FR2689749A1 - Surgical stapling instrument for circular anastomy - has cartridge-loaded cylindrical-conical stapling head attached to main tubular body via flexible actuating cable - Google Patents
Surgical stapling instrument for circular anastomy - has cartridge-loaded cylindrical-conical stapling head attached to main tubular body via flexible actuating cable Download PDFInfo
- Publication number
- FR2689749A1 FR2689749A1 FR9204490A FR9204490A FR2689749A1 FR 2689749 A1 FR2689749 A1 FR 2689749A1 FR 9204490 A FR9204490 A FR 9204490A FR 9204490 A FR9204490 A FR 9204490A FR 2689749 A1 FR2689749 A1 FR 2689749A1
- Authority
- FR
- France
- Prior art keywords
- instrument
- cartridge
- anvil
- handle
- flexible cable
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
Description
La présente invention concerne un instrument chirurgical permettant la réalisation d'anastomoses circulaires invaginantes par points totaux å l'aide d'agrafes chirurgicales. The present invention relates to a surgical instrument for the realization of invaginating circular anastomoses by total points with the aid of surgical staples.
Cet instrument se prête aussi bien à la confection d'anastomoses de type 'stermino-termi- nale", "termino-latérale", "latéro-terminale" et "latéro-latérale" at, plus particulièrement, dans les zones d'accès opératoire difficiles. This instrument is equally suitable for the manufacture of "terminal-terminal", "lateral-lateral", "latero-terminal" and "latero-lateral" anastomoses and, more particularly, in the access zones. difficult operation.
L'utilisation de l'agrafe chirurgicale métallique destinée a' remplacer les fils de suture en chirurgie (digestive en particulier} remonte au debut de ce siècle. En t 908, le Hongrois Hultl utilisa pour la transsection de l estomac le premier appareil à suture linéaire semi-automatique permettant de disposer de part et d'autre d'une ligne de section une rangee d'agrafes métalliques réparties en quinconce. The use of the metal surgical staple for replacing sutures in surgery (digestive in particular) dates back to the beginning of this century.At 908, the Hungarian Hultl used for the transsection of the stomach the first suture Linear semi-automatic to arrange on both sides of a section line a row of metal staples distributed in staggered rows.
Les premiers types d'appareillage d'agrafage métallique permettant la confection d'anas tomoses circulaires remontent å la fi n des années 1950 et sont attribues å 171 l'institut Scientifique d'Appareillage et d'instruments Chirurgicaux et Expérimentaux de Moscou. (instruments PKS 25, KZ 28, SPTU 21, 26, 29 et 32). The first types of metal stapling apparatus for the manufacture of circular anas tomoses date back to the late 1950s and are attributed to the Scientific Institute of Surgical and Experimental Instruments and Equipment in Moscow. (instruments PKS 25, KZ 28, SPTU 21, 26, 29 and 32).
L'utilisation de tels instruments de sutures mécaniques en chirurgie est devenue de plus en plus courante depuis une dizaine d'années et fait maintenant partie des procédés classiques utilisés dans divers domaines de la chirurgie et, en particulier, celui de la chirurgie digestive. The use of such mechanical suture instruments in surgery has become increasingly common over the past ten years and is now part of the conventional methods used in various fields of surgery and, in particular, that of digestive surgery.
Les arguments avancés en faveur de leur emploi sont à la fois chirurgicaux et commerciaux:
1 - sécurité de la suture par rapport aux points de suture classiques.The arguments in favor of their use are both surgical and commercial:
1 - safety of the suture compared to conventional stitches.
2 - simplicité : l'emploi de ces instruments a permis de simplifier considérablement de nombreux processus difficiles à realiser. 2 - simplicity: the use of these instruments has made it possible to considerably simplify many difficult processes to achieve.
3 - rapidité d'exécution et, de ce fait, réduction du temps nécessaire pour de telles opérations et de façon concomitante, reveil plus précoce du malade de son anesthésie svec utilisation d'une quantité moindre de drogues anesthésiques.
il résulte de ces trois arguments un quatrieme qui lui est d'ordre économique par le biais de la moindre durée d'hospitalisation.3 - speed of execution and, as a result, reduction of the time necessary for such operations and concomitantly, wakes the patient earlier from his anesthesia with the use of a lesser quantity of anesthetic drugs.
the result of these three arguments is a fourth which is economic in nature through the shorter duration of hospitalization.
En fait, certains éléments sont pris en défaut et sont en grande partie liés a' des problemes d'ordre mécanique que la présente invention veut résoudre. In fact, some elements are faulty and are largely related to mechanical problems that the present invention seeks to solve.
Les brevets US 3. 193.165 et US 3.338.874 décrivent des instruments dits de "première génération . Ces instruments utilisables d'un malade à l'autre après stérilisation présentent de nombreux inconvénients:
a - ils sont rigides, encombrants et entièrement métalliques, ce qui les rend lourds et inadaptés pour le travail avec les tissus mous que sont les viscéres et paruculierement le tube digestif.
b - Ils ont une structure complexe rendant d'une part leur fabrication conteuse et néces- sitant d'autre part qu'ils soient constamment entretenus, démontés, stérilisés pour chaque ope- ration et nettoyés après chaque utilisation.
c - Le chargement de l'instrument se fait manuellement agrafe par agrafe dans l'instrument avant chaque opération.
d - Le couteau de l'instrument doit être affûte périodiquement et des outils speciaux sont fréquemment nécessaires pour le montage, démontage, entretien et remplacement des pièces.
e - La répartition des agrafes s'effectue sur une ligne unique en trait discontinu rendant la sécurité de la suture aléatoire avec beaucoup de risques de fuite (fistule) et d'hémorragie des tranches de section. Ce risque de fuite est d autant plus important que la distance entre la tige centrale des instruments et le couteau circulaire est courte (ceci sera expliqué ultérieurement).
f - Ces instruments sont droits et rigides, et ne peuvent pas épouser les courbures du tube digestif.
g - Les différences d'épaisseur qui existent (meme chez un meme patient) entre deux structures tubulaires du tube digestif (c'est-à-dire oesophage, petit intestin, gros intestin...) a
"anastomoser", rendent nécessaire l'utilisation d'agrafes de longueurs différentes.
h - De meme, il existe des différences de calibre entre les différents segments du tube digestif qui posent un problème. En effet, l'instrument d'agrafage doit etre introduit dans les lumières (calibre interne) des deux structures tubulaires du tube digestif à "anastomoser" et les diamètres de la partie de l'instrument qui contient les agrafes, et de l'élément centre lequel s'écrasent ces agrafes doivent correspondre au diamètre intérieur de la lumière des organes. US Pat. Nos. 3,193,165 and 3,338,874 describe so-called "first generation" instruments which can be used from one patient to another after sterilization have numerous disadvantages:
a - they are rigid, bulky and entirely metallic, which makes them heavy and unsuitable for working with the soft tissues that are the viscera and paruculiarly the digestive tract.
b - They have a complex structure, making their storytelling on the one hand and requiring them to be constantly maintained, disassembled, sterilized for each operation and cleaned after each use.
c - The loading of the instrument is manually stapled in the instrument before each operation.
d - The instrument knife should be sharpened periodically and special tools are frequently required for assembly, disassembly, maintenance and replacement of parts.
e - The distribution of the staples is performed on a single line in broken lines making the security of the suture random with a lot of risk of leakage (fistula) and haemorrhage slices section. This risk of leakage is all the more important as the distance between the central rod of the instruments and the circular knife is short (this will be explained later).
These instruments are straight and rigid, and can not conform to the curvatures of the digestive tract.
g - The differences in thickness that exist (even in the same patient) between two tubular structures of the digestive tract (that is to say, esophagus, small intestine, large intestine ...) has
"anastomose", make it necessary to use staples of different lengths.
h - Similarly, there are caliber differences between the different segments of the digestive tract that pose a problem. Indeed, the stapling instrument must be introduced into the lumens (inner gauge) of the two tubular structures of the digestive tract to "anastomose" and the diameters of the part of the instrument that contains the staples, and the element center which crash these staples must match the inner diameter of the light of the organs.
Des solutions en partie imparfaites ont été apportées à quelques-uns de ces 4roblèrnes tout en provoquant de nouveaux inconvénients. Ainsi, le brevet US 3.552.626 propose des tetes interchangeables de support d'agrafe ayant des diamètres différents, mais, malheureusement, ces têtes interchangeables sont difficiles à installer et à démonter. De plus, la dimension minimale desdites tettes est limitée du fait du volume des raccords qui sont nécessaires pour assurer leur jonction avec l'instrument. Partially imperfect solutions have been made to some of these variables while causing new disadvantages. Thus, US Patent 3,552,626 proposes interchangeable staple holder heads having different diameters, but unfortunately these interchangeable heads are difficult to install and disassemble. In addition, the minimum dimension of said teats is limited because of the volume of fittings that are necessary to ensure their connection with the instrument.
En fait, il est actuellement bien établi par des études expérimentales qu'avec des instruments équipés de tetes (porteuses d agrafes) de diamètre extérieur de 21 mm, 25mm, 28mm et 31 mm, il il est possible de couvrir la plupart des diamètres internes des organes du tube digestif d'étires humains. En effet, les tissus organiques étant élastiques, ils se pretent bien à de petites dilatations S l'aide de "bougies" métalliques de calibre progressivement croissant jusqu'à adaptation du diamètre interne du tube digestif à anastomoser au diamètre externe le plus proche sur la gamma des quatre diamètres d'instruments précites. il va sans dire que cette dilatation aux bougies metalliques est relativement traumatisante pour le tube digestif. In fact, it is now well established by experimental studies that with instruments equipped with 21 mm, 25mm, 28mm and 31mm diameter heads (staple carriers), it is possible to cover most internal diameters. organs of the digestive tract of human stretches. Indeed, the organic tissues being elastic, they lend themselves well to small expansions S using metal "candles" gradually increasing caliber until adaptation of the internal diameter of the digestive tract to anastomose to the nearest outer diameter on the gamma of the four diameters of the aforementioned instruments. it goes without saying that this dilation with metal candles is relatively traumatic for the digestive tract.
De meme, il est bien établi qu'avec des agrafes ayant des branches d'environ 5mm, on arrive à couvrir différentes épaisseurs du tube digestif tout en restant dans un domaine de sécurité d'anastomose. La sécurité est optimale quand l'anastomose circulaire comprend deux rangées d'agrafes réparties en quinconce, comme l'avait suggéré en 1908 le Hongrois Hulti pour l'anasto- mose linéaire. Similarly, it is well established that with staples having branches of about 5mm, we can cover different thicknesses of the digestive tract while remaining in an area of safety anastomosis. Safety is optimal when the circular anastomosis consists of two rows of staggered staples, as suggested by the Hungarian Hulti in 1908 for linear anastomosis.
Les brevets FR 45 33345 et FR 81 00575 font état de memes types d'instruments qui peuvent etre réalisés soit de façon à oestre intégralement jetés après usage, soit de façon à étre réu tilisables apres restérilisation. Dans le premier cas "matériel à usage unique", ils sont habituellement confectionnés en plastique et, de ce fait, plus légers. Dans le second cas, ils sont mé- talliques et conservent les inconvénients cites plus haut (pour le brevet US 3.552.626). The patents FR 45 33345 and FR 81 00575 disclose the same types of instruments that can be made either so as to be completely discarded after use, or so as to be reusable after resterilization. In the first case "single-use material", they are usually made of plastic and, therefore, lighter. In the second case, they are metallic and retain the drawbacks mentioned above (for US Pat. No. 3,552,626).
On voit donc que malgré l'adaptation rationnelle continue de ces instruments, plusieurs imperfections restent à déplorer. La plus importante et la plus handicapante pour le chirurgien est celle de la rigidité des instruments actuellement sur le marché. En effet, ces instruments sont tous formes d'un manche prolongé d'un segment de cylindre rigide (droit dans le brevet FR 81 00575 et à angle fixe dans les brevets US 3.315.863; US 3.494.533) d'une longueur fixe portant à son bout un boîtier chargeur d'agrafes et un couteau circulaire traversé par une tige métallique centrale rigides porteuse d'une enclume contre laquelle viennent s'écraser les agrafes et le couteau lors du fonctionnement de l'instrument. It can thus be seen that, in spite of the continuous rational adaptation of these instruments, several imperfections remain to be deplored. The most important and the most debilitating for the surgeon is that of the rigidity of the instruments currently on the market. Indeed, these instruments are all forms of an extended handle of a rigid cylinder segment (right in the patent FR 81 00575 and fixed angle in US Patents 3,315,863; US 3,494,533) of a fixed length carrying at its end a staple magazine and a circular knife traversed by a rigid central metal rod carrying an anvil against which come crashing the staples and the knife during operation of the instrument.
Cette rigidité rend certains procédés chirurgicaux impossibles à réaliser et beaucoup d'autres procédés chirurgicaux très malaisés, car rigides, l'instrument ne pouvant s'adapter aux différentes tortuosités du tube digestif. This rigidity makes some surgical procedures impossible and many other surgical procedures very difficult, because rigid, the instrument can not adapt to different tortuosity of the digestive tract.
1 - La présente invention a pour but de fournir un instrument chirurgical danastomose circulaire d'une conception nouvelle et tres simple permettant de répondre aux différents incon- vénients enumeres ci-dessus. 11 est, en particulier, flexible afin de permettre la réalisation des procédés chirurgicaux d'anastomose circulaire meme dans les endroits d'accès opératoire impossible ou très difficile avec les instruments antérieurs. The object of the present invention is to provide a circular danastomosis surgical instrument of a new and very simple design making it possible to respond to the various disadvantages listed above. It is, in particular, flexible in order to allow the realization of surgical methods of circular anastomosis even in places of operation impossible or very difficult access with the previous instruments.
2 - L'instrument selon l'invention permettra la confection d'anastomoses circulaires de type "termino-terminal", "termino-latéral", "latéro-terminal" et "latéro-latéral". 2 - The instrument according to the invention will allow the manufacture of circular anastomoses of the "termino-terminal", "termino-lateral", "latero-terminal" and "latero-lateral" type.
3 - L'instrument selon l'invention est de manipulation aisée et peut etre agence pour la fabrication sous forme d'instrument à usage unique (jetable après un seul usage), d'instrument à usages multiples (non restérilisable au cours de la meme séance opératoire chez un meme patient) et enfin d'instrument de t4pe permanent et réutilisable d'un patient à l'autre après restérilisation. 3 - The instrument according to the invention is easy to handle and can be used for manufacturing as a single-use instrument (disposable after one use), multipurpose instrument (not resterilizable during the same time). operative session in the same patient) and finally permanent and reusable instrument from one patient to another after resterilization.
Les deux premières formes nous semblent préférables, car confectionnées en matière plastique elles procurent à l'instrument un faible poids et une plus grande sécurité d'asepsie. The first two forms seem preferable to us, because made of plastic material they give the instrument a low weight and a greater safety of asepsis.
50us toutes ces formes, il est possible d'échangeur une cartouche contenant agrafes et couteau circulaire. Ces cartouches bien que décrites dans l'invention avec quatre diamètres extérieurs de 21, 25, 28, 31mm pourront être fabriquées avec n'importe quel diamètre. Elles peuvent contenir une ou plusieurs rangees circulaires d'agrafes bien que deux rangées annulaires disposees concentriquement et en quinconce soient préférables. Ces deux rangées annulaires et le couteau circulaire entouré par elles suint disposées de sorte à occuper un minimum de largeur, ce qui permet une lumière résiduelle après anastomose plus grande et une plus grande facilité de retrait de l'instrument. Dans les deux dernières formes, il est également possible de changer l'enclume pour l'adapter au diamètre différent de la cartouche. In all these forms, it is possible to exchanger a cartridge containing staples and circular knife. These cartridges, although described in the invention with four outside diameters of 21, 25, 28, 31 mm, can be manufactured with any diameter. They may contain one or more circular rows of staples although two annular rows arranged concentrically and staggered are preferable. These two annular rows and the circular knife surrounded by them ooze arranged so as to occupy a minimum of width, which allows residual light after larger anastomosis and greater ease of removal of the instrument. In the last two forms, it is also possible to change the anvil to fit the different diameter of the cartridge.
4 - De part sa flexibilité et la possibilité de differentes longueurs des éléments flexibles, l'instrument de cette invention pourra entre introduit par les orifices digestifs naturels (anus, bouche) et éviter certaines incisionslongitudinales sur le tube digestif, (incisions qui servaient à l'introduction de l'instrument dans ce meme tube digestif afin de confectionner l'anastomose circulai re et qui devaient être refermées à la fi n de lJopérstion). Le cout et la durée de l'intervention s'en trouvent ainsi diminuées. 4 - Because of its flexibility and the possibility of different lengths of flexible elements, the instrument of this invention can between introduced by the natural digestive orifices (anus, mouth) and avoid certain longitudinal incisions on the digestive tract, (incisions which were used for introduction of the instrument into the same digestive tract to make the circulatory anastomosis and which had to be closed at the end of the operation). The cost and duration of the procedure are thus reduced.
5- De part ces memes caractéristiques et la possibilité d'extraction de la cartouche et de l'enclume, l'instrument permettrait une nouvelle possibilité d'introduction par voie buccale particulièrement intéressante en chirurgie oesophagienne. 5- Given these same characteristics and the possibility of extraction of the cartridge and the anvil, the instrument would allow a new possibility of introduction by oral particularly interesting in esophageal surgery.
6 -L'instrument, selon l'invention, est pourvu d'un dispositif permettant de fournir une indication visuelle, sur une échelle millimétrique colorée, de la distance séparant la cartouche (contenant les agrafes et le couteau) de l'enclume. Ceci permet un ajustement précis de cette distance afin de la faire rentrer dans l'intervalle opératoire qui correspond à l'épaisseur des tissus des organes tubulaires humains à anastomoser. Cette meme échelle permet, une fois l'anastomose terminee, de visualiser l'enclenchement du système d'agrafage et de section par le couteau. 6 -The instrument according to the invention is provided with a device for providing a visual indication, on a colored millimeter scale, the distance between the cartridge (containing the staples and the knife) of the anvil. This allows a precise adjustment of this distance to bring it into the operating range which corresponds to the thickness of the tissues of the human tubular organs to be anastomosed. This same scale allows, once the anastomosis is completed, to visualize the engagement of the stapling and sectioning system by the knife.
7- Les instruments d'agrafages chirurgicaux circulaires antérieurs comportent une tige coaxiale rigide de régalage dont le diamètre est important. Ceci confère à ces instruments une faible distance entre cette tige coaxiale et le couteau et, de ce fait, moins de sécurité dans l'agrafage des tissus humains qui ont tendance à se rétracter. (Les collerettes de coupes résiduelles après l'anastomose sous forme de bague sont tres étroites.)
L'instrument selon l'invention comprend une tige flexible coaxiale d'un diamètre très faible (lmmou meme moins) permettant d'augmenter la distance entre la tige et le couteau circulaire et, par ce biais, une plus grande sécurité d'agrafage (collerette de coupes résiduelles larges). De plus, cette tige, de par sa finesse et son extrémité apicale pointue lui permettant de percer directement la paroi tissulaire ne nécessite pas la confection d'une bourse d'enfouissement dans les parties latérales des anastomoses (dJou gain de temps).7- The prior circular surgical stapling instruments comprise a rigid coaxial rod of regaling of which the diameter is important. This gives these instruments a small distance between this coaxial rod and the knife and, as a result, less security in the stapling of human tissues that tend to retract. (The flanges of residual cuts after the anastomosis in the form of a ring are very narrow.)
The instrument according to the invention comprises a coaxial flexible rod with a very small diameter (1 mm or even less) making it possible to increase the distance between the rod and the circular knife and, by this means, greater security of stapling ( collar of large residual cuts). In addition, this rod, because of its fineness and pointed apical end allowing it to directly pierce the tissue wall does not require the construction of a burying pouch in the lateral parts of the anastomoses (or saving time).
8- L'instrument selon l'invention peut entre muni d'un dispositif apical integré à 17ins- trument et pouvant être associé ou dissocie de lui, servant à la dilatation non traumatisante des lumieres des tubes digestifs à anastomoser, afin d'adapter la cartouche (contenant agrafes et couteau) la plus proche. Ce meme dispositif facilite une fois l'anastomose terminée le retrait de l'instrument hors de la zone d'anastomose. The instrument according to the invention can be fitted with an apical device integrated with the instrument and capable of being associated or dissociated from it, serving for the non-traumatic dilation of the lumens of the digestive tubes to be anastomosed, in order to adapt the cartridge (containing staples and knife) nearest. This same device facilitates once the anastomosis is complete removal of the instrument outside the area of anastomosis.
La présente invention fournit un instrument flexible d'agrafage chirurgical circulaire utilisable pour la Jonction d'organes tubulaires du corps humain tels que les organes du tube digestif. The present invention provides a flexible circular surgical stapling instrument for use in joining tubular organs of the human body such as organs of the digestive tract.
L'instrument est composé d'une "tête", d'un "corps" et d'un manche". La téte de cet instrument est formée d'une cartouche amovible. Cette cartouche est composée d'un segment de cx71indre creux fermé par un cane ou un hémisphère à son sommet. Cette cartouche comporte un mécanisme de propulsion de deux rangées circulaires d'agrafes et d'un couteau circulaire vers une enclume lors de la manipulation d'une manette située sur le manche. Ceci par un mécanisme de traction sur un câble flexible tendu entre la cartouche et une manette sur le manche de l'instrument La base annulaire de la cartouche est creusée de formations alvéolaires, chacune re ceptrice d'une agraire, disposées concentriquement en deux rangées quinconcées. Entre l'élément propulseur des agrafes et le couteau circulaire, dénommés "marteau" d'une part, et la base de la cartouche d'autre part se trouve un ressort de compression. Celui-ci ne permet la sortie des agrafes et du couteau hors de la cartouche qu'une fois comprimé. Cela n'est possible que lorsque la cartouche est dans la position la plus proche possible de enclume, grâce à la manipulation de la manette. The instrument is composed of a "head", a "body" and a handle. "The head of this instrument consists of a removable cartridge.This cartridge is composed of a closed hollow cylinder segment. by a cane or a hemisphere at its top.This cartridge has a mechanism for propelling two circular rows of staples and a circular knife towards an anvil when manipulating a lever located on the handle. Tension on a flexible cable stretched between the cartridge and a lever on the handle of the instrument The annular base of the cartridge is hollowed out of cellular formations, each receiving an agrarian, arranged concentrically in two rows quinconcées. propeller element staple and circular knife, called "hammer" on the one hand, and the base of the cartridge on the other hand is a compression spring.The latter allows the release of the staples and knife out of the cartridge that Once compressed, this is only possible when the cartridge is in the position as close as possible to the anvil, thanks to the manipulation of the joystick.
L'enclume pouvant être également amovible comporte plusieurs creux servant à aplatir les agrafes. Elle est rattachée de façon amovible à l'une des extrémités du corps. Ce corps est composé d'un tuyau métallique spirale (similaire à un tuyau flexible de douche) permettant une flexibilité dans l'espace et une rigidité dans le sens axial de l'instrument une fois comprimé. 11 est rattaché à son autre extrémité au manche. Ce manche contient une manette à laquelle est rattache le cable qui passe axialement dans l'instrument jusqu'au marteau à travers enclume et le corps. The anvil can also be removable has several recesses for flattening the staples. It is attached removably to one end of the body. This body is composed of a spiral metal pipe (similar to a shower hose) allowing flexibility in space and rigidity in the axial direction of the instrument once compressed. It is attached at its other end to the handle. This handle contains a joystick to which is attached the cable that passes axially in the instrument to the hammer through anvil and the body.
Une fenêtre au niveau du manche montre ce câble sur lequel est dessiné une échelle millimétrique colorée permettant de connaître la distance cartouche/enclume dans un premier temps puis la distance marteau/enclume dans un second temps. A window at the handle shows the cable on which is drawn a colored millimeter scale to know the cartridge / anvil distance at first and then the distance hammer / anvil in a second time.
L'instrument peut en outre entre pourvu à l'extrémité de la cartouche d'un ballonnet en caoutchouc gonflable à distance à partir du manche de l'instrument et qui sert à la dilatation non traumatisante des lumières des tubes digestifs à anastomoser et pour le retrait de l'instrument hors de la zone d'anastomose après l'opération. The instrument can furthermore be provided at the end of the cartridge with an inflatable rubber balloon at a distance from the handle of the instrument and which serves for the non-traumatic dilation of the lumens of the digestive tubes to be anastomosed and for the removal of the instrument from the anastomosis area after the operation.
Deux variantes de ce dispositif sont proposes. Dans la première variante, préférable, car peu coûteuse, un ballonnet sous forme de doigt de gant est adapté sur le cone ou l'hémisphère du sommet de l'instrument et gonflé à l'extrémité du manche via un conduit sérique ou liquidien fixe dans l'instrument (å l'aide d'une seringue, par exemple). Two variants of this device are proposed. In the first variant, which is preferable because it is inexpensive, a balloon in the form of a thimble is adapted to the cone or hemisphere of the top of the instrument and inflated at the end of the handle via a fixed serum or fluid duct in the instrument (eg with a syringe).
La seconde variante utilise une sonde à ballonnet dont plusieurs type sont déjà commercialises, qui passent d'une extrémité de l'instrument à l'autre. Ceci est possible grâce à la réalisation d'un axe central linéaire et creux d'un bout à l'autre de l'instrument. The second variant uses a balloon probe of which several types are already commercialized, which pass from one end of the instrument to the other. This is possible thanks to the realization of a central axis linear and hollow from one end to the other of the instrument.
D'autres avantages et caractéristiques de l'invention seront mis en évidence dans la suite de la descriptiont donnée à titre d'exemples non limitatifs en référence aux dessins annexés:
- Figure I : vue en élévation latérale fragmentaire de l'instrument conforme à l'invention.Other advantages and characteristics of the invention will be demonstrated in the following description given as non-limiting examples with reference to the accompanying drawings:
- Figure I: fragmentary side elevational view of the instrument according to the invention.
- Figure Il vue en coupe longitudinale fragmentaire de l'instrument suivant la ligne A-A de la Figure I. - Figure II fragmentary longitudinal sectional view of the instrument along the line A-A of Figure I.
- Figure III : vue en coupe longitudinale partielles à échelle agrandie de l@ "tête" (cartouche) de l'instrument. - Figure III: partial longitudinal sectional view on an enlarged scale of the "head" (cartridge) of the instrument.
- Figure IV :agrandissement de la portion encerclee dans la Figure I I I. - Figure IV: enlargement of the portion encircled in Figure I I I.
- Figure @: vue en coupe transversale de la tete de l'instrument suivant la ligne B-B de la
Figure II. - Figure @: Cross-sectional view of the head of the instrument along line BB of the
Figure II.
- Figure VI: vue en coupe transversale de la base de la cartouche (vue suivant la ligne
C-C de la Figure II).- Figure VI: cross-sectional view of the base of the cartridge (view along the line
CC of Figure II).
- Figure VII: vue en coupe transversale de l'enclume de l'instrument (vue suivant la ligne D-D de la Figure II). - Figure VII: cross-sectional view of the anvil of the instrument (seen along the line D-D of Figure II).
- Figure VIII: agrandissement de la portion encerclée dans la Figure VII montrant une paire de creux servant à l'écrasement d'une agrafe. - Figure VIII: enlargement of the portion encircled in Figure VII showing a pair of recesses for crushing a staple.
- Figure IX : vueen coupe fragmentaire faîte suivant la ligne E-E de la Figure VIII. - Figure IX: fragmentary sectional view taken along the line E-E of Figure VIII.
- Figure X : vue en coupe longitudinale de différentes étapes dans la réalisation d'une anastomose latéro-terminale entre gros intestin et petit intestin. - Figure X: longitudinal sectional view of different stages in the realization of a late-terminal anastomosis between large intestine and small intestine.
Les Figures I et II exposent l'instrument dans son ensemble. II comporte une tette (1), un corps (2) et un manche (3). Figures I and II show the instrument as a whole. It comprises a tette (1), a body (2) and a handle (3).
Les parties sont en matiere plastique et/ou en métal de manière à convenir pour une utilisation dans un environnement chirurgical.Stérilisable par des mouens conventionnels, lin- vention se prête à une fabrication sous forme d un instrument à usage unique (jatable après un seul usage), d'un instrument à usage multiple chez le même patient sans être restérilisé lors de la même séance opératoire) ou d'un instrument du type permanent et réutilisable d'un patient à l'autre après restérilisation.
htitred'exemple, nous allons le décrire soussaformeà usage multiple chez le meme patient.The parts are made of plastic and / or metal so as to be suitable for use in a surgical environment. Sterilizable by conventional slings, the invention lends itself to manufacture in the form of a disposable instrument (disposable after a single use), a multipurpose instrument in the same patient without being re-sterilized during the same operating session) or an instrument of the permanent type and reusable from one patient to another after resterilization.
For example, we will describe it as a multiple-use form for the same patient.
La tête (1) de l'instrument exposé de façon détaillée dans la Figure III se presente sous forme d'une cartouche amovible du reste de l'instrument. Elle est composée d'un segment de cylindre creux (11) réalisé préférentiellement en matiere plastique moulée. La base (12) de ce culi ndre (1 1) qui est en regard de l'enclume (18) (qui sera decrite ultérieurement), est élargie et annulaire d'une hauteur de 6mm environ et creusée de formations alvéolaires ( (13) réceptrices chacune d'une agrafe (14), disposées concentriquement en deux rangers quinconcées préférentiellement. The head (1) of the instrument shown in detail in Figure III is in the form of a cartridge removable from the rest of the instrument. It is composed of a hollow cylinder segment (11) preferably made of molded plastic material. The base (12) of this culi ndre (1 1) which is opposite the anvil (18) (which will be described later), is enlarged and annular with a height of about 6mm and hollowed out of alveolar formations ((13 ) each receiving a staple (14), arranged concentrically in two rows quinconcés preferentially.
Les agrafes métalliques (14) logées dans ces formations alvéolaires (13) ont une forme en U inverse.
la Figure VI montre cette base (12) de la cartouche (1) avec ses formations alvéolaires guides d'agrafes, dont une paire a été numérotée (1 (13) à titre d'exemple.The metal staples (14) housed in these cellular formations (13) have an inverse U shape.
Figure VI shows this base (12) of the cartridge (1) with its alveolar staple guide formations, a pair of which has been numbered (1 (13) by way of example.
A l'intérieur du cylindre (11), se trouve le marteau composé d'un élément propulseur des agrafes ( 15) et un couteau circulaire (16). Inside the cylinder (11) is the hammer composed of a propelling element staples (15) and a circular knife (16).
L'élément propulseur des agrafes est constitué d'une rondelle pleine dont la périphérie porte des doigts chasseurs d'agrafes (17) disposés concentriquement en deux rangées quinconcées préférentiellement et correspondant en nombre et en place aux formations alvéolaires guides d'agrafes (13) decrites plus haut. Ainsi, ces doigts chasseurs d'agrafes peuvent entrer et sortir librement dans les formations alvéolaires comme dans un jeu mâle/femelle. The propelling element of the staples consists of a solid washer whose periphery carries staple-hunting fingers (17) arranged concentrically in two rows preferably staggered and corresponding in number and in place to the staple guide honeycomb formations (13). described above. Thus, these staple hunting fingers can enter and exit freely in the alveolar formations as in a male / female game.
L'élément propulseur d'agrafes peut etre réalisé de manière simple à partir de deux rondelles métalliques rayonnées, puis plicaturées et soudées ou collées, mais une fabrication en materiel plastique moulé est tout aussi possible. The staple propelling element can be made in a simple manner from two metal washers radiated and then plicated and welded or glued, but a manufacturing molded plastic material is just as possible.
Au centre de l'élément propulseur d'agrafes, et parallèlement auxdoigt@ chasseurs, est soude ou collé le couteau métallique circulaire (1 6). Celui-ci, taillé sur un segment cyli ndrique métal- lique, a le diamètre le plus proche possible du diamètre interne de la base de la cartouche sans limitation du jeu mâle/femelle décrit précédemment. In the center of the staple propelling element, and parallel to the hunters, is welded or glued the circular metal knife (1 6). The latter, cut on a cylindrical cylindrical segment, has the diameter as close as possible to the internal diameter of the base of the cartridge without limitation of the male / female clearance previously described.
La base pleine du marteau (19) comporte en son centre un orifice (20 > circulaire à méplat qui épouse exactement la forme de la tranche de section du cable flexible (21) qui le pénètre et qui sera décrit ultérieurement. The solid base of the hammer (19) comprises in its center a hole (20> circular flat which exactly matches the shape of the section of the flexible cable section (21) which penetrates and will be described later.
Un ressort à compression (22) est interposé entre l'élément propulseur des agrafes (de préférence entre les rangées circulaires des doigts chasseur agrafes d'une part et la base de la cartouche d'autre part). L'intérêt de celui-ci sera expliqué ultérieurement. A compression spring (22) is interposed between the staple propelling element (preferably between the circular rows of the staple hunting fingers on the one hand and the base of the cartridge on the other hand). The interest of this one will be explained later.
Le segment de cylindre (il) contenant le marteau (15+ 16) avec le ressort à compression (22) interposé, est fermé à sa seconde base par une surface annulaire (23) qui empêche la sortie du marteau hors du segment de cylindre. Cette surface annulaire possede un diamètre interne (24) fileté de manière à pouvoir recevoir l'épaulement fileté de la base d'un cêne ou d'une hémisphère (25) surmontant le segment de cylindre et épousant à sa base le meme diamètre externe que celui du segment de cylindre (11). The cylinder segment (11) containing the hammer (15 + 16) with the interposed compression spring (22) is closed at its second base by an annular surface (23) which prevents the exit of the hammer from the cylinder segment. This annular surface has an internal diameter (24) threaded so as to be able to receive the threaded shoulder of the base of a shaft or hemisphere (25) surmounting the cylinder segment and conforming at its base to the same external diameter as that of the cylinder segment (11).
Le corps (2) de l'instrument est composé d'un tuyau métallique spiralé (26) similaire à un flexible de douche (ou d'un ressort à traction gainé de même calibre), lui conférant une flexibilité dans l'espace et une rigidité dans le sens axial une fois comprime. Ce tuyau peut entre d'une longueur qui varie en fonction des besoins chirurgicaux. Un bouchon (27) métallique ou en plas- tique maintenu de façon fixe par soudage ou collage vient obturer l'extrémité (28) du tuyau spiralé.Ce bouchon troué à sa base (29) pour laisser passage au câble (21), comporte une rainure annulaire (30) qui est adaptée à un épaulement annulaire d'une pièce intermédiaire (31). La pièce intermédiaire peut par ce biais tourner librement dans le bouchon (27). La pièce intermédiaire (31) comporte un creux axial (32) qui est fileté intérieurement de manière à pouvoir être vissé sur l'épaulement fileté (33) de l'enclume (18). The body (2) of the instrument is composed of a spiral metal pipe (26) similar to a shower hose (or a sheathed tension spring of the same caliber), giving it flexibility in space and rigidity in the axial direction once compressed. This hose can be between a length that varies depending on the surgical needs. A plug (27) made of metal or plastic fixedly held by welding or gluing closes the end (28) of the spiral pipe.This plug with a hole in its base (29) for passing through the cable (21) comprises an annular groove (30) which is adapted to an annular shoulder of an intermediate piece (31). The intermediate piece can thereby rotate freely in the cap (27). The intermediate piece (31) has an axial recess (32) which is threaded internally so as to be screwed onto the threaded shoulder (33) of the anvil (18).
L'enclume métallique (1 8) a de préférence un profil tronconique pour faciliter le retrait de l'instrument après son utilisation. Son sommet est surmonté d'un épaulement (33) fileté extérieurement. L'enclume est traversée axialement par un trou circulaire à méplat (34) qui épouse exactement la forme de la tranche de section du cale flexible (21) qui le traverse. The metal anvil (18) preferably has a frustoconical profile to facilitate removal of the instrument after use. Its top is surmounted by a shoulder (33) threaded externally. The anvil is traversed axially by a circular hole flat (34) which fits exactly the shape of the section of section of the flexible shim (21) passing through.
La base de l'enclume (Figure VII) d'un diamètre équivalent à celui de la base de la cartouche (Figure VI) qu'elle regarde, est creusee dans sa partie centrale. Ce creux (35) a un diamètre très légèrement supérieur à celui du couteau circulaire (1 6) qui va venir s'y loger lors du fonctionnement de l'instrument. Ce creux agit comme une plaquette de coupe pour le couteau circulaire en soutenant le tissu en train autre découpé. La partie périphérique de la base de l'enclume se présente sous forme d'une collerette annulaire plane (36) de dimension similaire à la surface annulaire (37) de la base de la cartouche (1) qu'elle regarde. The base of the anvil (Figure VII) of a diameter equivalent to that of the base of the cartridge (Figure VI) that it looks, is hollowed in its central part. This hollow (35) has a diameter slightly greater than that of the circular knife (1 6) which will be housed there during operation of the instrument. This hollow acts as a cutting insert for the circular knife supporting the fabric in another cut-out train. The peripheral portion of the base of the anvil is in the form of a flat annular flange (36) of similar size to the annular surface (37) of the base of the cartridge (1) that it looks.
La collerette annulaire (36) comporte des petits creux (38) disposés concentriquement en miroirs avec les formations alvéolaires guides d'agrafes (13) de sorte que lors de la propulsion des agrafes, chacune de celles-ci vient s'ecraser dans une paire de petits creux. Chaque paire de petits creux (Figure VIII et IX) a une forme telle que l'agrafe en U inversé qui vient s'y écra- serJ va recevoir la forme d'un B couché. The annular flange (36) has small recesses (38) arranged concentrically in mirrors with the staple guide honeycomb formations (13) so that when the staples are propelled, each of them is crushed into a pair. small hollow. Each pair of small depressions (FIGS. VIII and IX) has a shape such that the inverted U-shaped clip which is crushed therein will receive the shape of a coated B.
La seconde extrémité du tuyau spirale 39) est fixee au manche (3J. Pour ce faire, un épaulement annulaire (40) est adapte à une rainure annulaire (41) sur le manche que l'on va décrire maintenant. The second end of the spiral pipe 39) is attached to the handle (3J, to do this, an annular shoulder (40) is fitted to an annular groove (41) on the handle which will now be described.
Le manche (3) est forme de deux moitiés symétriques qui sont réalises en matière plastique moulée et qui sont solidairement assemblées par soudages de façon bien connue. The handle (3) is formed of two symmetrical halves which are made of molded plastic and which are solidly assembled by welding in a well known manner.
Ces deux moities comportent toutes les deux une fenêtre transparente (42) au milieu de laquelle apparaît un repère fléché (54). Les extrémités (43) et (44) qui se poursuivent avec l'axe central de l'instrument ont toutes deux une configuration cylindrique. Ces configurations cylindriques comportent en leur partie interne un épaulement annulaire chacune. L'épaulement annulaire (45) s'sdapte à la rainure annulaire (46) du tuyau spiralé (26) alors que l'epau- lement annulaire (47) s'adapte à la rainure annulaire (48) sur la manette (46) de l'instrument. These two moities both include a transparent window (42) in the middle of which appears an arrowed mark (54). The ends (43) and (44) which continue with the central axis of the instrument both have a cylindrical configuration. These cylindrical configurations comprise in their inner part an annular shoulder each. The annular shoulder (45) is adapted to the annular groove (46) of the spiral pipe (26) while the annular shoulder (47) fits to the annular groove (48) on the handle (46). of the instrument.
L'axe du manche passant par les extrémités (43) et (44) laisse persister un tunnel creux (57) qui se poursuit avec la lumière du tuyau spiralé et correspondant à l'axe central de l'instrument (ligne A-A de la figure I).
ta manette de l'instrument (46) est indétachable du manche grace à ses rainures (48, 49) adaptées aux épaulements (47, 50) de ce manche et dotee d'une possibilité de mouvement circulaire sutour de l'axe central de l'instrument. Faite en matière plastique moulée, cette manette possède un prolongement cylindrique (51) qui passe dans le tunnel creux (57) du manche.The axis of the handle passing through the ends (43) and (44) leaves a hollow tunnel (57) which continues with the light of the spiral pipe and corresponding to the central axis of the instrument (line AA of FIG. I).
your handle of the instrument (46) is indétachable the handle thanks to its grooves (48, 49) adapted to the shoulders (47, 50) of this sleeve and provided with a possibility of circular movement sutour of the central axis of the 'instrument. Made of molded plastic, this handle has a cylindrical extension (51) which passes into the hollow tunnel (57) of the handle.
Ce prolongement cylindrique (51) est lui-même creux sur toute sa longueur et jusque l'extrémité (58) dola manette. il estfiletédanssa partie intérieure de sorte que lors de la manipulation de la manette, le prolongement culindrique vient se visser sur la vis (52). Cette vis constitue l'extrémité terminale d'un câble fin et flexible (21) dont la tranche de section circulaireà méplat épouse exactement la forme des orifices (34) et (20) de l'enclume et du marteau qu'il traverse. Cette disposition permet une adaptation maximale des doigts chasseurs d'agrafes (17) contre les petits creux (38) de l'enclume lorsque l'instrument est ferme. L'autre extrémi- te du câble est filetée extérieurement sur 5mm environ afin de pouvoir recevoir l'écrou (53). Sa terminaison est pointue (60) afin de pouvoir percer les tissus humains. Le câble (21) qui traverse l'axe central de l'instrument du manche jusqu'au marteau, porte une échelle millimétrée visible à travers les fenêtres transparentes (42). La flèche (54) sur le manche de l'instrument indique le poin This cylindrical extension (51) is itself hollow throughout its length and to the end (58) dola joystick. it isfiletédanssa inner part so that when handling the lever, the culindrique extension is screwed on the screw (52). This screw constitutes the end end of a thin and flexible cable (21) whose slice of circular section flattened exactly matches the shape of the orifices (34) and (20) of the anvil and the hammer through which it passes. This arrangement allows a maximum adaptation of the staple hunting fingers (17) against the small recesses (38) of the anvil when the instrument is closed. The other end of the cable is threaded externally about 5mm in order to receive the nut (53). Its termination is sharp (60) in order to pierce human tissue. The cable (21) which crosses the central axis of the instrument from the handle to the hammer, carries a millimeter scale visible through the transparent windows (42). The arrow (54) on the handle of the instrument indicates the point
Nous allons maintenant décrire comment l'instrument selon l'invention est utilise et fonctionne. We will now describe how the instrument according to the invention is used and works.
A titre d'exemple, nous allons décrire le fonctionnement de l'instrument en référence, avec une simple opération d'anastomose latéro-terminale entre gros intestin et petit intestin (Fiqure X). As an example, we will describe the operation of the instrument with reference, with a simple operation of late-terminal anastomosis between large intestine and small intestine (Fiqure X).
La première étape consiste à enlever la cartouche amovible. Pour ce faire, on dévisse le cone ou l'hémisphère (25), puis l'écrou (53) et on retire le segment de cylindre (11). L'instrument dénudé de sa cartouche est alors introduit dans la lumière du gros intestin (Figure Xa > . The first step is to remove the removable cartridge. To do this, we unscrew the cone or the hemisphere (25), then the nut (53) and remove the cylinder segment (11). The stripped instrument of its cartridge is then introduced into the lumen of the large intestine (Figure Xa>.
La terminaison pointue du cale flexible perce le gros intestin à l'endroit souhaité pour l'anastomose (Figure Xb). De par la finesse du câble flexible et de son extrémité pointue, aucune bourse sur cette partie latérale de l'anastomose n'est donc nécessaire. The pointed end of the flexible wedge pierces the large intestine at the desired location for the anastomosis (Figure Xb). Because of the fineness of the flexible cable and its pointed end, no purse on this lateral part of the anastomosis is therefore necessary.
Par manipulations de la manette de l'instrument dans un sens inverse à celui des aiguilles d'une montre, un rallongement de la partie extériorisée du câble à travers l'enclume se produit (Figure Xc) et affiche sur la fenêtre transparente des valeurs de plus en plus positives. Cette "ouverture" vient à etre limitée aux alentours de 60 à 70mm lorsque l'épaulement (55) de la vis (52) vient buter contre le butoir (56) à l'extrémité proximale du manche. By manipulating the joystick of the instrument in a counterclockwise direction, an extension of the externalized part of the cable through the anvil occurs (Figure Xc) and displays on the transparent window values of more and more positive. This "opening" is limited to around 60 to 70mm when the shoulder (55) of the screw (52) abuts against the stopper (56) at the proximal end of the handle.
La cartouche de l'instrument et alors réinsérée sur le cale (Figure Xd). Il est à ce stade important de bien veiller au bon positionnement du méplat du cible avec le méplat de l'orifice circulaire afin que puisse se faire l'adaptation maximale des doigts chasseurs d'agrafes contre les petits creux de l'enclume. The cartridge of the instrument and then reinserted on the hold (Figure Xd). It is important at this point to ensure the correct positioning of the flat part of the target with the flat of the circular hole so that can be made the maximum adaptation of the staple hunting fingers against the small hollow of the anvil.
Une bourse est faufilée sur l'extrémité terminale de l'intestin grêle à anastomoser. La cartouche et alors introduite par son extrémité conique ou hémisphérique à travers la lumière de l'intestin grêle à anastomoser et préalablement prépare afin que son calibre puisse recevoir la tette de l'instrument qui est la cartouche. ta bourse est dès lors serre autour du cable (Figure
Xe).A purse is threaded on the terminal end of the small intestine to be anastomosed. The cartridge and then introduced through its conical or hemispherical end through the lumen of the small intestine to anastomose and previously prepared so that its caliber can receive the tette of the instrument which is the cartridge. your purse is then tightened around the cable (Figure
Xe).
Cette préparation peut se faire bien évidemment à l'aide de bougies métalliques de calibre progressivement croissant. Mais il est de loin préférable d'utiliser la variante de notre instrument comportant le dispositif intégré de dilatation par ballonnet gonflable qui est atraumatique et de plus beaucoup plus commode. Cette variante de l'instrument sera décrite par la suite. This preparation can be done obviously with the help of metal candles gradually increasing caliber. But it is far better to use the variant of our instrument with the integrated device of inflatable balloon dilation which is atraumatic and moreover much more convenient. This variant of the instrument will be described later.
Par manipulation de la manette de l'instrument dans le sens des aiguilles d'une montre, un raccourcissement du câble et un rapprochement concomitant de la cartouche vers l'enclume se produisent. Ce mouvement de "fermeture" s'affiche sur la fenêtre transparente par un retour vers la valeur zéro. Les valeurs affichées traduisent à ce marnent la distance séparant la base de la cartouche de la base l'enclume. Une petite résistance tactile à la poursuite du mouvement de fermeture est ressentie par l'opérateur une fois arrivée à la valeur de l'intervalle opératoire et qui vient à être affichée sur la fenêtre transparente (valeur de l'ordre de 3 à 4mm environ). Cet intervalle opératoire correspond aux épaisseurs des tissus à joindre. Ces derniers sont interposés entre la base de la cartouche et l'enclume (somme des épaisseurs du petit et du gros i ntesti ns dans l'exemple présenté (Figure Xf)). Cet intervalle aurait pu être mesuré préalablement par le chirurgien (par exemple à l'aide d'instruments de mesure d'épaisseur de tissus décrits au brevet
FR 80 26721). La résistance tactile décrite précédemment est liee au ressort à compression (22) interposé entre l'élément propulseur des agrafes et la base de la cartouche et dont le rie est d'éviter la sortie des agrafes et du couteau circulaire hors de la cartouche tant que l'intervalle opératoire n'est pas atteint.By manipulating the instrument handle in a clockwise direction, shortening of the cable and concomitant approximation of the cartridge to the anvil occur. This "closing" movement is displayed on the transparent window by a return to the zero value. The displayed values translate to this marnent the distance separating the base of the cartridge from the base the anvil. A small tactile resistance to the pursuit of the closing movement is felt by the operator when he reaches the value of the operating interval and which is to be displayed on the transparent window (value of the order of 3 to 4 mm approximately) . This operating interval corresponds to the thickness of the tissues to be joined. The latter are interposed between the base of the cartridge and the anvil (sum of the thicknesses of the small and large nests in the example presented (Figure Xf)). This interval could have been measured beforehand by the surgeon (for example by means of tissue thickness measuring instruments described in the patent
FR 80 26721). The tactile resistance described above is related to the compression spring (22) interposed between the staple propelling element and the base of the cartridge and whose ria is to avoid the exit of the staples and the circular knife out of the cartridge as long as the operative interval is not reached.
La poursuite du mouvement de fermeture contre cette résistance provoque une traction du marteau vers l'enclume. Les agrafes contenues dans les formations alvéolaires guides d'agrafes sont alors propulsées par les doigts chasseurs d'agrafes vers les petits creux de l'enclume. Elles traversent les épaisseurs des deux tissus à joindre situés dans l'intervalle opératoire et s'ecrasent dans les petits creux. C'est alors quelles prennent une forme de B couché. Continuing the closing movement against this resistance causes a pull of the hammer towards the anvil. The staples contained in the alveolar formations staple guides are then propelled by the staple hunting fingers to the small recesses of the anvil. They cross the thicknesses of the two tissues to be joined located in the operative interval and crush in the small hollow. It is then that they take a B-lying form.
De façon concomitante, le couteau circulaire s'enfonce vers le creux (35) de l'enclume coupant à son passage comme à l'emporte-pièce, deux rondelles de tissus au dépens de chacun des tissus à joindre. (Une rondelle de gros intestin et une rondelle d'intestin grêle dans l'exemple présenté.) Ceci dans le but de rétablir une lumière entre les deux segments tubulaires du tube digestif à joinre. Cette lumière est plus grande que dans les instruments à anastomose circulaire rigide actuellement sur le marché (brevets US 3.315.863, US 3.494.533, FR 8100575) grâce au diamètre du couteau circulaire conçu pour avoir le diamètre le plus proche possible du diamètre interne de la base de la cartouche. Ceci diminue d'une part le risque de sténose de l'ana- stomoxe et facilite le retrait de 1 'instrument d'autre part. Par ailleurs, de part le diamètre de ce couteau circulaire précédemment decrit et le faible calibre du cabale flexible (21) > une plus grande distance entre tige axiale et couteau circulaire est obtenue. Ceci confère à cet instrument une plus grande sécurité de l'anastomose en donnant des collerettes annulaires de coupe tres large (rondelles pleines pratiquement). Concomitantly, the circular knife sinks towards the recess (35) of the anvil cutting in its passage as the punch, two washers of tissue at the expense of each of the tissues to be joined. (A slice of large intestine and a slice of small intestine in the example presented.) This is to restore light between the two tubular segments of the digestive tract to be joined. This light is larger than in rigid circular anastomosis instruments currently on the market (US Pat. No. 3,315,863, US Pat. No. 3,494,533, FR 8100575) due to the diameter of the circular knife designed to have the diameter as close as possible to the internal diameter. from the base of the cartridge. This decreases the risk of anastomosis stenosis and facilitates removal of the instrument from the other hand. Moreover, because of the diameter of this circular knife previously described and the low caliber of the flexible cabal (21)> a greater distance between axial rod and circular knife is obtained. This gives this instrument greater safety of the anastomosis by giving annular collars very wide cut (practically full washers).
Le bon deroulement de l'anastomose se traduit au niveau de la fenêtre transparente par une baisse de la valeur affichée de quelques millimetres (3 à 4mm en moyenne par rapport à la valeur de l'intervalle opératoire affiché antérieurement). The good progress of the anastomosis is reflected in the transparent window by a drop in the displayed value of a few millimeters (3 to 4mm on average compared to the value of the operating interval previously displayed).
La dernière etape consiste à retirer l'instrument hors des lumières digestives une fois l'anastomose terminée. Pour ce faire, une réouverture de l'instrument est nécessaire (Figure
Xg).Cette réouverture va libérer la collerette annulaire anastomotique saisie entre la base de la cartouche et la base de l'enclume quand l'instrument est fermé. Puis, un mouvement de rota tionZenfoncement de l'instrument fait passer l'enclume au-dessus de cette collerette annulaire anastomotique. L'instrument est alors refermé. Par un mouvement de rotation/traction, il est retire hors des lumières digestives en repassant par la zone d'anastomose. Le profil tronconique de l'enclume facilite ce passage qui peut eAtre par silleurs encore plus facilite par les instrument comportant l'option du ballonnet gonflable apical que nous allons décrire maintenant.The final step is to remove the instrument from the digestive lumen once the anastomosis is complete. To do this, a reopening of the instrument is necessary (Figure
Xg). This reopening will release the anastomotic ring collar seized between the base of the cartridge and the base of the anvil when the instrument is closed. Then, a rotational movement. Depression of the instrument causes the anvil to pass above this annular anastomotic collar. The instrument is then closed. By a movement of rotation / traction, it is removed out of the digestive lumens by ironing by the zone of anastomosis. The frustoconical profile of the anvil facilitates this passage, which can be made even easier by instruments with the option of the inflatable balloon apical we will now describe.
Le modèle à option ballonnet apical gonflable est similaire en tous points au modèle de base del'instrumentque nous avons décrit en détails jusqu'à présent. Il comporte par rapport au modèle de base un axe central d'instrument creux sur toute sa longueur du centre de la manette (58) Jusqu'au sommet du cône ou de l'hémisphère (59). Cet axe central creux est constitue par la succession d'une manette à prolongement cylindrique creuse sur toute sa longueur, dune vis (52) creuse le long de son axe poursuivie d'un câble flexible (21) creux également le long de son axe et jusqu'à sa terminaison pointue (60) à son autre extrémité. Cette succession d'éléments creux aboutit à la formation d'un conduit étanche par lequel peut se faire une injection d'air ou de liquide. L'orifice (58) au centre de la manette est de diamètre convenable pour recevoir l'embout d'une seringue par laquelle l'air ou le liquide sont injectés. The inflatable apical balloon option model is similar in all respects to the basic model of the instrument we have described in detail so far. It has in relation to the basic model a central hollow instrument axis along its entire length from the center of the handle (58) to the apex of the cone or the hemisphere (59). This hollow central axis is constituted by the succession of a cylindrical extension handle hollow over its entire length, a screw (52) hollow along its axis continued with a flexible cable (21) also hollow along its axis and until its pointed end (60) at its other end. This succession of hollow elements results in the formation of a sealed conduit through which an injection of air or liquid can take place. The orifice (58) in the center of the handle is of suitable diameter to receive the tip of a syringe through which air or liquid is injected.
Le cône ou l'hémisphère à la tête de l'instrument est troue à son sommet de sorte que l'air ou le liquide injecté par le centre de la manette va s'échapper par ce trou (59). The cone or hemisphere at the top of the instrument is pierced at its top so that air or liquid injected through the center of the handle will escape through this hole (59).
Les ballonnets gonflables sont faits d'une matière en caoutchouc ou d'une matière synthé- tique similaire. Deux variantes de l'option ballonnet gonflable apical sont proposes. Dans une premiere variante (Figure Xl), qui nous semble préférable, car peu couteuse, un ballonnet en forme de doigt de gant (61) est manchonné par sua base autour de l'épaulement fileté (25) du cone ou de l'hémisphère préalablement dévissé du segment de cylindre (11). Ce cône ou hémisphère manchonné du ballonnet est ensuite revissé sur le segment de cylindre cylindre (un joint torique peut être necessaire entre la base du cône ou de l'hémisphère et la base du segment de cylindre pour garder l'étanchéité). Dès lors une seringue adaptée sur l'orifice (58) au centre de la manette va pouvoir gonfler ce ballonnet avec de l'air ou du liquide. Inflatable balloons are made of a rubber material or a similar synthetic material. Two variants of the apical inflatable balloon option are proposed. In a first variant (FIG. Xl), which seems to us preferable because it is inexpensive, a balloon in the form of a thimble (61) is cuffed by its base around the threaded shoulder (25) of the cone or the hemisphere previously unscrewed from the cylinder segment (11). This cone or cuffed hemisphere of the balloon is then screwed onto the cylinder cylinder segment (an O-ring may be needed between the base of the cone or hemisphere and the base of the cylinder segment to keep the seal). Therefore a syringe adapted to the orifice (58) in the center of the lever will be able to inflate this balloon with air or liquid.
Dans une seconde variante (Figure XII), un ballonnet gonflable est porté à l'une des extrémités d'une sonde (62), et gonflable par une seringue à son autre extrémité. Une sonde de ce type (62) peut être introduite dans l'axe central creux de l'instrument afin de retrouver le ballonnet à la tete de l'instrument. Ce ballonnet etant gonflable par l'autre extrémité de la sonde extériorisée par l'orifice (58) de la manette. In a second variant (Figure XII), an inflatable balloon is carried at one end of a probe (62), and inflatable by a syringe at its other end. A probe of this type (62) can be introduced into the hollow central axis of the instrument in order to find the balloon at the head of the instrument. This balloon being inflatable by the other end of the probe exteriorized by the orifice (58) of the joystick.
Cette seconde variante outre son coût plus important que la première, pourrait nécessiter un calibre un peu plus important du cale flexible (21). This second variant in addition to its greater cost than the first, may require a slightly larger caliber of the flexible shim (21).
L'intérêt principal daces modèles à option ballonnetapical gonflable est lié à la dilatation non traumatisante des lumières du tube digestif à anastomoser afin d'introduire l'instrument dans ces lumières (Figure XIII). Elle se faisait jadis par passages successifs de bougies métalliques de calibre progressivement croissant distinctes des instrument à anastomose. Elle se fait dans 1' instrument à option ballonnet apical gonflable du présent brevet par gonflage progressif d'un ballonnet à la rate de l'instrument. Ce mode de dilatation, outre sa propriété atraumatique pour les tissus humains, est d'un gain de temps considérable pour le chirurgien. Par ailleurs, et secon dairement, ce ballonnet gonflable peut faciliter le retrait de l'instrument hors du tube digestif une fois l'anastomose termi nee. The main interest daces inflatable balloonapical option models is related to the non-traumatic dilatation of the lumens of the digestive tract to be anastomosed in order to introduce the instrument into these lumens (Figure XIII). It was formerly made by successive passages of metal candles gradually increasing caliber distinct instruments anastomosis. It is made in the inflatable apical balloon option instrument of the present patent by progressively inflating a balloon at the spleen of the instrument. This mode of expansion, in addition to its atraumatic property for human tissue, is a considerable time saver for the surgeon. Furthermore, and secondarily, this inflatable balloon can facilitate removal of the instrument from the digestive tract once the anastomosis is complete.
Les figures Xlll, XIV et XV montrent la réalisation d'une anastomose latero-terminale entre gros intestin et petit intestin à l'aide de l'instrument à option ballonnet gonflable apical conforme à l'invention. FIGS. XIII, XIV and XV show the realization of a latero-terminal anastomosis between the large intestine and the small intestine using the apical inflatable balloon option instrument in accordance with the invention.
Claims (10)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR9204490A FR2689749B1 (en) | 1992-04-13 | 1992-04-13 | FLEXIBLE SURGICAL STAPLING INSTRUMENT FOR CIRCULAR ANASTOMOSES. |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR9204490A FR2689749B1 (en) | 1992-04-13 | 1992-04-13 | FLEXIBLE SURGICAL STAPLING INSTRUMENT FOR CIRCULAR ANASTOMOSES. |
Publications (2)
Publication Number | Publication Date |
---|---|
FR2689749A1 true FR2689749A1 (en) | 1993-10-15 |
FR2689749B1 FR2689749B1 (en) | 1994-07-22 |
Family
ID=9428782
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
FR9204490A Expired - Lifetime FR2689749B1 (en) | 1992-04-13 | 1992-04-13 | FLEXIBLE SURGICAL STAPLING INSTRUMENT FOR CIRCULAR ANASTOMOSES. |
Country Status (1)
Country | Link |
---|---|
FR (1) | FR2689749B1 (en) |
Cited By (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1998004196A1 (en) | 1996-07-25 | 1998-02-05 | Haviv Toledano | A flexible annular stapler for closed surgery of hollow organs |
WO2002000122A1 (en) * | 2000-06-28 | 2002-01-03 | Genzyme Corporation | Device and method for performing vascular anastomosis |
WO2001066020A3 (en) * | 2000-03-06 | 2002-04-04 | Us Surgical | Apparatus and method for performing a bypass procedure in a digestive system |
EP1728476A2 (en) * | 2005-05-27 | 2006-12-06 | Ethicon Endo-Surgery, Inc. | Instrumentation for carrying out a gastrointestinal bypass |
US7901416B2 (en) | 2001-03-05 | 2011-03-08 | Tyco Healthcare Group, L.P. | Apparatus and method for performing a bypass procedure in a digestive system |
EP3031403A1 (en) * | 2007-03-15 | 2016-06-15 | Ethicon Endo-Surgery, Inc. | Re-loadable surgical stapling instrument |
EP3205288A1 (en) * | 2016-02-10 | 2017-08-16 | Covidien LP | Flexible circular stapler |
US10531887B2 (en) | 2015-03-06 | 2020-01-14 | Ethicon Llc | Powered surgical instrument including speed display |
US10888318B2 (en) | 2013-04-16 | 2021-01-12 | Ethicon Llc | Powered surgical stapler |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US20230050107A1 (en) * | 2017-02-22 | 2023-02-16 | Covidien Lp | Loading unit for surgical instruments with low profile pushers |
Families Citing this family (409)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US11890012B2 (en) | 2004-07-28 | 2024-02-06 | Cilag Gmbh International | Staple cartridge comprising cartridge body and attached support |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US20110295295A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument having recording capabilities |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US20070225562A1 (en) | 2006-03-23 | 2007-09-27 | Ethicon Endo-Surgery, Inc. | Articulating endoscopic accessory channel |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US8220690B2 (en) | 2006-09-29 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Connected surgical staples and stapling instruments for deploying the same |
US11980366B2 (en) | 2006-10-03 | 2024-05-14 | Cilag Gmbh International | Surgical instrument |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US11564682B2 (en) | 2007-06-04 | 2023-01-31 | Cilag Gmbh International | Surgical stapler device |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US11986183B2 (en) | 2008-02-14 | 2024-05-21 | Cilag Gmbh International | Surgical cutting and fastening instrument comprising a plurality of sensors to measure an electrical parameter |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
RU2493788C2 (en) | 2008-02-14 | 2013-09-27 | Этикон Эндо-Серджери, Инк. | Surgical cutting and fixing instrument, which has radio-frequency electrodes |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US10390823B2 (en) | 2008-02-15 | 2019-08-27 | Ethicon Llc | End effector comprising an adjunct |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
JP2012517287A (en) | 2009-02-06 | 2012-08-02 | エシコン・エンド−サージェリィ・インコーポレイテッド | Improvement of driven surgical stapler |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US9517063B2 (en) | 2012-03-28 | 2016-12-13 | Ethicon Endo-Surgery, Llc | Movable member for use with a tissue thickness compensator |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9211120B2 (en) | 2011-04-29 | 2015-12-15 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a plurality of medicaments |
US9301753B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Expandable tissue thickness compensator |
CA2812553C (en) | 2010-09-30 | 2019-02-12 | Ethicon Endo-Surgery, Inc. | Fastener system comprising a retention matrix and an alignment matrix |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9168038B2 (en) | 2010-09-30 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising a tissue thickness compensator |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9433419B2 (en) | 2010-09-30 | 2016-09-06 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a plurality of layers |
US9282962B2 (en) | 2010-09-30 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Adhesive film laminate |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
CA2834649C (en) | 2011-04-29 | 2021-02-16 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising staples positioned within a compressible portion thereof |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
JP6224070B2 (en) | 2012-03-28 | 2017-11-01 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Retainer assembly including tissue thickness compensator |
BR112014024098B1 (en) | 2012-03-28 | 2021-05-25 | Ethicon Endo-Surgery, Inc. | staple cartridge |
MX358135B (en) | 2012-03-28 | 2018-08-06 | Ethicon Endo Surgery Inc | Tissue thickness compensator comprising a plurality of layers. |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US9364230B2 (en) | 2012-06-28 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with rotary joint assemblies |
US9282974B2 (en) | 2012-06-28 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Empty clip cartridge lockout |
JP6290201B2 (en) | 2012-06-28 | 2018-03-07 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Lockout for empty clip cartridge |
US20140005718A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Multi-functional powered surgical device with external dissection features |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
BR112015021082B1 (en) | 2013-03-01 | 2022-05-10 | Ethicon Endo-Surgery, Inc | surgical instrument |
MX368026B (en) | 2013-03-01 | 2019-09-12 | Ethicon Endo Surgery Inc | Articulatable surgical instruments with conductive pathways for signal communication. |
US20140263541A1 (en) | 2013-03-14 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising an articulation lock |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
BR112016003329B1 (en) | 2013-08-23 | 2021-12-21 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT |
US9445813B2 (en) | 2013-08-23 | 2016-09-20 | Ethicon Endo-Surgery, Llc | Closure indicator systems for surgical instruments |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
JP6462004B2 (en) | 2014-02-24 | 2019-01-30 | エシコン エルエルシー | Fastening system with launcher lockout |
US9693777B2 (en) | 2014-02-24 | 2017-07-04 | Ethicon Llc | Implantable layers comprising a pressed region |
US20150272557A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Modular surgical instrument system |
US10201364B2 (en) | 2014-03-26 | 2019-02-12 | Ethicon Llc | Surgical instrument comprising a rotatable shaft |
US9826977B2 (en) | 2014-03-26 | 2017-11-28 | Ethicon Llc | Sterilization verification circuit |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
JP6532889B2 (en) | 2014-04-16 | 2019-06-19 | エシコン エルエルシーEthicon LLC | Fastener cartridge assembly and staple holder cover arrangement |
US10426476B2 (en) | 2014-09-26 | 2019-10-01 | Ethicon Llc | Circular fastener cartridges for applying radially expandable fastener lines |
JP6612256B2 (en) | 2014-04-16 | 2019-11-27 | エシコン エルエルシー | Fastener cartridge with non-uniform fastener |
CN106456176B (en) | 2014-04-16 | 2019-06-28 | 伊西康内外科有限责任公司 | Fastener cartridge including the extension with various configuration |
US10561422B2 (en) | 2014-04-16 | 2020-02-18 | Ethicon Llc | Fastener cartridge comprising deployable tissue engaging members |
US20150297222A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
US9737301B2 (en) | 2014-09-05 | 2017-08-22 | Ethicon Llc | Monitoring device degradation based on component evaluation |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
BR112017005981B1 (en) | 2014-09-26 | 2022-09-06 | Ethicon, Llc | ANCHOR MATERIAL FOR USE WITH A SURGICAL STAPLE CARTRIDGE AND SURGICAL STAPLE CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US9968355B2 (en) | 2014-12-18 | 2018-05-15 | Ethicon Llc | Surgical instruments with articulatable end effectors and improved firing beam support arrangements |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
MX2017008108A (en) | 2014-12-18 | 2018-03-06 | Ethicon Llc | Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge. |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US9993258B2 (en) | 2015-02-27 | 2018-06-12 | Ethicon Llc | Adaptable surgical instrument handle |
US10182816B2 (en) | 2015-02-27 | 2019-01-22 | Ethicon Llc | Charging system that enables emergency resolutions for charging a battery |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US10433844B2 (en) | 2015-03-31 | 2019-10-08 | Ethicon Llc | Surgical instrument with selectively disengageable threaded drive systems |
US10182818B2 (en) | 2015-06-18 | 2019-01-22 | Ethicon Llc | Surgical end effectors with positive jaw opening arrangements |
US10617418B2 (en) | 2015-08-17 | 2020-04-14 | Ethicon Llc | Implantable layers for a surgical instrument |
US11058426B2 (en) | 2015-08-26 | 2021-07-13 | Cilag Gmbh International | Staple cartridge assembly comprising various tissue compression gaps and staple forming gaps |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10736633B2 (en) | 2015-09-30 | 2020-08-11 | Ethicon Llc | Compressible adjunct with looping members |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10524788B2 (en) | 2015-09-30 | 2020-01-07 | Ethicon Llc | Compressible adjunct with attachment regions |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
CN108882932B (en) | 2016-02-09 | 2021-07-23 | 伊西康有限责任公司 | Surgical instrument with asymmetric articulation configuration |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10245030B2 (en) | 2016-02-09 | 2019-04-02 | Ethicon Llc | Surgical instruments with tensioning arrangements for cable driven articulation systems |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10314582B2 (en) | 2016-04-01 | 2019-06-11 | Ethicon Llc | Surgical instrument comprising a shifting mechanism |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10433840B2 (en) | 2016-04-18 | 2019-10-08 | Ethicon Llc | Surgical instrument comprising a replaceable cartridge jaw |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10667811B2 (en) | 2016-12-21 | 2020-06-02 | Ethicon Llc | Surgical stapling instruments and staple-forming anvils |
US10779823B2 (en) | 2016-12-21 | 2020-09-22 | Ethicon Llc | Firing member pin angle |
US10835245B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Method for attaching a shaft assembly to a surgical instrument and, alternatively, to a surgical robot |
US10881401B2 (en) | 2016-12-21 | 2021-01-05 | Ethicon Llc | Staple firing member comprising a missing cartridge and/or spent cartridge lockout |
US20180168609A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Firing assembly comprising a fuse |
US11191540B2 (en) | 2016-12-21 | 2021-12-07 | Cilag Gmbh International | Protective cover arrangements for a joint interface between a movable jaw and actuator shaft of a surgical instrument |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US10448950B2 (en) | 2016-12-21 | 2019-10-22 | Ethicon Llc | Surgical staplers with independently actuatable closing and firing systems |
US10736629B2 (en) | 2016-12-21 | 2020-08-11 | Ethicon Llc | Surgical tool assemblies with clutching arrangements for shifting between closure systems with closure stroke reduction features and articulation and firing systems |
MX2019007311A (en) | 2016-12-21 | 2019-11-18 | Ethicon Llc | Surgical stapling systems. |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US10682138B2 (en) | 2016-12-21 | 2020-06-16 | Ethicon Llc | Bilaterally asymmetric staple forming pocket pairs |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10537325B2 (en) | 2016-12-21 | 2020-01-21 | Ethicon Llc | Staple forming pocket arrangement to accommodate different types of staples |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
CN110099619B (en) | 2016-12-21 | 2022-07-15 | 爱惜康有限责任公司 | Lockout device for surgical end effector and replaceable tool assembly |
US10973516B2 (en) | 2016-12-21 | 2021-04-13 | Ethicon Llc | Surgical end effectors and adaptable firing members therefor |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10631859B2 (en) | 2017-06-27 | 2020-04-28 | Ethicon Llc | Articulation systems for surgical instruments |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US20190000459A1 (en) | 2017-06-28 | 2019-01-03 | Ethicon Llc | Surgical instruments with jaws constrained to pivot about an axis upon contact with a closure member that is parked in close proximity to the pivot axis |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US11678880B2 (en) | 2017-06-28 | 2023-06-20 | Cilag Gmbh International | Surgical instrument comprising a shaft including a housing arrangement |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US11974742B2 (en) | 2017-08-03 | 2024-05-07 | Cilag Gmbh International | Surgical system comprising an articulation bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US20190192148A1 (en) | 2017-12-21 | 2019-06-27 | Ethicon Llc | Stapling instrument comprising a tissue drive |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11350938B2 (en) | 2019-06-28 | 2022-06-07 | Cilag Gmbh International | Surgical instrument comprising an aligned rfid sensor |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
US11871925B2 (en) | 2020-07-28 | 2024-01-16 | Cilag Gmbh International | Surgical instruments with dual spherical articulation joint arrangements |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11980362B2 (en) | 2021-02-26 | 2024-05-14 | Cilag Gmbh International | Surgical instrument system comprising a power transfer coil |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US20220378425A1 (en) | 2021-05-28 | 2022-12-01 | Cilag Gmbh International | Stapling instrument comprising a control system that controls a firing stroke length |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11980363B2 (en) | 2021-10-18 | 2024-05-14 | Cilag Gmbh International | Row-to-row staple array variations |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1982002824A1 (en) * | 1981-02-17 | 1982-09-02 | United States Surgical Corp | Indicator for surgical stapler |
EP0095970A2 (en) * | 1982-05-28 | 1983-12-07 | United States Surgical Corporation | Surgical stapler apparatus with flexible shaft |
EP0173451A1 (en) * | 1984-08-09 | 1986-03-05 | Minnesota Mining And Manufacturing Company | Flexible surgical stapler and handle actuator assembly and firing head assembly suitable therefor |
EP0282157A1 (en) * | 1987-02-11 | 1988-09-14 | AVANT, Odis Lynn | Stapling apparatus for anastomosis, in particular for urethra-bladder anastomosis |
EP0427949A1 (en) * | 1989-10-17 | 1991-05-22 | Bieffe Medital S.A. | Apparatus for performing anastomosis |
EP0481619A1 (en) * | 1990-09-28 | 1992-04-22 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
-
1992
- 1992-04-13 FR FR9204490A patent/FR2689749B1/en not_active Expired - Lifetime
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1982002824A1 (en) * | 1981-02-17 | 1982-09-02 | United States Surgical Corp | Indicator for surgical stapler |
EP0095970A2 (en) * | 1982-05-28 | 1983-12-07 | United States Surgical Corporation | Surgical stapler apparatus with flexible shaft |
EP0173451A1 (en) * | 1984-08-09 | 1986-03-05 | Minnesota Mining And Manufacturing Company | Flexible surgical stapler and handle actuator assembly and firing head assembly suitable therefor |
EP0282157A1 (en) * | 1987-02-11 | 1988-09-14 | AVANT, Odis Lynn | Stapling apparatus for anastomosis, in particular for urethra-bladder anastomosis |
EP0427949A1 (en) * | 1989-10-17 | 1991-05-22 | Bieffe Medital S.A. | Apparatus for performing anastomosis |
EP0481619A1 (en) * | 1990-09-28 | 1992-04-22 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
Cited By (21)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1998004196A1 (en) | 1996-07-25 | 1998-02-05 | Haviv Toledano | A flexible annular stapler for closed surgery of hollow organs |
EP0923345A1 (en) * | 1996-07-25 | 1999-06-23 | Haviv Toledano | A flexible annular stapler for closed surgery of hollow organs |
EP0923345A4 (en) * | 1996-07-25 | 2002-01-30 | Haviv Toledano | A flexible annular stapler for closed surgery of hollow organs |
WO2001066020A3 (en) * | 2000-03-06 | 2002-04-04 | Us Surgical | Apparatus and method for performing a bypass procedure in a digestive system |
AU2001247292B2 (en) * | 2000-03-06 | 2006-04-06 | Covidien Lp | Apparatus and method for performing a bypass procedure in a digestive system |
US9173658B2 (en) | 2000-03-06 | 2015-11-03 | Covidien Lp | Apparatus and method for performing a bypass procedure in a digestive system |
US7179267B2 (en) | 2000-03-06 | 2007-02-20 | Tyco Healthcare Group Lp | Apparatus and method for performing a bypass procedure in a digestive system |
WO2002000122A1 (en) * | 2000-06-28 | 2002-01-03 | Genzyme Corporation | Device and method for performing vascular anastomosis |
US7901416B2 (en) | 2001-03-05 | 2011-03-08 | Tyco Healthcare Group, L.P. | Apparatus and method for performing a bypass procedure in a digestive system |
EP1728476B1 (en) * | 2005-05-27 | 2012-04-18 | Ethicon Endo-Surgery, Inc. | Instrumentation for carrying out a gastrointestinal bypass |
CN1879568B (en) * | 2005-05-27 | 2011-09-28 | 伊西康内外科公司 | Instrumentation and method for carrying out a gastrointestinal bypass |
EP1728476A2 (en) * | 2005-05-27 | 2006-12-06 | Ethicon Endo-Surgery, Inc. | Instrumentation for carrying out a gastrointestinal bypass |
EP3031403A1 (en) * | 2007-03-15 | 2016-06-15 | Ethicon Endo-Surgery, Inc. | Re-loadable surgical stapling instrument |
US10888318B2 (en) | 2013-04-16 | 2021-01-12 | Ethicon Llc | Powered surgical stapler |
US10531887B2 (en) | 2015-03-06 | 2020-01-14 | Ethicon Llc | Powered surgical instrument including speed display |
EP3205288A1 (en) * | 2016-02-10 | 2017-08-16 | Covidien LP | Flexible circular stapler |
US10603042B2 (en) | 2016-02-10 | 2020-03-31 | Covidien Lp | Flexible circular stapler |
AU2017200789B2 (en) * | 2016-02-10 | 2021-02-18 | Covidien Lp | Flexible circular stapler |
US20230050107A1 (en) * | 2017-02-22 | 2023-02-16 | Covidien Lp | Loading unit for surgical instruments with low profile pushers |
US11944304B2 (en) * | 2017-02-22 | 2024-04-02 | Covidien Lp | Loading unit for surgical instruments with low profile pushers |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
Also Published As
Publication number | Publication date |
---|---|
FR2689749B1 (en) | 1994-07-22 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
FR2689749A1 (en) | Surgical stapling instrument for circular anastomy - has cartridge-loaded cylindrical-conical stapling head attached to main tubular body via flexible actuating cable | |
CA2307735C (en) | Multipurpose catheter | |
EP0621007B1 (en) | Ligaturing and/or suturing system for endoscopic sugery | |
EP1815800B1 (en) | Surgical instrument for fixing soft tissue | |
JP5329232B2 (en) | Anoscope | |
US9492166B2 (en) | Surgical instrument and method for performing a resection | |
FR2476477A1 (en) | SURGICAL STAPLING INSTRUMENT FOR INTRALUMENAL ANASTOMOSIS | |
US20100176181A1 (en) | Surgical stapler | |
FR2925839A1 (en) | AUTOMATED ANCILLARY INSERTION AND FIXATION BY STAPLING AN ANNULAR BODY, IN PARTICULAR A PROSTHESIS, ON AN ANNULAR RESILIENT VOLUME | |
AU2013200165A1 (en) | Circular stapler with increased lumen diameter | |
WO2011007062A1 (en) | Surgical device for expanding and positioning a therapeutic tissue, in particular a hernia prosthesis, by coelioscopy | |
WO2006061514A1 (en) | Perforating trocar | |
EP3509503B1 (en) | Endoscopic needle carrier | |
FR2490482A1 (en) | SURGICAL APPARATUS FOR THE APPLICATION OF CIRCULAR ANASTOMOSIS ON THE BIG INTESTINE | |
EP3958754B1 (en) | Device for the treatment of haemorrhoidal disease | |
EP0266469B1 (en) | Oesophagus catheter | |
FR3079740A1 (en) | DEVICE FOR CLEANING A PHONATORY IMPLANT | |
WO2022200274A1 (en) | Endoscopic suture system and medical device using this system | |
FR3138766A1 (en) | Surgical suture system including improved cap | |
FR2636538A1 (en) | CATHETER FOR MEDICAL USE | |
AU2015261713B2 (en) | Surgical instrument and method for performing a resection | |
EP1446055B1 (en) | Surgical suture guide | |
EP1247492A1 (en) | Endoscopic suture device | |
WO2016156713A1 (en) | Ocular surgical instrument for removing at least a part of a retinal membrane of the eye of a patient | |
FR2691352A1 (en) | Circular stapler with variable diameter for surgical suturing of hollow organs using staples. |