device

专利摘要:
DOUBLE CLAMP CARTRIDGE FOR SURGICAL STAPLER. The present invention relates to a surgical stapler (10) that includes an end actuator (12) configured to receive an upper staple cartridge (160) and an upper staple cartridge (120). The lower staple cartridge includes staple actuators (43) arranged at a non-perpendicular or oblique angle. Staple triggers can be at an opposite angle to the perpendicular. The clamp actuators can also be coupled to an actuation element that articulates the clamp actuators perpendicularly before stapling. The actuating elements can be actuated by the firing bar (14) and / or by a sliding wedge-shaped support (41). The upper staple cartridge may also include angled staple drivers that are pivoted to the perpendicular. The upper staple cartridge and / or the lower staple cartridge may also include staple forming pockets (53). alternatively, a clamp driver can be perpendicular and the second clamp driver can be at a non-perpendicular angle. The second clamp driver can be operated in an angled stamped recess (230).
公开号:BR112014008379B1
申请号:R112014008379-7
申请日:2012-10-05
公开日:2021-01-26
发明作者:David T. Krumanaker；Robert J. Simms；Edit Goldberg；Thomas Osborne
申请人:Ethicon Endo-Surgery, Inc.；
IPC主号:

专利说明:

[0001] [001] In some contexts, endoscopic surgical instruments may be preferred over devices for traditional open surgery, since a smaller incision can reduce recovery time and complications in the postoperative period. Consequently, some endoscopic surgical instruments may be suitable for placing a distal end actuator in a desired surgical site through the trocar cannula. These distal end actuators can hold the tissue in various ways to achieve a diagnostic or therapeutic effect (for example, cutter, claw, cutter, stapler, clamp applicator, access device, drug delivery / gene therapy device and device for energy application using ultrasound, RF, laser, etc.). Endoscopic surgical instruments can comprise a rod between the end actuator and a cable portion, which is handled by the physician. This rod can allow insertion to the desired depth and rotation around the longitudinal axis of the rod itself, thus facilitating the positioning of the end actuator on the patient. The positioning of an end actuator can also be facilitated by the inclusion of one or more articulated joints or features, allowing the end actuator to be selectively articulated or even offset in relation to the longitudinal axis of the stem.
[0002] [002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers can be operated to staple layers of fabric, cut through stapled fabric layers, and urge staples through fabric layers to securely join separate layers of fabric near the separate ends of the fabric layers. Merely exemplary surgical staplers are presented in US Patent No. 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers", issued on February 21, 1989; US Patent No. 5,415,334, entitled "Surgical Stapler and Staple Cartridge", issued May 16, 1995; US 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 on January 6, 1998; US Patent No. 5,814,055, entitled "Surgical Clamping Mechanism", issued September 29, 1998; US Patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", issued December 27, 2005; US Patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", issued February 21, 2006; US 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 on December 4, 2007; US Patent No. 7,367,485, entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", published on May 6, 2008; US Patent No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", issued on June 3, 2008; US Patent No. 7,380,696, entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism", issued on June 3, 2008; US Patent No. 7,404,508, entitled "Surgical Stapling and Cutting Device", issued July 29, 2008; US patent No. 7,434,715, entitled "Surgical Stapling Instrument Having Multiple Shooting Courses with Aperture Lock", issued on October 14, 2008; and in US Patent No. 7,721,930, entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010. The description of each of the aforementioned US patents is incorporated into the present invention by reference. Although the aforementioned surgical staplers are described as 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.
[0003] [003] Although various types of surgical stapling instruments and associated components have been manufactured and used, it is believed that no one before the inventor (s) has manufactured or used the invention described in the attached claims. BRIEF DESCRIPTION OF THE DRAWINGS
[0004] [004] The attached drawings, which are incorporated into this specification and form part of it, illustrate modalities of the invention and, together with the general description provided above and the detailed description of the modalities provided below, serve to explain the principles of present invention.
[0005] [005] Figure 1A shows a perspective view of a surgical instrument of articulation with an end actuator in a non-articulated position;
[0006] [006] Figure 1B shows a perspective view of the surgical instrument of Figure 1A with an end actuator in an articulated position;
[0007] [007] Figure 2 represents a perspective view of the open end actuator of the surgical instrument of Figures 1A to 1B;
[0008] [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 firing bar in a proximal position;
[0009] [009] Figure 3B represents a side cross-sectional view of the end actuator of Figure 2, taken along line 3-3 of Figure 2, but showing the firing bar in the distal position;
[0010] [0010] Figure 4 represents a cross-sectional view from the end of the end actuator of Figure 2, taken along line 4-4 of Figure 2;
[0011] [0011] Figure 5 represents an exploded perspective view of the end actuator of Figure 2;
[0012] [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] [0013] Figure 7A depicts a cross-sectional elevation view of an example end actuator with an example lower cartridge and an upper example cartridge;
[0014] [0014] Figure 7B depicts a cross-sectional view with anterior elevation of the end actuator of Figure 7A, showing the firing bar extending through a vertical slot in the lower cartridge and the upper cartridge;
[0015] [0015] Figure 7C depicts a cross-sectional view with anterior elevation of the end actuator of Figure 7A, showing an exemplary upper wedge-shaped sliding support and the lower wedge-shaped sliding support moving the clamp actuators;
[0016] [0016] Figure 8A depicts a cross-sectional view with anterior elevation of an exemplary alternative end actuator with an alternative exemplary lower cartridge and an upper cartridge; and
[0017] [0017] Figure 8B depicts a cross-sectional view with anterior elevation of the end actuator of Figure 8A, showing an exemplary upper wedge-shaped sliding support and a lower wedge-shaped sliding support moving the clamp actuators.
[0018] [0018] The drawings are not intended to limit in any way, and it is envisaged that various modalities 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 specification 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 provisions shown. DETAILED DESCRIPTION
[0019] [0019] The following description of specific examples of the invention should not be used to limit the scope of the present invention. Other examples, characteristics, aspects, modalities and advantages of the invention will become evident to those skilled in the art from the following description, which uses illustrations, one of the best ways contemplated for carrying out the invention. As will be understood, the invention can have other different and obvious aspects, all without departing from the invention. Consequently, drawings and descriptions should be considered as illustrative rather than restrictive. Exemplary surgical stapler
[0020] [0020] Figures 1 to 6 represent an exemplary surgical stapling and separation instrument (10) that is dimensioned for insertion in a non-articulated state, as shown in Figure 1A, through a canal of the trocar cannula, up to a site surgery in a patient undergoing a surgical procedure. The stapling and separation surgical instrument (10) includes a cable portion (20) connected to an implement portion (22), the latter also comprising a rod (23) that ends distally in a hinge mechanism (11) and a end actuator (12) connected distally. When the articulation mechanism (11) and the end actuator (12) are inserted through the canal of the trocar cannula, the articulation mechanism (11) can be articulated remotely, as shown in Figure 1B, by the articulation control (13). Thus, the end actuator (12) can reach behind an organ or approach a 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) handled by the physician. In this way, the end actuator (12) is distal with respect to the most proximal portion of cable (20). It will also be recognized that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in connection with the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and absolute.
[0021] [0021] The end actuator (12) of the present example includes a lower jaw (16) and an articulated anvil (18). The handle portion (20) includes a pistol grip (24), against which a closing trigger (26) is pivotally pressed by the doctor in order to cause clamping or closing of the anvil (18) against the lower jaw ( 16) of the end actuator (12). This closure of the anvil (18) is obtained by means of an external closing sleeve (32), which moves longitudinally in relation to the cable portion (20) in response to the articulated actuation of the closing trigger (26) against the handle pistol (24). A distal closing ring (33) of the closing sleeve (32) is supported indirectly by the structure (34) of the implement portion (22). In the articulation mechanism (11), a proximal closing tube (35) of the closing sleeve (32) communicates with the distal closing ring (33). The structure (34) is flexibly connected to the lower jaw (16) via the articulation mechanism (11), allowing articulation in a single plane. The frame (34) also supports, in a longitudinal and sliding way, a firing steering member (not shown), which extends through the rod (23) and transmits a firing movement from the firing trigger (28) to the firing bar. firing (14). The trigger trigger (28) is furthest from the closing trigger (26), being pressed jointly by the doctor to staple and separate the tissue clamped on 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).
[0022] [0022] Figures 2 to 5 represent the end actuator (12) that employs an electronic beam firing bar (14) to perform a variety of functions. As can best be seen in Figures 3A and 3B, the firing bar (14) includes a cross-oriented top pin (38), a firing cap (44), a cross-oriented middle pin (46) and a cutting edge distal position (48). The upper pin (38) is located and is translatable inside an anvil pocket (40) of the anvil (18). The trigger bar cover (44) slidably engages the lower surface of the lower jaw (16), causing the trigger bar (14) to extend along the groove in the groove (45) (shown in Figure 3B ) that is formed along the lower jaw (16). The middle pin (46) slidably engages the top surface of the lower jaw (16), cooperating with the trigger bar cover (44). Thus, the firing bar (14) positively spaces the end actuator (12) during firing, avoiding mechanical tightening that can occur between the anvil (18) and the lower jaw (16) with a minimum amount of pinched tissue and avoiding the malformation of staples when an excessive amount of tissue is pinched.
[0023] [0023] Figure 2 shows the firing bar (14) positioned proximally and the anvil (18) hinged in an open position, allowing an unused staple cartridge (37) to be removably installed in the lower jaw groove (16). As best seen in Figures 4 and 5, the staple cartridge (37) in this example includes the cartridge body (70), which contains an upper platform (72), and is coupled to a lower cartridge tray (74) . As can be seen better in Figure 2, a vertical slot (49) is formed through part of the staple cartridge (37). Also as can be seen better in Figure 2, three rows of staple openings (51) are formed through the upper platform (72) on one side of the vertical slot (49), with another set of three rows of staple openings (51 ) formed through the upper platform (72) on the other side of the vertical slot (49). Returning 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 the form wedge (41) with location proximal to the clamp actuators (43). The wedge-shaped sliding support (41) is movable longitudinally inside the staple cartridge (37); whereas the staple actuators (43) are movable vertically inside the staple cartridge (37). The clips (47) are also positioned inside the cartridge body (70), above the corresponding clip drivers (43). In particular, each clamp (47) is propelled vertically inside the cartridge body (70) by a clamp driver (43), in order to propel the clamp (47) through an associated clamp opening (51). As can best be seen in Figures 3A and 3B and 5, the wedge-shaped sliding support (41) has inclined cam surfaces that push the clamp actuators (43) upwards, according to the wedge-shaped sliding support (41) ) is pushed distally through the staple cartridge (37).
[0024] [0024] With the end actuator (12) closed, as shown in Figure 3A, the firing bar (14) is advanced engaged with the anvil (18), through the entrance of the upper pin (38) in a longitudinal slot of the anvil (42). A drive block (80) is located at the distal end of the firing bar (14) and is configured to engage with the wedge-shaped sliding bracket (41) so that the wedge-shaped sliding bracket (41) is pushed distally by the propeller block (80) as the firing 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 fabric between the staple cartridge (37) and the anvil (18) . As shown in Figures 3A to 3B, the middle pin (46) and the drive block (80), together drive the staple cartridge (37) by entering a slot (49) inside the staple cartridge (37), the which leads the wedge-shaped sliding support (41) to the upward contact of the cam with the clamp actuators (43), which, in turn, impel the clamps (47) through the clamp openings (51) and to the forming contact with the staple formation cavities (53) on the inner surface of the anvil (18). Figure 3B represents the firing bar (14) completely translated distally after the separation and stapling of the fabric are completed.
[0025] [0025] Figure 6 shows the end actuator (12) driven by a single movement through the fabric (90). The cutting edge (48) cuts through the fabric (90), while the staple actuators (43) guide three alternating rows of staples (47) through the fabric (90) on each side of the cutting line produced by the cutting edge (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 cuts and stapling. This process can be repeated until the desired number of cuts and staples (47) has been applied. The anvil (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 replacing the staple cartridge (37).
[0026] [0026] It should be understood that the cutting edge (48) can separate fabrics substantially at the same time as the clips (47) are pushed through the fabric during each stroke of actuation. In the present example, the cutting edge (48) closely follows the insertion of the clips (47), so that a clip (47) is pushed through the fabric just before the cutting edge (48) passes through the same region of the fabric, although it should be understood that this order can be reversed, or that the cutting edge (48) can be directly synchronized with the adjacent clips. Although Figure 6 shows the end actuator (12) being driven in two layers (92, 94) of fabric (90), it should be understood that end actuator (12) can be driven 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 cutting line produced by the cutting edge (48) can substantially join the fabric at the cutting line, thereby reducing or preventing bleeding and / or leakage of other fluids on the cut line. Various suitable configurations and procedures in which the instrument (10) can be used will be apparent to those skilled in the art in view of the teachings contained herein.
[0027] [0027] It should be understood that the instrument (10) can be configured and is 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. 6,978,921; US patent No. 7,000,818; 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; and / or US patent No. 7,721,930.
[0028] [0028] 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. Several 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 various teachings of the patents cited herein will be apparent to those skilled in the art. It should also be understood that the teachings below are not limited to the instrument (10) or the devices taught in the patents cited here. The teachings below can be readily applied to several other types of instruments, including instruments that would not be classified with 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. Exemplary double staple cartridges
[0029] [0029] In some cases it may be useful to use double staple cartridges (37). For example, it may be useful to have a staple cartridge at the bottom (37) and a staple cartridge at the top (37) inserted into the end actuator (12) to staple fabrics (90) in the opposite direction. In addition, the use of opposite clips can also promote the safe coupling of materials on both sides of the fabric (90). In some cases, it can also be useful for angled clamps (47). Such angled clamps (47) can allow the vertical dimension of the clamp cartridges (37) to be reduced. While the following describes examples of double staple cartridge configurations for illustration only, other suitable configurations will be apparent to those skilled in the art in view of the teachings in the present invention. Dual rotary clamp cartridges with exemplary clamp actuator
[0030] [0030] Figures 7A to 7C describe an exemplary end actuator (100) configured to receive a lower cartridge (120) and an upper cartridge (160). It should be understood that the instrument (10) can be readily modified to incorporate the end actuator (100). The end actuator (100) of the present example includes an articulated lower jaw (102) and an articulated upper jaw (110). The end actuator (100) is coupled to the cable portion (20), described above. In particular, a physician can pivot the closing actuator (26) towards the pistol grip (24) to clamp, or close, the upper jaw (110) towards the lower jaw (102) of the actuator end (100). In the present example, the lower jaw (102) defines a lower recess (104) configured to receive the lower cartridge (120). In some versions, the lower jaw (102) additionally includes detectors (106) or press fit components that are configured to selectively couple the lower cartridge (120) to the lower jaw (102). In addition or alternatively, the lower jaw (102) can include an open distal end and the longitudinal rails (not shown) at or below the lower cartridge (120) can be slid. The lower jaw (102) and / or the lower cartridge (120) may include holders or snap-fit components at a distal end to selectively couple the lower cartridge (120) to the lower jaw (102) when the lower cartridge (120) it is slid proximally along the longitudinal rails. Of course, other configurations for inserting and coupling the lower cartridge (120) to the lower jaw (102) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0031] [0031] The upper jaw (110) defines an upper recess (112) configured to receive the upper cartridge (160). In some versions, the upper jaw (110) additionally includes detectors (114) or press fit components that are configured to selectively couple the upper cartridge (160) to the upper jaw (110). In addition or alternatively, the upper jaw (110) may include an open distal end and longitudinal rails (not shown) at or above the upper cartridge (160) that can be slid. The upper jaw (110) and / or the upper cartridge (160) may include holders or snap-fit components at a distal end to selectively couple the upper cartridge (160) to the upper jaw (110) when the upper cartridge (160) it is slid proximally along the longitudinal rails. Of course, other configurations for inserting and coupling the upper cartridge (160) to the upper jaw (110) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0032] [0032] The lower cartridge (120) of the present example comprises a cartridge body (122), an upper platform (124), a plurality of clamp openings (130), a plurality of clamp drivers (140), and a vertical slot (126). The lower cartridge (120) can also be constructed in accordance with at least some of the teachings of the cartridges (37, 160, 220 and 260) described herein. As shown in Figure 7A, the upper platform (124) includes a vertical slot (126) formed along a longitudinal axis of the lower cartridge (120) and four clamp openings (130) formed therein - two clamp openings (130) formed on each side of the vertical slot (126). It should be understood that the four staple openings (130) are a part of the four rows of staple openings (130) extending longitudinally along the lower cartridge (120). In addition, any number of rows of staple openings (130) can be formed on the upper platform (124), and the four rows of staple openings (130) are merely exemplary. In addition, the staple openings (130) can be arranged around the vertical slot (126) in various configurations. For example, the staple openings (130) can be symmetrically arranged around the vertical slot (126) or the staple openings (130) can be asymmetrically arranged around the vertical slot (126). As an example only, for a curved end actuator (100), three clamp openings (130) can be arranged on one side of the vertical slot (126) and a single clamp opening (130) can be arranged on the opposite side .
[0033] [0033] The upper platform (124) of the present example additionally comprises staple forming pockets (128) within which the staples (190) are moved through the staple actuators (180) of the upper cartridge (160), as will be described in more detail below. In the present example, each clamp opening (130) is further defined by an angled inner wall (132) and a vertical outer wall (134). Alternatively, the walls (132 and 134) can include arched walls. Of course, other configurations and orientations for the clamp openings (130) will be apparent to one skilled in the art in view of the teachings of the present invention. The vertical slot (126) extends longitudinally through the upper platform (124) and the cartridge body (122) so that the firing bar (14) is operable through it. In some versions, the vertical slot (126) is a longitudinally linear slot while in other versions the vertical slot (126) can be curved along the longitudinal axis for a curved end actuator (100).
[0034] [0034] The clip drivers (140) of the present example are arranged inside the cartridge body (122) and are vertically movable elements in the lower cartridge (120). In some versions the staple actuators (140) are selectively coupled inside the cartridge body (122) so that the staple actuators (140) are prevented from triggering inadvertently in relation to the cartridge body (122) until a support lower wedge-shaped slide (192), described below, engage the clamp actuators (140). For example, the clip drivers (140) can be adhesively attached to the cartridge body (122). In other versions, the clip drivers (140) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the cartridge body (122) so that an interference fit or a snap fit keeper is trained. Consequently, the staple actuators (140) are selectively secured in relation to the cartridge body (122) even if the user rotates or inverts the end actuator (100). Of course, other selectively attachable configurations will be apparent to one skilled in the art in view of the teachings of the present invention.
[0035] [0035] In the present example, a plurality of clips (190) is also arranged inside the cartridge body (122) and is arranged above the corresponding clip drivers (140). In particular, each clamp (190) is propelled vertically inside the cartridge body (122) by a clamp driver (140), in order to propel the clamp (190) through an associated clamp opening (130). In some versions the clamps (190) are selectively coupled to the clamp actuators (140) so that the clamps (190) are prevented from inadvertently activating in relation to the clamp actuators (140) until the lower wedge-shaped sliding support (192), described below, engage the staple actuators (140) to eject the staples (190) out of the staple openings (130). For example, the clamps (190) can be adhered to the clamp actuators (140) in an adhesive manner. In other versions, the clips (190) may each include a tab (not shown) that can be inserted into a slot (not shown) formed in the clip drivers (140), so that an interference fit is formed. In addition, a snap-fit component can be included in the clamp actuators (140) to secure the clamp (190) with the clamp actuator (140) until it is dispensed with. In some versions, the clip drivers (140) may include a release tab (not shown) that engages a tab (not shown) on the cartridge body (122) to release the clip (190) when the clip drivers (140 ) are driven vertically. Such a flap on the cartridge body (122) can be on or near the upper platform (124) so that the clamps (190) are released only when the clamp driver (140) is at its vertical driving peak. Consequently, the clamps (190) are selectively secured in relation to the cartridge body (140) even if the user rotates or inverts the end actuator (100). In addition to or instead of being attached to the clip drivers (140), the clips (190) can be selectively attached to the cartridge body (122), as by interference fit and / or otherwise through friction.
[0036] [0036] In the present example, the staple actuators (140) additionally comprise an actuating element (142) hingedly coupled to one or more staple actuators (140) and is operable to move the staple actuators (140) in relation to the cartridge body (122). As shown in Figure 7A, each actuating element (142) comprises a rod that is hingedly coupled to two clamp actuators (140). In the present example, a first actuating element (142) is pivotally coupled to a first set of two clamp actuators (140) on a first side of the vertical slot (126). A second actuating element (142) is pivotally coupled to a second set of two clamp actuators (140) on the opposite side of the vertical slot (126). As will be discussed in more detail in the present invention, the actuating elements (142) are configured to be moved outwards in relation to the cartridge body (122) by the firing bar (14), so that the clamp actuators ( 140) pivot from a first position, where the staple actuators (140) are at an angle to the upper platform (124), to a second position, where the staple actuators (140) are substantially perpendicular to the upper platform (124). Consequently, the vertical dimension of the lower cartridge (120) can be reduced. In addition, the longer clips (190) can be included in the lower cartridge (120) due to the initial angle of the clips (190). In other words, the cartridge (120) can accommodate relatively larger clamps (190) than the cartridge (37), without having to increase the outside diameter of the end actuator (100). In addition, the lower jaw (102) and the upper jaw (110) can be sized to allow more tissue (90) to each other, due to the reduced size of the lower cartridge (120). Of course, other configurations for the clamp actuators (140) and / or actuating elements (142) will be apparent to one skilled in the art in view of the teachings of the present invention. It should also be understood that the clamps (190) can initially be oriented at an oblique angle, like the clamps (190) in this example, or even in versions where the anvil (18) is used instead of the upper cartridge (160) .
[0037] [0037] The upper cartridge (160) of the present example comprises a cartridge body (162), a lower platform (164), a plurality of clamp openings (170), a plurality of clamp drivers (180), and a vertical slot (166). The upper cartridge (160) can also be constructed in accordance with at least some of the teachings of the cartridges (37, 120, 220 and 260) described herein. As shown in Figure 7A, the lower platform (164) includes the vertical slot (166) formed along a longitudinal axis of the upper cartridge (160) and a pair of staple openings (170) formed therein - a staple opening ( 170) formed on each side of the vertical slot (166). It should be understood that the two staple openings (130) are a part of the two rows of staple openings (170) extending longitudinally along the upper cartridge (160). In addition, any number of rows of staple openings (170) can be formed on the lower platform (164), and the two rows of staple openings (170) are merely exemplary. In addition, the staple openings (170) can be arranged around the vertical slot (166) in various configurations. For example, the staple openings (170) can be symmetrically arranged around the vertical slot (166) or the staple openings (170) can be asymmetrically arranged around the vertical slot (166). As an example only, for a curved end actuator (100), both clamp openings (170) can be arranged on the same side of the vertical slot (166).
[0038] [0038] The lower platform (164) additionally comprises staple forming pockets (168) in which the staples (190) are moved via staple actuators (140) of the lower cartridge (120), described below. In the present example, each clamp opening (170) is further defined by an angled inner wall (172) and a vertical outer wall (174). Alternatively, the walls (172 and 174) can include arched walls. Of course, other configurations and orientations for the clamp openings (170) will be apparent to one skilled in the art in view of the teachings of the present invention. The vertical slot (166) extends longitudinally through the lower platform (164) and the cartridge body (162), so that the firing bar (14) is operable through it. In some versions, the vertical slot (166) is a longitudinally linear slot while in other versions the vertical slot (166) can be curved along the longitudinal axis for a curved end actuator (100).
[0039] [0039] The clip drivers (180) of the present example are arranged inside the cartridge body (162) and are vertically movable elements in the upper cartridge (160). In some versions, the staple actuators (180) are selectively coupled inside the cartridge body (162), so that the staple actuators (180) are prevented from actuating in relation to the cartridge body (162) until a support upper wedge-shaped slide (196), described below, engage the clamp actuators (180). For example, the clip drivers (180) can be adhesive-bonded to the cartridge body (162). In other versions, the clip drivers (180) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the cartridge body (162), so that an interference fit or fit per keeper is formed. Consequently, the staple actuators (180) are selectively attached in relation to the cartridge body (162), so that the staple actuators (180) do not move due to the force of gravity. Of course, other selectively attachable configurations will be apparent to one skilled in the art in view of the teachings of the present invention.
[0040] [0040] In the present example, a plurality of clips (190) is also arranged inside the cartridge body (162) and is arranged below the corresponding clip drivers, as shown in Figure 7A (180). In particular, each clamp (190) is propelled vertically inside the cartridge body (162) by a respective clamp driver (180), in order to propel the clamp (190) through an associated clamp opening (170). In some versions, the clamps (190) are selectively coupled to the clamp actuators (180), so that the clamps (190) are prevented from inadvertently activating in relation to the clamp actuators (180), until the sliding support in shape upper wedge (196), described below, engage the clamp actuators (180) to eject the clamps (190) out of the clamp openings (170). For example, the clamps (190) can be adhesively joined to the clamp actuators (180). In other versions, the clips (190) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the clip drivers (180), so that an interference fit is formed. In addition, a snap-fit component can be included in the clamp actuators (180) to secure the clamp (190) with the clamp actuator (180) until it is dispensed with. In some versions, the clip drivers (180) may include a release tab (not shown) that engages a tab (not shown) on the cartridge body (162) to release the clip (190) when the clip drivers (180 ) are driven vertically. Such a tab on the cartridge body (162) can be on or near the upper platform (164) so that the clamps (190) are released only when the clamp driver (180) is at the end of its actuation movement. Consequently, the clamps (190) are selectively secured in relation to the clamp actuators (180), so that the clamps (190) do not disengage from the clamp actuators (180) due to the force of gravity. In addition to or instead of being attached to the clip drivers (180), the clips (190) can be selectively attached to the cartridge body (162), as by interference fit and / or otherwise through friction.
[0041] [0041] In the present example, the staple actuators (180) additionally comprise an actuating element (182) hingedly coupled to one or more staple actuators (180) and is operable to move the staple actuators (180) in relation to the cartridge body (162). As shown in Figure 7A, each actuation element (182) comprises a rod that is hingedly coupled to a clamp driver (180). In the present example, a first actuating element (182) is pivotally coupled to a first clip driver (180) on a first side of the vertical slot (166). A second actuating element (182) is pivotally coupled to a second clip driver (180) on the opposite side of the vertical slot (166). As will be discussed in more detail in the present invention, the actuating elements (182) are configured to be moved outwards in relation to the cartridge body (162) by the firing bar (14), so that the clamp actuators ( 180) pivot from a first position, where the staple actuators (180) are at an angle to the lower platform (164), to a second position, where the staple actuators (180) are substantially perpendicular to the upper platform (164). Consequently, the vertical dimension of the upper cartridge (160) can be reduced. In addition, the longer clips (190) can be included in the upper cartridge (160) due to the initial angle of the clips (190). In other words, the cartridge (160) can accommodate relatively larger clips (190) than the cartridge (37), without having to increase the outside diameter of the end actuator (100). In addition, the lower jaw (102) and the upper jaw (110) can be sized to allow more tissue (90) to each other due to the reduced size of the upper cartridge (160). Of course, other configurations for the clamp actuators (180) and / or actuating elements (182) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0042] [0042] Figures 7A to 7C describe the firing of the firing bar (14) through the lower and upper cartridges (120 and 160) to implant the staples (190) in the fabric (90). As shown in Figure 7A, the tissue (90) is trapped between the lower jaw (102) and the upper jaw (110) after the closing trigger (26) has been activated. In this initial position, the actuating elements (142 and 182) were not engaged by the firing bar (14), so that the clip drivers (140 and 180) are at an angle to the cartridge bodies (122 and 162 ), respectively. As previously discussed, the structure (34) longitudinally and slidingly supports a trigger member extending through the axis (23) and communicates a firing movement from the trigger trigger (28) to the trigger bar ( 14), as shown in Figures 1 to 5. When the trigger trigger (28) is activated by a user, the trigger bar (14) advances distally from the cable portion (20). As shown in Figure 7B, the cutting edge (48) of the firing bar (14) advances distally to section the fabric simultaneously (90) and the cam actuating elements (142 and 182) outwards in relation to the firing bar (14). As a result, the staple actuators (140 and 180) are articulated by the actuating elements (142 and 182) and the walls (134 and 174), so that the staple actuators (140 and 180) are substantially vertical in relation to the upper and lower platforms (124 and 164). As also shown in Figure 7B, the firing bar (14) includes a pair of flanges at the top and bottom ends of the firing bar (14) that slide along the outer channels of the lower and upper jaws (102 and 110). As will be evident to the person skilled in the art, the flanges cooperatively compress the lower and upper jaws (102 and 110) together with additionally securing the tissue (90) to each other when the firing bar (14) is activated distally.
[0043] [0043] With the clamp actuators (140 and 180) in a substantially vertical orientation, as shown in Figure 7C, a lower wedge-shaped sliding bracket (192) and an upper wedge-shaped sliding bracket (196) are advanced distally through the lower cartridge (120) and the upper cartridge (160), respectively. The lower wedge-shaped sliding support (192) of the present example comprises four tilt elements (194) coupled to a base element (195). The tilt elements (194) are configured to cam the clamp actuators (140) vertically with respect to the upper platform (124). Certainly, like the clamp openings (130), the lower wedge-shaped sliding support (192) can have less than four or more than four tilt elements (194). The upper wedge-shaped sliding support (196) of the present example comprises two tilt elements (198) coupled to a base element (199). The tilt elements (198) are configured to cam the clamp actuators (180) vertically in relation to the lower platform (164). Certainly, like the clamp openings (170), the upper wedge-shaped sliding support (196) can have less than two or more than two tilt elements (198). When the lower wedge-shaped sliding support (192) is advanced distally, the clamp actuators (140) are moved vertically so that the clamps (190), driven by the clamp actuators (140), are pushed out of the openings clip (130) of the lower cartridge (120). The staples (190) pierce through the fabric (90) and engage the staple forming pockets (168) formed on the lower platform (164) of the upper cartridge (160). Consequently, the staples (190) are flexed and staple the fabrics (90). Similarly, when the upper wedge-shaped sliding support (196) is advanced distally, the clamp actuators (180) are moved vertically so that the clamps (190), loaded by the clamp actuators (180), are propelled out of the staple openings (170) of the upper cartridge (160). The staples (190) pierce through the fabric (90) and engage the staple forming pockets (128) formed on the upper platform (124) of the upper cartridge (120). Consequently, the staples (190) are flexed and staple the fabrics (90). As shown in Figure 7C, opposing clamps (190) are stapled through the fabric (90) using the present end actuator (100) with an upper and lower cartridge (120 and 160). The user can then release the trigger trigger (28) and the closing trigger (26) to release the stapled fabric (90). The user can then replace the lower and upper cartridges (120 and 160) with the new lower and upper cartridges (120 and 160) to staple a new section of fabric (90).
[0044] [0044] Logically other configurations for the end actuator (100), the lower cartridge (120) and / or the upper cartridge (160) will be apparent to one skilled in the art in view of the teachings of the present invention. For example, in some versions a support material (not shown) can be attached to the lower cartridge (120) and / or the upper cartridge (160). Merely exemplary configurations for the lower cartridge (120) and / or upper cartridge (160) that have a support material are presented in US patent application serial number 13 / 233,664, entitled "Surgical Instrument and Buttress Material", deposited in September 15, 2011; US Patent Application Serial No. 13 / 231,064, entitled "Surgical Staple Cartridge with SelfDispensing Staple Buttress", filed September 13, 2011; US patent application serial number 13 / 232,401, entitled "Surgical Instrument with Fluid Fillable Buttress", filed on September 14, 2011; and US patent application serial number [Attorney Summary No. END6986USNP.0585747], entitled "Attachment of Surgical Staple Buttress to Cartridge", filed in _______, the descriptions of which are incorporated by reference in the present invention.
[0045] [0045] In addition, or in some versions in the alternative, an auxiliary material (for example, an adhesive, a therapeutic agent, etc.) can be applied to the fabric (90) through lower and / or upper cartridges (120 and 160 ). Merely exemplary auxiliary implantation mechanisms that can be incorporated into the lower and / or upper cartridges (120 and 160) are described in US patent application serial number 13 / 206,752, entitled "Device for Applying Adjunct in Endoscopic Procedure", filed in August 10, 2011; US patent application serial number 13 / 206,725, entitled "Surgical Staple with Localized Adjunct Coating", filed on August 10, 2011; US patent application serial number 13 / 233,633, entitled "Fibrin Pad Matrix with Suspended Heat Activated Beads of Adhesive", filed on September 15, 2011; US patent application serial number 13 / 233,646, entitled "Surgical Instrument with Filled Staple", filed on September 15, 2011; US Patent Application Serial No. 13 / 230,994, entitled "Resistive Heated Surgical Staple Cartridge with Phase Change Sealant", filed September 13, 2011; US patent application serial number 13 / 195,170, entitled "Adjunct Therapy Device Having Driver with Cavity for Hemostatic Agent", filed on August 1, 2011; US patent application serial number 13 / 240,141, entitled "Adjunct Therapy Device for Applying Hemostatic Agent", filed on September 22, 2011; US patent application serial number 13 / 242,164, entitled "Surgical Stapling Device with Adjunct Material Application Feature", filed on September 23, 2011; and US Patent Application Serial No. 13 / 240,074, entitled "Surgical Staple Assembly with Hemostatic Feature", filed on September 22, 2011; whose descriptions are hereby incorporated by reference.
[0046] [0046] Furthermore, while the end actuator (100) described here advanced on the firing bar (14) distally before the lower and upper wedge-shaped sliding supports (192 and 196), it should be understood that the sliding supports in the form of lower and upper wedges (192 and 196) they can precede the firing bar (14) and / or the cutting edge (48). For example, the lower and upper wedge-shaped sliding supports (192 and 196) may include a central element (not shown) that moves the actuating elements (142 and 182) outwardly in relation to the central element. Consequently, the lower and upper wedge-shaped sliding supports (192 and 196) can both orient the clamp drivers (140 and 180) vertically and route the clamp drivers (140 and 180) vertically through the tilt elements (194 and 198). In this way, the fabric (90) can be initially stapled before sectioning by the cutting edge (48). In yet another version, lower and upper wedge-shaped sliding supports (192 and 196) can be substantially longitudinally aligned with the cutting edge (48), so that the sectioning and stapling of the fabric (90) occurs in a way substantially simultaneous. Still other configurations for the end actuator (100), the lower cartridge (120) and / or the upper cartridge (160) will be apparent to one skilled in the art in view of the teachings of the present invention. B. Exemplary double staple cartridges
[0047] [0047] Figures 8A to 8B describe an exemplary alternative end actuator (200) configured to receive a lower cartridge (220) and an upper cartridge (260). It should be understood that the instrument (10) can be readily modified to incorporate the end actuator (200). The end actuator (200) of the present example includes a lower jaw (202) and an articulated upper jaw (210). The end actuator (200) is coupled to the cable portion (20), described above. In particular, a physician can pivot the closing actuator (26) towards the pistol grip (24) to clamp, or close, the upper jaw (210) towards the lower jaw (202) of the actuator end (200). In the present example, the lower jaw (202) defines a lower recess (204) configured to receive the lower cartridge (220). The lower jaw (202) additionally includes an edge (206) which is configured to receive a resilient lower lip (228) from the lower cartridge (220) so that the lower cartridge (220) is selectively attachable to the lower jaw (202). In addition or alternatively, the lower jaw (202) can include an open distal end and the longitudinal rails (not shown) at or below the lower cartridge (220) can be slid. The lower jaw (202) and / or the lower cartridge (220) may include holders or snap-fit components at a distal end to selectively couple the lower cartridge (220) to the lower jaw (202) when the lower cartridge (220) it is slid proximally along the longitudinal rails. In addition, the lower jaw (202) may have holders (not shown) similar to the holders (106) shown in Figures 7A to 7C. Of course, other configurations for inserting and coupling the lower cartridge (220) to the lower jaw (202) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0048] [0048] The upper jaw (210) defines an upper recess (212) configured to receive the upper cartridge (260). The upper jaw (210) additionally includes an edge (214) which is configured to receive a resilient upper lip (268) from the upper cartridge (220) so that the upper cartridge (220) is selectively attachable to the upper jaw (210). In addition or alternatively, the upper jaw (210) can include an open distal end and the longitudinal rails (not shown) at or above the upper cartridge (260) can be slid. The upper jaw (210) and / or the upper cartridge (260) may include holders or snap-fit components at a distal end to selectively couple the upper cartridge (260) to the upper jaw (210) when the upper cartridge (260) it is slid proximally along the longitudinal rails. In addition, the upper jaw (210) may have holders (not shown) similar to the holders (114) shown in Figures 7A to 7C. Of course, other configurations for inserting and coupling the upper cartridge (260) to the upper jaw (210) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0049] [0049] The lower cartridge (220) of the present example comprises a cartridge body (222), an upper platform (224), a plurality of internal clip openings (240), a plurality of external clip openings (244), a plurality of clip drivers (250), a vertical slot (226), and a resilient lower lip (228). The lower cartridge (220) can also be constructed in accordance with at least some of the teachings of the cartridges (37, 120, 160 and 260) described herein. In the present example, the resilient lower lip (228) is designed to selectively couple the lower cartridge (220) to the lower jaw (202) by an interference fit. As shown in Figure 8A, the upper platform (224) includes the vertical slot (226) formed along a longitudinal axis of the lower cartridge (220) and four staple openings (240 and 244) formed there — an external staple opening (244) and an internal clamp opening (240) formed on each side of the vertical slot (226). It should be understood that the four staple openings (240 and 244) are a part of the four rows of staple openings (240 and 244) extending longitudinally along the lower cartridge (220). In addition, any number of rows of staple openings (240 and 244) can be formed on the upper platform (224), and the four rows of staple openings (240 and 244) are merely exemplary. In addition, the clamp openings (240 and 244) can be arranged around the vertical slot (226) in other configurations. For example, the staple openings (240 and 244) can be symmetrically arranged around the vertical slot (226) or the staple openings (240 and 244) can be asymmetrically arranged around the vertical slot (226). Only as an example, for a curved end actuator (200), a single external clamp opening (244) and two internal clamp openings (240) can be arranged on one side of the vertical slot (226) and an opening of single external clamp (244) can be arranged on the opposite side.
[0050] [0050] In the present example, the internal clamp openings (240) are in communication with substantially vertical recesses (242) that have a clamp driver (250) there. The external clamp openings (244) are in communication with angular recesses (246) formed at an angle to the upper platform (224) and also that have a clamp driver (250) there. The angle of the angular recesses (246) can be from 0 degrees to 90 degrees, inclusive. In the example shown, the angular recesses (246) are arranged at an angle of approximately 15 degrees, although this is merely illustrative. It should be understood that longer clips (290) can be included in the lower cartridge (220) due to the angle of the clips (290). In other words, the lower cartridge (220) can accommodate relatively larger clips (290) than the cartridge (37) without having to increase the outside diameter of the end actuator (200). In addition, the lower jaw (202) and the upper jaw (210) can be sized to allow more tissue (90) and / or support material (not shown) with each other, due to the reduced size of the lower cartridge (220).
[0051] [0051] The upper platform (224) of the present example additionally comprises a plurality of stamped recesses (230) which have staple forming pockets (232) formed there. The staple forming pockets (232) are configured to receive and flex portions of staples (290) which are moved through staple actuators (286) of the upper cartridge (260), as will be described in more detail below. In the present example, the stamped recesses (230) are substantially vertical recesses which correspond to the vertical clamp openings (280) and recesses (282) of the upper cartridge (260), although this is merely optional. In fact, in some versions, the stamped recesses (230) can be angled with respect to the upper platform (224) in a configuration similar to the stamped external recesses (272) described below. Of course, other configurations and orientations for the stamped recesses (230) will be apparent to one skilled in the art in view of the teachings of the present invention. The vertical slot (226) extends longitudinally through the upper platform (224) and the cartridge body (222), so that the firing bar (14) is operable through it. In some versions the vertical slot (226) is a longitudinally linear slot, while in other versions the vertical slot (226) can be curved along the longitudinal axis for a curved end actuator (200).
[0052] [0052] The clamp actuators (250) of the present example are arranged inside the cartridge body (222) and are vertically movable elements in the lower cartridge (220). In some versions the staple actuators (250) are selectively coupled inside the recesses (242 and 246), so that the staple actuators (250) are prevented from triggering inadvertently in relation to the cartridge body (222) until a lower wedge-shaped sliding bracket (292), described below, engage the clamp actuators (250). For example, the clip actuators (250) can be adhesive-bonded to the cartridge body (222). In other versions, the clip drivers (250) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the cartridge body (222) so that an interference fit or an interlock fit. keeper is trained. Consequently, the clamp actuators (250) are selectively clamped in relation to the cartridge body (222) even if the user rotates or inverts the end actuator (200). Of course, other selectively attachable configurations will be apparent to one skilled in the art in view of the teachings of the present invention.
[0053] [0053] In the present example, a plurality of clips (290) is also arranged inside the cartridge body (222) and is arranged above the corresponding clip drivers (250). In particular, each clamp (290) is propelled vertically inside the cartridge body (222) by a clamp driver (250), in order to propel the clamp (290) through an associated clamp opening (240 and 244) . In some versions the clamps (290) are selectively coupled to the clamp actuators (250), so that the clamps (290) are prevented from inadvertently activating in relation to the clamp actuators (250) until the wedge-shaped sliding support bottom (292), described below, engage the clamp actuators (250) to eject the clamps (290) out of the clamp openings (240 and 244). For example, the clamps (290) can be adhesively joined to the clamp actuators (250). In other versions, the clamps (290) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the clamp actuators (250), so that an interference fit is formed. In addition, a snap-fit component can be included in the clamp actuators (250) to secure the clamp (290) with the clamp actuator (250) until it is dispensed with. In some versions, the clip drivers (250) may include a release tab (not shown) that engages a tab (not shown) on the cartridge body (222) to release the clip (290) when the clip drivers (250 ) are driven vertically. Such a tab on the cartridge body (222) may be on or near the upper platform (224) so that the clamps (290) are released only when the clamp driver (250) is at its vertical driving peak. Consequently, the clamps (290) are selectively clamped in relation to the cartridge body (250) even if the user rotates or inverts the end actuator (200). In addition to or instead of being attached to the clip drivers (250), the clips (290) can be selectively attached to the cartridge body (222), as by interference fit and / or otherwise through friction.
[0054] The upper cartridge (260) of the present example comprises a cartridge body (262), a lower platform (264), a plurality of upper clip openings (280), a plurality of clip drivers (286), a vertical slot (266) and a resilient upper rim (268). The upper cartridge (260) can also be constructed in accordance with at least some of the teachings of the cartridges (37, 120, 160 and 220) described herein. In the present example, the resilient upper lip (268) is designed to selectively couple the upper cartridge (260) to the upper jaw (210) by an interference fit. As shown in Figure 8A, the lower platform (264) includes the vertical slot (266) formed along a longitudinal axis of the upper cartridge (260) and two upper clip openings (280) formed on each side of the vertical slot (266) ). It should be understood that the two staple openings (280) are a part of two rows of staple openings (280) extending longitudinally along the top cartridge (260), although any number of staple openings (280) can be formed on the lower platform (264), and the two clip openings (280) shown are merely exemplary. In addition, the clamp openings (280) can be arranged around the vertical slot (266) in different configurations. For example, both clamp openings (280) can be arranged on one side of the vertical slot (266) for a curved end actuator (200). In the present example, the upper clip openings (280) are in communication with substantially vertical recesses (282) that have a clip driver (286) there. Certainly, alternatively the recesses (282) and clamp openings (280) can be configured according to the external clamp openings (244) and / or angular recesses (246) described above.
[0055] [0055] The lower platform (264) of the present example further comprises a plurality of stamped recesses (270 and 272) which have staple forming pockets (278) formed there. The staple forming pockets (278) are configured to receive and flex portions of staples (290) which are moved through staple actuators (250) of the lower cartridge (220), as described above. In the present example, the lower platform (264) includes a pair of stamped internal recesses (270) and a pair of stamped, or "minted", external recesses (272). The internal stamped recesses (270) substantially comprise vertical recesses which correspond to the vertical internal clamp openings (240) and recesses (242) of the lower cartridge (220), although this is merely optional. The external stamped recesses (272) comprise angled recesses which correspond to the external clip openings (244) and the angled recesses (246) of the lower cartridge (220). Of course, other configurations and orientations for the stamped recesses (270 and 272) will be apparent to one skilled in the art in view of the teachings of the present invention. The vertical slot (266) extends longitudinally through the lower platform (264) and the cartridge body (262) so that the firing bar (14) is operable through it. In some versions, the vertical slot (266) is a longitudinally linear slot while in other versions the vertical slot (266) can be curved along the longitudinal axis for a curved end actuator (200).
[0056] [0056] The clip drivers (286) of the present example are arranged inside the cartridge body (262) and are vertically movable elements in the upper cartridge (260). In some versions, the staple actuators (286) are selectively coupled inside the vertical recesses (282) so that the staple actuators (286) are prevented from triggering inadvertently in relation to the cartridge body (262) until a support upper wedge-shaped slide (296), described below, engage the clamp actuators (286). For example, the clip drivers (286) can be adhesive-bonded to the cartridge body (262). In other versions, the clip drivers (286) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the cartridge body (262), so that an interference fit is formed . Consequently, the clamp actuators (286) are selectively clamped relative to the cartridge body (262) even if the user rotates or inverts the end actuator (200). Of course, other selectively attachable configurations will be apparent to one skilled in the art in view of the teachings of the present invention.
[0057] [0057] In the present example, a plurality of clips (290) is also arranged inside the cartridge body (262) and is arranged below the corresponding clip drivers (286), as shown in Figure 8A. In particular, each clamp (290) is propelled vertically inside the cartridge body (262) by a clamp driver (286), in order to propel the clamp (290) through an associated clamp opening (280). In some versions the clamps (290) are selectively coupled to the clamp actuators (286), so that the clamps (290) are prevented from inadvertently activating in relation to the clamp actuators (286) until the wedge-shaped sliding support upper (296), described below, engage the clamp actuators (286) to eject the clamps (290) out of the clamp openings (280). For example, the clamps (290) can be adhesively joined to the clamp actuators (286). In other versions, the clips (290) can each include a tab (not shown) that can be inserted into a slot (not shown) formed in the clip drivers (286) so that an interference fit is formed. In addition, a snap-fit component can be included in the clamp actuators (286) to secure the clamp (290) with the clamp actuator (286) until it is dispensed with. In some versions, the clip drivers (286) may include a release tab (not shown) that engages a tab (not shown) on the cartridge body (262) to release the clip (290) when the clip drivers (286 ) are triggered. Such a tab on the cartridge body (262) can be on or near the upper platform (264) so that the clamps (290) are released only when the clamp driver (286) is at the end of its actuation movement. Consequently, the clamps (290) are selectively clamped in relation to the clamp actuators (286), so that the clamps (290) do not disengage from the clamp actuators (286) due to the force of gravity. In addition to or instead of being attached to the clip drivers (286), the clips (290) can be selectively attached to the cartridge body (262), as by interference fit and / or otherwise through friction.
[0058] [0058] Figures 8A to 8B describe the firing of the firing bar (14) through the lower and upper cartridges (220 and 260) to implant the staples (290) in the fabric (90). As shown in Figure 8A, the tissue (90) is trapped between the lower jaw (202) and the upper jaw (210) after the closing driver (26) has been activated. In this initial position, the clamp actuators (250 and 286) were not engaged by the lower or upper wedge-shaped sliding supports (292 and 296). As mentioned earlier, the structure (34) longitudinally and slidingly supports a triggering member that extends through the axis (23) and communicates a firing movement from the firing trigger (28) to the firing bar ( 14), as shown in Figures 1 to 5. When the trigger trigger (28) is activated by a user, the trigger bar (14) advances distally from the cable portion (20). As the firing bar (14) advances distally, a pair of propeller blocks (not shown), such as the propeller blocks (80) described above, each engages a respective wedge-shaped sliding support (292 and 296) so that the wedge-shaped sliding supports (292 and 296) are pressed distally by the propellant blocks, as the firing bar (14) advances distally through the upper and lower cartridges (220 and 260). As the wedge-shaped sliding brackets (292 and 296) are activated distally, each wedge-shaped sliding bracket (292 and 296) engages the respective clamp actuator assembly (250 and 286) to guide the clamp actuators upwards (250) and cam clamp drivers downwards (286). In turn, the clamp actuators (250 and 286) drive the clamps (290) outwards through a respective clamp opening (240, 244 and 280), through the fabric (90), and in the formation of contact with a respective staple-forming pocket (232 and 278) in a respective stamped recess (230, 270 and 272). In the present example, the lower wedge-shaped sliding support (292) comprises four tilt elements (294) (two internal vertical tilt elements (294) and two external angular tilt elements (294)) configured to route the clamps (250) towards the upper platform (224). The upper wedge-shaped sliding support (296) comprises two tilt elements (298) configured to guide the clamp actuators (286) towards the lower platform (264). Of course other configurations for the lower wedge-shaped sliding support (292) and / or the upper wedge-shaped sliding support (296) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0059] [0059] As shown in Figure 8B, the cutting edge (48) of the firing bar (14) also advances distally as the wedge-shaped sliding supports (292 and 296) are advanced distally. In some versions, the cutting edge (48) simultaneously cuts the fabric (90), as the wedge-shaped sliding supports (292 and 296) engage and move the clamp actuators (250 and 286), although this is merely optional. In fact, the cutting edge (48) can be configured to section the fabric (90) anterior to the cam of the staple actuators (250 and 286) or after the cam of the staple actuators (250 and 286). As also shown in Figure 8B, the firing bar (14) includes a pair of flanges at the top and bottom ends of the firing bar (14) that slide along the outer channels of the lower and upper jaws (202 and 210). As will be evident to the person skilled in the art, the flanges cooperatively compress the lower and upper jaws (202 and 210) together with additionally securing the fabric (90) to each other when the firing bar (14) is activated distally.
[0060] [0060] When the lower wedge-shaped sliding support (292) is advanced distally, the clamp actuators (250) are moved vertically so that the clamps (290), propelled by the clamp actuators (250), are propelled towards outside the staple openings (240 and 244) of the lower cartridge (220). The staples (290) pierce through the fabric (90) and enter the patterned recesses (270 and 272) to engage the staple forming pockets (278) formed on the lower platform (264) of the upper cartridge (260). Consequently, the staples (290) are flexed and staple the fabrics (90). Similarly, when the upper wedge-shaped sliding support (296) is advanced distally, the staple actuators (286) are moved vertically so that the staples (290), driven by the staple actuators (286) are extended to outside the staple openings (280) of the upper cartridge (260). The staples (290) pierce through the fabric (90) and enter the patterned recesses (230) to engage the staple forming pockets (232) formed on the upper platform (224) of the lower cartridge (220). Consequently, the staples (290) are flexed and staple the fabrics (90). As shown in Figure 8B, opposing clamps (290) are stapled through the fabric (90) using the present end actuator (200) with an upper and lower cartridge (220 and 260). The user can then release the trigger trigger (28) and the closing trigger (26) to release the stapled fabric (90). The user can then replace the lower and upper cartridges (220 and 260) with the new lower and upper cartridges (220 and 260) to staple a new section of fabric (90).
[0061] [0061] Of course, other configurations for the end actuator (200), the lower cartridge (220) and / or the upper cartridge (260) will be apparent to one skilled in the art in view of the teachings of the present invention. For example, in some versions a support material (not shown) can be attached to the lower cartridge (220) and / or the upper cartridge (260). Merely exemplary configurations for the lower cartridge (220) and / or the upper cartridge (260) with a support material are described in various references that are cited and incorporated by reference in the present invention. In addition, or in some versions in the alternative, an auxiliary material (for example, an adhesive, a therapeutic agent, etc.) can be applied to the fabric (90) through lower and / or upper cartridges (220 and 260). Merely exemplary auxiliary implantation mechanisms that can be incorporated in the lower and / or upper cartridges (220 and 260) are described in several references that are cited and incorporated by reference in the present invention. Still other configurations suitable for the end actuator (200), the lower cartridge, (220) and / or the upper cartridge (260) will be apparent to one skilled in the art in view of the teachings of the present invention.
[0062] [0062] Although certain configurations of exemplary surgical instruments have been described, several other ways in which surgical instruments can be configured will become apparent to elements skilled in the art in view of the teachings of the present invention. As an example only, the surgical instruments mentioned herein can be constructed in accordance with at least some of the 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. 6,978,921; US patent No. 7,000,818; 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; and US patent No. 7,721,930.
[0063] [0063] It is understood that any patent, publication, or other description material, in whole or in part, which is said to be incorporated into the present invention for reference purposes, is incorporated into the present invention only if the incorporated material does not enter in conflict with existing definitions, statements, or other description material presented in this description. Accordingly, and as far as necessary, the description as explicitly stated herein replaces any conflicting material incorporated herein by way of reference. Any material, or portion thereof, that is deemed to be incorporated by reference in the present invention, but which conflicts with definitions, statements, or other description materials existing herein will be incorporated here only to the extent that no conflict will appear between the embedded material and the existing description material.
[0064] [0064] Modalities of the present invention have application in the endoscopic and conventional open surgical instrumentation, as well as the application in surgery aided by robotics. For example, those skilled in the art will recognize that various teachings of the present invention can be easily combined with various teachings from US Patent No. 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument," published August 31, 2004, the description of which is incorporated herein by way of reference.
[0065] [0065] Modalities of the devices presented here can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, modalities of the devices presented here can be disassembled, in any number of particular parts or parts of the devices can be selectively replaced or removed in any combination. With the cleaning and / or replacement of particular parts, modalities of the devices can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will understand that the reconditioning of a device can use a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting refurbished device are all within the scope of the present application.
[0066] [0066] Just as an example, the modalities described here can be processed before surgery. First, a new or used instrument can be obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK pouch. The container and instrument can then be placed in a radiation field, which can penetrate the container, such as gamma radiation, X-rays or high-energy electrons. The radiation can exterminate bacteria on the instrument and the container. The sterile instrument can then be stored in a sterile container. The sealed container can keep the instrument sterile until it is opened at the medical facility. The device can also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide or water vapor.
[0067] [0067] Having shown and described various modalities of the present invention, other adaptations of the methods and systems described in the present invention can be made by means of suitable modifications by an element skilled in the art without departing from the scope of the present invention. Several of these possible modifications have been mentioned, and others will be evident to the elements versed in the technique. For example, the examples, modalities, geometry, materials, dimensions, proportions, steps and the like discussed above are illustrative and are not necessary. Consequently, the scope of the present invention should be considered in accordance with the terms of the following claims and it is understood that it is not limited to the details of the structure and operation shown and described in the specification and drawings.

权利要求:
Claims (12)
[0001]
Apparatus, comprising: (a) an instrument (10) comprising: i. a portion of cable (20), and ii. an end actuator (100) extending proximally to the cable portion (20), wherein the end actuator (100) comprises a lower jaw (16) and an upper jaw (110); (b) a lower staple cartridge (120) insertable in the lower jaw (16) of the end actuator (100), the lower staple cartridge (120) comprising: i. a first cartridge body (122) having an upper support (124), the upper support (124) comprising a first plurality of clamp openings (130) formed therein, ii. a first plurality of clip actuators (140) movable with respect to the first cartridge body (122), and iii. a first plurality of clips in communication with the first plurality of clip drivers (140), wherein the first plurality of clips is movable with respect to the first cartridge body (122); and (c) an upper staple cartridge (160) insertable in the upper jaw (110) of the end actuator (100), the upper staple cartridge (160) comprising: i. a second cartridge body (162) having a lower support (164), the lower support (164) comprising a second plurality of clip openings (170) formed therein, ii. a second plurality of clip actuators (180) movable with respect to the second cartridge body, and iii. a second plurality of clips in communication with the second plurality of clip drivers (180), wherein the second plurality of clips is movable with respect to the second cartridge body; characterized by the fact that (a) the first plurality of clamp actuators (140) are arranged at an angle not perpendicular to the upper support (124), and at least one clamp actuator (140) of the first plurality of clamp actuators (140) is pivotally coupled to an actuation element (142), wherein the actuation element (142) is operable to rotate at least one clamp driver (140) to a position in which at least one clamp driver (140) is perpendicular to the upper support (124); or (b) the second plurality of clamp actuators (180) is arranged at an angle not perpendicular to the lower support (164), and at least one staple actuator (180) of the second plurality of clamp actuators (180) is pivotally coupled to an actuation element (182), where the actuation element (182) is operable to rotate at least one clamp driver (180) to a position in which at least one clamp driver (180) is perpendicular to the lower support (164).
[0002]
Apparatus, according to claim 1, characterized by the fact that the instrument (10) still comprises a firing bar (14) that can be actuated longitudinally, in which the firing bar (14) has the purpose of acting laterally on the firing element. actuation (142) in relation to the first cartridge body (122).
[0003]
Apparatus according to claim 1, characterized by the fact that the upper support (124) still comprises a vertical slot (126), in which the vertical slot (126) extends longitudinally through a portion of the upper support (124) , and wherein the vertical slot (126) defines a first side of the upper support (124) and a second side of the upper support (124).
[0004]
Apparatus according to claim 3, characterized by the fact that a first clip driver (140) is disposed below the first side of the upper support (124) and in which a second clip driver (140) is disposed below the second side of the upper support (124).
[0005]
Apparatus according to claim 4, characterized by the fact that the first clamp driver (140) is pivotally coupled to a first actuating element (142), in which the second clamp driver (140) is coupled in an articulated to a second actuation element (142).
[0006]
Apparatus according to claim 5, characterized by the fact that the first actuating element (142) has the purpose of articulating the first clip driver (140) to a position in which the first clip driver (140) is perpendicular to each other. with respect to the upper support (124) and in which the second actuating element (142) aims to articulate the second clamp driver (140) to a second position in which the second clamp driver (140) is perpendicular to the support higher (124).
[0007]
Apparatus according to claim 1, characterized in that the lower support (164) of the upper staple cartridge (160) comprises a plurality of staple forming pockets (168), wherein the first plurality of staple actuators (140) aims to operate the first plurality of clamps (190) in communication with the plurality of clamp forming pockets (168).
[0008]
Apparatus according to claim 1, characterized in that the upper support (124) of the lower staple cartridge (120) comprises a set of staple forming pockets (128), wherein the second plurality of staple actuators (180) is intended to operate the second plurality of clips (190) in communication with the plurality of staple forming pockets (128).
[0009]
Apparatus according to claim 1, characterized by the fact that the lower staple cartridge (120) still comprises a sliding support in the form of a lower wedge, in which the sliding support in the form of a lower wedge is intended to drive the first plurality of staples (140) in relation to the first cartridge body (122).
[0010]
Apparatus according to claim 1, characterized in that the second plurality of clamp actuators (180) is arranged at an angle to the lower support (164), and in which the second plurality of clamp actuators (180) is at an angle not perpendicular to the lower support (164).
[0011]
Apparatus, according to claim 1, characterized by the fact that the instrument (10) comprises a closing trigger (26), in which the closing trigger (26) has the purpose of articulating the upper jaw (110) in relation to the lower jaw (16).
[0012]
Apparatus according to claim 1, characterized by the fact that the instrument (10) comprises a trigger actuator (28), in which the trigger actuator (28) is intended to act the first plurality of clamp actuators (140 ) and the second plurality of clamp actuators (180).

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同族专利:

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公开号 | 公开日

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US9089326B2|2015-07-28|

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EP2765924B1|2019-07-10|

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CN104053408B|2016-11-02|

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JP2014533134A|2014-12-11|

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CN104053408A|2014-09-17|

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US20130087599A1|2013-04-11|

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JP6117218B2|2017-04-19|

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BR112014008379A2|2017-04-11|

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RU2612513C2|2017-03-09|

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MX371308B|2020-01-24|

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MX2014004228A|2014-10-17|

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WO2013052808A2|2013-04-11|

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RU2014118458A|2015-11-20|

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EP2765924A2|2014-08-20|

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WO2013052808A3|2013-08-08|

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MX343928B|2016-11-28|

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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]|

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2019-11-19| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-11-24| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-01-26| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 05/10/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US13/267,922|2011-10-07|

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US13/267,922|US9089326B2|2011-10-07|2011-10-07|Dual staple cartridge for surgical stapler|

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