surgical stapling method and device

专利摘要:
METHOD AND SURGICAL STAPLING DEVICE.A surgical stapling device comprises a first jaw, a second jaw having an open position and a closed position in relation to the first jaw, a carriage, a controller, and an actuator configured to reciprocally drive at a high rate in relation to the first and second mandula-bull to translate the carriage with respect to the first and second jaws.
公开号:BR112013020443A2
申请号:R112013020443-5
申请日:2012-01-13
公开日:2020-08-11
发明作者:Michael P. Whitman；David Johnston；Peter Datcuk
申请人:New Hope Ventures；
IPC主号:

专利说明:

Described Report of the Invention Patent For: “METHOD AND DEVICE FOR SURGICAL CLAMPING”.
Cross Reference for Related Orders This order claims the benefit of US Provisional Patent Order 5 Serial No. 61 / 461,196, filed on January 14, 2011, which is expressly incorporated herein in its entirety as a reference.
Field of the Invention The present invention relates to a surgical stapling method and device.
Background of the invention Some surgical procedures require the tissue to be sectioned and closed. This is often the case in gastrointestinal tract surgery, when a tumor or lesion in the tract occurs. Usually transections proximally and distally are made on opposite sides of the injured section or tumor. For example, a tumor located in a patient's colon can be removed by transecting at two points on the proximal side of the tumor and then a second transection on the distal side of the tumor. Thus, the section of abnormal tissue can be removed, leaving two remaining members of the colon, which are then anastomosed or rewired. Since the surrounding tissues, exposing themselves to the contents of the interior of the colon or other organ, can greatly increase the risk of infection and associated complications, it is desirable that the remaining limbs remain closed until the limbs are anastomosed or brought together.
5 A linear cutter is a surgical device that staples tissues, typically between two opposite jaws, and staples and cuts the fixed tissue. Some devices include a stapling mechanism, which leads the staple lines to the fabric, typically before or simultaneously with the cut. These rows of staples serve to cut across and close the open ends of the cutting organ, thereby limiting the exposure of the surrounding tissue to the contents of the organ.
Advantageously one or more rows of staples are driven on each side of each cut.
In the stapling processes described above, staples are typically driven with a staple impeller arranged in one of the stapling jaws. The staple impeller forms the staples by pressing the staples from the first stapling jaw, into and through the attached fabric, and on an anvil in the opposite stapling jaw configured to bend or otherwise form the staple closure. In order to effectively staple the fabric, it is advantageous to fix the fabric, so that a small thickness, for example, a millimeter, is arranged between the two stapling jaws. To achieve this result, the stapling jaws must exert and maintain a substantial amount of the stapling force 5. A difficulty can arise when the clamps are then guided to the stapled tissue, as the time taken to clamp one jaw on an anvil on the other jaw applies a force between the jaws, which is opposite the force of stapling. Thus, during stapling, even more stapling force is required to be exerted by the stapling jaws. That is, the stapling jaws must apply sufficient force to maintain distance, both from the desired tissue between the jaws and to form the staples in their staple configuration. High stapling forces can be problematic as the proximally supported jaws can deflect or taper out, thus making it difficult to achieve a uniform tissue opening along the length of the jaws.
U.S. Patent No. US 4,520,817 describes a mechanism for potentially alleviating the aforementioned problems by providing a staple and cutting pusher transport block with a plurality of side projections that mount in grooves in opposite jaws according to the cutter and pusher are moved distally. These projection / groove couplings can assist in maintaining a clamping force by providing local support between the jaws in the clamp impeller region. However, a substantial amount of distally directed force must be applied to the stapler impeller in order to cut the fabric at the same time, press and form the staples and overcome additional resistance due to the projection / groove arrangement. Since the device of US Patent No. US 4,520,817 is a portable unit that requires full access to the surgery site, the operator is able to manually apply substantial force, pushing a button, in a location that is very close to the jaws.
Some of the aforementioned procedures can be performed endoscopically, which is generally less invasive and allows for faster healing compared to open surgery, which may require large incisions to allow the necessary access to use manual surgical instruments. Endoscopic procedures typically involve the insertion of instruments, through a small incision point, for example, through a cannula. The surgical instruments required to perform these procedures have generally elongated shafts that extend from a handpiece or other base unit to a final effector.
The end effectors of endoscopic surgical instruments are commonly referred to as the "final activity" of the instrument. They contain components, such as fasteners, which are often in the form of surgical clamps. These final effectors can transect, form anastomoses, and occlude viscera and vessels in the human body.
Since the final effectors and shaft have relatively small diameters, the final effector and shaft can be inserted through a cannula to perform the procedure, while the operator controls the instrument from outside the surgical site. A drawback of such devices is that they generally require the transfer of the mechanical force generated manually by the operator from the handpiece or base to the acting end. This is achieved by drive shafts, rods, cables and the like, which extend through the shaft. The transfer of force through these mechanisms results in substantial energy losses and makes precise control extremely difficult. In addition, these disadvantages can be amplified in systems using flexible axes.
Due to the mechanical deficiencies of these endoscopic instruments, the projection / groove arrangement of U.S. Patent No. US 4,520,817, which requires a substantial amount of distally applied manual force 5 to drive the staple impeller and a cutter, and is not quite suitable for endoscopic end effectors. U.S. Patent No. US 4,520,817 discloses a portable unit that requires full access to the surgical site, through which the operator is able to apply substantial force, pushing a button, in a location that is very close to the jaws. This is not feasible for endoscopic or natural orifice procedures, which are inherently superior procedures for opening and / or endoscopic procedures, due to trauma to the patient and minimizing operating room time.
Thus, there is a need for devices and methods that provide better energy transmission to the final effector. In addition, there is a need for devices and methods that provide improved attachment to a final effector. In addition, for surgical instruments where a final effector is connected to a flexible shaft, the difficulty of effectively transferring force to the final effector through the flexible shaft is not known. In this regard, an effective flexible stapler allows surgeons to use natural orifices or an umbilical approach to surgery. An effective flexible shaft stapler would allow advances in surgery through a single-door approach that would lead to 5 reduction in pain, elimination of incisions, and reduced operating time for the patient.
In addition, many surgical staplers use drive mechanisms that use a band unit, which is most often manually operated.
These manually operated devices require an operator to manually pull a lever to deliver a one-to-one stroke or to manually pull a trigger repeatedly to achieve a desired performance. Such devices depend on the force applied by the operator (for example, a force between the operator's fingers and thumb) for actuation. In this regard, there is a need for a device that does not require a drive band and is powered by other means of manual manipulation.
Summary of the Invention Examples of embodiments of the present invention use a reciprocating drive mechanism, which allows the transfer of force from a control set to a final effector, eliminating the need for a band unit together.
Examples of embodiments of the present invention improve the input / output ratio of known drive mechanisms one-by-one. Instead of providing 5 for a one-to-one stroke or a mechanism that requires manually pulling a trigger several times to achieve the same effect as a single full stroke, as, for example, modalities of the present invention provide a trigger mechanism oscillating. The oscillating mechanism can operate at high speed and receives input and output from a piston inside a cylinder, which moves back and forth quickly. Since this power input / output is achieved hydraulically, no manual input is required and the forces generated are greater than manual devices. Once the distance crossed by this back and forth is reached with a certain distance, the movement can be less and, in some cases, substantially less, at a relative distance that must be covered in order to activate the final effector. of a given surgical device, in particular, manually operated devices.
Examples of embodiments of the present invention can have one or more alternative pistons, which can perform one or more discrete steps of activating the surgical instrument. In this regard, an alternative piston can move back and forth quickly, at a distance of less than 100% of the intended stroke, either by a clamping mechanism 5 or firing characteristic in any given example of surgical device.
According to the exemplary embodiment of the present invention, a surgical apparatus comprises a first jaw, a second jaw that has an open position and a closed position with respect to the first jaw, a carriage, a controller, and an actuator configured to match the driver , for example, at a high rate in relation to the first and second jaws to translate the carriage in relation to the first and second jaws.
The drive can be hydraulically. In addition, hydraulic actuation may include the transfer of hydraulic force from a control module to an acting end. The transfer of hydraulic force can be provided by a hydraulic fluid arranged on a flexible shaft.
The drive can include an actuation bar.
The actuation bar may include a first plurality of ratchet teeth selectively engaged with the carriage in order to translate the carriage in a first direction.
The drive bar may include a second plurality of ratchet teeth selectively engaged with the carriage, in order to translate the carriage in a second direction.
The first direction can be a distal direction in relation to the first and second jaws and the second direction can be in a proximal direction in relation to the first and second jaws.
The carriage may include a first plurality of teeth configured for ratchet transport with the first series of ratchet teeth, when the actuation bar is engaged with the carriage in order to translate the carriage in the first direction.
The carriage may include a second plurality of ratchet-shaped carriage teeth with the second set of ratchet teeth, when the actuation bar is engaged with the carriage in order to translate the carriage in the second direction.
The carriage may include a bi-directional retaining spring mechanism, for example, a tongue, configured for ratchet with the first set of ratchet teeth, when the actuation bar is engaged with the carriage in order to translate the carriage in the first direction, and ratchet with the second set of ratchet teeth, when the actuation bar is engaged with the carriage in order to translate the carriage in the second direction. This arrangement has the advantage of providing a complete tooth between the tongue and the first and second sets of ratchet teeth, and preventing lateral loading of the carriage. In addition, the interruption of the carriage movement from the distal direction to the proximal direction requires no user action, and a minimum of mechanical action, such as the loading spring, causes the bidirectional locking mechanism to display its coupling with the first set of ratchet teeth to the second set of ratchet teeth. The spring load on the bidirectional locking mechanism can be the same, or substantially the same, before and after the bidirectional locking mechanism changes its engagement with the first set of ratchet teeth to the second set of retaining teeth.
Examples of embodiments of the present invention eliminate the need for necessary passages in the context of other devices. This can be achieved, for example, by providing an actuation mechanism that oscillates within a confined physical interval. This oscillation can be triggered by the corresponding oscillation of a control element arranged, for example, in a control module.
In addition, the oscillation of the control element can transfer the oscillating forces to a corresponding controller 5 of an acting end of the device, through the hydraulic fluid. The hydraulic fluid can be extended to the control module for the final effector, through the flexible shaft.
The swing control element and / or swing controller can be like one or more alternative pistons, for example, hydraulic pistons.
In accordance with the example methods of the present invention, a fabric is clamped between the opposing jaws and a carriage is advanced with respect to the opposing jaws via an oscillating actuator, in order to reduce and / or staple the attached fabric.
The carriage may include a force transfer bar.
The carriage can be configured to exert a clamping force between the first and second jaws, when the carriage is advanced to cut and / or staple the fabric. The stapling force exerted by the carriage may be the only stapling force applied between the opposing jaws. Thus, there may be no need for additional pistons, for example, to close the jaws, thus eliminating excess materials, reducing manufacturing costs, reducing the risk of malfunction and simplifying operation.
5 The swing trigger can be performed in response to an input signal from the operator. For example, oscillation can occur in response to the operation of a switch or other input. For example, the input can be a digital, digital wireless, and / or wired digital input mechanism. In addition, the device can be configured to continuously swing the actuator when the switch is in the first position. In addition, the device can be configured to cease oscillating the actuator in response to the switch being in a second position. In addition, the oscillation drive can be controlled via one or more digital, digital wireless, and / or digital wired control signals or any other suitable control system.
According to the exemplary embodiment of the present invention, a surgical stapling device comprises a first jaw, a second jaw that has an open position and a closed position with respect to the first jaw, an actuation bar arranged on the first jaw and which includes a first set of ratchet teeth, an oscillatingly shaped ratchet piston configured to move the actuation bar along a longitudinal direction of the first jaw, a housing, having at least one clamp and at least one groove. staple driving, located in the first jaw, and a carriage, including at least one wedge-pile clamp, selectively engaged with the first set of retaining teeth of the actuation bar to translate the carriage in a distal direction through the housing, the from a proximal terminal position to a distal position of the terminal, at a distance between the distal terminal position and the term position proximal end greater than a length of the oscillating travel stroke of the ratchet bar, in which the driving wedge clamp is adapted to drive the clamp through the clamp conduction groove against the second jaw during the distal movement of the carriage, through the accommodation.
The drive bar can also include a second set of retaining teeth, and the carriage can also be selectively engaged with the second set of ratchet teeth to translate the carriage in a proximal direction, through the housing from the position of the terminal distal to the proximal terminal position.
The ratchet piston can be hydraulically driven.
The surgical stapling device may further comprise a bidirectional locking mechanism adapted to engage with the first set of ratchet teeth 5 to translate the carriage in the distal direction and to engage with the second set of ratchet teeth to translate the carriage in the proximal direction.
The bidirectional locking mechanism can be engaged with the carriage by means of a spring force transfer pin, and can be spring loaded on the spring force transfer pin.
The actuation bar may include an enlarged opening, at the distal end, the enlarged opening, sized to allow the bi-directional spring locking mechanism to rotate around the spring force transfer pin to disengage with the first set of teeth. ratchet and engage with the second set of ratchet teeth.
The male ratchet piston includes a ratchet piston shaft that has a circumferential recess located at a distal end of the ratchet piston body, the actuation bar having a force transfer rib located at the proximal end of the actuation bar, the force transfer configured to engage the circumferential recess, the ratchet piston shaft configured to transfer the force to the ratchet via the circumferential recess and the force transfer rib to oscillate the actuation bar.
5 The ratchet piston can be a double-acting piston.
The surgical stapling device may further comprise a base unit including at least two single-acting pistons, in which one of the at least two single-acting pistons is in fluid communication with a side further away from the ratchet piston, and one of at least two single-acting pistons is in fluid communication with a proximal side of the ratchet piston, and each of the at least two single-acting pistons releases positive or negative hydraulic pressure at the distal end or proximal side of the ratchet piston .
The second jaw can be movable from the open to the closed position by a clamping force exerted on the second jaw by carriage.
The carriage may include a first set of carriage teeth and a second set of carriage teeth, the carriage engages with the actuation bar, through one of (i) the first set of carriage teeth to be wrapped with the first set of carriage teeth. ratchet teeth to translate the carriage distally through the housing and (ii) the second set of carriage teeth being wrapped with the second set of ratchet teeth to translate the carriage proximally through the housing.
The ratchet piston may include a ratchet piston shaft and a force transfer pin located at a distal end of the ratchet piston body, the actuation bar having a force transfer slot located at the proximal end of the ratchet bar. drive, the force transfer pin adapted to fit in the force transfer groove, the ratchet piston body adapted to transfer the force of the actuation bar, through the force transfer pin and the force transfer groove, to swing the actuation bar.
The surgical stapling device may further comprise an articulation stop piston located in a first groove of the stop pin the first jaw and a second groove of the stop pin the second jaw, and a stop piston configured to direct the anvil pivot pin. in the distal direction to exert a clamping force on the second jaw to move the second jaw from the open to the closed position, and to direct the anvil pivot pin proximally to release the fixation on the second jaw to move the second jaw from position closed to the open position.
The surgical stapling device may further comprise a housing for housing the piston of the ratchet piston, and a head release latch adapted to removably engage the piston housing with the first jaw, to which the ratchet piston is coupled with the actuation bar, when the piston housing is engaged the first jaw.
The surgical stapling device may further comprise a base unit having a hydraulic pump, a flexible shaft in hydraulic communication with the base unit and the ratchet piston, in which a hydraulic force generated by the hydraulic pump is transferable from the unit base for the ratchet piston. The base unit may include at least two single-acting pistons, one of the at least two single-acting pistons that is in fluid communication with a side further away from the ratchet piston, and one of the at least two single-acting pistons, in fluid communication with a proximal side of the ratchet piston, and each of the at least two single-acting pistons can release positive or negative hydraulic pressure at the distal end or the proximal side of the ratchet piston. The surgical stapling device can further comprise a control device, including a switch, located between the base units and the ratchet piston, and the switch can be operated selectively to initiate the transfer of hydraulic force from the base unit to the piston ratchet, and to selectively terminate the transfer of hydraulic force from the base unit to the ratchet piston.
According to the exemplary embodiment of the present invention, a method for surgical stapling comprises tightening a second jaw to a closed position with respect to a first jaw from an open position with respect to the first jaw, oscillatingly driving a ratchet piston, an oscillating actuation bar located on the first jaw by driving the ratchet piston, the oscillating actuation bar a length of stroke along a longitudinal direction of the first jaw, the actuation bar having a first set of ratchet teeth, arm a carriage in the distal direction from a proximal end terminal position to a distal terminal position by means of a housing located in the first jaw by the oscillation of the actuation bar, the housing having at least one clamp and at least one staple conduction groove , by coupling the ratchet with the first set of teeth, and leading to at least one clamp through at least one staple guide groove through the carriage ratchet in the distal direction, where the distance between the distal end position and the proximal end position is greater than the stroke length.
Other features and aspects of exemplary embodiments of the present invention are described in more detail below with reference to the accompanying figures.
Brief Description of the Drawings Figure 1 is an exploded perspective view of a surgical device, according to an example of an embodiment of the present invention.
Figure 2 shows the device of Figure 1 in an assembled condition.
Figure 3 shows the device of Figure 1, without a staple cartridge.
Figure 4 is a side view of the device in Figure 1, with the jaws in the closed position.
Figure 5 is a side view of a housing or assembly body for the device of Figure 1.
Figure 6 shows the body assembly of the device of Figure 1.
Figure 7 is a partial side view of the body assembly of the device of Figure 1.
Figure 8 is a front sectional view of the device of Figure 1.
Figure 9A is a partial top view of the device of Figure 1.
Figure 9B shows an anvil piston from the device of Figure 1.
Figure 9C shows a ratchet piston of the device of Figure 1.
Figure 9D is a partial view of the device in Figure 1, showing the assembly of the anvil set arranged on the anvil.
Figure 9E is an exploded view of the anvil assembly of the device of claim 1.
Figure 10A shows an assembly of the device of Figure 1 at actuation.
Figure 10B shows a carriage of the device of Figure 1.
Figures 10C to 10E show schematically the relationship between the position of the ratchet piston and the position of the actuation bar with respect to the fitting of the device of claim 1.
Figure 11A shows the device housing of the device of Figure 1.
Figure 11B is a top view of the housing of the device of Figure 1.
Figure 11C is a side view of the housing of the device of Figure 1.
Figure 11D is a bottom view of the housing of the device of Figure 1.
Figure 1 IE is a front view of the housing of the device of Figure 1.
Figure 1 The IF is a rear view of the housing of the device in Figure 1.
Figure 12A is a front view of a cylinder block of the body of the body assembly of the device of Figure 1.
Figure 12B is a sectional view corresponding to the section AA of Figure 12A.
Figure 13A is a bottom view of an anvil from the device of Figure 1.
Figure 13B is a side view of the support part of the device of Figure 1.
Figure 13C is a sectional view corresponding to the BB section of figure 13B.
Figure 13D is a back view of the anvil of the device of Figure 1.
Figure 13E is a sectional view corresponding to the CC section of Figure 13B.
Figure 14 is a perspective view of a surgical device, according to an example of an embodiment of the present invention.
5 Figure 15 shows an anvil piston from the device in Figure 14.
Figure 16 shows a toothed drive piston of the device in Figure 14.
Figure 17 shows the housing of the device in Figure 14, with the anvil piston.
Figure 18 is a bottom view of the housing of Figure 14 with the anvil closing piston and the force transfer piston.
Figure 19A is a side view of the housing assembly of the device of Figure 14.
Figure 19B is an enlarged view of section D of Figure 19A.
Figure 20A shows a carriage of the device of Figure 14.
Figure 20B is a left side view of the carriage of the device of Figure 14.
Figure 20C is a rear view of the carriage of the device of Figure 14.
Figure 20D is a bottom view of the carriage of the device of Figure 14.
Figure 21A shows a perspective view of an actuation bar of the device of Figure 14.
Figure 21B is a side view of the actuation bar of the device of Figure 14.
Figure 21C is a top view of the actuation bar of the device in Figure 14.
Figure 21D is an enlarged sectional view corresponding to point E of Figure 37.
Figure 21E is a rear view of the trigger bar of the device in Figure 14.
Figure 2 is a front view of the actuation bar of the device of Figure 14.
Figure 22A shows a surgical device, according to an exemplary embodiment of the present invention.
Figure 22B shows a perspective view of the surgical device of Figure 22A.
Figure 23 is a cross-sectional view of the surgical device of Figure 22A, with the anvil and the stop piston in its open positions.
Figure 24 is a partial cross-sectional view of the surgical device of Figure 22A, with the anvil and the stop piston in its open positions.
Figure 25 is a partial side view of the device of Figure 22A with the anvil in an open position.
Figure 26 is a partial side view of the device of Figure 22A with the anvil in a closed position.
Figure 27 is a partial cross-sectional view 5 of the device of Figure 22A with the anvil and the anvil piston in their closed positions.
Figure 28 is a partial view of the carriage and a drive assembly for the transport device of Figure 22A.
Figure 29 shows the carriage of the device of figure 22A detached from the retaining plate.
Figure 30 is a partial cross-sectional view of the device of Figure 22A with the anvil in an open position.
Figure 31A is a partial cross-sectional view of the device of Figure 22A with the anvil in a closed position and the ratchet piston in the proximal position.
Figure 3 IB is a partial cross-sectional view of the device in Figure 22 A, with the anvil in a closed position and the actuation of the ratchet piston in the distal position.
Figure 31 C is a partial cross-sectional view of the device of Figure 22A with the support part in a closed position and the ratchet piston moving from a distal position to a proximal position.
Figure 32 is a partial cross-sectional view of the device of Figure 22A with the anvil in a closed position and the ratchet piston in the distal position 5 and showing the orientation of the clamps through the recharge mesh.
Figure 33 shows the engagement of the charging mesh of the device of Figure 32A with clips from the charging compartment.
Figure 34 shows a carriage and an actuation set in Figure 32A.
Figure 35 shows the partial view of the bottom of the device of figure 32A, at the beginning of an advance / distal stroke.
Figure 35B shows a partial view of the bottom of the device of figure 32A, at the end of an advance / distal stroke.
Figure 36A shows a partial view of the bottom of the device of figure 32A, at the beginning of an inverse / proximal course.
Figure 36B shows a partial view of the bottom of the device of figure 32A, at the end of a reverse / proximal course.
Figure 37 is a partial cross-sectional view of the carriage coupling of the device of Figure 32A with an anvil assembly.
Figure 38A shows a perspective view of a carriage drive and guide assembly of the device of Figure 32A with the carriage and anvil assembly in a proximal region of the jaws.
Figure 38B shows a carriage drive assembly and orientation of the Figure 32A device with the carriage and anvil assembly advanced to a distal region of the jaws.
Figure 39 shows a surgical system, according to an example of the present invention.
Figure 40 shows a handpiece for use in connection with the surgical system of Figure 39. Figures 41A and 41B show a console for use in connection with the surgical system of Figure 39.
Figure 42 illustrates, schematically, the hydraulic operation to exert force and movement in a first direction and in a second direction opposite to the first direction.
Figures 43A and 43B show hydraulic control hardware.
Figure 44 is a partial internal perspective view of the device of Figure 32A, in connection with the equipment of Figure 43 of hydraulic control.
Figure 45 is a perspective view of a head assembly of a surgical device, according to an example of an embodiment of the present invention.
Figure 46 is a perspective view of a head assembly 5 of a surgical device, according to an example of an embodiment of the present invention.
Figures 47A to 47C show a partial bottom view of the device of Figure 45.
Figure 48 is a perspective view of an assembly of the connection device of Figure 45.
Figure 49 shows a carriage and staple impeller of the device of Figure 45.
Figure 50 is a perspective view of a surgical device, according to an example of an embodiment of the present invention.
Figure 51 shows a top view of an assembly of the connection device of Figure 50.
Figure 52 shows a partial bottom view of an assembly of the connection device of Figure 50.
Figure 53 is a perspective view of the carriage, the connection set, and the hydraulic drive system of the device in Figure 50.
Figure 54 is a perspective view of the carriage, the connection assembly, and the hydraulic drive system of the device in Figure 50.
Figure 55 is a perspective view of the carriage, the connection set and the hydraulic drive system of the device in Figure 50.
5 Detailed Description of the Invention Figures 1 to 13E illustrate a surgical device 5 which is an exploded view of a surgical device 5, according to an exemplary example of the present invention.
According to the example, methods of the present invention, the device 5 cuts and staples a tight tissue, using an oscillating actuator 505, in the exemplary form of a hydraulically driven actuation bar 505, to advance a carriage 405 along at least minus one from a first jaw and a second jaw. In the exemplary device 5, the first jaw 105 includes the housing and the second jaw 205 includes an anvil. In the illustrated example, the carriage 405 is configured to engage both the first jaw 105 and the second jaw 205, in order to exert a clamping force located at the axial location of the carriage 405, as it is advanced along the first and second jaws 105, 205. The 405 carriage specimens direct clips into the tight tissue and cut the tight tissue as it is advanced along the jaws by the 505 oscillating actuator. The axial location of the clamping force exerted by the 405 carriage is substantially aligned with the location axial of the concurrently-motor clamp, to effect a driving action 5 robust clamp. The carriage 405 can be moved in an inverted direction in relation to the jaws by additional oscillation of the actuating element 505, after changing a state of the oscillating drive element 505. In the example device 5, the state of the actuating bar 505 is changed by lateral displacement of the actuation bar in relation to the 405 carriage.
Referring to the exploded view of Figure 1, surgical device 5 includes housing 105, a lid 180, an anvil 205, a clamp-shaped plate 260, an anvil pivot pin 290, an anvil piston 305, a carriage 405 , an actuation / ratchet rod 505, a ratchet actuating piston 605, tubes 705, back cover 805, a cylindrical joint 825, screws 850, ring crimp 860, rechargeable housing 905 and rechargeable mesh 950.
Referring to the device 5 assembled as shown in figure 2, the anvil 205 is opened in an orientation in relation to the housing 105 and the refill compartment
905. The refill compartment 905 can be a replaceable staple cartridge, or the refill compartment 905 and refill compartment 950 can, in the form of a combination of a replaceable staple cartridge. In other words, the refill compartment 950 can remain with the housing 105 when the refill compartment 5905 is removed (as shown in Figure 3), or the refill compartment 950 can be mounted in the refill compartment 905, in such a way that the refill compartment 950 is removed together with the refill compartment 905. According to the last configuration, each refill compartment 905 can have its own refill compartment 950, or the refill compartment 905 can be interchangeable between different housings refill 905.
The anvil 205 can rotate around the anvil pivot pin 290 between the open orientation shown in Figure 2 with a closed orientation shown in Figure 4. The rotation of the anvil 205 in relation to the open orientation to the closed orientation is driven by a pin arrangement -in groove. The pin elements are incorporated in the device 5 as pins 310 which extend laterally from the anvil piston 305, as illustrated, for example, in Figure 9B.
Each of the pins 310 extends from its respective anvil piston mesh base 325 outwardly to a free end. Referring to Figure 9B,
the pins 310 meet along a common y-axis which is parallel to the longitudinal axis z of the anvil pivot pin 290 and is perpendicular to a plane, on which the anvil 205 rotates in relation to the body 105.
The anvil piston mesh 325 is coupled to an anvil piston axis 330 having a longitudinal axis z which is within the plane of rotation of the anvil 205 and perpendicular to the y axis of the proximal end portion of the anvil piston axis 330 it is an O-ring groove 335 formed between the proximal O-ring retaining wall 340 and the distal O-ring retaining wall 345.
Referring, for example, to Figure 7, the anvil piston 305 is arranged in the housing 105, such that the proximal region of the anvil piston 305, including the proximal and distal O-ring retaining walls 340 and 345, are arranged in a first hydraulic chamber 110 of the housing
105. The proximal and distal O-ring retaining walls 340 and 345 have cylindrical outer surfaces dimensioned to have a diameter slightly smaller than the diameter of the cylindrical inner surface of the first hydraulic chamber 110, such that the anvil piston 305 is sliding between the proximal and distal positions with respect to the first hydraulic chamber 110.
A seal is formed between the anvil piston 305 and the inner surface of the first hydraulic chamber 110 by an O-ring 320, shown in Figure 10A, which is retained in the O-ring insert 335 between the O-retaining walls. proximal and distal ring 340 and 345. Thus, a hydraulic space or volume is defined between the proximal surface 350 of the anvil piston 305, the cylindrical side walls of the first hydraulic chamber 110 and a proximal surface 115 of the first hydraulic chamber 110.
Likewise, a hydraulic space or volume is defined between the distal surface 355 of the anvil piston 305, the cylindrical side walls of the first hydraulic chamber 110 and a proximally directed surface 112a directed from a washer or a plate 112 at the distal end of the chamber hydraulic 110. The two hydraulic volumes defined in the first hydraulic chamber 110 are sealed together by the anvil piston 305, including the seal ring 320. These hydraulic volumes vary inversely from one another, depending on the axial position of the anvil piston 305. In In particular, when the anvil piston moves distally, the volume of the distal hydraulic volume decreases and the volume of the proximal hydraulic volume increases. Likewise, when the anvil piston moves proximally, the volume of the distal hydraulic volume increases and the volume of the proximal hydraulic volume decreases.
In addition, the hydraulic volume disposed proximally to the seal formed by the seal ring 320 of the anvil piston 305 is in fluid communication with a hydraulic supply pipe 705a, and the hydraulic volume disposed 5 distally to the seal formed by the seal ring 320 of the anvil piston 305 is in fluid communication with a hydraulic supply tube 705b.
The hydraulic supply tubes 705a, 705b extend proximally, for example, on a flexible shaft, to a handpiece and / or other appropriate control unit whenever one or more hydraulic control units are arranged. In response to a control signal, the hydraulic control units are configured to transmit the hydraulic fluid, for example, saline, at a controlled pressure and / or the flow rate entering or leaving the hydraulic volumes. Generally, the hydraulic drive system uses positive pressure to generate most, if not all, of the force exerted on the anvil piston 305 during both proximal and distal actuation of the anvil piston 305. In this regard, positive pressure is applied through the first hydraulic supply tubes 705a during the distal actuation of the anvil piston 305, and positive pressure is applied through the hydraulic supply tube 705b during the proximal actuation of the anvil piston 305. It should be appreciated, however, that a pressure negative pressure can be used in addition to or instead of positive pressure. However, negative pressure can be advantageous, particularly, in situations where the pressure is transmitted by elongated tubes. Generally, as the hydraulic fluid is added to one of the hydraulic fluid volumes, through one of the supply tubes 705a, 705b, the same amount of hydraulic fluid is withdrawn from the other hydraulic fluid volume, through the other supply tube. 705b, 705a, thereby providing a complementary relationship between the first and second volumes of hydraulic fluid and a complementary relationship between analog hydraulic supply pipes 705a, 705b.
Thus, by precisely controlling the hydraulic fluid transmitted through the supply tubes 705a, 705b, the hydraulic control units are able to precisely control the movement and position of the anvil piston 305, controlling the closed hydraulic volumes, the first hydraulic chamber 110. This double-acting piston arrangement, in which the first and second volumes of hydraulic fluid can be separately, yet complementarily adjusted, allows a closed fluid system that limits the interaction of the surgical device with the elements outside.
The shaft of the anvil piston 330 slides axially inside the washer or plate 112 and a seal ring 113 5 placed at the distal end of the first hydraulic chamber 110. The seal ring acts to radially support the distal portion of the body of the anvil piston 330 and forms a sliding seal between the piston rod of the anvil 330 and the housing 105 to prevent any leakage of hydraulic fluid from the first hydraulic chamber and to prevent any fluids or other undesirable contaminants from entering the first hydraulic chamber 110. The washer 112 provides a protective layer of material between piston 305 and the distal end of cylinder 110.
Referring to Figure 4, when the anvil piston 305 is distally and proximally actuated, the pins 310 extending laterally axially sliding within a groove of the anvil 120, which extends parallel to the longitudinal axis of a housing 105.
In this way, pins 310 are driven in a direction parallel to the longitudinal axis of a housing 105.
Referring to Figure 13B, the anvil 205 includes a hole 210 for receiving the anvil pivot pin 290 on the anvil 205, which rotates with respect to housing 105, and the refill compartment 905 supported by housing 105.
The anvil 205 has a longitudinal axis, b, which intersects the axis of rotation around the anvil pivot pin 5 290. The anvil 205 also includes a pair of anvil driving slots 220 arranged on the respective wings 225 of the anvil 205. Each of the anvil drive grooves 220 extends along a respective axis C that is offset from the axis of the articulation pin 290 and angle with respect to the longitudinal axis, b, when viewed along the axis of rotation defined by the anvil joint 290. When the device 5 is mounted, each pin 310 extends sequentially from the anvil piston 325, through the anvil drive groove 220 of the anvil 205 and into the anvil pin groove 120 of the housing 105.
Since each of the pins 310 extends through the groove both the anvil activation 220 and the anvil pin housing 120, and since the C axis of the anvil actuation groove 220 is offset from the axis of rotation of the anvil 205 and angle to the longitudinal axis b of anvil 205, the distal sliding of pins 310 within the slots of the stop pin 120 causes the anvil 205 to rotate from the open position to the closed position, and the proximal sliding of the pins 310 within the grooves of the stop pin 120 causes the anvil 205 to rotate from the closed to the open position. Thus, precisely and appropriately 5 the movement and position of the piston of the anvil 305 is controlled, the hydraulic control units are able to precisely and precisely control the movement, position and force exerted by the anvil 205.
Although the distal movement of the pins 310 act on the closure of the anvil 205, it should be understood that the angle of the C axis of the anvil activation groove 220 can be provided, in such a way that the proximal sliding of the pins 310 causes closure of the anvil 205 and distal sliding of pins 310 causes anvil 205 to open.
When the anvil 205 is in the closed position, as illustrated, for example, in Figure 4, the carriage 405, which is provided in the form of a force transfer bar, can be advanced distally along the longitudinal axis of a housing 105.
Referring to Figures 10A and 10B, carriage 405 includes a plate 410 that extends between a first jaw coupling portion 420 and a second jaw coupling portion 430. The first jaw coupling portion 420 is formed as a plate oriented perpendicular to plate 410 and includes a pair of opposite flanges 422, 426, and the second jaw coupling portion 430 also takes the form of a plate oriented perpendicular to plate 410 and which includes a pair of 5 opposite flanges 432, 433 Each of the flanges 422, 426, 432, 436 of the first and second jaw coupling portions 420, 430 project transversely in relation to the plate 410 and extend longitudinally in a direction parallel to the longitudinal axis of a housing 105, when the surgical procedure device 5 is in its assembled configuration, as illustrated, for example, in Figure 4.
The second jaw coupling portion 430 is configured to engage the lower jaw, which comprises the housing 105 and the refill compartment 905, such that the carriage 405 is capable of sliding along the longitudinal axis of a housing 105, while an axis of the housing 105 is being prevented from transverse to the longitudinal direction. In this respect, the carriage 405 is configured to be coupled to the housing 105, so that the second coupling portion of the jaw 430 below a plate or lower wall 130, illustrated, for example, in Figures 11E and 11F, while the retaining plate 460 is placed over the wall 130. The wall 130 includes a guide groove 135 that extends along the longitudinal axis of a housing 105 and configured to receive, slidingly, a guide rib 440 of the carriage 405, which extends between the second coupling portion of the jaw 430 and the retaining plate 460. The retaining plate 460 is a removable component of the carriage 405 and includes a groove 462 that facilitates removal. It should be understood, however, that the retaining plate 460 may be non-removable and / or formed as a single monolithic piece with the main body of the 405 carriage.
When the edge guide 440 is received by the guide groove 135, the lower wall 130 is arranged in an opening 439 or region between the opposite surfaces 437, 465 defined by the second jaw coupling portion 430 and the retaining plate 460, restricting, thus, the movement of the carriage 405 transversely to the longitudinal axis of a housing 105, when the carriage 405 slides along the guide slot 135. In particular, the surface 437 of the second jaw coupling portion 430 and a lower surface 131 of the wall lower 130 are coupled to each other to form a first positive stop against the movement of the carriage 405 with respect to the housing 105 in a first transverse direction to the longitudinal axis A of the housing 105.
Likewise, the lower surface 465 of the retaining plate 460 and a lower surface 131 of the lower wall 130 are coupled together to form a second positive stop against the movement of the carriage 405, in a second direction transverse to the longitudinal axis of a housing 105, the first and second directions are within the plane, in which the anvil 205 rotates between the open and closed positions in relation to the housing 105.
Referring to Figure 11D, the proximal groove guide 135 extends to an enlarged opening 136 having a width in the lower wall 130, which is greater than the width of the guide slot, thus allowing the carriage 405 to be disengaged of the guide slot 135, when the carriage 405 is positioned in the region of the enlarged opening 136.
Referring to Figures 13A to 13E, the anvil 205 includes a guide channel 230 that extends in the direction of the longitudinal axis b of the anvil 205, which is parallel to the longitudinal axis of a housing 105, when the anvil 205 is closed in a state in relation to the housing 105, as shown in Figure 4. Referring to Figures 1, 9D and 9E, when the device 5 is mounted, the guide channel 230 receives an anvil mesh assembly 268, which includes a locking plate of anvil 270, a low insertion friction coefficient 275, and a return connection 280. The anvil mesh assembly 268 is capable of sliding within the guide channel 230 between a proximal position and 5 a distal position. The proximal and distal directions of the slip are along the longitudinal axis b of the anvil 205 and parallel to the longitudinal axis A of the housing 105, when the anvil 205 is in the closed state, with respect to the housing 105, as shown in Figure 4. In Figure 11A, the anvil mesh assembly 268 is in the proximal position.
The anvil 205 includes a guide slot 235 formed between two guide flanges 240, 245 and opens near widened in the recess 240. Thus, the guide slot 235 starts at the proximal ends of the flange guide 240, 245, as shown in the figure 13A.
When the anvil mesh assembly 268 and the carriage 405 are in their respective positions proximal to the housing 105, the anvil 205 can be rotated to make the transition between the open and closed states, relative to the housing 105. When the anvil 205 rotates from the open to the closed state, the upper jaw portion 420 of the carriage coupling passes through an enlarged opening 282 in the return link
280 of the anvil carriage 468 and into the extended recess 250 of the anvil 205. In this respect, the enlarged opening 282 and the recess 250 are laterally enlarged to allow clearance between the carriage 405 and the entire structure of the anvil 205 or the anvil mesh assembly 268 during the anvil opening and closing in relation to the housing 105, when the anvil mesh assembly 268 and the carriage 405 are in their respective proximal positions.
During a surgical procedure, the anvil mesh assembly 268 and the carriage 405 are in their respective initial proximal positions, the entire anvil 205 is closed and opened in relation to the housing 105, respectively, to thereby secure and release the tissue between the anvil 205 and the housing 105 by actuation of the anvil piston 305 as shown in greater detail above.
After the anvil 205 is closed in relation to the housing 105 to fix a portion of the fabric between the anvil 205 and the housing 105, the carriage 405 is advanced distally in order to cut and staple the fabric of the damaged part.
In order to advance the carriage 405 distally, which, in this phase, is in its proximal position in relation to the housing 105 with the first jaw coupling part that extends through the enlarged opening 282 in the return connection 280 and in the recess 250 anvil 205, an alternative arrangement in the form of a ratchet arrangement, is actuated by means of the 5 ratchet actuation piston 605.
The ratchet-acting piston 605 includes features analogous to the anvil piston 305 described above and its functions are proximal and distally driven in the same general way as the anvil piston 305 described above. Referring to Figure 9C, ratchet-acting piston 605 includes a ratchet-acting piston shaft 630 that has a longitudinal axis ZZ that is parallel to the longitudinal axes A, Z of housing 105 and anvil piston 305. In a portion of the proximal end of the ratchet piston 630 is an O-ring groove 635 formed between a proximal O-ring retaining wall 640 and a distal O-ring retaining wall 645.
Referring, for example, to Figure 7, the ratchet-acting piston 605 is arranged in the housing 105, so that the proximal portion of the ratchet-acting piston 605, including the proximal and distal O-ring retaining walls 640 and 645, are arranged in a second hydraulic chamber 150 of housing 105. The proximal and distal O-ring retaining walls 640 and 645 have cylindrical outer surfaces dimensioned to have a diameter slightly smaller than the diameter of the second chamber's cylindrical inner surface hydraulic 150, such that the ratchet piston 605 is slidable between the proximal and distal positions 5 relative to the second hydraulic chamber 150.
A seal is formed between the ratchet-acting piston 605 and the inner surface of the second hydraulic chamber 150 by an O-ring 620, illustrated, for example, in Figure 10A, which is retained in the groove of the O-ring 635 between the proximal and distal O-ring retaining walls 40 and 645. Thus, a hydraulic space or volume is defined between the proximal surface 650 of the ratchet piston 605, the cylindrical side walls of the second hydraulic chamber 150 and a proximal face 155 of the second hydraulic chamber 150. Likewise, a hydraulic space or volume is defined between the distal surface 655 of the ratchet piston 605, the cylindrical side walls of the second hydraulic chamber 150 and a proximal surface 152a directed to a washer or plate 152 at the distal end of the hydraulic chamber 150. The two hydraulic volumes defined in the second hydraulic chamber 150 are sealed together by the ratchet piston 605, including the O-ring 620. These hydraulic volumes they vary inversely from one another, depending on the axial position of ratchet piston 605. In particular, when the ratchet piston moves distally, the volume of the distal hydraulic volume decreases and the volume of the proximal hydraulic volume 5 increases. Likewise, when ratchet piston 605 moves proximally, the volume of the distal hydraulic volume increases and the volume of the proximal hydraulic volume decreases.
Since the proximal walls 15, 155 of the hydraulic chambers 101, 150 form part of the back cover 805, a cylindrical gasket 825 is provided at an interface between the housing 105 and the back cover 805 to form a seal between them, when the housing 105 and the end cap are joined (for example, by means of 850 screws). In addition, the cylindrical gasket 825 is partially exposed to the interior of each of the hydraulic chambers 110, 150, thus providing a barrier between the proximal surfaces 350, 650 of the pistons 305, 605 and the respective proximal walls 115, 155, for thereby protecting the respective components 305, 605, 805 against damage or wear which would be due to the direct impact between the proximal surfaces 350, 650 of the pistons 305, 605 and the respective proximal walls 115, 155 by energy absorption. Likewise, the 112, 152 washers provide protection analogous to pistons 305, 605 and 105 of the housing,
avoiding direct impact between distal surfaces 355, 655 of pistons 305, 605 and housing 105 during forward or distal strokes of pistons 305, 605. These elements 805, 112, 152 can be made of any 5 suitable materials, including, for example, one or more elastomers.
In addition, these elements 805, 112, 152 can be formed from the same material, or one or more of these elements 805, 112, 152 can be formed from a different material than one or more of the other elements 805, 112, 152.
In addition, the hydraulic volume proximally arranged for the seal formed by the O-ring 620 of the ratchet piston 605 is in fluid communication with a hydraulic supply tube 705c. The hydraulic feed tubes 705c, 705d extend proximally, for example, on a flexible shaft, to the handpiece or other appropriate control unit, where the hydraulic control units are arranged. In response to a control signal, hydraulic control units are configured to transmit hydraulic fluid, for example, saline, at a controlled pressure and / or the flow rate in or out of the hydraulic volumes of the second hydraulic chamber 150. As with driving the anvil piston 305 described above, the hydraulic drive system generally uses positive pressure to generate most, if not all, of the forces exerted on ratchet piston 605 during both proximal and distal of the 5 ratchet piston 605. In this respect, positive pressure is applied through the first hydraulic supply tubes 705c during the distal actuation of the ratchet piston 605, and the positive pressure is applied through the hydraulic supply tube 705d during the proximal drive of the ratchet piston 605. However, as with the drive of the anvil piston 305 described above, it should be noted that a negative pressure vat can be used in addition to or instead of at positive pressure. Generally, as hydraulic fluid is added to one of the hydraulic fluid volumes, through one of the supply tubes 705c, 705d, the same amount of hydraulic fluid is drawn from the other hydraulic fluid volume, through the other supply tube. 705d, 705c, thereby providing a complementary relationship between the first and second volumes of hydraulic fluid and a similar complementary relationship between hydraulic supply pipes 705c, 705d.
Thus, by precisely controlling the hydraulic fluid transported through the supply pipes 705c, 705d, the hydraulic control units are able to precisely control the movement and position of the ratchet piston 605, controlling the sealed hydraulic volumes of the second hydraulic chamber 150 .
Referring to Figures 12A and 12B, the hydraulic fluid 5 of tube 705b is transmitted between chamber 110 and tube 705b, through a set of interconnected holes 170,
172. In this regard, the fluid could travel along an axial feed hole 170, which extends parallel to and spaced from cylinder 110, to a distal transverse supply hole 172 that connects axial supply hole 170 and the first distal end region of cylinder 110. Thus, tube 705b is capable of supplying and removing hydraulic fluid to and from the distal end region of cylinder 110.
Likewise, hydraulic fluid from tube 705d is transmitted between chamber 150 and tube 705d from an interconnected set of holes 174, 176. The fluid could travel along an axial supply hole 174, which extends parallel to and spaced from the cylinder 150, to a distal transverse supply hole 176, which connects the axial supply hole 172 and the first distal end region 150 of the cylinder. Thus, tube 705d is capable of supplying and removing hydraulic fluid to and from the distal end zone of cylinder 150.
Referring to Figure 12A, holes 172, 176 are shown to provide an opening for the housing on the left side of the figure. However, the extension of one of the holes 174 and 176 to the left of the holes 172, 174 in 5 Figure 4 is due to the formation of the holes 172, 176 by drilling two respective transverse holes within the side of the housing 105, which extends both in hole 170 and cylinder 150, and another that extends to both of hole 174 and cylinder 150. If any one hole 174, 176 is formed in this way, the part of hole 174, 176 that extends across the outer surface the housing 105 can be sealed by any suitable means, for example, by filling the hole with a pin, dowel, filler, adhesive and / or other suitable material.
Tubes 705a and 705c supply hydraulic fluid to the respective cylinders 110, 150 through respective proximal holes in the rear cover 805 of the housing assembly. These holes are concentric with the respective pipes 705a, 705c. It should be understood, however, that the delivery mechanism between tubes 705a, 705b, 705c, 705d and the respective regions of cylinders 110, 150 may vary from the exemplary embodiments.
The drive shaft of the ratchet piston 630 axially inside the washer 152 and a sealing ring 153 disposed at the distal end of the second hydraulic chamber
150. O-ring 152 acts to radially support the distal portion of the drive shaft of the ratchet piston 630 and forms a sliding seal between the drive shaft of the ratchet piston 630 and the housing 605 to prevent any unwanted fluids or other contaminants enter the second hydraulic chamber 150. Washer 152 provides a protective layer of material between piston 605 and the distal end of cylinder 150.
Referring to Figure 9C, ratchet actuation piston 605 includes a force transfer pin 610 that extends through a transverse hole in the drive shaft of ratchet piston 630. Thus, the longitudinal YY axis of the transfer pin force 610 that received in the orifice, as illustrated in Figure 9C is transversal and perpendicular to the longitudinal axis zz of the ratchet piston 605.
When the device 5 is mounted, the force transfer pin 610 of the ratchet actuation piston 605 is received in a force transfer groove from a proximal end 510 in the member 515 that extends transversely from the actuation bar 505. The coupling between the power transfer pin 610 and the power transfer slot 510 is shown, for example, on
Figure 10A. The force transfer pin 601 is dimensioned slightly smaller than the width of the force transfer slot 510, which extends transversely and perpendicular to the longitudinal axis 5 zz, and therefore the reciprocating movements of the actuation piston oscillating ratchet 605.
Thus, the longitudinally directed strokes of the ratchet actuating piston 605 also cause corresponding longitudinally directed strokes of the actuating bar 505, while the actuating bar 505 continues to slide in relation to the force transfer pin 610 along the force transfer slot length 510, regardless of the location where along the length of groove 510 the power transfer pin 610 is located. For example, in Figure 10A the drive bar 505 has been moved in a first lateral direction 40 with respect to the ratchet drive piston 605, so that the force transfer pin 610 is arranged at a first end of the force transfer slot 510 Figure 9A shows the actuation bar 505 after being moved in a second opposite lateral direction 45 with respect to the ratchet actuation piston 605, so that the force transfer pin 610 is disposed at a second opposite end of the transfer groove force
510. As shown in greater detail below, which of these two lateral positions of the transfer bar 505 is in effect with respect to the 5 ratchet actuation piston 605 will determine whether the carriage 405 is driven distally or proximally along the longitudinal axis of a housing 105.
Along the way of the reciprocal drive mechanism, the 405 carriage is continuously driven at substantial axial distances, while the drive mechanism remains a relatively limited axial location.
As stated above, when the device 5 is mounted and the carriage 405 is engaged in the groove 135, the second jaw coupling portion 430 is arranged under the bottom plate 130 of the housing 105.
In addition to the second jaw coupling portion 430, first and second ratchet elements 470, 480 are also arranged under the lower plate 130 when the carriage 405 is engaged in the guide groove 135. The ratchet elements 470, 480 are coupled to the second coupling portion of the jaw 430 by the respective spring arms 475, 485.
The actuation bar 505 is also arranged under the lower plate 130 of the housing 105. In this regard, the actuation bar 505 is slidably arranged between and supported by the housing 105 and the cover 180 fixed to the structure 105. The housing 105 , rear cover 805 and cover 180 form a housing assembly 5 105, 180, 805 when the device 5 is mounted. In this regard, the features described herein with respect to housing 105, cover 180 and back cover 805, generally also refer to characteristics of housing assembly 105, 180, 805 as a global unit. In addition, the features described herein, with respect to housing 10, cover 180 and back cover 805 need not be provided in the particular element 105 or 180 indicated. For example, although the alignment elements 160a, 160b described below are discussed as part of housing 105, it should be understood that these elements 160a, 160b are part of housing assembly 105 as a whole, and that one, more, or all of these elements 160a and / or l60b can be provided in other elements of the housing assembly 105, 180, for example, in the lid 180. In addition, the housing assembly 105, 180, 805 can be provided as a single component or having additional components, other than those described in relation to the illustrated examples.
As shown in Figure 10A, the trigger bar
505 has been moved in the first lateral direction 40, so that the actuation bar is in a first posterior position with respect to the carriage 405 and the housing 105. In the first lateral position, a set of 5 ratchet teeth 472 of the first ratchet element 470 engages a first set of corresponding teeth 572 of the drive bar 505. The engagement between teeth 472 and 572 is such that the first set of teeth 572 of the drive bar 505 locks with teeth 472 of the first ratchet element 470, when the actuation bar 505 is in each distal course of the reciprocating movement, but not when the actuation bar is in each proximal course.
Thus, each distal stroke of the reciprocating motion of the drive bar 505 pushes the carriage 405 an incremental distal distance along the guide groove 135, with respect to housing 105. However, each proximal stroke of the reciprocating allows the first set teeth 572 of the drive bar 505 slide along the first set of teeth 472 of the first ratchet element 470, due to the ramp surfaces of teeth 472 and
572. Thus, the actuation bar 505 is allowed to move proximally during each proximal stroke of the reciprocating movement of the actuation bar 505 without causing any substantial proximal translation of the 405 carriage. Thus, with each reciprocity cycle (a distal course plus a proximal course ) of the actuation bar 505 causes the carriage 405 to move an incremental distal distance.
Thus, upon the repetition of the reciprocating movement cycle of the drive bar 505, the carriage 405 is advanced distally.
Through this ratchet mechanism, the carriage 405 is driven distally along the guide groove 135 with respect to the housing 105, when the actuation bar is in the first lateral position.
In order to proximally translate the carriage 405 with respect to housing 105, an analog ratchet mechanism is coupled by moving the drive bar 505 to its second lateral position, as shown in Figure 9A, so that the second set of teeth 582 drive bar 505 is engaged with teeth 482 of the second ratchet element 480. However, the orientation of teeth 482, 582 is reversed. In this way, the engagement between teeth 482 and 582 is such that the second series of teeth 582 of the drive bar 505 locks with the teeth 482 of the second ratchet element 480, when the drive bar 505 is in each proximal course of the reciprocating movement, but not when the actuation bar 505 is in each distal course. Thus, each proximal stroke of the reciprocating motion of the actuation bar 505 pulls the carriage 405 a proximal incremental distance along the guide groove 135, with respect to housing 105. However, each distal stroke of the reciprocating motion allows the second set of teeth 582 of the drive bar 505 slide over the teeth 482 of the second ratchet element 480, due to the ramp surfaces of the teeth 482 and 582. Thus, the drive bar 505 moves proximally during each proximal stroke of the reciprocating movement of the bar drive 505 without causing any substantial distal translation of the carriage 405. Thus, with each reciprocity cycle (a distal stroke plus a proximal stroke) of the driving bar 505 causes the carriage 405 to move an incremental distal distance.
Thus, the repetition of the alternating movement cycle of the actuation bar 505, of the carriage 405 is proximally progressed. Through this ratchet mechanism, the carriage 405 is operated proximally along the guide groove 135 with respect to the housing 105, when the actuation bar is in the second lateral position.
Since each of the ratchet elements 470, 480 is influenced by spring, the spring arms 475, 480 for the respective set of teeth 572, 582, when the actuation bar 505 is in its respective first and second positions, the teeth 472, 482 of the first and second ratchet elements 470, 480 are able to reflect laterally along the contour formed by teeth 572, 582 to allow the ratchet action.
Referring to the schematic illustrations of Figures 10C 5 to 10E, in order to move the actuation bar 505 from the first lateral position to the second lateral position, the ratchet piston 605 moves within its total axial travel range 675 in the second chamber hydraulic 150 from a first axial region 660, in which the reciprocating movement is performed for distal actuation, for a second axial region 670, in which the reciprocating movement is carried out for proximal actuation.
Between the first and second axial regions 660, 670 is a transition region 665. In Figures 10C to 10E, to facilitate the illustration, the position of the ratchet piston 605 is schematically superimposed over the actuation bar 505, which controls the axial movement of ratchet piston 605. Thus, as illustrated schematically in Figures 10C to 10E, any axial displacement of ratchet piston 605 corresponds to the same amount of axial displacement as the actuation bar
505.
In addition, the actuation bar 505 is shown in its position in relation to the housing 105, in which the actuation bar 505 is slidably supported. In this regard, the actuation bar is restricted in its lateral position, each of Figures 10c to 10E by a pair of opposite alignment elements 160a, 160b, in the form of 5 projections directed inwards radially. It is to be noted that although the alignment elements 160a, 160b are each part of respective sets of alignment elements 160a, 160b of the housing 105, and only an alignment element 160a and 160b an alignment element are shown, together with the corresponding portions of the 505 actuating bar for ease of illustration.
Referring to Figure 10C, ratchet piston 605 is in the first axial region 660. When the ratchet piston 605 is in the first axial region 660, the actuating bar 505 is laterally bounded by the opposing alignment elements 160a, 160b, from so that the alignment element 160a is slidable along an outer surface 552 of a first axial element 550 of the drive bar 505 and the alignment element 160b is slidable along a recessed surface 564 of a second axial member 560 of the drive bar 505. The outer surface 552 and the recessed surface 554 extend axially along lines parallel to each other, as well as the guide groove 135 and the longitudinal axis of a housing 105, the arrangement of the first set of teeth 570 of the drive bar 505 and the second set of teeth 575 of the drive bar 505.
In this regard, when the device 5 is mounted, the outer surface 552 of the drive bar 505 is at a greater lateral distance from the longitudinal axis of the guide groove 135 than the recessed surface 554 of the drive bar 505, and the outer surface 562 of the actuation bar 505 is at a greater lateral distance from the longitudinal axis of the groove 135 than the guide surface of the recess 564 of the actuation bar
505.
As the drive bar 505 moves axially with respect to housing 105, the alignment elements 160a follow a first surface profile of the drive bar 505 which includes the outer surface 552, the recess surface 554 and a transition surface ramp 553 disposed between and being continuous with the outer surface 552 and the recessed surface 554.
At the same time, the alignment elements 160b follow a second surface profile of the actuation bar 505, which includes the outer surface 562, the recessed surface 564 and a ramp transition surface 563 arranged between and being continuous with the outer surface 562 and the recessed surface 564.
The outer surfaces 552, 562 correspond to the laterally opposite sides facing away from the actuation bar 505. The recessed surfaces 554 and the ramp transition surface 553 form part of an alignment recess 551 of the first axial member 550, which is lowered with respect to the outer surface 552. Likewise, the recessed surface 564 and the ramp transition transition 563 form part of an alignment cavity 551 of the second member 560, which is an axial recess with respect to the outer surface 552. In addition , the first illustrated recess portion 551 and the second recess portion 561 form a pair of opposed recesses 551, 561 defined axially. The pair of illustrated opposing recesses 551, 561 is one of three pairs of such opposing recesses 551, 561 arranged along the length of the drive bar 505 of an example device of Figure 1 illustrated. Each recess 551, 561, as well as the respective outer surfaces 552, 562 and the projections 160a, 160b work in the same way or analogous to the corresponding elements illustrated in Figures 10C to 10E. It should be understood that recesses 552, 562, or other geometries may be different from the illustrated examples. For example,
there may be more or less recesses 561, 562 and may be of a greater number of recesses 561, 562 arranged on one axial member 550, 560 than the other axial member 560, 550.
In addition, recesses 552, 562 can have different 5 geometries and / or irregular spacing, and / or opposite alignment projections 160a, 160b of one or more opposite pairs of alignment projections 160a, 160b can be axially displaced one other.
As shown in Figure 10C, the actuation bar is in the first lateral position, such that the first set of teeth 570 of the actuation bar is closer to the guide groove 135 than the second set of teeth 580 of the actuation bar 505.
In this position, the first set of teeth 570 is engaged with the corresponding teeth 472 of the first ratchet element 470 of the carriage 405. Since the outer surface 552 and the recessed surface 564 have a length that corresponds at least approximately to the length of the first axial region 660 of the ratchet piston 605, the reciprocating movement of the ratchet piston 605 between the proximal and distal positions within the first axial region 660 causes the actuation bar 505 to also reciprocate between the corresponding proximal and axial positions, remaining in the first lateral position.
Thus, the ratchet coupling between the first set of teeth 570 (which are arranged along the first axial member 550) and the first ratchet element 470 is maintained during the reciprocating movement of ratchet piston 5 and the bar drive 505 when the ratchet piston is in its first axial region 660. Thus, the distal movement of the carriage 405 is carried out by reciprocating movement of the ratchet piston 605 between the proximal and distal positions within the first axial interval 660.
In order to move the carriage 405 proximally, the device 5 must laterally move the drive bar 505 from the first lateral position (illustrated, for example, in Figure 10C) to the second lateral position (illustrated, for example, in Figure 10E) with respect to the course 135 along which the carriage 405 is distally and proximally advanced.
Referring to figure 10D, the lateral displacement of the actuation bar 505, between the first and second lateral positions is achieved by the extension of the ratchet piston 605, and therefore also the actuation bar 505, from the first region 660, on the transition region 665 arranged between the first and second regions 660, 670, and into the second region 670.
Figure 10E illustrates the ratchet piston 605 and the actuation bar 505 in the axial transition region 665. In this transitional position, the first alignment element 160a is configured to limit the actuation bar 505 laterally, contacting the ramped transition surface. 553 of the first axial member 550, while the second alignment element 160b is configured to limit the drive bar 505 laterally, contacting the ramp transition transition 563.
Since the alignment member 160a acts as a follower boss following a boss surface defined by the outer surface 552, the ramp transition surface 553, and the recess surface 554 and alignment members 160b act as a follower boss following from a shoulder surface defined by the outer surface 562, the ramp transition surface 563, and the recessed surface 564, the drive bar 505 is guided, through the transition ramp between the first position illustrated, for example, in Figure 10C, and the second position illustrated later, for example, in figure 10E.
Referring to Figure 10E, ratchet piston 605 is in the first axial region 660. When ratchet piston 605 is in the second axial region 670, the drive bar 505 is laterally bounded by the opposing alignment elements 160a, 160b , so that the alignment element 160a can slide along the surface of the recess 554 of the first axial member 550 of the drive bar 505, 160b and the alignment element can slide along the outer surface 562 of the second axial member 560 of the actuation bar 505. The surface recess 554 and the outer surface 562 extend axially along lines parallel to each other, as well as the guide groove 135 and the longitudinal axis of a housing 105, the arrangement of the first assembly of teeth 570 of the actuation bar 505 and the second set of teeth 580 of the actuation bar 505.
As shown in Figure 10E, the drive bar 505 is in the second lateral position, such that the second set of teeth 580 of the drive bar 505 are closer to the guide groove 135 than the first set of teeth 570 of the drive bar 505. In this position, the second set of teeth 580 is engaged with the corresponding teeth 482 of the second ratchet element 480 of the carriage 405. Since the outer surface 562 and the recessed surface 554 have a length that corresponds at least approximately the length of the first second region
670 of ratchet piston 605, the reciprocating movement of ratchet piston 605 between the proximal and distal positions within the second axial region 670 causes the actuation bar 505 to also alternate between the corresponding proximal and axial positions 5, remaining in the first lateral position. Thus, the ratchet coupling between the second set of teeth 580 (which are arranged along the second axial element 560) and the second ratchet element 480 is maintained during the reciprocating movement of the ratchet piston 605 and the actuation bar 505, when ratchet piston 505 is in its first axial region
660. Thus, the proximal movement of the carriage 405 is carried out by reciprocating movement of the ratchet piston 605 between the proximal and distal positions within the second axial gap 670.
Although the device 5 is configured to move the carriage 405 distally when the drive bar is in the first side position and to move the car 405 proximally when the drive bar 505 is in the second side position, it should be understood that this orientation can be reversed and the selective coupling between the drive bar 505 and the carriage 405 can be provided by another mechanism (s), in addition, or as an alternative, for the selective movement of the drive bar 505, between the first and second lateral positions in relation to housing 105.
In addition, although ratchet piston 605 triggers the distal movement of carriage 405 with respect to the housing 5, when piston 605 is actuated in the first axial proximal region 660, and triggers the proximal movement of carriage 405 with respect to housing 105, when piston 605 is driven in the second distal axial region 660, it should be understood that the device 5 can be configured to advance the carriage 405 distally, when piston 605 is reciprocal in an axial region distal from its available total axial stroke and to advance proximally to carriage 405 when piston 605 is reciprocal in a region proximal to its available total axial stroke. In addition, it should be understood that device 5 can be configured to allow piston 605 to use most or all of its available axial stroke during its reciprocating motion to drive carriage 405 axially and / or distally. In addition, other adjustment mechanisms for choosing the direction of rotation, in addition or as an alternative to the alignment projections 160a, 160b can be provided. For example, one or more dedicated actuators may be provided to select the coupling status of the alternate drive mechanism.
During a surgical procedure, the device 5 is positioned in such a way that a portion of tissue is placed between the upper jaw, including the anvil 5 205 and the lower jaw, including the housing 105 and the refill compartment 905. With the drive from the anvil 205 on the anvil pivot pin 290 to the closed position illustrated in Figure 4, the fabric is compressed to a thickness that allows the staple to be guided and formed reliably. For example, the gap between the anvil 205 and the opposite surface of the housing 5 and / or reload housing 905 can be equal to or less than that of the anvil 205 being in the 2 mm closed orientation.
During a surgical procedure, after closing the anvil 205, through the anvil piston 305, the carriage 405, which is in a proximal initial position, is advanced distally along the guide slot 135 by means of the ratchet piston 605, as as stated above. As the carriage advances distally, a cutting blade 450 cuts the fabric tightly in a linear fashion between the anvil 205 and the housing 105, while the carriage distally pushes a wedge-shaped recharge 950 in order to push clamps from the refill compartment 905 for the clamp-shaped plate 260 arranged in the guide channel
230. In this regard, the refill compartment 950, in the example of the illustrated embodiment, includes four parallel clamp direction wedges 952 configured to drive, for example, simultaneously, four respective 5 clamps in the form of a 260 clamp plate. wedges 952 extend above a sliding plate 954 configured to slide along the upper surface 132 of the lower wall 130 of the housing 105 in directions parallel to the longitudinal axis of a housing 105 and the longitudinal path of the guide slot 135.
The cutting edge of the cutting blade 450 preferably has an arc-shaped curvature, as shown. Curving can be beneficial, for example, to keep the center or edge of the fabric on the cutting edge or surface 450 of the blade when the blade is cutting the fabric. Although knife blade 450 is curved, it should be understood that any desired blade geometry or other cutting mechanism can be provided.
Although the refill compartment 905 of the illustrated example is a replaceable cartridge separate from the refill mesh 905, it should be understood that the refill mesh 950 can be incorporated in the cartridge, such that each cartridge assembly includes its own refill mesh
950. In addition, although the refill mesh 950 is configured to drive four clamps using four wedges 952, it should be understood that the refill mesh 950 can include any other number of wedges 952 or other staple driving elements configured to drive 5 any number of staples desirable.
As the carriage 405 advances distally from its initial proximal position, the first or upper part of the engagement jaw 420 involves mounting the anvil mesh 268. In particular, the flaps 422, 426 of the first portion of the jaw coupling 420 are received through the anvil closure plate 270, so that the anvil immobilization plate 270 extends below both flanges 422, 426. At this stage, the carriage 405, together with the anvil mounting rail 268, advance distally along the guide slot 235 of the anvil 205.
During this distal movement, anvil 205 extends from housing 105, through guide groove 235, and into guide channel 230. Anvil mesh assembly 268 is supported by and slides axially along the length of the channel guide 230 above the clamp-shaped plate 260 that extends along the guide channel
230. Plate 260 has a guiding groove shape 265, through which carriage 405 extends as well. In this regard, the flaps 422, 426 of the first jaw engagement portion 420 transfer the force in the direction of the housing 105 to the assembly of the anvil mesh 268. Since the clamp thrust plate 260 is disposed between the set of anvil mesh 268 and the housing 105, the force 5 is also transferred from the anvil mounting mesh 268 to the clamp thrust plate 260. In addition, the friction pads below 275 allow the carriage 405 to slide, despite being the force to be transferred across the sliding surface between the anvil mesh assembly 268 and the clamp pressure plate 260.
This reduced friction coupling can be particularly advantageous, since the axial force exerted by the actuation bar 505 at a location in the carriage 405 is substantially displaced from the sliding fit between the anvil mesh assembly 268 and the clamp pressure plate 260.
Thus, the first jaw coupling portion 420 and the second jaw coupling portion 430 engage the anvil 205 and the housing 105 to provide a clamping or reinforcing force located at the cutting and stapling location. This can be especially advantageous in that the forces that tend to drive the jaws 205, 105 are separated by increased pressing of clamps in the form of a clamp plate. In this context, the carriage or the force transfer bar, 405 has multiple functions, including, for example, the transfer of force to engage and form clamps, the cut fabric, and to maintain a stop position of the clamp thickness of 5 constant tissue. The inclination slope of jaws 105, 205 can be modified to increase the tightening effect, as the force transfer bar 405 travels through the jaws 105, 205.
Although the knife blade 450 is configured to continuously cut the initial tissue attached to the proximal end of the attached tissue, it should be understood that the blade can be configured to engage the trapped tissue at a location distally beyond the proximal end of the tight tissue. For example, blade 450 may be configured to oscillate or otherwise stimulate to engage the tissue at a predetermined and / or selectable location stapled along the jaws. In this sense, the blade 450 can be initially disengaged from the anvil mesh assembly 268, but after a pre-determined distance and / or the selectable distance and / or during the distal movement, oscillate upwards in engagement with the mesh assembly. anvil, in order to start cutting the fabric and allowing the transverse force to be transmitted from the carriage 405 to the assembly of the cleat 268 of the anvil mesh. Other blade configurations can also be provided.
Once the carriage 405 has reached a desired axial position (for example, after the portion of fabric 5 has been fully cut and stapled), the device 5 can retract the carriage 405 by moving the drive bar 505 from its first position lateral to its second lateral position, as defined above, and subsequent reciprocating movement of the ratchet jaw 605 in the second axial region 670 to the ratchet carriage 405 proximally to the housing 105.
When the carriage 405 moves proximally, the first part of the jaw coupling 410 may remain engaged with the anvil closure plate 270 of the anvil mesh assembly, or the first part of the jaw coupling 420 may disengage the closure plate anvil, in the event that the other proximal retraction of the carriage 405 causes the first portion of the jaw coupling 420 to contact the proximal end of the opening 282 of the return link 280 and thus pull the anvil mesh assembly 268 into the proximal direction.
When the device 5 is coupled to an axis (for example, the axis 5205 described below) that houses the hydraulic tube 705, the seal can be formed between the axis and the device 5 by compressing the axis wall of the rear cover 805 with the rear cover 860, illustrated in Figure
1.
Figures 14 to 21F illustrate a second exemplary surgical device 5, Figures 22A to 38B illustrate a third exemplary surgical device 3005, and Figures 45 to 55 illustrate a fourth exemplary surgical device 8005. The device 1005 includes the features described here in regards device 5, unless otherwise specified. In addition, device 5 also includes the features of device 1005 described herein, unless otherwise noted. In this respect, as reference numbers indicate similar or similar elements, but with any reference numbers 1 and 999 of device 5 corresponds to reference numbers 1001 to 1999, respectively, of device 1005. For example, housing 105 of device 5 corresponds to housing 1105 of device 1005, anvil 205 of device 5 corresponds to anvil 1205 of device 1005, etc.
Figures 22A to 38B illustrate a third exemplary surgical device 3005. Device 3005 includes the features described herein with respect to devices 5 and 1005, unless otherwise noted. In addition, devices 5 and 1005 include the features of device 3005 described herein, unless otherwise noted. In this regard, just as reference numbers indicate similar or similar elements, but with reference numbers 5 and 999 of device 5 and any reference numbers 1001 to 1999 of device 1005 corresponding to reference numbers 3001 to 3999, respectively , of device 3005. For example, housing 105 of device 5 and housing 1105 of device 1005 each correspond to housing 3105 of device 3005, anvil 205 of device 5 and anvil 1205 of device 1005 each correspond to anvil 3205 device 3005, etc.
Figures 45 to 55 illustrate a fourth exemplary surgical device 8005. The device 8005 includes the features described herein, with respect to devices 5, 1005 and 3005, unless otherwise indicated. In addition, devices 5, 1005 and 3005 also include the features of device 8005 described herein, unless otherwise noted. In this respect, as reference numbers indicate similar or similar elements, but with reference numbers 1 to 999 of device 5, and reference numbers 1001 to 1999 of device 1005, and any reference numbers
3001 to 3999 of device 3005 corresponding to reference numbers 8001 to 8999, respectively, of device
8005. For example, housing 105 of device 5, housing 1105 of device 1005, and housing 3105 of device 5, each corresponding to housing 8105 of device 8005, anvil 205 of device 5, anvil 1205 of device 1005, and anvil 3205 of device 3005 each corresponding to anvil 8205 of device 8005, etc.
In addition, insofar as any divergent characteristics are indicated between the examples of devices 5, 1005, 3005, 8005, it should be understood that examples of embodiments of the present invention may include the different characteristics, in combination or alternatively, and that the features can be provided in any desired combination.
Referring to Figure 16, ratchet piston 1605 of device 1005 differs from ratchet pistons 605, 3605 and 8605 of devices 5, 3005 and 8005, in which the coupling mechanism of the actuation bar is provided in the form of a plate-like extension 1610 projected downward from axis 1630 in an additional non-limiting mode of, in contrast to pin 610 of ratchet piston 605 and the distal channeled portion of axles 3630, 8630 of devices 3005, 8005, respectively, described in greater detail below. Extension 1610 engages and cooperates with the slot 1510 of the actuation bar 1505 in the same way as the pin 310 engages 5 in the slot 310 of the device 5.
Referring to Figures 20A to 20C, carriage 1405 of device 1005 differs from carriages 405, 3405 of devices 5 and 3005, in which blade 3450 is linear and angled to the distal end of device 1005 when the blade advances to anvil 1205 in an additional non-limiting modality. Anvil 1405 also differs in that the carriage 3405 is integrally formed as a single monolithic piece with the retaining plate 1460, instead of having a retaining plate 460, 1460, as a separate and / or removable component.
Referring to Figures 21A to 21C, the actuation bar 1505 of device 1005 differs from the actuation bars 505, 3505 and 8505 of devices 5, 3005 and 8005, in which the force transfer slot 1510 to receive extension 1610 is rectangular crosswise, when viewed from the top as in Figure 21C, and is open on one side of the actuation bar 1505 in the additional non-limiting mode.
The actuation bar 505 of the device 5 also differs from the actuation bars 1505 and 3505 of the devices 1005 and 3005, in which the axial recesses 1551, 1561 are axially aligned in an additional non-limiting embodiment. In this sense, a mechanism 5 similar to the mechanism illustrated in Figures 10C to 10E with respect to device 5 is provided, but with the alignment projections of the device 1005 to be compensated by the same amount as the alignment recesses 551, 561 of the opposed pair of the actuation bar 505 of device 5.
It should also be understood that an additional analogous mechanism can be provided where both opposing alignment recesses are axially displaced and the opposite alignment recess 551, 561 is displaced.
Referring to Figure 21, each tooth 1570 has a locking surface 1571 having a steeper slope in relation to the longitudinal extension of the drive bar 1505 of a ramp surface 1572. The ramp surface 1572 allows the first ratchet element 1470 to be pushed sideways (by means of the arm flexion spring 1475) to allow the actuation bar 1505 to move proximally with respect to the first ratchet element 1470, during the proximal strokes of the ratchet piston reciprocating
1605. During the distal stroke of the ratchet piston 605, the most inclined (in this case, perpendicular) to locking surfaces 1571 engages the first ratchet element 1470 to translate the carriage 1405 distally. It should be noted in this regard that the carriage 1405 can be held in position during proximal axial movement by means of frictional forces, due to the coupling between the carriage 1405 and the other elements of the device 1005. The teeth 1580 on the opposite side of the drive bar 1505 are inverted to allow a analog coupling reversed to move carriage 405 proximally to housing 105.
The ratchet elements 1470 and 1480 have ratchet teeth 1472, 1482, with a profile analogous to the tooth profile 1570 shown in Figure 21, such that the teeth locking surfaces 1472, 1482 contacts the respective teeth locking surfaces 1570, 1580, when the actuation bar moves the carriage 1405 in the respective axial directions, and the ramped surfaces of the teeth 1472, 1482 engage and translate with respect to the respective ramped surfaces of the teeth 1570, 1580 during secondary piston strokes. However, any other arrangement can be provided, including providing ratchet elements 1470 and / or 1480 with different tooth geometries and / or a different number of teeth than 1472, 1482 illustrated, including, for example, a single tooth 1472, 1482.
Referring to Figure 21C, it is further noted that the series of teeth 1570 stopped before reaching the distal end 5 of the first axial element 1550 and the second set of teeth 1580 stopped before reaching the proximal end of the second axial element 1560 , which results in a distal plane 1575 on the surface facing inward of the first axial element 1550 and a flat proximal end 1585 on the surface directed inwardly from the second axial element 1560. In this regard, the flat parts 1575, 1585 are supplied in the respective axial regions, where the first and second ratchet elements 470, 480, respectively, do not extend when the carriage 1405 is moved between its most proximal and distal positions, inside the housing
1105. However, it should be understood that any desired pattern of teeth can be provided.
Referring to Figures 21E and 21F, the lower portion of the actuation bar 1505 has lower chamfered edges when viewed in the axial direction. However, it must be understood that any desired geometry can be provided.
Referring to Figures 22A and 22B, surgical device 3005 is coupled to an axis 5410, in order to form a surgical system. Although the 5410 shaft is a flexible shaft, it should be understood that a rigid member can be provided. The 5410 shaft houses 3705a, 3705b, 3705c and 3705d hydraulic 5 feed tubes.
Referring to Figures 23 and 24, surgical device 3005 differs from surgical devices 5, 1005 and 8005, in which the refill compartment 3905, which functions as a staple cartridge, is received in a refill sleeve 3980 in such a way that a proximal portion of the refill housing 3905 is radially constrained by the retaining flanges 3981 of the refill sleeve 3980, in an example of an additional embodiment. The refill sleeve 3980 can be removed from the housing when the refill compartment 3905 is removed or the refill sleeve 3980 can be fixed in relation to housing 3105 when the refill compartment 3905 is removed.
Referring to Figures 25 and 26, surgical device 3005 differs from surgical devices 5, 1005 and 8005, in which the anvil drive groove 3220 is linear and includes a distal portion, which extend parallel to the groove of the anvil pin 3120 of housing 3105, when the anvil is in the closed position in relation to the housing, as shown in Figure 26,
in an example of additional modality. This arrangement can reduce or eliminate any forces exerted on proximally directed to the pins or shafts 3310 of the anvil piston 3305, when the fabric is being tightened between the 5 anvil 3205 and the housing 3105. The anvil 3205 also differs from the anvils 205, 1205 and 8205, wherein it includes a transverse member 3206 extending between a joint between the respective fixing surfaces of the anvil 3205 and housing 3105 and / or recharging housing 3905, in the example of additional embodiment. The cross member 3206 acts to form a positive stop to maintain an edge close to the fixed tissue extending proximally from the desired clamping region.
In addition, with reference to Figure 26, the driving pin 3310 has been moved forward or distally, from the position of Figure 25, in order to fix the stop 3205 downwards. In this respect, the clamping force, for example, during forward movement of the pin, is proportional to the fluid pressure applied to piston 3305. As illustrated, for example, in Figure 27, piston 3305 extends due to fluid pressure in cylinder 3110.
Figure 29 shows the 3405 carriage with the 3460 plate retainer removed. As with the other devices 5, 1005, 8005, the carriage or the force transfer bar, 3405 has multiple functions, including, for example, the transfer of force to engage and form clamps, cut fabric and maintain a 5 position anvil "staple" for constant thickness of the fabric.
Figure 31B shows piston 3605, the actuator (reciprocating bar 3505), and a carriage (force transfer bar) 3405 advancing, or distally, as indicated by the direction of the arrow shown in Figure 31B. Figure 31C shows piston 3605 moving backward, or proximal, as indicated by the direction of the arrow shown in Figure 31C. The piston then continues to swing back and forth between the positions illustrated, respectively, in Figures 31B and 31C.
Referring, for example, to Figures 30 to 32, device 3005 also differs from devices 5, 1005, in which the ratchet piston 3605 includes a circumferential recess 3610 in a distal end portion of the ratchet piston shaft 3630, in instead of a pin 610 or projection 1610, as provided in devices 5 and 1005, respectively, in an example of additional modality.
In addition, the actuation bar 3505 differs from the actuation bars 505 and 1505 of devices 5 and 1005,
which includes a 3510 force transfer edge,
in an example of additional modality, instead of force transfer slots 510, 1510. The ratchet piston
3605 is configured to couple with the actuation bar
5 3505 in a manner analogous to that established above with respect to ratchet pistons 605, 1605 and the actuation bars 505 and 1505 of devices 5 and 1005, except that instead of a projection or male element 610, 1610 of ratchet piston 605 , 1605 extending to a female recess or drive bar frame 505, 1505, ratchet piston 3605 includes a recess or female frame 3610 configured to receive a 3510 projection from the drive bar 3505. The force transfer edge extending transversely 3510 from the actuation bar 3505 extends to the circumferential recess
3610 of the 3630 axis, thus axially restricting the actuation bar 3505, with respect to the 3605 ratchet piston,
while allowing edge 3510 to slide transversely with respect to recess 3610 during actuation of the actuation bar 3505 between its first and second lateral positions, with respect to socket 3105. The force transfer edge 3510 has an upward projection
3511 which also extends into the circumferential recess
3610 of the 3605 ratchet piston, when the actuation bar 3505 is in its first lateral position.
Thus, the extension of the projection 3511, in addition to the part that extends transversely from the edge 3510, to the circumferential recess 3610 allowing the increase of structural integrity 5 at the point of force transfer between the ratchet piston 3605 and the actuation bar 3505 during the distal movement of the 3405 carriage.
Figures 32 and 33 show the direction of the clamps 3910 of the refill compartment 3905 during a distal actuation of the carriage 3405 to simultaneously cut and staple the fabric. As illustrated, the carriage 3405 is distally pushed into the 3950 refill mesh so that the wedges 3952 progressively push the clamps 3910 upward towards the clamp-shaped plate 3260 on the anvil 3205 to form the clamps. The 3952 wedges push the clamps, progressively increasing the 3920 clamp drivers arranged in the 3905 refill compartment. The clamps are ejected through the 3908 clamp guide slots or openings in the 3905 refill compartment.
It should be noted that the carriage 3405 travels a distal distance from its initial proximal position of housing 3105 before engaging the 3268 anvil mesh assembly. It should be understood, however, that this distance can be reduced or even eliminated. , if desired, in additional exemplary modalities.
Figures 35A to 36B show an actuation mechanism of the device 3005, including a mechanism for displacing the actuation bar 3505 between its first and second lateral positions. The mechanism differs from device 5, however, in that the alignment elements 3160a, 3160b are configured as pins. Pins 3160a and / or 3160b can be supported in housing 3105, cover 3180 and / or any other convenient structure of the housing assembly. Figures 35A to 36B are partial bottom views of the device 3005, 3005, with the device being: at the beginning of a forward / distal stroke in Figure 35A, at the end of a forward / distal stroke in Figure 35B, at the beginning of a reverse / proximal stroke in Figure 36A, and at the end of a reverse / proximal stroke in Figure 36B.
Figure 37 is a partial cross-sectional view of the carriage 3405 coupling of anvil assembly 3268 within anvil 3205. In this regard, the clamp-shaped plate 3260 is supported by two flanges or flanges 3212, in order to limit the plate shaped clamp 3260 to move transversely with respect to anvil 3205. The carriage 3405 extends vertically through the guide slot 3265 in the clamp shape plate 3260 and a portion of the guide channel 3230 above the clamp shape plate 3260 .
In this region, the first part of the jaw coupling 3420 is wrapped with the anvil lock plate 3270 of the anvil assembly 3268. In the configuration illustrated in Figure 5, the downward force exerted by the carriage 3405 is exerted from opposite flanges 3422 , 3426 from the upper portion of the jaw coupling 3420 to the structure of the anvil closure plate 3270 disposed under the flanges 3422, 3426. This force is then transferred from the anvil closure plate 3270 to the two inserts of low friction opposites 3275 arranged between the anvil closure plate 3270 and the clamp shape plate 3260. The force is then transferred from the low friction inserts 3275 to the shape of the clamp plate 3260, which then transfers the force for the anvil 3205, through the flanges or flanges 3212. In this way, a downward force is exerted by the carriage 3405 on the anvil 3205 during the cutting and stapling process. The corresponding complementary upward force is exerted on the lower jaw coupling, through the lower jaw coupling portion 3430 with housing 3105, in the same manner as described above in relation to device 5. Thus, carriage 3405 is tensioned between anvil 3205 and housing 3105 to propel the anvil
3205 and the housing 3105 to their relative tight positions, so as to maintain a constant stuck tissue thickness when the carriage 3405 is advancing or retracting axially, for example via the reciprocating drive mechanism described herein. The movement of the 3405 carriage from a location proximal to a distal location is sequentially illustrated in Figures 38A and 38B.
Referring, for example, to Figures 38A and 38, the anvil mesh set 3268 differs from the anvil mesh sets 268, 1268 of devices 5 and 1005, in which the anvil closure plate 3270 and the return connection 3280 are formed as a single monolithic piece in an example of additional modality.
When the carriage 3405 is proximally returned to its proximal position in housing 3105, after the distal cut and stapling movement, the carriage 3405 engages and slides the 3268 anvil mesh assembly back to its original proximal position on the 3205 anvil.
Referring to Figure 45, head assembly 8006 and piston 8010 of surgical device 8005 are illustrated. Head set 8006 includes housing 8105, anvil 8205, similar to devices 5, 1005 and 3005. Surgical device 8005 differs from surgical devices 5, 1005 and 3005, in which surgical device 8005 does not include an anvil driving piston , anvil drive pins or with an anvil drive groove. Instead, anvil 8205 of device 8005 5 includes an anvil pivot flange 8290 which engages with housing 8105 in anvil pivot groove 8120, as described in greater detail below.
Figure 46 illustrates the head assembly 8006, of the surgical device 8005, including the carriage 8405, reload mesh 8950 and clamp steering wedges 8952, located above the actuation bar 8505. The carriage 8405 is located in its proximal position in with respect to head assembly 8006, and anvil 8205 is opened again with respect to socket 8105. The anvil pivot flange 8290 is also illustrated. Inside the 8905 refill compartment, 8920 clamp guides are illustrated. Like devices 5, 1005, 3005, the carriage 8405 of device 8005 is readjusted forward, in the distal direction, causing the staple guiding wedges 8952 to force the 8920 clamp actuators into the clamps (not shown).
The ratchet of the 8005 device differs from the ratchet of the 5, 1005, 3005 devices, in which the 8405 carriage includes a bi-directional retaining spring mechanism or tongue
8470, instead of ratchet elements 470, 480 and spring arms 475, 485. Figures 47A to 47C illustrate the actuation bar 8505, having a first set of teeth 8570 and a second set of teeth 8580, and illustrates still 5 jaw 8470, having spring force transfer groove 8475, taking the end 8472, and following the edge
8473. The carriage 8405 is also illustrated, having a spring force transfer pin 8476. The carriage 8405 engages the tongue 8470, through the spring force transfer pin 8476, located in the spring force transfer slot 8475, of in order to transmit a spring force counterclockwise (from the perspective of Figure 47) in the 8470 tongue. In the pre-surgery position, before the activation of the surgical device 8005, as shown in Figure 47, the spring force in the counterclockwise 8472 of the tongue 8470 in contact with the first set of teeth 8570. First set of teeth 8570 are located in such a way that, when the movement of the actuation bar 8505 in the distal direction, as described below, the coupling the tip of the tongue 8472 of the jaw 8470 with the first set of teeth 8570 forces the carriage 8405 to move in the distal direction, and by means of the movement of the actuation bar 8505 in the proximal direction, as will be described Therefore, the coupling of the tongue tip 8472 of the jaw 8470 with the first set of teeth 8570 does not force the carriage 8405 to move proximally. The distance between each tooth in the first set of 8570 teeth must be less than the oscillation of the 8505 actuation bar, so that each proximal movement of the 8505 actuation bar allows the 8470 tongue (which remains under the spring force of counterclockwise) wrap with the next tooth distally from the first set of teeth
8570. In this way, the oscillation of the 8505 actuating bar creates a ratchet operation, moving the 8470 tongue, and therefore the 8405 carriage in the distal direction.
At the distal end of the first set of teeth 8570, the actuation bar 8505 includes an enlarged opening 8506 on the side of the actuation bar 8505, which includes the first set of teeth 8570. As the ratchet operation progressed, the carriage 8405 and the tongue 8470 eventually reach the distal end, where the tip of the tongue 8472 of the jaw 8470, after activation of the last tooth on the first set of teeth 8570, reaches the widened opening 8506. The widened opening 8506 is large enough that the spring force of the counterclockwise cause the 8470 tongue to rotate over the 8476 spring force transfer pin to the tongue tip
8472 of the jaw 8470 is wrapped with the second set of teeth 8580 on the side of the actuation bar 8505 opposite the first set of teeth 8570. The second set of teeth 8580 is located opposite, like the first set of teeth 8570, in such a way so that when movement of the actuation bar 8505 in the proximal direction, as described below, the coupling of the tongue tip 8472 of the jaw 8470 with the second set of teeth 8580 forces the carriage 8405 to move in the proximal direction, and the movement of the actuation bar 8505 in the distal direction, as will be described below, the engagement of the guide tip 8472 of the 8470 tongue with the second set of teeth 8580 does not force the carriage 8405 to move in the distal direction. The distance between each tooth in the second set of 8580 teeth must be less than the swing of the 8505 actuating bar, so that each distal movement of the 8505 actuating bar allows the 8470 tongue (which remains under the spring force in the anti-sense (clockwise) to engage with the next tooth proximally to the second set of teeth 8580.
In this way, the oscillation of the actuation bar 8505 creates a ratchet operation, moving the tongue 8470, and therefore the carriage 8405, in the proximal direction. This beneficial arrangement resulting from the use of the same force
(ie the oscillating piston and actuation bar) to move the carriage in the distal and proximal direction, with the simple rotation of the tongue spring. There are no complicated mechanisms to reverse the direction of travel of the carriage, so that the resulting systems are less complicated, simpler to operate, simpler and cheaper to manufacture and more efficient.
As noted above, device 8005 differs from devices 5, 1005 and 3005, in which device 8005 does not include an anvil driving piston, anvil driving pins, or an anvil driving groove. Instead, referring to Figure 48, the anvil 8205 of the device 8005 includes anvil pivot flanges
8290. The 8405 carriage includes first portion of the jaw coupling 8420 and the second portion of the jaw coupling 8430. The first portion of the jaw coupling 8420 includes flanges 8422 and 8426. The second jaw coupling portion 8430 includes rounded flange 8432. Flanges 8422 and 8426 engage carriage 8405 with anvil 8205, and rounded flange 8432 surrounds carriage 8405 with housing 8105.
Referring to Figures 48, 53 and 54, as the carriage 8405 moves distally from the head assembly 8006, the downward force exerted by the carriage 8405 is exerted from the opposite flanges 8422, 8426 of the upper jaw 8420 for coupling the clamp-shaped plate 8260 disposed under flanges 8422, 8426. The force is transferred to the clamp-shaped plate 5 8260, which then transfers the force to the anvil 8205. Thus, a Downward force is exerted by the carriage 8405 on the anvil 8205 during the cutting and stapling process. The corresponding complementary upward force is exerted on the coupling of the lower jaw, through the coupling portion of the lower jaw 8430 with the housing 8105, in the same manner described above in relation to device 5. Thus, the carriage 8405 is tensioned between the anvil 8205 and the housing 8105 to urge the anvil 8205 and the housing 8105 to their relative tight positions, so as to maintain a constant stuck tissue thickness when the carriage 8405 is being advanced or retracted axially, for example through the drive mechanism. shuttle described here.
Referring to Figures 48, 53 and 54, the drive bar 8505 of the device 8005 differs from the drive bars 505 and 1505 of the devices 5 and 1005, in that it includes a force transfer edge 8510, in an example of additional mode , similar to the force transfer edge 3510 of the device 3005, instead of force transfer slots 510, 1510. As in the device 3005, the ratchet piston 8605 is configured to engage with the actuation bar 8505, in a way
5 analogous to that established above in relation to the ratchet pistons 605, 1605 and the actuation bars 505, 1505 of the devices 5 and 1005, except that instead of a projection or male element 610, 1610 of the ratchet piston 605, 1605 that extends to a female recess or drive bar frame 505, 1505, ratchet piston 8605 includes a recess or female frame 8610 configured to receive an edge 8510 from the drive bar 8505. The transverse force transferring edge 8510 of the 8505 actuation bar extended
if for the circumferential recess 8610 of the 8630 axis,
thus restricting the actuation bar 8505 axially in relation to the ratchet piston 8605. The ratchet piston
8605, as well as the 605, 1605, and 3605 ratchet pistons,
includes an 8635 O-ring insert, proximal to the 8640 O-ring retaining wall, and distal, the 8645 O-ring retaining wall. The 8505 actuation bar is different from the 3005 actuation bar 3505 wherein the force transfer edge 8510 has two upward projections 851, which extend one within the circumferential recess 8610 of ratchet piston 8605.
Thus, the extension of one of the projections 8511 within a larger portion of the circumferential recess 8610 allows an increase in structural integrity at the point of transfer of force between the ratchet piston 8605 and the actuation bar 8505, during the distal movement of the carriage
8405. The actuation bar 8505 does not include the plurality of lateral positions of the actuation bars 5, 1505, and 3505, as additionally described herein.
In the fourth exemplary surgical device 8005, the carriage 8405 first remains inert or proximal position.
In this position, the first coupling portion of the jaw 8420 of the carriage 8405 is not involved with the anvil 8205, or is only partially involved with the anvil 8205, and the anvil 8205 is in an open position, the spring being in the open position. . The 8470 tongue can be engaged with the proximal tooth on the first set of 8570 ratchet teeth, or it can be in the closest position in relation to the actuation bar
8505. As the force of the 8605 ratchet piston is transferred to the 8505 bar and actuation, the 8470 tongue engages with the proximal tooth in the first set of 8570 ratchet teeth, distally orienting the 8405 carriage.
As the carriage 8405 moves in the distal direction, the first part of the jaw coupling 8420 wraps with channel guide 8230 and flange guide 8240 and 8245 to exert a clamping force on the anvil 8205, bringing the anvil 8205 in a closed position .
The first movement
5 distal of the carriage 8405 closing the anvil 8205 can be about 3mm.
The length of the first distal movement can be substantially the same or slightly greater than the stroke length of the 8605 ratchet piston and the axial distance between the first proximal position of the 8470 tongue, with respect to the first set of 8570 ratchet teeth. and the second proximal position of the 8470 tongue to couple the second proximal tooth of the first set of 8570 ratchet teeth. Within the distance of this first stroke or first tooth, the distal movement of the carriage 8405 can be stopped, and a carriage 8405 removed proximally, in order to open the anvil 8205 and prevent the surgical stapling process of the procedure.
Once the 8405 coach has progressed beyond this first distance, the stapling process continues.
This provision overcomes the need for a second piston to close the anvil, and instead provides only one piston to close the anvil,
drive the clamps, and advance the blade of the knife.
A single-piston system is less complicated and simpler to operate, simpler and cheaper to manufacture, and more efficient.
Figure 49 illustrates anvil 8205, carriage 8405, actuation bar 8505, clamp guide 8920 and an example clamp 8910. The carriage 8405 includes a plate
8410. While the cutting blade is not shown in Figure 49, none of the blades 450, 1450, 3450 of devices 5, 1005, 3405 are possible.
Referring to Figures 45 and 50 through 55, the head release latch 8007 is illustrated by connecting the head assembly 8006 (including anvil 8205 and housing 8105) to housing 8106, rear cover 8805 and steering column 8807. The Head release 8007 includes operational head release members 8008 and head release flanges 8009. In operation, head release flanges 8009 are located in head release slots 8107. When connected, as more specifically illustrated in Figures 53 and 54, the head release flanges 8009 are wrapped with head release slots 8107, and the ratchet actuation piston 8630 is wrapped, via circumferential recess 8610, to force the transfer edge 8510 of the actuation bar
8505. To release head assembly 8006 from the hydraulic system, as shown in figure 55, a user can use head release operating elements 8008 to remove flanges 8009 from grooves 8107. In combination with the double-acting piston directing the actuation bar 8505 and, therefore, the closed hydraulic drive system 5, the release of the head assembly allows the assembly of a new head to be used for each application of the surgical device. A new head set, including a new anvil, new clamps, and a new cutting blade, provides the advantage of increased sterility and simplifies efforts to keep a surgical device clean and sterile.
As best illustrated in Figures 50 to 55, the steering head 8807, connected to the end of flexible tube 5410, can be hydraulically actuated to provide hydraulic steering for the head assembly 8006, when connected to housing 8106. The steering head 8807 is wrapped with rear cover 8805 via pin 8806, on which the axial direction of the head assembly 8006 can be adjusted, in relation to the steering head 8807.
Hydraulic steering is carried out through the piston direction 8808, which can be a single acting or double acting piston.
In a known hydraulic way, the 8808 steering piston can be advanced to a distal end, or attracted to the proximal end, of an 8150 steering piston cylinder. When the 8808 steering piston is located halfway between the ends proximal and distal of the 8150 steering piston cylinder, the head assembly 8006 is located in the same axial direction as the steering head 5 8807. Advancing the steering piston 8808 to the distal end of the 8150 steering piston cylinder or drawing steering piston 8808 to the proximal end of the steering piston cylinder 8150, you can adjust the axial direction of the head assembly 8006 to the left or right with respect to the steering head 8807.
Figure 39 shows a surgical system 5005 can be provided in connection with one or more of the devices 5, 1005, 3005, 8005 described above. The device includes a control module, in the form of an example 5105 base unit that houses one or more hydraulic controllers. The 5105 base unit, which can be powered via a power outlet and / or battery powered and has an external 5110 switch and 5110 power-on light indicator, can also include various electronic products for the performance of the surgical procedure. In addition, the base unit 5105 has a plurality of indicators 5115a, which indicate the state of activity and disability and states of use of the 5005 system to provide visual indicators for the operator.
Extending from the base unit 5105 is a flexible shaft
5205 that connects to the 5105 base unit via a 5210 interchangeable connection plug. The 5205 axis extends
if from the base unit 5105 to a handle 5305
5 configured to be performed by an operator, for example, a surgeon, to perform a surgical procedure.
The handle 5305 has a housing 5310 and a pair of electronic switches 5315 and 5320. The switch 5315 is a switch configured to open and close the opposite jaws of an end effector 5505,
and switch 5300 is configured as a trigger to control a stapling cut and suture procedure for end effector 5505. End effector 5505 can be any of the devices 5, 1005, 3005, 8005 described above, such that the switch controls the opening and closing of the anvil 205, 1205, 3205, 8205 in relation to housing 105,
1105, 3105, 8205 and trigger switch 5320 controls the axial movement of the carriage 405, 1405, 3405, 8405 with respect to housing 105, 1105, 3105, 8105. Alternatively, as described here, with respect to the device 8005, the opening and closing of the anvil 8205 can be controlled by the axial movement of the carriage 8205,
and therefore, a separate control for the opening and closing of the anvil 8205 may not be necessary.
Extending from the distal end of handle 5310 is a rod 5405 formed of polyoxymethylene (e.g., Delrin ™) or any other suitable material, such as, for example, anodized aluminum. At the end of the stem 5 5405 is a flexible tube that extends from the stem 5410 a to the final effector 5505. The interior of the tube 5410 is in communication with the interior of the stem 5405. In this respect, the plurality of hydraulic tubes associated with the final effector, for example, in device 5, 1005, 3005, 8005 (for example, hydraulic tubes 705a, 705b, 705c and 705d) extend from inside the base unit 5105 to flexible shaft 5205, through handle 5305, 5405 through the rod, through the flexible tube 5410 and the acting end 5505, for example, the device 5, 1005, 3005, 8005 as described in this document.
Thus, device 5, 1005, 3005, 8005 can be operated as a 5505 end effector hydraulically and controlled by controllers in the 5105 control module, for example, in response to control signals from switches 5320, 5315. Although the controllers hydraulic units are arranged in a 5105 base unit, it should be understood that the controllers can be arranged in any suitable location, according to the example of additional modalities.
Although switches 5315, 5320 are electronic switches, it should be understood that purely mechanical switches can be provided.
The 5205 shaft is provided with a strain relief 5215 5 formed of molten elastomer or any other suitable material, at the connection point for the handle 5305. In addition, the housing 5310 of the handle 5305 can be formed by joining two halves of the mold (for example, the left and right halves).
At the distal end of the housing 5310 of each handle 5305 is a button 5325 and a button 5330. The button 5330 is rotatable about the longitudinal axis of the stem 5405 to trigger a movement of the final effector 5505, by bending the flexible tube 5410, just as such as, for example, the rotation of the device 3005, as illustrated in Figure 22B and / or one rotating in reverse. Any suitable movement or movements of the final effector 5505 can be configured to trigger the rotation of the 5330 button. The 5325 button has an unpressed position pattern in which the 5330 button is locked against rotation. When the button is pressed by the operator, the operator is then able to turn the 5330 button.
The flexible tube 5410 may include an inner tube of stainless steel mesh, which can be connected at each end thereof. Tube 5410 can accommodate one or more hinges for movement of end effector 5505. In addition, a portion of the heat sink can be provided to cover and / or seal the ends of flexible tube 510, for example, in the connection between flexible tube 5410 and rigid rod 5405.
Figure 40 shows another identifier 5305 'that can be provided in a system that is identical to the 5305 system described above, except to the extent indicated otherwise.
In addition, similar or similar elements are provided with reference numbers that are the same as the reference numbers in Figure 39, but followed by the '(apostrophe) character. The system of Figure 40 differs from the system of Figure 39, in which the identifier 5305 is provided in place of the handle 5305 in an example of an additional embodiment. The handle 5305 'functions in the same way as the handle 5305 and includes the same features as the handle 5305, unless otherwise noted.
The handle 5305 'differs from the handle 5305 in that it has a straight handle, as opposed to the pistol shape of the handle 5305 in an example of additional modality. The handle 5305 'is also different in that it includes a slide switch 5305' in that it includes a slide switch
5315 ', instead of the rocker switch 5315 of the handle 5305 to open and close the jaws of the final effector 5505, for example, the device 5, 1005, 3005, 8005. The axis 5405' which extends from the distal end of the handle 5305 '5 is formed from black machined anodized aluminum or any other suitable material, such as, for example, polyoxymethylene (for example, Delrin ™).
Figures 41A and 41B show a 5605 console. The 5605 console can be used as part of, or in connection with the 5005 system. The 5605 console includes a panel on the top 5610, which includes a 5615 display, such as a LCD screen or any other suitable graphic display, as well as a pair of 5620 speakers configured to output mono and / or stereo sound. The 5615 display and / or the 5620 loudspeakers can be configured to present information and / or alerts to the operator in connection with the process to be performed with the 5505 acting end (for example, device 5, 1005, 3005, 8005 ) of the 5005 system. For example, the display 5615 can be configured to display status information, health system information, end effector parameters (for example, the open or closed state of the end effector 5505 jaws and / or the cutting and / or stapling, as described in connection with devices 5, 1005, 3005, 8005), return information (for example, detected pressure, temperature, or other parameters), and / or any other suitable information . In addition, the display 5615 can be further configured to display and / or video images that can be obtained, for example, from an endoscopic camera. In this regard, the 5605 console can be used in combination with an endoscope and / or a monitor, to perform the procedures under vision.
In addition, the 5605 console can be used by the operator for input control signals, such as parameters that can be used to control the other components of the 5005 system, such as, for example, the 5505 actuating end and / or the unit base 5105.
The 5605 console can communicate with the base unit 5105 and / or any other component (s) of the system (for example, the handle 5305 and / or the end effector 5505) through any suitable communication mechanism. For example, the mechanism may involve wired communication and / or wireless transmission.
Figure 42 illustrates, schematically, the hydraulic operation to exert force and movement in a first direction 6130 and in a second direction 6135 opposite the first direction 6130. In this regard, the actuation of a hydraulic control piston 6105 in a cylinder of corresponding hydraulic control 6100 drives a 6155 hydraulic drive piston from a corresponding 6150 hydraulic drive cylinder.
5 The arrangement example in figure 42 provides two continuous sealed volumes of hydraulic fluid, 6140, 6145 (for example, saline or other suitable liquid). The first sealed volume 6140 is separated from the second sealed volume 6145 by the control piston 6105 and the drive piston 6155.
Referring to the arrangement on the left side of Figure 42, a force 6133 is applied to the control piston 6105, through the control piston shaft 6106, thus pressurizing the first volume of liquid 6140. The force can be applied by any suitable means, for example, an electric motor, solenoid, and / or any other suitable device. Since the system components, including the small holes in flexible pipes 6120, 6125, are relatively non-expandable, the force is substantially transferred to the portion of the first volume of hydraulic fluid 6140 in the drive cylinder
6150. The pressure increase in the first volume 6140 acts on the face of the drive cylinder 6150 by contacting the first volume 6140. In this respect, the force exerted on the drive piston 6145 by the first volume 6140 is generally equal to the pressure of the fluid 6140 multiplied by the area of piston 6140 exposed to pressurized fluid 6140, when viewed along the axis of drive chamber 5 6150. The application of force 6133 causes the pressure in the first fluid to be sufficiently greater than the fluid pressure of the volume 6145 that the driving piston 6155 moves in the direction 6130, due to a resulting force exerted on the piston 6155 in the direction
6130. As the control piston 6106 and the drive piston 6155 move inside the respective cylinders 6100, 6150, the fluid under pressure from the first volume 6140 flows in the pipe 6120 towards the control cylinder 6100 towards the cylinder drive 6150, and the fluid from the second volume 6145 flows in tube 6125 in a direction from drive cylinder 6155 to control cylinder 6100.
As shown in the right-hand portion of Figure 42, piston 6155 is driven in the reverse direction 6135 in a similar manner by a force 6137 in the opposite direction to that of force 6133 for the second pressurized volume 6145 and causes the fluids of the first and according to volumes 6140, 6145 flow in the tubes 6120, 6125 in opposite directions the instructions described above, with respect to the forward drive.
In the schematic illustration of Figure 42, hydraulic control cylinder 6100 and hydraulic control piston 6105 are arranged in a control module 6102, which 5 may be outside the sterile field of a surgical procedure, while hydraulic actuating cylinder 6150 and the hydraulic drive piston 6155 are arranged in a device 6152, with tubes 6120, 6125 interconnecting the control module 6102 and the device
6152. For example, referring to the 5005 system described above, hydraulic control cylinder 6100 and hydraulic control piston 6105 can be housed in base unit 5105, while hydraulic drive cylinder 6150 and hydraulic drive piston 6155 they are arranged on the acting end 5505 (for example, the device 5, 1005, 3005, 8005). For example, when the acting end 5055 is one of the devices 5, 1005, 3005, 8005, the drive mechanism of Figure 42 can be provided for driving the anvil pistons 305, 1305, 3305 and the ratchet pistons 605, 1605, 3605,
8605. Thus, the 5105 control module can operate two arrangements, one control piston to control the anvil piston 305, 1305, 3305 and one to independently control the ratchet piston 605, 1605, 3605, 8605.
Although pistons 6105 and 6145 are shown to be substantially the same diameter, it should be understood that the relative diameters can be selected to provide any desired hydraulic force.
5 Figure 43A shows control mechanism 7005 uses the same general design and driving principle as schematically illustrated and described in relation to Figure
42. The activation of forces 6133 and 6137 of Figure 42 are provided in mechanism 7005 of Figure 43A, by an electric motor 7010, which can be controlled by any suitable controller. The output shaft of the electric motor is coupled to a crank mechanism 7015, which includes an eccentric pin 7016, which is offset from the axis of rotation of the output shaft of the motor and is rotatably coupled to a connection 7020, which is also coupled rotatingly, via junction 7025, to an intermediate output shaft 7030. The 7030 axis is slidably supported in two axial positions spaced by a bearing block 7035, which allows the translation of the intermediate axis 7030 along its longitudinal axis, but restricts the 7030 intermediate axis to lateral movement or rotation. Thus, when the motor 7010 spins, the corresponding rotation of the eccentric pin 7016 causes an axial reciprocating movement of the intermediate shaft 7030. The intermediate shaft 7030 is coupled, through coupling 7040, to a control piston shaft 7106 of a control piston hydraulic 7105, which slides inside a hydraulic control cylinder 7100. Thus, the reciprocating movement 5 of the intermediate shaft 7030 causes piston 7105 to axially alternate within the cylinder 7100.
The control piston shaft 7106, the hydraulic control piston 7105 and the hydraulic control cylinder 7100 are analogous to the axis of the control piston 6106, the hydraulic control piston 6105, and the hydraulic control cylinder 6100 of the system in Figure 22. described above and therefore work in the same way. In this regard, the tubes corresponding to tubes 6120 and 6125 of Figure 42 are connected to the respective sides of cylinder 7100, through the respective fluid connections 7050 and 7055. For example, tube 705c, 1705c, 3705c can be coupled to connector 7050 and the complementary tube 705d, 1705d, 3705d coupled to connector 7055, or vice versa, in order to drive the ratchet piston 605, 1605, 3605, 8605 in the first hydraulic chamber 110, 1110, 3110, 8110. Thus, to the measure Since piston 7105 is alternated within cylinder 7100 by electric motor 7010, a corresponding reciprocating motion is actuated on the piston corresponding to piston 6155 in Figure 22.
In addition, in order to control the interval at which the piston (for example, ratchet piston 605) is activated (for example, alternating), the amplitude of movement (for example, reciprocating movement) of the control piston is controllable 5 by means of a linear actuator 7060, which is provided in the example as an air cylinder, but can be any suitable actuator. The linear actuator 7060 moves the drive cylinder 7100, with respect to piston 7105 by moving the drive cylinder 7100 axially with respect to the motor and other components of the 7005 system fixed unit. This is achieved by pushing a cylinder block 7101, in which the cylinder 7100 is formed, along the axis of cylinder 7100, through the axial extension or retraction of an output shaft 7065 of the linear actuator 7060. The linear actuator 7060 is driven by the air inlet / outlet valves 7070 and 7075.
The cylinder block 7101 is slidably supported on a block holder 7103, which limits the axial position of the block holder 7101, and therefore the cylinder 7105, in both axial directions, providing positive stops corresponding to two positions predetermined axial axes of the cylinder 7100, with respect to the available stroke margin of piston 7105. In this sense, the movement of the cylinder between these positions causes an analogous displacement in the piston to be driven. For example, the first predetermined position of cylinder 7100 can cause ratchet piston 605 to alternate in the first axial region 660, while movement of cylinder 7100 5 to the second predetermined position can cause ratchet piston 605 to alternate. in the second axial region 670, as described in greater detail above with respect to Figures 10C to 10E. Thus, the 7060 actuator is configured to move the 7100 drive cylinder from two fixed positions to create two selectable zones 660, 670 of the drive piston.
In addition, hydraulic tube 705a, 1705a, 3705a, 8705a of device 5, 1005, 3005 can be attached to connector 7050 and complementary tubes 705b, 1705b, 3705b attached to connector 7055, or vice versa, in order to drive the anvil piston 305, 1305, 3305 in the first hydraulic chamber 110, 1110, 3110. In this respect, the 7010 engine can be controlled in such a way that the piston is moved in a non-alternative way in order to drive the piston of anvil 305, 1305, 3305.
An O-ring 7107 maintains a seal at the interface between piston 7105 and cylinder 7100, which separates the first and second volumes of sealed fluids disposed on opposite sides of piston 7105.
Figures 43B to 43E, an alternative embodiment of the base unit are illustrated. The base unit 9105 includes a panel 901, in which a plug receiver 9008 connects the interior of the base unit 9105 to the connectable surgical device 5. The interchangeable plug connection 9210 includes shaft 9205 and the plug body 9003. Plug body 9003, with four single-acting pistons 9016, 9026, 9036 (bottom, not pictured), 9046 (foreground, not shown), can be attached to the 9008 plug receiver, for example, through wing nut 9007. Each of the pistons 9016, 9026, 9036 and 9046 are located in hydraulic chambers 9116, 9126, 9136 (bottom, not pictured), 9146 ( in the foreground, and not shown), respectively. The push rods 9019, 9029, 9039 and 9049 (in the foreground, not pictured), driven by a motor from the base unit 9105, engage with pistons 9016, 9026, 9036 and 9046, respectively, to provide positive force or negative in each hydraulic chamber. In front of the piston, each hydraulic chamber faces tubes 9216, 9226, 9236, and 9246, to translate the positive or negative hydraulic force experienced in each hydraulic chamber to the piston or pistons of the surgical device.
The pistons 9016 and 9026 form a pair of single-acting pistons that provide positive and negative hydraulic forces to the ratchet pistons of the present invention.
Hydraulic chambers 9116 and 9126 are in fluid connection with the complementary hydraulic chambers located distal and proximal to the double action ratchet pistons of the surgical device. Piston pairs 9016 and 9026, therefore, each complementing the hydraulic forces provided by the other, to oscillate the double-acting ratchet piston as needed. Pistons 9036 and 9046 can form an additional pair of single-acting pistons to provide positive and negative hydraulic forces for an additional double-acting piston, for example, an angled steering piston or piston.
Figure 44 is a partial internal perspective view of the device of Figure 22A 3005 in connection with the hydraulic control equipment 7005 of Figure 43. To alternate the ratchet piston 7605 as indicated above, hydraulic tubes 3705c would be connected, via the connector 3706c, in the order of hydraulic fluid transfer between the 7050 connector of the 7005 mechanism and the 3150 cylinder portion, which is proximal to the seal formed between the 3605 piston and the 3150 cylinder, and the 3705d hydraulic tube could be connected via the connector 3706d, in the order of hydraulic fluid transfer between the 7055 connector on the 7005 mechanism and the cylinder portion
3150, which is the distal seal formed between piston 3605 and cylinder 3150. In this way, the alternative piston 7105 in the driving cylinder 7100, which alternates in different directions to move cyclically the fluid in and out of the 5 connecting tube 7050 and 7055 and tubes 3705a and 3705b. The alternative fluid transfer tubes 3705a and 3705b create an oscillating movement at the end of the effector cylinder 150. This is achieved by the fluid entering and leaving the cylinder 3150 on both sides of the piston seal (formed between the 3605 piston and the cylinder 3150 with o-ring 3620) causes piston 3605 in end effector 3005 to alternate.
The anvil piston 3305 can be driven by a respective mechanism 7005, through a similar connection, through which the tubes 3705a, 3705b are connected to the respective supports 3706a and 3706b, 7050, 7055 to transmit the hydraulic fluid.
Although the alternative surgical devices 5, 1005, 3005, 8005 described above use a hydraulic drive system to transfer the force from a control module to the, it should be understood that other drive systems can be envisaged, for example, electromechanical controllers. For example, one or more solenoids (for example, in final effector 5, 1005, 3005,
8005 and / or any other location in the system) can be provided to retract the actuation bar and / or activate the anvil between the open and closed positions.
In addition, although alternative drive mechanisms are described in the examples as having one or more teeth, it should be understood that the engagement teeth can be dispensed with, and / or any other engagement mechanism, for example, a directional friction can be provided in addition to or as an alternative to the teeth described herein.
The arrangement of the surgical devices described herein includes a ratchet element that is located in the housing, not the handle. This arrangement allows the use of a flexible cable, which supports the remote operation of the surgical device.
Although the present invention has been described with reference to particular examples and exemplary embodiments, it should be understood that the foregoing description is by no means limiting. In addition, the features described here can be used in any combination.

权利要求:
Claims (17)
[1]
1. Surgical stapling device, characterized by the fact that it comprises; a first jaw; a second jaw having an open position and a closed position with respect to the first jaw; a drive bar arranged on the first jaw and which includes a first set of ratchet teeth; a ratchet piston oscillatingly configured to move the actuation bar along a longitudinal direction of the first jaw; a wrapper; having at least one clamp and at least one staple direction groove, located in the first jaw; and a carriage, including at least one clamp steering wedge, selectively engaged with the first set of ratchet teeth of the drive bar to transform the carriage in a distal direction, through the housing from a proximal end position to a position distal end, at a distance between the distal end position and the proximal end position greater than a length of the travel bar oscillation travel; wherein the clamp guide wedge is adapted to guide the clamp through the clamp guide groove against the second jaw, during the distal movement of the carriage through the housing.
[2]
2. Surgical stapling device, according to claim 1, characterized by the fact that the actuation bar includes a second set of ratchet teeth, and in which the carriage is even selectively engaged with the second set of ratchet teeth for transform the carriage in a proximal direction, through the casing from the distal end position to the proximal end position.
[3]
3. Surgical stapling device, according to claim 1, characterized by the fact that the ratchet piston is actuated hydraulically.
[4]
4. Surgical stapling device, according to claim 2, characterized by the fact that it also comprises a bi-directional locking mechanism adapted to engage with the first set of ratchet teeth to transform the carriage in the distal direction and to engage with the second set of ratchet teeth to turn the carriage in the proximal direction.
[5]
5. Surgical stapling device according to claim 4, characterized by the fact that the bidirectional locking mechanism is engaged with the carriage by means of a spring force transfer pin, and the bidirectional locking mechanism is the spring loaded around the spring force transfer pin.
[6]
6. Surgical stapling device, according to claim 5, characterized by the fact that the actuation bar includes an enlarged opening at a distal end, the enlarged opening dimensioned to allow the loaded spring bidirectional locking mechanism to rotate around the spring force transfer pin to disengage with the first set of ratchet teeth and engage with the second set of ratchet teeth.
[7]
7. Surgical stapling device according to claim 1, characterized by the fact that the ratchet piston includes a ratchet piston shaft that has a circumferential recess located at a distal end of the ratchet piston shaft, the actuation bar having a force transfer rib located at the proximal end of the actuation bar, the force transfer rib configured to fit the circumferential recess, the ratchet piston axis configured to transfer the force to the ratchet via the circumferential recess and the force transfer rib to swing the actuation bar.
[8]
8. Surgical stapling device, according to claim 1, characterized by the fact that the piston is a double-acting ratchet piston.
[9]
9. Surgical stapling device according to claim 1, characterized by the fact that the second jaw is movable from the open position to the closed position by a clamping force exerted on the second jaw by the carriage.
[10]
10. Surgical stapling device according to claim 2, characterized by the fact that the carriage includes a first set of carriage teeth and a second set of carriage teeth, the carriage engageable with the drive bar via a (i) the first set of carriage teeth being engaged with the first set of ratchet teeth to translate the carriage in the distal direction, through the casing and (ii) the second set of carriage teeth being involved with the second set of teeth ratchet to translate the carriage proximally through the enclosure.
[11]
11. Surgical stapling device according to claim 1, characterized by the fact that the ratchet piston includes a ratchet piston shaft and a force transfer pin located at a distal end of the ratchet piston shaft, the bar drive shaft having a force transfer slot located at the proximal end of the drive bar, the force transfer pin adapted to fit within the force transfer slot, the ratchet piston shaft adapted to transfer the force to the bar drive, through the force transfer pin and the force transfer slot to swing the actuation bar.
[12]
12. Surgical stapling device according to claim 1, characterized by the fact that it further comprises: an anvil pivot pin located in a first groove of the anvil pin of the first jaw and a second groove of the anvil pin the second jaw, and an anvil piston configured to direct the anvil pivot pin distally to exert a clamping force on the second jaw to move the second jaw from the open to the closed position, and to direct the anvil pivot pin in the direction proximal to release the fixation on the second jaw to move the second jaw from the closed to the open position.
[13]
13. Surgical stapling device according to claim 1, characterized by the fact that it further comprises: a piston casing to house the ratchet piston, and a locking release head adapted to releasably engage the piston casing with the first jaw, in which the ratchet piston is coupled with the actuation bar, when the piston casing is engaged with the first jaw.
[14]
14. Surgical stapling device, according to claim 1, characterized by the fact that it also comprises: a base unit having a hydraulic pump; a flexible shaft, in hydraulic communication with the base unit and the ratchet piston; wherein a hydraulic force generated by the hydraulic pump is transferable from the base unit to the ratchet piston.
[15]
15. Surgical stapling device according to claim 14, characterized by the fact that the base unit includes at least two single-acting pistons, one of at least two single-acting pistons that is in fluid communication with a furthest side of the ratchet piston, and one of the at least two single-acting pistons, being in fluid communication with a proximal side of the ratchet piston, and each of the at least two single-acting pistons requires positive hydraulic pressure or negative at the distal or proximal lateral end of the ratchet piston.
[16]
16. Surgical stapling device, according to claim 14, characterized by the fact that it further comprises: a control device, including a switch, located between the base unit and the ratchet piston; wherein the switch is operated to selectively initiate the transfer of hydraulic force from the base unit to the ratchet piston, and to selectively end the transfer of hydraulic force from the base unit to the ratchet piston.
[17]
17. Method for surgically stapling characterized by the fact that it comprises: tightening a second jaw to a closed position in relation to a first jaw from an open position in relation to the first jaw; swing the direction of a ratchet piston; oscillating an actuation bar located in the first jaw by driving the ratchet piston, the actuation bar oscillating a length of travel along a longitudinal direction of the first jaw, the actuation bar having a first set of ratchet teeth; rock a carriage in the distal direction from a proximal end position to a distal end position by means of a casing located in the first jaw by oscillating the actuation bar, the casing having at least one clamp and at least one clamp-leading slot , rocking the coupling with the first set of teeth, and driving at least one clamp through at least one clamp-leading slot through the carriage ratchet in the distal direction; wherein the distance between the distal end position and the proximal end position is greater than the stroke length.

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法律状态:
2020-08-25| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2020-10-20| B08F| Application dismissed because of non-payment of annual fees [chapter 8.6 patent gazette]|Free format text: REFERENTE A 8A ANUIDADE. |

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2021-03-02| B08G| Application fees: restoration [chapter 8.7 patent gazette]|

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2021-03-09| B08F| Application dismissed because of non-payment of annual fees [chapter 8.6 patent gazette]|Free format text: REFERENTE A 9A ANUIDADE |

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2021-07-13| B08G| Application fees: restoration [chapter 8.7 patent gazette]|

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2021-07-20| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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

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2021-11-09| B08F| Application dismissed because of non-payment of annual fees [chapter 8.6 patent gazette]|Free format text: REFERENTE A 10A ANUIDADE. |

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2022-03-03| B08K| Patent lapsed as no evidence of payment of the annual fee has been furnished to inpi [chapter 8.11 patent gazette]|Free format text: EM VIRTUDE DO ARQUIVAMENTO PUBLICADO NA RPI 2653 DE 09-11-2021 E CONSIDERANDO AUSENCIA DE MANIFESTACAO DENTRO DOS PRAZOS LEGAIS, INFORMO QUE CABE SER MANTIDO O ARQUIVAMENTO DO PEDIDO DE PATENTE, CONFORME O DISPOSTO NO ARTIGO 12, DA RESOLUCAO 113/2013. |

优先权:

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申请号 | 申请日 | 专利标题

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US201161461196P| true| 2011-01-14|2011-01-14|

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US61/461,196|2011-01-14|

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PCT/US2012/021380|WO2012097342A1|2011-01-14|2012-01-13|Surgical stapling device and method|

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