• 专利附录
  • 专利说明
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    • 专利摘要:
    RCOMPONENT TO LOCK THE TISSUE STAPLER BUTTON. The present invention relates to a surgical stapling instrument for performing a circular anastomosis comprising a structure of the stapling head, a structure of the actuating cable, a stem structure, a safety lock and a locking element. The staple head structure includes an anvil that moves in relation to a staple holder and a staple driver to guide staples from the staple holder to the fabric and against the anvil. The actuator cable structure has a first actuator that controls the movement of the anvil and a second actuator that controls the movement of the clamp driver. The structure of the rod couples the structure of the stapling head to the structure of the actuator cable. The safety lock prevents the operation of the second actuator when the gap between the anvil and the clamp holder is outside a predetermined range. The locking element is configured to prevent adjustment of the anvil span after the desirable height of the clamp has been adjusted within the predetermined range.
    公开号:BR112014014681B1
    申请号:R112014014681-0
    申请日:2012-12-11
    公开日:2021-01-26
    发明作者:Venkataramanan Mandakolathur Vasudevan；Edward G. Chekan；Kevin D. Felder；Jerome R. Morgan；Carl J. Shurtleff；Johnny H. Iii Alexander；John F. Cummings；Christopher C. Miller
    申请人:Ethicon Endo-Surgery, Inc.；
    IPC主号:
    专利说明:

    BACKGROUND
    [001] A variety of surgical stapling instruments perform circular anastomosis stapling operations. Examples of such devices and related concepts are presented in US Patent No. 5,205,459 entitled "Surgical Anastomosis Stapling Instrument", issued April 27, 1993, the description of which is incorporated herein by reference; US Patent No. 5,271,544 entitled "Surgical Stapling Anastomosis Instrument", issued December 21, 1993, the description of which is incorporated herein by reference; US patent No. 5,275,322 entitled "Surgical Stapling Anastomosis Instrument", issued on January 4, 1994, the description of which is incorporated herein by reference; US Patent No. 5,285,945 entitled "Surgical Stapling Anastomosis Instrument", issued on February 15, 1994, the description of which is incorporated herein by reference; US patent No. 5,292,053 entitled "Surgical Stapling Anastomosis Instrument", issued on March 8, 1994, the description of which is incorporated herein by reference; US Patent No. 5,333,773 entitled "Sealing Means for Endoscopic Surgical Anastomosis Stapling Instrument", issued on August 2, 1994, the description of which is incorporated herein by reference; US Patent No. 5,350,104 entitled "Sealing Means for Endoscopic Surgical Anastomosis Stapling Instrument", issued September 27, 1994, the description of which is incorporated herein by reference; and US Patent No. 5,533,661 entitled "Sealing Means for Endoscopic Surgical Anastomosis Stapling Instrument", issued July 9, 1996, the description of which is incorporated herein by reference.
    [002] Although several medical devices have been made and used, it is believed that no one before the inventors made or used the invention described in the attached claims. BRIEF DESCRIPTION OF THE DRAWINGS
    [003] Although the specification concludes with claims that specifically indicate and distinctly claim this technology, it is believed that this technology will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings, in which the same numbers reference points identify the same elements and where:
    [004] FIG. 1 describes a perspective view of an exemplary surgical stapling instrument;
    [005] FIG. 2 depicts an enlarged longitudinal cross section of a stapling head structure of the instrument of FIG. 1, showing the anvil completely open;
    [006] FIG. 3 describes an enlarged longitudinal cross section of the staple head structure of FIG. 2, illustrating the anvil in a closed position;
    [007] FIG. 4 describes an enlarged longitudinal cross section of the staple head structure of FIG. 2, illustrating the clip driver in a triggered position;
    [008] FIG. 5 depicts an enlarged longitudinal cross section of an actuator cable structure of the stapling instrument of FIG. 1, with the clamping lever in a locked position;
    [009] FIG. 6 describes an enlarged longitudinal cross section of the actuator cable structure of FIG. 5, with the clamping lever in an unlocked position;
    [0010] FIG. 7 describes an enlarged longitudinal cross section of the actuator cable structure of FIG. 5, in a triggered position;
    [0011] FIG. 8 describes a perspective view of an exemplary safety release element in a position to lock the clamp actuation lever;
    [0012] FIG. 9 describes a perspective view of the security release element of FIG. 8, in a position to unlock the clamp actuation lever and to lock the adjustment knob;
    [0013] FIG. 10 describes a perspective view of another exemplary safety release element in a position to lock the clamp actuation lever;
    [0014] FIG. 11 describes a perspective view of the security release element of FIG. 10, in a position to unlock the clamp actuation lever and to lock the adjustment knob;
    [0015] FIG. 12 describes a longitudinal cross-section of an exemplary structure of the actuator cable, illustrating a locking element of the closing system connected to a safety release element by locking the clamp actuation lever;
    [0016] FIG. 13 describes a longitudinal cross section of the actuator cable structure of FIG. 12, illustrating the safety release element by locking the adjustment knob;
    [0017] FIG. 14 describes a front view of the adjustment knob of FIG. 12;
    [0018] FIG. 15 depicts a perspective view of the adjustment knob of FIG. 12;
    [0019] FIG. 16 depicts a front view of the locking element of the closure system of FIG. 13.
    [0020] FIG. 17 describes a perspective view of the locking element of the closure system of FIG. 13.
    [0021] FIG. 18 describes a longitudinal cross section of an exemplary structure of the alternative actuator cable, illustrating a connection in a hook configuration connected to a safety release element by locking the clamp actuation lever;
    [0022] FIG. 19 describes a longitudinal cross section of the actuator cable structure of FIG. 18, illustrating the connection by locking the adjustment knob;
    [0023] FIG. 20 describes a cross-sectional view of the adjustment knob taken along line 20-20 of FIG. 18;
    [0024] FIG. 21 describes a longitudinal cross section of another exemplary structure of the actuator cable illustrating a connection in a wedge configuration connected to a safety release element by locking the clamp actuation lever;
    [0025] FIG. 22 describes a longitudinal cross-section of the actuator cable structure of FIG. 21, illustrating the connection by locking the adjustment knob;
    [0026] FIG. 23 describes a longitudinal cross section of another exemplary structure of the actuator cable illustrating a connection in a friction brake configuration connected to a safety release element by locking the clamp actuation lever; and
    [0027] FIG. 24 describes a longitudinal cross-section of the actuator cable structure of FIG. 23, illustrating the connection by locking the adjustment knob.
    [0028] The drawings are not intended to be limiting in any way, and it is contemplated that various modalities of technology can be executed in a variety of other ways, including those not necessarily represented in the drawings. The attached drawings incorporated and forming a part of the specification illustrate various aspects of the present technology, and together with the description they serve to explain the principles of the technology; it is understood, however, that this technology is not limited precisely to the provisions shown. DETAILED DESCRIPTION
    [0029] The following description of some examples of the technology should not be used to limit its scope. Other examples, elements, aspects, modalities and advantages of the technology will become evident to those skilled in the art with the following description, which is by means of illustrations, one of the best ways contemplated for the realization of the technology. As will be understood, the technology described here is capable of other different and obvious aspects, all without departing from the technology. Consequently, drawings and descriptions should be considered as illustrative rather than restrictive.
    [0030] It is further understood that any one or more of the teachings, expressions, modalities, examples, etc. described herein can be combined with any one or more of the other teachings, expressions, modalities, examples, etc., which are described in the present invention. The teachings, expressions, modalities, examples, etc. described below should not be seen in isolation from each other. Various suitable ways in which the teachings of the present invention can 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 in the scope of the appended claims. Surgical stapling instrument for exemplifying anastomosis
    [0031] With reference to FIG. 1, the surgical stapling instrument for circular anastomosis (50) of the present example includes a staple head structure in the distal position (60) connected by a longitudinal support rod structure (70) to a structure of the actuator cable in a proximal position (80). The stapling instrument includes an anvil structure (100) that is sliding longitudinally with respect to a stapling head structure (60). A rotary adjustment knob (82) is provided at the proximal end of an actuator cable frame (80) to adjust the spacing between the staple head frame (60) and the anvil frame (100). A movable indicator (84) is visible through a window (85) at the top of the cable structure (80) to indicate the clamp height selected by rotating the adjustment knob (82).
    [0032] A clamp actuation lever (86) is pivotally mounted on the actuator cable structure (80) to guide the surgical clamps from the staple head structure (60) when the anvil structure (100) is closed to provide the desired staple height. A pivoting safety lock (88) is mounted on the cable frame (80) to lock the clamp lever (86) against movement to make it impossible to activate the staple head frame (60) when the anvil gap is outside a predetermined range. The safety lock (88) is also configured to lock the adjustment button (82) when the safety lock (88) is hinged to allow the operation of the clamp actuation lever (86). While various components of the stapling instrument (50) will be described in detail below, it should be understood that the stapling instrument (50) can also incorporate at least some of the teachings of US Patent No. 5,205,459 and / or any other ( s) reference (s) incorporated by reference in the present invention. Other components, features and operabilities that can be incorporated into the stapling instrument (50) will be apparent to elements skilled in the art in view of the teachings of the present invention. Stapling head structure and example anvil structure
    [0033] With reference to FIG. 2, the structure of the stapling head (60) includes a tubular compartment (61) which slidably receives a staple driver (62), which can be advanced and retracted by the operation of the structure of the actuator cable (80). The clamp driver (62) includes a plurality of finger-like parts (63) for engaging and driving a plurality of clamps (90) from a clamp holder (68) mounted at the distal end of the compartment (61). The clamp holder (68) includes a plurality of clamp receiving slots (65) into which the clamps (90) are inserted. In addition, the staple driver (62) supports a circular knife or scalpel (69) which is advanced and retracted with the staple driver (62).
    [0034] The structure of the anvil (100) includes a generally circular anvil (102) mounted on an axially extending hollow rod (104), which is securely attached to a trocar (73) supported by the head structure. sliding stapling (60). The trocar (73) includes a pointed trocar tip (75) which is inserted into a hollow sleeve (105) at the proximal end of the anvil stem (104). In some alternative versions, the configurations of the trocar (73) and the hollow sleeve (105) are inverted so that the trocar (73) is mounted to the anvil structure (100) with the tip of the trocar (75) being inserted into a hollow sleeve (105) mounted on the staple head frame (60) for operation. A pair of elongated spring-like retaining clips (110) extends longitudinally along the anvil stem (104) to engage the tip of the trocar (75) when the trocar (73) is inserted into the anvil stem (104). The trocar (73) is slidably received in a central support tube (66) formed over the tubular compartment (61) for longitudinal movement in relation to the clamp support (68) mounted on the distal end of the compartment (61). The staple receiving slots (65) in the staple holder (68) are arranged in a circular assembly to receive the surgical staples (90). The clamp receiving slots (65) are arranged in two precisely spaced concentric annular rows. The anvil (102) includes an annular edge (106) with a plurality of staple-forming grooves to form staples (90) when pushed against the anvil (102).
    [0035] With the stapling instrument (50) in its open position (FIG. 2), the retaining clips (110) allow the anvil structure (100) to be fixed or separated from the trocar (73) by pushing or pulling, respectively , in the structure of the anvil (100). With the stapling instrument in its closed position (FIG. 3), the trocar (73) is retracted in the central support tube (66) which restricts the radial movement of the retaining clips (110) to maintain the tip of the trocar (75) at the place. As a result, the structure of the anvil (100) is confined to the trocar (73) so that the anvil (102) can withstand the force of the complete firing of the stapling instrument without disengaging the retaining clips (110) from the tip of the trocar ( 75). B. Exemplary actuator cable structure
    [0036] With reference to FIG. 5, the actuator cable structure (80) comprises a pair of elongated cable sections (81) that fit to form a generally cylindrical cable. The staple actuator lever (86) is pivotally mounted on the cable sections (81). The control rod (300) is contained between the cable sections (81) for longitudinal movement along the actuator cable structure (80). The adjustment knob (82) is rotatably supported by the proximal ends of the cable sections (81) and is threadably engaged with an elongated threaded rod (302) at the proximal end of the control rod (300). The threaded rod (302) and the control rod (300) together form a unitary structure in this example. A cylindrical cap (89) is attached to the proximal end of the hollow adjustment knob (82). The threaded rod (302) is threadably connected to an internally threaded sleeve (304) that is unitarily coupled with the distal end of the adjustment knob (82). The threaded sleeve (304) is received rotatably in an annular wall (305) formed in each cable section (81) and rotates unitarily with the adjustment knob (82). The distal end of the control rod (300) is slidably received in an elongated groove (212) in the proximal portion (200) of a compression member (92). The control rod (300) is connected at its distal end to a tension element (94) by a pin (242). The control rod (300) and the threaded rod (302) are prevented from rotating inside the cable structure (80). Thus, due to this and the threaded coupling between the threaded sleeve (304) and the threaded stem (302), the threaded stem (302) and the control stem (300) will translate in relation to the cable structure (80) when the adjustment knob (82) is rotated in relation to the cable structure (80).
    [0037] By turning the adjustment knob (82) counterclockwise, as seen in FIG. 1, the control rod (300) is advanced to move the tension element (94) in the distal direction to open the gap between the structure of the anvil (100) and the structure of the stapling head (60). A lock (307) (FIG. 5) on one of the cable sections (81) engages the screw (308) to limit the distal movement of the control rod (300). By turning the adjustment knob (82) in the opposite direction, that is, clockwise, the control rod (300) is retracted to move the tension element (92) in the proximal direction to close the gap between the anvil structure (100) and the staple head structure (60). A lock (309) on the cover (89) limits the proximal movement of the control rod (300). C. Locking means for the exemplary clamp lever
    [0038] The actuator cable structure (80) includes a safety release bracket (312) that is slidably supported in each of the cable sections (81). The safety release bracket (312) includes an elongated rectangular plate (314) received slidingly between a pair of longitudinal ribs (315) and (316) formed in each of the cable sections (81) below the threaded rod (302) of the control rod (300). The threaded rod (302) extends through a vertical flange (318) formed at the proximal end of the rectangular plate (314). A spiral spring (320) is interposed between the flange (318) and the annular wall (305) in each section of the cable (81) to normally tilt the flange (318) distally against the rib (315). At the distal end of the safety release bracket (312) is an arm projecting distally (322) that tilts upwards and ends in a finger projecting laterally (324) to control the movement of the indicator (84).
    [0039] The structure of the anvil (100) and the structure of the actuator cable (80) are shown completely open in Figures 2 and 5, respectively. With the anvil structure (100) fully open, the safety release bracket (312) is tilted distally by the spiral spring (320) to propel the flange in an upright position (318) against the rib (315) with the finger ( 324) distally advanced and disengaged from the indicator lever (326). When the control rod (300) is retracted, as shown in FIG. 6, the clip (306) on the control rod (300) is moved in a proximal direction to engage the flange (318) and moves the safety release bracket (312) in the proximal direction. Initially, as the anvil structure (100) begins to close, the finger (324) on the safety release bracket (312) remains disengaged from the indicator lever (326). When the gap between the anvil structure (100) and the stapling structure (60) is set at a predetermined interval of the instrument, the finger (324) engages and articulates the indicator lever (326) to move the indicator (84) in proximal way along a scale in the window (85) to provide an indication of the selected height of the clamp to be produced when the stapling instrument is triggered.
    [0040] The safety lock (88) is hingedly mounted under the safety release bracket (312) by a hinge pin extending between the cable sections (81). The safety lock (88) includes a projection (332) which, in its locked position (FIG. 5), is horizontally arranged under the safety release bracket (312). If the anvil span is outside, that is, above the predetermined range of the stapling instrument (Figures 2 and 5), the rectangular plate (314) of the safety release bracket (312) overlaps the protrusion (332) in the lock (88) and prevents the safety lock (88) from being disengaged from the clamp lever (86). The safety lock (88) thus locks the clamping lever (86) to the open position. On the other hand, when the anvil span is close to the predetermined interval (Figures 3 and 6), the safety release bracket (312) is retracted and the protrusion (332) on the safety lock (88) is disengaged from the rectangular plate (314) of the safety release bracket (312). The safety lock (88) can then be pivoted upwards (FIG. 6) to allow the clamp actuation lever (86) to be operated. D. Locking means for the exemplifying adjustment knob
    [0041] stapling instrument (50) can prevent the movement of the anvil structure (100) after the anvil span is adjusted to the desired height of the staple. For example, the structure of the actuator cable (80) can be modified so that the adjustment knob (82) is prevented from turning when the safety lock (88) is hinged upwards to allow the clamp actuation lever ( 86) is operated at the predetermined interval. Examples described below include variations in the structure of the actuator cable (80) to lock the adjustment button (82) while the clamp lever (86) is unlocked by the safety lock (88). Other exemplary configurations will be apparent to those elements skilled in the art in view of the teachings of the present invention. Locking structure of the integral adjustment knob with the exemplary safety lock
    [0042] adjustment knob (82) can be selectively locked by a locking element that is integral with the safety lock (88), as a component that moves unitarily with the safety lock (88). In this way, some variations of the safety lock (88) can engage a portion of the trigger cable structure (80) to prevent the rotation of the adjustment knob (82) when the safety lock (88) is hinged upwards. A merely illustrative example is shown in Figures 8 and 9, which shows a locking structure of the adjustment button (450) that includes a button extension rod (400), a safety lock (488), and a release bracket security (412). The button extension rod (400) is fixedly attached to the adjustment button (82) and extends distally therefrom. A threaded sleeve (404) with internal thread is fixedly attached to the distal end of the button extension rod (400), so that the adjustment button (82), the button extension rod (400), and the threaded sleeve (404) all rotate together unitarily. The threaded sleeve (404) in this example is substantially similar to the threaded sleeve (304) described above. In particular, the threaded rod (302) of the control rod (300) (not shown in Figures 8 to 9) is received in the threaded sleeve (404), so that rotation of the threaded sleeve (404) causes longitudinal translation of the rod control (300). While the threaded sleeve (304) of the examples described above is located proximal to the safety release bracket (312), the threaded sleeve (404) of the present example is located distal to the safety release bracket (412).
    [0043] The button extension rod (400) includes a region of flat sides (402) proximal to the threaded sleeve (404). In the present example, the flat-sided region (402) has an octagonal cross section. In other versions, the flat-sided region (402) can include any polygon with any number of flat sides or regions and / or can otherwise be configured with a side surface that can be engaged by a safety lock component (488 ). The security lock (488) is similar to the security lock (88) (FIG. 5), with the difference that the security lock (488) in this example includes an integral arm (490) that extends from the lock (488), so that the arm (490) is able to engage the button extension rod (400) in the upward hinged position (FIG. 9). The safety release bracket (412) is similar to the safety release bracket (312) (FIG. 5), with the difference that the elongated rectangular plate (414) of the safety release bracket (412) includes a slot (416) dimensioned to allow the arm (490) to pass inside it. In some other versions, the plate (414) and the arm (490) are configured so that the arm (490) simply moves past an outer perimeter of the plate (414) without having to pass through a slot or other component in the plate (414).
    [0044] FIG. 8 shows the locking structure of the adjustment knob (450) in an unlocked position in relation to the adjustment knob (82). While the safety lock (488) is in a downward position, the actuating lever (86) is locked in place, while the button extension rod (400) and the threaded sleeve (404) are free to rotate by moving the button. adjustment (82). In this way, the control rod (300) can be moved longitudinally based on the rotation of the adjustment knob (82). When the safety lock (488) is hinged upwards (FIG. 9) to allow the operation of the clamp actuation lever (86), the arm (490) engages a region of flat sides (402) of the extension rod of the button (400) to prevent rotation of the button extension rod (400). The arm (490) can engage a flat surface of the bottom, side, and / or top of the button extension rod (400). By preventing rotation of the adjustment knob (82), the knob extension rod (400) and the threaded sleeve (404), the longitudinal position of the control rod (300) is effectively locked in place. In this way, the anvil gap between the anvil (102) and the clamp holder (68) is effectively locked in place when the safety lock (488) is turned upwards, in position as shown in FIG. 9.
    [0045] In the present example, the arm (490) is oriented substantially parallel to the extension rod of the button (400), in an unlocked position; and articulates for an orientation that is oblique to the button extension rod (400) in a locked position (Figures 8 and 9). In some other versions, the arm (490) is oriented obliquely with respect to the button extension rod (400) in an unlocked position; and pivots for an orientation substantially parallel to the button extension rod (400) in an unlocked position. In addition, it should also be understood that a portion of the adjustment knob (82) may contain one or more flat sides, so that the arm (490) selectively engages a flat surface of the adjustment knob (82) to prevent rotation. Additional variations in the interface between the arm (490) and the button extension rod (400) (e.g., an elastomeric friction brake, etc.) will be apparent to those skilled in the art in view of the teachings of the present invention.
    [0046] In an additional example, a portion of the button extension rod (400) can be configured with a smaller diameter, in cases where the smaller diameter portion does not extend across the entire length of the button extension rod ( 400). Since the safety lock (488) is hinged in an upward position, the arm (490) can move freely beyond the outer diameter of the smaller diameter portion of the button extension rod (400), but the arm (490) would be prevented to move beyond the outer diameter of the larger diameter portion of the button extension rod (400). In this way, the arm (490) would prevent rotation of the button extension rod (400) only when the extension rod (400) is positioned longitudinally for engagement between the arm (490) and the larger diameter portion of the rod button extension (400). The arm (490) would not prevent rotation of the button extension rod (400) when the extension rod (400) is positioned longitudinally, with the smaller diameter portion of the button extension rod (400) located by the arm ( 490), since the arm (490) could not engage such a portion of the button extension rod (400).
    [0047] FIGS. 10 and 11 show another example of a locking structure of the adjustment knob (550). The locking structure of the adjustment button (550) in this example includes a button extension rod (400), a safety lock (588) and a safety release bracket (312). The locking structure of the adjustment button (550) is similar to the locking structure of the adjustment button (450) (FIGS. 8-9), except as otherwise described below. The security lock (588) of the adjustment locking structure (550) is similar to the security lock (488) of the adjustment button locking structure (450), with the difference that the security lock (588) has a plurality of integral arms (590) extending from the security lock (588). The arms (590) extend around the safety release bracket (312) and are able to engage the button extension rod (400) on the opposite flat surfaces of the flat-sided region (402) when the safety lock (588) is in the upward hinged position. The safety release bracket (312) of the adjustment button locking structure (550) in this example is the same as the safety release bracket (312) described above (for example, with reference to FIG. 5).
    [0048] FIG. 10 shows the locking structure of the adjustment knob (550) in an unlocked position in relation to the adjustment knob (82). While the safety lock (588) is in this downward position, the adjustment knob (82), the button extension rod (400) and the threaded sleeve (404) are free to rotate while the clamp lever (86) ) is locked in place. When the safety lock (588) is hinged upwards (FIG. 11) to allow the operation of the clamp lever (86), the arms (590) engage the opposite flat surfaces of the button extension rod (400) to prevent rotation of the adjustment knob (82), the knob extension rod (400) and the threaded sleeve (404). By preventing rotation of the adjustment knob (82), the knob extension rod (400), and the threaded sleeve (404), the longitudinal position of the control rod (300) is effectively locked in place. In this way, the anvil gap between the anvil (102) and the clamp holder (68) is effectively locked in place when the safety lock (588) is facing upwards, in the position shown in FIG. 11.
    [0049] In the present example, a plurality of integral arms (590) are able to engage the button extension rod (400) on the opposite flat surfaces of the flat-sided region (402) when the security lock (588) is on upward articulated position. However, additional variations in the interface between the integral arms (590) and the button extension rod (400), as a friction brake, will be apparent to those skilled in the art in view of the teachings in the present invention.
    [0050] 2. Locking structure of the adjustment button that moves longitudinally in relation to the exemplary security lock
    [0051] adjustment knob (82) and the control rod (300) can be selectively locked by a component that is connected to the security lock (88), instead of being a single component of the security lock (88). This locking component can translate in response to the movement of the safety lock (88), in order to lock the adjustment button selectively (82) and the control rod (300). Several examples of such features will be described in detail below, while other examples will be apparent to those skilled in the art in view of the teachings of the present invention.
    [0052] FIGS. 12 to 13 show an example of an adjustment button locking structure (650) that includes an adjustment button (682), a cover lock bracket (691), a safety lock connection (690), and a safety lock (688). The adjustment knob (682) is similar to the adjustment knob (82) (FIG. 5), except that the threaded sleeve (604) at the distal end of the adjustment knob (682) contains one or more outer teeth extending to outside (686) and a lock (606) (FIGS. 14 and 15). As shown in FIGS. 16 and 17, the cover lock bracket (691) includes a cylindrical body (694), a tooth (698) and a connecting bracket (696). The cylindrical body (694) is coaxially aligned with the threaded sleeve (604) and has a plurality of teeth extending inwardly (698). The teeth (698) are configured to selectively engage with the tooth (686) as will be described in more detail below. The connection bracket (696) extends from the cylindrical body (694) to connect the cover lock bracket (691) to the safety lock connection (690). The cover lock bracket (691) is constrained to move only longitudinally inside the cable structure (80).
    [0053] The security lock connection (690) connects the cover lock bracket (691) to the security lock (688) in an articulated way. The safety lock connection (690) can comprise a bar, rod, or other element. The security lock (688) is similar to the security lock (88) (FIG. 5), with the difference that the security lock (688) is able to connect to a connection, such as the security lock connection (690 ). The connection can be made at the proximal end of the top of the security lock (688) (FIG. 12), or any other area of the security lock (688). It should be understood that the lock connection (690) is configured to convert the articulation or swivel movement of the safety lock (688), into the longitudinal movement of the cover lock bracket (691). In particular, when the safety lock (688) is hinged from a first position (FIG. 12) to a second position (FIG. 13), the safety lock connection (690) drags the cover lock bracket (691) distally. When the safety lock (688) is pivoted from the second position (FIG. 13) back to the first position (FIG. 12), the safety lock connection (690) pushes the cover lock bracket (691) from proximal way.
    [0054] adjustment knob (682) and the control rod (300) are locked when the safety lock (688) is hinged upwards; and are unlocked when the safety lock (688) is folded down. In particular, when the adjustment knob (682) is in an unlocked position (FIG. 12), the cover lock bracket (691) is in a proximal position, so that the teeth (698) are not engaged with the teeth (686) in the threaded sleeve (604) and the adjustment knob (682) is free to rotate. When the safety lock (688) is hinged upwards (FIG. 13), the cover lock bracket (691) moves distally to engage the adjustment knob (682) to prevent rotation of the adjustment knob (682) and translation of the control rod (300). In the locked position, a portion of the teeth (698) of the cylindrical body (694) engages with at least a portion of the teeth (686) in the threaded sleeve (604). The diameters of the cylindrical body (694) and the threaded sleeve (604) are dimensioned so that the teeth (686) of the threaded sleeve (604) and the teeth (698) of the cylindrical body (694) engage each other to prevent rotation of the adjustment knob (682), to maintain the desirable span of the anvil and the height of the clamp when the cylindrical body (694) is advanced distally by the safety lock (688). The teeth (686 and 698) can be chamfered to guide the cylindrical body (694) over the threaded sleeve (604). The security lock (688) can be connected directly to the cover lock bracket (691) or the security lock (688) can be connected to the cover lock bracket (691) by one or more connections, such as the safety lock (690). The adjustment frame locking structure (650) can also be configured so that the control rod (300) includes slots or teeth that engage the cover lock bracket (691) to prevent rotation of the adjustment button (682 ) and translation of the control rod (300) when the safety lock (688) is hinged upwards.
    [0055] FIGS. 18 to 19 show another example of an adjustment button locking structure (750), which includes an adjustment button (782), a connection (796), a hook (798) and a safety lock (688). The adjustment knob (782) is similar to the adjustment knob (682) (FIG. 12), except that the threaded sleeve (704) at the distal end of the adjustment knob (782) contains a plurality of teeth extending to the outside of the teeth (786) and a lock (706), as best seen in FIG. 20. The connection (796) comprises a bar, rod, or other element that connects the safety lock (688) to the hook (798). One or more connections can be used to connect the security lock (688) to the hook (798). The hook (798) extends vertically towards the threaded sleeve (704). As the safety lock (688) is pivoted upwards to unlock the actuating lever (86), the connection (796) moves distally and the hook (798) engages the teeth (786) of the threaded sleeve (704) to prevent rotation of the adjustment knob (682), thus avoiding translation of the control rod (300).
    [0056] FIGS. 21 and 22 show yet another example of an adjustment button locking structure (850), which includes an adjustment button (782), a connection (896), a wedge (898) and a safety lock (688). The locking structure of the adjustment button (850) is similar to the locking structure of the adjustment button (750) (FIGS. 18 and 19), with the difference that the connection (896) connects the safety lock (688) to the wedge (898). The wedge (898) extends vertically towards the threaded sleeve (704). As the safety lock (688) is pivoted upwards to unlock the actuating lever (86), the connection (896) moves distally and at least a portion of the wedge (898) engages at least a portion of the teeth (786) of the threaded sleeve (704) to prevent rotation of the adjustment knob (682), thereby preventing translation of the control rod (300). A block or rivet (not shown) can be used to prevent the fitting (896) and the wedge (898) from drifting downward, away from the teeth (786) of the threaded sleeve (704) when the fitting (896) and the wedge (898) are advanced distally.
    [0057] FIGS. 23 and 24 show yet another example of an adjustment button locking structure (950), which includes an adjustment button (882), a connection (996), a friction brake (998) and a safety lock (688) ). The adjustment knob (882) is similar to the adjustment knob (682) (FIG. 12), except that the threaded sleeve (804) at the distal end of the adjustment knob (782) contains a lock (806) without any teeth. The lock (806) is configured to have a larger diameter than the threaded sleeve (804). The connection (996) comprises a bar, rod, or other element that connects the safety lock (688) to the friction brake (998). The friction brake (998) is configured to selectively engage the lock (806) on the threaded sleeve (804). As the safety lock (688) is pivoted upwards to unlock the actuating lever (86), the connection (996) moves distally and the friction brake (998) engages the lock (806) of the threaded sleeve (804) to prevent rotation of the adjustment knob (682) by the force of friction, thus avoiding the translation of the control rod (300). Various materials can be used in the friction brake (998) or in the lock (806), such as an elastomeric material.
    [0058] It should be understood that a detent component, a centralized component, and / or another type of selective retention component can be incorporated to substantially maintain the safety lock (88, 488, 588 and 688) in an upward hinged position . The safety lock (88, 488, 588 and 688) can also slide longitudinally instead of turning to selectively provide operation of the clamping lever (86). Other suitable ways in which the security lock (88, 488, 588 and 688) can be configured and operable will be apparent to those skilled in the art in view of the teachings of the present invention. Operation of the surgical stapling instrument for exemplifying anastomosis
    [0059] surgical stapling instrument (50) can be used to perform an intraluminal anastomosis in which two sections of the tissue are fixed together by a set of staples. As an example, the stapling instrument (50) can be used in a procedure to join a pair of sections of the hollow organ (for example, in the patient's colon or another section of the gastrointestinal tract) from end to end with a plurality of surgical clips arranged in a circular set around a hollow lumen between sections of the organ. In preparation for the anastomosis, purse-string sutures are made in the hollow organs to be anastomosed. For example, as shown in FIG. 2, two tubular sections of tissue (52) and (54) are prepared by sticking the pouch sutures (56) and (58), respectively, into the pouch-like tissue, adjacent to the open ends of the tubular sections of the tissue (52) and (54).
    [0060] If the surgical procedure is performed using a double bag suture technique, the stapling instrument (50) is inserted into the first section of tubular tissue (52), for example, inserting it into the patient's anal opening, with the structure of the anvil (100) attached to the structure of the stapling head (60) and completely closed. Prior to inserting the stapling instrument (50) into the patient, the adjustment knob (82) is rotated clockwise to retract the trocar (73) in the support tube (66) and to hold the anvil (102) against the clamp holder (68). The staple head structure (60) is positioned adjacent to the bag-sutured end of the tubular tissue section (52). Then, the adjustment knob (82) is turned clockwise to advance the control rod (300) and the tension element (92) until the trocar (73) is fully advanced to move the anvil structure (100 ) to its fully open position (FIG. 2). With the trocar (73) completely advanced, the bag sutured end of the tubular tissue section (52) is pulled together around the body of the cylindrical trocar (130) by pulling and tightening the bag suture (56). The pouch sutured tissue is pulled against the cylindrical trocar body (130) and the pouch suture (56) is tied to hold the tissue against the trocar body (130).
    [0061] The structure of the anvil (100) is inserted into the pouch sutured end of the tubular tissue section (54) and the tissue is pulled together around the anvil stem (104) by pulling and tightening the pouch suture ( 58). The pouch sutured tissue is pulled against the anvil stem (104) by tying the slit (158) distally adjacent to the raised circumferential section (152) on the anvil stem (104) and the pouch suture (58) is tied together . If desired, the anvil structure (100) can be separated from the trocar (73) to facilitate insertion of the anvil structure (100) into the tubular tissue section (54). After the pouch sutured end of the tubular tissue section (54) is tied against the anvil stem (104) by the pouch suture (58), the anvil structure (100) is fixed to the trocar (73).
    [0062] After the bag-sutured ends of the tubular fabric sections (52) and (54) are tied, the adjustment knob (82) is rotated clockwise to retract the trocar (73) in the support tube (66 ), to move the anvil (102) towards the clamp holder (68). As the trocar (73) is retracted, the trocar body (130) runs through the pouch suture end of the tissue section (52) in the proximal direction to pull the anvil stem (104) through the pouch suture tissue in the tube support (66). The stapling instrument (50) finally reaches the configuration shown in FIG. 3. The actuator cable structure (80) remains in the fully advanced or open configuration, as shown in FIG. 5 during this transition.
    [0063] When the gap between the anvil (102) and the clamp holder (68) is adjusted to produce a desirable clamp height within the operating range of the stapling instrument (50), the safety lock (88, 488, 588 and 688) is hinged upwards (FIGS. 6, 9, 11, 13, 19, 22 and 24) to disengage a clamping lever (86). In the hinged position, the safety lock (88, 488, 588 and 688) engages the control rod (300), the button extension rod (400), or the adjustment knob (82, 682, 782 and 882) to prevent rotation of the adjustment knob (82, 682, 782 and 882) and to maintain the selected clamp height. The stapling instrument (50) is triggered by holding and pivoting the clamp actuation lever (86) clockwise, as seen in FIG. 7, to move the clamp actuation lever (86) to its fired position. As a result, the actuating fingers (350) on the actuating arm (340) activate the firing clip (352) in the distal direction to advance the compression member (92) longitudinally along the stem structure (70). The compression member (92) advances the clamp driver (62) to move the trigger fingers (63) distally into the clamp receiving slots (65) to engage the clamps (90). The compression member (92) transmits the necessary compaction movement and force from the drive arm (340) to the staple driver (62) to drive the staples (90) from the staple holder (68) to the fabric and against the anvil (102). In addition, the circular knife (69) is advanced by the staple driver (62) to cut the fabric against the support washer (160). As shown in FIG. 4, the circular knife (69) divides the support washer (160) into two annular sections. The clips (90) connect the ends of the tissue sections (52) and (54) with a fluid-tight seal formed by concentric annular rows of clips (90). The circular knife (69) cuts the excess tissue inside the anastomosis close to the stapled region. Excess cut tissue can be confined within the staple head structure (60) (for example, between the inside of the circular knife and the outside of the trocar structure (73) and the anvil stem (104).
    [0064] After the stapling and cutting of the fabric are completed, the staple lever (86) is pulled by the spring (346) in its fully open position (FIG. 6). The actuating fingers (350) of the actuating arm (340) articulate counterclockwise, as seen in FIG. 6 to move the firing clip (352) and the compression member (92) in the proximal direction. As a result, the staple driver (62), which is connected by the locating fingers (230) to the compression member (92), and the circular knife (69) are retracted within the structure of the stapling head (60). In the case of a trapping of staples, fabric or other debris between the staple holder (68) and the trigger fingers (63), the retraction of the staple trigger (62) loosens the staple head structure (60) from the fabric before the stapling instrument (50) be removed from the patient. If greater force is required, the clamp actuation lever (86) can be manually returned to its fully advanced position to retract the clamp actuator (62).
    [0065] Then, the safety lock (88, 488, 588 and 688) is folded down, manually or automatically in conjunction with the stapling trigger instrument (50). When the safety lock (88, 488, 588 and 688) is folded down, the clamp lever (86) is locked and the adjustment knob (82, 682, 782 and 882) is disengaged from the safety lock (88, 488, 588 and 688), so that the adjustment knob (82, 682, 782 and 882) can rotate freely. The fabric stapled between the anvil (102) and the staple holder (68) is released by turning the adjustment knob (82) counterclockwise to advance the anvil structure (100), away from the head structure. stapling (60). The anvil (102) is moved through the lumen by manipulating the stapled tissue in a manner suitable for sliding the anvil through the stapled lumen. Then, the stapling instrument (50) is removed from the patient leaving the lumen stapled between the tubular tissue sections (52) and (54). Several
    [0066] The examples described above include several structures to selectively prevent the rotation of the adjustment knob (82), to thereby selectively prevent the translation of the control rod (300), to effectively lock / maintain an anvil gap during activation of the clamp lever (86). It should be understood that it may be possible to selectively avoid translation of the control rod (300) in response to the movement of the safety lock (88, 488, 588 and 688), without necessarily preventing the adjustment knob (82) from turning . As an example only, a coupling component (not shown) can couple the adjustment knob (82) with the threaded sleeve (304), and a safety lock (88) can selectively engage / disengage the coupling component. For example, when the safety lock (88) is in a position to lock the clamp actuation lever (86), the engagement component can provide unitary rotation of the adjusting knob (82) and the threaded sleeve (304) . When the safety lock (88) is moved to a position to unlock the clamp actuation lever (86), this can cause the engagement component to disengage the adjusting knob (82) from the threaded sleeve (304), so that the adjustment knob (82) will simply rotate freely (freewheel) without turning the threaded sleeve (304) when the adjustment knob (82) is turned with the safety lock (88) positioned to unlock the actuator lever. clamp (86). Other suitable variations will be apparent to those skilled in the art having the benefit of the teachings of the present invention.
    [0067] Although the examples of the present invention are described primarily in the context of surgical stapling instruments for anastomosis, it should be understood that the teachings of the present invention can be easily applied to a variety of other types of medical instruments. It should also be understood that the teachings of the present invention can be easily applied to any of the instruments described in any of the references cited in the present invention, so that the teachings of the present invention can be easily combined with the teachings of any of the references cited in the present invention in various ways. Other types of instruments in which the teachings of the present invention can be incorporated will be apparent to those skilled in the art.
    [0068] 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.
    [0069] Modalities of the devices described in the present invention can also be designed to be discarded after a single use, or to be used multiple times. Modalities can, in either or both cases, 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 specific parts, and subsequent reassembly. In particular, modalities of the device can be disassembled, in any number of specific parts or parts of the device can be selectively replaced or removed in any combination. With the cleaning and / or replacement of specific parts, the device's modalities 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.
    [0070] 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 the 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.
    [0071] 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 mandatory. 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 (18)
    [0001]
    1. Surgical stapling instrument for applying a plurality of surgical staples to the tissue, characterized by the fact that it comprises: (a) a structure of the stapling head (60), wherein the structure of the stapling head (60) comprises: ( i) a clamp holder (68) containing a plurality of surgical clamps (90), (ii) an anvil (102) to form the clamps (90), the anvil (102) being mounted on an anvil stem (104 ) slidably supported for movement relative to the staple head structure (60) to secure the fabric between the anvil (102) and the staple holder (68), and (iii) a staple driver (62) that its purpose is to guide the staples (90) from the staple holder (68) into the fabric and against the anvil (102); (b) an actuator cable structure (80), comprising: (i) a first actuator (82) operable to control the movement of the anvil (102), and (ii) a second actuator (86) operable to control the movement said clip driver (62); (c) a coupling of the stem structure (70) of the staple head structure (60) with the actuator cable structure (80); (d) a safety lock (88) responsive to the first actuator (82), where the safety lock (88) is configured to prevent the operation of the second actuator (86) when it goes between the anvil (102) and the clamp holder (68) is outside a predetermined distance; and (e) a locking element responsive to the safety lock (88), wherein the locking element is configured to prevent the operation of the first actuator (82) when the safety lock (88) is positioned to allow the operation of the second actuator (86).
    [0002]
    2. Surgical stapling instrument, according to claim 1, characterized by the fact that the locking element is integral with the safety lock (88).
    [0003]
    3. Surgical stapling instrument, according to claim 2, characterized by the fact that the first actuator (82) comprises an adjustment knob (82) that is rotatable to control the movement of the anvil (102); and where the safety lock (88) still comprises an integral arm (490) that selectively prevents the rotation of the adjustment knob (82) when the safety lock (88) is positioned to allow the operation of the second actuator (86) .
    [0004]
    4. Surgical stapling instrument, according to claim 3, characterized by the fact that the safety lock (88) includes a plurality of arms.
    [0005]
    5. Surgical stapling instrument, according to claim 3, characterized by the fact that the first actuator (82) still comprises an extension component unitarily coupled with the adjustment button (82), in which the extension component has a plurality of flat sides, wherein the integral arm (490) of the safety lock (88) is operable to selectively engage the button or at least one flat side of the plurality of flat sides.
    [0006]
    6. Surgical stapling instrument, according to claim 5, characterized by the fact that the plurality of flat sides together define a polygonal cross section.
    [0007]
    7. Surgical stapling instrument, according to claim 3, characterized by the fact that the integral arm (490) is movable from a first position to a second position, in which the integral arm (490) is parallel with a rotational axis of the adjustment knob (82) when the integral arm (490) is in the first position, where the integral arm (490) is oriented obliquely with respect to the rotational axis of the adjustment knob (82) when the integral arm (490) is in second position.
    [0008]
    8. Surgical stapling instrument, according to claim 3, characterized by the fact that the first actuator (82) still comprises a threaded sleeve (304) attached to the adjustment knob (82) and a control rod (300) with a threaded section engaged with the threaded sleeve (304), so that the adjustment knob (82) is rotatable to translate the control rod (300) through the threaded sleeve (304).
    [0009]
    9. Surgical stapling instrument, according to claim 1, characterized by the fact that the locking element is movable longitudinally to prevent the operation of the first actuator (82) when the safety lock (88) is positioned to allow the operation of the second actuator (86).
    [0010]
    10. Surgical stapling instrument, according to claim 9, characterized by the fact that the first actuator (82) comprises an adjustment knob (82) that is rotatable to control the movement of the anvil (102); wherein the adjustment knob (82) includes at least one tooth (686); and wherein the locking element includes a plurality of teeth (698) operable to selectively engage at least one tooth (686) of the adjustment knob (82) to prevent rotation of the adjustment knob (82) when the safety lock ( 88) is positioned to allow operation of the second actuator (86).
    [0011]
    11. Surgical stapling instrument, according to claim 10, characterized by the fact that the locking element comprises a body that surrounds a portion of the adjustment button (82) when the safety lock (88) is positioned to allow the operation of the second actuator (86).
    [0012]
    12. Surgical stapling instrument, according to claim 11, characterized by the fact that the body comprises a cylinder.
    [0013]
    13. Surgical stapling instrument, according to claim 9, characterized by the fact that the first actuator (82) comprises an adjustment knob (82) that is rotatable to control the movement of the anvil (102); and wherein the locking element includes a connection (796, 896, 996) that engages the adjustment knob (82) to prevent rotation of the adjustment knob (82) when the safety lock (88) is positioned to allow for operation of the second actuator (86).
    [0014]
    14. Surgical stapling instrument according to claim 13, characterized by the fact that the adjustment knob (82) still comprises a plurality of teeth (686).
    [0015]
    15. Surgical stapling instrument, according to claim 14, characterized by the fact that the connection (796) comprises a hook (798) whose purpose is to selectively engage the teeth of the adjustment button (82) when the safety lock (88) is positioned to allow operation of the second actuator (86).
    [0016]
    16. Surgical stapling instrument, according to claim 14, characterized by the fact that the connection (896) comprises a wedge (898) whose purpose is to selectively engage the teeth of the adjustment button (82) when the safety lock (88) is positioned to allow the operation of the second actuator (86).
    [0017]
    17. Surgical stapling instrument, according to claim 13, characterized by the fact that the connection (996) comprises a friction brake (998) which is operated to selectively engage the adjustment button (82) when the safety lock it is positioned to allow the operation of the second actuator (86).
    [0018]
    18. Surgical stapling instrument, according to claim 1, characterized by the fact that the structure of the stapling head (60) is operated to implant a plurality of staples (90) in an arrangement that is, in general, circular.
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    同族专利:
    公开号 | 公开日
    RU2623308C2|2017-06-23|
    US20160066906A1|2016-03-10|
    MX2014007195A|2014-07-22|
    CN103987331B|2016-11-02|
    EP2790593B1|2020-01-22|
    US9220505B2|2015-12-29|
    MX343429B|2016-11-03|
    CN103987331A|2014-08-13|
    RU2014129024A|2016-02-10|
    US9717496B2|2017-08-01|
    US20130153631A1|2013-06-20|
    JP6262144B2|2018-01-17|
    WO2013090223A1|2013-06-20|
    BR112014014681A2|2017-06-13|
    EP2790593A1|2014-10-22|
    JP2015503950A|2015-02-05|
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    法律状态:
    2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|
    2019-11-19| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|
    2020-11-24| B09A| Decision: intention to grant|
    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 11/12/2012, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US13/328,402|US9220505B2|2011-12-16|2011-12-16|Surgical stapling instrument with locking feature to lock anvil actuator|
    US13/328,402|2011-12-16|
    PCT/US2012/068861|WO2013090223A1|2011-12-16|2012-12-11|Feature to lock knob of tissue stapler|
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