. In several cases, the controller can determine the alternate staple firing path. based on one or more attributes of the T fabric being stapled. For example, the controller can identify blood vessels in T tissue and provide, or offer, an alternative staple firing path that directs the 2200 stapling instrument around blood vessels.
[0344] [0344] Referring to Figure 22, screen 2230 comprises a menu that includes a plurality of controls that are configured to modify the staple trigger path while the 2200 stapling instrument is deploying the staple path and / or after the instrument stapling 2200 has been stopped. Screen 2230 comprises a menu 2231 that includes a plurality of active controls that are configured for use while the stapling instrument 2200 is running its series of staple firing strokes to create the staple path. The 2231 menu comprises a 2232 vision control to change the video image shown in the central window of the 2235 image, for example. In at least one of these cases, the video control can be used to switch between different video feeds. Menu 2231 additionally comprises the staple line control 2240, discussed above, which is configured to modify the staple trigger path. The staple trigger system of the stapling instrument 2200 can be started by the user who operates a stapling control 2234 in menu 2231 and stopped by the user who operates a lock control 2236 in menu 2231.
[0345] [0345] In addition to the above, the drive shaft assembly attached to the grip of the 2200 stapling instrument can be rotated relative to the grip. The drive shaft assembly includes a swiveling slide joint configured to enable the distal head of the drive shaft assembly to rotate with respect to the handle, although any suitable arrangement can be used. As a result of this sliding joint, the user of the stapling instrument 2200 can selectively orient the screen 2230 with respect to the distal head of the stapling instrument 2200. In such cases, the user can maintain the orientation of the screen 2230 in relation to the patient, for example, even though the distal head is rotating to follow the staple firing path. Similarly, Figures 144 to 146 show the stapling instrument 1000 inserted in a patient P through a TC trocar and, due to a rotary interface between the handle screen and the instrument's drive shaft assembly of stapling 1000, the handle screen can be maintained by doctor C in a constant orientation with respect to themselves, even though the drive shaft assembly is rotating to follow the trigger path of FP clamps.
[0346] [0346] With reference to Figures 147 to 150, a 7000 stapling instrument comprises a handle 7010 including a handle 7020 and a drive shaft assembly 1200 mounted on handle 7010. Handle 7010 additionally comprises a web 7030 fixedly attached swiveling to the 7010 handle around a 7035 rotation joint. The 7030 screen is similar to the 2230 screen in many ways, most of which will not be discussed here for the sake of brevity. In use, the web 7030 can be rotated with respect to the handle 7010 to maintain proper orientation of the web 7030 in relation to the doctor C and / or any other reference structure.
[0347] [0347] Figure 180 shows a 1500 handle of a surgical instrument 100 for use by a physician during a surgical procedure. The handle 1500 comprises a central portion 110 delimited by one or more ergonomic handles 120 to facilitate the handling of the surgical instrument 100 by the physician. Each ergonomic handle 120 is configured to fit inside the doctor's hand for greater control and comfort. The grip 1500 comprises one or more interactive controls 180 configured to provide navigation commands to a surgical instrument end actuator 100. In several cases, one or more interactive controls 180 are configured to provide a user command that corresponds to a selection of one or more items. The interactive controls 180 are positioned on the grip 1500 in a location that allows easy operation by the doctor, such as in a location within reach of a doctor's thumb. In several cases, controls 180 are comprised of various types of keys and / or buttons, for example. In several cases, the interactive controls 180 comprise a toggle switch, an analog stick, an oscillator, a D button and / or any other suitable interactive control capable of facilitating the communication of a user command to the controller of the surgical instrument 100, for example example.
[0348] [0348] The handle 1500 additionally comprises a touch screen 1510. A portion of the touch screen 1510 shows a menu bar 1512 to the doctor. The menu bar 1512 options show various views of the surgical instrument 100 including, but not limited to, a view mode, a position mode and / or a clamp mode. In various display modes, data and / or images relevant to the surgical procedure and / or the condition of the surgical instrument 100 are shown. In viewing mode, the touchscreen 1510 shows a plurality of views of the surgical site, including, for example, a side view and a top view. The side view and the top view are shown in separate structures 1514, 1516 from the touch screen 1510, although they could be shown in any suitable manner. The physician can concentrate on a specific view by switching the desired view to a centralized and enlarged structure 1518 using the interactive controls 180, as described above. In various modalities, the physician can switch between views by dragging the desired view towards the central structure 1518 with an input device 1530, such as a doctor's pen or finger, for example. Input device 1530 is described in more detail below.
[0349] [0349] To create a sterile environment for surgical instrument 100, a sterile barrier 190 is extended over the handle 1500, as seen in Figure 181. As will be discussed in more detail below, the sterile barrier 190 is comprised of a material transparent elastic, such as plastic, for example. The sterile barrier 190 extends around the handle 1500 and a proximal portion of the drive shaft 200. The sterile barrier 190 comprises one or more precast areas 192 configured to fit over the interactive controls 180. The precast areas 192 assist in aligning the sterile barrier 190 on the handle 1500 of the surgical instrument 100. The sterile barrier 190 is extended over the touch screen 1510 to create a uniform, smooth barrier, or a uniform barrier at least substantially smooth. Fixing members 194, such as clamps, for example, secure the sterile barrier 190 at a position around a perimeter 193 of the touchscreen 1510. The sterile barrier 190 fits loosely with the remaining components of the grip 1500, and the barrier sterile 190 is attached to the drive shaft 200 of the surgical instrument 100, although any suitable arrangement can be used. The cover of the handle 1500 with the sterile barrier 190 protects various components of the handle 1500 against exposure to body fluids and / or contaminants, for example. Draining the sterile barrier 190 onto the handle 1500 and the proximal portion of the drive shaft 200 also provides a fast and inexpensive means for the handle 1500 of the surgical instrument 100 to be sterilized and reused.
[0350] [0350] Figure 182 shows a touchscreen assembly
[0351] [0351] Conductive particles 191 are dispersed throughout the sterile barrier 190, providing the sterile barrier 190 with a specific capacitance. The detection mechanism 1513 of the touchscreen assembly 500 comprises a plurality of pixels 1515 and a material, such as indium and tin oxide, for example, configured to create electrodes. In several cases, as discussed in more detail in relation to Figure 183, the electrodes are arranged in an orthogonal grid, although any suitable arrangement can be used. Among other things, the detection mechanism 1513 is configured to detect when the sterile barrier 190 is attached. More specifically, the detection mechanism 1513 detects the fixation of the sterile barrier 190 by the specific capacitance of the sterile barrier 190. When a physician is to use the functionality of the 1510 touch screen, the input device 1530, as mentioned above , is placed in contact with the sterile barrier 190 at a desired point of contact. The detection mechanism 1513 is configured to detect the additional capacitance of the input device 1530 and differentiate the capacitance of the input device 1530 from the capacitance of the sterile barrier 190. In addition, as the input device 1530 is brought into contact with the sterile barrier 190, the conductive particles 191 of the sterile barrier 190 are compressed or brought closer together. Such compression creates a higher density of conductive particles 191 in the area surrounding the contact point of the input device 1530 and, thus, a higher capacitance. The 1515 pixels of the 1513 detection mechanism are activated or energized close to the contact point due to the change in electrical charge at the contact point in the 1513 detection mechanism.
[0352] [0352] The 1510 touch screen is configured to function in the same and / or similar manner without the sterile barrier 190. In certain cases, the 1530 input device is comprised of a doctor's finger wrapped in a latex glove, for example. Latex medical gloves are typically thin enough not to impede the conductive qualities of a doctor's finger. In cases where the glove worn by the physician is expected to cushion the conductive qualities of the physician's finger, the settings of the 1510 touchscreen can be changed to increase the sensitivity of the 1513 detection mechanism.
[0353] [0353] Figure 183 shows the touch screen 1510 of Figure 182 when an input device 1530 comes into contact with the sterile barrier 190 of the touch screen assembly 500. As mentioned above, in several cases, the electrodes are arranged in an orthogonal grid, although any suitable arrangement can be used. In such cases, the electrodes comprise electrodes x 1542 and electrodes y 1544. The touch screen 1510 comprises a plurality of pixels 1515 arranged in a uniform or almost uniform manner throughout the detection mechanism 1513, although any suitable arrangement may be used. Figure 183 additionally shows several groups of activated pixel groupings 1517 and 1519. During their non-activated state, a low level capacitance is present in all 1515 pixels (Figure 182) on the touchscreen
[0354] [0354] Figure 184 shows a graphical representation 1550 of the relationship between the location of clusters of active pixels within the x 1542 electrodes of the 1510 touchscreen and the capacitance detected by the detection mechanism 1513. The first capacitance C1 is indicative of the low-level, or not activated, capacitance present through pixels 1515 of the touchscreen 1510 before the application of the sterile barrier 190. As a reference, capacitance C0 represents a detected capacitance of zero, and capacitance C1 represents a capacity greater than zero. A second capacitance C2 is indicative of a limit capacitance. When the limit capacitance C2 is exceeded, the surgical instrument 100 recognizes that the sterile barrier 190 is attached to the touchscreen 1510. In the graphic representation 1550, the sterile barrier 190 is attached to the touchscreen 1510, when the capacitance detected is above the limit capacitance C2. A third capacitance C3 represents another limit capacitance. When the detection mechanism 1513 detects a capacitance that is greater than the limit capacitance C3, the surgical instrument 100 recognizes that the input device 1530 is in contact with the sterile barrier 190. In the graphical representation 1550, the input device 1530 is in contact contact with the sterile barrier 190 in two places, when the detected capacitance exceeds twice the limit capacitance C3. When the input device 1530 is removed from the sterile barrier 190, the capacitance detected by pixels 1515 in clusters 1517 and 1519 returns to the capacitance below C3, but greater than or equal to C2. When the sterile barrier 190 is removed from the 1510 touchscreen,
[0355] [0355] Again with reference to Figure 182, the 1510 touch screen is, alternatively, a resistance sensitive screen. In at least one such embodiment, the sterile barrier 190 is comprised of a flexible material to enable the sterile barrier 190 to deflect in response to a force F applied by the input device 1530. In such an embodiment, the sensing mechanism 1513 of the touchscreen at touch 1510 is configured to detect the location and pressure created from the force rate F applied by the 1530 input device. Several user commands are associated with specific locations on the 1510 touch screen, and the location the detected pressure will correspond to one of several user commands.
[0356] [0356] With reference to Figure 24, a 2400 surgical instrument comprises a 2430 mesh. The 2400 stapling instrument is similar to the 2000 and 2200 stapling instruments in many ways and the 2430 mesh is similar to the 2130 and 2230 mesh in many respects. aspects, most of which will not be discussed in the present invention for the sake of brevity. The 2430 screen comprises a touch screen that includes a 2435 image screen. The 2435 image screen provides an image of the patient's T tissue that is to be stapled. The stapling instrument user 2400 can use a 2220 pen, for example, to draw one or more potential staple lines across the T fabric. For example, the user can draw a first staple line 2444 and a second staple line 2444 '. The stapling instrument controller 2400 may then require the user to choose between the two different staple lines 2444 and 2444 'to be followed. Similarly, the user of the 2400 stapling instrument can use the pen to modify a staple line 2444 into an alternate staple line 2444 '.
[0357] [0357] Again with reference to Figure 24, the image of the T fabric can be a substantially two-dimensional image of the top of the T fabric. In such cases, the controller is configured to map a two-dimensional trajectory of firing staples onto the T fabric. Referring to Figure 25, the image of the T-fabric can be a three-dimensional image if seen on the surface of the T-fabric. In such cases, the controller is configured to map a two-dimensional trajectory of triggering clips on the T-fabric. In this case, the 2220 pen and / or the patient's finger can be used to establish and / or modify the staple firing path. Referring now to Figures 26 and 27, the stapling instrument 2400 additionally comprises a joystick 2450 configured to modify the staple trigger path 2444 of the stapling instrument 2400. The joystick 2450 is mounted on the handle of the instrument stapling speed and is rotatable around a geometric axis. When the joystick 2450 is rotated to the right, or clockwise, the staple trigger path 2444 is curved to the right. Correspondingly, the staple trigger path 2444 is curved to the left when the joystick 2450 is rotated to the left or counterclockwise. Other arrangements of a joystick are possible.
[0358] [0358] Again with reference to Figures 26 and 27, the joystick 2450 can be used to modify the staple trigger path of the staple instrument 2400 while the staple instrument 2400 is paused, or it is not triggering staples. The 2450 joystick can also be used by the clinician to orient the stapling instrument 2400 in real time while the stapling instrument 2400 is firing staples. In several cases, at least a portion of the stapling instrument 2400 is visible on screen 2430 to assist the user in orienting the stapling instrument 2400. For example, a drive shaft 2410 of the stapling instrument 2400 is visible on the image screen
[0359] [0359] As described above, now with reference to Figure 23, the stapling instrument 2100 comprises a handle 2110 that includes a handle 2120 and a screen 2130 mounted on the handle 2110. The screen 2130 can comprise any suitable configuration, but the size of the screen 2130 may be limited due to space restrictions of the handle 2110. In many cases, the stapling instrument 2100 may be part of a surgical system 2300 that includes an external screen 2330 in addition to or in place of the screen built-in
[0360] [0360] In addition to the above, the built-in screen 2130 comprises a touch screen, but could be operated by means of
[0361] [0361] When a first overlay, or layer, is modified on one of screens 2130 and 2330, the stapling instrument controller 2100 modifies the first overlay on the other screen. Similarly, when a second overlay, or layer, is modified on one of screens 2130 and 2330, the stapling instrument controller 2100 modifies the second overlay on the other screen. In addition, the 2100 stapling instrument user can modify an overlay, or layer, on a screen without modifying the other overlays, or layers, on the screen or on any screen.
[0362] [0362] Although the staple trigger paths, and / or other images, projected on the built-in and external screens described above are very useful for producing a desired staple trigger path, a stapling instrument can include one or more projectors configured to show an image on the patient's tissue that can help the user of the stapling instrument produce a desired staple trigger path. Referring to Figures 160 and 161, a 7400 stapling instrument comprises a 7410 drive shaft, a 7420 distal head, and a 7490 projector mounted on the 7420 distal head. In at least one case, the 7490 projector is attached to the head distal 7420. The 7490 projector is configured to project an I image onto patient S's stomach P. The 7490 projector is sized and configured to be inserted into the patient via a CT trocar, but could be inserted into a patient through an open incision . The 7490 projector is positioned proximal to an anvil 7460 of the distal head 7420, but distally to a joint that swivels the distal head 7420 to the drive shaft 7410. As a result, the 7490 projector, and the image that it projects, moves with the distal head
[0363] [0363] Referring to Figure 162, a 7500 stapling instrument comprises a 7510 drive shaft, a 7520 distal head and a 7570 pivot joint that swivelly connects the distal head 7520 to the 7510 drive shaft. The 7500 stapling instrument additionally comprises a 7590 projector that extends along the 7510 drive axis. The 7590 projector comprises a flexible tube mounted on the 7510 drive shaft and the 7520 distal head and is configured to flex when the 7520 distal head is articulated. As a result, the image I projected by the projector 7590 tracks the orientation of the distal head 7520 and can be projected distally from an anvil 7560 of the 7500 stapling instrument. The 7590 projector comprises a lens and is configured to project an image I; however, several alternative modalities are envisaged in which a projector comprises more than one lens and / or can project more than one image onto the patient's tissue.
[0364] [0364] Referring again to Figure 160, the 7490 projector comprises a first lens 7492 and a second lens 7494. The first lens 7492 and the second lens 7494 are in signal communication with the controller of the 7400 stapling instrument and are configured to project at least one image onto the patient's tissue. In certain cases, the first lens 7492 and the second lens 7494 project the same image. The first lens 7492 and the second lens 7494 are fixedly mounted on the 7490 projector so that they project the image at a common focal point, although they could project an image, or images, at different focal points. In various embodiments, the orientation of the first lens 7492 and / or the orientation of the second lens 7494 can be adjusted to change the focal point. In at least one such mode, the 7490 projector comprises a first motorized actuator system to change the orientation of the first lens 7492 and a second motorized actuator system to change the orientation of the second lens 7494.
[0365] [0365] In certain cases, in addition to the above, the first 7492 lens of the 7490 projector can be configured to project a first image onto the patient's tissue and the second 7494 lens can be configured to project a second, or different, image in the patient's tissue. The 7400 stapling instrument controller is configured to supply, change, and / or alter the image projected by the first 7492 lens and / or the second 7494 lens. In many cases, the images projected by the first 7492 lens and the second lens 7494 can provide a two-dimensional image on the patient's tissue. In other cases, images projected by the first lens 7492 and the second lens 7494 can provide a three-dimensional image on the patient's tissue. The projection of a three-dimensional image can be facilitated by the lenses 7492 and 7494 being oriented, or orientable, in different directions.
[0366] [0366] Referring to Figure 165, a 7700 stapling instrument comprises a distal head 7720 positioned on a first side of the patient's T tissue and an anvil 7760 positioned on a second side of the patient's T tissue. Similar to the other stapling instruments disclosed here, the 7700 stapling instrument is configured to implant the 7730 staples into the T tissue and cut the T tissue along a 7740 incision during a series of staple firing strokes. The 7700 stapling instrument further comprises a 7770 projector configured to project an I image onto the T fabric. The I image in Figure 165 shows the location of the next firing stroke that includes two side areas to which the staple clusters will be applied. Referring to Figure 166, an image projected by the 7770 projector comprises a line designating the FP clamp trigger path and / or a line designating an alternative FP clamp trigger path. These lines can be continuous lines and / or dashed lines, for example. The lines can be the same color or different colors.
[0367] [0367] In addition to the above, the 7700 stapling instrument controller is configured to modify the image projected by the 7770 projector as the 7700 stapling instrument moves, or advances, along a staple trigger path. The controller can continuously evaluate and determine where the next triggering stroke should occur and also continuously adapt the image projected by the 7700 stapling instrument. In several cases, the controller can update the projected image after each triggering stroke, for example. example. In some cases, the controller can continuously project an image, or a series of images, using the 7770 projector, while in other cases, the controller can intermittently project an image, or a series of images, with the using the 7770 projector. In at least one case, the controller can use the 7770 projector to display an image before the 7700 stapling instrument grips the fabric. In such cases, the user of the 7700 stapling instrument will have an opportunity to pause or stop the 7700 stapling instrument before taking another staple firing course.
[0368] [0368] Referring to Figure 167, a 7800 stapling instrument comprises a distal head 7820 positioned on a first side of the patient's T tissue and an anvil 7860 positioned on a second side of the patient's T tissue. Similar to the other stapling instruments disclosed here, the 7800 stapling instrument is configured to implant the 7830 staples into the T tissue and cut the T fabric through a 7840 incision during a series of staple firing strokes. The 7800 stapling instrument further comprises a 7870 projector that includes a first 7872 lens and a second 7874 lens. The first 7872 lens is configured to project a first I1 image onto the patient's T tissue and the second 7874 lens is configured to project a second I2 image on the patient's T tissue. Image I1 shows the locations of the next group of staples and image I2 shows the cutting path of the 7800 stapling instrument, although any suitable images could be projected. The I1 and I2 images can be continuous lines and / or dashed lines, for example. The I1 image can be the same color as the I2 image or have a different color.
[0369] [0369] As discussed above, the stapling instruments disclosed here may comprise at least one projector for projecting images onto the patient's tissue and at least one camera to observe the patient's tissue. With reference to Figures 163 and 164, a 7600 stapling instrument comprises a drive shaft, a distal head and a video system. The video system comprises at least one 7690 image projector and a 7670 camera system comprising at least one camera, such as a first camera 7672 and a second camera 7674, for example, which are in communication with the controller. The first camera 7672 is aimed in a first direction and is focused on a first F1 area of the patient's tissue and the second camera 7674 is aimed in a second direction and is focused on a second area F2, or different area, of the patient's tissue . In several cases, the controller is configured to display both images on the screen of the surgical instrument at the same time, or at different times so that the user can switch between the images. In certain cases, the controller is configured to use the images from the first and second cameras 7672 and 7674 to generate a composite image and present the composite image on the screen of the surgical instrument.
[0370] [0370] In addition to the above, the first 7672 camera comprises a digital camera configured to provide a first digital video stream to the controller while the second 7674 camera comprises a digital camera configured to provide a second digital video stream . The 7670 camera system further comprises a first actuator system configured to move the first 7672 camera and / or a second actuator system configured to move the second 7674 camera. In other embodiments, one or both of the 7672 camera orientations and 7674 are fixed. In any case, the image I projected onto the patient's tissue by the 7690 projector can be captured by the first camera 7672 and / or the second camera 7674 and can be viewed by the user of the 7600 surgical instrument through the surgical instrument screen.
[0371] [0371] In addition to the above, the 7690 projector, and / or any of the projectors disclosed here, are configured to emit light at any suitable wavelength. In several cases, the 7690 projector emits visible light, infrared light and / or ultraviolet light, for example. Among other things, visible light is useful for the doctor to see the color of the tissue when the visible light is reflected on the tissue. Red or pink tissue indicates healthy, vascularized tissue, while dark or black tissue may indicate diseased tissue. Also in addition to the above, the 7670 camera system is configured to capture visible light, infrared light and / or ultraviolet light, for example. Infrared light indicates the presence of heat, such as large blood vessels, for example. The ultra-violet light indicates the presence of blood, or bleeding, for example. In addition to or in place of the above, a projector can be configured to emit sound waves, subsonic waves, and / or ultrasonic waves and the surgical instrument can comprise one or more acoustic sensors configured to detect the waves that reflect the patient's tissue and generate data that can be used by the controller to generate a three-dimensional profile of the patient's tissue.
[0372] [0372] With reference to Figure 142, the stapling instruments described here are configured to repeatedly trigger staples on a patient's tissue, such as the patient's stomach S, for example. Many of the stapling instruments disclosed here are self-activating, self-propelling and / or self-directed because they are sufficiently motorized so that they can follow and self-propel along an intended, or modified, path of triggering FP staples, while firing staples , such as staples 6630, for example, on the patient's tissue. Staples are continuously ejected from the stapling instruments as the stapling instruments move along the FP staple trigger path. In several cases, the staple trigger system of a stapling instrument enters a pause between staple firing strokes while the stapling instrument is moved along the staple trigger path. Such pauses, however, are part of the continuous operation of the stapling instrument. As discussed above, with reference to Figure 143, many of the stapling instruments described here are configured to deploy a staple grouping, such as staple clusters
[0373] [0373] In addition to the above, many of the stapling instruments disclosed here can at least partially rotate between staple shots. As a result, such stapling instruments can follow complex and / or nonlinear staple firing paths. Referring to Figure 174, the previous stapling instruments have been configured to deploy linear portions of 8230 'staple lines comprised of 8230 staples, for example. To rotate the staple line within the fabric, an overlapping region 8235 'was created on the staple line portions 8230'. Such an arrangement created a high density of staples 8230 in the overlapping region 8235 ', thereby highly compressing the fabric in the overlapping region 8235'. In addition, overlapping region 8235 'represents a sharp turn in the staple firing path, which could create potential leak paths in the staple line.
[0374] [0374] The stapling instruments disclosed here can be used to perform any suitable surgical procedure. For example, with reference to Figure 179, a stapling instrument disclosed here can be used during a gastric bypass procedure to produce an SP gastric pouch and thereby effectively reduce the size of the patient's stomach S . Due to the systems of the stapling instruments disclosed here, these stapling instruments can create a curved path of staples 7930 'which, in turn, creates a curved SP gastric pouch. The previous stapling instruments, with reference to Figure 178, would generate a staple path including linear portions 8230 'that would form a square SP gastric pouch, or a SP gastric pouch with a right-angled corner. It is believed that the curved SP gastric pouch produced by the stapling instruments disclosed here will have fewer leaks than the linear SP gastric pouches produced by the previous stapling instruments.
[0375] [0375] As described in more detail in this document, with reference to Figure 177, the stapling instruments disclosed here can be used during a stomach reduction procedure to produce an SS gastric sleeve and thereby reduce efficacy. - accurately the size of the patient's stomach S. Due to the stapling instrument systems disclosed here, these stapling instruments can create a curved staple path 7930 '
[0376] [0376] In addition to the above, gastric bypass procedures and gastric sleeve procedures assist in weight loss and are used to treat severe obesity. Both procedures serve to drastically decrease the size of the stomach to limit food intake. Gastric bypass procedures involve creating a small section within the stomach to receive food and blocking the rest of the stomach. Among other things, restricting the size of the stomach serves to limit the amount of fat and calories absorbed by a patient's body. Gastric bypass procedures create a direct path from the small section of the stomach to the small intestine. In such cases, as a result, this direct trajectory eliminates the use of the large intestine in management.
[0377] [0377] The gastric sleeve procedure involves creating a trajectory similar to a sleeve that runs from the esophagus, through the stomach, and goes to the large intestine. Laparoscopic sleeve gastrectomy (LSG, "laparoscopic sleeve gastrectomy") is a type of gastric sleeve procedure that involves transection and cauterization.
[0378] [0378] Figure 28 illustrates various parts of the stomach anatomy involved during various stages of an LSG procedure. In particular, Figure 28 illustrates the stomach before an dilator B is inserted into stomach S during an LSG procedure. As seen in Figure 28, the omentum O, which is a double layer of adipose tissue, is connected to the outer layer of the stomach S. The omentum O comprises two parts - the greater omentum and the lesser omentum. The greater omentum serves to store fat deposits and the lesser omentum connects the S stomach and intestines to the liver. Stomach S comprises several areas of shading based on the thickness of gastric tissue S. The thickness of gastric tissue S creates a first shadow S1a and a second shadow S1b. The size and location of shadows S1a and S1b vary based on the thickness of stomach S. As further illustrated in Figure 28, the first shadow S1a appears along the greater curvature GC ("greater curvature") of the stomach and the second shadow S1b appears along the lower LC ("lesser curvature") curvature of stomach S. As discussed in more detail below, shadows S1a and S1b are used to determine, or estimate, the thickness of stomach S along the larger GC curvature and the smaller LC curve, respectively. After the stomach thickness S is determined, or estimated, it is used to determine the appropriate size and placement of the dilator B in relation to the SL shading lines calculated as seen in Figure 28.
[0379] [0379] Figure 33 illustrates another view of the stomach anatomy, according to several modalities. Similar to the anatomy of the stomach shown in Figure 28, the thickness of the gastric tissue creates a first shadow S1 and a second shadow S2. Similar to what was discussed above, the first shadow S1 occurs along the major curvature GC and the second shadow S2 occurs along the minor curvature LC. The first shadow S1 and the second shadow S2 intersect at a point S3. During a gastric sleeve procedure, the location of the pylorus P x and point S3 is used to determine the location of the cut line C1 that is displaced from the pylorus Px at a distance A. As illustrated in Figure 33 and described in more detail below, the diameter D of the sleeve is determined based on the estimated thickness of the fabric.
[0380] [0380] Figure 152 illustrates various parts of the stomach that are involved during various stages of an LSG procedure. In particular, Figure 152 illustrates the initial stages of an LSG procedure in which a dilator B is inserted into stomach S. At the beginning of the LSG procedure, a surgeon inserts dilator B through a patient's mouth. , up to esophagus E, and through the esophageal sphincter to finally reach the patient's stomach. After reaching the patient's stomach, the S dilator is positioned so that the end of the S dilator rests on the PC pyloric channel and stops on the PS pyloric sphincter. As also illustrated in Figure 152, the dilator S is configured to seat along the shape and length of the stomach S along the angular notch AN ("angular notch") of a minor curvature LC. As will be described in more detail below with reference to Figure 153, a 7210 dilator can be used which comprises magnetic properties that are configured to interact with and guide a 7100 stapling instrument along a predetermined path beside the 7210 dilator.
[0381] [0381] Again with reference to Figure 152, a distance D1 is measured along the PA pyloric antrum ("pyloric antrum") of the greater GC curvature after the dilator is placed in its final position. The distance D1 is used to determine the location of the pylorus Px and is used to determine the location of the cut line C1. The 7210 dilator shown in Figure 153 creates one or more magnetic fields that are used to guide the 7100 stapling instrument to the 7210 dilator. After that, with reference to Figure 154, the 7100 stapling instrument follows the magnetic fields along a path adjacent to the 7210 dilator to create the cut line C1. As a result, cut line C1 extends upward through the patient's stomach S along the shape and curvature of both stomach S and dilator 7210. Cut line C1 then continues upward through the es - patient's stomach S along the path adjacent to the 7210 dilator until reaching the His AH angle. As the cutting line is established, the 7100 stapling instrument applies staples, such as 7130 staples, to the fabric along both sides of the C1 cutting line. The remaining portion of stomach S still in communication with the esophagus is substantially the size and shape of the 7210 dilator. A substantial portion of stomach S, which begins at the pyloric antrum PA and ends at the angle of His AH, is eliminated from the envelope. - development in the digestive process. The eliminated portion of stomach S is shown in more detail in Figure 154 and includes the greater GC curvature of stomach S.
[0382] [0382] In some cases, a doctor can estimate an appropriate staple firing path in the patient's stomach by observing certain anatomical markers in the stomach and / or in other locations within the surgical site. With reference to Figure 152, the stapling instruments disclosed here, such as the 7100 stapling instrument, for example, are configured to detect anatomical markers within the patient to determine the proper staple firing path. In addition to the above, the stapling instruments disclosed here may comprise one or more cameras configured to capture, or detect, one or more anatomical markers and, also, a controller configured to calculate a staple trigger path. based on the anatomical markers detected. In at least one case, the stapling instrument is configured to detect the minor curve of the stomach and calculate a staple firing path in the gastric tissue that is parallel, or at least substantially parallel, to the minor curve. Other anatomical markers of the patient's stomach that can be detected and used to determine the staple firing path include the angular notch, esophageal sphincter, His angle, pyloric sphincter and / or pyloric antrum, for example. example.
[0383] [0383] As discussed above, the smaller stomach curve can be used to determine the staple firing path. In several cases, however, the smaller curve is at least partially obscured by fat and / or connective tissue. That said, the smallest curve, the smallest omentum, and any overlap between the smallest curve and the smallest omentum, for example, can be visibly differentiated. More specifically, the uncovered gastric tissue has a first color, the minor omentum has a second color that is different from the first color, and the overlap between the two has a third color that is different from the first color and the second color. These colors are detectable by the stapling instruments to determine an appropriate staple trigger path. In certain cases, the color of the gastric tissue under the lesser omentum creates a shadow that is detectable by the stapling instrument. Other methods can be used to determine the proper location for the staple trigger path.
[0384] [0384] In addition to the above, an SS gastric sleeve created during a gastric bypass procedure needs to have a passage large enough, sufficient for digestion, defined in it to allow the passage of food. As a result, with reference now to Figure 29, the staple firing path through the patient's stomach S needs to be sufficiently spaced from the lower stomach curve to create sufficient digestion passage D. The stapling instruments disclosed here can be configured to detect the smallest curve of the stomach and calculate a staple trigger path, such as staple trigger path SP1, for example, which is a certain distance X from the edge of the stomach S. In others In such cases, the stapling instruments revealed here can be configured to detect the lesser omentum LO ("lesser omentum") that bypasses the smaller curve of the stomach and calculate the trigger path of staples SP1, for example, as a pre-distance X -established or predetermined in the opposite direction from the edge of the stomach S.
[0385] [0385] As mentioned above, detecting the edge of stomach S can be difficult. In certain cases, the stapling instruments disclosed here may comprise a camera system configured to observe the color of the gastric tissue and / or the color changes in the gastric tissue in order to determine the edge of the stomach S. In such cases, the stapling instruments disclosed here can be configured to detect the edge of the stomach by assessing the thickness of the gastric tissue and / or changes in the thickness of the gastric tissue. A patient's gastric tissue is typically thinner around the perimeter, or edge, of the stomach than in the middle of the stomach and it has been observed that the color of the gastric tissue is often a function of its thickness. In other words, the tissue around the stomach's perimeter appears to have a darker shade or color due to its thinner thickness. This shadow region S1 is marked by the distance Z1 in Figure 29. The distance Z1 also marks the transition from the thinnest tissue to the total tissue thickness region T 1 of the stomach S. In several cases, the surgical instruments disclosed here can be configured to determine the trigger path for staples SP1 by establishing the trigger path for staples SP1 at a certain distance from the shadow region S1, for example. In at least one case, surgical instruments can establish the firing path of SP1 clips at a certain distance from the midpoint between the lower omentum LO and the edge of the shadow region S1, for example.
[0386] [0386] In addition to the above, the controller of the stapling instruments disclosed here may comprise an edge detection algorithm. The edge detection algorithm is configured to detect a first light intensity in a first location and a second light intensity in a second location on the gastric tissue. The edge detection algorithm is additionally configured
[0387] [0387] As discussed above, the thickness of the gastric tissue can affect the color or shade of the gastric tissue. Thus, stomachs that have thicker tissue (Figure 29) will typically have different colors and / or shades than stomachs with thinner tissue (Figure 31). The thinner fabric in Figure 31 has a shadow region S 2 bounded by the distance Z2. The distance Z2 also marks the transition from the thinnest tissue to the total tissue thickness region T2 of the stomach S2. In several cases, the surgical instruments disclosed here can be configured to determine the path for triggering staples SP2 by establishing the path for triggering staples SP2 at a certain distance from the shadow region S2, for example. In at least one case, surgical instruments can establish the firing trajectory of SP2 clips, at a certain distance from the midpoint between the lower omentum LO2 and the edge of the shadow region S2, for example.
[0388] [0388] The staple trigger path SP1 establishes a first sleeve profile and the staple trigger path SP2 establishes a second sleeve profile that is different from the first sleeve profile. The first sleeve profile comprises a first width X and the second sleeve profile comprises a second width Y, which is different from the width X. Regardless of the sleeve profile that is generated by a stapling instrument disclosed in the present invention, the The stapling instrument's tissue drive system is configured to drive the stapling instrument along the staple firing path which creates the desired gastric sleeve. Such a stapling instrument can be configured to identify anatomical markers and to be directed towards, in the opposite direction to and / or parallel to one or more anatomical markers.
[0389] [0389] In addition to the above, with reference to Figure 153, the 7100 stapling instrument comprises a drive shaft 7110, a 7120 distal head and a 7170 articulation joint that swivelly connects the distal head 7120 to the drive shaft
[0390] [0390] With reference to Figure 154, the 7100 stapling instrument comprises one or more sensors, such as Hall effect sensors, for example, which are configured to detect the intense SMF magnetic fields and the weak WMF magnetic fields. The sensors are in communication with the 7100 stapling instrument controller, which can use the sensor data to detect the arrangement of the SMF intense magnetic fields and the WMF weak magnetic fields and align the staple firing path with the SMF fields and WMF, so that the 7100 stapling instrument follows the 7210 dilator to create the desired gastric sleeve profile. In at least one case, the intensity of the SMF intense magnetic fields is twice as intense as the weak WMF magnetic fields, for example. In other cases, the intensity of the SMF intense magnetic fields is 50% more intense than the intensity of the weak WMF magnetic fields, for example.
[0391] [0391] With reference to Figures 155 and 157, the 7210 dilator
[0392] [0392] In use, in addition to the above, a voltage source is applied to the winding circuits 7214 and 7216. The voltage applied to each winding circuit 7214 and 7216 is the same, or at least substantially the same. Alternatively, a first voltage is applied to the winding circuits 7214 and a second voltage, or different voltage, is applied to the winding circuits 7216. In several alternative embodiments, the winding circuits 7214 are not separate circuits; instead, they are part of a long circuit and a single current flows through each of the winding circuits
[0393] [0393] As described above, the 7210 dilator uses electricity to create magnetic fields. In several alternative embodiments, an expander may comprise permanent magnets that create magnetic fields. In at least one case, the dilator comprises strong permanent magnets that create an intense magnetic field and weak permanent magnets that create a weak magnetic field. In at least one of these cases, the strong permanent magnets and the weak permanent magnets are alternately arranged to create the intense SMF magnetic fields and the alternating weak WMF magnetic fields shown in Figure 154, for example. That said, an dilator can create one or more magnetic fields in any suitable manner.
[0394] [0394] With reference to Figure 156, the dilator 7310 comprises an internal flexible core 7312 and a plurality of conductor windings configured to emit the SMF and WMF magnetic fields discussed here. The flexible core 7312 is comprised of a non-conductive, or at least substantially non-conductive material, such as rubber, for example. Conductive windings include 7314 winding circuits that are configured to emit weak WMF magnetic fields and 7316 winding circuits that are configured to emit intense SMF magnetic fields. The 7314 winding circuits have fewer windings than the 7316 winding circuits and will produce weaker magnetic fields than the 7316 winding circuits for a given current. Each 7314 winding circuit comprises a conductive wire that is wrapped around the inner flexible core 7312 and that is in communication with a 7310 dilator controller. The windings of the 7314 circuits are more compact, or more dense, than the windings of circuits 7214. For example, the windings of circuits 7214 extend longitudinally as they wrap around core 7212, whereas the windings of circuits 7314 do not extend longitudinally, or at least not substantially from that form. Similarly, the windings of the 7316 circuits are more compact, or more dense, than the windings of the 7216 circuits. The dense or compact windings can create dense or compact magnetic fields that can be more discernible to the instrument. stapling 7100, for example.
[0395] [0395] The surgical instrument systems described here are powered by an electric motor; however, the surgical instrument systems described here can be induced in any appropriate manner. In certain cases, the engines disclosed here may comprise a portion or portions of a robotically controlled system. US Patent Application Serial No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPROYMENT ARRANGEMENTS, now US Patent No. 9,072,535, for example, discloses several examples of a robotic surgical instrument system with more details.
[0396] [0396] The surgical instrument systems described here have been described in connection with the implantation and deformation of the clamps; however, the modalities described in the present invention are not limited in this way. Several modalities are foreseen, which implant fasteners instead of staples, like claws or tacks, for example. In addition, several modalities are contemplated, which use any suitable means to seal the fabric. For example, an end actuator, according to various modalities, may comprise electrodes configured to heat and seal the tissue. Likewise, for example, an end actuator according to certain modalities, can apply vibratory energy to seal the fabric. Examples
[0397] [0397] Example 1 - Surgical stapler for stapling a patient's tissue that comprises a handle, a drive shaft that extends from the handle, and an end actuator that extends from the drive shaft . The end actuator comprises a staple cartridge comprising a plurality of staples removably stored therein and an anvil configured to deform the staples. The surgical stapler additionally comprises a projector configured to project an image of the end actuator onto the tissue. Example 2- Surgical stapler, according to Example 1, in which the end actuator comprises a distal end, and the projector is configured to project the image onto the tissue at a location that is distal to the distal end. Example 3 - Surgical stapler, according to Example 1 or 2, in which the end actuator additionally comprises a distal end, the distal end comprising a distal periphery, and the image replicating the distal periphery . Example 4 - Surgical stapler, according to Examples 1, 2 or 3, in which the end actuator additionally comprises a distal end, the distal end comprising a distal periphery, and the image comprising an outline of the part distal riferia.
[0418] [0418] All of the descriptions of: - U.S. Patent No. 5,403,312, entitled "ELECTROSURGI-CAL HEMOSTATIC DEVICE", which was granted on April 4, 1995; - U.S. Patent No. 7,000,818, entitled "SURGICAL STA-
[0419] [0419] Although several devices have been described here in connection with certain modalities, modifications and variations of these modalities can be implemented. Specific resources, structures or characteristics can be combined in any appropriate way in one or more modalities. Therefore, the specific features, structures or features illustrated or described in connection with a modality can be combined, in whole or in part, with the resources, structures or features of one or more other modalities, without limitation. In addition, where materials are revealed for certain components, other materials can be used. In addition, according to several modalities, a single component can be replaced by multiple components and multiple components can be replaced by a single component, to perform one or more specific functions. The aforementioned description and the following claims are intended to cover all such modifications and variations.
[0420] [0420] The devices disclosed here can be designed to be discarded after a single use, or can be designed to be used multiple times. In either case, however, a device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps including, but not limited to, disassembling the device followed by cleaning or replacing specific parts of the device and subsequent reassembly of the device. In particular, a reconditioning facility and / or surgical team can dismantle a device
[0421] [0421] The devices revealed here can be processed before surgery. First, a new or used instrument can be obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and the instrument can then be placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays and / or high-energy electrons. Radiation can kill bacteria on the instrument and the container. The sterile instrument can then be stored in a sterile container. The sealed container can keep the instrument sterile until it is opened at the clinic. A device can also be sterilized using any other known technique, including, but not limited to, beta radiation, gamma radiation, ethylene oxide, plasma peroxide and / or water vapor.
[0422] [0422] Although this invention has been described as having exemplary designs, the present invention can be further modified within the spirit and scope of the description. It is intended, therefore, that this application covers any variations, uses or adaptations of the invention with the use of its general principles.
[0423] [0423] Any patent, publication or other description material, in whole or in part, taken as incorporated by reference to the present invention, is incorporated into the present invention only to the extent that the incorporated materials do not conflict with defini - existing statements, statements or other description material presented in this description.
Thus, and as necessary, the description as explicitly presented herein replaces any conflicting material incorporated by reference to the present invention.
Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other description materials existing herein, will be incorporated here only to the extent that that there is no conflict between the embedded material and the existing description material.

权利要求:
Claims (19)
[1]
1. Surgical stapler for stapling a patient's tissue, characterized by comprising: a handle; a drive shaft extending from said handle; an end actuator extending from said drive shaft, wherein said end actuator comprises: a staple cartridge comprising a plurality of removably stored staples therein; and an anvil configured to deform said clips; and a projector configured to project an image of said end actuator onto the fabric.
[2]
2. Surgical stapler, according to claim 1, characterized in that said end actuator additionally comprises a distal end, and wherein said projector is configured to project said image onto the tissue in a location that is distal to the said distal end.
[3]
Surgical stapler according to claim 1, characterized in that said end actuator additionally comprises a distal end, wherein said distal end comprises a distal periphery, and said image replicating said periphery distal.
[4]
Surgical stapler according to claim 1, characterized in that said end actuator further comprises a distal end, wherein said distal end comprises a distal periphery, and wherein said image comprises an outline of the said distal periphery.
[5]
5. Surgical stapler according to claim 1,
characterized in that said end actuator further comprises a distal end, and wherein said projector is configured to project said image onto the fabric at a location that is lateral to said distal end.
[6]
6. Surgical stapler, according to claim 1, characterized in that said image replicates an outline of said end actuator.
[7]
7. Surgical stapler, according to claim 1, characterized in that it additionally comprises a firing mechanism configured to execute a first staple firing course and a second staple firing course, in which said projector is configured to design the correct positioning of said end actuator to execute said second clamp firing course after executing said first clamp firing course.
[8]
8. Surgical stapler, according to claim 1, characterized in that it further comprises a firing mechanism configured to execute a plurality of staple firing strokes, in which each said staple firing course deploys said staples in a pattern staples, and wherein said image represents said staple pattern.
[9]
9. Surgical stapler, according to claim 8, characterized in that said projector is configured to project said staple pattern along an intended path.
[10]
10. Surgical stapler according to claim 9, characterized in that said image comprises a first image, and wherein said projector is additionally configured to project a second image of said staple pattern along an alternative path.
[11]
11. Surgical stapler according to claim 10,
characterized in that said projector is configured to show said first image and said second image simultaneously.
[12]
12. Surgical stapler, according to claim 11, characterized in that said handle comprises a control screen that includes a control, and in which said control is operable to manipulate said second image in relation to said first image.
[13]
13. Surgical stapler, according to claim 10, characterized in that said projector is configured to display said first image and said second image alternatively.
[14]
14. Surgical stapler according to claim 13, characterized in that said handle comprises a control screen that includes a control, and in which said control is operable to manipulate said second image in relation to said first image.
[15]
Surgical stapler according to claim 1, characterized in that it additionally comprises a tissue cutting mechanism that includes a cutting member configured to execute a tissue cutting course, wherein said image represents the orientation of said cutting course cut in the fabric.
[16]
16. Surgical stapler, according to claim 1, characterized in that it additionally comprises a tissue cutting mechanism that includes a cutting member configured to execute a tissue cutting course, wherein said image represents the length of said cutting course in the fabric.
[17]
17. Surgical stapler according to claim 1, characterized in that said staple cartridge comprises an adhesive that reliably holds said staples together.
[18]
18. Surgical stapler to staple the tissue of a patient, characterized by comprising: a handle;
a drive shaft extending from said handle; an end actuator extending from said drive axis, wherein said end actuator comprises: a plurality of clamps; an anvil configured to deform said clips; and a trigger mechanism configured to implant the said clips into a clip pattern, wherein said trigger mechanism is operable in a reciprocal manner to deploy a series of said clip patterns along a staple path; and means for projecting an image onto the fabric indicating said staple path.
[19]
19. Surgical stapler to staple the tissue of a patient, characterized by comprising: a handle; a drive shaft extending from said handle; an end actuator extending from said drive axis, wherein said end actuator comprises: a plurality of clamps; an anvil configured to deform said clamps into a series of clamp patterns along a clamp path; and a fabric cutting mechanism configured to cut the fabric reciprocally along an incision path with respect to said staple path; and means for projecting, on the tissue, an image that indicates the said incision path.

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同族专利:

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公开号 | 公开日

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US20190192227A1|2019-06-27|

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WO2019123100A1|2019-06-27|

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EP3501406A1|2019-06-26|

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US11129680B2|2021-09-28|

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JP2021506474A|2021-02-22|

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CN111511291A|2020-08-07|

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JPS4711908Y1|1968-01-18|1972-05-02|

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JPS5033988U|1973-07-21|1975-04-11|

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JPS552966Y2|1974-02-08|1980-01-24|

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JPS543B2|1974-02-28|1979-01-05|

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FR2446509B1|1977-04-29|1981-07-03|Garret Roger|

---

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法律状态:
2021-12-07| 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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US15/850,433|US11129680B2|2017-12-21|2017-12-21|Surgical instrument comprising a projector|

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US15/850,433|2017-12-21|

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PCT/IB2018/059847|WO2019123100A1|2017-12-21|2018-12-10|Surgical instrument comprising a projector|

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