 SURGICAL INSTRUMENT APPLIANCE
专利摘要:
The present invention relates to a surgical instrument including a handle portion, a rod housing a trigger bar, and an end actuator comprising an anvil, a lower jaw, and a clamping and separating assembly responsive to a longitudinal closing movement produced by the cable portion and the shank. the lower jaw is configured to receive a removable cartridge. the cartridge includes a compartment, a plurality of clips disposed in the compartment, and a holder disposed on the plurality of clips. the support defines openings, each opening being substantially disposed in each clamp. the instrument includes an anvil cartridge detachably received in an anvil frame. the anvil cartridge is separated by the fire bar when the fire bar is advanced through the fabric so that material from the anvil cartridge is released into the separated fabric. 公开号:BR112014006828B1 申请号:R112014006828-3 申请日:2012-09-19 公开日:2021-06-22 发明作者:Stephen J. Balek；Chad P. Boudreaux；Matthew D. Holcomb；Edward A. Rhad 申请人:Ethicon Endo-Surgery, Inc.； IPC主号:
专利说明:
BACKGROUND [001] In some contexts, endoscopic surgical instruments may be preferred over devices for traditional open surgery, as a smaller incision can reduce recovery time and complications in the postoperative period. Consequently, some endoscopic surgical instruments may be suitable for placing a distal end actuator at a desired surgical site via the cannula of a trocar. These distal end actuators can secure tissue in a variety of ways to achieve a diagnostic or therapeutic effect (eg, endocutter, gripper, cutter, stapler, clip applicator, access device, drug delivery device/gene therapy and device for applying energy using ultrasound, RF, laser, etc.). Endoscopic surgical instruments may comprise a rod between the end actuator and a handle portion, which is manipulated by the physician. This nail can allow insertion to the desired depth and rotation around the longitudinal axis of the nail itself, thus facilitating the positioning of the extremity actuator on the patient. Positioning an end actuator can also be facilitated by the inclusion of one or more swivel joints or features, allowing the end actuator to be selectively swiveled or even offset with respect to the longitudinal axis of the stem. [002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers can be operated to staple fabric layers, cut through stapled fabric layers, and push the staples through fabric layers to securely join the separate fabric layers near the separate ends of the fabric layers. Merely exemplary surgical staplers are revealed; US Patent No. 4,805,823 entitled "Pocket Configuration for Internal Organ Staplers", issued February 21, 1989; U.S. Patent No. 5,415,334 entitled "Surgical Stapler and Staple Cartridge", issued May 16, 1995; U.S. Patent No. 5,465,895 entitled "Surgical Stapler Instrument", issued November 14, 1995; US Patent No. 5,597,107 entitled "Surgical Stapler Instrument", issued January 28, 1997; US Patent No. 5,632,432 entitled "Surgical Instrument", issued May 27, 1997; US Patent No. 5,673,840 entitled "Surgical Instrument", issued October 7, 1997; US Patent No. 5,704,534 entitled "Articulation Assembly for Surgical Instruments", issued January 6, 1998; US Patent No. 5,814,055 entitled "Surgical Clamping Mechanism", issued September 29, 1998; US Patent No. 6,964,363 entitled "Surgical Stapling Instrument having Articulation Joint Support Plates for Supporting a Firing Bar", granted on November 15, 2005; US Patent No. 6,978,921 entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", issued December 27, 2005; US Patent No. 6,988,649 entitled "Surgical Stapling Instrument Having a Spent Cartridge Lockout", issued January 24, 2006; U.S. Patent No. 7,000,818 entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", granted February 21, 2006; US Patent No. 7,111,769 entitled "Surgical Instrument Incorporating an Articulation Mechanism having Rotation about the Longitudinal Axis", issued September 26, 2006; U.S. Patent No. 7,143,923 entitled "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil", issued December 5, 2006; US Patent No. 7,303,108 entitled "Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack", issued December 4, 2007; US Patent No. 7,367,485 entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", issued May 6, 2008; US Patent No. 7,380,695 entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", granted June 3, 2008; US Patent No. 7,380,696 entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece EBeam Firing Mechanism", granted June 3, 2008; US Patent No. 7,404,508 entitled "Surgical Stapling and Cutting Device", issued July 29, 2008; U.S. Patent No. 7,434,715 entitled "Surgical Stapling Instrument Having Multiple Strokes of Firing with Aperture Lock", granted on October 14, 2008; US Patent No. 7,721,930 entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010; and US Patent No. 7,455,208 entitled "Surgical Instrument with Articulating Shaft with Rigid Firing Bar Supports", issued November 25, 2008. The description of each of the above-cited US patents is incorporated by reference into the present invention. Although the aforementioned surgical staplers are described as being used in endoscopic procedures, it should be understood that these surgical staplers can also be used in open procedures and/or other non-endoscopic procedures. [003] Although various types of surgical stapling instruments and associated components have been manufactured and used, it is believed that no one prior to the inventor(s) has manufactured or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS [004] The attached drawings, which are incorporated into and form part of this descriptive report, illustrate embodiments of the invention and, together with the general description given above and the detailed description of the embodiments given below, serve to explain the principles of the present invention. [005] Figure 1A shows a perspective view of a hinged surgical instrument with an end actuator in a non-articulated position; [006] Figure 1B shows a perspective view of the surgical instrument of figure 1A with an end actuator in an articulated position; [007] Figure 2 represents a perspective view of an open-end actuator of the surgical instrument of Figures 1A-1B; [008] Figure 3A shows a side cross-sectional view of the end actuator of figure 2, taken along line 3-3 of figure 2, with the trigger bar in a proximal position; [009] Figure 3B represents a side cross-sectional view of the end actuator of figure 2, taken along line 33 of figure 2, but showing the trigger bar in a distal position; [0010] Figure 4 shows an end cross-sectional view of the end actuator of figure 2, taken along line 4-4 of figure 2; [0011] Figure 5 shows an exploded perspective view of the end actuator of figure 2; [0012] Figure 6 shows a perspective view of the end actuator of figure 2, positioned on the fabric and being actuated once on the fabric; [0013] Figure 7 shows a fragmentary perspective view of a version of an anvil of the end actuator of Figure 2, and an anvil cartridge configured for removable reception in an opening of the anvil; [0014] Figure 8 shows a view in elevation from distal to proximal of an alternative version of the anvil cartridge; [0015] Figure 9 shows a distal to proximal elevation view of an alternate version of an anvil and lower jaw of the end actuator of Figure 2, the anvil and lower jaw respectively including cartridges; [0016] Figure 10 shows a distal to proximal elevation view of an alternative version of an anvil of the end actuator of Figure 2, the anvil further including another version of an anvil cartridge, and the opening of anvil is configured for receiving the anvil cartridge; [0017] Figure 11 shows a distal to proximal elevation view of an alternative version of an anvil of the end actuator of Figure 2, the anvil further including another version of an anvil cartridge, and the opening of anvil is configured for receiving the anvil cartridge; and [0018] Figure 12 shows a perspective view of an end actuator with an anvil cartridge including a tissue repair composition, the end actuator being positioned and actuated on the tissue to release the tissue repair composition onto the fabric. [0019] The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the invention may be carried out in a variety of other ways, including those not necessarily represented in the drawings. The accompanying drawings incorporated and forming a part of the descriptive report illustrate various aspects of the present invention, and together with the description serve to explain the principles of the invention; it is understood, however, that this invention is not limited to the arrangements shown. DETAILED DESCRIPTION [0020] The following description of specific examples of the invention should not be used to limit the scope of the present invention. Other examples, features, aspects, modalities and advantages of the invention will become apparent to those skilled in the art from the following description, which uses illustrations, one of the best contemplated modes for carrying out the invention. As will be understood, the invention may have other different and obvious aspects, all without departing from the invention. Consequently, the drawings and descriptions are to be regarded as illustrative in nature and not restrictive. I. Exemplary surgical stapler [0021] Figures 1-6 show an exemplary surgical stapling and separating instrument (10) that is sized for insertion, in a non-articulated state, as illustrated in Figure 1A, through the cannula conduit of a trocar, to a surgical site in a patient undergoing a surgical procedure. The surgical stapling and separating instrument (10) includes a handle portion (20) connected to an implement portion (22), the latter further comprising a rod (23) which terminates distally in a hinge mechanism (11) connected distally. to the end actuator (12). When the articulation mechanism (11) and the distal end actuator (12) are inserted through the cannula conduit of a trocar, the articulation mechanism (11) can be remotely articulated, as shown in Figure 1B, by the control of articulation (13). Thus, the end actuator (12) can reach behind an organ or approach tissue at a desired angle or for other reasons. It should be understood that terms such as "proximal" and "distal" are used in the present invention with reference to the handle portion (20) of the instrument (10) manipulated by the physician. In this way, the end actuator (12) is distal with respect to the most proximal cable portion (20). It will further be recognized that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in relation to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and absolute. [0022] The end actuator (12) of the present example includes a lower jaw (16) and a hinged anvil (18). The handle portion (20) includes a pistol grip (24), against which a closing trigger (26) is pivotally pressed by the physician in order to pinch or close the anvil (18) against the lower jaw ( 16) of the end actuator (12). This closing of the anvil (18) is achieved by means of an external closing sleeve (32), which translates longitudinally in relation to the handle portion (20) in response to the articulated actuation of the closing trigger (26) against the handle pistol (24). A distal closure ring (33) of the closure sleeve (32) is indirectly supported by the frame (34) of the implement portion (22). In the hinge mechanism (11), a proximal closure tube (35) of the closure sleeve (32) communicates with the distal portion (closure ring) (33). The frame (34) is flexibly connected to the lower jaw (16) via the articulation mechanism (11), allowing articulation in a single plane. The frame (34) also longitudinally and slidingly supports a firing guiding member (not shown), which extends through the rod (23) and transmits firing motion from the firing trigger (28) to the firing bar. shot (14). The firing trigger (28) is furthest away from the closing trigger (26), being pivotally pressed by the physician to staple and separate the tissue clamped in the end actuator (12), as will be described in more detail below. Then, the release button (30) is released to release the tissue from the end actuator (12). [0023] Figures 2-5 show the end actuator (12) employing an electronic beam firing bar (14) to perform a variety of functions. As best seen in Figures 3A and 3B, the firing bar (14) includes a transversely oriented top pin (38), a firing bar cap (44), a transversely oriented middle pin (46) and a cutting edge. in a distal position (48). The top pin (38) is located and is translatable within an anvil pocket (40) of the anvil (18). The trigger bar cap (44) slidingly engages the lower surface of the lower jaw (16), causing the trigger bar (14) to extend along the slot in the channel (45) (shown in Figure 3B ) which is formed along the lower jaw (16). The middle pin (46) slidingly engages the top surface of the lower jaw (16), cooperating with the trigger bar cap (44). In this way, the firing bar (14) affirmatively spaces the end actuator (12) during firing, avoiding mechanical pinching that can occur between the anvil (18) and the lower jaw (16) with a minimal amount of pinched tissue and preventing bad staple formation when an excessive amount of tissue is clamped. [0024] Figure 2 shows the firing bar (14) positioned proximally and the anvil (18) hinged in an open position, allowing a cartridge of unsold staples (37) to be installed in the lower jaw channel (16) . As best seen in Figures 4 and 5, the staple cartridge (37) of this example includes the cartridge body (70), which contains an upper platform (72), and is coupled to a lower cartridge tray (74) . As best seen in Figure 2, a vertical slit (49) is formed through part of the staple cartridge (37). Also as best seen in Figure 2, three rows of staple openings (51) are formed across the top platform (70) on one side of the vertical slot (49), with another set of three rows of staple openings (51 ) formed through the upper platform (70) on the other side of the vertical slot (49). Turning to Figures 3 to 5, a wedge-shaped sliding support (41) and a plurality of clamp drivers (43) are captured between the cartridge body (70) and the tray (74), with the sliding support in form. wedge (41) located proximal to the staple drivers (43). The wedge-shaped slide holder (41) is movable longitudinally within the staple cartridge (37); while the staple drivers (43) are movable vertically within the staple cartridge (37). The staples (47) are also positioned within the cartridge body (70), above the corresponding staple drivers (43). In particular, each clamp (47) is urged vertically into the cartridge body (70) by a staple driver (43) so as to urge the clamp (47) through an associated clamp opening (51). As best seen in Figures 3A and 3B and 5, the wedge-shaped sliding support (41) has slanted cam surfaces that push the clamp drivers (43) up, as in the wedge-shaped sliding support (41 ) is pushed distally through the staple cartridge (37). [0025] With the end actuator (12) closed, as shown in Figure 3A, the trigger bar (14) is advanced engaged with the anvil (18) by entering the upper pin (38) into a longitudinal slot of the anvil (42). A drive block (80) is located at the distal end of the trigger bar (14) and is configured to engage the wedge slide support (41) so that the wedge slide support (41) is pushed. distally by the drive block (80) as the trigger bar (14) is advanced distally through a staple cartridge (37). During this firing, the cutting edge (48) of the firing bar (14) enters the vertical slot (49) of the staple cartridge (37), separating the clamped tissue between the staple cartridge (37) and the anvil (18) . As shown in Figures 3A and 3B, the middle pin (46) and the drive block (80) together drive the staple cartridge (37) into a firing slot inside the staple cartridge (37), the which drives the wedge-shaped sliding bracket (41) into upward contact of cams with the staple drivers (43), which in turn urges the staples (47) through the staple openings (51) and into contact former with the clamp forming cavities (53) on the inner surface of the anvil (18). Figure 3B depicts the trigger bar (14) completely distally translated after tissue separation and stapling is completed. [0026] Figure 6 shows end actuator (12) actuated by a single movement through the fabric (90). As shown, the cutting edge (48) cut the fabric (90), while the staple drivers (43) drove three alternating rows of staples (47) through the fabric (90) on either side of the cut line produced by the edge. sharp (48). The clamps (47) are all oriented substantially parallel to the cut line in this example, although it should be understood that the clamps (47) can be positioned in any suitable orientations. In the present example, the end actuator (12) is removed from the trocar after the first stroke is completed, the staple cartridge sent (37) is replaced with a new staple cartridge, and the end actuator (12) is again inserted through the trocar to reach the stapling site for additional cutting and stapling. This process can be repeated until the desired amount of cuts and staples (47) has been applied. The incus (18) may need to be closed to facilitate insertion and removal through the trocar; and the anvil (18) may need to be opened to facilitate replacement of the staple cartridge (37). [0027] It should be understood that the cutting edge (48) can stop tissue substantially at the same time as the clamps (47) are pushed through the tissue during each stroke of actuation. In the present example, the cutting edge (48) closely follows the insertion of the staples (47), so that a staple (47) is pushed through the tissue just before the cutting edge (48) passes through the same region of the tissue, although it should be understood that this order can be reversed, or that the cutting edge (48) can be directly synchronized with the adjacent clamps. Although Figure 6 shows the end actuator (12) being actuated on two layers (92, 94) of fabric (90), it should be understood that the end actuator (12) can be actuated through a single layer of fabric ( 90) or more than two layers (92, 94) of fabric. It should also be understood that the formation and positioning of staples (47) adjacent to the cut line produced by the cutting edge (48) can substantially bind tissue together at the cut line, thus reducing or preventing bleeding and/or leakage of other bodily fluids in the cut line. Various suitable configurations and procedures in which instrument 10 can be used will be apparent to those skilled in the art in view of the teachings contained herein. [0028] It should be understood that the instrument (10) is configurable and operable in accordance with any other teachings of US Patent No. 4,805,823; US Patent No. 5,415,334; US Patent No. 5,465,895; US Patent No. 5,597,107; US Patent No. 5,632,432; US Patent No. 5,673,840; US Patent No. 5,704,534; US Patent No. 5,814,055; US Patent No. 6,964,363; US Patent No. 6,978,921; US Patent No. 6,988,649; US Patent No. 7,000,818; US Patent No. 7,111,769; US Patent No. 7,143,923; US Patent No. 7,303,108; US Patent No. 7,367,485; US Patent No. 7,380,695; US Patent No. 7,380,696; US Patent No. 7,404,508; US Patent No. 7,434,715; US Patent No. 7,721,930; and/or US Patent No. 7,455,208. As noted above, the descriptions of each of these patents are incorporated by reference to the present invention. Additional exemplary modifications that can be made to the instrument (10) will be described in more detail below. Various suitable ways in which the teachings below can be incorporated into the instrument (10) will be apparent to those skilled in the art. Similarly, various ways in which the teachings below can be combined with the various teachings of the patents cited herein will be apparent to those skilled in the art. It is also to be understood that the teachings below are not limited to the instrument (10) or devices taught in the patents cited herein. The teachings below can be readily applied to many other types of instruments, including instruments that would not be classified as surgical staplers. Various other suitable devices and configurations in which the teachings below can be applied will be apparent to those skilled in the art in view of the teachings contained herein. II. Exemplary anvil cartridge Figures 7-8 show exemplary anvil cartridges (100A, 100B) arranged in the anvil structure (102) of the anvil (101), which is similar to the anvil (18), different from that shown below. The anvil cartridge (100A, 100B) can hold or be formed from various materials such as glue, fabric and/or various other materials that will be apparent to those skilled in the art in view of the teachings contained herein. Such material can be deposited on the fabric when the end actuator (12) having the anvil cartridge (100A, 100B) is actuated. [0030] As shown in Figure 7, the anvil cartridge (100A) can be removably received in the anvil frame (102) in the direction of the arrow (A). The distal end (104) of the anvil structure (102) defines an opening (106) that is sized to receive a correspondingly shaped portion (108) of the anvil cartridge (100A). The opening (106) is arranged above and communicates with an anvil slit (103), which is similar to the anvil slit (42) described above. The anvil cartridge (100A) includes a downwardly projecting portion (110) sized for reception in the anvil slot (103). [0031] As shown in Figure 8, the anvil cartridge (100B) may alternatively omit a downwardly projecting portion (110), but includes the portion (108) of the anvil cartridge (100B) received in the opening ( 106) of the anvil frame (102) so that the portion (108) still communicates with the anvil slot (42). In either case, the firing bar (14) can be fired through the anvil slot (103), as described above, to cut the anvil cartridge (100A, 100B) and release material from the anvil cartridge (100A, 100B) over the fabric (90), while the anvil (101) cooperates with the lower jaw (16) of the end actuator (12) to clamp the fabric (90). Simultaneously, the clips (47) of the cartridge (37) can be driven upwards towards the clip pockets (not shown) on the anvil (101) to be formed on the clips, which secure the fabric (90) and portions of the cartridge. fabric (90) together as described above. [0032] In use, after the anvil cartridge (100A, 100B) is attached to the anvil frame (102), the end actuator (12) will function as described above to separate and staple the tissue (90). The anvil cartridge material (100A, 100B) which is separated by the firing bar (14) can be deposited onto the fabric (90). By way of example only, the anvil cartridge (100A, 100B) can be formed as a support to structurally support a row of staples. Additionally, or alternatively, the anvil cartridge (100A, 100B) may comprise a material including, for example, a hemostatic agent to aid blood clotting and reduce bleeding at the separate surgical site and/or stapled along of the fabric (90). Additionally, or alternatively, the anvil cartridge (100A, 100B) may comprise a biodegradable polymer that is operable to aid tissue repair, as described below. Additionally, when the surgical clamp (47) is inserted into tissue (90) by an instrument (10) in the manner shown above, the surgical clamp (47) will compress, connect and support such layers (92, 94) of tissue (90) as shown in figure 12. The material from the anvil cartridge (100A, 100B) will contact the compressed tissue (90) and release over the tissue (90) to aid tissue repair, reducing the amount of bleeding in the tissue. surgical site. In addition, or alternatively, the material of the anvil cartridge (100A, 100B) can provide a boost to the integrity of the mechanical attachment of tissue (90) by the staples (47). The surgical clip (47) may comprise a material selected from iron, nickel-titanium alloy, stainless steel and/or titanium. Of course, any other suitable materials can be used. [0033] The material for the anvil cartridge (100A, 100B) may comprise, for example, auxiliary compound or hemostatic agents such as fibrin or thrombin that help to clot blood and reduce the volume of bleeding at the surgical site. The hemostatic capabilities of these auxiliary compounds may also contribute to the use of these auxiliary compounds as adhesives and sealants. Agents can help to clot blood at the surgical site, which allows tissue surrounding the blood to remain together and can prevent leakage along the stapled tissue site, for example. The auxiliary compounds that form the anvil cartridge (100A, 110B) may also include various adhesives, curing agents, and/or antimicrobial agents, etc. These auxiliary compounds or reagents may also include, but are not limited to, supporting components or medical fluid such as platelet-poor plasma (PPP), platelet-rich plasma (PRP), starch, chitosan, alginate, fibrin, polys, saccharide , cellulose, collagen, bovine collagen, gelatin adhesive- resorcin-formalin, oxidized cellulose, shellfish-based adhesive, poly(amino acid), agarose, amylose, hyaluronan, polyhydroxybutyrate (PHB), hyaluronic acid, poly(vinyl) pyrrolidone) (PVP), poly(vinyl alcohol) (PVA), polylactide (PLA), polyglycolate (PGA), polycaprolactone (PCL) and its copolymers, VICRYL® (Ethicon, Inc., Somerville, NJ, USA), MONOCRYL material, PANACRYL (Ethicon, Inc., Somerville, NJ, USA) and/or any other material suitable to be mixed with biological material and introduced into a wound or problem site, including combinations of materials. For example, the anvil cartridge (100A, 100B) may comprise a material selected from the following materials: epsilon-caprolactone glycolide, bovine pericardium, polylactic acid, polyglycolic acid, polyglactin, polyglactin, polyglyconate, whey protein, cellulose gum, starch, gelatin, silk, nylon, polypropylene, woven polyester, polybutester, polyethylene, and/or polyether-ether-ketones. Other components, materials, substances, etc., which can be used in a medical fluid or support will be apparent to those skilled in the art in view of the teachings contained herein. [0034] In some versions, a medical fluid can be suspended in a biocompatible vehicle to form the anvil cartridge material (100A, 100B). Suitable vehicles can include, for example, a physiological buffer solution, a high-flow gel solution, saline, and water. In the case of gel solutions, the tissue repair composition can be in a high-flow gel form prior to delivery to the target site, or it can form a gel and remain in place after delivery to the target site. High flow gel solutions can comprise one or more gelling materials with or without the addition of water, saline, or physiological buffer solution. Suitable gelling materials include biological and synthetic materials. Exemplary gelling materials include proteins, polysaccharides, polynucleotides, and other materials such as alginate, cross-linked alginate, poly(N-isopropyl acrylamide), poly(oxyalkylene), poly(ethylene oxide)-poly(propylene oxide) copolymers. poly(vinyl alcohol), polyacrylate, or monostearoyl glycerol cosuccinate/polyethylene glycol (MGSA/PEG) copolymers, and combinations of any of the aforementioned. [0035] The anvil cartridge (100A, 100B) may comprise a dressing, a foam, a matrix, a mesh, or another structure, in accordance with the teachings, by way of example, of US patent application publication no. ° 2009/0120994, entitled "Surgical Fastening Device with Initiator Impregnation of a Matrix or Buttress to Improve Adhesive Application", published May 14, 2009, the description of which is incorporated herein by reference. The material may comprise, for example, a matrix with a plurality of openings therein, an open cell or closed cell foam, and/or a tissue dressing. The material may include porosities that induce a capillary absorption characteristic to extract adhesive from the material and ensure that the openings remain free of adhesive, allowing tissue growth through the openings after application to the tissue (90). [0036] Additionally or alternatively, the anvil cartridge (100A, 100B) may comprise an adhesive such as, but not limited to, polymerizable and/or crosslinkable materials such as a cyanoacrylate adhesive. The adhesive, for example, can be a monomeric (including prepolymer) adhesive composition, a polymeric adhesive composition, or any other compound that can adhere to the fabric. In some versions, the monomer can be a 1,1-disubstituted ethylene monomer, for example, an alpha-cyanoacrylate. When cross-linked or polymerized, cyanoacrylate can change from a liquid to a solid. Polymerized adhesives, for example, can be formulated to be flexible to rigid and can be spongy. If desired, the adhesive may be a single-part or dual-part adhesive, and/or may contain additives as alternative compounds. Polymerization of the adhesive can occur from, but is not limited to, exposure to moisture, heat and/or adhesion initiators such as those described in US Patent Application Publication No. 2009/0120994, the disclosure of which is incorporated by reference above. Other suitable materials and compositions that can be used to form the anvil cartridge (100A, 100B) will be apparent to those skilled in the art in view of the teachings of the present invention. III. Another sample anvil cartridge Figure 9 shows another exemplary anvil cartridge (112) received in the recess (114) defined in the top surface (116) of the anvil structure (118) of the anvil (115), which is similar to the anvil. (18), except as described below. The anvil cartridge (112) may be made of a material similar to the anvil cartridges (100A, 100B) described above. The lower jaw (16) receives the cartridge from the lower jaw (37), which may include a material similar to that of the anvil cartridge (112) and/or a material that cooperates with the material of the anvil cartridge (112). The firing bar (14) defines an I-shaped cross section for firing through an anvil slit (not shown) and a respective oppositely positioned cartridge slit (not shown) to release material from the respective cartridges ( 112, 37) onto the fabric (90) when the fabric (90) is clamped between the lower jaw (16) and the anvil (18) of the end actuator (12). IV. Another sample anvil cartridge [0038] Figure 10 shows another exemplary anvil cartridge (120) received in the recess (122) defined in the top surface (124) of an anvil structure (126) of the anvil (123) which is similar to anvil (18), except as described below. The inner side walls (127) of the anvil structure (126) defining the recess (122) are substantially rectangular in shape such that the inner side walls (127) press in parallel against the sides (129) of the cartridge. anvil (120) to secure the anvil cartridge (120) in the recess (122). An anvil slot (143) is in communication with the recess (122) and is similar to the anvil slot (42) described above. [0039] The anvil cartridge (120) includes an upper portion (128) and a lower portion (130). The upper portion (128) may be comprised of a stiffening material such as ceramic, metal, or other suitable material, evident to those skilled in the art in view of the teachings contained herein. The lower portion (130) may be comprised of a material such as an adhesive material attached to the material of the upper portion (128), or any other suitable material (e.g. any material described above with respect to the anvil cartridges (100A, 100B) , etc.). [0040] The firing bar (14) includes a cross pin (134) similar to the cross pin (38) described above and a vertical cutting edge (132) similar to the cutting edge (48) described above. The firing bar (14) fires through the anvil slit (143) to release material from the respective cartridge (120) onto the fabric (90), when the fabric (90) is secured between the lower jaw (16) and the anvil (123) of the end actuator (12). In particular, the cutting edge (132) traverses the length of the anvil slot (143) during actuation of the firing bar (14). The cross pin (134) passes through an opening (136) between the lower recess surface (138) of the recess (122) and a lower portion (130) of the anvil cartridge (120). An upper portion (140) of the cutting edge (132) that is above the pin (134) separates through the lower portion (130) of the anvil cartridge (120) during distal actuation of the trigger bar (14). V. Another Exemplary Anvil Cartridge [0041] Figure 11 shows another exemplary anvil cartridge (142) which is removably received in the direction of arrow (B) in a channel (144) of an anvil (145) which is similar to the anvil ( 18) described above different from that set out below. The trough (144) is defined within an upper surface (146) of an anvil structure (148) of the anvil (145). In contrast to the recess (122) of Figure 10, the channel (144) is defined by the inner side walls of the anvil (145) which have the lower portions (150) substantially parallel to each other and the upper portions (152) flex at each other. toward each other in a mutually face-to-face relationship. The lower portions (150) will press together and engage the side portions (154) of the anvil cartridge (142). The upper portions (152) will be disposed on the upper surface (156) of the anvil cartridge (142) to provide a resistance against the upper surface (156) which prevents the anvil cartridge (142) from sliding out of the groove ( 144) in the vertical direction substantially perpendicular to the direction of the arrow (B). [0042] The anvil cartridge (142) of this example includes an upper portion (158) and a lower portion (160). The upper portion (158) may be comprised of a hardened material such as ceramic, metal, or other suitable material as will be apparent to those skilled in the art in light of the teachings contained herein. The lower portion (160) may be comprised of a material such as an adhesive attached to the material of the upper portion (158), any of the materials described above with respect to the cartridges (100A, 100B0, and/or any other suitable material. [0043] Figure 12 shows an example end actuator (12) being used to apply the contents of one of the exemplary anvil cartridges (100A, 100B, 112, 120, 142) described herein to the fabric (90), resulting in a tissue repair composition (162) over tissue (90). After such an application, as described above, the tissue repair composition (162) of the anvil cartridge (100A, 100B, 112, 120, 142) may substantially surround and/or at least partially coat the clips (47) which compress the layers (92, 94) of the fabric (90). [0044] It should be understood that any one or more of the teachings, expressions, modalities, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, modalities, examples, etc. which are described here. The teachings, expressions, modalities, examples, etc. described below should not be viewed in isolation from one another. Various suitable ways in which the teachings of the present invention may be combined will be readily apparent to those skilled in the art in view of the teachings of the present invention. These modifications and variations are intended to be included within the scope of the appended claims. [0045] Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in robotic-assisted medical treatments and procedures. [0046] Versions of the above may be designed to be discarded after a single use, or they may be designed to be used multiple times. Versions can, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps of disassembling the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, some versions of the device can be disassembled, in any number of particular parts or parts of the device can be selectively replaced or removed in any combination. With cleaning and/or replacement of particular parts, some versions of the device can be reassembled for subsequent use in a reconditioning facility, or by a user immediately prior to a surgical procedure. Those of skill in the art will understand that reconditioning a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. The use of such techniques, and the resulting refurbished device, are all within the scope of this order. [0047] By way of example only, the versions described here can be sterilized before and/or after a procedure. In a sterilization technique, the device is placed in a closed, sealed container such as a plastic or TYVEK bag. The container and device can then be placed in a radiation field, such as gamma radiation, X-rays or high energy electrons, which can penetrate the container. Radiation can kill bacteria in the device and container. The sterilized device can then be stored in a sterile container for later use. The device may also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide, or water vapor. [0048] In view of the presentation and description of several versions in this disclosure, additional adaptations of the methods and systems described in this document may be made through appropriate modifications made by an expert in the art, without departing from the scope of this invention. Several of these possible modifications have been mentioned, and others will be evident to those skilled in the art. For example, the examples, versions, geometry, materials, dimensions, proportions, steps and the like discussed above are illustrative only and are not required. Accordingly, the scope of the present invention is to be considered in accordance with the terms of the following claims and it is understood that it is not limited to the details of structure and operation shown and described in the specification and drawings.
权利要求:
Claims (11) [0001] 1. A surgical instrument apparatus (10), comprising: a handle portion (20); a rod (23) housing a firing bar (14); an end actuator (12) comprising an anvil (101, 115, 123, 145), a lower jaw (16), and a clamping and separating assembly responsive to a longitudinal closing movement produced by the handle portion (20) and the shank (23), the anvil (101, 115, 123, 145) comprising a plurality of clamp-forming cavities (53); a removable staple cartridge (37), the lower jaw (16) being configured to receive the staple cartridge (37), the staple cartridge (37) comprising: a housing (70), a plurality of clamps (47) disposed in the housing (70), and a platform (72) disposed over the plurality of clamps (47), the platform (72) defining openings (51), each opening (51) being disposed over each clamp (47). ) and each opening (51) corresponding to a respective staple-forming cavity (53); and a removable anvil cartridge (100A, 100B, 112, 120, 142) configured for receiving at the anvil (101, 115, 123, 145); the anvil (101, 115, 123, 145) comprising an anvil slit (103, 143) and an opening (106, 114, 136, 144) disposed above and in communication with the anvil slit (103, 143) , and the anvil cartridge (100A, 100B, 112, 120, 142) is configured to receive at least the opening (106, 114, 136, 144); and the trigger bar (14) being configured to advance through the anvil slot (103, 143) in response to the longitudinal closing movement produced by the cable portion (20) and the rod (23) along a length. sufficient to separate the anvil cartridge (100A, 100B, 112, 120, 142) when the anvil cartridge (100A, 100B, 112, 120, 142) is received in the opening (106, 114, 136, 144) of the anvil ( 101, 115, 123, 145) and simultaneously urges the staples (47) from the staple cartridge (37) towards the staple forming cavities (53) of the anvil (101, 115, 123, 145); characterized in that the staple cartridge (37), the anvil (101, 115, 123, 145) and the anvil cartridge (100A) are configured such that the staples (47) are urged from the cartridge. clamp (37) into the staple forming cavities (53) without passing through the anvil cartridge (100A, 100B, 112, 120, 142). [0002] 2. Apparatus (10) according to claim 1, characterized in that the anvil opening (106, 136, 144) is defined at a distal end of the anvil (101, 123, 145). [0003] 3. Apparatus (10) according to claim 1, characterized in that the anvil cartridge (100B, 112, 120, 142) is configured to receive only at the opening (106, 114, 136, 144). [0004] 4. Apparatus (10) according to claim 3, characterized in that the anvil (101, 123) comprises an anvil structure (102, 126), and wherein the opening (106, 136) is closed by the and disposed within the anvil structure (102, 126). na (101, 115, 123, 145). [0005] 5. Apparatus (10) according to claim 1, characterized in that the anvil cartridge (100A, 100B, 112, 120, 142) comprises an adhesive. [0006] 6. Apparatus (10) according to claim 1, characterized in that the anvil cartridge (120) comprises an adhesive disposed below an element comprising a ceramic material or metallic material (128). [0007] 7. Apparatus (10) according to claim 6, characterized in that the trigger bar (14) is configured to advance through the anvil slot (143) in response to the longitudinal closing movement produced by the cable portion (20) and by the rod (23) over a length sufficient to separate through the adhesive from the anvil cartridge (120) when the anvil cartridge (120) is received in the opening (136) of the anvil (123). [0008] 8. Apparatus (10) according to claim 1, characterized in that the anvil (123, 145) comprises an anvil structure (126, 148), and the opening is an anvil channel (136, 144) , and wherein the anvil channel (136, 144) is formed in part by a top surface (128, 146) of the anvil structure (126, 148). [0009] 9. Apparatus (10) according to claim 8, characterized in that a pair of side walls (127) of the anvil channel (136) is parallel. [0010] 10. Apparatus (10) according to claim 8, characterized in that a pair of side walls (150, 152) defining the anvil channel (144) includes upper portions (152) that flex toward a another, and wherein each upper portion (152) of each sidewall is disposed over the anvil channel (144). [0011] 11. Apparatus according to claim 1, characterized in that the anvil cartridge (100A, 100B, 112, 120, 142) comprises a biocompatible material.
类似技术:
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同族专利:
公开号 | 公开日 JP2014531259A|2014-11-27| US9198644B2|2015-12-01| BR112014006828A2|2017-10-31| WO2013043683A1|2013-03-28| RU2612510C2|2017-03-09| EP2757958B8|2021-04-07| EP2757958B1|2021-01-06| MX2014003514A|2014-12-05| MX351075B|2017-09-28| US20130075445A1|2013-03-28| CN103957817A|2014-07-30| EP2757958A1|2014-07-30| EP3799799A1|2021-04-07| JP6162124B2|2017-07-12| CN103957817B|2017-05-03| RU2014115985A|2015-10-27|
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cartridge into a surgical stapler| US10687806B2|2015-03-06|2020-06-23|Ethicon Llc|Adaptive tissue compression techniques to adjust closure rates for multiple tissue types| US10548504B2|2015-03-06|2020-02-04|Ethicon Llc|Overlaid multi sensor radio frequencyelectrode system to measure tissue compression| US9808246B2|2015-03-06|2017-11-07|Ethicon Endo-Surgery, Llc|Method of operating a powered surgical instrument| US9918717B2|2015-03-18|2018-03-20|Covidien Lp|Pivot mechanism for surgical device| US10863984B2|2015-03-25|2020-12-15|Ethicon Llc|Low inherent viscosity bioabsorbable polymer adhesive for releasably attaching a staple buttress to a surgical stapler| US10568621B2|2015-03-25|2020-02-25|Ethicon Llc|Surgical staple buttress with integral adhesive for releasably attaching to a surgical stapler| US10172618B2|2015-03-25|2019-01-08|Ethicon Llc|Low glass transition temperature bioabsorbable polymer adhesive for releasably attaching a staple buttress to a surgical stapler| 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assembly and loading units for surgical stapling devices| US10299789B2|2015-05-05|2019-05-28|Covidie LP|Adapter assembly for surgical stapling devices| US10039532B2|2015-05-06|2018-08-07|Covidien Lp|Surgical instrument with articulation assembly| US10349941B2|2015-05-27|2019-07-16|Covidien Lp|Multi-fire lead screw stapling device| US10172615B2|2015-05-27|2019-01-08|Covidien Lp|Multi-fire push rod stapling device| US10548599B2|2015-07-20|2020-02-04|Covidien Lp|Endoscopic stapler and staple| US9987012B2|2015-07-21|2018-06-05|Covidien Lp|Small diameter cartridge design for a surgical stapling instrument| US10064622B2|2015-07-29|2018-09-04|Covidien Lp|Surgical stapling loading unit with stroke counter and lockout| US10045782B2|2015-07-30|2018-08-14|Covidien Lp|Surgical stapling loading unit with stroke counter and lockout| US11058425B2|2015-08-17|2021-07-13|Ethicon Llc|Implantable layers for a surgical instrument| US10349940B2|2015-08-24|2019-07-16|Ethicon Llc|Surgical stapler buttress 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having force-based motor control| US10327769B2|2015-09-23|2019-06-25|Ethicon Llc|Surgical stapler having motor control based on a drive system component| US10299878B2|2015-09-25|2019-05-28|Ethicon Llc|Implantable adjunct systems for determining adjunct skew| US10285699B2|2015-09-30|2019-05-14|Ethicon Llc|Compressible adjunct| US10980539B2|2015-09-30|2021-04-20|Ethicon Llc|Implantable adjunct comprising bonded layers| US10561420B2|2015-09-30|2020-02-18|Ethicon Llc|Tubular absorbable constructs| US10213204B2|2015-10-02|2019-02-26|Covidien Lp|Micro surgical instrument and loading unit for use therewith| US10772632B2|2015-10-28|2020-09-15|Covidien Lp|Surgical stapling device with triple leg staples| US10357248B2|2015-10-29|2019-07-23|Ethicon Llc|Extensible buttress assembly for surgical stapler| US10085745B2|2015-10-29|2018-10-02|Ethicon Llc|Extensible buttress assembly for surgical stapler| US10433839B2|2015-10-29|2019-10-08|Ethicon Llc|Surgical stapler buttress assembly with gel adhesive 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法律状态:
2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]| 2019-10-29| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]| 2020-11-10| B07A| Technical examination (opinion): publication of technical examination (opinion) [chapter 7.1 patent gazette]| 2021-04-06| B09A| Decision: intention to grant [chapter 9.1 patent gazette]| 2021-06-22| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 19/09/2012, OBSERVADAS AS CONDICOES LEGAIS. |
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申请号 | 申请日 | 专利标题 US13/239,919|2011-09-22| US13/239,919|US9198644B2|2011-09-22|2011-09-22|Anvil cartridge for surgical fastening device| PCT/US2012/056051|WO2013043683A1|2011-09-22|2012-09-19|Anvil cartridge for surgical fastening device| 相关专利
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