surgical stapling instrument

专利摘要:
SURGICAL STAPLING INSTRUMENT WITH ENHANCED TRIGGER ARRANGEMENT. The present invention relates to a surgical stapling instrument including a actuator button that can be moved from one side of the stapling instrument to another side in order to reposition the actuator button without having to reposition the stapling instrument in one surgical site. A stapling instrument can include a propeller bar, a compartment that has a first side and a second side, and a actuator button rotatably mounted to the propeller bar and the actuator button can be configured to be rotated between a first position where the actuator button can be moved along the first side of the compartment and a second position where the actuator button can be moved along a second side of the compartment. Alternatively, a surgical stapling instrument may comprise one or more actuator buttons that can be operably engaged and disengaged with a drive bar in order to selectively use the actuator buttons.
公开号:BR112013003402B1
申请号:R112013003402-5
申请日:2011-08-11
公开日:2021-02-17
发明作者:James J. Bedi；Chester O. Baxter Iii
申请人:Ethicon Endo-Surgery, Inc.；
IPC主号:

专利说明:

[0001] [0001] This non-provisional patent application is a continuation application in part under 35 USC §120 of US patent application serial number 12 / 725,993, entitled STAPLE CARTRIDGE, filed on March 17, 2010, which is a continuation application in part under 35 USC §120 of US Patent Application Serial No. 12 / 234,149, entitled "SURGICAL STAPLING INSTRUMENT WITH CUTTING MEMBER ARRANGEMENT", filed on September 19, 2008, the entire descriptions of which are incorporated herein by reference to the present invention. This non-provisional patent application is a continuation application in part under 35 USC §120 of US patent application serial number 12 / 622,099, entitled "SURGICAL STAPLER HAVING A CLOSURE MECHANISM", filed on November 19, 2009 which claims the benefit under 35 USC §119 (e) of US Provisional Patent Application No. 61 / 250,377, entitled "SURGICAL STAPLER", filed on October 9, 2009, the entire descriptions of which are incorporated herein, by reference to present invention. This non-provisional patent application is a continuation application in part under 35 USC §120 of US Patent Application Serial No. 12 / 843,436, entitled "SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT", filed July 26 2010, which is an application for continuation under 35 USC §120 of US Patent Application Serial No. 12 / 030.424, entitled "SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT", filed on February 13, 2008, the entire descriptions of which are hereby incorporated by reference to the present invention. BACKGROUND i. Technical Field
[0002] [0002] The present invention relates to stapling instruments and, in various embodiments, to a surgical stapling instrument for producing one or more rows of staples. ii. Background of the related technique
[0003] [0003] In recent years, there is an increasing tendency for surgeons to use stapling instruments to suture body tissues, such as a lung, esophagus, stomach, duodenum and / or other organs in the intestinal tract. The use of an appropriate stapling instrument can, in many cases, do a better job in less time and simplify previously difficult surgical procedures, such as gastrointestinal anastomoses. The two- and four-row linear cutting staplers comprised instruments without a cartridge into which the staples were loaded manually and individually. Other prior devices included a pre-sterilized disposable staple loading unit and a cutting element that could be used to divide the fabric and form rows of staples simultaneously. An example of such a surgical stapler is presented in US patent No. 3,499,591, entitled INSTRUMENT FOR PLACING LATERAL GASTROINTESTINAL ANASTOMOSES, which was granted on March 10, 1970, the description of which is incorporated herein by way of reference.
[0004] [0004] A stapling instrument may include a pair of elongated cooperating clamping elements, each clamping element being adapted to be inserted into an internal tubular body organ to be joined by anastomosis. In various embodiments, one of the claw elements can support a staple cartridge with at least two rows of staples spaced laterally, and the other claw element can support an anvil with staple forming pockets aligned with the staple rows in the staple cartridge . In general, the stapling instrument may further include a drive bar and a knife blade which are slidable with respect to the clamping elements to sequentially eject staples from the staple cartridge through cam surfaces on the drive bar. In at least one embodiment, the cam surfaces can be configured to activate a plurality of clip clamps loaded by the cartridge and associated with the individual clamps to push the clamps against the anvil and form spaced laterally rows of clamps deformed in the fabric trapped between the elements. claw. In typical stapling instruments, however, the anvil is not movable in relation to the staple cartridge since the claw elements have been joined and the formed height of the staples cannot be adjusted. In at least one embodiment, the knife blade may follow the propellant bar and cut the fabric along a line between the staple rows. Examples of such stapling instruments are provided in US Patent No. 4,429,695, entitled SURGICAL INSTRUMENTS, which was issued on February 7, 1984, the full description of which is incorporated herein by way of reference. SUMMARY
[0005] [0005] In at least one form, a surgical stapling instrument may comprise a first side, a second side, a longitudinal axis, a first compartment element, and a second compartment element. The first compartment member may comprise a staple cartridge attachment portion configured to operably support a staple cartridge, and a first rail lock that extends along the longitudinal axis. The second compartment element may comprise a claw element configured to operably support an anvil configured to deform staples positioned from the staple cartridge, and a second rail lock that extends along the longitudinal axis. The surgical stapling instrument may additionally comprise a drive bar configured to move a staple driver in relation to the staple cartridge holding portion and the claw element; an actuator configured to receive a force on it, the actuator being configured to be moved between a first position and a second position, where the actuator is configured to be moved along the first side when the actuator is in the first position, the actuator being configured to be moved along the second side when the actuator is in the second position and the actuator additionally comprising at least one rail lock receiver configured to receive the first rail lock and the second lock of rail.
[0006] [0006] In at least one form, a surgical stapling instrument may comprise a first side, a second side, a first compartment element, and a second compartment element. The first compartment element may comprise a first proximal end portion, a first distal end portion, a staple cartridge attachment portion configured to operably support a staple cartridge, and a first longitudinal locking portion extending from the first portion of the proximal end towards the first portion of the distal end. The second compartment element may comprise a second proximal end portion, a second distal end portion, a claw element configured to operably support an anvil configured to deform staples positioned from the staple cartridge, and a second portion of longitudinal lock extending from the second portion of the proximal end towards the second portion of the distal end. The surgical stapling instrument may additionally comprise a drive element configured to move a staple booster relative to the staple cartridge holding portion and the claw element, and an actuator configured to receive a force, the actuator being configured to be moved between a first position and a second position, where the actuator is configured to be moved along the first side when the actuator is in the first position, and the actuator is configured to be moved along the second side when the The actuator is in the second position, and the actuator additionally comprises at least one actuator locking portion configured to be aligned with the first longitudinal locking portion and the second longitudinal locking portion.
[0007] [0007] In at least one form, a surgical stapling instrument may comprise a first side, a second side, a longitudinal axis, a first compartment element, and a second compartment element. The first compartment member may comprise a staple cartridge attachment portion configured to operably support a staple cartridge, and a first rail lock that extends along the longitudinal axis. The second compartment element may comprise a claw element configured to operably support an anvil configured to deform staples positioned from the staple cartridge, and a second rail lock that extends along the longitudinal axis. The surgical stapling instrument may additionally comprise a drive bar configured to move a staple booster relative to the staple cartridge holding portion and the claw element, and an actuator configured to receive a force, the actuator being configured to be moved between a first position and a second position, the actuator being configured to be moved along the first side when said actuator is in the first position, the actuator being configured to be moved along the second side when the The actuator is in the second position, and the actuator additionally comprises capture means for capturing the first rail lock and the second rail lock. BRIEF DESCRIPTION OF THE DRAWINGS
[0008] [0008] The characteristics mentioned above and other characteristics and advantages of this invention, and the way of obtaining them, will become more apparent and the invention itself will be better understood by reference to the following description of modalities of the invention, taken in conjunction with the attached drawings, of which:
[0009] [0009] Figure 1 is a perspective view of an anastomotic linear stapling instrument;
[0010] [00010] Figure 2 is a side elevation view showing the anastomotic stapling instrument of figure 1 partially disassembled with its claw element that carries the upper anvil detached from its claw element that carries the lower staple cartridge;
[0011] [00011] Figure 3 is a side elevation view showing the anastomotic stapling instrument of figure 1 in its disassembled configuration;
[0012] [00012] Figure 4 is a cross-sectional view of the anastomotic stapling instrument of figure 1 showing a cam mechanism for separating the rear portions of the upper and lower clamping elements;
[0013] [00013] Figure 5 is a bottom view of the claw element that carries the anvil of the anastomotic stapling instrument of figure 1;
[0014] [00014] Figure 6 is a top view of the claw element that carries the staple cartridge of the anastomotic stapling instrument of figure 1;
[0015] [00015] Figure 7 is a bottom view of the anastomotic stapling instrument of figure 1;
[0016] [00016] Figure 8 is a view of the anterior end of the anastomotic stapling instrument of Figure 1;
[0017] [00017] Figure 9 is a view of the rear end of the anastomotic stapling instrument of figure 1;
[0018] [00018] Figure 10 is a perspective view of a propellant bar and the knife blade assembly of the anastomotic stapling instrument of figure 1;
[0019] [00019] Figure 11 is a perspective view of a propeller block and an actuator button that are the components of the propellant bar and the knife blade assembly of figure 10;
[0020] [00020] Figure 12 is a partial cross-sectional view of the posterior portion of the anastomotic stapling instrument of figure 1 illustrating the cam mechanism in its inoperative position;
[0021] [00021] Figure 13 is a partial cross-sectional view of the posterior portion of the anastomotic stapling instrument of figure 1 illustrating the cam mechanism in its operational position;
[0022] [00022] Figure 14 is a side view of the staple cartridge of the anastomotic stapling instrument of figure 1;
[0023] [00023] Figure 15 is a top view of the staple cartridge of the anastomotic stapling instrument of figure 1;
[0024] [00024] Figure 16 is a bottom view of the staple cartridge of the anastomotic stapling instrument of figure 1;
[0025] [00025] Figure 17 is a partial cross-sectional view of the anvil and the claw elements that carry the staple cartridge of figures 5 and 6 illustrating the operation of the propellant bar and the knife blade assembly of figure 10;
[0026] [00026] Figure 18 is a cross-sectional view of the anastomotic stapling instrument of figure 1 along line 18-18 in figure 4;
[0027] [00027] Figure 19 is a cross-sectional view of the anastomotic stapling instrument of figure 1 along line 19-19 in figure 4;
[0028] [00028] Figure 20 is a detailed view of a portion of the anvil and staple cartridge shown in figure 18;
[0029] [00029] Figure 21 is a perspective view of a stapling instrument according to a non-limiting embodiment of the present invention;
[0030] [00030] Figure 22 is a perspective view of the stapling instrument of figure 21 illustrating a first actuator button in an extended position;
[0031] [00031] Figure 23 is a perspective view of the stapling instrument of figure 21 illustrating the extended actuator button of figure 22 after it has been moved distally;
[0032] [00032] Figure 24 is an exploded view of a latching mechanism to functionally interconnect one or more actuator buttons with a propeller bar of the stapling instrument of figure 21;
[0033] [00033] Figure 25 is a perspective view of a guide element of the engagement mechanism of Figure 24;
[0034] [00034] Figure 26 is a perspective view of an actuator button for the stapling instrument of figure 21;
[0035] [00035] Figure 27 is another perspective view of the engagement mechanism of Figure 24;
[0036] [00036] Figure 28 is a perspective view of the stapling instrument of figure 21 illustrating the first actuator button in a stowed position and a second actuator button in an extended position;
[0037] [00037] Figure 29 is a partial exploded view of a stapling instrument according to a non-limiting embodiment of the present invention;
[0038] [00038] Figure 30 is a partial perspective view of the stapling instrument of figure 29 illustrating an actuator button after it has been distally advanced along a first side of the stapling instrument;
[0039] [00039] Figure 31 is a partial perspective view of the stapling instrument of figure 29 illustrating the actuator button of figure 30 being rotated between a first position and a second position;
[0040] [00040] Figure 32 is a partial perspective view of the stapling instrument of figure 29 illustrating the actuator button of figure 30 after it has been moved distally along a second side of the stapling instrument;
[0041] [00041] Figure 33 is an exploded view of a set of the propeller bar of the stapling instrument of figure 29 configured to allow the actuator button of figure 30 to be rotated between its first and second positions;
[0042] [00042] Figure 34 is a perspective view of a surgical stapling instrument according to at least one embodiment of the present invention;
[0043] [00043] Figure 35 is an exploded perspective view of the surgical stapling instrument in figure 34;
[0044] [00044] Figure 36 is an exploded elevation view of the surgical stapling instrument of figure 34;
[0045] [00045] Figure 37 is a partial cross-sectional view of the surgical stapling instrument of figure 34 illustrating the first and second portions being assembled together;
[0046] [00046] Figure 38 is a partial cross-sectional view of the surgical stapling instrument of figure 34 illustrating the proximal end of the first portion of figure 37 being locked at the proximal end of the second portion of figure 37 and illustrating the second portion being rotated in towards the first portion;
[0047] [00047] Figure 39 is a partial cross-sectional view of the surgical stapling instrument in figure 34, illustrating a lock rotated in the first portion, the lock being engaged with the second portion and the lock being rotated in a partially closed position;
[0048] [00048] Figure 40 is a partial cross-sectional view of the surgical stapling instrument of figure 34 illustrating the lock of figure 39 in a closed position;
[0049] [00049] Figure 41 is a perspective view of a staple cartridge assembly for the surgical stapling instrument of figure 34;
[0050] [00050] Figure 42 is an exploded view of the staple cartridge assembly of figure 41;
[0051] [00051] Figure 43 is a cross-sectional view of the staple cartridge assembly of figure 41 along line 43-43 in figure 42;
[0052] [00052] Figure 44 is an exploded view of a staple sled assembly and cutting element of the staple cartridge assembly of figure 41;
[0053] [00053] Figure 45 is a perspective view of the clamp sled assembly and cutting element of Figure 44;
[0054] [00054] Figure 46 is a perspective view of the surgical stapling instrument of figure 34 illustrating a staple discharge actuator moved distally along a first side of the surgical stapling instrument;
[0055] [00055] Figure 47 is a perspective view of the surgical stapling instrument of figure 34 illustrating the staple discharge actuator of figure 46 moved distally along a second side of the surgical stapling instrument;
[0056] [00056] Figure 48 is a cross-sectional view of a surgical stapling instrument according to at least one alternative embodiment of the present invention illustrating a lock in a partially closed position and a locking mechanism engaged with a clamp discharge actuator;
[0057] [00057] Figure 49 is a cross-sectional view of the surgical stapling instrument of figure 48, the lock being moved to a closed position and disengaging the locking mechanism of the clamp discharge actuator;
[0058] [00058] Figure 50 is a perspective view of an anvil assembly of the surgical stapling instrument of figure 34;
[0059] [00059] Figure 51 is an exploded perspective view of the anvil assembly of figure 50;
[0060] [00060] Figure 52 is another exploded perspective view of the anvil assembly of figure 50;
[0061] [00061] Figure 53 is an exploded cross-section elevation view of the anvil assembly of figure 50;
[0062] [00062] Figure 54 is a cross-sectional view of the anvil assembly of figure 50 illustrating an anvil adjustment element in a first position;
[0063] [00063] Figure 55 is a cross-sectional view of the anvil assembly of Figure 50 illustrating the adjustment element of the anvil of Figure 54 in a second position;
[0064] [00064] Figure 56 is a cross-sectional view of the anvil assembly of figure 50 illustrating the adjustment element of the anvil of figure 54 in a third position;
[0065] [00065] Figure 57 is a perspective view of a surgical stapling instrument according to at least one alternative embodiment of the present invention;
[0066] [00066] Figure 58 is a cross-sectional view of the surgical stapling instrument of figure 57 along line 58-58 in figure 57;
[0067] [00067] Figure 59 is a partial exploded view of the proximal end of the surgical stapling instrument of Figure 57 including a detent mechanism for releasably holding a rotating anvil adjustment element in position;
[0068] [00068] Figure 60 is a perspective view of the surgical stapling instrument of figure 57 with some components removed and others shown in cross section;
[0069] [00069] Figure 61 is an exploded view of portions of the surgical stapling instrument of figure 57 illustrating a rotating anvil adjustment element in a first orientation;
[0070] [00070] Figure 62 is a perspective view of the adjustment element of the rotating anvil of figure 61;
[0071] [00071] Figure 63 is an end view of the surgical stapling instrument of figure 57 with some components removed and others shown in broken lines illustrating the rotating anvil adjustment element in the first orientation of figure 61;
[0072] [00072] Figure 64 is an end view in cross section of the surgical stapling instrument of figure 57 along line 64-64 in figure 57;
[0073] [00073] Fig. 65 is an end view of the surgical stapling instrument of Fig. 57 illustrating the adjustment element of the rotating anvil of Fig. 61 rotated in a first direction in a second orientation;
[0074] [00074] Figure 66 is an end view in cross section of the surgical stapling instrument of figure 57 illustrating the anvil adjustment element in the second orientation of figure 65;
[0075] [00075] Fig. 67 is an end view of the surgical stapling instrument of Fig. 57 illustrating the adjusting element of the rotating anvil of Fig. 61 rotated in a second direction in a third orientation;
[0076] [00076] Figure 68 is an end view in cross section of the surgical stapling instrument of figure 57 illustrating the anvil adjustment element in the third orientation of figure 67;
[0077] [00077] Figure 69 is a perspective view of an actuator for rotating the anvil adjustment element of figure 61;
[0078] [00078] Figure 70 is a partial cross-sectional view of a surgical stapling instrument including a spring configured to pull the distal end of a first portion of the cable away from the distal end of a second portion of the cable when the stapling instrument it is in a partially closed configuration;
[0079] [00079] Figure 71 is a perspective view of the surgical stapling instrument in figure 34 similar to that in figure 50;
[0080] [00080] Figure 72 is a detailed view of a lock projection extending from an anvil of a surgical stapling instrument according to at least one alternative embodiment of the present invention;
[0081] [00081] Figure 73 is a diagram illustrating the lock projection of figure 72 and a lock configured to engage the lock projection and move the lock projection to a recess of the lock;
[0082] [00082] Figure 74 is an elevation view of the lock projection of figure 72;
[0083] [00083] Figure 75 is a perspective view of a staple pouch according to at least one embodiment of the present invention;
[0084] [00084] Figure 76 is a top view of the staple pouch of figure 75;
[0085] [00085] Fig. 77 is a cross-sectional view of the clip pouch of Fig. 75 along line 77-77 in Fig. 76;
[0086] [00086] Figure 78 is a cross-sectional view of the staple pouch of figure 75 along line 78-78 in figure 76;
[0087] [00087] Figure 79 is another top view of the staple pouch in figure 75;
[0088] [00088] Figure 80 is a cross-sectional view of the staple pouch in figure 75 along line 80-80 in figure 79;
[0089] [00089] Figure 81 is a cross-sectional view of the staple pouch in figure 75 along line 81-81 in figure 79;
[0090] [00090] Figure 82 is an elevation view of a surgical clamp in a non-deformed shape;
[0091] [00091] Figure 83 is an elevation view of the surgical clamp of Figure 82 in a deformed shape according to at least one embodiment of the present invention;
[0092] [00092] Figure 84 is a side view of the surgical clamp of figure 82 in the deformed shape of figure 83;
[0093] [00093] Figure 85 is a plan view of the surgical clamp of figure 82 in the deformed shape of figure 83;
[0094] [00094] Figure 85A is another plan view of the surgical clamp of figure 82 in the deformed shape of figure 83;
[0095] [00095] Figure 86 is an elevation view of a surgical clamp in a non-deformed shape;
[0096] [00096] Figure 87 is a bottom view of the surgical clamp in Figure 86 in a non-deformed shape;
[0097] [00097] Figure 88 is a bottom view of the surgical clamp of Figure 86 in a deformed shape according to at least one embodiment of the present invention;
[0098] [00098] Figure 89 is a partial cross-sectional view of the surgical clamp in Figure 86;
[0099] [00099] Figure 90 is an elevation view of a surgical clamp in a deformed shape in accordance with at least one embodiment of the present invention;
[0100] [000100] Figure 91 is an elevation view of a surgical clamp in a deformed shape;
[0101] [000101] Figure 92 is an exploded perspective view of the surgical stapling instrument of figure 34;
[0102] [000102] Figure 93 is an exploded elevation view of the surgical stapling instrument of figure 34;
[0103] [000103] Figure 94 is a partial cross-sectional view of the surgical stapling instrument of figure 34, illustrating a lock rotated in the first portion, the lock being engaged with the second portion and the lock being rotated in a partially closed position;
[0104] [000104] Figure 95 is a perspective view of a staple cartridge assembly of the surgical stapling instrument of figure 34;
[0105] [000105] Figure 96 is an exploded view of the staple cartridge assembly of Figure 95;
[0106] [000106] Figure 97 is a cross-sectional view of the staple cartridge assembly of figure 95;
[0107] [000107] Figure 98 is an exploded view of a staple sled and the cutting element assembly of the staple cartridge assembly of figure 95;
[0108] [000108] Figure 99 is a perspective view of the staple sled and the cutting element assembly of figure 98;
[0109] [000109] Figure 100 is a detailed view of a distal end of a pusher bar to be connected in a functional way to a sled of clamps and cutting set of figure 98, the distal end of the pusher bar being illustrated in a proximal position in solid lines and a second position, distal, in dashed lines;
[0110] [000110] Figure 101 is a partial bottom view of the staple cartridge assembly of figure 95; and
[0111] [000111] Figure 102 is a cross-sectional view of a staple cartridge assembly according to an alternative embodiment;
[0112] [000112] Figure 103 is a perspective view of a surgical stapling instrument comprising a staple discharge actuator in a partially advanced position;
[0113] [000113] Figure 104 is a cross-sectional view of the surgical stapling instrument of figure 103 illustrating the staple discharge actuator in the partially advanced position;
[0114] [000114] Figure 105 is a cross-sectional view of the surgical stapling instrument of figure 103 illustrating the staple discharge actuator being returned to an untriggered position;
[0115] [000115] Figure 106 is a top view of the surgical stapling instrument of figure 103 illustrating the staple discharge actuator being moved distally;
[0116] [000116] Figure 107 is a top view of the surgical stapling instrument of figure 107 illustrating the staple discharge actuator being moved proximally;
[0117] [000117] Figure 108 is another perspective view of the surgical stapling instrument of figure 103;
[0118] [000118] Figure 109 is a cross-sectional view of the proximal end of the surgical stapling instrument of figure 103 illustrating the clip unloading actuator in an unchained position;
[0119] [000119] Figure 110 is a cross-sectional view of the proximal end of the surgical stapling instrument of figure 103 illustrating the staple discharge actuator rotated to a first side of the surgical stapling instrument compartment; and
[0120] [000120] Figure 111 is a cross-sectional view of the proximal end of the surgical stapling instrument of figure 103 illustrating the clamp discharge actuator in a partially fired position.
[0121] [000121] The corresponding reference characters indicate the corresponding parts through the various views. The exemplifications described herein illustrate preferred embodiments of the invention, in one form, and such exemplifications should not be considered to limit the scope of the invention in any way. DETAILED DESCRIPTION
[0122] [000122] Certain exemplary modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described here. One or more examples of three modalities are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting modalities, and that the scope of the various modalities of the present invention is defined only by the claims. The aspects illustrated or described in connection with an exemplary modality can be combined with the aspects of other modalities. These modifications and variations are intended to be included in the scope of the present invention.
[0123] [000123] Full descriptions of the following US patent applications are hereby incorporated by reference: US patent application serial number 12 / 725,993, entitled STAPLE CARTRIDGE, filed on March 17, 2010; US patent application serial number 12 / 234,149, entitled SURGICAL STAPLING INSTRUMENT WITH CUTTING MEMBER ARRANGEMENT, filed on September 19, 2008; US patent application serial number 12 / 234,143, entitled SURGICAL STAPLER HAVING AN INTERMEDIATE CLOSING POSITION, filed on September 19, 2008; US patent application serial number 12 / 234,133, entitled SURGICAL STAPLER WITH APPARATUS FOR ADJUSTING STAPLE HEIGHT, filed September 19, 2008; US patent application serial number 12 / 234,113, entitled LOCKOUT ARRANGEMENT FOR A SURGICAL STAPLER, filed September 19, 2008; US patent application serial number 12 / 622,099, entitled SURGICAL STAPLER HAVING A CLOSURE MECHANISM, filed on November 19, 2009; US patent application serial number 12 / 622,130, entitled METHOD FOR FORMING A STAPLE, filed on November 19, 2009; US patent application serial number 12 / 622,113, entitled SURGICAL STAPLER COMPRISING A STAPLE POCKET, filed on November 19, 2009; US patent application serial number 12 / 843,436, entitled SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT, filed on July 26, 2010; US patent application serial number 12 / 030,424, entitled SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT, filed on February 13, 2008; and US provisional patent application No. 61 / 250,377, entitled SURGICAL STAPLER, filed on October 9, 2009.
[0124] [000124] With reference to figures 1 and 2, a linear anastomotic stapling instrument, generally 20, may comprise a claw element that carries the upper elongated anvil 22 and a claw element that carries the lower elongated staple cartridge 24. The claw element carrying the upper anvil 22 can be supported by a handle 26 with an anterior portion of the claw element extending forward thereto. The claw element carrying the lower staple cartridge 24 can be supported by a cable 28 with an anterior portion of the claw element extending forward thereto. As shown in figure 3, the upper handle 26 and the lower handle 28 can be properly shaped to form a hand grip to facilitate the handling and operation of the stapling instrument by a surgeon. An enlarged protrusion 27 and a small posterior protrusion 29 can be provided on each cable for this purpose. In various embodiments, cables 26 and 28 can be made of plastic or other lightweight materials, for example, while claw elements 22 and 24 can be made from stainless steel or other similar materials, for example.
[0125] [000125] As shown in figure 5, the upper claw element 22 may comprise an elongated one-piece channel structure including a pair of opposite elongated side walls 30 connected by a top wall 31. The upper cable 26 may include a pair of dependent tabs 32 located within the upper cable adjacent to its front end. The upper claw element 22 may include a slot 34 (figure 4) formed in an intermediate position along its top wall 31 through which the dependent flaps 32 can project downwardly. A locking pin 36 can extend through circular holes formed in the side walls 30 of the upper claw element 22 and through circular holes formed in the dependent flaps 32 to pivotally connect the upper claw element to the upper handle 26.
[0126] [000126] Referring to figure 5, the front portion of the upper jaw element 22 can be provided with a pair of elongated inwardly extending flanges 38 which can define an anvil 40 of the stapling instrument. The flanges 38 can be separated by a central longitudinal slot 42 which extends along the entire length of the anvil 40. At the proximal end of the central slot 42, the flanges 38 can be provided with inwardly inclined guide surfaces 41. Each flange 38 it can also be provided with two longitudinal rows of evenly spaced staple-forming pockets 44. With reference to figures 4 and 5, a tapered anvil tip 46 can be mounted in front of the claw element that carries the anvil 22 to facilitate insertion of the claw element into hollow tubular body organs, for example. The tip of the anvil 46 can include an elongated body 48 (figure 4) that can be inserted through the longitudinal passage above the anvil 40 defined by the side walls 30 and flanges 38 of the upper jaw element. This elongated body 48 can extend between the dependent flaps 32 above the locking pin 36 and can include an enlarged rear portion 50 located behind the flaps 32 to hold the anvil tip 46 in place on the upper claw element 22.
[0127] [000127] With reference to figures 2 and 6, the gripper element carrying the lower cartridge 24 can comprise an elongated one-piece channel structure including a pair of opposing elongated side walls 52 connected by a base wall 53. Along the rear portion of the lower jaw element 24, a pair of elongated and spaced upright side flanges 54 (figure 2) can extend upwards from their opposite side walls 52. As shown in figures 5 and 6, the width of the lower jaw element 24 between its side flanges 54 may be greater than the width of the upper jaw element 22 between its side walls 30 to allow the rear portion of the upper jaw element to be received between the side flanges 54 of the jaw element when the stapling instrument is assembled for operation. As shown in figure 2, each side flange 54 of the lower jaw element 24 may include a vertical notch 56 located in line with the locking pin 36 on the upper jaw element 22. When the upper jaw element 22 and the lower jaw element 24 are mounted, the opposite ends of the lock pin 36 can be received in the grooves 56.
[0128] [000128] As shown in figures 2 and 6, the lower jaw element 24 can hold a staple cartridge 60 which is adapted to receive a plurality of surgical staples 61 (figure 17) arranged in at least two laterally spaced longitudinal rows. The staple cartridge 60 can be mounted on the front portion of the lower jaw element 24 between its side walls 52. The staple cartridge 60 can be divided longitudinally by an elongated central slot 62 (figure 6) that extends from the proximal end of the cartridge towards its distal end. In various embodiments, a plurality of staple openings 64 formed in the staple cartridge 60 can be arranged in two pairs of rows spaced laterally, with each pair of rows arranged on opposite sides of the central longitudinal slot 62. A plurality of surgical staples 61 ( figure 17) can be mounted inside the openings 64 of the cartridge 60. As shown in figure 6, the staple openings 64 in adjacent rows can be misaligned to provide a more effective stapling of the tissue when the instrument is operated. Referring to Figures 15 and 16, the staple cartridge 60 may include a pair of longitudinal slots 66 located on opposite sides of the elongated central slot 62 and disposed between the misaligned rows of the openings 64 on each side of the central slot. Each longitudinal slot 66 may extend from the proximal end of the cartridge 60 towards its distal end.
[0129] [000129] As shown in figure 17, a plurality of clamp boosters 65 can be slidably mounted in the clamp openings 64 to move the clamps 61 that are loaded into the clamp cartridge 60. With reference to figure 6, each booster of staple 65 can be designed to simultaneously move two staples 61 located in adjacent rows provided in the staple cartridge 60. In this way, in various embodiments, a first set of staple boosters 65 can be provided to move staples 61 in the misaligned rows located on one side of the central longitudinal slot 62, and a second set of clamp boosters 65 can be provided for driving the clips 61 in the pair of adjacent rows located on the other side of the central longitudinal slot 62.
[0130] [000130] As shown in figures 2 and 3, similarly to the above, the front or distal end of the staple cartridge 60 can include a tapered tip 68 to facilitate insertion of the lower jaw element 24 into a hollow body member tubular, for example. Immediately behind its tapered tip 68, the staple cartridge 60 can be provided with a pair of rear extending protrusions 70 (one shown in figure 14) which can be received in corresponding notches provided on the side walls 52 of the claw element bottom 24. At the rear of the staple cartridge 60, a pair of dependent arms 72 can extend downwardly from the cartridge. Each arm 72 can be notched to provide a side opening 74. When the cartridge 60 is mounted on the lower jaw element 24, its protrusions 70 can be received in corresponding notches provided at the front ends of the side walls 52 and their dependent arms 72 extend down through an opening 76 (figure 4) formed in the base wall 53 of the claw element 24. The lower claw element 24 may include a pair of dependent tabs 78 (figure 18) that extend downwardly from their side walls 52 on opposite sides of opening 76. A pivot pin 80 can extend through holes formed in the dependent tabs 78 of the lower jaw element 24 and through side openings 74 of the dependent arms 72 in the staple cartridge 60 to secure the cartridge of clamps to the lower gripper element.
[0131] [000131] With reference to figure 2, the stapling instrument 20 may include a locking mechanism, generally 90, for locking the upper clamping element 22 and the lower clamping element 24 together in an intermediate position along the clamping elements . In various embodiments, the clamping elements 22 and 24 can be locked together in a position adjacent to the proximal ends of the anvil 40 and the staple cartridge 60. In at least one embodiment, the locking mechanism 90 may comprise a locking arm 92 (figure 2) hingedly connected to the lower claw element 24 through pivot pin 80 (figure 4). The locking arm 92 may have a channel-shaped configuration and may include a pair of opposing elongated side walls 94 (figure 6) that are spaced apart enough to occupy the side walls 52 of the lower jaw element 24. Each wall side 94 of the locking arm 92 can include a hook element extending upwards and forwards 96 provided with a forward facing slot 98 to receive the locking pin 36. A cover 100 can be installed on the lower surface of the locking arm locking 92. When locking arm 92 is closed, as shown in figure 3, the cover 100 can be aligned with the bottom of the bottom cable 28 to facilitate the handling and operation of the stapling instrument 20 by the surgeon. In various embodiments, cover 100 may be made of plastic or other lightweight materials, for example, while locking arm 92 may be made of stainless steel, for example. As shown in figure 7, cover 100 can include elongated flanges 102 and 104 extending outwardly from their opposite sides, which can serve as finger grips to allow locking arm 92 to be rotated downwardly from its locked position to its unlocked position. When the locking arm 92 is moved to its closed or locked position, the slit surfaces 98 of the hook elements 96 can cooperate with the locking pin 36 which can act as a lock on the center to hold the locking arm 92 in the its locked position.
[0132] [000132] With reference to figures 6 and 10, the preferred mode of the stapling instrument 20 may include an improved propeller bar and knife blade assembly, generally 110, which can be slidably mounted for longitudinal movement in relation to the elements upper and lower jaws 22 and 24, respectively, to drive the clamps 61 from the clamp cartridge 60 into the fabric trapped between the claw elements, forming clamps 61 against the anvil 40, and cutting the fabric along a line between the rows of staples formed in the fabric. The drive bar and knife blade assembly 110 may include a drive block 112 (figure 6) that can be received by sliding into the lower channel-shaped claw element 24 between its upright side flanges 54. As shown in figure 11, the drive block 112 can be attached to an actuator 114 by a flange 116 which includes a laterally extending finger 118 provided with a longitudinally extending notch 119 on its top surface. The finger 118 can be press-fitted into a side slot 120 formed in the drive block 112 to locate the notch 119 under a longitudinal locking bar 121 to secure the drive block 112 and the actuator 114 together. The flange 116 of the actuator button 114 can extend through and run along an elongated slit 122 (figure 2) formed on a side flange 54 of the lower jaw element 24.
[0133] [000133] The propeller bar and knife blade assembly 110 may include a pair of clamp propeller bars 124 (figure 10) projecting forward from the propeller block 112 and received by sliding into the elongated slits 66 (figure 16) of the staple cartridge 60. The drive block 112 can be provided with a pair of vertical slots 126 (figure 11) to which the drive bars 124 are attached. As shown in figure 10, the front end of each clamp propeller bar 124 can be provided with a wedge-shaped tip 128 that defines an inclined cam surface 130 to interconnect clamp boosters 65 when the propeller bars 124 are moved to facing into the staple cartridge 60. As shown in figure 21, each staple pusher 65 can be provided with an inclined surface 132 oriented at the same angle as the cam surface 130 of each staple propeller bar 124 to provide a sliding contact horizontal between the surfaces.
[0134] [000134] With reference to figures 6 and 10, the propeller bar and knife blade 110 may include a knife block 134 which is slidably mounted for longitudinal movement along the lower jaw element 24 between its upright side flanges 54. The knife block 134 may include a knife support bar 136 that extends forward into the central longitudinal slot 62 of the staple cartridge 60. An inclined knife blade 138 provided with a beveled cutting edge 140 can be located at the front end of knife support bar 136. The beveled cutting edge of knife blade 138 can be oriented at an angle to elongated claw elements 22 and 24 and can be received by sliding into the central longitudinal slot 62 of the staple cartridge 60.
[0135] [000135] In various embodiments, the knife block 134 may include a pair of longitudinal slots 135 (figure 19) extending through it, which slidily receives the clip propeller bars 124 to allow the drive block 112 to slide in relation to the knife block. Consequently, when the propeller block 112 is moved forward towards the clamp cartridge 60 by the actuator button 114, the clamp propellers 124 can slide through knife block 134, which remains stationary until the propeller block moves to engage with the knife block. After knife block 134 is engaged with drive block 112, knife block and drive block can simultaneously advance towards staple cartridge 60. As shown in figure 17, knife blade 138 can be moved forward through the staple cartridge 60 together with staple propellers 124, forming staples 61 in the fabric trapped between the claw elements and cutting the fabric between the rows of staples. Thereafter, when the actuator button 114 is retracted, the propeller block 112 may initially slide the clamp propellers 124 backward through knife block 134, which may remain stationary. Each staple propeller bar 124 may include a protruding portion 142 that can move to engage with knife block 134 after the staple propeller bars 124 are removed by a predetermined distance. With the protruding portions 142 of the staple propellers 124 engaging the knife block 134, the propeller block 112 and the knife block 134 can be retracted simultaneously by the actuator button 114 for the propellers 124 and the knife blade 138 return to the starting position.
[0136] [000136] According to various embodiments of the invention, the stapling instrument 20 can be provided with clamping means for applying clamping forces to the clamping elements to drive the staple cartridge 60 and the anvil 40 together during the formation of the staples 61. The clamping means may include means for moving the clamping elements away from a remote position of the locking mechanism to withstand the forces exerted on the staple cartridge 60 and the anvil 40 when the clamps 61 are formed. In at least one embodiment, a cam means can be mounted on one of the claw elements and can be coupled with the other claw element to move said claw elements away from the remote position to drive the staple cartridge 60 and the anvil 40 together. In various embodiments, a cam element can be pivotally mounted on one of the claw elements in a remote position of the locking mechanism. The cam element can be pivoted from a first non-operating position to a second operating position to move the remote ends of the claw elements away. The cam element can be operated by the drive block 112 of the drive bar and knife blade assembly 110 to move to its operating position when the drive block is advanced and to return to its non-operating position when the drive block is retracted.
[0137] [000137] In various embodiments, a cam mechanism, usually 150, can be located next to the rear end of the lower jaw element 24, as shown in figure 4. The cam mechanism 150 may include a cam element 152 mounted hinged in a transverse pivot pin 154 that extends between the upright side flanges 54 of the lower jaw element 24. The cam element 152 may include a first lower cam surface 156 for engaging the top wall 31 of the upper jaw element 22 with the cam 152 in its first non-operating position (figure 12) and a second upper cam surface 158 for interconnecting the top wall 31 of the upper claw element 22 with the cam 152 arranged in its second operating position (figure 13) . The first cam surface 156 can be arranged to keep the upper and lower jaw elements substantially parallel as the cam 152 in its non-operational position. The second cam surface 158 can be arranged to raise the rear end of the upper gripper element 22 by approximately 3.2 mm (0.125 inch), for example, when the cam 152 rotates from its non-operating position to its operating position. In addition, the upper gripper element 22 may be flexible enough to allow the rear portion of the upper gripper element 22 to tilt upwards away from the lower gripper element 24 when the cam element 152 is moved from its non-operating position to its operational position.
[0138] [000138] As shown in figure 4, the cam element 152 may include a radially extending notch 160 that divides the cam into a large anterior finger 162 and a small posterior finger 164. The anterior finger of cam 162 may include a surface horizontal backward facing 165, and the rear finger of cam 164 may include an inclined forward facing surface 166. With cam 152 in its non-operational position, the front finger of cam 162 and the rear finger of cam 164 may extend to down through an elongated slot 168 formed in the base wall 53 of the lower jaw element 24.
[0139] [000139] In various embodiments, cam element 152 can be operated by drive block 112 to move from its non-operating position to its operating position when the drive block is moved forward. As shown in Figure 11, the powertrain 112 may include a pair of rearward extending arms 170 that are spaced apart to define a gap 172 between them. The rear ends of the arms 170 can be connected by a cam actuating pin 174 that extends through the gap 172. Referring to figures 4 and 11, with the cam element 152 in its non-operational position, the front cam finger 162 can extend through the gap 172 between the arms 170 of the drive block 112, while the cam actuator pin 174 can be received in the notch 160 between the front finger 162 and the rear finger 164 of the cam element.
[0140] [000140] As shown in figure 12, with the cam element 152 disposed in its first non-operational position, the top wall 31 of the upper gripper element 22 can rest on the first cam surface 156 of the cam element. With the cam element 152 in its non-operational position, the top wall 31 of the upper claw element 22 can be substantially parallel to the base wall 53 of the lower claw element 24. In addition, the drive block 112 can be located in the its start position spaced backwards from knife block 134. When the drive block 112 is moved forward, as indicated by arrow 182 (figure 13), the cam actuator pin 174 can engage the rear surface 165 of the finger front cam 162 to rotate cam member 152 in a counterclockwise direction, as indicated by arrow 184, to rotate the cam element to its second operating position and move its second cam surface 158 to engage with the wall top 31 of the upper claw element 22. With the cam element 152 rotated to its operational position, the top wall 31 of the upper claw element 22 can be flexed upward, as indicated by arrow 186, it moves away from the base wall 53 of the lower gripper element 24. The cam element can apply forces to the upper gripper element 22 and to the lower gripper element 24 which flexes the rear portions of the gripper elements by moving them apart. As a result of flexing the back portions of the upper claw element 22 and the lower claw element 24 by moving them apart, additional clamping forces can be applied to the front portions of the upper claw element 22 and the lower claw element 24 to secure the anvil 40 and the staple cartridge 60 against the fabric trapped between the clamping elements. In this way, the anvil 40 and the staple cartridge 60 can be pushed together to withstand the forces exerted on the anvil and the staple cartridge when the drive bar and knife blade 110 is moved forward to form staples 61 and cut the fabric.
[0141] [000141] With reference to figure 13, when the powertrain 112 is retracted after the clamps 61 are formed, the cam actuator pin 174 can engage the inclined surface 166 of the rear cam finger 164 to rotate the cam element 152 in the clockwise. When the cam actuator pin 174 moves along the inclined surface 166 within the notch 160, the cam element 152 can rotate clockwise and return to its first non-operating position (figure 12) with its first cam surface 156 in engagement with the top wall 31 of the upper gripper element 22. As a result, the forces exerted on the rear portions of the upper gripper element 22 and the lower gripper element 24 by the cam 152 can be released and the upper wall 31 of the upper claw element 22 can return to a substantially parallel relationship with the base wall 53 of the lower claw element 24. Similarly, the clamping forces applied to the front portions of the claw elements 22 and 24 can be released to loosen the anvil 40 and the staple cartridge 60.
[0142] [000142] In various embodiments, the stapling instrument 20 may include spacer means mounted on one of the claw elements to maintain a predetermined gap between the staple cartridge 60 and the anvil 40 of the stapling instrument. With reference to figures 4 and 6, this spacer means can be incorporated as a spacer pin 190 mounted next to the distal end of the staple cartridge 60. The spacer pin 190 can extend vertically upwards from the base wall 53 of the element lower jaw 24 through the staple cartridge 60 and project upwards from the top of the staple cartridge by a predetermined distance. As shown in figure 5, an anvil flange 38 may include a flange section 192 adjacent to its distal end to interconnect the spacer pin 190. With the stapling instrument mounted for operation (figure 4), the spacer pin 190 can interconnect the flange section 192 to maintain a predetermined gap between the anvil 40 and the staple cartridge 60.
[0143] [000143] In the operation of the stapling instrument 20, the fabric to be stapled and cut can be placed initially between the clamping elements 22 and 24 and stapled by the clamping elements. In this way, the cables 26 and 28 can be unlocked by the pivoting movement of the locking arm 92 down to their unlocked position (figure 2). As a result, the opposite ends of the locking pin 36 can be disengaged from the slots 98 formed in the hook elements 96 of the locking arm 92. Thereafter, the upper and lower claw elements 22 and 24 can be separated by disengaging the locking pin. locking 36 of the slits 56 formed on the side flanges 54 of the lower gripper element.
[0144] [000144] Next, the tissue to be stapled and cut can be placed on the clamping elements 22 and 24. For example, as shown in figure 17, a piece of tubular intestinal tissue can be slid over the anterior portion of each element of claw. After the fabric is placed on the clamping element, the stapling instrument 20 can be reassembled. Reassembly can be carried out by aligning the locking pin 36 with the vertical slots 56 formed on the upright side flanges 54 of the lower jaw element 24. Subsequently, the side flanges 54 of the lower jaw element 24 can be positioned within the upper cable 26 , occupying the side walls 30 of the upper clamping element 22, while the opposite ends of the locking pin 36 can be inserted into the vertical slots 56. Finally, the locking arm 92 can be rotated upwards to its locked position (figure 3) with its cover 100 flush with the bottom of the lower cable 28. As a result, the hook elements 92 can be rotated over the locking pin 36 and the slots 98 can receive the opposite ends of the locking pin. In this way, the upper claw element 22 and the lower claw element 24 can be locked together in an intermediate position along it, in a position adjacent to the anvil 40 and the staple cartridge 60. In addition, the spacer pin 190 can interconnect the flange section 192 of the anvil 40 through the body tissue to maintain a predetermined gap between the anvil 40 and the staple cartridge 60.
[0145] [000145] After the fabric is trapped between the clamping elements, the stapling instrument 20 can be triggered by moving the actuator button 114 forward to activate the propeller bar and knife blade 110. Initially, on activating the clamping mechanism cam 150, drive block 112 and drive bars 124 (Fig. 4) can be moved forward, while knife block 134 can remain stationary. Since only the propeller block 112 and its propellers 124 are moved forward to activate the cam element 152, the initial force required to operate the stapling instrument 20 can be reduced.
[0146] [000146] With reference to figure 12, during the initial displacement of the propeller block 112, the propeller bars 124 can slide through the knife block 134 and the wedge-shaped tips 128 of the propeller bars can begin to move forward through the grooves 66 of the staple cartridge 60. When the drive block 112 moves towards knife block 134, its cam actuator pin 174 can interconnect the rear surface 165 of the front cam finger 162 to rotate the cam 152 anti- -time, as indicated by arrow 184 of figure 13, to move the second cam surface 158 of the cam element for engagement with the top wall 31 of the upper gripper element 22. The cam element 152 can apply forces to the tracking element upper jaw 22 and the lower jaw element 24 which flexes the rear portions of the jaw elements away from them. As a result, the rear end of the top wall 31 of the upper gripper element 22 can be flexed upward by approximately 3.2 mm (0.125 inch), for example, relative to the rear end of the base wall 53 of the mounting element. lower jaw 24. Flexing the rear ends of the jaw elements 22 and 24 can result in additional clamping forces on the front portions of the jaw elements to secure the anvil 40 and the staple cartridge 60 against the fabric trapped between the jaw elements. claw. These additional clamping forces tend to resist the forces exerted on the anvil 40 and the staple cartridge 60, while the fabric is cut and the staples 61 are formed against the anvil 40, to maintain the desired spacing between the anvil 40 and the cartridge of staples 60 to produce formed staples 61 that are of substantially uniform height.
[0147] [000147] Referring to figure 13, after the cam mechanism 150 is activated, the drive block 112 can subsequently interconnect knife block 134 to begin the longitudinal movement of knife block 134 towards staple cartridge 60. In several In some embodiments, the initial spacing between drive block 112 and knife block 134 can be arranged such that drive block 112 interconnects knife block 134 slightly before cam element 152 arrives in its operational position. Alternatively, the initial spacing between drive block 112 and knife block 134 can be arranged so that drive block 112 initially interconnects knife block 134 after movement of cam element 152 to its operational position has ended. When the drive block 112 interconnects knife block 134, forward movement of knife blade 138 along the central longitudinal slots 42 and 62 of anvil 40 and staple cartridge 60, respectively, can be initiated. Thereafter, the staple propellers 124 and the knife blade 138 can be moved simultaneously to staple and cut the tissue trapped between the anvil 40 and the staple cartridge 60.
[0148] [000148] When the propeller block 112 is moved forward, the staple propeller bars 124 can be moved longitudinally along the slots 66 provided in the staple cartridge 60. The two wedge-like cam surfaces 130 of the staple propeller bars 124 they can move through slots 66 to engage with the angled surfaces of the clip boosters 65 to sequentially direct the clips 61 of the cartridge 60 and to form the clips 61 in the B-shape configuration against the anvil flanges 38. The cam surfaces 130 they can be located at the same distance from the propeller block 112 to simultaneously activate the clamp boosters 65 located on opposite sides of the central longitudinal slot 62. Simultaneously, the knife block 134 can be moved forward to move the knife blade 138 through the slot central longitudinal slot 42 of the anvil 40 and through the central longitudinal slot 62 of the staple cartridge 60 to cut the fabric stuck between the claw elements. The additional clamping forces applied to the front portions of the upper claw element 22 and the lower claw element 24 via the cam mechanism 150 may tend to resist the forces exerted on the anvil 40 and the staple cartridge 60 when the clamps 61 are formed.
[0149] [000149] After the propeller block 112 is completely moved forward to form all the clamps in the cartridge 60, the propeller block can be retracted towards its starting position by the retraction of the actuator button 114. Initially, only the propeller block 112 can be retracted. move behind the staple cartridge 60 because the staple propellers 124 slide through the knife block 134 which remains stationary. When the displaced portions 142 of the staple drive bars 124 interconnect the front of the knife block 134, the knife block can be moved back from the staple cartridge 60 together with the drive block 112. As a result, the drive bars of staples 124 and knife blade 138 can be retracted simultaneously from staple cartridge 60 and anvil 40.
[0150] [000150] When the powertrain 112 returns to its starting position, the cam actuator pin 174 may interconnect the inclined surface 166 of the rear cam finger 164 to rotate the cam element 152 clockwise towards its unrestricted position. operational. The pin of the cam actuator 174 can move along the inclined surface 166 into the slot 160 between the cam fingers 162 and 164 to return the cam element 152 to its non-operating position. As a result, the second cam surface 158 of the cam element 152 can be disengaged from the top wall of the upper gripper element 22 and the rear end of the top wall 31 of the upper gripper element 22 and move downward for engagement. with the first cam surface 156. Simultaneously, the front cam finger 162 can pivot down into the gap 172 between the fingers 170 on the propeller block 112, and both cam fingers 162 and 164 can pivot down into the slot 168 formed in the base wall 53 of the lower claw element 24. Subsequently, with the cam element 152 in its non-operational position, the locking arm 92 can be rotated downwards, as shown in figure 2, to allow the element upper jaw 22 and the lower jaw element 24 are disassembled. At this point, the cut and stapled fabric can be removed from the clamping elements.
[0151] [000151] As described above, a surgical stapling instrument can include an actuator button, such as actuator button 114 (figure 1), for example, which can be configured to move a drive bar assembly forward, such as the assembly propeller bar 110 (figure 10), inside a staple cartridge of the surgical stapling instrument. In various embodiments, the actuator button 114 can be configured to be picked up by a surgeon so that the surgeon can apply force to him. In various circumstances, the actuator button 114 may come into contact or be in a borderline position with the tissue surrounding the surgical site when it is advanced distally. In at least one circumstance, as a result, the surgeon may have to reposition the stapling instrument so that the actuator button 114 can pass through the tissue. In other circumstances, the surgeon may have to force the actuator button 114 through the tissue. In any case, such circumstances may be inappropriate and, as a result, there is a need for a stapling instrument that has an actuator button that can be manipulated to reduce the possibility of the actuator button hitting the surrounding tissue.
[0152] [000152] In various embodiments of the present invention, with reference to figure 21, the stapling instrument 220 may include the claw element that carries the anvil 222 extending from the upper handle 226, the claw element that carries the cartridge of clamps 224 extending from the lower cable 228, and the actuators 214a and 214b that can be operably engaged with a propeller assembly, such as a propeller assembly 210 as shown in figure 24, for example . In various embodiments, a staple cartridge can be removably attached to the claw element that carries staple cartridge 224, for example, so that, after the staple cartridge has been used up, it can be replaced with another staple cartridge. Bobby pins. In at least one embodiment, the drive bar assembly 210 may include a clamp booster formed integrally with it, or functionally mounted thereto, which can be moved through the clamp cartridge, as described above. In at least one other embodiment, the staple cartridge may include a staple driver contained therein, which can be engaged and pushed distally by the drive bar assembly. In any case, the first actuator button 214a, for example, can be rotated between a first position (figure 21) in which it is functionally disengaged from the drive bar assembly 210 and the second position (figure 22) in which it is functionally engaged with the propeller bar assembly 210. Similarly, the second actuator button 214b can be configured to be rotated between the first and second positions in which it is functionally disengaged and engaged, respectively, with the assembly of propellant bar 210.
[0153] [000153] In various modalities, as a result of the above, the actuating buttons of a stapling instrument can be selectively engaged with a set of propellant bar so that, in the event that an actuator button can come into contact or be in a borderline position with the tissue surrounding the surgical site when it is moved forward, the actuator button can remain in its retracted position while another actuator button can be extended to advance the propeller bar assembly distally. In at least one such embodiment, with reference to figure 22, the first actuator button 214a can be rotated to its second position so that it can be functionally engaged with the propellant assembly 210 while the second actuator button 214b can remain in its stowed position. Subsequently, with reference to figure 23, the first actuator button 214a can be moved distally with respect to the upper cable 226 and the lower cable 228 along the first side 201 of surgical stapler 210 in order to move the drive train 210. At least In one embodiment, the first actuator button 214a can be slid into the first slot 227 defined between, or within, the upper handle 226 and the lower handle 228. In various other circumstances, with reference to figure 28, the first actuator button 214a may remain in its stowed position while the second actuator 214b can be rotated to its extended position. Similar to the above, the second actuator button 214b can be moved distally along the second side 203 of the stapling instrument 210 to move the drive bar assembly 210 into the second slot 229, for example. In at least one embodiment, both the actuator buttons 214 can be extended to move the drive bar assembly 210 distally. In various alternative modalities, although not illustrated, a stapling instrument may include more than two actuators that can be used selectively to move a set of propellant bar and / or knife blade. In fact, as a result of the above, the actuator buttons on a surgical instrument can be engaged with a set of propellant bars independently of one another.
[0154] [000154] In several modalities, in addition to the above, the actuating buttons of a stapling instrument can be located in a first position in which they can be held in position and kept out of operational engagement with a propeller bar assembly. In at least one embodiment, with reference to figure 24, the stapling instrument 201 may further include the guide element 209 which can be configured to guide the actuators 214 when they are rotated between their first and second positions. In various embodiments, with reference to figures 24 to 26, the guide element 209 can include guide rails 211 which can be received by sliding inside the grooves 213 of the actuators 214 so that when the actuators 214 are rotated, the guide element 209 can dictate the path along which the actuators 214 are moved. In addition, guide rails 211 and grooves 213 may comprise interlocking elements that can cooperatively prevent actuators 214 from being accidentally moved proximally and / or distally, for example. In at least one such embodiment, the guide element 209 can prevent one or more of the actuator buttons 214 from being moved along with the drive bar assembly 210 when the drive bar assembly 210 is moved in a distal position, as described above. In various embodiments, a slight friction or interference fit may be present between the guide rails 211 and the grooves 213 so that the possibility that the actuator knobs 214 may be accidentally rotated in their extended positions can be reduced. Although not shown, actuators may include guide rails that extend from them, which can be received by sliding in the grooves within the guide element, for example. In any case, with reference to figure 25, the guide element 209 can include one or more retaining elements 215 that can be configured to hold the guide element 209 in an intermediate position between the upper cable 226 and the lower cable 228. In addition, with reference to figures 24 and 25, the guide element 209 can include an opening 217 that can be configured to receive the retaining pin 219 extending therethrough, the retaining pin 219 can be configured to be engaged with the upper cable 226 and / or the lower cable 228 to hold the guide element 209 in position.
[0155] [000155] In various modalities, when the actuator buttons 214 are rotated between their first and second positions, as described above, the grooves 213 can be rotated out of engagement with the guide rails 211 and the actuator buttons 214 can be engaged in functionally with the propeller bar assembly 210. In at least one embodiment, with reference mainly to figure 24, the propeller bar assembly 210 may include a first engaging element, such as slots or grooves 205, for example, and buttons actuators 214 may each include a second engagement element, such as projections 207, for example, the first and second engagement elements being operatively engaged with one another in order to functionally engage one or more of the actuators 214 with the propeller bar assembly 210. In at least one embodiment, the projections 207 can be received intimately within the slits 205 so that when a force is applied applied to one or more of the actuator buttons 214, the force can be transmitted to the set of propeller bar 210 through the projections 207 and the side walls of the slits 205. In at least one modality, similar to the above, a slight friction or interference fit may be present between projections 207 and slots 205 to hold actuators 214 in their extended position. In any case, although not shown, the first coupling element can include projections extending from the propeller bar assembly, which can be configured to be received inside recesses or slits within the actuators. In addition to or instead of the above, with reference to figure 24, the drive bar assembly 210 may further include the second guide rails 221 which can be configured to be received by sliding inside the slots or grooves 223 within the buttons actuators 214, rails 221 and grooves 223 can be configured to guide actuator buttons 214 to their second position and / or transmit forces from actuator buttons 214 to the propeller bar assembly 210 once they are in their second position. Similar to guide rails 211, guide rails 221 can be configured to create slight friction or interference fit with grooves 223 to hold actuator buttons 214 in position. In addition to the above, in various embodiments, actuator bar 210 may include column 225 on which actuators 214 can be rotated. In at least one embodiment, actuators 214 can include recesses 227 that can be circumvented so that the side walls of recesses 227 can receive and slide around column 225 and, as a result, column 225 can guide the actuator buttons 214 when they are rotated between their first and second positions, for example.
[0156] [000156] In various embodiments of the present invention, a stapling instrument can include an actuator button that can be configured to be selectively moved along a first side of the stapling instrument and a second side of the stapling instrument. In at least one embodiment, referring to figures 29 and 30, the stapling instrument 320 may include an upper cable 326, a lower cable 328, and an actuator button 314, the actuator button 314 being similar to the discussed above, be configured to move a drive bar assembly forward within a staple cartridge. In at least one embodiment, the upper cable 326 and the lower cable 328 can define the first slot 327 and the second slot 329 with each other, both slots 327 and 329 can be configured to allow the actuator button 314 to slide through the same. More particularly, in various embodiments, the actuator button 314 can be configured so that it is selectively slid through the first slot 327 along the first side 301 or, alternatively, through the second slot 329 along the second side 303. In several embodiments, with reference to figure 31, the stapling instrument 320 may also include the third slot 331 which can be configured to allow the actuator button 314 to be moved from one side of the stapling instrument to the other. In at least one such modality, as a result, a surgeon can selectively position the actuator button 314 so that, if it appears that the actuator button 314 can collide with tissue if it is advanced distally on one side of the stapling instrument, the button actuator 314 can be rotated on the other side of the stapling instrument before it is advanced. Although the first and second sides of the illustrated embodiment are located on opposite sides of the surgical instrument 320, other embodiments are intended in which the first and second slits are located, for example, on adjacent sides and / or sides that are directly opposite each other. . In addition, other modalities are considered in which the sides of a stapling instrument are not readily discernible, such as, for example, instruments that have round and / or arched portions.
[0157] [000157] In several modalities, with reference mainly to figure 29, the first slot 327 can be configured so that it defines a path for the actuator button 314 parallel, or at least substantially parallel to a path defined by the second slot 329. In at least at least one mode, the third slot 331 can be configured to connect the first slot 327 and the second slot 329 so that it can define a path for the actuator button 314 that is perpendicular, or at least substantially perpendicular, to the paths defined by the slots 327 and 329. In such modalities, the actuator button 314 can be rotated over the top of the surgical instrument to move the actuator button 314 from the first side 301 to the second side 303. In the event that a surgeon decides to reposition the actuator button on the first side 301, the surgeon can move the actuator button 314 back through slot 311 until it is positioned again within the first slot 327. In various modalities alternative ages, although not illustrated, a third slot can define a path for actuator button 314 that is parallel, or at least substantially parallel, and / or coplanar, or at least substantially coplanar with the paths defined by slits 327 and 329. In several additional modalities, a third slot can define a path that is inclined with respect to the paths defined by slots 327 and 329. In any case, a third slot can be configured to connect the first and second slots so that an actuator button can be used. be slid inside them.
[0158] [000158] As described above, the stapling instrument 320 may include a propeller bar assembly that can be operably engaged with the actuator button 314, for example, so that the actuator button 314 can be configured to move the set of actuators propeller bar distally. In various embodiments, with reference to figure 33, the stapling instrument 320 may include the propeller bar assembly 310 which may include a first portion 333 in a functional manner coupled with a set of knives, for example, and, in addition, a second portion 335 which can be pivotally mounted to the first portion 333. In at least one embodiment, the first portion 333 can define an axis 337 about which the second portion 335 can be rotated. In at least one such embodiment, the second portion 335 may include an opening 339 defined therein, which may be configured to receive the first portion 333 intimately. In at least one embodiment, although not shown, the propellant assembly 310 may further include one or more retaining elements, such as snap screws, for example, configured to extend within a groove in the first portion 333, for example, to retain the second portion 335 to the first portion 333. In various embodiments, the second portion 335 can include the support 341 extending from it, which can be configured to secure the actuator button 314 to the second portion 335. In order to move the actuator button from one first side of the stapling instrument 320 to the other side , as described above, the actuator button 314 and the second portion 335 can be rotated relative to the first portion 333 so that the actuator button 314 can be selectively positioned within the first slot 3 27 and the second slot 329. In at least one embodiment, although not shown, a stapling instrument can have more than two slots to receive an actuator button when it is moved inside a staple cartridge. In any case, in various alternative embodiments, the first portion 333 and the second portion 335 can be mounted together in a fixed manner so that they are rotated together around the 337 axis. In at least one such embodiment, the first portion 333 can be configured to rotate with respect to a substantially non-rotatable portion of the propellant assembly 310.
[0159] [000159] With reference to figure 34, a surgical stapling instrument, generally 1100, can comprise a first portion of the cable 1102 and a second portion of the cable 1104. In various embodiments, the first portion of the cable 1102 and the second portion of the cable 1104 can be configured to be held by a surgeon, for example, and can comprise a hand grip portion 1106. In at least one embodiment, the first portion of handle 1102, referring to figures 35 and 36, can include a first cap 1108 attached to a first frame 1110, and similarly, the second portion of cable 1104 may include a second cap 1112 attached to a second frame 1114. Caps 1108 and 1112 may have ergonomic curves or otherwise have suitable curves to assist a surgeon in handling the 1100 stapling instrument within a surgical site. In various embodiments, the cable covers 1108 and 1112, for example, can include extended protuberances 1109 and 1113, respectively, which can facilitate the insertion of the stapling instrument 1100 into a surgical site. In various embodiments, the cable covers 1108 and 1112 can be made from plastic and lightweight materials and / or any other suitable material, for example, while the cable structures 1110 and 1114 can be made from stainless steel, titanium , and / or any other suitable material, for example.
[0160] [000160] In various embodiments, with respect again to figures 34 to 37, the distal ends of the cable portions 1102 and 1104 can comprise an end effector 1120 that can be configured to treat tissue within a surgical site, for example example. In at least one such embodiment, end effector 1120 may include a staple cartridge channel 1122 configured to receive and / or retain a staple cartridge, as described in more detail below. In certain embodiments, the staple cartridge channel 1122 may comprise a one-piece structure in the form of an elongated channel extending from the first structure of the cable portion 1110. In at least one embodiment, the staple cartridge channel 1122 may include a pair of opposing elongated side walls 1124 connected by a bottom wall 1126. Along the rear or proximal portion of the staple cartridge channel 1122, a pair of upright and spaced side flanges 1128 can extend upwardly from walls opposite sides 1124. In various embodiments, the width of the staple cartridge channel 1122 between the side flanges 1128 can be greater than the width of the upper jaw element, or anvil, 1130 extending from the second portion of the handle 1104. In at least one embodiment, the distance between the flanges 1128 can be configured to allow at least a portion of the anvil 1130 to be received between the side flanges 1128 when the inst stapling tool is mounted for operation. As shown in figure 35, each side flange 1128 can include a notch, or recess, 1127, for example, which can be configured to receive one or more lock projections 1131, for example, extending from anvil 1130, and / or any other suitable portion of the second portion of cable 1104, as described in more detail below.
[0161] [000161] As indicated above, again referring to figures 34 to 37, the staple cartridge channel 1122 can be configured to support and / or retain a staple cartridge, such as the staple cartridge 1150, for example , inside the end effector 1120, the staple cartridge being able to include one or more staples (not shown) removably stored there. In various embodiments, referring to figures 41 to 43, the staple cartridge 1150 may include one or more staple cavities 1151 which can be configured to store staples in any suitable arrangement, such as, for example, in at least two longitudinal rows laterally spaced, for example. In at least one embodiment, referring to figures 42 and 43, the staple cartridge 1150 may include the body 1152 and a reservoir or retainer 1154 of the staple cartridge, the body 1152 and / or reservoir 1154 of the staple cartridge it can be configured to define a channel, or trajectory, to receive a sled of staples and / or cutting element in a sliding way. In at least one embodiment, the reservoir 1154 can include flexible arms 1155, for example, which can be configured to engage the body of the staple cartridge 1152 in a quick-fit or and / or snap-fit arrangement. Referring to figures 43 to 45, the staple cartridge 1150 may further include the staple sled assembly 1160 which may include the portion of the staple sled 1162 and, in addition, the cutting element 1164. In various embodiments , the cutting element 1164 may include cutting edge 1165 and locking arm 1166, for example, with locking arm 1166 being configured to be snap-fit and / or snap-in at opening 1163 on staple sled 1162 when the cutting element 1164 is mounted on the staple sled portion 1162. In various other embodiments, the portion of the staple sled 1162 can be integrally molded to the cutting element 1164.
[0162] [000162] In addition to the above, referring to figures 41 to 43, the body of the staple cartridge 1152 may include a slot, such as slot 1156, for example, which can be configured to receive at least a portion of the cut 1164 and / or any other portion of the staple sled assembly 1160 and the propeller bar assembly 1200 (discussed below), slot 1156 being configurable to allow cutting element 1164 to be moved between a first and a second positions inside the staple cartridge 1150. In several embodiments, a slot 1156 can be configured to allow the cutting element 1164 to be moved between a proximal position (figure 43) and a distal position to cut the fabric positioned in the middle position. staple cartridge 1150 and anvil 1130, for example. With reference again to figures 43 to 45, the staple sled portion 1162 can include cam surfaces, ramp, or actuator 1167 that can be configured to engage staple boosters positioned within the staple cartridge 1150. In various embodiments, with reference In Fig. 42, staple cartridge 1150 can include staple drivers 1168 which can be lifted or slid upward into staple cavities 1151 by the sled portion 1162 so that the upward movement of staple drivers 1168 can eject or dispense the clamps at least partially positioned within the 1151 clamp cavities. While the 1168 clamp boosters can, in fact, be lifted vertically upwards, the term upwards, and the like, may mean that the 1168 clamp boosters, for example, they are moved towards the top surface or deck 1158 of the staple cartridge and / or towards the anvil 1130, for example. In certain embodiments, as shown in Figure 42, each clamp driver 1168 may include one or more inclined surfaces 1169 oriented at the same angle as the cam surface 1167, and / or any other suitable angle, which may provide a sliding contact surface relatively flat or at least substantially flat between staple sled 1162 and staple boosters 1168. In various embodiments, a staple booster can be configured to dispense with only one staple, while, in certain embodiments, a staple booster can be configured for simultaneously dispensing two or more staples located in adjacent rows, for example. Other devices are featured in US Patent Application Serial No. 12 / 030,424, entitled SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT, which was filed on February 13, 2008, the description of which is incorporated here for reference.
[0163] [000163] In various embodiments, as described above, a surgical stapling instrument may include a staple slitting set / set configured to cut tissue and dispense staples from a staple cartridge. However, in certain embodiments, a surgical stapling instrument may not require or include a cutting element. In at least such an embodiment, a staple cartridge can include a staple sled positioned thereon and / or a surgical instrument can be configured to move a staple sled into a staple cartridge in order to staple the tissue, for example, without dissecting it in another way. In certain other embodiments, a staple cartridge may include a sleigh of staples positioned therein when a surgical instrument may include a cutting element that can move in or in relation to the staple cartridge. In at least one such embodiment, the cutting element can be moved to contact the staple sled so that the cutting element and the staple sled can be moved together. Thereafter, the cutting element can be sufficiently retracted to allow the staple cartridge to be detached from the surgical instrument and replaced with a new staple cartridge that has a new staple sled. Such modalities can be useful when a sleigh of staples becomes worn or deformed during use. Other modalities are envisaged, in which a staple cartridge can include a cutting element positioned therein when a surgical instrument can include a sleigh of staples that can move in or in relation to the staple cartridge. In at least one such embodiment, similarly to that described above, the staple sled can be moved to contact the cutting element so that the cutting element and the staple sled can be moved together. Thereafter, the staple sled can be retracted sufficiently to allow the staple cartridge to be detached from the surgical instrument and replaced with a new staple cartridge that has a new cutting element. Such modalities can be useful when a cutting element becomes worn or deformed during use. In various embodiments, as described in more detail below, the staple cartridge can include a protective wrapper or cover configured to prevent, or at least reduce the chance of, a surgeon or other doctor touching the cutting element positioned inside the staple cartridge while handles the staple cartridge, for example.
[0164] [000164] In several modalities, in addition to the above, the staple cartridge channel 1122 and / or the staple cartridge 1150, for example, can include one or more projections and / or cooperative recesses, for example, that can be configured to removably retain staple cartridge 1150 within staple cartridge channel 1122. Once staple cartridge 1150 has been inserted into staple cartridge channel 1122, in various embodiments, the first portion of cable 1102 can be installed on the second portion of the cable 1104. In several other embodiments, the staple cartridge can be inserted into the staple cartridge channel after the first and second portions of the cable have been assembled together. In any case, referring to figures 34 to 41, the first portion of the cable 1102 and the second portion of the cable 1104 can include the proximal ends 1103 and 1105, respectively, which can be assembled together so that the first and second portions of the cable can be swiveled or pivoted to each other. In various embodiments, referring to figures 35 and 36, the first portion of cable 1102 may include one or more pins, or projections, 1111 extending therefrom, which can be configured to be received by sliding within a or more grooves, channels, or slots 1115 in the second portion of cable 1104. In certain embodiments, slots 1115 can be defined in the second cable structure 1114 and projections 1111 can extend from a proximal end column 1107 extending if from the first structure of the cable 1110, for example. In order to assemble the first portion of the cable 1102 and the second portion of the cable 1104, with reference to figure 37, the open ends of the slits 1115 can be aligned with the projections 1111 so that the second portion of the cable 1104, for example, can be moved in relation to the first portion of the cable 1102 and the projections 1111 can be slid into the slots 1115. In at least one embodiment, as shown in figures 35 and 36, the open ends of the slits 1115 can be located proximally to their closed ends. In at least one such embodiment, the proximal end 1105 of the second portion of the cable 1104 can be positioned distally with respect to the proximal end 1103 of the first portion of the cable 1102 so that the second portion of the cable 1104 can be moved proximally so that position the projections 1111 inside the slits 1115. In several other circumstances, the first portion of the cable 1102 can be positioned proximally to the second portion of the cable 1104 and slide in a distal position to position the projections 1111 inside the slits 1115.
[0165] [000165] In various embodiments, with reference to figure 38, the second portion of the cable 1104 can be rotated towards the first portion of the cable 1102 so that the anvil 1130 can be placed in relation to the staple cartridge 1150 and / or to the staple cartridge channel 1122. In certain embodiments, the first portion of the cable 1102 can be rotated towards the second portion of the cable 1104 and / or the first and second portions of the cable can be rotated towards each other. In any case, the projections 1111 and the slits 1115, when engaged with each other, can comprise a pivot around which one or both of the first and the second portions of the cable can be moved in relation to the other. In various embodiments, the second portion of the handle 1104 can be moved relative to the first portion of the handle 1102 so that the anvil 1130 is placed in opposition close to the staple cartridge 1150. In certain embodiments, with reference to figure 39, the second portion of the cable 1104 can be moved relative to the first portion of the cable 1102 so that the lock projections 1131 extending from the second portion of the cable 1104 can be aligned with and / or inserted into the recesses 1127 within the first portion of the cable 1102 In various embodiments, with reference mainly to figures 35 and 36, the first portion of the cable 1102 may also include a locking mechanism 1180 swiveled to it, which can be used to engage the locking projections 1131 that extend to from the second portion of the cable 1104 and secure the first and second portions of the cable together. Although not illustrated, other modalities are intended, in which a locking mechanism is pivotally mounted to the second cable portion and lock projections can extend from the first cable portion. In any case, in at least one embodiment, the locking mechanism 1180 can be mounted on the first frame 1110 by one or more pivot pins 1182 which can be configured to define an axis around which the lock 1180 can be rotated.
[0166] [000166] In certain embodiments, now with reference to figures 37 and 38, the lock mechanism 1180 may include the lock structure 1184 and, in addition, the lock cover 1186 mounted on the lock structure 1184. In several other embodiments, the lock cover and the lock structure may comprise an integral unit or, in certain embodiments, the lock mechanism may not even include a cover. In certain embodiments, the latch structure 1184 may be channel-shaped and may include a pair of elongated opposing side walls 1185 that are separated by a distance sufficient to cover the first portion of structure 1110. In at least one embodiment, the cover of the lock 1186 can be made of plastic and lightweight materials and / or any other suitable material, for example, while the structure of lock 1184 can be made of stainless steel and / or any other suitable material, for example. In certain embodiments, when the locking mechanism 1180 is closed, as shown in figure 40, the locking cap 1186 can be aligned with the first cap of the cable 1108. The locking cap 1186 can include a curved portion 1187 which can be configured to assist a surgeon in handling the surgical instrument 1100, in which at least one curved portion 1187 can be aligned with, or at least substantially aligned with, the protrusion 1109 extending from the first cap of the cable 1108 The locking mechanism 1180 may further include one or more locking arms 1188 extending from it, which can be configured to engage one or more locking projections 1131 extending from the second portion of cable 104 and pulling and / or attach the projections 1131 inside the recesses 1127, as shown in figure 40. In at least one embodiment, at least one of the locking arms 1188 can be formed integrally with the latch structure 1184. In certain embodiments, with reference to figure 39, at least one of the locking arms 1188 can include a distal hook 1189 that can be configured to wrap around at least a portion of the projections 1131 so as to encompass or circling, or at least partially encompassing and circling, the projections 1131. In at least one embodiment, the locking arms 1188 can act as an upper central lock to hold the lock mechanism 1180 in its locked or closed position.
[0167] [000167] In use, in various circumstances, the first portion of the cable 1102 or the second portion of the cable 1104 can be positioned on a first side of tissue within a surgical site and the other portion of the cable can be rotated to position itself from the opposite side of the fabric. In such embodiments, the staple cartridge 1150 can be positioned on one side of the fabric and the anvil 1130 can be positioned on the other side of the fabric. Subsequently, as also described above, the locking mechanism 1180 can be activated so that it can be moved between an open position and a closed position in order to lock the second portion of cable 1104 with the first portion of cable 1102 and apply a force for fixing to the fabric positioned between the staple cartridge 1150 and the anvil 1130. In certain circumstances, the locking mechanism 1180 can be moved between an open position (figure 38), a partially closed or intermediate position (figure 39) and a second position (figure 40). In at least one such embodiment, referring to figures 38 and 39, the locking mechanism 1180 can be moved between an open position in which the locking arms 1188 are not engaged with the projections 1131 and a partially closed position in which the locking arms 1188 are engaged with the projections 1131 so that, although the anvil 1130 has been at least partially placed in opposition to the staple cartridge 1150, a sufficient gap can remain between the anvil 1130 and the staple cartridge 1150 that can allow the end effector 1120 is repositioned in relation to the tissue, for example. Once the anvil 1130 and the staple cartridge 1150 have been sufficiently positioned in relation to the fabric, the locking mechanism 1180 can be moved between its partially closed position and a closed position, as shown in figure 40.
[0168] [000168] In several embodiments, in addition to the above, a surgical stapling instrument may also include an induction element that can be configured to induce the first portion of the stapling instrument in the opposite direction of a second portion of the cable. In at least one embodiment, as described in more detail below, a spring and / or any suitably resilient material can be positioned between the first and second portions of the cable so that the anvil and the staple cartridge of the stapling instrument can be removed from each other. In certain embodiments, the spring can be configured to at least partially separate the first and second portions of the cable, so that there is a gap between the anvil and the staple cartridge, the gap may be sufficient to allow the fabric be positioned between them. In use, a surgeon can position such a surgical stapling instrument without having to separate and secure the first and second portions of the cable separately from one another. Such an instrument can be especially useful when the stapling instrument is in a partially closed configuration and the surgeon is manipulating the instrument within a surgical site. After the surgeon is satisfied with the placement of the stapling instrument, he can compress and / or disengage the spring and place the stapling instrument in a closed configuration.
[0169] [000169] In various circumstances, as described above, the distal end of the first portion of the cable 1102 can be moved relative to the distal end of the second portion of the cable 1104, specifically when the locking mechanism 1180 is not engaged, or is engaged only partially, with projections 1131 of the second portion of cable 1104. In these circumstances, projections 1111 and slots 1115 at the proximal ends of the first and second portions of the cable can be configured to retain at least the proximal ends of the first and second portions of the cable. cable together when the distal ends of the first and second portions of the cable are being moved relative to each other, for example. In other words, projections 1111 and slots 1115 can cooperate to prevent, or at least inhibit, that the first portion of cable 1102 comes off completely from the second portion of cable 1104. In certain embodiments, a first portion of cable may include a the first latch portion and a second lug portion can include a second latch portion, wherein the first and second latch portions can be configured to be engaged with each other and prevent the first lug portion from loosening completely from the second cable portion. In at least one embodiment, the projections 1111 may comprise the first lock portion and the slits 1115 may comprise the second lock portion. Previous stapling instruments lacked these locking portions and, instead, relied on a single locking mechanism to hold the first and second portions of the cable together. In circumstances in which the locking mechanisms of these earlier stapling instruments were not fully engaged with the first and second portions of the cable, the first and second portions of the cable could detach completely from each other, thus requiring, for example, that a surgeon to reposition and reassemble the cable portions. In certain circumstances, a complete detachment of the first and second cable portions of these previous clips could expose at least a portion of a cutting element.
[0170] [000170] In several modalities, as described above, the locking mechanism 1180 can be configured to be moved between an open position, a partially closed position, and a closed position. When the locking mechanism 1180 is in its open position, as also described above, projections 1111 can be inserted and / or removed from the slots 1115. When the locking mechanism 1180 is in its partially closed position, with reference to figure 39, the locking arms 1188 can be configured to engage locking projections 1131 so that these projections 1111 cannot be removed from slots 1115. In at least one embodiment, locking arms 1188 and locking projections 1131 can be configured to prevent , or at least inhibit that the second portion of the cable 1104 is moved distally with respect to the first portion of the cable 1102 and, as a result, prevent, or at least inhibit, that the projections 1111 are disengaged from the slits 1115. corresponding locking arms 1188 and locking projections 1131 can be configured to prevent the first portion of cable 1102 from being moved proximally to the second portion cable 1104. Similar to the above, in various modalities, the locking arms 1188 and locking projections 1131 can also be configured to prevent, or at least inhibit, that the projections 1111 are removed from the slits 1115 when the mechanism lock lever 1180 is in its closed position (figure 40). In certain embodiments, in addition to the above, lock projections 1131 may extend from the second portion of cable 1104 to a location between its proximal and distal ends. In at least one such embodiment, projections 1111 and slots 1115 can be configured to secure the first and second portions of the cable together at their proximal ends, while the locking mechanism 1180 can be used to secure the first and second portions cable together in an intermediate location. In any case, in certain embodiments, the first and second portions of the cable cannot be disengaged from each other unless the locking mechanism 1180 is moved to its fully open position. In at least one such embodiment, the projections 1111 and the slots 1115 cannot be disengaged from each other when the locking mechanism 1180 is in a closed and / or partially closed position.
[0171] [000171] When the anvil 1130 and the staple cartridge 1150 are sufficiently positioned, the fabric positioned between the anvil 1130 and the staple cartridge 1150 can be stapled and / or cut. In various embodiments, with reference to figure 36, the surgical stapling instrument 1100 may further include a propeller bar assembly 1200 that can be configured to advance and / or retract the staple sled assembly 1160 into the staple cartridge 1150, for example. example. In at least one embodiment, the drive bar assembly 1200 can include drive bar 1202 and clamp discharge actuator 1204, with clamp discharge actuator 1204 being configured to move drive bar 1202 and sled assembly of staples 1160 in the distal position to dispense the staples from the staple cartridge 1150 and deform the staples against the anvil 1130, as described above. In at least one embodiment, referring to figures 44 and 45, the staple sled 1162 can include a groove, channel, or slot 1161 that can be configured to receive, and can be functionally connected to a distal end 1201 ( figure 36) of the drive bar 1202. In certain embodiments, the staple sled assembly 1160 can be functionally engaged with the drive bar 1202 when the staple cartridge 1150 is inserted into the staple cartridge channel 1122. In at least one embodiment, the distal end 1201 and the slot 1161 can include cooperating elements that can allow the distal end 1201 and the slot 1161 to be mounted in a transverse direction, but prevent or at least inhibit the distal end 1201 and the slot 1161 from being disassembled one the other in a proximal and / or distal direction. In other embodiments, the drive rod 1202 can be moved in a distal position before contacting and engaging the 1160 clamp sled assembly. In at least one embodiment, the 1160 clamp sled assembly may remain stationary until the propeller bar 1202 contact him. In any case, as described above, the actuator 1204 can be functionally connected to the propeller bar 1202 so that a thrust and / or traction force can be applied to the actuator 1204 and transmitted to the propeller bar 1202. In certain embodiments, as described in more detail below, actuator 1204 can be pivotally connected to a proximal end 1203 of drive bar 1202 so that actuator 1204 can be selectively rotated between at least the first and second positions.
[0172] [000172] In addition to the above, referring to figures 34, 46 and 47, the actuator 1204 can be movable between a first position on a first side 1116 of the surgical stapling instrument 1100 (figure 46), a second position on a second side 1117 (figure 47), and an intermediate position (figure 34) located at the proximal ends 1103 and 1105 of the first and second cable portions 1102 and 1104. When the actuator 1204 has been rotated to the position on the first or second sides 1116, 1117, actuator 1204 can be moved in a distal position. In various circumstances, as a result, a surgeon may select whether to move the 1204 actuator in a distal position along the first side 1116 or the second side 1117. Such circumstances may arise when the 1204 actuator is more likely to collide with the surrounding tissue. the surgical site, for example, when the 1204 actuator is moved distally along one side of the surgical instrument compared to the other. In various embodiments, referring to figures 35 and 36, the actuator 1204 can include an arm 1206 extending from it and the arm 1206 can be installed pivotally to the proximal end 1203 of the propeller bar 1202. In certain embodiments, again referencing to figures 34, 46 and 47, surgical instrument 1100 may include a first slot (not shown) extending along the first side 1116 and a second slot 1118 extending along the second side 1117, the first and the second slots can be configured to slide at least a portion of the actuator 1204. In at least one embodiment, the side walls of the first and second slits can delimit or at least help delimit the movement of the 1204 actuator so that it can be moved along a predetermined path. With reference to figure 47, the second slot 1118, for example, can be defined between the first portion of the cable 1102 and the second portion of the cable 1104 so that when the actuator 1204 is moved distally along the second side 1117, the arm 1206 of the actuator 1204 can be slid between the first and second portions of the cable. Similar to the above, the first slot can also be defined between the first and second portions of the cable. In various modalities, with reference again to figures 46 and 47, the surgical instrument 1100 may also include an intermediate slot 1119 which can also be configured to allow the arm 1206, and / or any other suitable portion of the actuator 1204, to slide into it . In at least one such embodiment, the intermediate slot 1119 can connect the first and second slots so that, when the actuator 1204 is positioned in its intermediate position, the actuator 1204 can be moved to one of its first and second positions. In certain embodiments, the first slot, the second slot 1117, and the intermediate slot 1119 can be parallel, or at least substantially parallel to each other and / or be on the same plane, although other modalities are intended in which one or more of the slots are not are parallel to each other and / or are on a different plane. In addition, although the first and second sides of the illustrated embodiment are located on opposite sides of the 1100 surgical instrument, other embodiments are intended in which the first and second slits are located, for example, on adjacent sides and / or sides that are directly opposite each other. In addition, other modalities are considered in which the sides of a stapling instrument are not readily discernible, such as, for example, instruments that have round and / or arched portions.
[0173] [000173] In several modalities, in addition to the above, the surgical stapling instrument 1100 may also include a locking mechanism that can prevent, or at least inhibit, the actuator 1204 and, correspondingly, the sled assembly staples 1160, are moved prematurely. In at least one embodiment, the locking mechanism can be configured to prevent, or at least inhibit, that the actuator 1204 is moved in a distal position before the locking mechanism 1180 is moved to a closed position, or at least partially closed. In certain embodiments, referring generally to figure 38, the surgical stapling instrument 1100 may also include the locking mechanism 1220 which can be engaged with the actuator 1204 and can remain engaged with the actuator 1204 while the locking mechanism 1180 is in a fully open position (figure 38) and / or a position at least substantially open. In various embodiments, locking mechanism 1220 may include lock 1222 which can be pulled to engage actuator 1204 by a pulling force applied to it by locking spring 1224, for example. In at least one such embodiment, the actuator 1204 may include one or more grooves, channels, or slots (not shown) that can be configured to receive at least a portion of the lock 1222. In use, the locking mechanism 1220 can secure the actuator 1204 in position until the locking mechanism 1180 is moved to its completely closed position (figure 40) and / or a position at least substantially closed. In such circumstances, in at least one mode, the locking mechanism 1180 can be configured to engage the locking mechanism 1220 and disengage the lock 1222 from the actuator 1204. In at least one such mode, referring to figures 38 to 40, the locking mechanism 1180 may further include a cam 1183 which can be configured to engage the cam surface 1223 with locking 1222 when the locking mechanism 1180 is moved to its closed position and, as a result, sliding and / or moving away from another the lock 1222 of the actuator 1204. In various embodiments, the cam 1183 may comprise a wall, a rib, and / or a ridge extending from the lock cover 1186 and / or the lock structure 1184. In any case, once lock 1222 has been sufficiently disengaged from actuator 1204, in at least one mode, actuator 1204 can be moved from its intermediate position, shown in figure 34, to one of its first and second positions, as shown in the figures 46 and 47.
[0174] [000174] As described above, the locking mechanism 1220 can be configured to prevent, or at least inhibit, the drive bar 1202 from being moved in a distal position before the locking mechanism 1180 is moved to a predetermined position, such as, for example, a closed position and / or a partially closed position. Advantageously, the locking mechanism 1220 can also prevent, or at least inhibit, that the clamp sled assembly 1160 is displaced before the first portion of the cable 1102 and the second portion of the cable 1104 are assembled together. In fact, the locking mechanism 1220 can prevent the fabric positioned between the anvil 1130 and the staple cartridge 1150 from being cut and / or stapled before the anvil 1130 and staple cartridge 1150 are properly positioned in relation to the fabric. In addition, the locking mechanism 1220 can prevent the clips from being dispensed into the fabric before an adequate clamping force is applied to the fabric. In any case, when the locking mechanism 1180 is put back in its fully open position, and / or in a partially open position, the cam 1183 can be moved away from the lock 1222 so that the locking spring 1124 can place the lock 1222 in engagement with the 1204 actuator again. In several other embodiments, referring to figures 38 and 39, the locking mechanism 1220 'can include a lock 1222' comprising a cam surface 1223 'and, in addition, a stop 1226' which can limit the relative movement of the locks 1222 '. In at least one embodiment, the cam 1183 can be configured, for example, to contact the cam surface 1223 'and, due to the curved, chamfered and / or inclined surface of the cam surface 1223', the cam 1183 can be configured to direct latch 1222 'in a distal position, as shown in figure 49. Latch 1222' can be directed in a distal position so that pin 1228 ', which extends from latch 1222', can be moved between a first position (figure 48) in which it is positioned inside opening 1229 'in actuator 1204' and a second position (figure 49) in which pin 1228 'has been sufficiently removed from opening 1229'. In various embodiments, the stop 1226 ’can be configured so that when the lock 1222’ is directed in a distal position, the stop 1226 ’can come into contact with the cam 1183 when the lock 1222’ has been sufficiently displaced. In such embodiments, the stop 1226 ’can be configured to control the second position, or offset position, of the latch 1222’. Similar to the above, when the actuator 1180 is removed from its closed position and the cam 1183 is disengaged from the locking mechanism 1220 ', the locking spring 1224' can put the lock 1222 'in engagement with the actuator 1204' again .
[0175] [000175] In various modalities, as described above, a discharge actuator can be used to move a propellant bar, a sled of clamps, and / or a cutting element between a first and a second position. As also described above, the propeller bar assembly 1200, for example, can be used to move a staple sled assembly, for example, the staple sled assembly 1160, for example, between a proximal position (figure 43 ) and a distal position. In certain embodiments, a staple cartridge, such as the staple cartridge 1150, may include a staple sled assembly 1160 contained therein, the staple sled assembly 1160 may be positioned in a proximal position, as shown in figure 43, when the staple cartridge is mounted or inserted into the staple cartridge channel 1122. In at least such an embodiment, referring to figures 41 to 43, the staple cartridge 1150 may include an additional compartment 1170 that can be configured to cover at least a portion of the cutting element 1164 when the staple sled assembly 1160 is in its proximal position, for example. In several embodiments, the 1170 compartment can be configured to protect a surgeon, for example, when handling the staple cartridge, when inserting the staple cartridge into the surgical stapler, and / or when joining two or more portions of the surgical stapler, for example . In at least one such embodiment, at least an upper portion of the cutting edge 1165 may extend above the deck or top surface 1158 of the staple cartridge 1150 and, if there is no protective compartment, such as compartment 1170, for example, the the upper portion of the cutting edge 1165 may be exposed.
[0176] [000176] In various embodiments, as described above, the cutting element 1165 can be at least partially positioned within the slot or channel 1156 and, as shown in figure 43, at least the top or top portion of the cutting element 1164 can extends above deck 1158. In at least one embodiment, referring to figures 41 to 43, compartment 1170 may include a first wall, or portion, 1172 extending from a first portion 1157 of the cartridge body staples 1152, a second wall, or portion, 1174 extending from a second portion 1159 of the staple cartridge body 1152, and a wall or top portion 1176 extending between the first wall 1172 and the second wall 1174 In certain embodiments, a compartment additionally comprises only a support wall, or support portion, extending from a staple cartridge body and, in addition, a top wall or upper portion extending from the same. In other embodiments, a compartment further comprises one or more side walls or portions and no top wall. In at least such an embodiment, the side walls of the compartment can be configured to extend above the upper face of the cutting element, or to extend at least above a cutting edge of the cutting element, for example. In any case, as shown in figure 43, at least a portion of the cutting element 1164 can be positioned under the upper wall 1176 and / or between the side walls 1172 and 1174 when the staple sled assembly 1160 is in its proximal position . In certain embodiments, the cutting element 1164 can be completely positioned under the upper wall 1176 and / or completely positioned inside the compartment 1170. In at least one embodiment, the cutting element 1164 can be positioned under the upper wall 1176 for the surface cutting edge 1165 does not extend beyond the distal edge 1175 and / or the proximal edge 1177 of the upper wall 1176. In at least one embodiment, compartment 1170 may include a rear wall 1178 that can be configured to limit the proximal movement of the cutting element 1164 and / or any other portion of the staple sled assembly 1160. In various embodiments, at least a portion of compartment 1170, for example, can be integrally formed with the body of the staple cartridge 1152. In at least one such embodiment, the first wall 1172, the second wall 1174, the upper wall 1176, and / or the rear wall 1178 can be formed when the body of the staple cartridge 1152 is movable given by injection, for example. In certain embodiments, at least a portion of compartment 1170 can be installed in the body of the staple cartridge 1152 via a quick-fit arrangement, pressure-fit arrangement, and / or any other suitable manner.
[0177] [000177] In several embodiments, in addition to the above, the cutting element 1164 can be defined by a flat or at least substantially flat body, which has a knife edge extending along at least one side of the body of the cutting element. cut. In at least one such embodiment, the first wall 1172 and / or the second wall 1174 can be configured and arranged so as to include internal flat surfaces, or at least substantially flat 1173 which are parallel or at least substantially parallel to the lateral surfaces of the cutting element 1164. In certain embodiments, cutting element 1164 can be received narrowly between the internal surfaces 1173 of walls 1172 and 1174. In at least one embodiment, the distance between walls 1172 and 1174 can be equal, or at least less substantially equal to the width of the slot 1156. In any case, a compartment can be configured so that at least a portion of the compartment extends over at least a portion of the slot 1156, for example. In certain embodiments, compartment 1170 may contain or completely surround a cutting element 1164 and / or cutting surface 1165. In at least one embodiment, although not shown, a compartment may include a separating and / or cuttable portion that can be at least partially detached, separated and / or otherwise deformed in order to allow a cutting element to leave the compartment. In at least one such embodiment, the cutting surface of the fabric can be configured to contact the compartment to break and / or cut a wall of the compartment, for example. In various embodiments, the compartment wall can include a thin portion, a portion with reduced thickness, a cut mark and / or any other configuration to facilitate deformation and / or incision of the compartment wall. In certain embodiments, a cutting element can include one or more additional cutting surfaces and / or anvils, for example, which can be configured to deform and / or cut the compartment. In at least one embodiment, the compartment may include a movable and / or flexible portion, such as, for example, a hinged and / or flexible tab, which can be configured to move and / or flex sufficiently to allow the cut pass. In any case, modalities are contemplated in which the cutting element can have any appropriate configuration for cutting the fabric and the protective compartment can have any suitable configuration for enclosing or at least partially surrounding the cutting element. In addition, although a cutting element may comprise a sharp edge, as described above, other suitable cutting elements are contemplated, such as, for example, those that have sufficient electrical current to dissect tissue, for example.
[0178] [000178] As described above, compartment 1170 can be configured to cover, contain and / or surround a cutting element when it is in its proximal position. In various embodiments, the cutting element can be moved in a distal position to cut the fabric, for example, and then retracted proximally so as to position the cutting element again within the 1170 compartment. In such modalities, the cutting element can be at least partially covered by compartment 1170 when the staple cartridge is installed and removed from a surgical stapling instrument. In certain embodiments, a new or unused staple cartridge can be inserted into the staple cartridge channel to replace the at least partially used staple cartridge. In at least one such embodiment, the new staple cartridge may include a new cutting element and / or assembly of the staple sled positioned therein, although modalities are contemplated in which cutting element and / or staple sled assembly previously used it can be sufficiently removed from the worn staple cartridge and moved into the new staple cartridge to be reused. In embodiments in which a new cutting element and / or staple sled assembly is provided with a new staple cartridge, a sharp cutting edge, for example, can be used with each staple cartridge.
[0179] [000179] In various embodiments, although not illustrated, a staple cartridge can include two or more compartments configured to cover at least partially a cutting element when it is in two or more positions. In at least one embodiment, a staple cartridge may include a proximal compartment configured to cover at least partially the cutting element when it is in a proximal position, for example, and, in addition, a distal compartment configured to cover at least partially the cutting element when it is in a distal position, for example. In at least such an embodiment, the cutting element can be positioned inside the proximal compartment when the staple cartridge is installed in a surgical stapling instrument and, in certain embodiments, the cutting element can be moved into the distal compartment after having the tissue positioned inside the end effector was transected, for example. In such embodiments, as a result, the cutting element can be at least partially positioned within the distal compartment when the staple cartridge is removed from the surgical stapler. Such modalities can be particularly useful when a container, for example, is positioned between the proximal compartment and the distal compartment of the staple cartridge. In various embodiments, although not shown, a cutting element can be moved proximally from a distal position to a proximal position, and / or any other suitable position.
[0180] [000180] In various embodiments, as discussed above, a staple cartridge 1150 can be inserted into a staple cartridge channel 1122. Referring now to figure 92, a proximal end 1213 of staple cartridge 1150 can be positioned within a proximal end 1123 of staple cartridge channel 1122 while a distal end 1211 of staple cartridge 1150 can be positioned within a distal end 1121 of staple cartridge channel 1122. In at least one embodiment, distal end 1121 of the staple channel staple cartridge 1122 may comprise one or more projections and / or one or more recesses which can be aligned correspondingly with one or more projections and / or one or more recesses at the distal end 1211 of staple cartridge 1150, for example. In at least such an embodiment, each side wall 1124 of the staple cartridge channel 1122 may comprise a projection, or tab, 1279 and a recess, or slot, 1278, with each side of the staple cartridge 1150 comprising, with reference to 95, a projection 1274 configured to be positioned within a recess 1278 and, in addition, a recess 1270 configured to receive a projection 1279. In various embodiments, each recess 1270 of the staple cartridge 1150 may comprise opposite side walls 1272 and 1273 and a distal surface 1271, the distal surface 1271 being able to be positioned against the projection 1279 positioned therein when staple cartridge 1150 is positioned in staple cartridge channel 1122. In various circumstances, as discussed in more detail below, distal surfaces 1271 of recesses 1270 can serve as a interface surface from which various characteristics of the staple cartridge 11 50 can be predetermined. In some circumstances, the distal end 1211 of the staple cartridge 1150 may be aligned with and / or inserted into the distal end 1121 of the staple cartridge channel 1122 before the proximal end 1213 of the staple cartridge 1150 is inserted into the proximal end 1123 of the channel of staple cartridge 1122. For example, the distal end 1211 of staple cartridge channel 1150 can be aligned with the staple cartridge channel 1122 so that projections 1279 are positioned within recesses 1270 with the staples 1150 can be moved from side to side, or rotated, towards staple cartridge channel 1122 so that the proximal end 1213 of staple cartridge 1150 is inserted into end 1123 of staple cartridge channel 1122.
[0181] [000181] When the distal end 1211 of the staple cartridge 1150 is engaged with the distal end 1121 of the staple cartridge channel 1122, as described above, the projections 1274 of the staple cartridge 1150 can be inserted into the recesses 1279 of the cartridge channel staples 1122 by hooking the projections 1274 below the projections 1278 of the staple cartridge channel 1122. In these circumstances, the cooperation of the projections 1274 and 1278 and recesses 1270 and 1279 can secure the distal end 1211 of the staple cartridge 1150 with the distal end of the cartridge staple cartridge 1122, and in addition, align the staple cartridge 1150 with the staple cartridge channel 1122 so that staple cartridge 1150 can be inserted between the side walls 1124 of the staple cartridge channel 1122. Since the distal end 1211 of the staple cartridge 1150 has been hooked into the staple cartridge channel 1122, at least one of the hook cartridge 1150 and the channel of the cartridge clamp floor 1122 can be rotated towards each other. In various circumstances, with reference again to figures 92 and 95, the staple cartridge 1150 can be pivoted towards the staple cartridge channel 1122 so that the alignment slots 1280 in the staple cartridge channel 1150 become aligned with the side flanges 1128. In various embodiments, the staple cartridge 1150 can comprise 1280 alignment slits on opposite sides of it which can each be configured to receive a side flange 1128. In at least one embodiment, each 1280 alignment slot can comprise side walls 1283 and 1284 and a base wall 1281 extending between side walls 1283 and 1284. In addition to the above, a predetermined distance 1289 can be measured between the distal relation surfaces 1271 of the recesses 1270 to the base walls distal 1281 from alignment slits 1280. Referring now to figures 93 and 95, the predetermined distance 1288 between the distal end of the projections s 1279 and the distal end of the side flanges 1128 may be shorter than the distance 1289 between the distal surfaces 1271 of the recesses 1270 and the base walls 1281 of the alignment slits 1280. Because the distance 1288 is shorter than the distance 1289, the staple cartridge 1150 can be rotated to a position as described above so that flanges 1128 can enter alignment slits 1280. In various embodiments, alignment slits 1280 can be sized and configured so that side flanges 1128 are received narrowly between the side walls 1283 and 1284 so that there is little, if any, relative movement between the side flanges 1128 and the side walls of the alignment slits 1280, for example.
[0182] [000182] In several alternative embodiments, in addition to the above, the proximal end 1213 of the staple cartridge 1150 can be inserted into the distal end 1121 of the staple cartridge channel 1122 and slid proximally between the side walls 1124, so that the proximal end 1213 of the staple cartridge groove 1150 enters the proximal end 1123 of the staple cartridge groove 1122. During the alignment movement, the side flanges 1128 can come into alignment with the slits 1280 and, in addition, the projections 1279 they can enter recesses 1270. In certain embodiments, the staple cartridge 1150 can be either slid or rotated in the staple cartridge channel 1122. In any case, in various embodiments, the staple cartridge 1150 and the staple cartridge channel 1122 can be configured so that the staple cartridge 1150 can be removably attached within the staple cartridge channel 1122. In at least one way now referring mainly to figures 95 and 100, the staple cartridge 1150 may comprise one or more retaining characteristics that can be configured to releasably engage one or more retaining characteristics in the staple cartridge channel 1122. More particularly , in at least one of such an embodiment, the staple cartridge 1150 may comprise one or more retaining slots 1190 which can be configured to engage one or more retaining keys 1195 in the staple cartridge channel 1122. In various embodiments, again with Referring to Fig. 95, each retaining slot 1190 may comprise a first portion, or inlet portion 1191, that can be configured to receive a retaining key 1195 therein and, in addition, a second portion 1192 that can be configured to receive the retention key 1195 after it has passed through the input portion 1191. The input portion 1191, in certain embodiments, can define a first width between a proximal side 1193 and a distal side 1194 of the retention slot 1190 and, in addition, the second portion 1192 can define a second width between the proximal side 1193 and the distal side 1194 that is wider than the first width of the portion inlet 1191. In various embodiments, the first width of the inlet portion 1191 may be narrower than the width of the holding key 1195 and the second width of the second portion 1192 may be wider than the width of the holding key 1195. In in at least such an embodiment, a retention slot 1190 can be configured to engage a retention switch 1195 in at least one of a pressure adjustment and / or a locking adjustment. In certain embodiments, at least one on the proximal side 1193 and / or the distal side 1194 can be configured to flex or tilt externally as the retention key 1195 is inserted into the retention slot 1190. At least as much modality, the proximal sides 1193 can be moved proximally. In any case, with reference to figure 100, once the retention slot 1190 has received the retention key 1195, the proximal side 1193 of the retention slot 1190 can be positioned on a proximal side 1196 of the retention key 1195 and the distal side 1194 of retaining slot 1190 can be positioned on a distal side 1197 of retaining key 1195.
[0183] [000183] As highlighted above, staple cartridge 1150 can be mounted on staple cartridge channel 1122 by coupling distal end 1211 of staple cartridge 1150 and distal end 1121 of staple cartridge channel 1122 and then rotating the end proximal 1213 of the staple cartridge 1150 at the proximal end 1123 of the staple cartridge channel 1122. In at least such an embodiment, the retaining slots 1190 can be configured to engage the retaining keys 1195 as the staple cartridge 1195 is rotated in its seated position within the staple cartridge channel 1122. Now with reference to figure 93, a predetermined distance 1199 between the distal relation surfaces 1271 of the recesses 1270 and the retaining slots 1190 can be dimensioned and configured so that the slots holders 1190 are aligned with the holders 1195 as the staple cartridge 1150 is rotated to the position described above. Correspondingly, in at least one embodiment, a distance between the distal ends of the projections 1279 and retaining keys 1195 can be such that it is equal to, or at least substantially equal to, the distance 1199. In various circumstances, the distances mentioned above can be measured towards the center of the features comprising slots 1190 and retaining keys 1195. For example, distance 1199 can be measured towards the center of slot 1190 in an intermediate way to the proximal and distal side walls thereof, for example . In various embodiments, the retaining slot 1190 can additionally comprise insertion, chamfered, and / or radiated surfaces, which can be configured to guide, or direct, the retaining keys 1195 in the retaining slots 1190. In at least such an embodiment, these insertion surfaces may be wider than the first 1191 portions.
[0184] [000184] A staple cartridge 1150 is rotated towards the staple cartridge 1122, and a staple cutting and / or sling element positioned inside the staple cartridge 1150 can be operably engaged with the drive bar 1202. More particularly, now with reference to figures 97 to 99, the staple cartridge 1150 can include a cutting element 1160 that can be functionally coupled with the drive bar 1202 so that, after the staple cartridge 1150 has settled within the staple cartridge channel 1122, drive bar 1202 and cutting element 1160 can be advanced together as described above. In at least one embodiment, the cutting element 1160 may comprise a slot 1161 that can be configured to receive a distal pusher projection 1294 (figure 93) at the distal end of the propeller bar 1202. More particularly, now with reference to figure 101, the slot 1161 of the cutting element 1160 can be aligned with an access slot 1290 at the bottom of the staple cartridge 1150 so that when the proximal end 1213 of the staple cartridge 1150 is seated at the proximal end 1123 of the staple cartridge channel 1122 , the drive projection 1294 of the drive bar 1200 can extend through the access slot 1290 in the slot 1161 of the cutting element 1160. In various embodiments, the slot 1161 and the drive projection 1294 can be sized and configured so that there is little, or none, relative movement between them. More particularly, now with reference to figures 98 and 99, the slit 1161 can comprise a distal side wall 1291 and a proximal side wall 1292 with the driving projection 1294 being securely received between the side walls 1291 and 1292. In various embodiments , now with reference to figures 93 and 101, the drive bar 1202 can additionally comprise a recess, or slot, 1295 positioned proximally to the drive projection 1294 and slot 1295 can be configured to receive a proximal projection 1293 (figure 97) extending from the cutting element 1160. Similar to the above, the slit 1295 can be defined by side walls that can be configured to intimately receive the proximal projection 1293 so that there is little, if any, movement relative between them.
[0185] [000185] As described above, the slot 1161 of the cutting element 1160 can be positioned inside the staple cartridge 1150 so that it is aligned with the pusher projection 1294 of the drive bar 1202 when the staple cartridge 1150 is seated inside the channel of staple cartridge 1122. Now with reference to figure 96, a predetermined distance 1299 can be defined between the distal surfaces 1271 of the recess 1270 and the slot 1161, the distance 1299 being equal to, or at least substantially equal to, a predetermined distance 1297 between the distal end of the projections 1279 and the driving projection 1294. In various circumstances, the cutting element 1160 can be moved through a range of positions between the most proximal position, where it is positioned in compartment 1170, and a more distal position, after it has been advanced through the cutting slot 1156. In several modalities, the distance 1299 can be measured in relation to the cutting element 1160 when it is in its most proximal position. Similar to the above, the distances 1297 and 1299 can be measured for the center or midpoint of the booster projection 1297 and slit 1161, respectively. In various embodiments, the surgical instrument 1100 may additionally comprise a locking mechanism that can be configured to secure the drive bar 1202 in position while the cutting element 1160 is engaged with the pusher projection 1294. Similar to the above, in certain embodiments , a distance 1298 can be defined between the distal end of the projections 1279 and the recess 1295 of the propellant bar 1202, the distance 1298 being equal to, or substantially equal to, the distance between the distal surface 1271 of the recesses 1270 and the projection 1293 of the cutting element 1160. In various embodiments, now mainly with reference to figures 97 and 100, the staple cartridge 1150 can comprise a defined gap region between the proximal end 1295 of the staple cartridge body 1152 and the proximal end 1294 of the staple cartridge reservoir 1154, this gap region can be configured to receive the bar drive 1202 and / or a portion of the staple cartridge channel 1122 therein, for example. In any case, the propeller bar 1202 can be advanced distally once it has been engaged with the cutting element 1160, this movement is shown in figure 100 which illustrates the distal end 1201 of the propeller bar 1202 in a proximal position (illustrated with solid lines) and a second, distal position (illustrated in dashed lines), for example.
[0186] [000186] In various embodiments, as described above, the distal end 1211 of the staple cartridge 1150 can be engaged with the distal end 1121 of the staple cartridge channel 1122 and then pivoted towards the staple cartridge channel 1122 so that the proximal end 1213 of staple cartridge 1150 can be seated at proximal end 1123 of staple cartridge channel 1122. This process may comprise engaging projections 1274 of staple cartridge 1150 below projections 1276 of staple cartridge channel 1122 and then, as described above, rotate the staple cartridge 1150 until the alignment slots 1280 are positioned adjacent to the flanges 1182. At this point, in various embodiments, the cutting element 1160 may not be engaged with the drive bar 1202 and, in addition, the 1190 retaining slots may not be engaged with the 1195 retaining keys. As a result, the surgeon or clinician can adjust the position of the grain cartridge samples 1150 into the staple cartridge channel 1122 before the staple cartridge 1150 is locked in position. Once the side flanges 1182 have been positioned at least partially in the alignment slots 1280, the proximal end 1213 can be further rotated towards the staple cartridge channel 1122. At this point, the cutting element 1160 can enter into functional engagement with the drive bar 1202 and, in addition, the retaining slots 1190 can engage the retaining keys 1195. In various embodiments, the cutting element 1160 can functionally engage the drive bar 1202 at the same time, or at least substantially to the at the same time, that the retaining slots engage the retaining keys 1195. More particularly, in at least one embodiment, the pusher projection 1294 of the drive bar 1202 can enter the slot 1161 of the cutting element 1160 at the same time as the retention 1195 enter, or fit by pressure, into the second portions 1192 of the slots 1190. In at least such an embodiment, the cutting element 1160 may not be displaced drive by the drive bar 1202 until the staple cartridge 1150 is closed by pressure, or seated, in place. In certain alternative embodiments, the cutting element 1160 can be functionally engaged with the drive bar 1202 before the retaining keys 1195 are fully seated within the retaining slots 1190 when the proximal end 1213 of the staple cartridge 1150 is seated on the proximal end 1123 of the staple cartridge channel 1122. In various embodiments, the retaining slots 1190 can be aligned with each other so that they engage the retaining keys 1195 at the same time, or at least substantially at the same time. In at least such an embodiment, the retaining slots can be configured so that the retaining keys 1195 enter the second portions 1192 of the retaining slits 1190 simultaneously. In at least one embodiment, the retaining slits 1190 can be positioned along an axis that is transverse or perpendicular to a longitudinal axis defined by the cutting slot 1156. In various embodiments, the retaining slits 1190, and the axis defined between they can be positioned proximally to the cutting element 1160, regardless of the position of the cutting element 1160, even when the cutting element 1160 is in its most proximal position, for example.
[0187] [000187] In various embodiments, the cutting slot 1156 can define a first portion of the body 1152a on a first side of it and a second portion of body 1152b on a second side, or opposite side of it. Referring to figures 95 and 98, the first body portion 1152a can comprise a first plurality of clip cavities 1151 and, in addition, the second body portion 1152b can comprise a second plurality of clip cavities 1151. In at least one In this embodiment, the first body portion 1152a can comprise a more proximal staple cavity 1151a that can be positioned proximally to the other staple cavities 1151 in the first body portion 1152a. In at least one embodiment, the entire staple cavity 1151a can be positioned proximal to the base wall 1281 of alignment slot 1280 in the first body portion 1152a, while in other embodiments, at least a portion of the cavity staple 1151a can be positioned proximal to the base wall 1281. As shown in figure 97, the alignment slot 1280 in the first body portion 1152a is positioned laterally in relation to the most proximal staple cavity 1151a and furthermore , laterally in relation to the cutting slot 1156. In addition to the above, the first body portion 1152a may comprise a second, more proximal staple cavity 1151c that can be positioned proximally to the other staple cavities 1151 in the first portion of body 1152a except for the most proximal staple cavity 1151a. In at least one embodiment, the entire staple cavity 1151c can be positioned proximal to the base wall 1281 of alignment slot 1280 in the first body portion 1152a, while in other embodiments, at least a portion of the cavity clamp 1151c can be positioned proximal to the base wall 1281. As shown in figure 97, the alignment slot 1280 in the first body portion 1152a is positioned at least partially laterally in relation to the second most proximal clamp cavity 1151c . Still referring to figure 97, the first body portion 1152a can comprise a retention slot 1190 therein which can be positioned proximally to the staple cavities 1151 therein, including the staple cavities 151a and 1151c, for example .
[0188] [000188] Referring to figure 95, in addition to the above, the second body portion 1152b may comprise a more proximal staple cavity 1151b which can be positioned proximally to the other staple cavities 1151 in the second body portion 1152b . In at least one embodiment, the entire staple cavity 1151b can be positioned proximal to the base wall 1281 of alignment slot 1280 in the second body portion 1152b, while, in other embodiments, at least a portion of the cavity clamp 1151b can be positioned proximally to the base wall 1281. As shown in figure 95, the alignment slot 1280 in the second body portion 1152b is positioned laterally in relation to the most proximal clamp cavity 1151b and the section 1156. In addition to the above, the second body portion 1152b may comprise a second, more proximal staple cavity 1151d which may be proximally positioned with respect to the other staple cavities 1151 in the second body portion 1152b except for the most proximal clamp 1151b. In at least one embodiment, the entire staple cavity 1151d can be positioned proximal to the base wall 1281 of alignment slot 1280 in the second body portion 1152b, while, in other embodiments, at least a portion of the cavity clamp 1151d can be positioned proximal to the base wall 1281. As shown in figure 95, the alignment slot 1280 in the second body portion 1152b is positioned at least partially laterally in relation to the second clamp cavity 1151d more proximal . Still referring to figure 95, the second body portion 1152b may comprise a retention slot 1190 therein, which can be positioned proximally to the staple cavities 1151 therein, including the staple cavities 1151b and 1151d, for example example.
[0189] [000189] In various embodiments, in addition to the above, the body of the 1152 staple cartridge can be comprised of plastic and can be formed using an injection molding process. Consequently, in various embodiments, the clip boosters 1168 (figure 42) can be mounted in clip cavities 1151 and the cutting element 1160 can be positioned within the body of the cartridge 1152 so that the cutting element 1164 is located within the compartment 1170, as described above. The staple cartridge reservoir 1154 can then be mounted on the staple cartridge body 1152. In various embodiments, with reference now to Figure 96, the distal end 1277 of the staple cartridge reservoir 1154 can be aligned with the proximal end 1295 of the staple cartridge body 1152, so that the staple cartridge body can be slid into the staple cartridge reservoir 1154 between opposite walls 1154a and 1154b, for example. The body of the staple cartridge 1152 and the reservoir 1154 can be slid in relation to each other until the projections of the reservoir 1276 are positioned within the recesses 1270 and the projections 1274 are positioned within the recesses of the reservoir 1275. At the same time, the projections latches 1288 extending from the staple cartridge body 1152 can be received into the latch openings 1287 in the staple cartridge reservoir 1154, so that the reservoir 1154 can be locked into the body of the staple cartridge 1152. In In various embodiments, the side walls 1154a and 1154b of reservoir 1154 can flex or tilt outward as they pass over the lock projections 1288 and then resiliently return inward when the lock openings 1287 are aligned with the lock projections 1288 At this point, the arms 1155 extending from the reservoir 1154 can be aligned and positioned within the retaining slots section 1287 in the body of the staple cartridge 1152. In certain embodiments, now with reference to figure 101, the staple cartridge 1150 may additionally comprise a retaining element, such as a retaining element 1300, for example, which can be configured to clog selectively the slot 1301 in the body of the staple cartridge 1152, for example. In at least one embodiment, the retaining element 1300 may comprise a pivoting arm 1303 that can be rotated between a first position in which it extends beyond the slot 1301 (shown in continuous lines) and a second position in which it is positioned adjacent to slot 1301 (shown in broken lines). In at least such an embodiment, an integral pivot pin 1302 (figure 95) can extend from arm 1303 into an opening in the body of staple cartridge 1152, which can define an axis around which arm 1303 can be rotated. In certain embodiments, the arm 1303 may include a lock element 1304 extending therefrom, which can be configured to be releasably engaged with a lock cavity 1305 in the body of the staple cartridge 1152 to hold the arm 1303 in at least one of your first and second positions, for example. In certain embodiments, positioning the arm 1303 beyond the slot 1301 can prevent, or at least inhibit, the cutting element 1160, for example, from sliding out of the staple cartridge 1150.
[0190] [000190] To facilitate the insertion and removal of the staple cartridge 1150 from the staple cartridge channel 1122, in various embodiments, the staple cartridge 1150 may comprise gripping portions positioned on opposite sides thereof, for example. In at least one embodiment, now with reference to figures 97 and 101, the staple cartridge body 1152 may comprise side portions 1285 positioned adjacent to alignment slits 1280, the side portions 1285 being able to be held and / or pushed by a doctor to seat the proximal end 1213 of the staple cartridge 1150 on the proximal end of the staple cartridge channel 1122, for example. This force can be applied to the top surfaces, or in contact with the fabric, of the side portions 1285 as the proximal end 1213 of the staple cartridge 1150 is rotated to the position as described above. In various embodiments, a lifting force can be applied to the side portions 1285 to lift the proximal end 1213 of the staple cartridge 1150 out of the staple cartridge channel 1122. In at least such an embodiment, with reference mainly to figure 101, each side portion 1285 can comprise one or more steps, ridges, and / or elevations, such as elevations 1287a and 1287b, and / or 1287c, for example, which can be configured to increase the physician's grip on side portions 1285. In several modalities, elevations 1287a and 1287b, and / or 1287c can be positioned at different heights in relation to each other. In any case, staple cartridge 1150 can be removed from channel 1122 by lifting the proximal end 1213 of staple cartridge 1150 out of channel 1122 and then unhooking, or disengaging, the distal end 1211 of staple cartridge 1150 from the distal end 1121 channel 1122, for example. As the staple cartridge 1150 is removed from channel 1122, the slot 1161 within the cutting element 1160 can be moved away and disengaged from the pusher projection 1294 of the drive bar 1202, for example.
[0191] [000191] In various circumstances, in addition to the above, the drive bar 1202 and the cutting element 1160 can be returned to their proximal positions before the staple cartridge 1150 is removed from the staple cartridge channel 1122. In this position, as discussed above, the cutting edge 1165 can be positioned within compartment 1170. In various embodiments, now with reference to figure 102, an alternative embodiment of a staple cartridge 1150 'is shown without an 1170 compartment. In at least one of such In this embodiment, the cutting edge 1165 may extend at least partially above the deck surface 1158 of the staple cartridge body 1152 in its proximal position and / or any other positions distally advanced, for example.
[0192] [000192] In several embodiments, in addition to the above, anvil 1130 may include one or more openings, slits, or recesses 1179 (figure 50) that can be configured to receive at least a portion of compartment 1170 when anvil 1130 is placed as opposed to the staple cartridge 1150, for example. In at least one embodiment, there may be sufficient clearance between the housing 1170 and the recess 1179 so that the anvil 1130 and the staple cartridge 1150 can be moved relative to each other without interference, or at least without substantial interference between them. In embodiments that have more than one cutting element compartment, as described above, an opposite anvil may have more than one corresponding opening to receive the compartments. In various embodiments, an anvil may include a movable cutting element and at least one compartment to cover, enclose and / or at least partially surround the cutting element. In certain embodiments, although not shown, both the anvil and the staple cartridge can comprise at least one movable cutting element and / or at least one compartment configured to cover, surround or at least partially encase the cutting elements when they are in a proximal position, for example.
[0193] [000193] As described above, the propeller bar assembly 1200 can be moved in a distal position to move the staple sled assembly 1160 within the staple cartridge assembly 1150. In various embodiments, as also described above, wedge-like cam surfaces 1167 of the staple sled 1162 can be engaged with the angled surfaces 1169 on the staple drivers 1168 to sequentially and / or simultaneously staple the staple cartridge 1150 against the anvil 1130 and form the staples in any appropriate configuration, such as B-shaped configurations, for example. In at least one such embodiment, with reference to figure 50, the anvil 1130 may include one or more staple forming surfaces, such as staple pockets 1132, for example, which can be configured to deform the staples. In certain embodiments, the anvil 1130 may also include a slot, channel, or groove 1133 which can be configured to slide at least a portion of the staple sled 1162, the cutting element 1164 and / or the drive bar 1202, for example. example. In at least one embodiment, although not shown, an anvil may include an anvil plate that can be positioned securely and / or immovably within a defined anvil channel within the anvil. In several other embodiments, as illustrated in figures 51 and 52 and described in more detail below, anvil 1130 may include anvil plate 1134 positioned movably within the anvil channel 1136. In certain embodiments, the anvil channel 1136 may include opposite side walls 1137 and, in addition, a base 1138 extending between side walls 1137. In at least one embodiment, anvil 1130 may further include a distal nose portion 1139, for example, installed thereon, the nose portion 1139 can be configured to be snap-fit and / or quickly attached to the anvil channel 1136, for example, so that the nose portion 1139 can be securely retained there. In certain embodiments, the nose portion 1139 may consist of a soft and / or malleable material, such as, for example, rubber and may comprise any suitable shape that can facilitate insertion of the anvil 1130 into a surgical site, for example. In some embodiments, with reference to figure 51, a nose portion, such as nose portion 1139 ', may be attached to an anvil by one or more fasteners 1139a'. Similarly, with reference to figure 34, a staple cartridge channel and / or staple cartridge, such as staple cartridge 1150, for example, may include a nose portion, such as, for example, nose portion 1153 , which can facilitate the insertion of the staple cartridge 1150 in a surgical site, for example.
[0194] [000194] As indicated above, staples can be dispensed from a staple cartridge and deformed against an anvil. In various circumstances, the distance between the staple forming surfaces on the anvil 1130 and the staple sled 1162 can determine the level of deformation of the staples. For example, if the distance between the anvil pockets 1132 on the anvil 1130 and the top surfaces 1135 on the staple sleigh 1162 (figures 43 to 45) is relatively large, the staples will be less deformed compared to when the distance between the pockets of the anvil 1132 and the surfaces of the sled 1135 is relatively small. Correspondingly, if the distance between the anvil pockets 1132 and the surfaces of the sled 1135 is relatively small, the clamps will be more deformed compared to when the distance between the anvil pockets 1132 and the surfaces of the sled 1135 is relatively large. Often, the distance between the anvil pockets 1132 and the surfaces of the sled 1135 is called the height of clamp formation. Sometimes, the height of staple formation can be measured between the top surface, or deck, of the staple cartridge and the staple forming surfaces on the anvil. For the purposes of this application, however, any reference to a staple forming height, or the like, may include one or both forms of measurement, where appropriate, and / or any other form of suitable measurement. In any case, as described in more detail below, a surgical stapling instrument, such as a 1100 stapling instrument, may include means for adjusting the staple forming height.
[0195] [000195] In several modalities, in addition to the above, an anvil may include one or more forming surfaces that can be joined and / or moved away from a staple cartridge in order to adjust the height of the staple formation. In at least one embodiment, referring to figures 50 to 56, anvil 1130 may include the anvil plate 1134 that can be positioned movably and / or slidably within the anvil channel 1136. In certain embodiments, the anvil 1130 may further include one or more retaining pins or guides 1140, the anvil plate 1134 may include one or more retaining slots or guides 1141 configured to receive slidingly at least a portion of the pins 1140. In at least one In such an embodiment, pins 1140 and / or slots 1141 can be configured to define a predetermined path along which the anvil plate 1134 can be moved. Referring to Figure 51, pins 1140 and slots 1141 can be structured and arranged so that the anvil plate 1134 can be moved along a linear or at least substantially linear path, the linear path being at least partially defined by axes 1142 and 1143, for example. Other modalities are contemplated in which an anvil plate can be moved along a non-linear path, for example, a curved and / or curvilinear path, for example. In certain embodiments, at least a portion of the pins 1140 can be retained within the openings 1144 in the side walls 1137, and in at least one embodiment, the pins 1140 can be snapped into the openings 1144. In any case, as described in the present invention, pins 1140 can guide the anvil plate 1134 as it is joined and / or moved away from the staple cartridge 1150, for example.
[0196] [000196] In several modalities, in addition to the above, a surgical stapling instrument, such as the 1100 stapling instrument, may include one or more adjustment elements configured to position a portion of an anvil, such as a plate of the anvil. anvil 1134, for example, in relation to other portions of an anvil set and / or an opposite staple cartridge. In certain embodiments, referring to figures 51 and 52, the stapling instrument 1100 may include an anvil plate adjustment element 1230 that can be configured to limit the movement range of the anvil plate 1134. In at least one such With reference to figures 120 and 121, the adjustment element 1230 can be positioned between the anvil plate 1134 in a first position in which the first surface, or step, 1231 of the adjustment element 1230 is positioned between the base 1138 of the anvil channel 1136 and the first positioning surface 1145 on the anvil plate 1134. In this first position, the first step 1231 can define the amount of relative movement possible, or allowed between the anvil plate 1134 and the anvil channel 1136. For example, when the anvil 1130 is attached against the fabric, as described above, the anvil plate 1134 can come into contact with the fabric and slide upwards towards the base 1138 to the first surface. and positioning 1145 come into contact with the first step 1231. Once the surface 1145 and step 1231 are in contact, the adjusting element 1230 can prevent or at least inhibit the anvil plate 1134 from moving further towards the base 1138. In at least one such embodiment, as a result, the adjusting element 1230 can act as a stop so that the distance between the base 1138 and the fabric contact surface 1148 on the anvil plate 1134 can be defined by a first distance 1234. Although base 1138 is used as a reference data in the present example, other portions of anvil 1130 and / or an opposite staple cartridge, for example, could be used as reference data. When the adjusting element 1230 is in its first position, as described above, the second surface, or step, 1232 of the adjusting element 1230 can be positioned between the base 1138 and the second positioning surface 1146 on the anvil plate 1134, and in addition, the third surface, or step, 1233 can be positioned between the base 1138 and the third positioning surface 1147. With reference to figure 53, the adjusting element 1230 can include two or more sets of steps, 1231, 1232 , and / or 1233 and the anvil plate 1134 may include two or more sets of positioning surfaces 1145, 1146, and / or 1147. Although the first step 1231 and the first positioning surface 1145 are described above as being configured to control the position of the anvil plate 1134, the second and third steps (1232, 1233) of the adjustment element 1230 and the second and third positioning surfaces (1146, 1147) of the anvil plate 1134, respectively, also They can also be configured to control the position of the anvil plate 1134. However, for the sake of brevity, the present example will be described with respect to the first surface, or step 1231, as being the surface that controls the position of the anvil plate 1134, but the reader will understand that steps 1232 and 1233 can also control the position of the anvil plate 1134.
[0197] [000197] In certain embodiments, the first position of the adjusting element 1230 can provide a relatively small, or short, clamp-forming height. In other embodiments, although not shown, the first position of an adjustment member can provide a relatively large intermediate clamp height and / or any other suitable height. In the event that the formation height associated with the first position of the adjustment element is adequate, a surgeon may continue to use the surgical stapling instrument to staple and / or cut the tissue, as described above. However, in the event that the clamp formation height is inadequate, a surgeon or other physician can move the adjustment element 1230 so that the adjustment element 1230 can allow the anvil plate 1134 to slide upward for a distance different when the anvil plate 1134 comes into contact with the tissue positioned between the anvil 1130 and the staple cartridge 1150. In at least one of these circumstances, the distance allowed for the anvil plate 1134 to slide upwards can be greater, providing, thus, a higher forming height for the clamps. Correspondingly, in other circumstances, the adjustment element can be moved so that the anvil plate 1134 can slide up a short distance when the anvil plate 1134 comes into contact with the fabric, for example, thus providing , a shorter staple forming height. Although the term "upwards" and the like may mean vertically upwards, the term is not limited to that; on the contrary, "up" can mean any direction towards the base of the anvil and / or away from a staple cartridge, for example. In any case, the adjustment element 1230 can be moved between its first position, shown in figure 54, and a second position, shown in figure 55, in order to increase the height of clamp formation. As indicated by the arrow "P" in figure 55, the adjustment element 1230 can be slid proximally in order to move the adjustment element 1230 between its first and second positions, although modalities in which an adjustment element can be slid in distal position and / or any other suitable direction to adjust the adjustment element 1230. When the adjustment element 1230 has been moved to its second position, with reference to figure 55, a first surface, or step, 1231 can be positioned between the base 1138 and the second positioning surface 1146 of the anvil plate 1134. In this second position, the first step 1231 can again define the level of relative movement allowed between the anvil plate 1134 and the anvil channel 1136. At least at least one embodiment, similarly to the above, the adjustment element 1230 can act as a stop so that the distance between the base 1138 and the contact surface with the fabric 1148 on the anvil plate 1134 can be defined by a second distance 1235.
[0198] [000198] In addition to the above, the adjustment element 1230 can be moved between its second position, shown in figure 55, and a third position, shown in figure 56, in order to increase the clamp formation height again. As indicated by the arrow "P" in figure 56, the adjustment element 1230 can be slid proximally in order to move the adjustment element 1230 between its second and third positions. When the adjustment element 1230 has been moved to its third position, with reference to figure 56, a first surface, or step 1231, can be positioned between the base 1138 and the third positioning surface 1147. In this third position, the first step 1231 can again define the level of relative movement between the anvil plate 1134 and the anvil channel 1136. In at least one embodiment, similar to the above, the adjusting element 1230 can act as a stop so that the distance between the base 1138 and the fabric contact surface 1148 on the anvil plate 1134 can be defined by a third distance 1236. Although the adjustment element 1230 can be selectively moved between three positions, as described above, to provide three different heights of clamp forming, other modalities comprising an adjustment element that can be moved between more than three positions to provide more than three different forming heights Staple connections are contemplated. For example, an adjustment element can be movable between four positions in order to provide four staple forming heights. Additional modalities comprising an adjustment element that can be moved between two positions to provide two staple forming heights are contemplated. In addition, while the surfaces, or steps, 1231, 1232, and 1233 of the adjusting element 1230 are arranged in a decreasing order, other arrangements in which the surfaces, or steps, are arranged in an ascending order are contemplated. Other provisions are contemplated in which the surfaces, or stages, are not necessarily arranged in ascending or descending order. Similarly, the positioning surfaces 1145, 1146, and 1147 of the anvil plate 1134 can be arranged in ascending order, descending order (figure 53), and / or any other suitable order. In addition, although the adjustment element 1230 can be slid along an axis, other modalities are contemplated in which an adjustment element can be moved along any suitable path, such as, for example, curved and / or curvilinear paths. .
[0199] [000199] As described above, with reference to figure 54, the adjustment element 1230 can comprise three surfaces, or steps, 1231, 1232, and 1233, while the anvil plate 1134 can comprise three corresponding adjustment surfaces 1145, 1146, and 1147. When the adjustment element 1230 is in its first position, for example, a first surface 1231 can be positioned so as to be contiguous or adjacent to a first adjustment surface 1145, the second surface 1232 can be positioned so to be contiguous or adjacent to the second adjustment surface 1146, and the third surface 1233 can be positioned so as to be contiguous or adjacent to the third adjustment surface 1147. When the adjustment element 1230 is slid in relation to the anvil plate 1134, as described above and referring to figures 55 and 56, the surfaces 1231, 1232, and 1233 of the adjusting element 1230 can be aligned sequentially with respect to the surfaces cies 1145, 1146, and 1147 of the anvil plate 1134. In at least one such embodiment, an adjustment element can have a number of steps equal to the number of positioning surfaces on an anvil plate. Other modalities are contemplated, in which an adjustment element has more steps than the positioning surfaces on the anvil plate. In at least one such embodiment, an anvil plate may include a positioning surface with the steps of an adjustment element being selectively used to limit upward movement of the anvil plate, for example. In various embodiments, with reference generally to the adjusting element 1230 and the anvil plate 1134, an anvil plate may include a positioning surface, such as the positioning surface 1145, with steps 1231, 1232, and 1233 of the adjusting element 1230, for example, can be selectively positioned between the base 1138 and the positioning surface 1145. In such embodiments, the first step 1231 can have a first thickness or height that can stop or limit the upward movement of the anvil plate 1134 in order to define a first staple forming height, the second step 1232 can have a second thickness or height that can stop or limit the upward movement of the anvil plate 1134 in order to define a second forming height staple and, in addition, the third step 1233 can have a third thickness or height that can stop or limit the upward movement of the anvil plate 1134 in order to define a third height clamp formation. In at least one embodiment, the thickness or height of steps 1231, 1232, and / or 1233 can be measured between a back surface 1237 of the adjusting element 1230 and a surface over the steps (1231, 1232, 1233) that will come into contact with the anvil plate 1134. In various embodiments, the difference in height, or thickness, between the first stage 1231 and the second stage 1232 can be equal to, or at least substantially equal to the difference in height, or thickness, between the second stage 1232 and the third step 1233. In at least one such embodiment, as a result, the heights of the step may increase at a linear rate, or at least at a substantially linear rate. In alternative modalities, the difference in height, or thickness, between the first and second stages may be different from the difference in height, or thickness, between the second and third stages. In at least one such embodiment, the height, or thickness, of the first, second, and third stages may not increase or decrease at a linear rate; particularly, although not illustrated, the height, or thickness, of the steps can increase or decrease at a non-linear and / or geometric rate.
[0200] [000200] As described above, an adjustment element, such as, for example, the adjustment element 1230 can be movable between two or more positions. In various embodiments, a surgical stapling instrument may include an actuator configured to move the adjustment element. In at least one embodiment, referring to figures 50 to 53, surgical stapling instrument 1100 may include actuator 1250 which can be functionally attached to adjustment element 1230 so that a force can be applied to actuator 1250 and transmitted to the adjustment element 1230. In certain embodiments, the actuator 1250 may include portions of handle, or cables, 1252 that can be configured to be held by a surgeon, for example, in order to advance or retract the adjustment element 1230 inside the anvil 1130, as described above. In certain embodiments, the handle portions 1252 may extend from the actuator body 1251, the actuator body 1251 may include one or more openings, slits, or cavities 1253 that can be configured to receive at least a portion of the adjustment element 1230. In at least one such embodiment, with reference to figure 52, adjustment element 1230 may include lock 1254 extending therefrom, at least a portion of lock 1254 may be received within the opening 1253 in order to secure the actuator body 1251 to the adjustment element 1230. In various embodiments, the lock 1254 can include one or more resilient or flexible legs 1255 that can be bent when inserted into opening 1253, but return resiliently, or return at least partially, to their uninflected position after feet 1256 of legs 1255 are pushed sufficiently through opening 1253. In at least one embodiment, feet 1256 can avoid, or at least least inhibit, that the body of the actuator 1251 is detached from the adjustment element 1230.
[0201] [000201] In several modalities, in addition to the above, the surgical stapling instrument 1100 may also include a detent mechanism that can be configured to hold, or to release reliably, the actuator 1250 and / or the adjustment element 1230 in position. In at least one embodiment, with reference to figure 52, the retaining element 1260 can be attached to the actuator 1250 and, in at least some embodiments, the body of the actuator 1251 can include one or more channels, grooves, or recesses 1257 that can be configured to receive and / or retain a holding body 1261 of the holding element 1260. In at least one embodiment, the holding body 1261 can include one or more openings 1263 and / or any other suitable channels, slits, or grooves, which can be configured to receive one or more fasteners to secure the holding body 1261 to actuator 1251, for example. The detent element 1260 can further include detent legs 1262 which can be configured to engage one or more recesses, openings, or grooves 1101 (figures 35 to 40) in the first portion of structure 1110, for example. More particularly, referring to figures 34 and 35, each side flange 1128 may include one or more recesses 1101 (1101a, 1101b, and 1101c) defined therein, the detent legs 1262 being able to be engaged with the top surfaces side flanges 1128 so that detent legs 1262 can be slid in and out of recesses 1101. In the illustrated embodiment, each side flange can include three recesses 1101 that can be configured to removably hold actuator 1250 in a first position distal, a second intermediate position, and a third proximal position, the first, second, and third positions of the actuator 1250 can correspond respectively to the first, second, and third positions of the adjustment element 1230 described above. For example, when the actuator 1250 is in its first distal position, the detent legs 1262 of the detent element 1260 can be positioned within the recess 1101a in order to removably hold the actuator 1250 and the adjusting element 1230 in their first positions. By applying sufficient force, actuator 1250 can be moved proximally to its second position so that detent legs 1162 are positioned within recess 1101b and actuator 1250 and adjusting element 1230 are retained in their second positions. Similarly, by applying sufficient force, actuator 1250 can be moved proximally to its third position so that detent legs 1162 are positioned within recess 1101c and actuator 1250 and adjustment element 1230 are retained in their third positions . In various embodiments, the holding legs 1162 can be configured so that the actuator 1250 can be placed back in its first and / or second position.
[0202] [000202] As described above, the adjustment element 1230 can be moved along a predetermined path between two or more positions by the actuator 1250. In various embodiments, the surgical stapling instrument 1100, for example, can include one or more guides to control or limit the movement of the adjustment element 1230 and / or the actuator 1250. In some embodiments, the adjustment element 1230 can be received narrowly between the side walls 1137 of the anvil 1130 so that the side walls 1137 can orient the control element adjustment 1230. In at least one embodiment, the side walls 1137 can be configured to control or limit the lateral or side-to-side movement of the adjustment element 1230. In various embodiments, the holding legs 1162 of the holding element 1160 can understand resilient elements that can be configured to apply a changing force or upward pulling force on the adjustment element 1230 so to position the adjustment element 1230 against or at least adjacent to the base 1138 and the intermediate side walls 1137. In certain embodiments, with reference to figure 52, the base 138 of the anvil 1130 may also include a guide slot 1149 which can be configured to receive at least a portion of the adjusting element 1230 and / or actuator 1250 so that the guide slot 1149 can limit the movement of the adjusting element 1230 and actuator 1250. In at least one embodiment, the lock 1254 of the adjustment element 1230 can be configured to extend through guide slot 1149 so that when lock 1254 is inserted into opening 1253 of actuator 1250, as described above, base 1138 of anvil 1130 can be captured between the adjustment element 1230 and actuator 1250. In certain embodiments, the guide slot 1149 can be configured to limit the movement of the latch 1254 so that the adjusting element 1230 can be prevented, or at least inhibited, from being moved into position distal adjustment when the adjusting element 1230 is in its first position or most distal position and / or, similarly, prevented or at least inhibited from being moved proximally when the adjusting element 1230 is in its third position, or more proximal position .
[0203] [000203] In several embodiments, in addition to the above, a detent element, similar to detent element 1260, for example, can be used to separate the first portion of cable 1102 and the second portion of cable 1104 from each other. In at least one embodiment, with reference to figure 70, the surgical stapling instrument 1100 'may include a holding element 1260' configured to position the first portion of the cable 1102 and the second portion of the cable 1104 so that there is a gap between the anvil 1130 and staple cartridge 1150. Such a feature, as described above, can allow a surgeon to easily manipulate the surgical instrument without having to keep the first and second portions of the cable away from each other. In certain embodiments, the holding element 1260 'can be sufficiently installed to the second portion of the cable 1104 so that the holding legs 1262' extending from the holding element 1260 'can contact the flanges 1128 and, when compressed, can apply a modifying force to the first and second portions of the cable. As seen in figure 70, the legs 1262 'can come into contact with the surfaces 1101d on the flanges 1128. In order to compress the detent legs 1262', the locking mechanism 1180 can be moved to a partially closed position so that the lock 1188 can engage, and at least partially encircle, the lock projections 1131. In this configuration, a surgeon can manipulate the instrument and, when satisfied with its position, can move the lock mechanism 1180 to a closed position and further compress the holding legs 1262 '. Similar to the above, the holding element 1260 'can be fixed, or otherwise functionally engaged with the actuator 1250 so that when the actuator 1250 is moved between its first, second and third positions, as described above, the legs 1262 'can engage the recesses 1101a, 1101b, and 1101c, respectively. In at least one such embodiment, as a result, actuator 1250 may have a pre-stage position in which actuator 1250 is positioned distally with respect to its first position and, in addition, surfaces 1101d may comprise pre-treated surfaces. stage against which legs 1262 'can be positioned when actuator 1250 is in its pre-stage position.
[0204] [000204] As described above, an adjustment element can be slid or moved between the first and second positions in order to adjust the formation height of the staples dispensed by a surgical stapling instrument. In various embodiments, although not shown, an adjustment element can be configured to positively move an anvil plate in the same direction and / or in the opposite direction of an opposite staple cartridge, for example. In at least one such embodiment, a surgical stapling instrument may include one or more traction elements, such as springs, for example, configured to position the anvil plate against the adjustment element so that when the adjustment element is moved between its first and second positions, the adjustment element can move the anvil plate between the first and second positions in order to establish the first and second staple heights. In various embodiments, as a result of the above, an adjustment element can be configured to rotate a portion of an anvil into position. In at least one such embodiment, an adjustment member can be slid along an axis in order to positively displace an anvil plate. In other embodiments, a rotating adjustment element can be configured to positively move an anvil plate in the same direction and / or in the opposite direction of a staple cartridge, for example.
[0205] [000205] In addition to the above, as described in more detail below, an adjustment element can be rotated to adjust the clamp formation height. Referring to figures 57 to 69, surgical instrument 1100 'may include, similarly to the above, a first portion of cable 1102', a second portion of cable 1104 ', and a locking mechanism 1180' which can be used to secure the fabric between the anvil 1130 'and the staple cartridge 1150'. Referring to Figure 58, also similarly to the above, the locking mechanism 1180 'can be pivotally coupled to the first portion 1102' by one or more pivot pins 1182 ', with the locking mechanism 1180' being able to include one or more more locking arms 1188 'which can be configured to engage the second portion 1104' and lock the first and second portions of the cable together. Also similarly to the above, referring to figures 58 and 60, the surgical instrument 1100 'can also include the propeller bar assembly 1200' which can be configured to move a cutting element and / or sled of staples into end effector 1120 '. In at least one such embodiment, the propeller bar assembly 1200 'may include a proximal end 1203' and an actuator 1204 ', with actuator 1204' being able to be pivotally installed at the proximal end 1203 'and selectively positioned on the first and second sides of the 1100 'stapling instrument. In various embodiments, the surgical stapling instrument 1100 'can comprise elements that are the same or similar to those described with respect to the surgical stapling instrument 1100 and can be operated in the same or similar way to the 1100 instrument and, as a result, such details are not repeated here.
[0206] [000206] In various embodiments, with reference to figure 60, the surgical instrument 1100 'can include a rotary adjustment element 1230' which can be selectively positioned in at least one first and a second position in order to provide different heights of formation. clip. In certain embodiments, surgical instrument 1100 'may include an actuator 1250' that can be functionally connected to adjustment element 1230 'so that actuator 1250' can move adjustment element 1230 'between at least its first and second positions. In at least one embodiment, with reference to figure 61, the actuator 1250 'may include the body of the actuator 1251' and the handle or cable portion, 1252 '. The actuator body 1251 'can include an opening 1258' that can be configured to receive a proximal end 1238 'of the adjusting element 1230' so that rotational movement, torque, and / or forces can be transmitted between actuator 1250 'and the adjustment element 1230 '. In at least one such embodiment, with reference to figure 69, opening 1258 'may comprise a non-circular profile and / or a profile that includes one or more flat guiding surfaces configured to transmit rotational movement between actuator body 1251' and the 1230 'actuator. In certain embodiments, opening 1258 'can be sized and configured to receive closely the proximal end 1238' of actuator 1230 '. In at least one embodiment, opening 1258 'can be configured to receive the proximal end 1238' in a quick-fit or and / or snap-fit arrangement. In various embodiments, again with reference to figure 61, the cable portion 1104 'can include one or more slots 1259' that can be configured to allow at least a portion of the body of the actuator 1251 'to extend through them so that the handle portion 1252 'can be installed on actuator body 1251' with at least a portion of cable portion 1104 'positioned between them. In at least one such embodiment, the second portion of the cable 1104 'can further include the recess 1253' which can be configured so that at least a portion, or all, of the handle portion 1252 'is positioned within the recess 1253 '. In certain embodiments, the recess 1253 'can be configured so that the handle portion 1252' does not extend above the top surface of the second portion of the handle 1104 'although, in other embodiments, an upper portion of the handle portion 1252' may extends above the second portion of the cable 1104, as shown in figure 63, so that the handle portion 1252 'can be easily accessed by a surgeon.
[0207] [000207] In various embodiments, as described above, an adjustment element can be rotated between at least the first and second positions to adjust the height of formation of the staples dispensed by a surgical stapler. In certain embodiments, with reference to figure 61, a surgical stapling instrument may include an adjustment element rotatably positioned within an anvil, the adjustment element being configurable to limit the relative movement of a movable portion of the anvil . In at least one such embodiment, the surgical stapling instrument 1100 'may include an anvil plate 1134' that can be slidably retained within the anvil channel 1136 'by the retaining pins or guide 1140', the guide pins being 1140 'can be configured to allow the anvil plate 1134' to slide upward when the anvil plate 1134 'comes into contact with the fabric, as described above. Referring to figures 60, 63 and 64, the adjustment element 1230 'can be positioned in a first position or orientation, so that it can limit the upward movement of the anvil plate 1134' within the anvil channel 1136 'and dictate the height of staple formation of the staples. In at least one such embodiment, referring to figures 63 and 64, the adjusting element 1230 'can include the first opposing surfaces 1231' that can be positioned between the base 1138 'of the anvil channel 1136' and the positioning surface 1145 'of the anvil plate 1134' so that when the positioning surface 1145 'comes into contact with one of the first surfaces 1231', the surface contact with the fabric 1148 'of the anvil plate 1134' can be positioned at a first distance 1234 'from a relation surface 1129' on the anvil 1130 ', for example. Correspondingly, the forming surfaces 1132 'can be positioned apart a first distance from a staple cartridge so that, when the staples are dispensed by the staple cartridge, they can be deformed to a first staple height. In addition to the above, a first diameter 1241 'can be defined between the first surfaces 1231' and the first diameter 1241 'can define a maximum position of the upward movement of the anvil plate 1134' within the anvil channel 1136 '.
[0208] [000208] As indicated above, the adjustment element 1230 'can be rotated in order to adjust the formation height of the clamps. In various embodiments, the adjusting element 1230 'can be rotated between its first position, or orientation (figures 63 and 64) and a second position, or orientation (figures 65 and 66). In at least one embodiment, referring to figures 65 and 66, the cable 1252 'can be rotated in a direction indicated by the arrow "A", in order to move the adjustment element 1230' between its first and second positions. Similarly to the above, when the actuator 1230 'is in its second position, or orientation, the actuator 1230' can limit the upward movement of the anvil plate 1134 'within the anvil channel 1136' and dictate the forming height. of staples of staples. In at least one such embodiment, referring to figures 65 and 66, the adjusting element 1230 'can include the second opposing surfaces 1232' which can be positioned between the base 1138 'and the positioning surface 1145' so that, when the positioning surface 1145 'comes into contact with one of the second surfaces 1232', the surface contact with the fabric 1148 'of the anvil plate 1134' can be positioned at a second distance 1235 'from a relation surface 1129', for example example. Correspondingly, the forming surfaces 1132 'can be positioned a second distance away from a staple cartridge so that, when the staples are dispensed by the staple cartridge, they can be deformed to a second staple height. In various embodiments, similarly to the above, a second diameter 1242 'can be defined between the second surfaces 1232', the second diameter 1242 'being able to define the maximum upward movement position of the anvil plate 1134' within the anvil channel 1136 '. Although the first surfaces 1231 'and the second surfaces 1232' can be defined by flat or at least substantially flat surfaces, other embodiments are contemplated in which the first and second surfaces 1231 'and 1232' can include at least partially arched contours or curved. In any case, with reference to figure 60, the adjusting element 1230 'can include one or more gap slots 1240' that can be configured to provide a gap between the actuator 1230 'and the retaining pins 1140'. The gap slots 1240 'can be configured to provide a gap between the actuator 1230' and the retaining pins 1140 'when the actuator 1230' is in its first position, second position, and / or any other suitable position.
[0209] [000209] In several modalities, in addition to the above, the adjustment element 1230 'can be rotated between its first position or orientation, (figures 63 and 64) and a third position, or orientation (figures 67 and 68). In at least one embodiment, referring to figures 67 and 68, the cable 1252 'can be rotated in a direction indicated by the arrow "B", in order to move the adjustment element 1230' between its first and third positions. Similar to the above, when the actuator 1230 'is in its third position or orientation, the actuator 1230' can limit the upward movement of the anvil plate 1134 'within the anvil channel 1136' and dictate the height of formation of staple staple. In at least one such embodiment, referring to figures 67 and 68, the adjusting element 1230 'can include the third opposing surfaces 1233' that can be positioned between the base 1138 'and the positioning surface 1145' so that, when the positioning surface 1145 'comes into contact with one of the third surfaces 1233', the surface contact with the fabric 1148 'of the anvil plate 1134' can be positioned at a third distance 1236 'from a relationship surface 1129', for example example. Correspondingly, the forming surfaces 1132 'can be moved a third distance away from a staple cartridge so that, when the staples are dispensed by the staple cartridge, they can be deformed to a third staple height. In various embodiments, similarly to the above, a third diameter 1243 'can be defined between the third surfaces 1233', the third diameter 1243 'being able to define the maximum position of upward movement of the anvil plate 1134' within the anvil channel 1136 '. Again referring to figures 67 and 68, the third surfaces 1233 'can be defined by an at least partially arched contour, although other modalities are contemplated in which the third surfaces 1233' can include flat or at least substantially flat contours. In at least one embodiment, the adjusting element 1230 'can be configured so that the greatest distance or diameter between the third arched surfaces 1233' can be used to define the third clamp height.
[0210] [000210] As described above, referring to figures 63 and 64, the adjustment element 1230 'can be positioned in a first position or orientation, to establish a first forming height for the staples dispensed by the surgical stapling instrument 1100' . As also described above, referring to figures 65 and 66, the actuator 1250 'can be used to move the adjusting element 1230' to its second position or orientation, to establish a second forming height for the clamps. To do this, in at least one mode, a force can be applied to the cable 1252 ', which can cause the cable 1252' and the adjustment element 1230 'attached to it, to rotate in a direction indicated by the arrow "A ". In at least one embodiment, the adjustment element 1230 'and / or the actuator 1250' can be sufficiently retained so that when the adjustment element 1230 'is rotated, the adjustment element 1230' can be rotated about an axis , such as axis 1245 '(figure 60), for example. In at least one embodiment, with reference to Fig. 58, the proximal end 1203 'of the propellant assembly 1200' may include one or more grooves, channels, or recesses 1205 'that can be configured to receive and / or retain at least one adjustment element 1230 'and / or actuator 1250'. In any case, as shown in figures 63 to 66, the second position or orientation of the adjustment element 1230 'may allow the anvil plate 1134' to slide a greater distance within the anvil channel 1136 'compared to when the adjustment element 1230 'is in its first position. In at least one embodiment, as a result, the second staple forming height may be greater than the first staple forming height. As also described above, referring to figures 67 and 68, the actuator 1250 'can be used to move the adjusting element 1230' to its third position or orientation, to establish a third forming height for the clamps. To do this, in at least one mode, a force can be applied to the cable 1252 ', which can cause the cable 1252' and the adjusting element 1230 'to rotate in a direction indicated by the arrow "B ". As shown in figures 63, 64, 67 and 68, the third position or orientation of the adjustment element 1230 'may allow the anvil plate 1134' to slide a shorter distance into the anvil channel 1136 'compared to when the adjustment element 1230 'is in its first position In at least one embodiment, as a result, the first and second staple forming heights can be greater than the third staple forming height. In at least one such embodiment, the first position of the adjustment element 1230 ', and the actuator 1250', can represent an intermediate position, with the adjustment element 1230 'being selectively moved to its second and third positions directly from from your first position. In practice, the first position of the adjustment element 1230 'can represent an intermediate height of the clamp, the second and third positions of the adjustment element 1230' can represent higher and lower clamp heights, respectively. In certain embodiments, with reference to figure 57, the surgical stapling instrument 1100 'may include one or more signals thereon, which can be configured to inform the stapling formation heights, or at least the relative formation heights, that can be selected. For example, the second portion of cable 1104 'may include a first signal 1245' which may indicate an intermediate height or first height of the clamp, a second signal 1246 'which may indicate a higher height, or a second height of the clamp, and in addition in addition, a third signal 1247 'which may indicate a shorter height, or third height of the clamp.
[0211] [000211] In various embodiments, in addition to the above, one or more of the first surfaces 1231 ', second surfaces 1232', and third surfaces 1 233 'may comprise or define, or at least partially understand or define, a perimeter or circumference of the adjustment element 1230 '. As discussed above, due to the first, second and third diameters (1241 ', 1242' and 1243 ') defined by the first, second, and third surfaces (1231', 1232 ', and 1233'), respectively, the perimeter or circumference of the adjustment element 1230 'may be non-circular. However, in certain embodiments, the perimeter or circumference of the adjusting element 1230 'may be symmetrical, substantially symmetrical, and / or non-symmetrical. In various embodiments, in addition to the above, an adjustment element may comprise a cam rotatably positioned between the base 1138 'of the anvil 1130' and the adjustment surface 1145 'of the anvil plate 1134', for example. In at least one such embodiment, one or more of the first surfaces 1231 ', second surfaces 1232' and third surfaces 1233 ', for example, can comprise or define a cam profile which, similarly to the above, can be configured to positively position the anvil plate 1134 'and / or provide a stop against which the anvil plate 1134' can be positioned. In any case, although not illustrated, several modalities are contemplated, in which an adjustment element can be slid and rotated in order to establish two or more staple formation heights for the staples dispensed by a surgical stapling instrument. In at least one such embodiment, an adjustment element can comprise a cam profile that can be defined along the length of the adjustment element, the longitudinal and / or rotational movement of which can be used to move the cam profile between at least minus the first and second positions.
[0212] [000212] In various embodiments, similarly to the above, the surgical instrument 1100 'may further include a holding mechanism configured to hold, or at least releasably hold, the actuator 1250' in position. In at least one embodiment, referring to figures 58 and 59, the surgical instrument 1100 'may further include the holding element 1260' comprising the holding body 1261 'and one or more holding legs 1262'. With reference to figure 59, the holding body 1261 'can include one or more grooves, recesses, or channels 1263' that can be configured to receive at least a portion of the proximal end 1105 'of the second portion of the cable 1104' so that the element holder 1260 'can be held in position. In at least one such embodiment, the proximal end 1105 'may further include one or more grooves, channels, or recesses 1265' that can be configured to receive closely the retaining element 1260 '. In certain embodiments, at least a portion of the holding body 1261 ', such as channel 1263', for example, can be retained by snap-fit, quick-fit and / or suitably retained in recess 1265 '. As also illustrated in figure 59, each detent leg 1262 'of detent member 1260' may include one or more projections 1264 'extending therefrom, which can be configured to engage actuator body 1251' and secure releasably actuator 1250 'in position. In at least one embodiment, with reference to figure 69, the actuator body 1251 'may include one or more recesses, or holes, 1269' that can be configured to receive a projection 1264 '. When a projection 1264 'is positioned inside the recess 1269', the projection can be configured to hold the actuator 1250 'in its first position, for example, until sufficient force is applied to the actuator 1250' in order to cause the projection 1264 'is moved out of the recess 1269'. More particularly, the force applied to the actuator 1250 'can be transmitted to the projection 1264' and, due to the cooperating surfaces between the projection 1264 'and the recess 1269', the detent leg 1262 'associated with the projection 1264' can be flexed or moved proximally to allow the actuator body 1251 'to be moved relative to it. In order to favor such proximal movement, with reference to figure 58, the recess 1265 'can include elongated portions 1266' which can each be configured to receive at least a portion of the legs 1262 'so that the legs 1262' can move with respect to cable portion 1104 '. As the actuator 1250 'is moved in its second or third position, the body of the actuator 1251' can come into contact with a projection 1264 'extending from another leg 1262' and deflect leg 1262 'proximally so that when actuator 1250 'is in its second or third position, leg 1262' can jump forward, or distally, so that projection 1264 'can be secured within recess 1269'. In at least one embodiment, in addition to the above, the interaction between the projections 1264 'and the side walls of the recess 1269' may be such that the actuator 1250 'can be safely maintained in one of its first, second, and third positions, for example, but still allows the 1250 'actuator to be moved by applying sufficient force. In such embodiments, the holding element 1260 'can prevent, or at least inhibit, that the actuator 1250' and, consequently, the adjusting element 1230 'are accidentally displaced.
[0213] [000213] As discussed above and shown in figure 35, each side flange 1128 of the first portion of cable 1102 can include a notch or recess 1127, for example, which can be configured to receive one or more lock projections 1131, for example, extending from anvil 1130, and / or any other suitable portion of the second portion of cable 1104. As also discussed above, with reference mainly to figures 35 and 36, the first portion of cable 1102 may further include a locking mechanism 1180 swiveled to it, which can be used to engage the lock projections 1131 extending from the second portion of cable 1104 and secure the first and second portions of cable 1102, 1104 together. The locking mechanism 1180 may further include one or more locking arms 1188 extending therefrom, which can be configured to engage one or more locking projections 1131 and pulling and / or securing the projections 1131 within the recesses 1127 , as shown in figure 40. Referring to figure 39, at least one of the locking arms 1188 can include a distal hook 1189 that can be configured to wrap around at least a portion of the projections 1131 so as to encompass or encircle, or at least partially encompass and surround the projections 1131. In at least one embodiment, the locking arms 1188 can act as an upper central lock to hold the lock mechanism 1180 in its locked or closed position.
[0214] [000214] In various modalities, now with reference to figure 71, each projection 1131 can comprise a slot or groove 1190 positioned between the side wall 1191 and an enlarged end or head, 1192 of the projection 1131, the slot 1190 being configurable to receive at least a portion of the locking arm 1188. More particularly, in at least one embodiment, the slot 1190 may be wider than the width of the locking arm 1188 so that when the locking arm 1188 is engaged with the projection 1131, locking arm 1188 can enter slot 1190. In some circumstances, the width of each slot 1190 may be slightly larger than the width of a locking arm 1188 so that the locking arm is received narrowly within slot 1190 In various circumstances, the slot 1190, the side wall 1191 and the head 1192 of the projection 1131 can be dimensioned and configured so as to avoid or at least limit relative movement. lateral movement, that is, the movement away from or towards the sides of the anvil 1130, between the locking arm 1188 and the projection 1131. In addition to the above, however, the locking arms 1188 can slide longitudinally into the grooves 1190 while the locking arms 1188 move the projections 1131 into the recesses 1127 in the first portion 1102. Due to this relative sliding movement between the locking arms 1188 and the projections 1131, frictional forces that can resist the movement of the locking arms 1188 can generated between them. In various circumstances, the magnitude of these frictional forces can be significant when the normal or perpendicular contact forces between the locking arms 1188 and the side walls of the groove 1190 are large. In many circumstances, as a result, the operator of the surgical instrument has to overcome these frictional forces when operating the 1180 locking mechanism.
[0215] [000215] In several alternative modalities, now with reference to figures 72 and 73, a surgical instrument can comprise one or more lock projections that have a rotating bearing that can reduce the magnitude of the frictional forces between the locking arms of a mechanism lock and lock projections. In at least one embodiment, an anvil 1330, which can be substantially similar to anvil 1130 in many respects, may comprise a lock projection 1331 extending from each of its sides, each lock projection 1331 being able to comprise a 1393 swivel bearing. In use, the 1188 locking arms of the 1180 locking mechanism, for example, can come in contact with the 1393 swivel bearings in order to position the 1331 lock projections in the 1127 recesses. In various circumstances, the arms locking elements 1188 can slide through the surface or outside diameter of the 1393 bearings; however, as bearings 1393 can rotate relative to locking arms 1188, the magnitude of the frictional forces between locking arms 1188 and projections 1331 may be less than the magnitude of the frictional forces between locking arms 1188 and the projections 1131. Due to these minor frictional forces, a lower closing or clamping force may be required to activate the 1180 locking mechanism, for example.
[0216] [000216] In various embodiments, with reference mainly to figure 74, each rotary bearing 1393 may comprise a circular or round outer diameter 1394 and, in addition, a circular or round bearing opening 1395 extending therefrom. In certain embodiments, each projection 1331 may further comprise a stem portion 1396 extending from the side wall 1391 and an enlarged end, or head, 1392 extending from the stem portion 1396, and, as illustrated in Fig. 64, the stem portion 1396 may extend through the bearing opening 1395 of the rotary bearing 1393. In various embodiments, the stem portion 1396 may comprise a circular or round outer diameter, which can be received narrowly within the bearing opening. 1395 so that there is little relative radial movement between them, if it occurs. The diameter of the 1395 bearing opening, however, can be sufficiently larger than the outer diameter of the 1396 stem portion, so that the 1393 bearing can rotate with respect to the 1396 stem portion about a 1399 axis. the rotary bearing 1393 can be retained on the stem portion 1396 by the enlarged head 1392. More particularly, in at least one embodiment, the enlarged head 1392 can be larger than, or can define a diameter greater than, the diameter of the bearing opening 1395 so that a rotary bearing 1393 cannot slide off the end of the stem portion 1396. In certain embodiments, the side wall 1391 and the head 1392 can define a gap between them and, in addition, the bearing 1393 it can comprise a width, the span distance being greater than the width of the 1393 bearing. In at least one embodiment, the span distance may be slightly greater than the width of the 1393 bearing. so that the 1393 bearing does not tilt, or tilt at least substantially, with respect to the 1399 shaft, for example.
[0217] [000217] As discussed above, the locking arms 1188 of the locking mechanism 1180 can be configured to engage the 1393 bearings and position the 1393 bearings within the 1127 recesses. surgical instrument may comprise a locking mechanism 1380 which may comprise the first and second locking arms 1388 extending from it on opposite sides of the anvil 1331 and the staple cartridge channel 1324. In use, similarly to exposed above, the locking arms 1388 can contact the bearings 1393 in order to move the bearings 1393 into the recesses 1327 in the staple cartridge channel 1324 and move the anvil 1331 towards the staple cartridge channel 1324. Such movement is illustrated with imaginary lines in figure 74. In various modalities, each locking arm 1388 can define, at least partially, a groove, or slot 1397, each slot 1397 can be configured to receive a 1393 bearing. In at least one embodiment, a slot 1397 can comprise a first guiding surface, or side wall, 1398a that can be positioned against bearing 1393 and, as a locking force is applied to the locking mechanism 1380, locking arm 1388 can apply a locking force to bearing 1393. In these circumstances, bearing 1393 can further enter slot 1397 when locking mechanism 1380 is rotated to its closed position. In various circumstances, slot 1397 may additionally comprise a second guiding surface, or side wall, 1398b which can be positioned against the other side and / or the opposite side of bearing 1393 so that an opening force can be applied to bearing 1393 through the locking arm 1388. As the locking mechanism 1380 is moved to its open position, bearing 1393 may come out of slot 1397. In any case, the first guiding surface 1398a and the second guiding surface 1398b can define a width between them, which can be larger than the outside diameter of bearing 1393 so that bearing 1393 can move inside slot 1397. In some embodiments, the slot width may be slightly larger than the outside diameter of bearing 1393. In at least one embodiment, at least portions of the first targeting surface 1398a and the second targeting surface 1398b may be parallel, or p link less substantially parallel to each other. In at least one such embodiment, at least portions of the first targeting surface 1398a can be positioned opposite the second targeting surface 1398b.
[0218] [000218] As described above, a surgical stapling instrument can be configured to deform one or more surgical staples between a first configuration, not dispensed, and a second configuration, dispensed. In various embodiments, now with reference to figure 72, a surgical clamp, such as clamp 1400, for example, can comprise a base 1402, a first leg, or deformable element, 1404 extending from base 1402 and, in addition , a second leg, or deformable element, 1406 extending from base 1402. In certain embodiments, base 1402, first leg 1404 and second leg 1406 may consist of a continuous wire, with at least one In this embodiment, the first leg 1404 and the second leg 1406 can each be tilted in a direction that is perpendicular to the base 1402 before the clamp 1400 is inserted and deformed by a surgical stapler. More particularly, the clamp 1400 can be manufactured so that the base 1402 is oriented along a base line 1401 and so that the legs 1404 and 1406 are oriented along lines 1409 and 1411, respectively, which are perpendicular, or at least substantially perpendicular to the baseline 1401. In various embodiments, the first leg 1404 can be positioned at a first end of the base 1402 and the second leg 1406 can be positioned at a second end of the base 1402, with at least one embodiment, a midline 1403 can be defined, which extends through a midpoint of base 1402 and extends in a direction perpendicular to baseline 1401. Staple 1400 can be configured so that base 1402, the first leg 1404, and the second leg 1406 are located, or are or at least substantially located, in the same plane, or in a common plane, when the clamp 1400 is in its first configuration or configuration ration not implanted. In such embodiments, the base line 1401, along which the base 1402 is oriented, and the perpendicular lines 1409 and 1411, along which the legs 1404 and 1406 are oriented, can be located in the same plane.
[0219] [000219] In several modalities, in addition to the above, the continuous wire comprising base 1402, first leg 1404, and second leg 1406 may consist of titanium and / or stainless steel, for example. In at least one embodiment, the first leg 1404 can comprise a first end 1405 and the second leg 1406 can comprise a second end 1407, the ends 1405 and 1407 each comprising a sharp or chamfered tip, which can be configured to pierce bone and / or tissue. In use, the staple 1400 can be deformed by a surgical stapler in order to capture tissue, for example, inside the staple 1400. In various embodiments, the staple 1400 can be dispensed from a staple cartridge so that the ends 1405 and 1407 of the legs of clamp 1404 and 1406, respectively, come into contact with an anvil positioned opposite the clamp 1400. In these circumstances, a first compression force F1 can be applied to the first leg 1404 and a second compression force F2 can be applied. applied to the second leg 1406 while the base 1402 is supported by at least a portion of the staple cartridge. As described in more detail below, the anvil may comprise a staple pouch that can apply the first compression force F1 to the first leg 1404, so that the end 1405 of the staple leg 1404 is moved towards the base 1402. Similarly , the staple pouch can apply the second compression force F2 to the second leg of the staple 1406 so that the end 1407 of the staple leg 1404 is also moved towards the base 402. In addition to the above, as also discussed in more detail below, now with reference to figures 83 to 85, the staple pouch can tilt the first leg of the staple 1404 to a first side of the base 1402 and the second leg of the staple 1406 to a second side, or opposite side, of the base 1402.
[0220] [000220] In various embodiments, with reference to figures 82 and 83, the first leg 1404 of the clamp 1400 can be tilted so that the end 1405 of the first leg 1404 is moved towards the base 402 and towards the second leg 1406 when the first leg 1404 is deformed by the first compression force F1. In at least one embodiment, the end 1405 can be moved from a first side 1410 of the midline 1403, as shown in figure 82, to a second side 1412 of the midline 1403, as shown in figure 83. Similarly, the second leg 1406 of clip 1400 can be tilted so that the end 1407 of the second leg 1406 is moved towards the base 1402 and towards the first leg 1404 when the second leg 1406 is deformed by the second compression force F2. In at least one embodiment, the end 1407 can be moved from a second side 1412 of the midline 1403, as shown in figure 82, to a first side 1410 of the midline 1403, as shown in figure 83. In the installed, or deformed configuration , of the clamp 1400, as shown in figure 83, the ends 1405 and 1407 of the legs of the clamp 1404 and 1406 can extend beyond the midline 1403 to form an angle between them. More particularly, the end 1405 of the first leg 1404, when in its deformed configuration, can extend along, or in relation to, a first axis 1414 and, similarly, the end 1407 of the second leg 1406, when in its deformed configuration may extend along, or in relation to, a second axis 1416 so that the first axis 1414 and the second axis 1416 define an angle 1417 between them. In some embodiments, the angle 1417 can be approximately 90 degrees, for example. In certain embodiments, the angle 1417 can be in a range between approximately 0.1 degree and approximately 89 degrees, for example. In various embodiments, the angle 1417 can be greater than 90 degrees, while in at least one embodiment, the angle 1417 can be greater than approximately 90 degrees, but less than 180 degrees, for example.
[0221] [000221] In several modalities, in addition to the above, the first axis 1414 and the second axis 1416 can, in various modalities, be oriented, or crossed, at a transverse angle in relation to the other, that is, at least when the clamp 1400 is viewed from the side or elevation view of figure 83. More particularly, it is evident from the analysis of figure 85 that, although axes 1414 and 1416 extend in transverse directions when viewed from the side (figure 83), the axes 1414 and 1416 cannot, in at least one modality, actually cross with each other. In such embodiments, when viewing the clamp 1400 from above or below (figure 85), for example, axes 1414 and 1416 may extend in parallel, or at least substantially parallel, directions. In addition, in various embodiments, the reader will note that the first axis 1414 and the second axis 1416 are not perpendicular to baseline 1401. In other words, the end 1405 of the first leg of the clip 1404 and the end 1407 of the second leg of the clamp 1406 are not pointing directly downward towards base 1402 and baseline 1401. In at least one such embodiment, the first axis 1414 and the second axis 1416 may extend at an acute angle with respect to baseline 1401 , for example.
[0222] [000222] As described above, a surgical instrument can be configured to deform the clamp 1400 of figure 82, for example, between a non-deformed shape (figure 82) and a deformed shape (figure 83). In various embodiments, as also described above, the surgical instrument may comprise an anvil that has a staple pouch configured to receive and deform at least a portion of the staple. In certain embodiments, now with reference to figure 75, an anvil may comprise a contact surface with the fabric 1501 and a plurality of staple bags 1500 formed therein, each staple bag 1500 being configurable to deform a staple 1400. In various embodiments, each staple bag 1500 may comprise a longitudinal axis 1599 (figure 76) and, in addition, a first forming container 1502 and a second forming container 1504 positioned in relation to the longitudinal axis 1599. In use, the first forming container 1502 can be configured to receive the first clamp leg 1404 from clamp 1400 and the second training container 1504 can be configured to receive the second clamp leg 1406. More particularly, in at least one embodiment, the clamp pocket 1500 can be positioned in relation to the clamp 1400 so that when the clamp 1400 is ejected from a staple cartridge, for example, the end 1405 of the blade the first leg 1404 can enter the first training container 1502 and the end 1407 of the second leg 1406 can enter the second training container 1504. In addition to the above, the end 1405 of the first leg of the clip 1404 can contact the base 1506 of the first forming container 1502 so that the first compression force F1 can be applied to the first leg 1404 and, similarly, the end 1407 of the second leg of the clip 1406 can contact the base 1508 of the second forming container 1504 so that the second compression force F2 can be applied to the second leg 1406.
[0223] [000223] In various embodiments, in addition to the above, the first forming container 1502 may comprise an inner portion 1510 and an outer portion 1512, where, when the end 1405 of the first leg of the clamp 1404 enters the first forming container 1502 , the end 1405 can enter the outer portion 1512. Upon entering the outer portion 1512 of the forming container 1502, the end 1405 can contact the base 1506 and, due to the concave curve of the base 1506, the end 1405 can be directed inwards towards the inner portion 1510. More particularly, now with reference to figures 77 to 81, the base 1506 can be curved towards the surface of contact with the fabric 1501 so that, at the moment the leg of the staple 1404 enters in contact with the base 1506, the end 1405 can be directed downward, that is, away from the surface of contact with the fabric 1501, and inward along the curved concave surface towards a point d and inflection 1595. In several embodiments, inflection point 1595 can represent the point at which the concave surface of the base 1506 will begin to deflect the end 1405 of the first leg 1404 upward towards the surface of contact with the fabric 1501. In several modalities, the radius of curvature, r, of the concave surface can be constant, or at least substantially constant, in the longitudinal direction along its length, as shown in figures 80 and 81. In certain modalities, the radius of curvature r of the surface concave base 1506 can be consistent over the entire width of base 1506 between a first inner side wall 1516 and a first outer side wall 1517. In any case, as the end 1405 of the first leg 1404 is advanced to the inner portion 1510 of the container formation 1502, the end 1405 can come into contact with a transition radius 1514 positioned between the base 1506 and the first internal side wall 1516. In such modalities es, the transition radius 1514 can be configured to direct the end 1405 against the first inner side wall 1516.
[0224] [000224] As shown in figure 76, in addition to the above, the first internal side wall 1516 can be oriented at an angle with respect to the longitudinal axis 1599 of the staple bag. In certain embodiments, the first inner side wall 1516 can be oriented at an acute angle, such as 10 degrees, for example, with respect to the longitudinal axis 1599. In various embodiments, the first inner side wall 1516 and the longitudinal axis 1599 cannot be neither perpendicular nor parallel to each other. In any case, the first inner side wall 1516 can extend through the axis 1599 so that a first portion of the first inner side wall 1516 is positioned on a first side 1515 of the axis 1599 and a second portion of the first inner side wall 1516 is positioned on a second side 1517 of the axis 1599. In various embodiments, as a result, the first inner side wall 1516 can extend between the first outer portion 1512 and the first inner portion 1510. When the end 1405 of the first leg 1404 comes into contact with the first inner side wall 1516, as described above, the end 1405 can be directed along with the first inner side wall 1516 and away from the longitudinal axis 1599 so that the leg of the clip 1404 is flexed away from the common plane of the clip 1400 facing the first side 1515 of the axis 1599. As the end 1405 of the first leg 1404 is directed together with, or is flexed by, the first inner side wall 1516, as described above, the leg of the clip 1404 can also be directed or flexed by the base 1506. In other words, the first side wall 1516 and the first base 1506 can cooperate to deform the first leg of the clip 1404 so that the end 1405 is redirected towards the base 1402 and, simultaneously, to a first side of the base 1402, as described above. At some point during the insertion of the first leg of the clip 1404 into the first forming container 1502, the end 1405 of the first leg of the clip 1404 can emerge from the first inner portion 1510 of the first training container 1502 and, as the leg of the clip 1404 is, further deformed by the clamp pocket 1500, the end 1405 can be directed along the first axis 1414 (figure 83) as described above.
[0225] [000225] In several embodiments, in addition to the above, the first inner side wall 1516 can extend along the inner side of the first base 1506, and in at least one embodiment, the first forming container 1502 can additionally comprise a first external side wall 1517 extending along an opposite side of the first base 1506. In certain embodiments, similarly to the above, the first forming container 1502 may additionally comprise a transition radius 1519 positioned between base 1506 and outer side wall 1517. In at least one embodiment, now with reference to figure 76, the outer side wall 1517 may extend in a direction parallel, or at least substantially parallel, to the longitudinal axis 1599 of the staple bag. As also shown in figure 76, the first inner side wall 1516 and the first outer side wall 1517 can extend in directions that are transverse to each other. In at least one embodiment, the inner side wall 1516 can extend at an acute angle, such as, for example, approximately 15 degrees with respect to the outer side wall 1517. In various embodiments, as a result, the outer portion 1512 of the first container forming area 1502 can be wider than the inner portion 1510. In at least one such embodiment, the width of the outer portion 1512 and the inner portion 1510 may narrow between a first width and a second width.
[0226] [000226] In various embodiments, again referring to figure 76, the outer portion 1512 of the first forming container 1502 may comprise a first outer wall 1513 which may extend in a direction that is perpendicular to the first outer wall 1517 and / or the longitudinal axis 1599 and can define the outermost portion of the forming container 1502. In at least one embodiment, in addition to the above, the width of the first outer wall 1513 can be such that the outer portion 1512 can capture the end 1405 of the first leg 1404 and guide it into the inner portion 1510 of the container 1502, as described above. In at least one such embodiment, the first outer wall 1513 may be at least twice as wide as the diameter of the first leg 1404. In certain embodiments, the first forming container 1502 may additionally comprise a channeling surface 1528 surrounding the first portion inner 1510 and the first outer portion 1512, which can be configured to orient the leg of the clip 1404 into and / or out of the forming container 1502. In various embodiments, the inner portion 1510 can additionally comprise an inner wall 1511 that can define the deepest portion of the forming container 1502. Similar to the above, the inner wall 1511 can also define the narrowest portion of the forming container 1502. In at least one embodiment, the width of the inner wall 1511 can be equal , or at least substantially equal, to the diameter of the first leg 1404, so that the inner wall 1511 can control the place where the ex tremor 1405 emerges from the staple forming container 1502.
[0227] [000227] In various embodiments, in addition to the above, the second forming container 1504 may comprise an inner portion 1520 and an outer portion 1522, where, when the end 1407 of the second leg of clip 1406 enters the second forming container 1504 , the end 1407 can enter the outer portion 1522. Upon entering the outer portion 1522 of the forming container 1504, the end 1407 can contact the base 1508 and, due to the concave curve of the base 1508, the end 1407 can be directed inwardly towards the inner portion 1520. More particularly, in a manner similar to that described above, the base 1508 can be curved towards the surface of contact with the fabric 1501 so that, at the moment the leg of the clamp 1406 comes into contact with the base 1508, the end 1407 can be directed downward, that is, away from the surface of contact with the fabric 1501, and inward along the curved concave surface towards an inflection point 1596. In several embodiments, the inflection point 1596 can represent the point at which the concave surface of the base 1508 will begin to deflect the end 1407 of the second leg 1406 upwards towards the surface of contact with the fabric 1501. In several embodiments , the radius of curvature, r, of the concave surface can be constant, or at least substantially constant, in the longitudinal direction along its length, similarly to the base 1506 of the first forming container 1502, as shown in figures 80 and 81 In any case, as the end 1407 of the second leg 1406 is advanced to the inner portion 1520 of the forming container 1504, the end 1407 can come into contact with a transition radius 1524 positioned between the base 1508 and the second inner side wall 1526 In such embodiments, the transition radius 1524 can be configured to direct end 1407 against the second inner side wall 1526.
[0228] [000228] As shown in figure 76, in addition to the above, the second internal side wall 1526 can be oriented at an angle with respect to the longitudinal axis 1599 of the staple bag. In certain embodiments, the second inner sidewall 1526 can be oriented at an acute angle, such as 10 degrees, for example, with respect to the longitudinal axis 1599. In various embodiments, the second inner sidewall 1526 and the longitudinal axis 1599 cannot be neither perpendicular nor parallel to each other. In any case, the second inner side wall 1526 can extend through the axis 1599 so that a first portion of the second inner side wall 1526 is positioned on a first side 1515 of the axis 1599 and a second portion of the second inner side wall 1526 is positioned on a second side 1517 of the axis 1599. In various embodiments, as a result, the second inner side wall 1526 can extend between the second outer portion 1522 and the second inner portion 1520. When the end 1407 of the second leg 1406 comes into contact with the inner side wall 1526, as described above, the end 1407 can be directed along with the inner side wall 1526 so that the leg of the clip 1406 is flexed away from the common plane of the clip 1400 facing the first side 1517 of the axis 1599 As the end 1407 of the second leg 1406 is directed along with, or is flexed by, the inner side wall 1526, as described above, the leg of the clamp 1 406 can also be directed and flexed by the base 1508. In other words, the second inner side wall 1526 and the second base 1508 can cooperate to deform the second leg of the clip 1406 so that the end 1407 is redirected towards the base 1402 and simultaneously towards a second side, or opposite side, of the base 1402, as described above. At some point during the insertion of the second leg of the clip 1406 into the second forming container 1504, the end 1407 of the second leg of the clip 1406 can emerge from the second inner portion 1520 of the second training container 1504 and, depending on the leg of the clip 1406 is further deformed by the clamp pocket 1500, the end 1407 can be directed along the second axis 1416 (figure 83) as described above.
[0229] [000229] In several embodiments, in addition to the above, the second inner side wall 1526 may extend along the inner side of the second base 1508, and in at least one embodiment, the second forming container 1504 may additionally comprise a second outer side wall 1527 extending along an opposite side of the second base 1508. In certain embodiments, similarly to the above, the second forming container 1504 may additionally comprise a transition radius 1529 positioned between the base 1508 and the outer side wall 1527. In at least one embodiment, now with reference to figure 76, the outer side wall 1527 may extend in a direction parallel, or at least substantially parallel, to the longitudinal axis 1599 of the staple bag. As also shown in figure 76, the second inner side wall 1526 and the second outer side wall 1527 can extend in directions that are transverse to each other. In at least one embodiment, the inner side wall 1526 may extend at an acute angle, such as, for example, approximately 15 degrees with respect to the outer side wall 1527. In various embodiments, as a result, the outer portion 1522 of the second container forming area 1504 can be wider than the inner portion 1520. In at least one such embodiment, the width of the outer portion 1522 and the inner portion 1520 may narrow between a first width and a second width.
[0230] [000230] In various embodiments, again referring to figure 76, the outer portion 1522 of the second forming container 1504 may comprise a second outer wall 1523 that can extend in a direction that is perpendicular to the second outer wall 1527 and / or the longitudinal axis 1599 and can define the outermost portion of the forming container 1504. In at least one embodiment, in addition to the above, the width of the second outer wall 1523 can be such that the outer portion 1522 can capture the end 1407 of the second leg 1406 and guide it into the inner portion 1520 of container 1504, as described above. In at least one such embodiment, the second outer wall 1523 may be at least twice as wide as the diameter of the second leg 1406. In certain embodiments, the second forming container 1504 may additionally comprise a channeling surface 1529 surrounding the second portion inner 1520 and the second outer portion 1522, which can be configured to orient the leg of the clip 1406 into and / or out of the forming container 1504. In various embodiments, the inner portion 1520 may additionally comprise an inner wall 1521 that can define the deepest portion of the forming container 1504. Similar to the above, the inner wall 1521 can also define the narrowest portion of the forming container 1504. In at least one embodiment, the width of the inner wall 1521 can be equal , or at least substantially equal, to the diameter of the second leg 1406, so that the inner wall 1521 can control the place where the end ade 1407 emerges from the staple forming container 1504.
[0231] [000231] As discussed above, with reference again to figures 76 to 78, the first forming container 1502 may comprise a first inner side wall 1516 and a second forming container 1504 may comprise a second inner side wall 1526. As illustrated in the figure 76, the first inner portion 1510 of the forming container 1502 can be positioned in close proximity, or in close relationship, with the second inner portion 1520 of the forming container 1504 so that the first inner side wall 1516 can be positioned next to the second inner side wall 1526. In at least one embodiment, the first inner portion 1510, or at least a substantial portion thereof, can be displaced relative to the longitudinal axis 1599 of the staple pouch in the first direction 1515 while the second inner portion 1520 , or at least a substantial portion thereof, can be displaced with respect to longitudinal axis 1599 in the second direction 1 517. In various embodiments, the staple pouch 1500 may comprise a wall 1530 positioned between the first inner portion 1510 and the second inner portion 1520, the first side of the wall 1530 being able to comprise the first inner side wall 1516 and one being the second side of the wall 1530 may comprise the second internal side wall 1526. In at least one such embodiment, the first internal side wall 1516 can be parallel, or at least substantially parallel, to the second internal side wall 1526. More particularly, at least In one embodiment, the first inner side wall 1516 can define a first plane and the second inner side wall 1526 can define a second plane, the first plane and the second plane being parallel, or at least substantially parallel, to each other. In various embodiments, with reference again to figures 77 and 78, the first internal side wall 1516 can be perpendicular, or at least substantially perpendicular, to the contact surface with the fabric 1501 and, similarly, the second internal side wall 1526 can be perpendicular, or at least substantially perpendicular, to the tissue contact surface 1501.
[0232] [000232] In several embodiments, in addition to the above, the first inner side wall 1516 may comprise a first vertical portion 1516a that is perpendicular, or at least substantially perpendicular, to the contact surface with the fabric 1501. In at least one embodiment, the first vertical portion 1516a can extend across the longitudinal axis 1599 or cross it. In various embodiments, the first vertical portion 1516a can extend over all or just a portion of the first internal side wall 1516. Similarly, the second internal side wall 1526 can comprise a second vertical portion 1526a that is perpendicular, or at least substantially perpendicular, to the contact surface with the fabric 1501. In at least one embodiment, such a second vertical portion 1526a may extend through or cross the longitudinal axis 1599. In various embodiments, the second vertical portion 1526a can extend over all or just a portion of the second inner side wall 1526. During the implantation of the clamp 1400, in addition to the above, the end 1405 of the first leg 1404 can be in contact with the first vertical portion 1516a of the first inner side wall 1516, simultaneously, the end 1407 of the second leg 1406 is in contact with the second vertical portion 1526a of the second inner side wall 1526. Under these circumstances, the first vertical portion 1516a and the second vertical portion 1526a may comprise a vertical cavity. More particularly, the vertical portions 1516a and 1526a can cooperate to control, deflect, and tilt the legs of the clip 1404 and 1406 in opposite directions, that is, towards the sides of a common plane, as described above, when the legs 1404 and 1406 come into contact with the inner side walls 1516 and 1526 of the training containers 1502 and 1504, respectively. For example, again with reference to figure 75, the first vertical portion 1516a can be configured to deflect and tilt the leg of the clip 1404 to a first side of the base 1402 and the second vertical portion 1526a can be configured to deflect and tilt the leg of the clamp. clamp 1406 for a second side, or opposite side, of the base 1402.
[0233] [000233] In several modalities, in addition to the above, the vertical cavity comprising the vertical portions 1516a and 1526a can extend along the entire length of the first and second internal side walls 1516 and 1526, while, in other modalities, the cavity The vertical cavity can extend over only a portion of the side walls 1516 and 1526. In at least one embodiment, the vertical cavity can be approximately 0.13 cm (0.05 inches) in length, that is, the overlap of the first surface vertical 1516a and the second vertical surface 1526a can be approximately 0.13 cm (0.05 inches), for example, along the lengths of the inner surfaces 1516 and 1526. In various embodiments, the length of the vertical cavity can be between approximately 0.08 cm (0.03 inches) and approximately 0.25 cm (0.10 inches), for example. In certain embodiments, the length of the vertical cavity may be approximately twice the radius of curvature (r) of the curved concave surface of the base 1506, for example. In various embodiments, the length of the vertical cavity can be approximately equal to the radius of curvature (r) of the base 1506, for example. In at least one embodiment, the length of the vertical cavity can be between approximately 0.5 * r and approximately 2 * r, for example. In several embodiments, in addition to the above, the vertical cavity can extend beyond the longitudinal axis 1599 of the staple bag 1500 so that, in at least one embodiment, at least a portion of the vertical cavity can be positioned on a first side and / or a second side of the 1599 axis. In certain embodiments, the vertical cavity may extend through the central portions of the first and second forming vessels 1502 and 1504.
[0234] [000234] In various embodiments, the first internal side wall 1516 may additionally comprise a first inclined portion which, in at least one embodiment, can be oriented at an acute angle with respect to the contact surface with the fabric 1501. In at least one such an embodiment, the first inclined portion can be positioned outwardly with respect to the first vertical portion 1516a. In certain embodiments, the first inner sidewall 1516 may comprise an inclined portion positioned towards the outer portion 1512 which may progressively become more perpendicular to the inner portion 1510 of the first forming container 1502 until the inclined portion passes into the first vertical portion 1516a. In various embodiments, the second internal side wall 1526 may additionally comprise a second inclined portion which, in at least one embodiment, can be oriented at an acute angle with respect to the contact surface with the fabric 1501. In at least one such embodiment, the second inclined portion can be positioned outwardly with respect to the second vertical portion 1526a. In certain embodiments, the second inner sidewall 1526 may comprise an inclined portion positioned towards the outer portion 1522 which may progressively become more perpendicular to the inner portion 1520 of the second forming container 1504 until the inclined portion passes into the second vertical portion 1526a.
[0235] [000235] In various embodiments, now with reference to figure 85A, the clamp pocket 1500 can be configured to deform the first leg of the clamp 1404 so that the first end 1405 is deflected a first distance X1 from baseline 1401. Similarly, the second leg of the clamp 1406 can be deformed so that the second end 1407 is deflected a second distance X2 from baseline 1401. In certain embodiments, the distance X1 and the distance X2 can be equal, or at least least substantially the same. In several other modalities, the distances X1 and X2 can be different. In at least one such embodiment, the first leg 1404 can be deformed so that the first end 1405 is positioned closer to the base 1402 than the second end 1407, for example. In such embodiments, the first axis 1414 of the deformed clamp leg 1404 and the second axis 1416 of the deformed clamp leg 1406 may not be parallel. More particularly, in at least one embodiment, the first axis 1414 may extend at a first angle with respect to baseline 1401 and the second axis 1416 may extend at a second angle with respect to baseline 1401 with the second angle is different from the first angle. In various embodiments, the first leg 1404 and the second leg 1406 can extend beyond the midline 1403 at different angles. In certain other embodiments, the first leg 1404 and the second leg 1406 may extend at different angles with respect to baseline 1401 although one or both legs 1404 and 1406 may not extend beyond the midline 1403.
[0236] [000236] In several embodiments, in addition to the above, a surgical stapler may comprise a staple pouch that can be configured to deform a staple leg from staple 1400 so that it is located within, or substantially within, a common plane with the base 1402 and, in addition, deform the other leg of the clamp of the clamp 1400 to one side of the base 1402, as described above. In at least one embodiment, the first leg 1404 can be deformed so as to extend beyond the midline 1403 in a direction that is coplanar, or at least substantially coplanar, with the base 1402 and, in addition, the second leg 1406 can be deformed so as to extend beyond the midline 1403 in a direction that is transverse to the plane. In other words, in at least one embodiment, axis 1414 and baseline 1401 of clip 1400 can be coplanar, or at least almost coplanar, with each other, while the second axis 1416 can extend in a direction that follows through of a plan. In certain embodiments, at least one of the first leg 1404 and the second leg 1406 may not extend beyond the midline 1403.
[0237] [000237] In various embodiments, in addition to the above, the clamp pocket 1500 can be configured to deform the legs of clamp 1404 and 1406 of clamp 1400 simultaneously, or at least substantially simultaneously. In at least one embodiment, the base 1506 of the first forming container 1502 can contact the end 1405 of the first leg of the clip 1404 at the same time, or at least substantially at the same time, as the base 1508 of the second forming container 1504 comes into contact with the end 1407 of the second leg of the clip 1406. In certain other embodiments, a pocket for the clips can be configured to deform the legs of the clip 1404 and 1406 sequentially. In at least one such embodiment, a first forming container can be brought into contact with the first leg of the clip 1404 before a second forming container is brought into contact with the second leg of the clip 1406, for example. In various alternative embodiments, although not shown, a surgical clamp can comprise more than two legs of the clamp, such as, for example, three legs of the clamp or four legs of the clamp and a pocket for clamps can comprise a corresponding amount of training containers clamp to deform the clamp legs.
[0238] [000238] In several embodiments, in addition to the above, the wire comprising the surgical clamp 1400 may comprise a circular, or at least substantially circular, cross section. In various other embodiments, now with reference to figures 86 to 89, a surgical clamp, such as clamp 1600, for example, can comprise a non-circular cross section. In at least one embodiment, the clamp 1600 may comprise a base 1602, a first leg 1604 and a second leg 1606, the base 1602 and legs 1604 and 1606 being able to consist of a continuous wire. In various embodiments, the continuous yarn may comprise a rectangular cross section, for example. In at least one embodiment, with reference to figure 89, the rectangular cross section can comprise a base (b) and a height (h), the base (b) being defined in relation to a central lateral axis (x) , and the height (h) can be defined in relation to a central longitudinal axis (y). In various circumstances, the rectangular cross section can be defined as having two moments of inertia, that is, a first moment of inertia (Ix) defined with respect to the axis (x) and a second moment of inertia (Iy) defined with respect to the (y) axis. In at least one circumstance, the first moment of inertia (Ix) can be calculated as (b * h ^ 3) / 12 while the second moment of inertia (Iy) can be calculated as (h * b ^ 3) / 12. Although the clamp 1600 comprises a rectangular, or at least substantially rectangular, cross section, any other suitable non-circular cross section can be used, such as, for example, oblate, elliptical and / or trapezoidal cross sections.
[0239] [000239] As illustrated in figure 89, the base (b) of surgical clamp 1600 is greater than the height (h) and, in view of the above, the moment of inertia (Iy) of the rectangular cross section is greater than the moment of inertia (Ix). In various modalities, as a result, the ratio of the moment of inertia, that is, Iy / Ix, of the rectangular cross section can be greater than 1.0. In certain embodiments, the ratio of the moment of inertia can be between approximately 2.0 and approximately 2.7, for example. In certain other embodiments, the ratio of the moment of inertia can be between approximately 1.1 and approximately 3.0, for example. As a result of this, the leg 1604 is more likely to bend on the axis (x) than on the axis (y) when a force, such as the compression load F1, for example, is applied to the leg 1604. case, excluding all other considerations, the leg 1604, in such modalities, is more likely to bend within a common plane defined by clamp 1600 when it is in its undeformed state than to bend to one side of the base of the clamp 1602. In several modalities, however, a surgical stapler comprising an anvil and a staple pouch according to the modalities described here, such as the staple pouch 1500, for example, can be used to make legs 1604 and 1606 of the clamp 1600 to bend out of its common plane when deformed. In such modalities, this lateral deflection can occur despite the fact that the moment of inertia Iy, which resists this deformation, is greater than the moment of inertia Ix. As shown in figure 88, the first leg 1604 of clamp 1600 can be deformed so as to bend with respect to both the (x) and (y) axes of its cross section and, as a result, the first leg of clamp 1604 it can be twisted or deformed so that the end 1605 of the first leg of the clip 1604 is positioned on a first side of the base 1602. Similarly, the second leg 1606 can be deformed so as to bend in relation to both axes (x ) and (y) of its cross section and, as a result, the second leg of the clip 1606 can be twisted or deformed so that the end 1607 of the second leg of the clip 1606 is positioned on a second side of the base 1602.
[0240] [000240] In various embodiments, now with reference to figure 90, a surgical clamp, such as surgical clamp 1700, for example, can comprise a base 1702 and, in addition, a first leg 1704, and a second leg 1706 extending from base 1702. In certain embodiments, similarly to the above, base 1702, first leg 1704, and second leg 1706 can be located, or at least substantially located, in a common plane when clamp 1700 is in a non-deformed, or non-implanted configuration, that is, a configuration before being deformed by an anvil of a surgical stapler, for example. In the deformed or dispensed configuration of the clamp 1700, as shown in figure 90, the first leg 1704 can be deformed so that the end 1705 points to the base 1702 and the second leg 1706. More particularly, in at least one embodiment, the end 1705 can be located along, or with respect to, a first axis 1714 which is oriented at an angle to the midline 1703. Similarly, the second leg 1706 can be deformed so that the end 1707 points to the base 1702 and for the first leg 1704. More particularly, in at least one embodiment, the end 1707 can be located along, or with respect to, a second axis 1716 which is oriented at an angle with respect to the midline 1703. In In various embodiments, the ends 1705 and 1707 of the legs 1704 and 1706 may not cross the midline 1703. In certain embodiments, similarly to the above, the 1705 end of the first leg 1704 may be deformed to fit extend to a first side of the base 1702 and the end 1707 of the second leg 1706 can be deformed so as to extend to a second side, or opposite side, of the base 1702 so that the legs 1704 and 1706 are not completely positioned in the same plane base 1702 in its deformed configuration, for example.
[0241] [000241] In various embodiments, a surgical clamp, such as clamp 1800 (figure 91), for example, can comprise a base 1802, a first leg 1804, and a second leg 1806, with clamp 1800 being able to comprise a substantially configuration U-shaped in its undeformed, or not implanted configuration. In at least one such embodiment, legs 1804 and 1806 may extend in a perpendicular direction, or at least substantially perpendicular, with respect to base 1802. In various circumstances, clamp 1800 may be deformed into a B-shaped configuration, as shown in figure 91. In at least one such embodiment, the first leg 1804 can be curved downwardly towards the base 1802 so that the axis 1814 extending through the end 1805 is perpendicular, or at least substantially perpendicular, to the line base 1801. Similarly, the second leg 1806 can be curved downwards towards base 1802 so that the axis 1816 extending through the end 1807 is perpendicular, or at least substantially perpendicular, to the base line 1801. In at least in such a circumstance, the legs 1804 and 1806 can be curved so that the axes 1814 and 1816 are parallel, or at least substantially parallel, to each other. In various embodiments, again with reference to figure 91, the legs of the clamp 1804 and 1806 can be deformed so as not to cross the central line 1803. The legs of the clamp 1804 and 1806 can be deformed so as to remain in the same plane, or at least substantially on the same plane as the base 1802.
[0242] [000242] Several examples described below are provided, which incorporate one or more aspects of the various modalities described above. Such examples are exemplary and various aspects of the various modalities described in this application can be combined into a single embodiment. In each of the examples described below, the surgical clamp may comprise a base that defines a base line, a first leg and a second leg extending from the base, and a midline between the first leg and the second leg . Example 1
[0243] [000243] A surgical clamp can be deformed so that:
[0244] [000244] A surgical clamp can be deformed so that:
[0245] [000245] A surgical clamp can be deformed so that
[0246] [000246] A surgical clamp can be deformed so that
[0247] [000247] A surgical clamp can be deformed so that
[0248] [000248] Several of the deformed staples described above comprise one or more staple legs that cross the midline of the staple base. In various embodiments, as a result, the deformed clip legs can overlap, at least partially. More particularly, the deformed clip legs, when viewed from the side, can cooperate to traverse the base of the clip from one end to the other without leaving gaps between them. Such modalities can be particularly useful, especially when used to staple vascular tissue. More specifically, the overlapping legs of the clamp can compress the blood vessels within the tissue regardless of where the blood vessels extend through the clamp. Staples that have gaps between the legs, or legs that do not extend the entire length of the staple base when deformed, may not be able to adequately compress all blood vessels in the tissue and, as a result, one or more vessels blood vessels may leak.
[0249] [000249] In several modalities, in addition to the above, a surgical instrument can be configured to dispense a plurality of staples 1400 in the manner described above and illustrated in figures 83 to 85. In at least one embodiment, the surgical stapler can dispense with staples 1400 in a sequential manner along a staple path and / or in a simultaneous manner, for example. In certain embodiments, a surgical instrument can be configured to dispense a plurality of staples 1600 in the manner described above and illustrated in figure 88. In at least one embodiment, similar to the above, the surgical stapler can dispense with staples 1600 of a sequential shape along a staple path and / or in a simultaneous manner, for example. In various embodiments, in addition to the above, a surgical instrument can be configured to dispense a plurality of staples 1700 in the manner described above and illustrated in figure 90. In at least one embodiment, the surgical stapler can dispense with staples 1700 in a manner sequentially along a staple path and / or in a simultaneous manner, for example.
[0250] [000250] In various embodiments, now with reference to figures 103 to 108, a surgical stapling instrument 2100 may comprise, similarly to the above, a first portion of compartment 2102 and a second portion of compartment 2104 that can be connected functionally to each other by a latch 2180. Latch 2180 can comprise a frame 2184 that can be pivotally mounted to a frame 2110 of the first portion of compartment 2102. In use, latch 2180 can be configured to interconnect a frame 2114 of the second compartment portion 2104 and pull the second portion of compartment 2104 towards the first portion of compartment 2102 and move the anvil holder portion 2130 of the second portion of compartment 2104 towards the staple cartridge holder portion 2124 of the first portion of the compartment 2102. In several embodiments, the first portion of compartment 2102, the second portion of compartment 2104, eat rava 2180 can each comprise one or more external compartments with contours or gripping portions, for example. In at least one such embodiment, the first portion of compartment 2102 may comprise an external compartment 2108, the second portion of compartment 2104 may comprise an external compartment 2112, and lock 2180 may comprise an external compartment 2186. Surgical stapling instrument 2100 it may additionally comprise a staple unloading actuator 2204 which can, similarly to the above, be selectively positioned on opposite sides of the surgical stapling instrument. More particularly, in addition to the above, the actuator 2204 can be selectively positioned on a first side of the portions of the housing 2102, 2104 so that the actuator 2204 can be moved distally along the first side or selectively positioned on a second side of the portions compartment 2102, 2104 so that actuator 2204 can be moved distally along the second side. In at least one embodiment, the first portion of compartment 2102 and the second portion of compartment 2104 can define one or more slots 2118 with each other which can allow actuator 2204 to be moved along the first and second sides. In at least one such embodiment, slots 2118 can be connected by an intermediate slot 2331 which can extend around and / or through the proximal end of the surgical stapling instrument 2100.
[0251] [000251] In addition to the above, referring to figures 103 to 111, the clip unloading actuator 2204 can be installed in a rotating manner to a 2220 actuating bar, and in at least one mode, the actuator 2204 can be installed in a rotating manner to the actuation bar 2220 through a connection connection 2206. With reference mainly to figures 109 to 111, the actuator 2204 can be rotated between an intermediate position, or neutral (figure 109) in which the actuation bar 2220 is locked in position and cannot be advanced distally and an unlocked position (figure 110) in which the actuation bar 2220 and actuator 2204 are ready to be fired distally. Although figure 110 illustrates the actuator 2204 in an unlocked position on the first side of the surgical stapling instrument compartment, the actuator 2204 can also be moved to an unlocked position on the second side or opposite side of the surgical stapling instrument compartment. The following example, although discussed with respect to actuator 2204 being moved along the first side of the compartment, also applies with respect to actuator 2204 being moved along the second side of the compartment. In any case, the actuator 2204 and the first portion of the housing 2102, for example, may comprise various interlocking elements that can prevent, or at least limit, the relative movement between the actuation bar 2220 and the first portion of the housing 2102. More particularly, in at least one embodiment, the first portion of compartment 2102 may comprise one or more slits and / or one or more projections that can be configured to cooperate with one or more slits and / or one or more projections of actuator 2204 of so that the actuation bar 2220 is not advanced distally until the actuator 2204 has been sufficiently rotated out of its neutral position and to an unlocked position. In various embodiments, the proximal end of the first portion of housing 2102 may comprise an end column 2107 which may include a retaining slot 2213 configured to receive at least a portion of the actuator connection 2206 therein, such as retaining projection 2214. When actuator 2204 is in its neutral position, retaining projection 2214 is positioned in retaining slot 2213 and neither actuator 2204 nor actuator bar 2220 can be advanced distally. When the actuator 2204 is rotated towards an unlocked position, the retaining projection 2214 can move out of the retaining slot 2213 in the end column 2107 and into a receiving slot 2215 in the actuation bar 2220 as shown in the figure 110. In at least one embodiment, the actuator bar 2220 and actuator 2204 can remain in a locked condition until the retaining projection 2214 has completely exited the retaining slot 2213. Thereafter, the actuator 2204 can be advanced distally. In addition to or instead of the above, the end column 2107 may additionally comprise a retaining wall 2211 which can, similarly to the above, prevent distal movement of the actuator 2204 and the actuation bar 2220. More particularly, the connection of the actuator 2206 can additionally comprise a retaining projection 2216 which can be positioned behind, or distally with respect to the retaining wall 2211 when the actuator 2204 is in its neutral position and, due to such alignment, the retaining wall 2211 can provide a support surface that prevents distal movement of the retention projection 2216. Once the actuator 2204 has been rotated sufficiently out of its neutral position towards an unlocked position, the retention projection 2216 can be moved to a position in the channel 2217 which is out of longitudinal alignment with the retaining wall 2211, thus allowing relative longitudinal movement between them.
[0252] [000252] As described above, once actuator 2204 has been moved to an unlocked position (figure 110), actuator 2204 can be moved distally to a triggered position (figure 111). In these cases, now with reference to figure 106, a force can be applied to the actuator 2204 in order to advance the actuation bar 2220 distally and cut the fabric and / or implant the staples from a staple cartridge, as described above. In these cases, the force can rotate and seat the 2204 actuator in a fully implanted position, or at least almost completely implanted. In at least one embodiment, the drive bar 2220 may comprise one or more stops, such as stops 2221 (Fig. 111), for example, which can limit the rotation of actuator 2204 in the distal direction. In at least one such embodiment, the actuation bar 2220 may comprise a first stop 2221 configured to limit the rotation of the actuator 2204 towards the first side of the instrument and a second stop 2221 configured to limit the rotation of the actuator towards the second side of the instrument. In certain embodiments, with reference to figure 106, the stops 2221 can be configured so that the actuator 2204 is positioned along a perpendicular axis, or at least substantially perpendicular, to a longitudinal axis 2299 of the surgical stapling instrument 2100. Such The position of actuator 2204 is also illustrated in figure 104. Now with reference to figure 107, a force can be applied to actuator 2204 in order to retract actuator 2204 proximally. In these cases, the force can cause the actuator 2204 to rotate proximally until it comes in contact with the first portion of compartment 2102 and / or with the second portion of compartment 2104. Such position of actuator 2204 is also illustrated in figure 105, being that actuator 2204 can be positioned against rail lock 2131 and / or rail lock 2132, for example, in order to avoid any further rotation of actuator 2204.
[0253] [000253] In several embodiments, as described above, lock 2180 can be used to lock the first portion of compartment 2102 and the second portion of compartment 2104 together. In certain embodiments, actuator 2204 can be used to limit the relative movement between portions of compartment 2102, 2104 and / or to move portions of compartment 2102, 2104 towards each other. In at least one embodiment, with respect mainly to figures 103, 104, and 108, actuator 2204 can comprise a recess, or channel, 2130 that can be configured to receive rail locks 2131 and 2132 when actuator 2204 is moved along the first side of the surgical stapling instrument 2100 or, alternatively, receive the rail locks 2133 and 2134 when the actuator 2204 is moved along the second side of the surgical stapling instrument 2100. In any case, the recess 2130 can be configured to capture an opposite set of tracks, such as tracks 2131 and 2132, for example, and prevent, or at least limit, the relative movement between them. More particularly, in at least one embodiment, the recess 2130 may comprise a first support surface 2135 positioned opposite the first rail lock 2131 and a second support surface 2136 positioned opposite the second rail lock 2132 so that the support surfaces 2135, 2136 can prevent, or at least limit, the movement of the first portion of compartment 2102 and the second portion of compartment 2104 moving away from each other. In some cases, there may be gaps between the support surfaces 2135, 2136 and the rail locks 2131, 2132, respectively, when the support surfaces 2135, 2136 are in a position adjacent to the rail locks 2131, 2132 while, in other circumstances , the support surface 2135 can contact the rail lock 2131 and / or the support surface 2136 can contact the rail lock 1232, for example. In use, in various circumstances, the actuator 2204 can be moved from its neutral position (figure 109) to its unlocked position (figure 110) and, in such a position, the recess 2130 can be aligned with a set of rails 2131,2132 or a set of rails 2133, 2134 depending on whether the actuator 2204 has been rotated to the first or second side. When actuator 2204 is advanced distally, in some cases, actuator 2204 may come into contact with the rails and cam, or direct the rails towards each other. In such circumstances, the first portion of compartment 2102 and the second portion of compartment 2104 may be provided with a cam, or directed towards each other.
[0254] [000254] In various embodiments, as described above, actuator 2204 can receive, capture, and / or interconnect a rail lock extending from each of the first portion of compartment 2102 and the second portion of compartment 2104. In various alternative embodiments, actuator 2204 can be configured to receive, capture, and / or engage two or more rail locks extending from the first portion of compartment 2102 and / or the second portion of compartment 2104. In certain embodiments, the first portion of compartment 2102 and / or the second portion of compartment 2104 may comprise one or more locking channels that can be configured to receive at least a portion of the actuator. In various embodiments, the compartment portions and the actuator of the surgical stapling instrument can comprise any suitable locking portions that can be configured to receive, align, retain, capture, lock, move, cam rotate, and / or limit movement of the portions of the surgical instrument compartment. In various modes, with reference mainly to figures 106 and 107, the rail locks 2131, 2132, 2133, and / or 2134 can extend longitudinally along the stapling instrument 2100 so that, in at least one mode, they meet extend in a longitudinal direction from the proximal end of the surgical stapling instrument 2100 towards the distal end of the instrument which is parallel, or at least substantially parallel, to the longitudinal axis 2299. In addition, in at least one mode, the rail 2131,2132, 2133, and / or 2134 can extend in parallel directions, or at least substantially parallel, to each other.
[0255] [000255] In several modalities, in addition to the above, a surgical clamp can consist of titanium, such as titanium wire, for example. In certain embodiments, a surgical clamp may consist of an alloy comprising titanium, aluminum, and / or vanadium, for example. In at least one embodiment, the surgical clamp may consist of surgical stainless steel and / or an alloy comprising cobalt and chromium, for example. In any case, the surgical clamp can consist of metal, such as titanium, and an external surface of metal oxide, such as titanium oxide, for example. In various embodiments, the outer surface of metal oxide can be coated with a material. In certain embodiments, the coating material may consist of polytetrafluoroethylene (PTFE), such as Teflon®, and / or tetrafluoroethylene (TFE) such as ethylene-tetrafluoroethylene (ETFE), perfluroralcoxyethylene-tetrafluoroethylene (PFA), and / or fluorinated ethylene (FFA) FEP), for example. Certain coatings may comprise silicon. In various embodiments, such coating materials can prevent, or at least inhibit, further oxidation of the metal. In certain embodiments, the lining materials may provide one or more slippery surfaces against which the anvil, or staple pockets, may come into contact with the staples in order to reduce the frictional force between them. In many circumstances, lower frictional forces between the clamps and the clamp pockets can reduce the force required to deform the clamps.
[0256] [000256] The devices described here can be designed to be discarded after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, the device can be disassembled, in any number of particular parts or parts of the device can be selectively replaced or removed, in any combination. When cleaning and / or replacing particular parts, the device can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will appreciate that the reconditioning of a device can use a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting reconditioned device, are all within the scope of the present patent application.
[0257] [000257] Preferably, the present invention described here will be processed before surgery. First, a new or used instrument is obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK pouch. The container and the instrument are then placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays or high-energy electrons. The radiation kills bacteria on the instrument and the container. The sterile instrument can then be stored in a sterile container. The sterile container keeps the instrument sterile until it is opened at the medical facility.
[0258] [000258] 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 will cover any variations, uses or adaptations of the invention with the use of its general principles. In addition, this application is intended to cover such changes to the present description, in accordance with known or customary practice in the technique to which this invention belongs.

权利要求:
Claims (6)
[0001]
Surgical stapling instrument (2100), comprising: a first side; a second side; a first compartment element (2102), comprising: a first proximal end portion; a first distal end portion; a staple cartridge attachment portion (2124) configured to operationally support a staple cartridge; and a first longitudinal lock portion (2131) extending from the first proximal end portion towards the first distal end portion; a second compartment element (2104), comprising: a second proximal end portion; a second distal end portion; a claw element (2130) configured to operably support an anvil configured to deform staples positioned from the staple cartridge; and a second longitudinal lock (2132) extending from the second proximal end portion towards the second distal end portion; a trigger bar (2220) configured to move a staple driver in relation to the fixing portion of the staple cartridge (2124) and a claw element (2130); and an actuator configured to receive a force on it, the actuator being configured to be moved between a first position and a second position, the actuator being configured to be moved along the first side when the actuator is in the first position, the actuator being configured to be moved along the second side when the actuator (2204) is in the second position, and the actuator (2204) additionally comprises at least a portion of the actuator lock configured to be aligned with the first longitudinal lock portion (2131) and the second longitudinal lock portion (2132); characterized by the fact that at least one locking portion of the actuator comprises a first support surface (2135) configured to engage the first longitudinal lock portion (2131) and a second support surface (2136) configured to engage the second portion of longitudinal lock (2132) and where the first support surface (2135) and the second support surface (2136) are configured to drive the first compartment element (2102) and the second compartment element (2104), one in direction to the other when the actuator (2204) is advanced distally.
[0002]
Surgical stapling instrument according to claim 1, characterized by the fact that the first longitudinal lock portion (2131) and the second longitudinal lock portion (2132) extend from the first side, in which at least a portion actuator locking mechanism is configured to receive the first longitudinal locking portion (2131) and the second longitudinal locking portion (2132) when the actuator (2204) is in the first position, where the first housing element (2102) still comprises a third longitudinal lock portion (2133) extending from the second side, wherein the second compartment element (2104) still comprises a fourth longitudinal lock portion (2134) extending from the second side, and in which at least one locking portion of the actuator is further configured to be aligned with the third locking portion (2133) and the fourth locking portion (2134) when the actuator (2204) is in the second position to.
[0003]
Surgical stapling instrument, according to claim 1, characterized by the fact that the first portion of the longitudinal lock (2131) comprises a first rail lock that extends along a longitudinal axis of the surgical instrument (2100); the second longitudinal lock portion (2132) comprises a second rail lock that extends along the longitudinal axis; and the locking portion of the actuator comprises at least one rail lock receiver configured to receive the first rail lock and the second rail lock.
[0004]
Surgical stapling instrument, according to claim 3, characterized in that the first rail lock and the second rail lock extend from the first side, in which at least one rail lock receiver is configured to receive the first rail lock and the second rail lock when the actuator is in the first position, wherein said first compartment element (2102) additionally comprises a third rail lock extending from the second side, wherein the second compartment element (2104) further comprises a fourth rail lock extending from the second side, and wherein at least one rail lock receiver is configured to receive the third rail lock and the fourth rail lock when the actuator is in the second position.
[0005]
Surgical stapling instrument, according to claim 1 or 3, characterized by the fact that it still comprises, the anvil.
[0006]
Surgical stapling instrument, according to claim 3 or 5, characterized by the fact that it still comprises the staple cartridge.

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同族专利:

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EP2603149B1|2019-03-13|

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CA2808084C|2019-01-08|

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EP3513743A1|2019-07-24|

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公开号 | 申请日 | 公开日 | 申请人 | 专利标题

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法律状态:
2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-09-10| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-06-09| B06A| Notification to applicant to reply to the report for non-patentability or inadequacy of the application [chapter 6.1 patent gazette]|

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

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2021-02-17| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 11/08/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US12/855,351|2010-08-12|

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US12/855,351|US8453908B2|2008-02-13|2010-08-12|Surgical stapling instrument with improved firing trigger arrangement|

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PCT/US2011/047353|WO2012021671A1|2010-08-12|2011-08-11|Surgical stapling instrument with improved firing trigger arrangement|

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