SURGICAL INSTRUMENT AND STAPLE CARTRIDGE FOR USE IN CONNECTION WITH A SURGICAL INSTRUMENT

专利摘要:
surgical instrument for cutting and fixing with apparatus to determine the state of the cartridge and the firing movement. The present invention relates to sensor arrangements for determining the position of a trigger element in an end actuator of a surgical instrument. in various forms, the sensor array comprises a resistive element supported on the end actuator. as the trigger element translates within the end actuator, it makes contact in motion with the resistive element to generate signals that indicate the position of the trigger element. in other arrangements, the sensor can detect the state or presence of a staple cartridge in the end actuator. the sensor array can communicate with a memory device, with the processor and with the indicator.
公开号:BR112014020050B1
申请号:R112014020050-5
申请日:2013-01-30
公开日:2022-01-04
发明作者:Jerome R. Morgan；Frederick E. Shelton, Iv
申请人:Ethicon Endo-Surgery, Inc；
IPC主号:

专利说明:

FIELD
[0001] In general, the present invention relates to surgical instruments and, more specifically, to surgical cutting and fixation instruments with an electronic sensor capable of determining the state of the cartridge and the firing movement. BACKGROUND
[0002] Surgical instruments often comprise a distal end actuator that engages tissue at a surgical site to achieve a diagnostic or therapeutic effect (e.g. endocutter, gripper, cutter, staplers, loop applicator, access device, delivery device drug/gene therapy and energy device using ultrasound, RF, laser, etc.). For example, known surgical staplers include an end actuator that simultaneously makes a longitudinal incision in the tissue and applies rows of staples on opposite sides of the incision. Such surgical staplers often have a trigger bar that translates to the end actuator in response to manual or motorized drive movements. The firing bar moves a cutting element through the tissue held in the end actuator and moves a plurality of wedges against the actuators that hold the staples to enable the firing of the end actuator staples.
[0003] Surgical instruments, in general, do not provide sufficient feedback to the user during operation. Generally speaking, for example, many robotically controlled surgical staplers do not alert the user to positioning forces and the position of the cutting element during cutting and stapling operations. Consequently, motor-driven endocutters in which the drive movements are activated only by pressing a button are generally not accepted by clinicians. Consequently, there is a need in the art for surgical instruments that address some of these deficiencies.
[0004] The aforementioned discussion is only intended to illustrate some of the deficiencies present in the field of the invention at the moment and should not be understood as a waiver of the scope of the embodiment. SUMMARY
[0005] The present description is related to an electronic sensor for determining the position of a triggering element in the end actuator and/or the status of a staple cartridge in the end actuator. The electronic sensor has a resistive element supported on the end actuator. A trip element configured to translate on the end actuator comes into movable contact with the resistive element as the trip member translates. As the trigger element translates, a cutting element attached to it can cut resistors in the resistive element. The electronic sensor can communicate with a memory device, processor and indicator.
[0006] In accordance with general aspects of various embodiments of the present invention, there is provided a surgical instrument comprising a surgical end actuator which, in turn, comprises an elongated channel having a proximal end and a distal end; a trigger element configured to selectively translate between said proximal end of said elongate channel and said distal end of said elongate channel upon application of a drive motion thereto; a resistive element held for moving contact with said trigger element, as said trigger element is moved from said proximal end to said distal end of said elongated channel, such that said resistive element generates output signals indicating the positions of said trigger element within said elongate channel; and a memory device that operatively communicates with said resistive element and is configured to record said output signals as said trigger element translates through said elongated channel.
[0007] In accordance with other general aspects of various embodiments of the present invention, there is provided a staple cartridge for use in conjunction with a surgical instrument, said staple cartridge comprising a cartridge body configured to be operatively supported by the surgical instrument, so so that a trigger element of the surgical instrument can translate longitudinally through said cartridge body by applying a driving motion thereto; and a resistive element held in said cartridge body for contact in motion with the firing element, as the firing element is translated therethrough, said resistive element is configured to operatively transmit output signals indicative of the firing element positions within said cartridge body for a memory portion of the surgical instrument.
[0008] According to still other general aspects, various modalities of the present invention are directed to a surgical instrument, which comprises a robotic system which, in turn, comprises a processor and a surgical end actuator that operationally interface said robotic system to receive triggering motions from it. The surgical end actuator comprises an elongated channel having a proximal end and a distal end; a trigger element configured to selectively translate between said proximal end of said elongate channel and said distal end of said elongate channel upon application of a drive motion thereto by said robotic system; and a resistive element held for moving contact with said trigger element as said trigger element is moved from said proximal end to said distal end of said elongated channel such that said resistive element generates indicative output signals from the positions of said trigger element within said elongate channel and transmit said output signals to said processor. BRIEF DESCRIPTION OF THE DRAWINGS
[0009] The embodiments described herein will become more apparent and better understood by reference to the following description of non-limiting embodiments of the description, taken in conjunction with the accompanying drawings.
[00010] FIGURE 1 is a perspective view of a surgical instrument for cutting and fixing according to various modalities.
[00011] FIGURE 2 is another perspective view of a surgical instrument for cutting and fixing according to various modalities.
[00012] FIGURES 3 to 5 are exploded views of an instrument end and stem actuator according to various embodiments.
[00013] FIGURE 6 is a side view of the end actuator according to various embodiments.
[00014] FIGURE 7 is an exploded view of the instrument handle according to various embodiments.
[00015] FIGURES 8 and 9 are partial perspective views of the cable according to various embodiments.
[00016] FIGURE 10 is a side view of the cable according to various embodiments.
[00017] FIGURES 10A and 10B illustrate a proportional sensor that can be used according to various modalities.
[00018] FIGURE 11 is a schematic diagram of a circuit used in the instrument according to various embodiments.
[00019] FIGURE 12 is a top view of an end actuator showing an electronic sensor in the elongated channel in accordance with various embodiments.
[00020] FIGURE 13 is a bottom perspective view of a staple cartridge having an electronic sensor in accordance with various embodiments.
[00021] FIGURE 14 is a top view of an electronic sensor according to various embodiments.
[00022] FIGURE 15 is a perspective view of a robotic controller according to various embodiments.
[00023] FIGURE 16 is a perspective view of the robotic surgical arm car/handler of a robotic system that operationally supports a plurality of surgical tool modalities.
[00024] FIGURE 17 is a side view of the robotic surgical arm car/handler shown in FIGURE 16 in accordance with various embodiments.
[00025] FIGURE 18 is a perspective view of an exemplary car structure, with positioning links to provide operational support to robotic manipulators that can be used with various modalities of surgical tools.
[00026] FIGURE 19 is a perspective view of a surgical tool in accordance with various embodiments.
[00027] FIGURE 20 is an exploded assembly view of an adapter and tool holder arrangement for attaching various modalities of surgical tools to a robotic system.
[00028] FIGURE 21 is a side view of the adapter shown in FIGURE 20.
[00029] FIGURE 22 is a bottom view of the adapter shown in FIGURE 20.
[00030] FIGURE 23 is a top view of the adapter of FIGURES 20 and 21.
[00031] FIGURE 24 is a partial bottom perspective view of the surgical tool modalities of FIGURE 19.
[00032] FIGURE 25 is a partial exploded view of a portion of a pivotable surgical end actuator in accordance with various embodiments.
[00033] FIGURE 26 is a perspective view of the surgical tool embodiment of FIGURE 10 with the tool attachment housing removed.
[00034] FIGURE 27 is a rear perspective view of the surgical tool embodiment of FIGURE 24 with the tool attachment housing removed.
[00035] FIGURE 28 is a front perspective view of the surgical tool embodiment of FIGURE 24 with the tool attachment housing removed.
[00036] FIGURE 29 is a partial exploded perspective view of the surgical tool modalities of FIGURE 28.
[00037] FIGURE 30 is a partial cross-sectional side view of the surgical tool modalities of FIGURE 24.
[00038] FIGURE 31 is an enlarged cross-sectional view of a portion of the surgical tool shown in FIGURE 30.
[00039] FIGURE 32 is an exploded perspective view of a portion of the tool holding portion of the surgical tool modality shown in FIGURE 24.
[00040] FIGURE 33 is an exploded, enlarged perspective view of a portion of the clamping portion of the tool of FIGURE 32.
[00041] FIGURE 34 is a partial cross-sectional view of a portion of the elongated shank assembly of the surgical tool of FIGURE 24.
[00042] FIGURE 35 is a top view of an end actuator showing an electronic sensor in the elongated channel in accordance with various embodiments.
[00043] FIGURE 36 is a bottom perspective view of a staple cartridge having an electronic sensor in accordance with various embodiments. DETAILED DESCRIPTION
[00044] This detailed description discloses, among other things, electronic sensor arrangements for use in the end actuator of a surgical instrument. In various embodiments, the electronic sensor determines the position of a triggering element in the end actuator and/or the status of a staple cartridge in the end actuator. The unique and innovative aspects of the present description may allow a variety of different electronic sensors to be used effectively in connection with a variety of types and shapes of surgical instruments, end actuators and staple cartridges. While the description of the present invention pertains to cutting/stapling operations and the like, it should be recognized that this is an exemplary embodiment and is not intended to be limiting. Other tissue fixation techniques can also be used. Furthermore, in other embodiments, different types of end actuators can be used, as end actuators for other types of surgical devices such as grippers, cutters, staplers, clip appliers, access devices, drug delivery devices/gene therapies , devices using ultrasound, RF or laser, etc.
[00045] The Applicant of the present application also has the following patent applications, which are each incorporated herein by reference in their respective entireties:• US Patent Application Serial No. 13/118,272, entitled "ROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT WITH FORCE-FEED CAPABILITIES"• US Patent Application Serial No. 12/949,099 entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES"• US Patent Application Serial No. 11/343,803, now US Patent No. 7,845,537, entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES"• US Patent Application Serial No. 11/343,498, now US Patent No. 7,766,210, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH USER FEEDBACK SYSTEM"• US Patent Application Serial No. 11/343,573, now US Patent No. 7,416,101, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH LOADING FORCE FEEDBACK"• US Patent Application Serial No. 11/344,035, now US Patent No. 7,422,139, entitled "MOTOR-DRIVEN S URGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK"• US Patent Application Serial No. 11/343,447, now US Patent No. 7,770,775, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH ADAPTIVE USER FEEDBACK"• Application for US Patent Serial No. 11/343,562, now US Patent No. 7,568,603, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH ARTICULATABLE END EFFECTOR"• US Patent Application Serial No. 11/344,024, now Publication of US Patent No. 2007/0175955, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH MECHANICAL CLOSURE SYSTEM"• US Patent Application Serial No. 11/343,321, now US Patent Publication No. 2007/0175955, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM"• US Patent Application Serial No. 11/343,563, now US Patent Publication No. 2007/0175951, entitled "GEARING SELECTOR FOR A POWERED SURGICAL CUTTING ANDFASTENING STAPLING INSTRUMENT"• Application US Patent Serial No. 11/344,020, now US Patent No. 7,464,846, entitled "SURGICAL INSTRUMENT HAVING A REMOVABLE BATTERY" • US Patent Application Serial No. 11/343,439, now US Patent No. 7,644,848, entitled "ELECTRONIC LOCKOUTS AND SURGICAL INSTRUMENT INCLUDING SAME"• US Patent Application Serial No. 11/343,547, now US Patent No. 7,753,904, entitled "ENDOSCOPIC SURGICAL INSTRUMENT WITH A HANDLE THAT CAN ARTICULATE WITH RESPECT TO THE SHAFT"• US Patent Application Serial No. 11/344,021, now US Patent No. 7,464,849, entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS"• US Patent Application Serial No. 11/343,546, now US Patent Publication No. 2007/0175950 entitled "DISPOSABLE STAPLE CARTRIDGE HAVING AN ANVIL WITH TISSUE LOCATOR FOR USE WITH A SURGICAL CUTTING AND FASTENING INSTRUMENT AND MODULAR END EFFECTOR SYSTEM THEREFOR"• US Patent Application Serial No. 11/343,545, now US patent publication no. 2007/0175949 , entitled "SURGICAL INSTRUMENT HAVING A FEEDBACK SYSTEM"• US Patent Application Serial No. 13/021,105, now US Patent Publication No. 2011/0121052, entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES"• US Patent Application No. Serial 13/118,259 entitled "SURGICAL INSTRUMENT WITH WIRELESS COMMUNICATION BETWEEN A CONTROL UNIT OF A ROBOTIC SYSTEM AND REMOTE SENSOR"• US Patent Application Serial No. 13/118,210 entitled "ROBOTICALLY-CONTROLLED DISPOSABLE MOTOR DRIVEN LOADING UNIT"• Application US Patent Application Serial No. 13/118,194 entitled "ROBOTICALLY-CONTROLLED ENDOSCOPIC ACCESSORYCHANNEL"• US Patent Application Serial No. 13/118,253 entitled "ROBOTICALLY-CONTROLLED MOTORIZED SURGICALINSTRUMENT"• US Patent Application Serial No. 13 /118,278, entitled "ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS" • US Patent Application Serial No. 13/118,190, entitled "ROBOTICALLY-CONTROLLED MOTORIZED SURGICAL CUTTING AND F ASTENING INSTRUMENT"• US Patent Application Serial No. 13/118,223 entitled "ROBOTICALLY-CONTROLLED SHAFT BASED ROTARY DRIVE SYSTEMS FOR SURGICAL INSTRUMENTS"• US Patent Application Serial No. 13/118,263 entitled "ROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT" HAVING RECORDING CAPABILITIES"• US Patent Application Serial No. 13/118,246 entitled "ROBOTICALLY-DRIVEN SURGICAL INSTRUMENT WITH E-BEAM DRIVER"• US Patent Application Serial No. 13/118,241 entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS"• US Patent Application Serial No., entitled "ROBOTICALLY-CONTROLLED END EFFECTOR", filed on February 13, 2012, Attorney Document No. END5773USCIP6/050698CIP6.
[00046] Certain exemplary embodiments will now be described to provide a general understanding of the principles of structure, function, fabrication and use of the devices and methods of the present invention presented. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting embodiments, and that the scope of the various embodiments of the present invention is defined only by the embodiments. Reference throughout the specification to "several modalities", "some modalities", "one modality", or "the modality", or the like, means that an attribute, structure, or characteristic described in conjunction with the modality is included in at least one modality. Thus, cases of the phrases "in several modalities", "in some modalities", "in a modality", "in a modality", or similar, at points throughout the descriptive report do not necessarily refer to the same modality. Furthermore, the specific features, structures or features illustrated or described in connection with an exemplary embodiment may be combined with the features, structures or features of other exemplary embodiments, in any suitable manner, in one or more embodiments. Such modifications and variations are intended to be included within the scope of the present description.
[00047] This detailed description will first describe an electronically controlled, motor-driven surgical cutting and fixation instrument in accordance with some embodiments of the present disclosure. However, those skilled in the art will understand that a surgical instrument according to various embodiments of the present description may be powered and controlled in other ways, for example, by manual force and/or robotic controls. As described in more detail below, the electronically controlled, motor-driven surgical instrument end actuator could alternatively be powered and controlled by a robotic system. SURGICAL INSTRUMENT FOR CUTTING AND FASTENING
[00048] Figures 1 and 2 show a motor-driven, electronically controlled surgical instrument for cutting and fixing 10, in accordance with various embodiments of the present invention. The embodiment illustrated is an endoscopic surgical instrument 10 and, in general, the embodiments of the instrument 10 described herein are cutting and clamping endocutters. It should be noted, however, in accordance with other embodiments of the present invention, that the instrument 10 may be a non-endoscopic surgical cutting instrument, such as a laparoscopic instrument. Additionally, a person skilled in the art will readily understand that the various methods and devices disclosed in the present invention can be used in a variety of surgical procedures and applications including, for example, in connection with open surgical procedures. As the present detailed description proceeds, those skilled in the art will further appreciate that the various instruments disclosed in the present invention can be inserted into a body in any manner, such as through a natural orifice, through a shaped incision or perforation hole. in fabric, etc. The working portions or end actuator portions of instruments may be inserted directly into the patient's body or may be inserted through an access device which has a working channel through which the end actuator and elongated stem of an instrument surgery can be advanced.
[00049] The surgical instrument 10, shown in Figures 1 and 2, comprises a handle 6, a rod 8, and an articulated end actuator 12 pivotally connected to the rod 8 to a pivot pivot 14. A pivot control 16 may be provided adjacent the handle 6 to effect rotation of the end actuator 12 about the pivot pivot 14. It will be understood that various embodiments may include a non-pivoting end actuator and consequently may not have a pivot pivot 14 or control of articulation 16.
[00050] In the illustrated embodiment, the end actuator 12 is configured to act as an endocutter for clamping, cutting and stapling tissue, however, in other embodiments different techniques may be used for fixing or sealing the cut tissue. For example, end actuators that use RF (radio frequency) energy or adhesives to join the sectioned tissue can also be used. US Patent No. 5,709,680 entitled "Electrosurgical Hemostatic Device" issued to Yates et al., and US Patent No. 5,688,270 entitled "Electrosurgical Hemostatic Device With Recessed And/Or Offset Electrodes" issued to Yates et al. ., which are incorporated herein by reference in their entirety, disclose cutting instruments that use RF energy to secure cut tissue. US Patent Application Serial No. 11/267,811, in the name of Morgan et al. and US Patent Application Serial No. 11/267,363, in the name of Shelton et al., which are also incorporated herein by reference in their entirety, disclose cutting instruments that use adhesives to secure cut tissue.
[00051] The handle 6 of the instrument 10 may include a closing trigger 18 and a triggering trigger 20 to actuate the end actuator 12. It will be recognized that instruments which have end actuators aimed at different surgical tasks may have numbers or types different from triggers or other controls suitable for operating the end actuator 12. The end actuator 12 is shown separately from the handle 6 by a rod 8, preferably elongated. In one embodiment, a physician or instrument operator 10 can pivot end actuator 12 with respect to stem 8 using pivot control 16, as described in more detail in pending U.S. Patent No. 7,670,334, issued March 2 2010 entitled "Surgical Instrument Having An Articulating End Effector" by Geoffrey C. Hueil et al., which is incorporated herein by reference in its entirety.
[00052] In this example, the end actuator 12 includes, among other things, a groove of clamps 22 and a clamping member capable of pivotally relocating, such as an anvil 24, which are maintained with a spacing that guarantees effective stapling. and cutting tissue attached to the end actuator 12. The handle 6 includes a pistol grip 26 towards which a closing trigger 18 is pivotally pulled by the physician to lead to the attachment or closure of the anvil 24 towards the groove. of clips 22 of the end actuator 12 to thereby secure the tissue positioned between the anvil 24 and the channel 22. The firing trigger 20 is situated further out with respect to the closing trigger 18. Since the closing trigger 18 is locked in the closed position, as described in more detail below, the trigger 20 can be rotated slightly towards the pistol grip 26, so that it can be reached by the operator using a one hand. Then the operator can pull the trigger trigger 20 pivotally towards the pistol grip 26 to cause stapling and cutting of the tissue attached to the end actuator 12. In other embodiments, different types of attachment members other than the anvil 24 may be used. be used, such as an opposing claw, etc.
[00053] The terms "proximal" and "distal" are used in the present invention with reference to a physician's manipulation of the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the physician, and the term "distal" refers to the portion located furthest from the physician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "upward" and "downward" may be 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/or absolute.
[00054] In the illustrated embodiment, the closing trigger 18 can be activated first. When satisfied with the positioning of the end actuator 12, the clinician can retract the closing trigger 18 to the fully closed and locked position adjacent to the pistol grip 26. The firing trigger 20 can then be actuated. The trigger trigger 20 returns to the open position (shown in Figures 1 and 2) when the clinician removes pressure, as described more fully below. A release button present on the handle 6 can, when pressed, release the lock of the closing trigger 18.
[00055] Figures 3 to 6 show embodiments of a rotationally driven end actuator 12 and stem 8 according to various embodiments. Figure 3 is an exploded view of the end actuator 12 according to various embodiments. As shown in the illustrated embodiment, the end actuator 12 may include, in addition to the previously mentioned groove 22 and anvil 24, a cutting instrument 32, a slide holder 33, a staple cartridge 34 which is removably seated in the groove. 22, and a helical screw shank 36. The cutting instrument 32 can be, for example, a knife. Anvil 24 may be pivotally opened and closed on pivot pins 25 connected to the adjacent end of channel 22. Anvil 24 may also include, at its proximal end, a tab 27 which is inserted into a component of the mechanical closure system to opening and closing the anvil 24. When the closing trigger 18 is actuated, i.e., withdrawn by a user of the instrument 10, the anvil 24 can rotate around the pivot pins 25 forming a closed or locked position. If the grip of the end actuator 12 is satisfactory, the operator can actuate the trigger 20 which, as explained in more detail above, causes the knife 32 and the slide support 33 to run longitudinally along the channel 22, cutting therefrom. so the tissue is trapped within the end actuator 12. The movement of the slider 33 along the channel 22 causes the staples (not shown) of the staple cartridge 34 to be driven through the separated tissue and with respect to the closed anvil 24, which turns the staples to secure the separate fabric. In various embodiments, the slider 33 may be an integral component of the cartridge 34. US Patent No. 6,978,921 entitled "SURGICAL STAPLING INSTRUMENT INCORPORATING AN EBEAM FIRING MECHANISM", issued to Shelton, IV et al., which is herein integrally incorporated by reference, provides more detail on these two-motion cutting and clamping instruments. The slide support 33 can be part of the cartridge 34, so that when the knife 32 is retracted after the cutting operation, the slide support 33 does not retract.
[00056] Figures 4 and 5 are exploded views and Figure 6 is a side view of the end actuator 12 and the stem 8 according to various embodiments. As shown in the illustrated embodiment, stem 8 may include an adjacent closure tube 40 and a distal closure tube 42 pivotally connected by a pivot connection 44. Distal closure tube 42 includes an opening 45 into which the tab 27 on the anvil 24, so as to open and close the anvil 24, as described in more detail below. Disposed within the closure tubes 40, 42 may be a proximal toothed tube 46. Disposed within the proximal toothed tube 46 may be a pivoting (or proximal) main drive shaft 48 that communicates with a secondary (or distal) drive shaft 50. ) by means of a set of bevel gears 52. The secondary drive shaft 50 is connected to a drive gear 54 which engages an adjacent drive gear 56 of the helical screw rod 36. The vertical bevel gear 52b can seat and rotate in a opening 57 at the distal end of adjacent structuring tube 46. A distal structuring tube 58 may be used to enclose the secondary drive shaft 50 and the drive gears 54, 56. Collectively, the primary drive rod 48, the secondary drive rod 50, and pivot assembly (e.g., bevel gear assembly 52a-c) are sometimes referred to in the present invention as a "bevel assembly". main drive rod".
[00057] A bearing 38, positioned at a distal end of the staple groove 22, receives the helical screw 36, allowing the helical screw 36 to rotate freely with respect to the groove 22. A helical screw shank 36 can interface a threaded opening ( not shown) of the knife 32, so that rotation of the shank 36 causes the knife 32 to translate distally or proximally (depending on the direction of rotation) through the clamp groove 22. Consequently, when the shank is rotated drive 48 through actuation of trigger trigger 20 (as explained in greater detail below), bevel gear set 52a-c causes secondary drive rod 50 to rotate, which in turn, because of engagement of the drive gears 54, 56 causes the helical screw rod 36 to rotate, which causes the knife drive member 32 to travel longitudinally along the groove 22 to cut q any tissue trapped inside the end actuator 12.
[00058] In various embodiments, the staple channel 22 has a proximal end 23a and a distal end 23b, and the knife or cutting element 32 is configured to travel longitudinally through the channel 22 between the proximal end 23a and the 23b, when a driving motion is applied to the cutting element 32. In other embodiments, the clamp groove 22 has an inner surface 28 and a slot 30 that extends through the inner surface 28. See Figure 12. The knife 32 can translate along the slot 30 as it travels longitudinally through the clamp channel 22. The slider 33 can be made, for example, of plastic, and can have an inclined distal surface. As the sliding support 33 traverses the channel 22, the angled front surface can push up or drive the staples in the staple cartridge through the clamped fabric and against the anvil 24. The anvil 24 turns the staples, thereby stapling the cut tissue. . When knife 32 is retracted, knife 32 and slider 33 can disengage, thus leaving slider 33 at the distal end of groove 22, or slider can return with knife.
[00059] As described above, due to the lack of user feedback for the cutting/stapling operation, there is a lack of general acceptance among clinicians using motor-driven endocutters where the cutting/stapling operation is actuated by simple pressure of a button. In contrast, embodiments of the present invention provide a motor-driven endocutter with user feedback of the positioning, force, and/or position of cutting instrument 32 on end actuator 12.
[00060] Figures 7 to 10 illustrate an exemplary embodiment of a motor-driven endocutter and, in particular, the cable thereof, which provides feedback to the user regarding the positioning and loading force of the cutting instrument 32 on the end actuator 12. In addition, the modality can use energy supplied by the user by retracting the firing trigger 20 to power the device (a so-called "electronically controlled" mode). The modality can be used with the above-described modalities of the turn-actuated end actuator 12 and stem 8.
[00061] As shown in the illustrated embodiment, the handle 6 includes lower outer side pieces 59 and 60, and upper outer side pieces 61 and 62, which join together to generally form the outside of the handle 6. A battery 64 , such as a lithium-ion battery, may be disposed within the pistol grip portion 26 of the handle 6. The battery 64 powers a motor 65 disposed in an upper portion of the pistol grip portion 26 of the handle 6. In accordance with In various embodiments, the motor 65 may be a brushed direct current motor, which has a maximum speed of approximately 5,000 RPM. The motor 65 can drive a 90° bevel gear set 66 comprising a first bevel gear 68 and a second bevel gear 70. The bevel gear set 66 can drive a planetary gear set 72. The planetary gear set 72 can include a pinion gear 74 connected to a drive rod 76. The pinion gear 74 may drive an annular coupling gear 78 which drives a worm gear drum 80 via a drive rod 82. A ring 84 may be threaded in the worm gear drum 80. Therefore, when the motor 65 rotates, the ring 84 is forced to move along the worm gear drum 80 by means of the bevel gear set 66, the planetary gear set 72 and the gear annular 78, interposed there.
[00062] Cable 6 may also include an operating motor sensor 110 (see Figure 10) in communication with the trigger trigger 20 to detect when the trigger trigger 20 has been withdrawn (or "closed") towards the trigger portion 20. grip of gun 26 of handle 6 by the operator to thereby actuate the cutting/stapling operation by end actuator 12. Sensor 110 may be a proportional sensor such as a rheostat or a variable resistor. When trigger trigger 20 is pulled, sensor 110 detects movement, and sends an electrical signal indicative of the voltage (or power) to be supplied to motor 65. When sensor 110 is a variable resistor or the like, motor rotation 65 can be generally proportional to the amount of movement of the trigger 20. That is, if the operator only pulls or closes the trigger 20 for a short distance, the rotation of the motor 65 is relatively low. When firing trigger 20 is fully pulled (or placed in the fully closed position), the rotation of motor 65 is at its maximum. In other words, the more force the user applies when pulling trigger trigger 20, the more voltage is applied to motor 65, causing higher rotational speeds.
[00063] Handle 6 may include a handle midpiece 104 adjacent to the upper portion of the trigger 20. Handle 6 may also comprise a return spring 112 connected between posts over the handle midpiece 104 and the trigger trigger. trigger 20. Return spring 112 can force trigger trigger 20 to its fully open position. Thereby, when the operator releases the trigger trigger 20, the return spring 112 pulls the trigger trigger 20 to its open position, thus removing the sensor actuation 110, and stopping the rotation of the motor 65. Furthermore, due to the spring 112, whenever a user closes the firing trigger 20, he will experience resistance to the closing operation, thus obtaining feedback as to the amount of rotation exerted by the motor 65. Additionally, the operator may stop retracting the firing trigger. 20 to thereby remove force from sensor 110 and thus stop motor 65. In this way, the user can stop positioning of end actuator 12, thus providing the operator with a measure of control of the cutting/clamping operation.
[00064] In various embodiments, the distal end of the worm gear drum 80 includes a distal drive shaft 120 which drives an annular gear 122 which, in turn, couples to a pinion gear 124. The pinion gear 124 is connected to main drive rod 48 of the main drive rod assembly. In this way, rotation of motor 65 causes the main drive rod assembly to rotate, which causes end actuator 12 to act as described above.
[00065] A ring 84 threaded or otherwise secured to the helical gear barrel 80 may include a column 86 which is disposed within a slot 88 of a slotted arm 90. See Figures 8 and 9. The slotted arm 90 has an opening 92 at its opposite end 94 which receives a pivot pin 96 which is connected between the outer side pieces of the handle 59, 60. The pivot pin 96 is also disposed through an opening 100 in the trigger 20 and from an opening 102 in the middle part 104 of the handle.
[00066] In addition, cable 6 may include an engine reversing sensor (or end of stroke sensor) 130 and an engine stop (or stroke start) sensor 142. See Figure 10. In various embodiments, the motor reversing sensor 130 may be a limit switch located at the distal end of the worm gear drum 80 so that the ring 84 threaded on the worm gear drum 80 contacts and activates the motor reversing sensor 130 when the ring 84 reaches the distal end of worm gear drum 80. Motor reversing sensor 130, when activated, sends a signal to motor 65 to reverse its direction of rotation, thus removing knife 32 from end actuator 12 after the cutting operation.
[00067] Motor stop sensor 142 can be, for example, a normally closed limit switch. In various embodiments, it may be located at the adjacent end of the helical gear drum 80, such that the ring 84 activates the key 142 when the ring 84 reaches the adjacent end of the helical gear drum 80.
[00068] In operation, when an operator of instrument 10 pulls back trigger trigger 20, sensor 110 detects the positioning of trigger trigger 20 and sends a signal to motor 65 to induce forward rotation of motor 65, for example, at a rate proportional to the amount the operator pulls back trigger trigger 20. Forward rotation of motor 65, in turn, rotates annular gear 78 at the distal end of planetary gear assembly 72, thereby causing causing the worm gear drum 80 to rotate, and causing the ring 84 threaded on the worm gear drum 80 to move distally along the worm gear drum 80. Rotation of the worm gear drum 80 also directs the drive shaft assembly. main drive as described above which in turn leads to positioning of knife 32 on end actuator 12. That is, knife 32 and slider 33 are brought across groove 22 longitudinally, thereby cutting the tissue trapped in the end actuator 12. Furthermore, the stapling operation of the end actuator 12 is effected in embodiments in which a stapler-type end actuator 12 is used.
[00069] When the cutting/stapling operation of the end actuator 12 has been completed, the ring 84 on the worm gear drum 80 will have reached the distal end of the worm gear drum 80, activating the motor reversing sensor 130, the which sends a signal to the motor 65 to reverse the direction of rotation of the motor 65. This in turn causes the knife 32 to retract and also causes the ring 84 on the helical gear drum 80 to move backwards until the adjacent end of the helical gear drum 80.
[00070] Cable midpiece 104 (Figure 7) includes a rear shoulder-shaped portion 106 that engages slotted arm 90, as best shown in Figure 8. Cable midpiece 104 also has a lock forward motion 107, which engages trigger trigger 20. See Figure 10. Movement of slotted arm 90 is controlled, as explained above, by rotation of motor 65. When slotted arm 90 rotates counterclockwise while the ring 84 runs from the adjacent end of the helical gear drum 80 to the distal end, the handle midpiece 104 will be free to rotate counterclockwise. In this way, when the user withdraws the trigger trigger 20, the trigger trigger 20 will engage the forward movement stop 107 of the handle midpiece 104, causing the handle midpiece 104 to rotate counterclockwise. . Due to the rear guard 106 that engages the slotted arm 90, however, the handle midpiece 104 will only be able to rotate counterclockwise as far as the slotted arm 90 will allow. Thus, if the motor 65 stops rotating for any reason, the slotted arm 90 will stop rotating, and the user will not be able to withdraw the trigger 20 further, due to the fact that the middle part of the handle 104 not be free to rotate counterclockwise due to slotted arms 90.
[00071] Figures 10A and 10B illustrate two states of a variable sensor that can be used as the engine run sensor 110 in accordance with various embodiments of the present invention. Sensor 110 may include a face portion 280, a first electrode (A) 282, a second electrode (B) 284, and a dielectric compressible material 286 between electrodes 282 and 284, such as an electroactive polymer (EAP) . Sensor 110 may be positioned so that face portion 280 contacts trigger trigger 20 when retracted. Consequently, when the trigger 20 is retracted, the dielectric material 286 is compressed, as shown in Figure 10B, so that the electrodes 282 and 284 are closer together. Since the distance "b" between electrodes 282, 284 is directly related to the impedance between electrodes 282, 284, the greater the distance, the greater the impedance, and the smaller the distance, the lower the impedance. In this way, the amount of compression of the dielectric material 286 caused by retraction of the trigger 20 (denoted as force "F" in Fig. 42) is proportional to the impedance between the electrodes 282, 284, which can be used to proportionally control the motor. 65.
[00072] The components of an exemplary closing system for closing (or securing) the anvil 24 of the end actuator 12 by retracting the closing trigger 18 are also shown in Figures 7 to 10. In the illustrated embodiment, the closing system includes a yoke 250 connected to the closing trigger 18 by a pivot pin 251 inserted through openings aligned in both the closing trigger 18 and the yoke 250. A pivot pin 252, around which the closing trigger 18 rotates, is inserted through another opening in the closing trigger 18, which is offset from the point at which the pin 251 is inserted through the closing trigger 18. In this way, the retraction of the closing trigger 18 causes the upper part of the closing trigger 18, to which yoke 250 is attached via pin 251, rotate counterclockwise. The distal end of the fork 250 is connected, via a pin 254, to a first lock bracket 256. The first lock bracket 256 connects to a second lock bracket 258. Collectively, the lock brackets 256 and 258 define an opening in which the proximal end of the proximal closure tube 40 (see Figure 4) is supported and maintained so that the longitudinal movement of the closure brackets 256, 258 causes longitudinal movement of the proximal closure tube 40. The instrument 10 it also includes a lock rod 260 disposed within the proximal lock tube 40. The lock rod 260 may include a window 261 within which a post 263 exists over one of the outer parts of the handle, such as the outer bottom side piece 59 in the illustrated embodiment, it is arranged to securely connect the closing rod 260 to the handle 6. In this way, the proximal closing tube 40 is able to move longitudinally. The closure rod 260 may also include a distal collar 267 that fits into a cavity 269 in the adjacent structuring tube 46 and is held therein by a cap 271 (see Figure 4).
[00073] In operation, when the yoke 250 rotates due to retraction of the closing trigger 18, the closing clamps 256, 258 cause the adjacent closing tube 40 to move distally (i.e., away from the cable end). of the instrument 10), which causes the distal closure tube 42 to move distally, which causes the anvil 24 to rotate around the pivot pins 25 to the closed or locked position. When the lock trigger 18 is unlocked from the locked position, the adjacent lock tube 40 is caused to slide proximally, which causes the distal lock tube 42 to slide proximally, which, by virtue of the tab 27 which is inserted into the window 45 of distal closure tube 42 causes the anvil 24 to rotate about pivot pins 25 to the open or unsecured position. Thus, by retracting and locking the closing trigger 18, an operator can clamp the tissues between the anvil 24 and the channel 22, and can release the tissues after the cutting/stapling operation, by unlocking the closing trigger 20 of its locked position.
[00074] Figure 11 is a schematic diagram of an electrical circuit of instrument 10, in accordance with various embodiments of the present invention. When an operator initially pulls the trigger trigger 20 after the trigger locks to close 18, the sensor 110 is activated allowing current to flow through it. If the normally open switch 130 of the motor reversing sensor is open (meaning that the end of stroke of the end actuator has not been reached), current will flow to a single-pole and double-acting relay 132. motor reversal 130 is not closed, inductor 134 of relay 132 will not be energized so relay 132 will be in its de-energized state. The circuit also includes a cartridge lock sensor 136. If the end actuator 12 includes a staple cartridge 34, the sensor 136 will be in the closed state, allowing current to flow. Otherwise, if end actuator 12 does not include a staple cartridge 34, sensor 136 will be open, thus preventing battery 64 from powering motor 65.
[00075] When staple cartridge 34 is present, sensor 136 is closed, which energizes a single pole, single drive relay 138. When relay 138 is energized, current flows through relay 136, through variable resistor sensor 110, and up to motor 65 via a dual-pole, dual-drive relay 140, thus powering motor 65 and allowing it to rotate forward.
[00076] When end actuator 12 reaches the end of its stroke, motor reversing sensor 130 will activate, thus closing switch 130 and energizing relay 134. This causes relay 134 to assume its energized state (not shown in Figure 11), which causes current to bypass the cartridge lock sensor 136 and variable resistor 110, and instead causes current to flow to both normally closed double poles, to the double drive 142 and back to motor 65, but in a manner via relay 140 that causes motor 65 to reverse the direction of rotation.
[00077] As motor stop sensor switch 142 is normally closed, current will flow back to relay 134 to keep it closed until switch 142 opens. When knife 32 is fully retracted, motor stop sensor switch 142 is activated, causing switch 142 to open, thus removing power from motor 65.
[00078] In other embodiments, instead of a 110 proportional type sensor, an on-off type sensor could be used. In these embodiments, the rotation rate of the engine 65 would not be proportional to the force applied by the operator. Instead, motor 65 would generally rotate at a constant speed. The operator, however, would still experience force feedback as the trigger 20 is engaged with the gear drive train. TRIGGER AND CARTRIDGE STATUS MOTION SENSORS
[00079] In other embodiments, the surgical instrument for cutting and fixing 10 may not comprise an engine running sensor 110, a reversing engine sensor 130 and/or an engine stall sensor 142, as described above. In other embodiments, for example, the surgical instrument 10 may use an electronic sensor 150 to determine the position of a trigger in the end actuator 12 and/or the status or presence of a staple cartridge 34 in the end actuator 12. For purposes of describing the illustrated embodiment, the cutting element 32, the slider 33, the actuation bar 36 and other elements configured to translate in the end actuator 12 are collectively referred to in the present invention as trigger elements. As shown in Figure 14, in one format, the electronic sensor 150 comprises a resistive element 152 that is supported on the end actuator 12 of the surgical instrument 10. The resistive element 152 can be supported by the clamp channel 22, by the clamping member 20. , by the staple cartridge 34 or by another element in the end actuator 12. As the trigger element translates longitudinally through the end actuator 12, the trigger element may be in moving contact with the resistive element 152.
[00080] As noted above, in various embodiments, the resistive element 152 of the electronic sensor 150 is supported by the elongate channel 22. For example, in at least one embodiment, the resistive element 152 is secured to the elongate channel 22 by an adhesive. In other embodiments, the resistive element 152 may be attached to a component in the elongate channel 22. Referring to Figure 12, the resistive element 152 may be positioned on the inner surface 28 of the staple channel 22 so that a trigger element between in contact with the resistive element 152 as the trigger element travels longitudinally through the staple channel 22. In alternative embodiments, the resistive element 152 is supported by or otherwise attached to the staple cartridge 34. Referring to Figure 13, the resistive element 152 may be supported by the cartridge body 35 of the staple cartridge 34. For example, the resistive element 152 may be secured to the base surface of the cartridge body 35 by a suitable adhesive. In other embodiments, the resistive element 152 may be supported in an arrangement of slots (not shown) formed in the base surface of the cartridge body 35 or otherwise retained in position by fasteners formed therein. In the embodiment illustrated in Figure 13, the resistive element 152 is positioned in the cartridge body 35 of the staple cartridge 34 so that a portion of the trigger element contacts the resistive element 152 as the trigger element travels longitudinally through the staple channel 22.
[00081] In various embodiments, the resistive element 152 of the electronic sensor 150 comprises a resistor 154 or a plurality of resistors 154. For example, the resistive element 152 may comprise a circuit with a plurality of resistors 154a, 154b, 154c, etc. and a plurality of nodes 156a, 156b, 156c, etc. Referring to Figure 12, a node 156 may be positioned between each resistor 154. For example, a first node 156a is positioned between a first resistor 154a and a second resistor 154b; a second node 156b is positioned between the second resistor 154b and the third resistor 154c; and a third node 156c is positioned between the third resistor 154c and a fourth resistor 154d; etc. In other words, a node 156 may be positioned between each successive resistor 154 in a circuit in the resistive element 152. The voltage across each node 156 is uniform or substantially uniform. As long as the resistors 156 are intact, the voltage at each node 156 will be different from the voltage at the other nodes 156. Referring to Figure 12, resistors 154a, 154b, 154c, ..., 154z can be arranged in a parallel configuration, so so that the equivalent resistance (REq) of resistive element 152 can be calculated according to: 1/REq = 1/Ra + 1/Rb + 1/Rc + . + 1/Rz,
[00082] where Ra is the resistance in resistor 154a, Rb is the resistance in resistor 154b, Rc is the resistance in resistor 154c, and Rz is the resistance in the most distal resistor 154z in the resistive element 152. Resistance can be measured in ohms ( Q). In an alternative embodiment, resistors 154a, 154b, 154c, ., 154z can be arranged in a series configuration so that the equivalent resistance (REq) of resistive element 152 can be calculated according to: REq = Ra + Rb + Rc + . + Rz.
[00083] As described above, a trigger element on the end actuator 12 is in moving contact with the resistive element 152, as the trigger element translates between the proximal end 23a of the clamp channel 22 and the distal end 23b of the channel of clamps 22. In one embodiment, the trigger element can slide along a surface of the resistive element 152 as the slider 33 and knife 32 are moved along the elongate channel 22. In another embodiment, the trigger element trigger can contact protuberances on resistive element 152 as slider 33 and knife 32 are moved along elongated channel 22. resistor 152, the resistive element 152 generates output signals that indicate the position of the trigger element within the elongate channel 22. The output signals generated by the resistive element 152 may be voltage (or power) measurements across resistive element 152. For example, resistive element 152 could generate a signal indicative of voltage at each node 156 between successive resistors 154.
[00084] In various embodiments, with reference to Figure 12, the trigger element may come into movable contact with the resistive element 152 such that the trigger element cuts off portions of the resistive element 152. For example, the cutting element 32 may traverse portions of the resistive element 152 when the cutting element 32 moves longitudinally through the elongate channel 22 in response to driving motions applied thereto. In at least one embodiment, for example, the resistive element 152 may be positioned on the inner surface 28 of the elongate channel 22 and oriented so that the resistive element 152 at least partially covers the slot 30 through the inner surface 28 of the channel 22 As described above, the slot 30 can be configured to receive the cutting element 32 when the trigger 20 is operated, causing the cutting element 32 and the sliding support 33 to move longitudinally along the channel 22. For example, the cutting element 32 may move from a first position at an adjacent location along the slot 30 to a second position at an intermediate location along the slot 30, and from the second position to a third position at a location distal to the along slot 30. The first position may correspond to a first node 156a, the second position may correspond to another node 156m and the third position may correspond to yet another node 156z. As the cutting element 32 moves longitudinally between the nodes along the slot 30, the cutting element 32 cuts the tissue trapped between the channel 22 and the anvil 20. The cutting element 32 also cuts portions of the resistive strip 152 covering the portion of the slot 30 through which the cutting element 32 translates. Referring again to Figure 12, the cutting element 32 is positioned between the proximal end 23a of the elongate channel 22 and the distal end 23b of the channel 22. As shown in that Figure, the cutting element 32 has traversing nodes 156a, 156b and 156c. . Furthermore, the cutting element 32 has separate proximal resistors 154a, 154b and 154c; however, intermediate and distal resistors 154m, 154n and 154z, among others, remain intact. It will be understood that when the cutting element 32 is advanced distally through the clamp channel 22 from an initial to its final position, the cutting element will have traversed each node 156 and cut each resistor 154 in the resistive element 152 during that stroke. trigger.
[00085] When the cutting element 32 cuts off portions of the resistive strip 152, the cutting element may cut resistors 154 disposed along part of a circuit in the resistive element 152. For example, with reference to Figure 12, the cutting element 32 can cut resistor 154a, then resistor 154b, followed by resistor 154c and so on. until the triggering element reaches the distal end 23b of the elongated channel 22. Resistors 154a, 154b, 154c, ..., 154z. can be arranged in parallel, as shown in Figure 14. In such an embodiment, the equivalent resistance of resistor element 152 can increase as each successive resistor is sheared by shear element 32 according to the ratio: 1/REq = 1/Ra + 1/Rb + 1/Rc + . + 1/Rz.
[00086] In an alternative embodiment, resistors 154a, 154b, 154c, etc. can be arranged in series. In such an embodiment, the equivalent resistance of resistor element 152 may decrease as each successive resistor is sheared by shear element 32 according to the relationship: REq = Ra + Rb + Rc + . + Rz.
[00087] Additionally, the voltage across resistive element 152 can be determined by Ohm's law, which states: V = I x REq,
[00088] where V represents voltage, I represents current and REq represents equivalent resistance. Voltage can be measured in volts (V), current can be measured in amperes (A), and resistance can be measured in ohms (Q). Assuming a constant current through resistive element 152, as the equivalent resistance changes with shear resistors 154, the voltage across the resistive element changes accordingly. Accordingly, the position of shear element 32 as it translates along resistive element 152 can be determined from output signals indicative of voltage generated by resistive element 152 when resistors 154 are sheared.
[00089] In another embodiment, when the resistive element 152 is supported by the cartridge body 35 of the staple cartridge 34, the cutting element 32 can cut parts of the resistive element 152. Referring to Figure 13, the resistive element 152 can be positioned in the cartridge body 35 of the staple cartridge 34 and oriented so that the resistive element 152 at least partially overlaps a slot 37 through the cartridge body 35. Similarly to that described above, a slot 37 in the cartridge body cartridge 35 can be configured to receive cutting element 32 when firing trigger 20 is actuated causing cutting element 32 and slider 33 to move longitudinally along channel 22. For example, cutting element 32 can move from a first position at an adjacent location along slot 37 to a second position at an intermediate location along slot 37, and from the second position to a third position at a location d along slot 37. When cutting element 32 moves longitudinally between a plurality of positions along slot 37, cutting element 32 cuts tissue secured between groove 22 and anvil 20. Cutting element 32 it also cuts off portions of the resistive strip 152 that overlap the portion of the slot 37 in the staple cartridge 34, through which the cutting element 32 translates. Similar to the above, when the cutting element cuts resistors 154 in resistive element 152, the equivalent resistance in resistive element 152 changes, which results in a corresponding change in voltage at resistive element 152.
[00090] In various embodiments, with reference to Figure 3, the staple channel 22 may include a pad, portion, point or contact surface 158. The contact pad 158 may be positioned on the inner surface 28 of the staple channel 22. In various embodiments, when the resistive element 152 is positioned in the cartridge body 35 of the staple cartridge 34 (Figure 14), the contact pad 158 in the groove 22 may be configured to contact a portion of the resistive element 152. A Contact pad 158 may contact a circuit of resistive element 152, a wire 168 extending from resistive element 152, or a contact pad operatively engaged with the resistive element. Additionally, contact pad 158 may communicate with conductive elements 170, 172 and/or memory device 160 via a wired or wireless connection, as described in greater detail below.
[00091] The surgical instrument also comprises a memory device 160 that operatively communicates with the resistive element 152 of the electronic sensor 150. See Figure 1. Directly or indirectly, the resistive element 152 sends a signal to the memory device 160, which records the signal as described in more detail below. Memory device 160 may be integrated into electronic sensor 150. In another embodiment, memory device 160 may be external to the electronic sensor and may be positioned close to resistive element 152, as in elongate channel 22 of end actuator 12. In other embodiments, with reference to Figure 1, memory device 160 may be positioned further from resistive element 152, as in cable 6 of instrument 10. Memory device 160 may be any type of device capable of storing or recording signals of the sensor. For example, memory device 160 may include a microprocessor, electrically erasable read-only programmable memory (EEPROM), or any other suitable storage device. Memory device 160 can record signals emitted by resistive element 152 in any suitable manner. For example, in one embodiment, memory device 160 may record the signal from resistive element 152 when the signal changes, such as when cutting element 32 cuts a resistor 154 in resistive element 152, resulting in a change in equivalent resistance and a corresponding change in voltage at resistive element 152. In another embodiment, memory device 160 may record the state of resistive element 152 and signals from other sensors, such as motor run sensor 110, motor reversing sensor 130, and /or the motor stop sensor 142, in the surgical instrument 10 when the signal of any sensor changes state. This can cause a sudden change in the state of the instrument 10. In various embodiments, the memory device 160 and/or the sensor(s) can be implemented to include products from the bus system 1- WIRE available from DALLAS SEMICONDUCTOR such as a 1-WIRE EEPROM.
[00092] In various embodiments, memory device 160 is externally accessible, allowing an external device, such as a computer, to access instrument conditions recorded by memory device 160. For example, memory device 160 may include an input data input 162. Data input 162 may provide stored instrument conditions in accordance with any wired or wireless communication protocol, for example, in serial or parallel format. Memory device 160 may also include removable medium 164 in addition to or instead of output port 162. Removable medium 164 may be any type of suitable data storage device that can be removed from instrument 10. For example, removable medium 164 may include any suitable type of flash memory, such as a Personal Computer Memory Cards International Association (PCMCIA) card, a COMPACTFLASH card, a MULTIMEDIA card, a FLASHMEDIA card, etc. Removable media 164 may also include any type of disk-based storage device, for example, a portable hard drive, a compact disc (CD), a digital video disc (DVD), etc.
[00093] The output of resistive element 152 may be provided to memory device 160, for example, via an analog to digital converter (not shown). In various embodiments, output signals from resistive element 152 may first be transmitted to an integrated circuit (not shown) for signal amplification. Additionally, the output may be encoded and/or modulated according to a modulation scheme.
[00094] Output from electronic sensor 150 can be provided to memory device 160 by wired communication. Referring to Figure 1, insulated wires or similar conductors 168 may transmit an electrical signal indicating the position of the trigger element in the end actuator 12 to the memory device 160. The wires 168 may be produced from an electrically conductive polymer. and/or metal (e.g. copper) and may be flexible enough to pass through a pivot hinge 14 without being damaged by the hinge.
[00095] In another embodiment, the signal may be transmitted wirelessly to memory device 160. Various modes of wireless communication are described in US Patent Application Serial No. 13/118,259, granted to James R Giordano et al., filed May 27, 2011, the disclosure of which is incorporated herein by reference in its entirety. Referring to Figure 12, to transmit the wireless signal, the resistive element 152 may comprise a conductive element 170 which functions as a transmit antenna. Conductive element 170 may transmit signals from resistive element 152 and receive power from a power source, such as a battery, external or internal to surgical instrument 10. Conductive element 170 of resistive element 152 is preferably insulated from outer rod 8 electrically conductive instrument 10.
[00096] In another embodiment, the conductive element 170 may comprise components of the end actuator 12 and the stem 8. In such an embodiment the resistive element 152 is electrically connected to the stem 8 and the memory device is isolated from the stem. For example, the inner surface 30 of the elongated channel 22 may comprise a conductive material, which, in turn, may be electrically coupled to the conductive elements of the rod 8 (such as closing tubes 40, 42) by direct or indirect electrical contact. The rod 8 may be grounded by the lower and upper side outer pieces 59-62, which may be produced from electrically insulating materials such as plastic. Additional components of end actuator 12 may comprise insulating material and memory device 160 is insulated from stem 8. Components of end actuator 12 and stem 8 electrically connected to conductive element 170 of sensor 150 may serve as part of an antenna for transmitting indicative signals from resistive element 152 to memory device 160. Alternatively, memory device 160 may be in electrical communication with specific components of end actuator 12 and stem 8 and resistive element 152 may be isolated. The specific components of the end actuator 12 and the stem, electrically connected to the memory device 160, can serve as part of an antenna for receiving signals from the sensor 150. The resistive element 152 can be isolated by positioning it on the inner surface 28 of the channel. elongate 22, which is produced from an electrically insulating material, such as plastic.
[00097] The surgical instrument 10 may comprise various conductive elements for transmitting signals from the resistive element 152 to the memory device 160. For example, with reference again to Figure 12, the resistive element 152 may transmit a signal to a conductive element 170. The signal may be transmitted by an insulated wire 168. Such an intermediate conductor element 170 may be located, for example, in the end actuator 12, along the rod 8 or in the cable 6 of the instrument 10. The conductor element 170 may transmit the signal. to a distal intermediate driver element 172a, which can then transmit the signal to a proximal intermediate driver element 172b or memory device 160 (shown diagrammatically in Figure 1). If more conductive connections are arranged between the resistive element 152 and the memory device 160, the distance between the conductive elements 170, 172 can be reduced and a weaker signal can be used to transmit the signal. Alternatively, if fewer conductive connections are available, a stronger signal may be required due to longer transmission distances. As the distances between the conductive elements 170, 172 can be fixed and known, the power levels can be optimized to low levels so as to minimize interference with other systems in the instrument 10 environment.
[00098] Alternatively, a combination of wired and wireless connections may be used to transmit signals from resistive element 152 to memory device 160. For example, with reference to Figure 1, end actuator 12 may include a wire 168 which connects the resistive element 152 to a distal intermediate conductive element 172a on the stem 6 of the instrument. The signal can then be transmitted wirelessly from the distal intermediate conductor element 172a to a proximal intermediate conductor element 172b. The proximal intermediate driver element 172b may transmit the signal to the memory device 160 through a wire 168 or through a wireless connection.
[00099] Resistive element 152 can communicate with memory device 160 using any suitable frequency (eg an ISM band). Furthermore, resistive element 152 may transmit signals in a frequency range different from the frequency range of signals received from memory device 160. Furthermore, while only one antenna is discussed above with respect to electronic sensor 150, in other embodiments the sensor electronic 150 may comprise separate receive and transmit antennas.
[000100] Surgical instrument 10 may also comprise a processor 180 that operatively interfaces memory device 160. Referring to Figure 1, processor 180 and memory device 160 may comprise an integral component. In another embodiment, processor 180 and memory device 160 are separate components of the surgical instrument. Processor 180 determines the position of trigger element in end actuator 12 from output of resistive element 152. In one embodiment, processor 180 records the position of cutting element 32 in end actuator 12 from signals indicating voltage. from resistive element 152. For example, if resistors 154 of resistive strip 152 are connected in parallel, the equivalent resistance of resistive element 152 increases as each successive resistor 154 is sheared. Corresponding changes in voltage in resistive element 152 indicate the nodal position of cutting element 32 along resistive strip 152, which additionally corresponds to the location of cutting element 32 in elongated channel 22.
[000101] After determining the position of the triggering element in the elongate channel 22, the position can be communicated to an indicator that indicates the position of the triggering element. The indicator may be a visual indication screen 190 on user-visible instrument cable 6. Additionally or alternatively, the position can be transmitted to the user by tactile indication. For example, when the knife 32 reaches the end of the slot 30 in the clamp groove 22, the user may be alerted by the increased resistance of the trigger 20. In another embodiment, referring to Figure 7, the user may be alerted by vibrations in the pistol grip 26 of the instrument 10 by a vibrating element 192 that operatively communicates with the processor 180.
[000102] The unique and innovative aspects of the various embodiments of the present disclosure utilize an electronic sensor to determine the position of a triggering element in the end actuator of a surgical instrument and/or the status of a staple cartridge in the end actuator. Accordingly, the unique arrangements and principles of the various embodiments of the present description may allow for a variety of different types of electronic sensors presented and claimed in the present invention to be used effectively in conjunction with other types and shapes of surgical instruments, end actuators, and cartridges. staples used in conjunction with a trigger element. The aforementioned discussion describes an electronically controlled, motor-driven surgical instrument for cutting and fixation in accordance with some embodiments of the present disclosure. However, as stated above, those skilled in the art will understand that a surgical instrument according to various embodiments of the present description can be actuated and controlled in other ways, such as by manual force or robotic controls. For example, the end actuator 12 described above can be driven and controlled by a robotic system, such as the robotic system 1000 described in more detail below.ROBOTIC SYSTEMS
[000103] Figure 15 shows a version of a master controller 1001 that can be used in conjunction with a robotic slave-arm carriage 1100 of the type shown in Figure 16. A master controller 1001 and a robotic-slave-arm carriage 1100, as well as their respective components and control systems are collectively referred to in the present invention as a robotic system 1000. Examples of such systems and devices are disclosed in US Patent No. 7,524,320, issued April 28, 2009, entitled "Mechanical Actuator Interface System for Robotic Surgical Tools", by Michael J. Tierney et al., which has been incorporated herein by reference. Accordingly, various details of such devices will not be described in detail in this document beyond what may be necessary to understand various embodiments and forms of the present invention. As is well known, the master controller 1001 usually includes a control system (generally represented as 1003 in Figure 15) that is held by the surgeon and manipulated in space while the surgeon views the procedure through a sound screen. 1002. Master controllers 1001 generally comprise manual input devices which preferably move with multiple degrees of freedom and which often also have an actionable cable for driving tools (e.g. for the closing the clamping jaws, applying an electrical potential to an electrode, or similar). Various robotic controller and surgical tool arrangements are disclosed in US Patent Application Serial No. 13/118,241 entitled "Surgical Stapling Instruments with Rotatable Staple Deployment Arrangements", the full disclosure of which is incorporated herein by reference.
[000104] As can be seen in Figure 16, in one form, the robotic arm carriage 1100 is configured to drive a plurality of surgical tools, generally designated as 1200. Various robotic surgery systems and methods employing arrays of master controller and robotic arm car are disclosed in US Patent No. 6,132,368, entitled "Multi-Component Telepresence System and Method", the disclosure of which is incorporated herein by reference in its entirety. In various forms, robotic arm carriage 1100 includes a base 1102 from which, in the illustrated embodiment, three surgical tools 1200 are supported. In various forms, surgical tools 1200 are each supported by a series of manually pivotable links, commonly referred to as adjustment joints 1104 and a robotic manipulator 1106. These structures are illustrated in the present invention with protective covers that extend over much of the robotic link. These protective covers may be optional and may be limited to any size or entirely eliminated in some embodiments to minimize the inertia that is encountered by the servomechanisms used to manipulate such devices, to limit the volume of moving components to avoid collisions, and to limit the total weight of the carriage 1100. The carriage 1100 is generally of adequate dimensions for transporting the carriage 1100 between operating rooms. The 1100 carriage can be configured to typically pass through standard operating room doors and into standard hospital elevators. In various forms, cart 1100 would preferably have a weight and would include a wheel system (or other transport) that allows cart 1100 to be positioned next to an operating table by a single attendant.
[000105] Now referring to Figure 17, in at least one form, robotic manipulators 1106 may include a link 1108 that limits the movement of the surgical tool 1200. In various embodiments, link 1108 includes rigid links coupled by swivel joints in an arrangement parallelogram so that surgical tool 1200 pivots about a point in space 1110, as described more fully in U.S. Patent No. 5,817,084, the full disclosure of which is incorporated herein by reference. The parallelogram arrangement constrains rotation to rotate about an axis 1112a, sometimes called the pan axis. The links supporting the parallelogram linkage are pivotally mounted to installation joints 1104 (Figure 15) so that the surgical tool 1200 also rotates about an axis 1112b, sometimes called the yaw axis. Yaw and pitch axes 1112a, 1112b intersect at remote center 1114, which is aligned along a shank 1208 of surgical tool 1200. Surgical tool 1200 may have additional actuated degrees of freedom as supported by manipulator 1106 including sliding motion. of surgical tool 1200 along the longitudinal axis of the tool "LT-LT". As surgical tool 1200 slides along tool axis LT-LT with respect to manipulator 1106 (arrow 1112c), remote center 1114 remains fixed with respect to base 1116 of manipulator 1106. Therefore, the entire manipulator is, in general, moved to reposition remote center 1114. Link 1108 of handler 1106 is driven by a series of motors 1120. These motors actively move link 1108 in response to commands from a processor of a control system. As will be discussed in further detail below, motors 1120 are also employed to manipulate surgical tool 1200.
[000106] An alternative joint structure configuration is illustrated in Figure 18. In this embodiment, a surgical tool 1200 is supported by an alternative manipulator structure 1106' between two tissue manipulation tools. Those skilled in the art will appreciate that various embodiments of the present invention may incorporate a wide variety of alternative robotic structures including those described in US Patent No. 5,878,193 entitled "Automated Endoscope System For Optimal Positioning", the description of which is incorporated herein in full by reference. Additionally, although data communication between a robotic component and the robotic surgical system processor is primarily described herein with reference to communication between the surgical tool 1200 and the master controller 1001, it should be understood that similar communication can occur between a circuit of a manipulator, an adjustment joint, an endoscope or other image capturing device or the like and the robotic surgical system processor for component compatibility checking, component type identification, component calibration communication (such as drift or the like) , confirmation of component coupling to robotic surgical system or similar.
[000107] A non-limiting exemplary surgical tool 1200 that is well suited for use with a robotic system 1000 that has a tool drive assembly 1010 (Figure 20), which is operatively coupled to a master controller 1001, which can be operated through the actions of an operator (i.e., a surgeon) is depicted in Figure 19. As can be seen in that figure, surgical tool 1200 includes a surgical end actuator 2012 that comprises an endocutter. In at least one form, the surgical tool 1200 generally includes an elongate stem assembly 2008 that has a proximal closure system tube 2040 and a distal closure system tube 2042 that are coupled together by a hinge joint. 2011. Surgical tool 1200 is operatively coupled to the manipulator by a tool support portion generally designated 1300. Surgical tool 1200 further includes an interface 1230 that mechanically and electrically couples tool support portion 1300 to the manipulator. One type of interface 1230 is illustrated in Figures 20 to 24. In various embodiments, the tool clamping portion 1300 includes a tool clamping plate 1302 that operatively supports a plurality of rotatable body parts (four are shown in Figure 24), disks or driven elements 1304, each including a pair of pins 1306 that extend from a surface of the driven element 1304. A pin 1306 is closer to an axis of rotation of each of the driven elements 1304 than the other pin 1306 on the same driven element 1304, which helps ensure positive angular alignment of the driven element 1304. Interface 1230 includes an adapter portion 1240 that is configured to mountably engage mounting plate 1302 as will be discussed further below . Adapter portion 1240 may include an arrangement of electrical connection pins 1242 (Figure 22) that may be coupled to a memory structure by a circuit board within tool attachment portion 1300. Although interface 1230 is described herein invention with reference to mechanical, electrical and magnetic coupling elements, it should be understood that a wide variety of telemetry modalities can be used including infrared, inductive coupling or the like.
[000108] As can be seen from Figures 20 to 23, the adapter portion 1240 generally includes a tool side 1244 and a support side 1246. In various forms, a plurality of rotating bodies 1250 are mounted on a floating plate. 1248 which has a limited range of movement with respect to the surrounding adapter structure normal to the main surfaces of adapter 1240. Axial movement of floating plate 1248 helps disengage pivoting bodies 1250 from tool clamping portion 1300 when levers 1303 along from the housing sides of the tool clamping portion 1301 are driven (see Figure 19). Other mechanisms/arrangements may be employed for releasably coupling the tool support portion 1300 to the adapter 1240. In at least one form, pivoting bodies 1250 are resiliently mounted to a floating plate 1248 by resilient radial members that extend in a circumferential indentation. around swivel bodies 1250. Swivel bodies 1250 can move axially with respect to plate 1248 by deflecting these resilient structures. When arranged in a first axial position (toward the tool side 1244), the rotating bodies 1250 are free to rotate without angular limitation. However, as the swivel bodies 1250 move axially toward the tool side 1244, tabs 1252 (extending radially from the swivel bodies 1250) laterally engage retainers on the floating plates to limit the angular rotation of the swivel bodies 1250 to the around their axes. This limited rotation can be used to help actionably engage the rotating bodies 1250 with drive pins 1272 of a corresponding tool support portion 1270 of the robotic system 1000, as the drive pins 1272 will push the rotating bodies 1250 in the limited rotation position until pins 1234 are aligned with (and slide into) openings 1256'. The openings 1256 on the tool side 1244 and the openings 1256' on the support side 1246 of rotatable bodies 1250 are configured to precisely align the driven elements 1304 (Figure 24) of the tool clamping portion 1300 with the driven elements 1271 of the tool holder. tool 1270. As described above with respect to inner and outer pins 1306 of driven elements 1304, apertures 1256, 1256' are at different distances from the axis of rotation in respective swivel bodies 1250 thereof in order to ensure that the alignment is not misaligned. 180 degrees from the intended position. Additionally, each of the openings 1256 is slightly elongated radially to properly receive the pins 1306 in the circumferential orientation. This allows the pins 1306 to slide radially within the openings 1256, 1256' and accommodate some axial misalignment between the tool 1200 and the tool holder 1270, while minimizing any angular misalignment and setback between the driving and driven elements. The openings 1256 on the side of the tool 1244 are offset by about 90 degrees from the openings 1256' (shown in dashed lines) on the side of the holder 1246, as can be seen more clearly in Figure 23.
[000109] Various embodiments may additionally include an arrangement of electrical connector pins 1242 located on the support side 1246 of the adapter 1240 and the tool side 1244 of the adapter 1240 may include slots 1258 (Figure 23) to accommodate an array of pins (not shown) of the tool attachment portion 1300. In addition to transmitting electrical signals between the surgical tool 1200 and the tool holder 1270, at least some of these electrical connections may be coupled to an adapter memory device 1260 (Figure 22) by a 1240 adapter circuit board.
[000110] A removable latch arrangement 1239 may be employed to releasably attach the adapter 1240 to the tool holder 1270. As used herein, the term "tool drive assembly" when used in the context of the robotic system 1000 encompasses at least various embodiments of adapter 1240 and tool holder 1270, and which has been designated generally as 1010 in Figure 20. For example, as can be seen in Figure 20, tool holder 1270 may include a first arrangement of locking pins 1274 which is sized to be accommodated in hook slots 1241 provided in adapter 1240. Additionally, tool holder 1270 may further have second locking pins 1276 which are sized to be retained in corresponding locking shackles 1243 in adapter 1240. In at least one form, a locking assembly 1245 is movably supported on adapter 1240 and is orientable between a first locked position in which the feet Locking pins 1276 are retained within respective locking shackles 1243 and an unlocked position in which second locking pins 1276 may be in or removed from locking shackles 1243. A spring or springs (not shown) are employed to guide the lock assembly in locked position. A ferrule on the tool side 1244 of the adapter 1240 can be slidably received tabs that extend laterally from the tool mounting compartment 1301.
[000111] Turning now to Figures 24 to 31, in at least one embodiment, the surgical tool 1200 includes a surgical end actuator 2012 that comprises, in this example, among other things, at least one component 2024 that can be selectively moved between the first and second position relative to at least one other component 2022 in response to various control movements applied to it as will be discussed in more detail below. In various embodiments, component 2022 comprises an elongated channel 2022 configured to operably hold a surgical staple cartridge 2034 therein, and component 2024 comprises a pivotally translatable gripping member, such as an anvil 2024. Various embodiments of actuator Surgical End Actuator 2012 are configured to hold the Anvil 2024 and Elongated Channel 2022 in a spacing that ensures effective stapling and sectioning of tissue held by the Surgical End Actuator 2012. As can be seen in Figure 30, the Surgical End Actuator 2012 additionally includes a cutting tool 2032 and a sliding support 2033. The cutting tool 2032 can be, for example, a knife. Surgical staple cartridge 2034 operatively houses a plurality of surgical staples (not shown) therein that are supported on movable staple drivers (not shown). As cutting instrument 2032 is driven distally through a centrally arranged slot (not shown) in surgical staple cartridge 2034, it also forces slider 2033 distally. As the slide support 2033 is distally driven, the "wedge-shaped" configuration thereof makes contact with the movable clamp drivers and directs them vertically toward the closed anvil 2024. The surgical clamps are formed as they are surface driven. formation located on the underside of the anvil 2024. The slide support 2033 can be part of the surgical staple cartridge 2034, so that when the cutting instrument 2032 is retracted after the cutting operation, the slide support 2033 does not retract. The anvil 2024 may be pivotally opened and closed at a pivot point 2025 located at the proximal end of the elongated channel 2022. The anvil 2024 may also include a tab 2027 at the proximal end thereof that interacts with a component of the mechanical closure system. (described further below) to facilitate opening of anvil 2024. Elongated channel 2022 and anvil 2024 may be made of electrically conductive material (such as metal) so that they can serve as part of an antenna that communicates with sensor(s) on the end actuator as described above. The surgical staple cartridge 2034 may be produced from insulating material (such as plastic) and the sensor(s) may be attached or disposed on the surgical staple cartridge 2034, as also described above.
[000112] As can be seen from Figures 24 to 31, the surgical end actuator 2012 is attached to the tool attachment portion 1300 by an elongated stem assembly 2008, in accordance with various embodiments. As shown in the illustrated embodiment, the stem assembly 2008 includes a pivot joint generally denoted 2011 that allows the surgical end actuator 2012 to be selectively pivoted about an axis of the AA-AA joint that is substantially transverse to a longitudinal axis. of the LT-LT tool. See Figure 25. In other embodiments, the pivot joint is omitted. In various embodiments, the stem assembly 2008 may include a closure system tube assembly 2009 comprising a proximal closure system tube 2040 and a distal closure system tube 2042 that are pivotally connected by pivot connections 2044 and operatively supported on a back assembly generally shown as 2049. In the illustrated embodiment, the column assembly 2049 comprises a distal column portion 2050 that is secured to the elongated channel 2022 and pivotally coupled to the proximal column portion 2052. tube closure system 2009 is configured to slide axially over the back assembly 2049 in response to actuation motions applied thereto. Distal closure tube 2042 includes an opening 2045 into which tab 2027 on anvil 2024 is inserted to facilitate opening of anvil 2024 as distal closure tube 2042 is moved axially in the proximal "PD" direction. Closure tubes 2040, 2042 can be made of electrically conductive material (such as metal) so that it can serve as part of the antenna, as described above. Components of the main drive shaft assembly (e.g., drive shafts 2048, 2050) may be produced from a non-conductive material (such as plastic).
[000113] In use, it may be desirable to rotate the 2012 Surgical End Actuator around the longitudinal axis of the LT-LT tool. In at least one embodiment, the tool support portion 1300 includes a rotational drive assembly 2069 that is configured to receive a corresponding rotary output motion from the tool drive assembly 1010 of the robotic system 1000 and convert that output motion swivel for a rotary control motion to rotate the 2008 elongated stem assembly (and 2012 surgical end actuator) around the longitudinal axis of the LT-LT tool. In various embodiments, for example, the proximal end 2060 of the proximal closure system tube 2040 is pivotally supported on the tool mounting plate 1302 of the tool support portion 1300 by a front support bracket 1309 and a sliding support bracket 1309. lock 2100 which is also movably supported on tool mounting plate 1302. In at least one form, rotational drive assembly 2069 includes a tube gear segment 2062 that is formed at (or attached to) the proximal end 2060 of the proximal closure system tube 2040 for engagement operable by a rotational gear assembly 2070 that is operatively supported on tool mounting plate 1302. As can be seen in Figure 27, rotational gear assembly 2070, in at least one embodiment, comprises a rotation drive gear 2072 which is coupled to the corresponding first disc or driven element 1304 on the side of the adapter. 1307 of the tool clamping plate 1302, when the tool clamping portion 1300 is coupled to the tool drive assembly 1010. See Figure 24. The rotational gear assembly 2070 further comprises a rotationally driven gear 2074 that is supported rotatably on the tool mounting plate 1302 in meshing with the tube gear segment 2062 and the rotation drive gear 2072. An application of a first rotary output movement of the tool drive assembly 1010 of the robotic system 1000 to the corresponding driven element 1304 will thus cause rotation of the rotation drive gear 2072. Rotation of the rotation drive gear 2072 ultimately results in the rotation of the elongated rod assembly 2008 (and the surgical end actuator). 2012) around the longitudinal axis of the LT-LT tool (represented by the arrow "R" in Figure 27). It will be appreciated that applying a rotary output motion from the tool drive assembly 1010 in one direction will result in the elongated rod assembly 2008 and surgical end actuator 2012 rotating around the longitudinal axis of the LT-LT tool. in a first direction and an application of the rotary output motion in an opposite direction will result in the elongated stem assembly 2008 and surgical end actuator 2012 rotating in a second direction that is opposite to the first direction.
[000114] In at least one embodiment, closure of the anvil 2024 with respect to the staple cartridge 2034 is achieved by axial movement of the closure system tube assembly 2009 in the distal direction "DD" on the back assembly 2049. As noted above , in various embodiments, the proximal end 2060 of the proximal closure system tube 2040 is supported by the sliding closure bracket 2100 which comprises a portion of a locking drive, generally shown as 2099. In at least one form, the sliding bracket Closure tube 2100 is configured to hold Closure Tube 2009 on Tool Mounting Plate 1320 so that Proximal Closure System Tube 2040 can rotate relative to Closure Slide Holder 2100 while still traveling axially with the Slide Holder lock 2100. In particular, as can be seen in Figure 32, the lock slide support 2100 has a standing tab 2101 that extends to the interior of a radial groove 2063 in the proximal end portion of the proximal closure tube 2040. In addition, as can be seen in Figures 29 and 32, the sliding closure bracket 2100 has a tab portion 2102 that extends through a slot 1305 in tool attachment plate 1302. Flap portion 2102 is configured to retain sliding lock bracket 2100 in sliding engagement with tool mounting plate 1302. In various embodiments, sliding lock bracket 2100 has a upright 2104 having a closing rack gear 2106 formed therein. The 2106 Closing Rack Gear is configured to drive engagement with a 2110 Closing Gear Assembly. See Figure 29.
[000115] In various forms, the Closing Gear Assembly 2110 includes a Closing Sprocket 2112 which is coupled to a corresponding second one of the driven discs or elements 1304 on the adapter side 1307 of the tool mounting plate 1302. Refer to Fig. 24. Thus, the application of a second rotary output movement of the tool drive assembly 1010 of the robotic system 1000 to the corresponding second driven element 1304 will cause a rotation of the closing sprocket 2112 when the tool support portion 1300 is coupled to the tool drive assembly 1010. The closing gear assembly 2110 additionally includes a closing reduction gear assembly 2114 which is held in mesh engagement with the closing sprocket 2112. As can be seen in Figures 28 and 29, the closing reduction gear assembly 2114 includes a driven gear 2116 that is pivotally supported. a in mesh engagement with the closing sprocket 2112. The closing reduction gear assembly 2114 additionally includes a first closing drive gear 2118 which is in mesh engagement with a second closing drive gear 2120 which is supported pivotally on the tool mounting plate 1302 in mesh engagement with the closing rack gear 2106. In this way, the application of a second rotary output movement from the tool drive assembly 1010 of the robotic system 1000 to the second corresponding driven element 1304 will cause the closing sprocket 2112 and the closing transmission 2110 to rotate and ultimately driving the closing sliding bracket 2100 and the closing system tube assembly 2009 axially. The axial direction in which the closure system tube assembly 2009 ultimately moves depends on the direction in which the second driven element 1304 is rotated. For example, in response to a rotary output motion received from the tool drive assembly 1010 of the robotic system 1000, the closing slide bracket 2100 will drive in the distal direction "DD" and ultimately drive the tube assembly. of closure system 1009 in the distal direction. As the distal closure system tube 2042 is distally driven, the end of the closure tube segment 2042 will engage a portion of the anvil 2024 and cause the anvil 2024 to revolve to a closed position. Upon application of an "opening" outward motion of the tool drive assembly 1010 of the robotic system 1000, the closing sliding bracket 2100 and rod assembly 2008 will be driven in the proximal "PD" direction. As the distal closure system tube 2042 is driven in the proximal direction, the opening 2045 therein interacts with the tab 2027 on the anvil 2024 to facilitate opening thereof. In various embodiments, a spring (not shown) may be employed to orient the anvil to the open position when the distal closure system tube 2042 has been moved to its home position. In various embodiments, the various gears of the closing gear assembly 2110 are sized to generate the closing forces necessary to satisfactorily close the anvil 2024 in the tissue to be cut and clamped by the surgical end actuator 2012. For example, transmission gears 2110 closure can be sized to generate approximately 32-54 kg (70-120 lbs).
[000116] In various embodiments, the cutting instrument 2032 is driven through the surgical end actuator 2012 by a knife bar 2200. See Figures 30 and 32. In at least one form, the knife bar 2200 can be manufactured from of, for example, stainless steel or other similar material and has a substantially rectangular cross-sectional shape. Such a knife bar configuration is rigid enough to push the cutting instrument 2032 through the pinched tissue in the 2012 Surgical End Actuator, while still being flexible enough to allow the 2012 Surgical End Actuator to articulate with respect to the 2012 Surgical End Actuator tube. proximal closure 2040 and proximal dorsum portion 2052 around the axis of the AA-AA joint as will be discussed in further detail below. As can be seen in Figures 33 and 34, the proximal back portion 2052 has a rectangle-shaped passageway 2054 that extends therethrough to support the knife rack 2200 as it is pushed axially therethrough. Proximal dorsum portion 2052 has a proximal end 2056 that is pivotally mounted to a dorsum mounting bracket 2057 secured to tool mounting plate 1032. See Figure 32. Such an arrangement allows proximal dorsum portion 2052 to pivot. , but do not move axially, into the 2040 Proximal Closure System Tube.
[000117] As shown in Figure 30, the distal end 2202 of the knife rack 2200 is attached to the cutting instrument 2032. The proximal end 2204 of the knife bar 2200 is pivotally attached to a knife rack gear 2206 so that that knife bar 2200 is free to rotate with respect to knife rack gear 2206. See Figure 32. As can be seen from Figures 26 to 31, knife rack gear 2206 is slidably supported within the housing. of the rack 2210 which is secured to the tool attachment plate 1302 so that the knife rack gear 2206 is retained in mesh engagement with a knife gear assembly 2220. More specifically, and with reference to Figure 29, at least In at least one embodiment, the knife gear assembly 2220 includes a knife sprocket 2222 that is coupled to the third disc or corresponding driven element 1304 on the adapter side 1307 of the tool attachment plate. 1302. See Figure 24. Thus, applying another rotary output motion from robotic system 1000 through tool drive assembly 1010 to corresponding third driven element 1304 will cause knife sprocket 2222 to rotate. The 2220 knife gear assembly additionally includes a 2224 knife gear reduction assembly that includes a 2226 first knife driven gear and a 2228 second knife drive gear. swivel to the tool clamp plate 1302 so that the knife driven first gear 2226 is in mesh engagement with the knife sprocket 2222. Similarly, the second knife drive gear 2228 is in mesh engagement with a third knife drive gear 2230 that is pivotally supported on the tool mounting plate 1302 in mesh engagement with the gear 2206. In various embodiments, the gears of the knife gear assembly 2220 are sized to generate the forces necessary to drive the cutting element 2032 through the tissue held in the surgical end actuator 2012 and actuate the clamps thereon. For example, the 2230 knife drive assembly gears can be sized to generate approximately 18 to 45 kg (40 to 100 lbs). It will be understood that application of a rotary output motion of the tool drive assembly 1010 in one direction will result in axial movement of the cutting instrument 2032 in a distal direction and application of rotary output motion in an opposite direction will result in the axial displacement of the cutting instrument 2032 in a proximal direction.
[000118] Figure 35 illustrates another 2012 end actuator that includes an electronic sensor 2150. The electronic sensor 2150, similar to the sensor 150 described above, determines the position of a trigger element in the end actuator 2012 and/or the state or the presence of a staple cartridge 2034 in the end actuator 2012. The cutting element 2032, the sliding support 2033, the knife rack 2200 and other elements configured to translate in the end actuator 2012 are collectively referred to in the present invention as cutting elements. shot. In at least one form, the electronic sensor 2150 comprises a resistive element 2152 that is supported within the end actuator 2012 of the surgical tool 1200. The resistive element 2152 may be supported by the clamp groove 2022, the clamping member 2024, the cartridge of clamps 2034 or by another element in the end actuator 2012. As a trigger element translates longitudinally through the end actuator 2012, the trigger element may be in contact in motion with the resistive element 2152.
[000119] In various embodiments, the resistive element 2152 of the electronic sensor 2150 is supported by the elongate channel 2022. For example, in at least one form, the resistive element 2152 is secured to the resistive element 2152 in the elongate channel 2022 by an adhesive. In other embodiments, the resistive element 2152 may be secured to the component in the elongate channel 2022. Referring to an embodiment shown in Figure 35, the resistive element 2152 is positioned on the inner surface 2028 of the clamp channel 2022 such that a trigger contacts resistive element 2152 as trigger element travels longitudinally through staple channel 2022. In alternative embodiments, resistive element 2152 is supported by staple cartridge 2034. Referring to Figure 36, resistive element 2152 can be supported by the cartridge body 2035 of the staple cartridge 2034. Similar to the above, the resistive element 2152 can be positioned on the cartridge body 2035 of the staple cartridge 2034 so that at least a portion of the triggering element comes into contact with each other. contact with resistive element 2152 as the trigger element travels longitudinally through the staple channel 2022.
[000120] As described above with respect to resistive element 152, resistive element 2152 of electronic sensor 2150 may comprise a plurality of resistors 2154 and a plurality of nodes 2156. Resistors 2154 may be arranged in a parallel configuration or may be arranged in series. Referring to Figure 35, a trigger element on end actuator 2012 is in moving contact with resistive element 2152 as the trigger element translates between the proximal end 2023a of the staple channel 2022 and the distal end 2023b of the staple channel 2022. As the trigger element travels through the clamp channel 2022 and comes into motion contact with the resistive element 2152, the resistive element 2152 generates output signals that indicate the position of the trigger element within the elongated channel 22. output generated by resistive element 2152 can be voltage (or power) measurements across resistive element 2152.
[000121] In various embodiments, with reference to Figure 35, the trigger element may come into contact in motion with the resistive element 2152, such that the trigger element cuts off portions of the resistive element 2152, as described in more detail above with with respect to resistive element 152. Accordingly, the position of shear element 32 as it translates along resistive element 2152 can be determined from output signals indicating the voltage generated by resistive element 2152 as resistors 2154 are sheared.
[000122] The robotic system 1000 may also comprise a processor 2180 that operationally interfaces the master controller 1001. In various embodiments, the processor 2180 may be integrated into the master controller 1001. As described in more detail above with respect to the processor 180, the processor 2180 can determine the position of the trigger in end actuator 12 from the output signals from sensor 2150. Directly or indirectly, sensor 2150 can output a signal to processor 2180, as described in more detail above. In various embodiments, processor 2180 may comprise a memory device 2160. As described in more detail above with respect to memory device 160, memory device 2160 may be any type of device capable of storing or recording sensor signals and may be communicating with the resistive element 2152 of the sensor 2150 by wired or wireless communication or a combination thereof through wires 168, conductive elements 170 and contact pads 158 (FIGURE 3). In other embodiments, memory device 2160 may not be integrated with processor 2180; The memory device may be a separate component of the robotic system 1000 that operatively communicates with the resistive element 2152 of the sensor 2150 and then transmits the output signals from the sensor 2150 to the processor 2180.
[000123] If processor 2180 is not integrated with master controller 1001, processor 2180 may communicate the position of the trigger element to master controller 1001. When the position of the trigger element in the elongate channel 2022 is determined, the position may be communicated to an indicator 2190 that indicates the position of the trigger. The indicator can be a visual indication screen, such as a 1005 feedback gauge, or a haptic indication.
[000124] The devices described here may be designed to be discarded after a single use, or they may be designed to be used multiple times. In either case, however, the device may be refurbished for reuse after at least one use. Overhaul may include any combination of the steps of disassembling the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, the device may be dismantled, and any number of particular parts or parts of the device may be selectively exchanged or removed, in any combination. After cleaning and/or replacing particular parts, the device can be reassembled for subsequent use in a refurbishment facility or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that refurbishing 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 this application.
[000125] As stated above, the unique and innovative aspects of the various embodiments of the present description utilize an electronic sensor to determine the position of a trigger element in the end actuator of a surgical instrument and/or the state or presence of a cartridge of clamps on the end actuator. Accordingly, the unique arrangements and principles of various embodiments of the present disclosure may allow for a variety of different types of electronic sensors disclosed and claimed in the present invention to be used effectively in conjunction with other types and shapes of surgical instruments, end actuators, and cartridges. of staples used in conjunction with a trigger element. The aforementioned discussion describes a robotic system with a surgical instrument for cutting and fixing, in accordance with some embodiments of the present disclosure. However, as stated above, those skilled in the art will understand that a surgical instrument in accordance with various embodiments of the present disclosure may be alternately actuated and controlled.
[000126] The purpose of the foregoing description and the following embodiments is to encompass all modifications and variations that are within the scope of the present description. Although dimensions are illustrated in some of the figures, these dimensions are intended to serve as examples of modalities and should not be construed as limiting. If materials are presented for certain components, other materials may be used.
[000127] Any patent, publication, or other descriptive material, in whole or in part, which is said to be incorporated by reference into the present invention is incorporated into the present invention only to the extent that the incorporated materials do not come into conflict with existing definitions, statements or other descriptive material presented in this description. Accordingly, and to the extent necessary, the description as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, which is incorporated by reference in the present invention, but which conflicts with existing definitions, statements, or other descriptive materials set forth herein, will be incorporated herein only to the extent that no conflict will appear between the embedded material and the existing description material.

权利要求:
Claims (18)
[0001]
1. Surgical instrument (10; 1000), comprising: a surgical end actuator (12; 2012), comprising: an elongated channel (22; 2022) having a proximal end and a distal end; and a trigger element configured to selectively translate between the proximal end of the elongate channel (22; 2022) and the distal end of the elongate channel (22; 2022) upon application of a triggering motion thereto, wherein the trigger element comprises a cutting element (32; 2032); characterized in that it further comprises: a resistive element (152; 2152) held for contact in motion by the trigger element as the trigger element is moved from the proximal end to the distal end of the elongated channel (22; 2022), wherein the resistive element (152; 2152) comprises: a proximal node, a distal node, and an intermediate node positioned intermediate between the proximal node and the distal node; a first separable resistor positioned intermediate between the proximal node and the intermediate node; and a second separable resistor positioned intermediate between the intermediate node and the distal node; wherein the cutting element (32; 2032) is configured to sequentially cut the first separable resistor and the second separable resistor as the trigger element translates between the proximal end and the distal end of the elongate channel (22; 2022), and wherein the resistive element (152; 2152) generates output signals indicative of updated positions of the trigger element within the elongate channel (22; 2022) as the trigger element sequentially traverses the proximal node, the intermediate node, and the distal node; and a memory device (160; 2160) operatively communicating with the resistive element (152; 2152) and configured to record output signals as the trigger element translates through the elongated channel (22; 2022).
[0002]
2. Surgical instrument (10; 1000), according to claim 1, characterized in that the resistive element (152; 2152) comprises a plurality of resistors (154a-154z; 2154) including the first separable resistor and the second separable resistor, and wherein the resistors of the resistive element (152; 2152) are connected in parallel.
[0003]
3. Surgical instrument (10; 1000), according to claim 1, characterized in that the resistive element (152; 2152) comprises a plurality of nodes (156; 2156) including the proximal node, the intermediate node, and the distal node, and wherein the output signals comprise signals indicative of voltage at the nodes of the resistive element (152; 2152).
[0004]
4. Surgical instrument (10; 1000), according to claim 3, characterized in that it further comprises a processor (180; 2180) that operationally interfaces with the memory device (160; 2160) and computes trigger element positions in the surgical end actuator (12; 2012) from the signals indicating voltage at the nodes in the resistive element (152; 2152).
[0005]
5. Surgical instrument (10; 1000), according to claim 4, characterized in that it further comprises an indicator (2190) communicating with the processor (180; 2180) to indicate positions of the triggering element within the elongated channel (22). ; 2022).
[0006]
6. Surgical instrument (10; 1000) according to claim 5, characterized in that the indicator (2190) comprises a visual indication device.
[0007]
7. Surgical instrument (10; 1000) according to claim 5, characterized in that the indicator (2190) comprises a tactile indication arrangement (1005).
[0008]
8. Surgical instrument (10; 1000), according to claim 1, characterized in that the trigger element translates in response to drive movements applied to it by a robotic system (1000) operationally interfacing with the surgical end actuator (12; 2012), the robotic system (1000) comprising a processor (180; 2180) that operationally interfaces with the memory device (160; 2160) and computes trigger element positions in the surgical end actuator (12; 2012) .
[0009]
9. Surgical instrument (10; 1000), according to claim 1, characterized in that the surgical end actuator (12; 2012) is configured to operatively support a cartridge of surgical staples (34; 2034).
[0010]
10. Surgical instrument (10; 1000), according to claim 9, characterized in that the resistive element (152; 2152) is supported on the staple cartridge (34; 2034).
[0011]
11. Staple cartridge (34; 2034) for use in connection with a surgical instrument (10; 1000), the staple cartridge (34; 2034) characterized in that it comprises: a cartridge body (35; 2035) configured to be operatively supported by the surgical instrument (10; 1000) so that a triggering member of the surgical instrument (10; 1000) can translate longitudinally through the cartridge body (35; 2035) upon application of a driving motion thereto; and a resistive element (152; 2152) supported on the cartridge body (35; 2035) for contact in motion by the trigger element as the trigger element is translated therethrough, wherein the resistive element (152; 2152) comprises: a proximal resistor; and a distal resistor; wherein the trigger element is configured to sequentially traverse the proximal resistor and the distal resistor as the trigger element translates longitudinally through the cartridge body (35; 2035), and wherein the resistive element (152; 2152 ) is configured to operatively communicate output signals indicative of firing element positions within the cartridge body (35; 2035) to a memory portion (160; 2160) of the surgical instrument (10; 1000).
[0012]
12. Staple cartridge (34; 2034), according to claim 11, characterized in that the cartridge body (35; 2035) has an elongated slot (22; 2022) therein configured to receive at least a portion of the trigger element therein, wherein the trigger element comprises a cutting element (32; 2032), and wherein portions of the resistive element (152; 2152) are oriented relative to the elongated slot (22; 2022) so that the cutting element (32; 2032) sequentially cutting portions of the resistive element (152; 2152) as the cutting element (32; 2032) is moved from a proximal end to a distal end of the cartridge body (35; 2035) .
[0013]
13. Clamp cartridge (34; 2034), according to claim 12, characterized in that the resistive element (152; 2152) comprises: a plurality of resistors (154a-154z; 2154) including the proximal resistor and the distal resistor; and a plurality of nodes (156; 2156), wherein said node is positioned between adjacent resistors in the resistive element (152; 2152).
[0014]
14. Clamp cartridge (34; 2034), according to claim 13, characterized in that the resistors in the resistive element (152; 2152) are connected in parallel.
[0015]
15. Staple cartridge (34; 2034), according to claim 13, characterized in that the output signals comprise signals indicating voltage at the nodes in the resistive element (152; 2152).
[0016]
16. Surgical instrument, comprising: a robotic system (1000) comprising a processor (180; 2180); and a surgical end actuator (2012) operatively interfacing with the robotic system (1000) to receive drive motions therefrom, the surgical end actuator (2012) comprising: an elongated channel (2022) having a proximal end and an end distal; and a trigger element configured to selectively translate between the proximal end of the elongated channel (2022) and the distal end of the elongated channel (2022) upon application of a triggering movement thereto from the robotic system (1000); characterized in that further comprising: a resistive element (2152) held in motion contact by the trigger element as the trigger element is moved from the proximal end to the distal end of the elongated channel (2022), wherein the resistive element (2152) comprises: a proximal resistor; and a distal resistor; wherein the trigger element is configured to sequentially engage the proximal resistor and the distal resistor as the trigger element is moved from the proximal end to the distal end of the elongated channel (2022), and wherein the resistive element ( 2152) generates output signals indicative of trigger element positions within the elongate channel (2022) and communicates the output signals to the processor (180; 2180).
[0017]
17. Surgical instrument according to claim 16, characterized in that it further comprises an indicator (2190) communicating with the processor (180; 2180) to provide indications of trigger element positions as the trigger element is moved from the proximal end to the distal end of the elongated channel (2022).
[0018]
18. Surgical instrument, according to claim 17, characterized in that the indicator (2190) comprises a tactile indication arrangement (1005).

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同族专利:

---

公开号 | 公开日

---

US9730697B2|2017-08-15|

---

JP2015512662A|2015-04-30|

---

EP2814404A2|2014-12-24|

---

RU2014137126A|2016-04-10|

---

US9044230B2|2015-06-02|

---

US20130206814A1|2013-08-15|

---

RU2631209C2|2017-09-19|

---

BR112014020050A2|2017-06-20|

---

US20170319209A1|2017-11-09|

---

WO2013122739A3|2013-11-14|

---

MX349058B|2017-07-06|

---

CN104135951A|2014-11-05|

---

MX2014009714A|2014-09-12|

---

CN104135951B|2017-03-15|

---

US20150223816A1|2015-08-13|

---

US10695063B2|2020-06-30|

---

WO2013122739A2|2013-08-22|

---

JP6174049B2|2017-08-02|

---

EP2814404B1|2020-04-01|

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法律状态:
2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-12-17| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2021-06-01| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2021-10-19| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2022-01-04| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 30/01/2013, 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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US13/372,205|2012-02-13|

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US13/372,205|US9044230B2|2012-02-13|2012-02-13|Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status|

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PCT/US2013/023721|WO2013122739A2|2012-02-13|2013-01-30|Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status|

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