JP7346422B2 - Surgical instrument having a display with an image layer - Google Patents

Description

The present invention relates to surgical instruments and to surgical stapling and cutting instruments and staple cartridges for use therewith designed for stapling and cutting tissue in a variety of situations.

Various features of the embodiments described herein, together with their advantages, can be understood from the following description in conjunction with the accompanying drawings.
1 is a perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 2 is a cross-sectional view of the stapling instrument of FIG. 1 taken along line 2-2 of FIG. 1; FIG. 2 is a partial perspective view of the drive system of the stapling instrument of FIG. 1; FIG. 4 is a plan view of the drive system of FIG. 3; FIG. 4 is an elevational view of the drive system of FIG. 3 shown in a first operational configuration; FIG. 6 is a side view of the drive system of FIG. 3 shown in a first operating configuration of FIG. 5; FIG. 4 is a side view of the drive system of FIG. 3 shown in a second operating configuration; FIG. 1 is a partial perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 1 is a partial perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 9 is a perspective view of the handle housing of the stapling instrument of FIG. 8; FIG. FIG. 2 is a perspective view of a battery according to at least one embodiment. FIG. 2 is a perspective view of a handle of the stapling instrument of FIG. 1; 1 is a perspective view of a surgical stapling instrument including a display according to at least one embodiment; FIG. 14 shows status controls on the display of FIG. 13; FIG. Figure 14 shows the speed controls on the display of Figure 13; 14 shows a fault threshold control on the display of FIG. 13; FIG. 14 shows directional controls on the display of FIG. 13; FIG. Figure 13 shows the display of Figure 13 and the speed control of Figure 15; Figure 14 shows the display and speed controls of Figure 13; 14 shows the display and staple path controls of FIG. 13 being used to change the staple firing path of the stapling instrument; FIG. 22 shows the display of FIG. 13 and the staple path control of FIG. 21 being used to change the staple firing path of the stapling instrument. 14 shows the display of FIG. 13 and controls for stopping the stapling instrument along the staple firing path; FIG. 3 illustrates a surgical instrument system including an external or off-board display, according to at least one embodiment. 5 illustrates a display of a surgical stapling instrument according to at least one embodiment. 25 shows the display of FIG. 24 being used to alter the staple firing path when forming a gastric sleeve during a gastric reduction procedure. 25 shows a joystick being used to change the staple firing path on the display of FIG. 24; FIG. Figure 3 shows a stapling instrument being guided along a staple firing path. Showing the patient's stomach. FIG. 2 is a cross-sectional view of a patient's stomach. 30 is a cross-sectional view of the target inserted into the stomach of FIG. 29; FIG. 30 is a cross-sectional view of a patient's stomach that is thinner than the stomach of FIG. 29; FIG. Figure 32 is a cross-sectional view of the target inserted into the stomach of Figure 31; Figure 2 illustrates various anatomical features that may be referenced during the gastric sleeve procedure. 1 is a partial elevational view of a surgical stapling instrument including a shaft, an end effector, and an articulation joint, according to at least one embodiment; FIG. 35 is a partial elevational view of the stapling instrument of FIG. 34 showing the end effector in an articulated position; FIG. FIG. 3 is a bottom cross-sectional view of an end effector of a surgical stapling instrument according to at least one embodiment. 1 is a partial cross-sectional view of a surgical stapling instrument with a tissue drive system, according to at least one embodiment; FIG. 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 showing the tissue drive system engaged with patient tissue; FIG. FIG. 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 showing the tissue drive system pushing the patient's tissue in a first direction; 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 showing the tissue drive system pushing the patient's tissue in a second direction; FIG. 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 showing the tissue drive system being disengaged from the patient's tissue; FIG. 1 is a partial elevational view of a drive system including a synchronization mechanism, in accordance with at least one embodiment; FIG. 43 illustrates the synchronization mechanism of FIG. 42 actuating the end effector drive system. 1 illustrates a drive system configured to reciprocally drive a plurality of end effector drive systems. Figure 3 shows a plot of two synchronized end effector drives. FIG. 3 is a table showing synchronization of four end effector drives. FIG. A-G illustrate operating steps of a surgical stapling instrument according to at least one embodiment. 3 is a table illustrating synchronization of end effector drives of a surgical stapling instrument according to at least one embodiment. 1 is a module for operating a surgical stapling instrument according to at least one embodiment. FIG. 3 is a partial perspective view of an end effector including a tissue drive system according to at least one embodiment shown extended. 51 is a partial perspective view of the tissue drive system of FIG. 50 being retracted; FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the tissue drive system in a retracted configuration. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the tissue drive system in a lowered configuration; FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the tissue drive system being extended; FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the teeth of the tissue drive system in an extended configuration; FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the drive system being retracted; FIG. 1 is a partial perspective view of a tissue drive system according to at least one embodiment; FIG. 58 is a partial perspective view of the tissue drive system of FIG. 57 in an extended configuration; FIG. 4 illustrates operating steps of a tissue drive system of a surgical stapling instrument, according to at least one embodiment. 4 illustrates operating steps of a tissue drive system of a surgical stapling instrument, according to at least one embodiment. 4 illustrates operating steps of a tissue drive system of a surgical stapling instrument, according to at least one embodiment. 4 illustrates operating steps of a tissue drive system of a surgical stapling instrument, according to at least one embodiment. 59A further illustrates operating steps of the tissue drive system of FIG. 59A. 59B further illustrates the operating steps of the tissue drive system of FIG. 59B. 59C further illustrates operating steps of the tissue drive system of FIG. 59C. 59D further illustrates the operating steps of the tissue drive system of FIG. 59D. 1 is a partial perspective view of a surgical stapling instrument including a tissue drive system according to at least one embodiment; FIG. 62 is a partial perspective view of the tissue drive system of FIG. 61 in an extended configuration; FIG. 1 is a perspective partial cross-sectional view of a surgical stapling instrument with a tissue drive system, according to at least one embodiment; FIG. 64 is a bottom cross-sectional view of the stapling instrument of FIG. 63; FIG. 1 is a partial cross-sectional view of a surgical stapling instrument including a reduced pressure system, according to at least one embodiment; FIG. 66 is a partial detail view of the tissue drive system of the stapling instrument of FIG. 65; FIG. 66 is a partial cross-sectional view of the stapling instrument of FIG. 65 showing tissue being drawn into the end effector of the stapling instrument; FIG. 67 is a partial detail view of the tissue drive system of FIG. 66; FIG. 66 is a partial cross-sectional view of the stapling instrument of FIG. 65 showing tissue being released; FIG. 1 is a partial cross-sectional view of a surgical stapling instrument with a reduced pressure system, according to at least one embodiment; FIG. 71 is a partial cross-sectional view of the stapling instrument of FIG. 70 showing the first and second drive feet of the stapling instrument in a retracted configuration; FIG. 71 is a partial cross-sectional view of the stapling instrument of FIG. 70 showing the first drive foot in an extended position; FIG. 71 is a vacuum manifold of the stapling instrument of FIG. 70 in fluid communication with a first drive foot; FIG. 1 is a partial perspective view of a surgical stapling instrument according to at least one embodiment; FIG. Figures A-D illustrate operating steps of a surgical stapling instrument according to at least one embodiment. 1 is a partially cross-sectional perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 77 illustrates operational steps for steering the stapling instrument of FIG. 76; 77 illustrates operational steps for steering the stapling instrument of FIG. 76; 77 illustrates operational steps for steering the stapling instrument of FIG. 76; 77 illustrates operational steps for steering the stapling instrument of FIG. 76; FIG. 2 is a cross-sectional end view of a surgical stapling instrument according to at least one embodiment. 1 is a partial elevational view of a surgical stapling instrument according to at least one embodiment with a tissue drive device; FIG. Figure 79 shows the position of the foot of the tissue drive device corresponding to Figure 79; 80 is a partial elevational view of the stapling instrument of FIG. 79 showing the foot extended; FIG. 81 shows the position of the foot of the tissue drive device corresponding to FIG. 80; FIG. 80 is a partial elevational view of the stapling instrument of FIG. 79 showing the foot in an extended configuration; FIG. Figure 82 shows the position of the foot of the tissue drive device corresponding to Figure 81; 80 is a partial elevational view of the stapling instrument of FIG. 79 showing the foot being retracted; FIG. Figure 83 shows the position of the foot of the tissue drive device corresponding to Figure 82; 80 is a partial cross-sectional view of the tissue drive device of the stapling instrument of FIG. 79; FIG. 80 illustrates the kinematics of the tissue drive device of the stapling instrument of FIG. 79; 85 shows a cam capable of generating the kinematics of FIG. 84; 85 is a perspective view of a cam capable of generating the kinematics of FIG. 84; FIG. 1 is a partial perspective view of a surgical stapling instrument including a tissue drive device according to at least one embodiment; FIG. 3 illustrates a tissue drive device of a surgical stapling instrument according to at least one embodiment. 89 depicts the tissue drive device of FIG. 88 in an extended configuration. 4 illustrates operating steps of a surgical stapling instrument including a tissue drive device, according to at least one embodiment. 4 illustrates operating steps of a surgical stapling instrument including a tissue drive device, according to at least one embodiment. 4 illustrates operating steps of a surgical stapling instrument including a tissue drive device, according to at least one embodiment. 4 illustrates operating steps of a surgical stapling instrument including a tissue drive device, according to at least one embodiment. Figures A-D illustrate operating steps of a surgical stapling instrument including a tissue drive device, according to at least one embodiment. 3 illustrates a tissue drive device of a surgical stapling instrument according to at least one embodiment. 93 depicts the tissue drive device of FIG. 92 in an extended configuration. 1 is a partially cross-sectional perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 1 is a partial elevational view of a surgical stapling instrument with a tissue cutting member, according to at least one embodiment; FIG. 96 shows the tissue cutting member of FIG. 95 being moved throughout a tissue cutting stroke. 1 is a partial perspective view of a surgical stapling instrument according to at least one embodiment; FIG. FIG. 2 is a perspective view of two linked staples, according to at least one embodiment. 99 is a partial perspective view of the staple of FIG. 98 separated; FIG. 98 is a partial cross-sectional view of the staple firing system of the stapling instrument of FIG. 97 including a staple firing chamber, according to at least one embodiment; FIG. 100 depicts staples being fired by the staple firing system of FIG. 100; 100 shows another staple being loaded into the staple firing chamber of FIG. 100; 98 is a bottom cross-sectional end view of the stapling instrument of FIG. 97; FIG. 1 is a partially cross-sectional perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 105 illustrates the operating steps of the stapling instrument of FIG. 104; 105 illustrates the operating steps of the stapling instrument of FIG. 104; 105 illustrates the operating steps of the stapling instrument of FIG. 104; 105 illustrates the operating steps of the stapling instrument of FIG. 104; 1 is a partial perspective view of a surgical stapling instrument according to at least one embodiment; FIG. 107 is an exploded perspective view of a staple clip for use with the surgical stapling instrument of FIG. 106; FIG. FIG. 3 is a top view of a staple clip according to at least one embodiment. 109 is an end view of the staple clip of FIG. 108 positioned within a surgical stapling instrument; FIG. 109 is a perspective view of the staple clip of FIG. 108; FIG. FIG. 3 is an end view of a staple clip according to at least one embodiment positioned within a surgical stapling instrument. FIG. 112 is a perspective view of the staple clip of FIG. 111; FIG. 3 is an end view of a staple clip according to at least one embodiment positioned within a surgical stapling instrument. FIG. 114 is a perspective view of the staple clip of FIG. 113; FIG. 3 is a partial plan view of a staple strip in an unfolded configuration, according to at least one embodiment. 116 is an end view of the staple strip of FIG. 115 in an unfolded configuration; FIG. 116 is an end view of the staple strip of FIG. 115 in a folded configuration; FIG. 116 is a perspective view of the staple strip of FIG. 115 being deployed; FIG. FIG. 2 is a perspective view of a staple cluster according to at least one embodiment. 120 is a partial perspective view of the staple cluster of FIG. 119 being loaded into a surgical stapling instrument; FIG. 1 is a partial perspective view of a surgical stapling instrument with an deployable staple cluster, according to at least one embodiment; FIG. 1 is a partial perspective view of a surgical stapling instrument with a tissue drive device according to at least one embodiment; FIG. 123 is a partial perspective view of the stapling instrument of FIG. 122 showing the tissue drive device in an extended configuration; FIG. 123 illustrates the cross-sectional width of the distal head of the stapling instrument of FIG. 122; 123 is a cross-sectional view of the tissue grasping surface of the tissue drive device of FIG. 122; FIG. 1 is a cross-sectional end view of a surgical stapling instrument including a tissue drive device according to at least one embodiment shown in an extended configuration; FIG. 127 is a cross-sectional end view of the stapling instrument of FIG. 126 showing the tissue drive device in a retracted configuration; FIG. 2 illustrates a firing drive for a surgical stapling instrument according to at least one embodiment shown in an unfired configuration. 129 depicts the tissue drive device of the stapling instrument of FIG. 128 shown in an extended configuration. 129 shows the firing drive of FIG. 128 shown in a firing configuration. 128B shows the tissue drive device of FIG. 128A in a retracted configuration. 129 shows the firing drive of FIG. 128 shown in an unfired configuration; 128B shows the tissue drive device of FIG. 128A in a retracted configuration. 1 is a perspective view of a staple loading system of a surgical stapling instrument according to at least one embodiment; FIG. 132 is a top view of the staple loading system of FIG. 131; FIG. 132 is a partial elevational view of the staple loading system of FIG. 131; FIG. 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in an unfired configuration; FIG. 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in a firing configuration; FIG. 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 being retracted to an unfired configuration; FIG. 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in an unfired configuration; FIG. 5 illustrates a stapling pattern that may be generated by a surgical stapling instrument according to at least one embodiment. 5 illustrates a stapling pattern that may be generated by a surgical stapling instrument according to at least one embodiment. 1 illustrates a surgical stapling instrument according to at least one embodiment. 140 illustrates the operational steps used by the stapling instrument of FIG. 140 to create and deploy staples. The staple firing line within the patient's stomach is shown. 4 illustrates the progression of staple firing in accordance with at least one embodiment. Figure 2 shows the stapling instrument of Figure 1 being used during a surgical procedure. Figure 2 shows the stapling instrument of Figure 1 being used during a surgical procedure. Figure 2 shows the stapling instrument of Figure 1 being used during a surgical procedure. 2 illustrates a surgical stapling instrument according to at least one embodiment being used during a surgical procedure. 148 is a partial elevational view of the surgical stapling instrument of FIG. 147; FIG. FIG. 148 is a partial perspective view of the stapling instrument of FIG. 147 in a first configuration; FIG. 148 is a partial perspective view of the stapling instrument of FIG. 147 in a second configuration; 1 illustrates the potential outcomes of a gastric sleeve procedure using the surgical stapling instrument disclosed herein. The guide is shown inserted into the patient's stomach. A guide is shown being used to define a staple firing path within a patient's stomach. 154 shows the guide of FIG. 153 being used to form a gastric sleeve during a gastric bypass procedure. 154 is a partial cross-sectional view of the guide of FIG. 153; FIG. FIG. 3 is a partial cross-sectional view of a guide in accordance with at least one embodiment shown with some components removed. 154 is a schematic diagram of the guide of FIG. 153; 1 is a perspective view of a surgical stapling system including a loadable staple cartridge according to at least one embodiment; FIG. 159 illustrates certain operational components of the stapling system of FIG. 158; 1 is an end view of a surgical stapling instrument with a projector system that includes two lenses, according to at least one embodiment; FIG. The stapling instrument of FIG. 160 is shown in use during a surgical procedure. 1 illustrates a surgical stapling system including a projector, according to at least one embodiment. 1 illustrates a surgical stapling system that includes a vision system and a projection system, according to at least one embodiment. 164 shows the projector system of the stapling system of FIG. 163 being used. 4 illustrates a projection image on tissue of a patient, according to at least one embodiment. 3 illustrates a staple firing path projected onto a patient's tissue, according to at least one embodiment. a first projector configured to project a first portion of a staple firing path onto tissue of a patient and a second portion of a staple firing path onto tissue of a patient, according to at least one embodiment; and a second projector configured as shown in FIG. 1 is a partial elevational view of a surgical stapling instrument with an articulating end effector according to at least one embodiment; FIG. FIG. 169 is a partial elevational view of the surgical stapling instrument of FIG. 168; FIG. 3 is a partial elevational view of a surgical stapling instrument including an articulating end effector and a dampener configured to reduce unintended movement of the end effector, according to at least one embodiment. 1 is a partial elevational view of a surgical stapling instrument including an end effector dampener, according to at least one embodiment; FIG. 172 shows the stapling instrument of FIG. 171 being used in a surgical procedure. 172 shows the stapling instrument of FIG. 171 being used in a surgical procedure. FIG. 6 illustrates a staple firing path formed by a surgical stapling instrument with a longitudinal end effector. 2 illustrates a staple firing path formed by a surgical stapling instrument disclosed herein. FIG. 6 illustrates a staple firing path formed by a surgical stapling instrument with a longitudinal end effector. 2 illustrates a staple firing path formed by a surgical stapling instrument disclosed herein. FIG. 6 illustrates a staple firing path formed by a surgical stapling instrument with a longitudinal end effector. 2 illustrates a staple firing path formed by a surgical stapling instrument disclosed herein. FIG. 2 is a perspective view of a handle of a surgical instrument according to at least one embodiment. 181 is a perspective view of the handle of the surgical instrument of FIG. 180 enclosed in a sterility barrier; FIG. 182 is a partial cross-sectional view of the sterilization barrier and touch-sensitive display of the handle of FIG. 181; FIG. 183 is a top view of the touch-sensitive display of FIG. 182 showing a grid of electrodes with a plurality of pixels activated; FIG. 183 is a graph illustrating the relationship between the position of the active pixel of FIG. 183 and the capacitance detected by the touch-sensitive display of FIG. 182.

Corresponding reference characters indicate corresponding parts throughout the figures. The examples set forth herein are illustrative of various embodiments of the invention in one form, and such illustrations should not be construed as limiting the scope of the invention in any way. do not have.

The applicant of this application owns the following U.S. patent applications filed December 21, 2017, each of which is incorporated herein by reference in its entirety.
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The applicant of this application owns the following U.S. patent applications filed December 19, 2017, each of which is incorporated herein by reference in its entirety.
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The applicant of this application owns the following U.S. patent applications filed December 15, 2017, each of which is incorporated herein by reference in its entirety.
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The applicant of this application owns the following U.S. patent applications filed June 29, 2017, each of which is incorporated herein by reference in its entirety.
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The applicant of this application owns the following U.S. patent applications filed June 28, 2017, each of which is incorporated herein by reference in its entirety.
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The applicant of this application owns the following U.S. patent applications filed June 27, 2017, each of which is incorporated herein by reference in its entirety.
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The applicant of this application owns the following U.S. patent applications filed December 21, 2016, each of which is incorporated herein by reference in its entirety.
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- U.S. Patent Application No. 15/385,910, Title: "ANVIL HAVING A KNIFE SLOT WIDTH";
- U.S. Patent Application No. 15/385,906, Title: "FIRING MEMBER PIN CONFIGURATIONS";
- U.S. Patent Application No. 15/386,188, Title: "STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES"
- U.S. Patent Application No. 15/386,192, Title: "STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES"
- U.S. Patent Application No. 15/386,206, Title: "STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES"
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser. ”,
- U.S. patent application Ser. INSTRUMENT SYSTEM”,
- U.S. Patent Application No. 15/385,890, entitled "SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE SYSTEMS";
- U.S. patent application Ser. IFFERENT SYSTEMS”,
- U.S. patent application Ser. EFFECTOR OF THE SURGICAL SYSTEM”
- U.S. Patent Application No. 15/385,894, Title: "SHAFT ASSEMBLY COMPRISING A LOCKOUT";
- U.S. Patent Application No. 15/385,895, title: SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULATION LOCKOUTS;
- U.S. Patent Application No. 15/385,916, Title: "SURGICAL STAPLING SYSTEMS"
- U.S. Patent Application No. 15/385,918, Title: "SURGICAL STAPLING SYSTEMS";
- U.S. patent application Ser.
- U.S. patent application Ser. LOCKOUT FEATURES”,
- U.S. Patent Application No. 15/385,923, Title: "SURGICAL STAPLING SYSTEMS"
- U.S. patent application Ser. TOR UNLESS AN UNFIRED CARTRIDGE IS INSTALLED IN THE END EFFECTOR”,
- U.S. patent application Ser. ENTS”,
- U.S. patent application Ser. RGICAL INSTRUMENT”,
- U.S. patent application Ser. ECTOR JAWS”,
- U.S. patent application Ser.
- U.S. patent application Ser. ,
- U.S. patent application Ser. ACTUATION OF A JAW CLOSURE SYSTEM”
- U.S. patent application Ser. MENT IN AN ARTICULATED CONFIGURATION”, and - U.S. Patent Application No. 15/385,936, Invention The name is "ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES".

The applicant of this application owns the following U.S. patent applications filed June 24, 2016, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 15/191,775, Title: "STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES";
- U.S. patent application Ser.
- U.S. Patent Application No. 15/191,834, Title: "STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME";
- U.S. Patent Application No. 15/191,788, entitled "STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES," and - United States Patent Application No. 15/191,818, entitled "STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES." FFSET LONGITUDINAL STAPLE ROWS”.

The applicant of this application owns the following U.S. patent applications filed June 24, 2016, each of which is incorporated herein by reference in its entirety.
- U.S. Design Patent Application No. 29/569,218, title of invention "SURGICAL FASTENER";
- U.S. Design Patent Application No. 29/569,227, title of invention "SURGICAL FASTENER";
- U.S. Design Patent Application No. 29/569,259, title of the invention "SURGICAL FASTENER CARTRIDGE", and - U.S. Design Patent Application No. 29/569,264, title of the invention "SURGICAL FASTENER CARTRIDGE".

The applicant of this application owns the following patent applications filed on April 1, 2016, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 15/089,325, Title: "METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM," now U.S. Patent Application Publication No. 2017/0281171;
- U.S. Patent Application No. 15/089,321, entitled "MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY," now U.S. Patent Application Publication No. 2017/0281163;
- U.S. Patent Application No. 15/089,326, entitled "SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD," now U.S. Patent Application Publication No. 2017/0 No. 281172,
- U.S. Patent Application No. 15/089,263, entitled "SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP PORTION," now U.S. Patent Application Publication No. 2017/0281165;
- U.S. Patent Application No. 15/089,262, entitled "ROTARY POWERED SURGICAL INSTRUMENT WITH MANUAL ACTUATABLE BAILOUT SYSTEM," now U.S. Patent Application Publication No. 2017/0281161;
-A US Patent Available No. 15/089, 277, the name of the invention "Surgical Cutting and End End End End WITIL WITIL WITIL CONCENTRIC DRIVE MEMBER" 2017/0281166,
- U.S. patent application Ser. OUT A SHAFT AXIS”, currently U.S. Patent Application Publication No. 2017/0281168,
- U.S. Patent Application No. 15/089,258, entitled "SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION," now U.S. Patent Application Publication No. 2017/0281178;
- U.S. Patent Application No. 15/089,278, entitled "SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVE CUTTING OF TISSUE," now U.S. Patent Application Publication No. 2017/0281162;
- U.S. Patent Application No. 15/089,284, titled "SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT," now U.S. Patent Application Publication No. 2017/0281186;
- U.S. Patent Application No. 15/089,295, Title: "SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSION LOCKOUT," now U.S. Patent Application Publication No. 2017/0281187;
- U.S. Patent Application No. 15/089,300, Title: "SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT," now U.S. Patent Application Publication No. 2017/0281179;
- U.S. Patent Application No. 15/089,196, Title: "SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT," now U.S. Patent Application Publication No. 2017/0281183;
- U.S. Patent Application No. 15/089,203, entitled "SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT," now U.S. Patent Application Publication No. 2017/0281184;
- U.S. Patent Application No. 15/089,210, titled "SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGE LOCKOUT," now U.S. Patent Application Publication No. 2017/0281185;
- U.S. Patent Application No. 15/089,324, Title: "SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM," now U.S. Patent Application Publication No. 2017/0281170;
- U.S. Patent Application No. 15/089,335, Title: "SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS," now U.S. Patent Application Publication No. 2017/0281155;
- U.S. Patent Application No. 15/089,339, Title: "SURGICAL STAPLINING INSTRUMENT," now U.S. Patent Application Publication No. 2017/0281173;
- U.S. patent application Ser. Publication No. 2017/0281177,
- U.S. Patent Application No. 15/089,304, entitled "SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET," now U.S. Patent Application Publication No. 2017/0281188;
- U.S. Patent Application No. 15/089,331, titled "ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLE/FASTENERS," now U.S. Patent Application Publication No. 2017/0281180;
- U.S. Patent Application No. 15/089,336, entitled "STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES," now U.S. Patent Application Publication No. 2017/0281164;
- U.S. Patent Application No. 15/089,312, entitled "CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUE SUPPORT," now U.S. Patent Application Publication No. 2017/0281189;
- U.S. Patent Application No. 15/089,309, titled "CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM," now U.S. Patent Application Publication No. 2017/0281169, and - U.S. Patent Application No. 15/089,349, The title of the invention is “CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL”, currently US Patent Application Publication No. 2017/0281174.

The applicant of this application also owns the United States patent applications identified below, filed December 30, 2015, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser. No. 89018,
- U.S. patent application Ser. No. 019, and - U.S. Patent Application No. 14/984, No. 552, the title of the invention is "SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROL CIRCUITS", currently US Patent Application Publication No. 2017/0189020.

The applicant of this application also owns the United States patent applications identified below, filed February 9, 2016, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 15/019,220, entitled "SURGICAL INSTRUMENT WITH ARTICULATION AND AXIALY TRANSLATABLE END EFFECTOR," now U.S. Patent Application Publication No. 2017/0224333;
- U.S. Patent Application No. 15/019,228, entitled "SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224342;
- U.S. Patent Application No. 15/019,196, entitled "SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT," now U.S. Patent Application Publication No. 2017/0224330;
- U.S. patent application Ser. ASSEMBLY”, currently U.S. Patent Application Publication No. 2017/0224331,
- U.S. Patent Application No. 15/019,215, entitled "SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224332;
-A US Patent Available No. 15/019, 227, the name of the invention, "AlticalAtable Surgical UITH SINGLE WITH SINGLE WITH SINGLE WITH SINGLE ARRANGEMENTS" 2017/0224334,
- U.S. Patent Application No. 15/019,235, titled "SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVE ARTICULATION SYSTEMS," now U.S. Patent Application Publication No. 2017 /0224336,
- U.S. patent application Ser. Patent Application No. 15/019, No. 245, title of the invention "SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTION ARRANGEMENTS", currently US Patent Application Publication No. 2017/0224343.

The applicant of this application also owns the United States patent applications identified below, filed February 12, 2016, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 15/043,275, entitled "MECHANISMS FOR COMPENSATION FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS," and - U.S. Patent Application No. 15/043,28 No. 9, title of the invention “MECHANISMS FOR COMPENSATION FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS”.

The applicant of this application owns the following patent applications filed on June 18, 2015, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 14/742,925, titled "SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS," now U.S. Patent Application Publication No. 2016/0367256;
- U.S. Patent Application No. 14/742,941, titled "SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES," now U.S. Patent Application Publication No. 2016/0367248;
- U.S. patent application Ser. No.,
- U.S. patent application Ser. MEMBER FOR ARTICULATION SUPPORT”, currently U.S. Patent Application Publication No. 2016/0367254,
- U.S. patent application Ser. No. 246, and - U.S. Patent Application No. 14/742,876 No., title of the invention “PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLE SURGICAL INSTRUMENTS”, currently US Patent Application Publication No. 2016/0367245.

The applicant of this application owns the following patent applications filed on March 6, 2015, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser.
- U.S. patent application Ser. ,
- U.S. patent application Ser. 6/0256154,
- U.S. Patent Application No. 14/640,935, titled "OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION," now U.S. Patent Application Publication No. 2016 /0256071 issue,
- U.S. patent application Ser. Publication No. 2016/0256153,
- U.S. patent application Ser. EASURES”, currently U.S. Patent Application Publication No. 2016/0256187;
- U.S. patent application Ser.
- U.S. patent application Ser. ROM HANDLE, currently U.S. Patent Application Publication No. 2016/0256155,
- U.S. Patent Application No. 14/640,837, Title: "SMART SENSORS WITH LOCAL SIGNAL PROCESSING," now U.S. Patent Application Publication No. 2016/0256163;
- U.S. patent application Ser. No. 2016/0256160,
- U.S. patent application Ser. 4/640, No. 780, title of the invention "SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING", currently US Patent Application Publication No. 2016/0256161.

The applicant of this application owns the following patent applications filed on February 27, 2015, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 14/633,576, titled "SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION," now U.S. Patent Application Publication No. 2016/0249919;
- U.S. patent application Ser. WITHIN AN ACCEPTABLE PERFORMANCE BAND”, currently U.S. Patent Application Publication No. 2016/0249915,
-A US Patent Available No. 14/633,560, the name of the invention "Surgical Charging System THAT CHARGES AND / OR CONDITITIONS OR MORE BATTERIES" Published 2016/0249910,
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 14/633,548, Title: "POWER ADAPTER FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2016/0249909;
- U.S. Patent Application No. 14/633,526, Title: "ADAPTABLE SURGICAL INSTRUMENT HANDLE," now U.S. Patent Application Publication No. 2016/0249945;
- U.S. patent application Ser. SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER”, currently U.S. Patent Application Publication No. 2016/0249917.

The applicant of this application owns the following patent applications filed on December 18, 2014, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser. ING STROKE OF A FIRING MEMBER, now U.S. Pat. No. 9,844,374;
- U.S. Patent Application No. 14/574,483, Title: "SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS," now U.S. Patent Application Publication No. 2016/0174969;
- U.S. patent application Ser.
- U.S. patent application Ser. Application Publication No. 2016/0174976,
- U.S. patent application Ser. TIVE TO A STAPLE CARTRIDGE”, currently U.S. Patent Application Publication No. 2016/0174972 ,
- U.S. Patent Application No. 14/575,143, entitled "SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS," now U.S. Patent Application Publication No. 2016/0174983;
- U.S. patent application Ser. Currently, US Patent Application Publication No. 2016/0174975,
- U.S. patent application Ser. , currently U.S. Patent Application Publication No. 2016/0174973,
- U.S. Patent Application No. 14/574,493, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM," now U.S. Patent Application Publication No. 2016/0174970, and - U.S. Patent Application No. No. 14/574,500 , the title of the invention is "SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM", currently US Patent Application Publication No. 2016/0174971.

The applicant of this application owns the following patent applications filed on March 1, 2013, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser. No.,
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 13/782,460, entitled "MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS," now U.S. Pat.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 13/782,375, entitled "ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM," now U.S. Patent No. 9,398,911, and - U.S. Patent Application No. 13/782, 536 No. 9,307,986, entitled "SURGICAL INSTRUMENT SOFT STOP," now U.S. Pat. No. 9,307,986.

The applicant of this application also owns the following patent applications filed on March 14, 2013, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser.
- U.S. Patent Application No. 13/803,193, entitled "CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT," now U.S. Pat.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 13/803,130, entitled "DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS," now U.S. Patent Application No. 9,351,727, and - U.S. Patent Application No. 13/803,159 No. , the title of the invention is "METHOD AND SYSTEM FOR OPERATION A SURGICAL INSTRUMENT", currently US Patent Application Publication No. 2014/0277017.

The applicant of this application also owns the following patent application filed on March 7, 2014, the entire contents of which are incorporated herein by reference:
- U.S. Patent Application No. 14/200,111, entitled "CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,629,629.

The applicant of this application also owns the following patent applications filed on March 26, 2014, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 14/226,106, titled "POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2015/0272582;
- U.S. Patent Application No. 14/226,099, entitled "STERILIZATION VERIFICATION CIRCUIT," now U.S. Pat.
- U.S. Patent Application No. 14/226,094, titled "VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT," now U.S. Patent Application Publication No. 2015/0272580;
- U.S. patent application Ser. No.,
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 14/226,097, entitled "SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS," now U.S. Pat.
- U.S. Patent Application No. 14/226,126, titled "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2015/0272572;
- U.S. Patent Application No. 14/226,133, Title: "MODULAR SURGICAL INSTRUMENT SYSTEM," now U.S. Patent Application Publication No. 2015/0272557;
- U.S. Patent Application No. 14/226,081, entitled "SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT," now U.S. Pat.
- U.S. patent application Ser.
- United States patent application Ser. SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT”, currently U.S. Patent Application Publication No. 2015/0280384.

The applicant of this application also owns the following patent applications filed on September 5, 2014, each of which is incorporated herein by reference in its entirety.
- U.S. Patent Application No. 14/479,103, titled "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE," now U.S. Patent Application Publication No. 2016/0066912;
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser. No. 8,
- U.S. Patent Application No. 14/479,110, entitled "POLARITY OF HALL MAGNET TO DETECT MISLOADSED CARTRIDGE," now U.S. Patent Application Publication No. 2016/0066915;
- U.S. patent application Ser.
- U.S. Patent Application No. 14/479,115, entitled "MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE," now U.S. Patent No. 9,788,836, and - U.S. Patent Application No. 14/479,108, The title of the invention is “LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION”, currently US Patent Application Publication No. 2016/0066913.

The applicant of this application also owns the following patent applications filed on April 9, 2014, each of which is incorporated herein by reference in its entirety.
- U.S. patent application Ser.
- U.S. patent application Ser. UTPUT, now U.S. Pat. No. 9,649,110;
- U.S. patent application Ser. T”, now U.S. Pat. No. 9,844,368;
- U.S. Patent Application No. 14/248,588, Title: "POWERED LINEAR SURGICAL STAPLE/FASTENER," now U.S. Patent Application Publication No. 2014/0309666;
- U.S. Patent Application No. 14/248,591, entitled "TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0305991;
- U.S. patent application Ser. ITH SURGICAL END EFFECTOR SHAFTS, now U.S. Pat. No. 9,801,626;
- U.S. Patent Application No. 14/248,587, Title: "POWERED SURGICAL STAPLE/FASTENER," now U.S. Patent Application Publication No. 2014/0309665;
- U.S. Patent Application No. 14/248,586, entitled "DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0305990, and - U.S. Patent Application No. 14/248,60 No. 7 , title of the invention ``MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS,'' now U.S. Patent No. 9,814,460.

The applicant of this application also owns the following patent applications filed on April 16, 2013, each of which is incorporated herein by reference in its entirety.
- U.S. Provisional Patent Application No. 61/812,365, title of the invention "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR";
- U.S. Provisional Patent Application No. 61/812,376, title of invention "LINEAR CUTTER WITH POWER";
- U.S. Provisional Patent Application No. 61/812,382, title of the invention "LINEAR CUTTER WITH MOTOR AND PISTOL GRIP";
- U.S. Provisional Patent Application No. 61/812,385, entitled "SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS AND MOTOR CONTROL," and - U.S. Provisional Patent Application No. 61/812,372, Title of the Invention Name: “SURGICAL INSTRUMENT WITH” MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR”.

Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described herein and illustrated in the accompanying drawings. . Well-known operations, components, and elements have not been described in detail in order not to obscure the embodiments described herein. The reader understands that the embodiments described and illustrated herein are non-limiting examples and, therefore, that the specific structural and functional details disclosed herein may be representative and exemplary. will be understandable. Variations and modifications may be made thereto without departing from the scope of the claims.

The terms "comprise" (any of the forms of comprise, such as "comprises" and "comprising"), "have" (any of the forms of have, such as "has" and "having"); "include" (any of the word forms of include, such as "includes" and "including") and "contain" (any of the word forms of contain, such as "contains" and "containing") It is a linking verb that can be changed. As a result, a surgical system, device, or apparatus that "comprises," "has," "includes," or "contains" one or more elements has one or more elements. However, it is not limited to having only one or more of these elements. Similarly, an element of a system, device, or apparatus that "comprises," "has," "includes," or "contains" one or more features has those one or more features; It is not limited to having only one or more characteristics.

The terms "proximal" and "distal" are used herein with reference to the clinician manipulating the handle portion of the surgical instrument. The term "proximal" refers to the part closest to the clinician, and the term "distal" refers to the part located away from the clinician. It will be further understood that for convenience and clarity, spatial terms such as "vertical," "horizontal," "above," and "below" may be used herein with reference to the drawings. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein can be used in many surgical procedures and applications, including, for example, in connection with open surgery. By reading the Detailed Description herein, the reader will understand that the various instruments disclosed herein can be used to make incisions or punctures made in tissue, such as through natural orifices. It will be further understood that it may be inserted into the body in any manner, such as through a hole. The working or end effector portions of these instruments may be inserted directly into the patient's body or through an access device having a working passageway through which the end effector and elongate shaft of the surgical instrument can be advanced. Good too.

Various surgical instruments configured to fasten tissue of a patient are disclosed herein. As described in more detail below, such surgical instruments include an end effector and multiple drive systems configured to perform various end effector functions. Such drive systems include, for example, an anvil drive system configured to clamp tissue within an end effector, a staple firing system configured to deploy staples within tissue, and/or to cut tissue. The tissue cutting system may include a tissue cutting system configured to. Such drive systems may also include, for example, articulating drive systems configured to articulate an end effector, tissue drive systems configured to move an end effector relative to tissue, and/or A staple loading system configured to reload staples can be included. As discussed in more detail below, two or more of these drive systems may be operably coupled to a common drive system such that they are operated synchronously.

A stapling instrument 1000 is shown in FIG. Stapling instrument 1000 includes a handle 1100, a shaft assembly 1200 extending from handle 1100, and an end effector 1300 extending from shaft assembly 1200. Handle 1100 includes a frame 1110 and gripping portions 1120 positioned on opposite sides of frame 1110. Handle 1100 further includes a plurality of electric motors configured to operate the drive system of stapling instrument 1000. Although three electric motors 1130, 1140, and 1150 are shown, surgical instrument 1000 can include any suitable number of electric motors. Each electric motor is operably coupled to a rotatable output. For example, electric motor 1130 is operably coupled to rotatable output 1135, electric motor 1140 is operably coupled to rotatable output 1145, and electric motor 1150 is operably coupled to rotatable output 1155. operably connected. Handle 1100 further includes a battery 1160 that powers electric motors 1130, 1140, and 1150, for example. Referring to FIG. 11, battery 1160 includes, for example, a lithium 18650 battery, but may include any suitable battery. Referring primarily to FIG. 12, battery 1160 is located within a battery compartment 1115 defined within handle frame 1110, but may be stored in any suitable location. Battery 1160 is also configured to power the control system and/or display of handle 1110, which will be described in more detail below.

A handle 1100' is shown in FIGS. 8 and 10. Handle 1100' is similar to handle 1100 in many respects, most of which are not discussed herein for the sake of brevity. Handle 1100' includes a battery compartment accessible through door 1115'. Door 1115' allows for replacing batteries within the battery compartment. A handle 1100'' is shown in FIG. Handle 1100'' is similar to handle 1100 in many respects, most of which are not discussed herein for the sake of brevity. The handle 1100'' includes a plug 1115'' configured to power the handle 1100'' from, for example, a generator and/or a wall outlet. In various examples, the handle 1100'' may be powered by an internal source, such as a battery 1160, and an external source, such as a plug 1115''.

Referring again to FIG. 1, the handle frame 1110 includes a connector 1170. Shaft assembly 1200 includes an outer housing 1210 that includes a shaft connector 1270 that is configured to engage handle connector 1170 to couple shaft assembly 1200 to handle 1100 . Shaft connector 1270 and handle 1170 include rotatable bayonet interconnects, although any suitable interconnects may be used. Shaft assembly 1200 further includes a rotatable input portion 1235 configured to be operably coupled with rotatable output portion 1135 when shaft assembly 1200 is assembled to handle 1100. There is. Similarly, shaft assembly 1200 also includes a rotatable input portion 1245 configured to be operably coupled with rotatable output portion 1145 and a rotatable output portion when shaft assembly 1200 is assembled to handle 1100. a rotatable input portion 1255 configured to be operably coupled with portion 1155 .

In addition to the above, outer shaft housing 1210 further includes a distal connector 1290. End effector 1300 includes a shaft portion 1310 that includes an end effector connector 1390 configured to engage distal connector 1290 to couple end effector 1300 to shaft assembly 1200. End effector connector 1390 and distal shaft connector 1290 include rotatable interconnects, although any suitable interconnect may be used. End effector 1300 further includes a first drive configured to be operably coupled to shaft input 1235 when end effector 1300 is assembled to shaft assembly 1200. Similarly, end effector 1300 has a second drive configured to be operably coupled to shaft input 1245 and operably connected to shaft input 1255 when end effector 1300 is assembled into shaft assembly 1200. and a third drive device configured to be coupled to.

In various examples, shaft assembly 1200 and/or end effector 1300 include one or more sensors and/or electrically driven components. Referring to FIG. 2, stapling instrument 1000 includes at least one electrical circuit extending through handle 1100, shaft assembly 1200, and end effector 1300. The electrical circuit includes conductors in the handle 1100, shaft assembly 1200, and end effector 1300, which conductors are connected when the shaft assembly 1200 is assembled to the handle 1100 and the end effector 1300 is assembled to the shaft assembly 1200. are arranged in electrical communication with each other. Although FIG. 2 shows four conductors 1280 within shaft assembly 1200 as part of two separate electrical circuits, any suitable number of conductors and/or circuits may be used. Handle connector 1170 and shaft connector 1270 include electrical contacts that are rotated into engagement when shaft assembly 1200 is rotatably assembled to handle 1100. Similarly, distal shaft connector 1290 and end effector connector 1390 include electrical contacts that are rotated into engagement when end effector 1300 is assembled to shaft assembly 1200.

Referring again to FIG. 1, end effector 1300 further includes a distal head 1320 rotatably connected to shaft portion 1310 about articulation joint 1370. End effector 1300 also includes an articulation drive system configured to articulate distal head 1320 relative to shaft portion 1310. Distal head 1320 includes an anvil 1360 that is movable between open and closed positions. In use, anvil 1360 is moveable toward tissue compression surface 1325 by an anvil drive system to clamp or compress tissue within end effector 1300. As discussed below in connection with FIGS. 3-7, the tissue compression surface 1325 is mounted on a tissue drive system configured to engage patient tissue and move the stapling instrument 1000 relative to the patient tissue. It is defined.

Referring primarily to FIG. 3, the end effector 1300 includes a rotatable drive shaft 1330 that selectively opens the anvil 1360 and operates the tissue drive system (FIGS. 4-6) to patient It can be used to reposition distal head 1320 against tissue and close anvil 1360 (FIG. 7) before stapling instrument 1000 performs a staple firing stroke. The drive shaft 1330 is driven by an electric motor, and the drive shaft 1330 is further configured such that a key 1332 extending from the drive shaft 1330 is operably engaged with the tissue drive system (FIGS. 4-6). and a second position in which the key 1332 is operably engaged with the anvil drive system (FIG. 7). When drive shaft 1330 is in its first position, key 1332 is positioned within key slot 1333 defined within drive gear 1331 of the tissue drive system. When drive shaft 1330 is in its second position, key 1332 is positioned within a key slot 1363 defined within drive collar 1361 of the anvil drive system.

Referring to FIGS. 4-6, the tissue drive system includes a first foot 1380a and a second foot 1380b. The feet 1380a, 1380b are extendable to engage patient tissue and then retractable to pull the distal head 1320 of the end effector 1300 against the patient tissue. The tissue drive system is configured to extend the first foot 1380a while retracting the second foot 1380b, and similarly to extend the second foot 1380b while retracting the first foot 1380a. There is. FIG. 4 shows the first foot 1380a in the extended position and the second foot 1380b in the retracted position. As a result of the above, the tissue drive system may be configured to drive the end effector 1300 across tissue to form a staple firing path within the tissue. In various alternative embodiments, the tissue drive system is configured to simultaneously extend the first foot 1380a and the second foot 1380b and/or retract the first foot 1380a and the second foot 1380b simultaneously. may be configured.

In addition to the above, the tissue drive system includes a first gear train configured to transmit rotation of the drive shaft 1330 to a first gear 1380a and a first gear train configured to transmit rotation of the drive shaft 1330 to a second gear 1380b. and a second gear train configured as follows. The first gear train includes a spur gear 1381a that operably meshes with the drive gear 1331, a transmission gear 1382a that operably meshes with the spur gear 1381a, and a spur gear 1383a that operably meshes with the transmission gear 1382a. The rotation of 1330 is transmitted to spur gear 1383a. The first gear train further includes a shaft gear 1384a that operably meshes with spur gear 1383a. Referring primarily to FIGS. 5 and 6, shaft gear 1384a is fixedly mounted to transmission shaft 1385a such that rotation of spur gear 1383a is transmitted to transmission shaft 1385a. The first gear train further includes a bevel gear 1386a fixedly mounted on the transmission shaft 1385a, a side bevel gear 1387a operatively meshing with the bevel gear 1386a, and a pinion gear 1388a fixedly mounted on the side bevel gear 1387a. The pinion gear 1388a is configured to rotate together with the side bevel gear 1387a. Referring primarily to FIG. 6, pinion gear 1388a operatively meshes with a rack 1389a mounted on first foot 1380a that converts rotational input motion into translational motion of first foot 1380a.

The second gear train is similar in many respects to the first gear train, except that the second gear train does not include a transmission gear intermediate the two spur gears, as explained below. . The second gear train includes a spur gear 1381b operatively meshing with drive gear 1331 and a spur gear 1383b operably meshing with spur gear 1381b such that rotation of shaft 1330 is transmitted to spur gear 1383b. The second gear train further includes a shaft gear 1384b that operably meshes with spur gear 1383b. Referring primarily to FIG. 5, shaft gear 1384b is fixedly mounted to transmission shaft 1385b such that rotation of spur gear 1383b is transmitted to transmission shaft 1385b. The second gear train further includes a bevel gear 1386b fixedly mounted on the transmission shaft 1385b, a side bevel gear 1387b operatively meshing with the bevel gear 1386b, and a pinion gear 1388b fixedly mounted on the side bevel gear 1387b. The pinion gear 1388b is configured to rotate together with the side bevel gear 1387b. Pinion gear 1388b operatively meshes with a rack 1389b mounted on second foot 1380b that converts rotational input movement into translational movement of second foot 1380b.

The presence of transmission gear 1382 a in the first gear train and the absence of a corresponding transmission gear in the second gear train causes first foot 1380 a and second foot 1380 b to rotate drive shaft 1330 . In response to this, each will move in the opposite direction. For example, when drive shaft 1330 is rotated in a first direction, first foot 1380a is extended and second foot 1380b is retracted. Similarly, when drive shaft 1330 is rotated in a second or opposite direction, first foot 1380a is retracted and second foot 1380b is extended. As discussed above, the first and second feet 1380a, 1380b are configured to grip and pull the end effector 1300 against tissue as they are extended and retracted. Although the movement of the feet 1380a, 1380b may be linear, other embodiments are also disclosed herein that provide different movements, such as, for example, arcuate movements.

Once the end effector 1300 is properly moved relative to the tissue by the tissue drive system, the drive shaft 1330 is longitudinally translated out of engagement with the tissue drive system and the anvil drive, as shown in FIG. Engage with the system. In various examples, rotation of drive shaft 1330 may be stopped before disengaging from the tissue drive system. In other examples, drive shaft 1330 can continue to rotate when disengaged from the tissue drive system and translated into engagement with drive collar 1361. In either case, drive collar 1361 has a threaded opening 1362 defined therein, which threaded opening includes threads 1365. Anvil 1360 includes a push rod 1364 extending therefrom, the push rod including an end threadably engaged with threads 1365 within opening 1366. When drive collar 1361 is rotated in a first direction by drive shaft 1330, drive collar 1361 pushes anvil 1360 away from feet 1380a and 1380b to open anvil 1360. Once the anvil 1360 is sufficiently opened, the drive shaft 1330 may be shifted to engage the tissue drive system and move the end effector 1300 relative to the tissue. Drive shaft 1330 may then be re-engaged with the anvil drive system. As shown in FIG. 7, when drive collar 1361 is rotated in a second or opposite direction at such a point, drive collar 1361 pulls anvil 1360 toward feet 1380a and 1380b, causing Close or clamp 1360. Once anvil 1360 is closed, the staple firing system of stapling instrument 1000 may be activated. At such point, anvil 1360 may be reopened by the anvil drive system and the cycle described above may be repeated.

Notably, drive shaft 1330 extends along a longitudinal axis 1339 that is collinear with a longitudinal axis 1369 extending through pushrod 1364 of the anvil drive system. Such configuration allows drive shaft 1330 to be operably coupled to push rod 1334 via drive collar 1361. Notably, drive collar 1361 also includes a proximal flange 1367 and a distal flange 1368 extending therefrom. Flanges 1367 and 1368 act as stops to limit longitudinal movement of anvil 1360 in the proximal and distal directions, respectively. Flanges 1367 and 1368 therefore define the limits of the opening and closing strokes of anvil 1360. Anvil 1360 includes a tissue clamping surface that extends perpendicular or at least substantially perpendicular to longitudinal axis 1369 and moves longitudinally relative to distal head 1320. Anvil 1360 includes a movable jaw, and tissue drive system feet 1380a and 1380b include another movable jaw positioned on the opposite side of anvil 1360.

Referring again to FIG. 3, a longitudinal gap exists between the tissue drive system drive gear 1331 and the anvil drive system drive collar 1361. As a result, there may be a pause in motion when shifting between the tissue drive system and the anvil drive system. The shorter the gap, the shorter the pause, whereas the longer the gap, the longer the pause. Other embodiments are also envisioned where there is no or little clearance between drive gear 1331 and drive collar 1361, so that operational pauses may be eliminated.

Referring again to FIG. 1, end effector 1300 includes a plurality of staple cartridges 1400 stored therein. Stapling instrument 1000 includes a cartridge drive system configured to force staple cartridge 1400 into end effector 1300. As a result, the cartridge drive system can be used to reload end effector 1300 without having to remove stapling instrument 1000 from the surgical site. However, once the supply of staple cartridges 1400 in end effector 1300 is exhausted, unless stapling instrument 1000 includes a system for loading the cartridges during operation of stapling instrument 1000, stapling instrument 1000 It may have to be removed from the surgical site and reloaded. Such systems are described in more detail below. In any event, end effector 1300 may be removed from shaft assembly 1200 and an unused end effector 1300 may then be attached to shaft assembly 1200 to reload stapling instrument 1000.

Referring again to FIG. 1, each end effector 1300 is intended for as many uses as there are staples or staple cartridges stored within the end effector 1300. Shaft assembly 1200 is intended for more uses than end effector 1300. As a result, a used end effector 1300 can be replaced with another end effector 1300 without having to replace the shaft assembly 1200. In at least one example, for example, each end effector 1300 is intended for 10 uses and the shaft assembly is intended for 100 uses. Handle 1100 is intended for more uses than shaft assembly 1200 and/or end effector 1300. As a result, a used shaft assembly 1200 can be replaced without the need to replace the handle 1100. In at least one example, for example, shaft assembly 1200 is intended for 100 uses and handle 1100 is intended for 500 uses.

As described above, stapling instrument 1000 is configured to open or unclamp the anvil through reciprocating motion, create relative movement between the end effector and patient tissue, and then reclamp the anvil. Equipped with a drive system. 42 and 43 illustrate an exemplary embodiment of another reciprocating drive system that may be used. Drive system 2800 includes a rotatable drive shaft 2830 and a drive gear 2831 fixedly attached to drive shaft 2830. Drive system 2800 further includes a spur gear 2832 that operably meshes with drive gear 2831 such that rotation of drive shaft 2830 is transmitted to spur gear 2832. Drive system 2800 includes a bevel gear 2833 attached to and rotating with bevel gear 2832, a side bevel gear 2834 operatively meshing with bevel gear 2833, and a spur gear 2835 operably meshing with a gear attached to one side of bevel gear 2834. Prepare more. Drive system 2800 includes a pinion gear 2836 that is fixedly attached to and rotates with spur gear 2835, an output gear 2837 that is operatively engaged with pinion gear 2836, and an output gear 2837 that is fixedly attached to and rotates with output gear 2837. It further includes a cam 2838. As a result of the above, rotation of drive shaft 2830 causes cam 2838 to rotate, which is translated into reciprocating motion of drive shaft 2830, as explained below.

In addition to the above, drive system 2800 includes a rotatable shifter 2840 that includes a cam arm 2848 and a shifter arm 2849 that is rotatable about a pivot 2841. In use, cam 2838 is configured to engage cam arm 2848 of shifter 2840 to rotate shifter 2840 between a first position (FIG. 43) and a second position (FIG. 42). There is. As shown in FIG. 42, when the shifter 2840 is rotated to its second position, the cam arm 2848 engages a shoulder 2839 defined on the drive shaft 2830 and forces the drive shaft 2830 upwardly. . A spring 2820 is positioned between the shoulder 2839 and the stapling instrument frame 2819, which spring is compressed when the drive shaft 2830 is moved to its second position, imparting potential energy therein. accumulate. As shown in FIG. 43, as cam 2838 continues to rotate, cam 2838 disengages from cam arm 2848 and spring 2820 resiliently returns drive shaft 2830 to its first position. This reciprocating movement of the drive shaft 2830 between its first and second positions may be utilized to operate a reciprocating drive system within the end effector of the stapling instrument.

FIG. 44 shows another exemplary embodiment of a reciprocating drive system. Drive system 2900 includes an electric motor 2930, a first drive system 2940 operably coupled to electric motor 2930, and a second drive system 2950 operably coupled to electric motor 2930. Electric motor 2930 includes a rotatable output shaft 2931 and a drive gear 2932 fixedly mounted to output shaft 2931. First drive system 2940 includes an input gear 2942 that operably meshes with drive gear 2932. Input gear 2942 is fixedly attached to drive shaft 2943 such that drive shaft 2943 rotates with input gear 2942. First drive system 2940 further includes a barrel cam 2944 that is slidably mounted on drive shaft 2943 and rotates therewith. Barrel cam 2944 includes an opening 2945 defined therein that, for example, transmits rotation between drive shaft 2943 and barrel cam 2944 while still allowing relative translation therebetween. a non-circular profile configured to Barrel cam 2944 further includes a cam slot 2949 defined about its periphery, which cam slot interacts with a cam pin 2919 mounted on frame 2910 such that when barrel cam 2944 is rotated, barrel cam 2944 further translated. Barrel cam 2944 is translated distally when barrel cam 2944 is rotated in a first direction, and translated proximally when barrel cam 2944 is rotated in a second, opposite direction. The first drive system 2940 further includes a drive shaft 2946 extending from the barrel cam 2944 and configured to drive the first end effector function.

Second drive system 2950 includes an input gear 2952 that operably meshes with drive gear 2932. Input gear 2952 is fixedly attached to drive shaft 2953 such that drive shaft 2953 rotates with input gear 2952. The second drive system 2950 further includes a barrel cam 2954 that is slidably attached to and rotates with the drive shaft 2953. Barrel cam 2954 has an opening 2955 defined therein that, for example, transmits rotation between drive shaft 2953 and barrel cam 2954 while still allowing relative translation therebetween. a non-circular profile configured to Barrel cam 2954 further includes a cam slot 2959 defined about its periphery, which cam slot interacts with a cam pin 2919 mounted on frame 2910 so that when barrel cam 2954 is rotated, barrel cam 2944 further translated. Barrel cam 2954 is translated distally when barrel cam 2954 is rotated in a first direction and translated proximally when barrel cam 2954 is rotated in a second, opposite direction. The second drive system 2950 further includes a drive shaft 2956 extending from the barrel cam 2954 and configured to drive the second end effector function.

When electric motor 2930 of drive system 2900 is rotated in a first direction, first drive shaft 2946 is advanced distally and second drive shaft 2956 is retracted proximally. Correspondingly, the first drive shaft 2946 is retracted proximally and the second drive shaft 2956 is advanced distally when the electric motor 2930 is operated in a second, opposite direction. . Other embodiments in which drive shafts 2946 and 2956 are distally advanced at the same time are also envisioned.

92 and 93, stapling instrument 4500 includes a tissue drive device 4590 that includes a first foot 4580a and a second foot 4580b. The first foot 4580a has a rack of teeth 4583a defined thereon, the second foot 4580b has a rack of teeth 4583b defined thereon, and the tissue drive device 4500 has racks 4583a and 4583b defined thereon. It further includes a pinion gear 4593 that meshes with and is engaged with. The pinion gear 4593 is rotatable back and forth about the axis to reciprocally extend and retract the feet 4580a and 4580b, thereby driving the stapling instrument against the patient's tissue. Tissue drive device 4590 further includes a first actuator 4592 pinned to pinion gear 4593 at pivot joint 4591 and a second actuator 4594 pinned to pinion gear 4593 at pivot joint 4595. In use, the first actuator 4592 is pushed and/or the first actuator 4592 is pressed to rotate the pinion gear 4593 in a first direction, extend the second foot 4580b, and retract the first foot 4580a. Actuator 2 4594 is pulled. Correspondingly, first actuator 4592 is pulled to rotate pinion gear 4593 in a second direction, extend first foot 4580a, and retract second foot 4580b, and/or Second actuator 4594 is pushed. Notably, feet 4580a and 4580b are displaced linearly and in opposite directions. Accordingly, feet 4580a and 4580b are configured such that when one of feet 4580a and 4580b is retracted to pull tissue, the other foot slides or slides against tissue as it is extended. ing.

As discussed above, the feet 1380a and 1380b of stapling instrument 1000 are extended and retracted along a linear path. In such an example, feet 1380a and 1380b can slide over tissue when extended and then grip and pull tissue when retracted. Feet 1380a and 1380b may include teeth extending therefrom that slide against tissue when feet 1380a and 1380b are moved in one direction and against tissue when moved in the opposite direction. It has a contour that facilitates grasping the tissue. In at least one example, the teeth are, for example, substantially triangular, but with a shallow angle on a first side and a steeper angle on the other side. In such an example, the shallow angle allows the first side to slide against the tissue, whereas the steeper angle on the second side allows the feet 1380a and 1380b to slide against the tissue when the feet 1380a and 1380b are retracted. bite into or grasp tissue.

As mentioned above, feet 1380a and 1380b are driven along a linear path by racks 1389a and 1389b defined thereon. In some examples, the linear movement of the feet 1380a and 1380b may be strictly guided, with little, if any, drift or deflection from linear movement. 88 and 89, in various embodiments, the foot of the tissue drive system can include one or more joints that provide at least one additional degree of freedom, such that the foot can be It is possible to deviate from a straight path. Tissue drive system 4200 includes a first foot 4280a and a second foot 4280b movably connected by link 4282. Link 4282 is connected to a first foot 4280a at a pivot joint 4281a and to a second foot 4280b at a pivot joint 4281b. Feet 4280a and 4280b are moved proximally and distally by an input portion 4290 that includes a drive shaft 4292 connected to link 4282 at pivot joint 4283. Pivot joints 4281a, 4281b, and 4283 allow feet 4280a and 4280b to be lifted or lifted upwardly as they extend across the tissue.

As mentioned above, the stapling instruments disclosed herein with tissue drive systems propel themselves throughout the patient's tissue as they staple and cut the patient tissue along the staple firing path. Constructed to be driven or marched. In various examples, tissue thickness may vary along the length of the staple firing path. Stated another way, the tissue may increase and/or decrease in thickness in the anteroposterior and/or lateral directions. Referring again to FIGS. 88 and 89, the degrees of freedom provided by pivot joints 4281a, 4281b, and 4283 allow feet 4280a and 4280b to tilt in response to such changes in tissue thickness. . For example, feet 4280a and 4280b may be sloped in the anteroposterior and/or lateral directions. Furthermore, feet 4280a and 4280b can tilt independently of each other. Thus, feet 4280a and 4280b may be tilted in the same direction or in different directions. Therefore, alternative embodiments in which foot 4280a and foot 4280b slope in the same direction are also envisioned. Such a configuration may have a simpler drive system. In any case, the feet 4280a and 4280b can raise and lower themselves according to changes in tissue thickness and can have the desired traction on the tissue.

Referring now to FIG. 87, stapling instrument 4100 includes a distal stapling head 4120, which, like stapling instrument 1000, includes a tissue drive system 4190 that includes a foot 4180. Tissue drive system 4190 includes a rocker link 4192 rotatably mounted within stapling head 4120 about pivot pin 4124 . Rocker link 4192 includes leg 4193 and pivot pin 4124 extends through an opening 4194 defined within leg 4193. Each leg 4193 is pivotally connected to a foot 4180 about a pivot pin 4195. In use, tissue drive system 4190 rocks rocker link 4192 back and forth to extend and retract foot 4180 along a non-linear or curved path. Although the feet 4180 are extended and retracted together, embodiments are also envisioned in which each is moved in opposite directions. Further, in addition to the above, foot 4180 may tilt about pivot pin 4195 to accommodate changes in tissue thickness. In various examples, the tissue drive system 4190 can lift the foot 4180 away from the tissue during at least a portion of the tissue drive stroke, such as at the end of the tissue drive stroke.

37-41, surgical instrument 2700 includes a distal head 2720 that includes an anvil 2760, a tissue drive foot 2780, and a tissue drive device 2790. Tissue drive device 2790 includes a positioning rod 2791 attached to drive foot 2780 at a pivot joint 2781. Positioning rod 2791 is displaceable along the longitudinal axis to engage (FIG. 38) and disengage (FIG. 41) drive foot 2780 with respect to patient tissue T. Referring to FIG. 37, when drive foot 2780 is disengaged from tissue and retracted into distal head 2720, distal tip 2785 of drive foot 2780 is positioned within distal head 2720 and distal Do not extend from the tip. Additionally, once drive foot 2780 is retracted into distal head 2720, drive foot 2780 is locked in place or prevented from rotating. More specifically, the distal head 2720 includes a control slot 2724 defined therein, and the foot 2780 includes two control pins 2784 slidably disposed within the control slot 2724 and their The control pin is configured to prevent drive foot 2780 from rotating when drive foot 2780 is in its retracted position (FIGS. 37 and 41) and when drive foot 2780 is in its engaged position (FIGS. 38-40). The drive foot 2780 is configured to allow rotation, as discussed below.

Referring to FIGS. 38-40, drive foot 2780 is configured to engage patient tissue T and drive distal head 2720 relative to the tissue to reposition distal head 2720 relative to the tissue. ing. Tissue drive device 2790 includes a first driver 2792 and a second driver 2793 configured to rotate foot 2780 about pivot joint 2781. The first driver 2792 includes a push end disposed within a first socket 2782 defined on the drive foot 2780 and the second driver 2793 includes a push end disposed within a first socket 2782 defined on the opposite side of the drive foot 2780. with a push end disposed within socket 2783. Referring to FIG. 40, first driver 2792 is displaceable toward tissue to rotate drive foot 2780 in a first direction. Referring to FIG. 39, a second driver 2793 is displaceable towards tissue to rotate the drive foot in a second, opposite direction. In use, drive foot 2780 is rotatable back and forth by tissue drive device 2790 to create relative movement in an anterior or posterior direction between distal head 2720 and tissue.

78-85, the stapling instrument 3900 includes a staple firing system 3950 configured to staple patient tissue, a staple firing system 3950 configured to clamp patient tissue against a tissue compression surface 3925, and a staple firing system 3950 configured to staple patient tissue. an anvil 3960 configured to deform staples deployed by 3950 and a foot 3980 configured to generate relative movement between distal head 3920 and tissue when anvil 3960 is in an unclamped position and a distal head 3920. Stapling instrument 3900 further includes a tissue drive device 3990 configured to extend and retract foot 3980. 83 and 84, the tissue drive device 3990 includes a rotatable drive shaft 3992 and a worm gear 3993 fixedly attached to the drive shaft 3992 such that the worm gear 3993 along with the drive shaft 3992 Rotate. Worm gear 3993 is matingly engaged with a gear surface 3995 defined on one side of drive wheel 3994. Drive wheel 3994 is rotatably mounted about pin 3991 mounted to distal head 3920. As a result of the above, drive wheel 3994 rotates in response to rotation of drive shaft 3992.

In addition to the above, and with reference to FIGS. 79-82, the tissue drive device 3990 further includes a coupler bar 3996 that includes a cam slot 3999 (FIGS. 83 and 82) defined in a second side or face of the drive wheel 3994. 85) with a first end slidably disposed within. In at least one example, coupler bar 3996 includes a pin that rides within cam slot 3999. Coupler bar 3996 further includes a second end pivotally mounted to foot 3980 at pivot joint 3998. As the drive wheel 3994 is rotated, the sidewall of the cam slot 3999 pushes the first end of the coupler bar 3996 through the path or motion shown in FIG. This path is also shown in FIGS. 79A, 80A, 81A, and 82A, following the movement of tissue drive device 3990 and foot 3980 shown in FIGS. 79, 80, 81, and 82, respectively. FIG. 79 shows the foot 3980 in a retracted position, and FIG. 79A shows a dot P on the foot movement path FM representing the position of the foot 3980 along the foot movement path FM. FIG. 80 shows the foot 3980 extended and FIG. 80A shows the dot P advanced along the foot movement path FM. FIG. 81 shows foot 3980 in a fully extended position and dot P advanced further along foot motion path FM. FIG. 82 shows foot 3980 returned to the retracted position. At such point, the movement of foot 3980 may be repeated, ie, reciprocated.

In addition to the above, the coupler bar 3996 includes a longitudinal slot 3997 defined therein, into which the staple head 3920 cooperates to limit or constrain movement of the coupler bar 3996. An extending pin 3927 is provided. Figures 84 and 85 map three corresponding positions labeled 1, 2, and 3 along the cam slot 3999 and firing motion path FM. Position 1 corresponds to point P in Figure 79A, position 2 corresponds to point P in Figure 80A, and position 3 corresponds to point P in Figure 81A. In various examples, tissue drive device 3990 includes a four-bar linkage in which foot 3980 is lofted when extended. To facilitate this movement, each foot 3980 has a slot 3981 defined therein, the sidewalls of those slots sliding against pins 3921 extending into the slot 3981. The pin 3921/slot 3981 configuration allows the foot 3980 to translate and rotate during the tissue drive stroke cycle.

FIG. 86 shows an alternative embodiment of a cam path 4099 with a shoulder that prevents backward movement of the coupler bar 3996 within the slot 3999. For example, cam path 4099 includes a first shoulder 4091 that corresponds to position 1 and FIG. 79A; once coupler bar 3996 passes this point, coupler bar 3996 cannot back out past position 1. Cam path 4099 includes a second shoulder 4092 that corresponds to position 2 and FIG. 80A; once coupler bar 3996 passes this point, coupler bar 3996 cannot back out past position 2. Cam path 4099 also includes a third shoulder 4093 that corresponds to position 3 and FIG. 81A; once coupler bar 3996 passes this point, coupler bar 3996 cannot back out past position 3.

50-56, stapling instrument 3100 includes a distal head 3120 that includes an anvil 3160 and a tissue drive foot 3180. Referring to FIG. 50, the drive foot 3180 is extendable to engage patient tissue and then, referring to FIG. 51, to move the distal head 3120 relative to the patient tissue. It is possible to retreat. Each drive foot 3180 includes a rack or array of teeth 3193 configured to engage patient tissue, which rack or array is also movable between extended and retracted positions. FIG. 51 shows teeth 3193 extending from drive foot 3180 when drive foot 3180 is retracted from the extended position. More specifically, teeth 3193 protrude from tissue compression surface 3125 defined on drive foot 3180 when drive foot 3180 is retracted from their fully extended position. On the other hand, referring to FIG. 50, when the drive foot 3180 is extended, the teeth 3193 do not protrude from the tissue compression surface 3125, thereby causing the drive foot 3180 to contact the patient tissue while being extended. It is possible to slide against.

52-56, stapling instrument 3100 includes a tissue drive device 3190 configured to extend and retract drive foot 3180 and extend and retract teeth 3193. Referring to FIGS. Tissue drive device 3190 includes an input bar 3191 that extends into and is movable within a cavity 3181 defined within each drive foot 3180. The input bar 3191 has circuit configurations including a raised retracted position (FIGS. 52 and 56), a lowered retracted position (FIG. 53), a lowered extended position (FIG. 54), and a raised extended position (FIG. 55). moving the drive foot 3180 through a non-linear path. Input bar 3191 includes a pin 3192 extending therefrom that extends into a slot 3182 defined in drive foot 3180. As discussed in more detail below, the interaction between pin 3192 and the sidewall of slot 3182 transmits movement of input bar 3191 to drive foot 3180. Each of the slots 3182 extends along an axis that is transverse and non-parallel to the longitudinal axis of the distal head 3120, resulting in the desired movement of the drive foot 3180 and teeth 3193.

As shown in FIG. 52, when the input bar 3191 is in the fully retracted position, the input bar 3191 positions the drive foot 3180 in its raised retracted position. In this position, teeth 3193 protrude through windows 3183 defined in drive foot 3180. Referring to FIG. 53, when input bar 3191 is moved out of its fully retracted position, pin 3192 interacts with the sidewall of slot 3182 and cams drive foot 3180 downward. At such point, teeth 3193 no longer protrude through window 3183. As input bar 3191 is moved further away from its fully retracted position, input bar 3191 begins to extend drive foot 3180, as shown in FIG. Notably, teeth 3193 do not protrude through window 3183 when drive foot 3180 is extended. However, as shown in FIG. 55, when the input bar 3191 is retracted, the pin 3192 interacts with the sidewall of the slot 3182 and raises the drive foot 3180, causing the tooth 3193 to protrude through the window 3183. Become. As a result, the teeth 3193 engage or grasp patient tissue and pull the tissue against the distal head 3120 until the drive foot 3180 is fully retracted, as shown in FIG. be able to. At such point, the tissue may be stapled and/or dissected. The above process may be repeated to move staple instrument 3100 along the entire staple firing path.

57-59D, stapling instrument 3200 includes a distal stapling head 3220 that includes a tissue drive foot 3270 that is driven by a tissue drive system, such as the tissue drive system of stapling instrument 1000. , are extended outward and retracted inward along the same path. Accordingly, the stapling head 3220 further includes a lateral drive foot 3280 that moves with the drive foot 3270, but can also move laterally relative to the drive foot 3270, as shown in FIGS. 57 and 58. As a result, the lateral drive foot 3280 is extended along one path, as shown in FIGS. 59A and 59B, and then laterally extended, as shown in FIGS. 59C and 59D. may be retracted along the route. Further, drive feet 3270 and 3280 can pull distal head 3220 against patient tissue in two different directions, thereby controlling the relative movement between distal stapling head 3220 and patient tissue. Provides greater control over

Referring primarily to FIGS. 57 and 58, drive feet 3270 and 3280 are rotatably coupled as a pair. Each pair includes an actuator plate 3260, a first link 3272 pivotally connected to a drive foot 3270 about a pivot 3271, and a first link 3272 pivotally connected to a lateral drive foot 3280 about a pivot 3281. A second link 3282. Referring to FIG. 58, when a downward force is applied to the actuator plate 3260, the actuator plate 3260 pushes against the joint 3213 rotatably connecting the first link 3272 and the second link 3282, thereby causing the side The side foot 3280 is displaced outwardly. Additionally, distal head 3220 constrains lateral movement of drive foot 3270 so that drive foot 3270 does not move laterally when lateral drive foot 3280 is laterally extended. However, referring to FIGS. 60A-60D, alternative embodiments are envisioned in which drive foot 3270 may also move laterally. In either case, a biasing member, such as, for example, a torsion spring disposed within and/or coupled to the fitting 3213, causes the drive foot to move laterally after the pushing force is removed from the actuator plate 3260. It can be set back. 59A-59D illustrate a series of steps that may be repeated by surgical instrument 3200 to move stapling instrument 3200 along a staple firing path. 60A-60D also illustrate a series of steps that may be repeated by surgical instrument 3200 to move stapling instrument 3200 along a staple firing path.

61 and 62, surgical instrument 3300 includes a distal head 3320 and a laterally extendable drive foot 3380. Drive foot 3380 is coupled to distal head 3320 via flexible connector 3375 and actuator 3370. When a compressive force is applied to the actuator 3370, the actuator 3370 is displaced and/or compressed, which causes the connector 3375 to extend laterally and the corresponding drive foot 3380 to be pushed laterally. When the compressive force is removed from actuator 3370, connector 3375 elastically contracts and pulls drive foot 3380 inwardly. Drive foot 3380 can include a tissue grasping mechanism defined thereon, the tissue grasping mechanism configured to push and/or pull patient tissue as drive foot 3380 is being moved laterally. It is constructed. As a result, drive foot 3380 can create relative movement between distal head 3320 and patient tissue.

91A-91D, stapling instrument 4400 includes a distal head 4420 that includes a tissue cutting drive 4440, a staple firing drive 4450, and a tissue drive that includes a foot 4480. Each foot 4480 is rotatably mounted to the distal head 4420 about a pivot pin 4481 and is rotatable to drive the distal head 4420 relative to patient tissue. Figure 91 shows foot 4480 in the retracted position. FIG. 91B shows foot 4480 extended. FIG. 91C shows foot 4480 in a fully extended position. Figure 91D shows foot 4480 being retracted. When foot 4480 is extended, foot 4480 drives distal head 4420 against patient tissue. Notably, the feet 4480 are synchronized such that they are extended and retracted together, and in such instances, the feet 4480 extend in a straight or at least substantially straight line. The distal head 4420 can be driven along. That said, one of the feet 4480 may be extended while the other foot 4480 is retracted. In such an example, foot 4480 can rotate distal head 4420 along a curved path.

76 and 77A-77D, stapling instrument 3800 includes a distal head 3820 that includes a staple firing system 3850, an anvil 3860, and a tissue drive system. The tissue drive system includes a first foot 3880a and a second foot 3880b and selectively extends and retracts the feet 3880a and 3880b to move the stapling instrument 3800 along the staple firing path FP. configured to be moved. The tissue drive system is configured to move or march the stapling instrument 3800 along a linear and/or curved staple firing path. 77A and 77B, the tissue drive system simultaneously extends and retracts the first foot 3880a and the second foot 3880b by equal or at least approximately equal amounts to move the distal firing head 3220 into a straight line. The projector is configured to move along a firing path. 77C and 77D, the tissue drive system is also configured to extend and retract only one of the feet 3880a and 3880b to pivot the distal firing head 3220. For example, referring to FIG. 77C, the tissue drive system extends the first foot 3880a without extending and retracting the second foot 3880b to pivot the distal head 3820 in the first direction. and can be retracted. Similarly, referring to FIG. 77D, the tissue drive system extends the second foot 3880a without extending and retracting the first foot 3880a to pivot the distal head 3820 in a second direction. It can be moved out and retracted.

As discussed above, the tissue drive system is configured to pivot the distal head 3820 of the stapling instrument 3800 by activating one of the feet 3880a and 3880b but not the other. Alternatively, the tissue drive system may be configured to pivot distal head 3820 by extending one of feet 3880a and 3880b less than the other. Distal head 3820 may be rotated gradually in such cases. The tissue drive system may also be configured to pivot distal head 3820 by moving feet 3880a and 3880b in opposite directions. In such an example, distal head 3820 may follow a small or tight radius of curvature within staple firing path FP.

63 and 64, stapling instrument 3400 includes a distal head 3420 that includes a staple firing system 3450, an anvil 3460, and a tissue drive system. The tissue drive system includes two drive wheels 3480 and a shaft 3481 rotatably supported by a mount 3482 that extends through an opening defined in the center of the drive wheels 3480. . Drive wheels 3480 are fixedly attached to pins 3481 so that they rotate together. Each drive wheel 3480 includes an array of teeth extending thereabout, and at least one of the drive wheels 3480 is matingly engaged with the drive shaft of the electric motor. The teeth extending around the drive wheel 3480 are also suitably configured to engage and grasp patient tissue. In use, the electric motor is operated to pivot the drive wheel 3480 to create relative motion between the distal head 3420 and patient tissue and move the distal head 3420 along the staple firing path. obtain.

Referring to FIG. 94, stapling instrument 4600 includes a distal head 4620 that includes a staple firing system 4650, an anvil 4660, and a tissue drive system. The tissue drive system includes two drive wheels 4680, each rotatably supported by a separate pin extending through the center thereof. As a result, drive wheels 4680 can be rotated independently. Each drive wheel 4680 includes an array of teeth extending thereabout, which is matingly engaged with the drive shaft of the electric motor. Stated another way, the tissue drive system includes two electric motors configured to independently rotate the drive wheel 4680. Similar to the above, the teeth extending around the drive wheel 4680 are also suitably configured to engage and grasp patient tissue. In use, the electric motor pivots the drive wheel 4680 to create relative movement between the distal head 4620 and patient tissue, causing the distal head 4620 to staple, as described in further detail below. It can be operated to move along a firing path.

In addition to the above, the tissue drive system is configured to rotate the drive wheels 4680 at the same speed and in the same direction to move the distal head 4620 along a linear staple firing path. The tissue drive system is also configured to rotate the wheels 4680 in the same direction but at different speeds to pivot the distal head 4620 along the curved staple firing path. Distal head 4620 may pivot gradually in such cases. The tissue drive system is also configured to pivot only one of the wheels 4680 and not the other drive wheel 4680 to pivot the distal head 4620 along the curved staple firing path. There is. Furthermore, the tissue drive system is further configured to rotate the drive wheels 4680 in opposite directions to pivot the distal head 4620 along a curved staple firing path having a small or tight radius of curvature. There is.

The tissue drive system further includes a lateral drive wheel 4670 positioned laterally to drive wheel 4680. As before, each lateral drive wheel 4670 is operably coupled to a different electric motor. As a result, the tissue drive system of stapling instrument 4600 includes four electric motors that can operate simultaneously or at different times. Lateral drive wheel 4670 can be operated independently of drive wheel 4680, but may be operated simultaneously with one or both of drive wheels 4680. Additionally, lateral drive wheels 4670 are movable independently of each other. Similar to the drive wheel 4680, the tissue drive system can pivot the lateral drive wheels 4670 together at the same speed, at different speeds, and/or in different directions to move the distal head 4620 along the staple firing path. configured to be moved. Additionally, the tissue drive system may pivot any suitable combination of drive wheels 4670 and 4680 in any suitable direction and at any suitable speed to direct stapling instrument 4600 along a desired staple firing path. configured to be moved.

Referring to FIG. 36, stapling instrument 2600 includes a distal head 2620 that includes a staple firing system 2650, an anvil 2660, and a tissue drive system. The tissue drive system includes two drive wheels 2670 and two drive wheels 2680 that can be independently rotated simultaneously or at different times to move the distal head 2620 along the staple firing path. Each drive wheel 2670 is rotatable about an axis 2671 and each drive wheel 2680 is rotatable about an axis 2681, but the axis 2671 is not parallel to the axis 2681. In fact, axes 2671 and 2681 are orthogonal, but may be oriented in any suitable direction. Although the tissue drive system includes four electric motors configured to separately rotate drive wheels 2670 and 2680, the tissue drive system may include any suitable number of electric motors to drive drive wheels 2670 and 2680. It may have an electric motor. In use, the electric motor pivots drive wheels 2670 and 2680 to create relative motion between distal head 2620 and patient tissue and to move distal head 2620 along a staple firing path. , can be operated.

75A-75D, stapling instrument 3700 includes a distal head 3720 that includes an anvil 3760 and a tissue drive system that includes a tissue drive foot 3780. Stapling instrument 3700 is similar to stapling instrument 1000 in many respects, most of which are not discussed herein for the sake of brevity. Anvil 3760 is movable relative to foot 3780 between a closed or clamped position (FIGS. 75A and 75D) and an open or unclamped position (FIGS. 75B and 75C). Referring to FIG. 75B, while anvil 3760 is open, drive foot 3780 may be extended to engage and grasp tissue. Referring to FIG. 75C, drive foot 3780 is then retracted to create relative movement between distal head 3720 and patient tissue. Referring to FIG. 75D, anvil 3760 is movable toward its closed position while and/or after drive foot 3780 is retracted. Drive foot 7580 may have tissue-grasping teeth and/or any suitable means for gripping and pulling tissue. In various examples, drive foot 7580 is configured to apply reduced pressure to tissue to grasp and pull tissue. In at least one such example, the reduced pressure system is turned off during the operating steps shown in FIGS. 75A and 75B and turned on during the operating steps shown in FIGS. 75C and 75D, for example. In such an example, the reduced pressure may retain tissue within the distal head 7520 when the anvil 7560 is closed, but otherwise the reduced pressure is turned off during the operating step shown in FIG. 75D. Embodiments are also envisioned.

65-69, stapling instrument 3500 includes a distal head 3520 that includes an anvil 3560 and a tissue drive system that includes a vacuum supply line 3570 and two vacuum graspers 3580. and two Grasper extenders 3590. Vacuum supply line 3570 includes a manifold 3571 configured to provide a vacuum differential to two grasper extenders 3590 and two vacuum graspers 3580. Each grasper extender 3590 includes a bellows 3591 in communication with a manifold 3571 that contracts and expands when reduced pressure is transmitted to its inner plenum. When bellows 3591 contracts, it extends grasper 3580 to the position shown in FIG. Each bellows 3591 is in fluid communication with a cavity 3581 defined within the grasper 3580, thereby allowing a reduced pressure differential to be transmitted to a grasper hole 3582 defined in the tissue engaging surface 3585 of the grasper 3580. Become. This reduced pressure differential in the grasper hole 3582 allows patient tissue to be held against the tissue engaging surface 3585.

As discussed above, the extension of the grasper 3580 corresponds to the application of a reduced pressure differential to the tissue. When vacuum supply line 3570 no longer supplies a vacuum differential to bellows 3591, bellows 3591 elastically re-expands and deflates, retracting grasper 3580 accordingly, as shown in FIG. 67. Similarly, bellows 3591 can also re-inflate and retract grasper 3580 when the vacuum differential is reduced. In any event, the vacuum differential across the grasper hole 3582 may decrease as the grasper 3580 is retracted. In some cases, the residual vacuum differential in the grasper hole 3582 may be sufficient to draw patient tissue into the tissue chamber 3525 of the distal head 3520. In other examples, the residual vacuum differential across the grasper hole 3582 may not be sufficient by itself to draw patient tissue into the tissue chamber 3525. With this in mind, grasper 3580 includes flexible teeth 3586 extending from tissue engaging surface 3585 thereof. Referring to FIG. 66, when the grasper 3580 is extended, the flexible teeth 3586 slide over the patient tissue without catching, or at least not significantly, against the patient tissue. This relative movement is also facilitated by the transverse angle at which teeth 3586 extend from tissue engaging surface 3585. Referring to FIG. 68, when grasper 3580 is retracted, teeth 3586 bite into patient tissue and draw patient tissue into tissue chamber 3525. Again, this is facilitated by the angle of the teeth 3586 and can compensate for the loss of vacuum differential in the grasper hole 3582.

Once patient tissue is positioned within tissue chamber 3525, the tissue may be stapled and/or dissected. The supply line 3570 does not provide a reduced pressure differential during stapling and/or cutting operations because doing so would extend the grasper 3580 and displace tissue. Thus, for example, the vacuum supply may be turned off during stapling and/or cutting operations if another method of holding the tissue in place exists. In any event, the anvil 3560 may then be opened again, the distal head 3520 may be moved relative to the tissue, and vacuum delivery may be used to re-extend the tissue grasper 3580, thus following the process described above. may be repeated, as shown in FIG.

70-73, stapling instrument 3600 includes a distal stapling head 3620 that includes a staple firing system 3650, an anvil 3660, a tissue cutting system 3640, and a tissue grasping system that utilizes a vacuum differential. There is. Stapling instrument 3600 is similar to stapling instrument 3500 in many respects, most of which are not discussed herein for the sake of brevity. Therefore, the tissue grasping system has two separate and distinct vacuum supply lines: a first bellows 3690a in fluid communication with a first tissue drive foot 3680a via a foot manifold 3685a; supply line 3670a, and a second supply line 3670b that communicates with a second bellows 3690b that is also in fluid communication with a second tissue drive foot 3680b via foot manifold 3685b. Foot manifold 3685a includes an array of manifold openings 3686 that communicate with foot openings 3682 defined in first foot 3680a when vacuum is supplied to first supply line 3670a. In addition, the reduced pressure difference is transmitted to the foot opening 3682. Foot manifold 3685b includes an array of manifold openings 3686 that communicate with foot openings 3682 defined in second foot 3680b when vacuum is supplied to second supply line 3670b. In addition, the reduced pressure difference is transmitted to the foot opening 3682. The stapling instrument 3600 selectively applies a vacuum to the first supply line 3670a and the second supply line 3670b such that the first drive foot 3680a and the second drive foot 3680b can be selectively extended and retracted. further comprising a control system configured to add to the control system. In some examples, feet 3680a and 3680b are synchronized and extended and retracted together at the same time, while in other examples, feet 3680a and 3680b are extended and retracted at different times.

An alternative embodiment of a stapling instrument 3600' is shown in FIG. 74. Stapling instrument 3600' is similar to stapling instrument 3600 in many respects. That said, the instrument 3600' includes a larger tissue drive foot 3680' with more vacuum holes 3682 defined therein compared to the tissue drive foot 3680 of the stapling instrument 3600.

47A-47G, stapling instrument 3000 includes a staple firing system, an anvil closure system that includes an anvil 3060, a tissue drive device that includes at least one drive foot 3080, and a tissue drive system that releasably retains tissue. and a tissue gripper 3070 configured to. Referring to FIG. 47A, anvil 3060 is movable from a clamped position to an unclamped position to unclamp patient tissue T. Referring to FIG. 47B, tissue gripper 3070 is engageable with patient tissue T to hold the tissue in place while drive foot 3080 is extended, as shown in FIGS. 47C and 47D. It is shown. Tissue gripper 3070 may be engaged with tissue when anvil 3060 is opened and/or after anvil 3060 is opened. In either case, referring to FIG. 47E, the tissue gripper 3070 is removed before the drive foot 3080 is retracted to pull the distal head 3020 against the tissue and position the distal head 3020 at a new position along the staple firing path. and then disengaged from the tissue (shown in FIG. 47F). Referring to FIG. 47G, at that point the patient tissue is clamped by the anvil 3060 and the staple firing system is operated to staple the tissue. At that point, the above cycle may be repeated.

As shown in FIGS. 47D-47F, drive foot 3080 is in fluid communication with a reduced pressure source 3090. Similar to above, drive foot 3080 can utilize a vacuum differential from vacuum source 3090 to grasp patient tissue. Also similar to above, a reduced pressure differential from reduced pressure source 3090 may be used to extend drive foot 3080. That said, drive foot 3080 may be extended using any suitable mechanism.

Referring again to FIG. 78, stapling instrument 3900 further includes a tissue gripper 3970. Tissue gripper 3970 can be used with drive foot 3980 in the same or similar manner that tissue gripper 3070 is used with drive foot 3080.

45, 46, 48, and 49 illustrate operating sequences of stapling devices that may be used with the stapling devices disclosed herein, such as, for example, stapling device 4000 and/or stapling device 3900 described above. ing. Stapling instrument 4000 is similar in many respects to other stapling instruments disclosed herein, most of which are not discussed herein for the sake of brevity. The stapling instrument 4000 includes an anvil drive system 4060, a staple firing system 4050, a tissue cutting system 4040, a tissue grasping system 4090, and a tissue drive system configured to move the stapling instrument 4000 relative to patient tissue. 4080. FIG. 49 shows the operational steps of stapling instrument 4000 occurring in the order presented. For example, step 4003 follows step 4002, step 4002 follows step 4001, and so on. That said, as shown in FIG. 46 and described in more detail below, it is understood that adjacent operational steps may occur simultaneously, or at least with some degree of overlap. should be understood. Furthermore, the operational steps of FIG. 49 may be rearranged in any suitable order.

Referring again to FIG. 49, operational step 4001 includes loading a staple cartridge into stapling instrument 4000 and/or pushing the staple cartridge into position within stapling instrument 4000. Operation step 4002 includes removing staples from the staple cartridge, and operation step 4003 includes placing the staples in place within staple firing drive 4050. Acting step 4004 includes articulating the end effector of stapling instrument 4000 as necessary. Accordingly, operation step 4004 may also occur before and/or during steps 4001, 4002, and/or 4003. Operation step 4005 includes positioning the end effector over patient tissue, and operation step 4006 includes operating anvil drive system 4060 to clamp the anvil over the tissue. Operation step 4005 may also be performed before operation step 4004.

In addition to the above, act 4007 includes forming a staple to the anvil and act 4008 includes deploying a knife of tissue cutting system 4040. Although operation step 4007 occurs before operation step 4008, steps 4007 and 4008 may occur simultaneously or with some degree of overlap. Acting step 4009 includes retracting the knife using tissue cutting system 4040, which follows acting step 4008. Operation step 4010 includes grasping and holding patient tissue positioned within the end effector of stapling instrument 4000 using tissue grasping system 4090. Operation step 4011 includes unclamping the anvil using anvil drive system 4060. In such instances, stapling instrument 4000 can retain tissue even when the anvil is open as a result of the tissue grasping system. Acting step 4012 includes advancing a foot of tissue drive system 4080. Acting step 4013 includes activating tissue grasping system 4090 to ungrasp tissue, and acting step 4014 includes retracting the foot of tissue drive system 4080 to advance stapling instrument 4000 relative to the tissue. include.

In addition to the above, FIG. 46 shows that certain operational steps may occur simultaneously or with some degree of overlap. For example, opening the anvil 4011 and loading the staple cartridge into position 4001 may occur simultaneously or with at least some overlap. Similarly, the steps 4002 and/or 4003 may include advancing the staples into position within the staple firing drive 4050, e.g., opening the anvil 4011, grasping the tissue using the tissue grasping system 4090. Simultaneously or in some way with step 4010, extending 4012 the foot of tissue drive system 4080, releasing tissue 4013 using grasping system 4090, and/or retracting 4014 the foot of tissue drive system 4080. May occur with duplication. Additionally, reloading 4001 with another staple cartridge into position within stapling instrument 4000 may occur simultaneously with or with some overlap with cutting 4008 the tissue and/or retracting 4009 the tissue cutting knife. This may occur with

In addition to the above, FIG. 45 illustrates the operating cycles of the anvil drive system 4060 and tissue drive system 4080 of the stapling instrument 4000. The actuation cycle of FIG. 45 is plotted against time t, with the limit 0 on the horizontal time axis representing the beginning of the cycle sequence of stapling instrument 4000. Referring to the operating cycle of anvil drive system 4060, peak 4006 correlates with step 4006 described above, which includes closing or clamping the anvil onto tissue. Similarly, pause 4011 correlates with step 4011 described above, which includes releasing or unclamping the tissue. Referring now to the operating cycle of tissue drive system 4080, peak 4012 correlates with step 4012 that includes extending a foot of tissue drive system 4080, and peak 4014 includes retracting a foot of tissue drive system 4080; Correlated step 4014 includes driving stapling instrument 4000 against patient tissue. Comparing the operating cycles of anvil drive system 4060 and tissue drive system 4080, it can be seen that when the foot is extended, the anvil is opening or is opening. Additionally, it may be recognized that the anvil is open when the foot is retracted and that the anvil is closed at the beginning of the next cycle of stapling instrument 4000.

As discussed above, it may be desirable to perform certain operating steps of stapling instrument 4000 sequentially and other operating steps concurrently. However, in some cases, it may not be desirable to perform certain operational steps at that time. As such, stapling instrument 4000 is configured to lock out certain drive systems and prevent them from operating while other drive systems of stapling instrument 4000 are operated. Lockouts may include, for example, mechanical lockouts and/or electrical lockouts. All of the drive systems of the stapling instrument 4000 are electrically powered and in communication with the controller of the stapling instrument 4000, so that the drive system can be locked out using the controller. The controller includes, for example, a microprocessor configured to electronically lock out one or more drive systems during operation of one or more other drive systems. FIG. 48 is a chart showing which operational steps are prevented from being executed while other operational steps are being performed. For example, during step 4001 a staple cartridge is loaded into position, articulating 4004 the end effector of stapling instrument 4000, positioning 4005 the stapling instrument 4000 relative to tissue, and unclamping the anvil. All operating steps other than 4011 are locked out or prevented from occurring. In this example, staple firing system 4050, tissue drive system 4080, and tissue grasping system 4090 are locked out. This is just one example. Other steps may be unlocked during step 4001 if it is determined that doing so is not detrimental or unacceptably detrimental to the operation of stapling instrument 4000.

90A-90D, stapling instrument 4300 includes a distal head 4320 that includes a staple firing system 4350, an anvil drive system that includes an anvil 4360, and a tissue cutting system 4340. Stapling instrument 4300 is similar to stapling instrument 1000 and stapling instrument 4400 in many respects, most of which are not discussed herein for the sake of brevity. Stapling instrument 4300 further includes upper feet 4370a and 4370b and lower feet 4380a and 4380b. Similar to foot 4480 of stapling instrument 4400, feet 4370a, 4370b, 4380a, and 4380b are used to move distal head 4320 relative to patient tissue T in an extended position (FIG. 90A) and a retracted position (FIG. 90B to 90D). Referring to FIG. 90A, feet 4370a and 4380a comprise a first synchronized pair of feet that move together to grasp patient tissue when moved to their extended position. In such cases, feet 4370a and 4380a are moved toward each other to apply compressive force or pressure to the tissue. Referring to FIG. 90B, when the feet 4370a and 4380a are retracted, the feet 4370a and 4380a pull on the tissue and move the distal head 4320 relative to the tissue. Referring to FIG. 90C, when feet 4370a and 4380a are retracted, staple firing system 4350 and tissue cutting system 4340 staple and cut patient tissue. Staple firing system 4350 and tissue cutting system 4340 may be operated simultaneously, although staple firing system 4350 may be operated before tissue cutting system 4340. Therefore, cutting the tissue before stapling can cause unnecessary bleeding. Notably, however, foot 4370a and foot 4380a apply clamping pressure to the tissue while stapling instrument 4300 is stapling and cutting the tissue. Referring to FIG. 90D, once the tissue is stapled and dissected, feet 4370a and 4380a move away from the tissue to unclamp it.

As mentioned above, feet 4370a and 4380a are operably coupled together such that they move together as a pair. They rotate together as a pair, they clamp together as a pair, and they unclamp together as a pair. Various alternative embodiments are envisioned in which only one of the feet 4370a and 4380a moves to clamp and unclamp tissue, but the feet 4370a and 4380a still rotate together as a pair. The synchronized second pair of feet, including feet 4370b and 4380b, moves in the same manner as the synchronized first pair of feet, including feet 4370a and 4380a, and therefore a description of their movement will be briefly described. Not repeated to do. Thus, the movement of the first pair of feet is synchronized with the movement of the second pair of feet. More specifically, the second pair of feet are extended at the same time as the first pair of feet are extended, and the second pair of feet are clamped at the same time as the first pair of feet are extended. the second pair of feet are retracted at the same time as the first pair of feet are retracted, the second pair of feet are clamped at the same time as the first pair of feet are retracted to grasp the tissue; The clamp is released at the same time as it is released. In certain examples, the movements of the first pair of feet and the second pair of feet are not synchronized or not completely synchronized. In at least one such example, the first pair of feet are extended and retracted independently of the second pair of feet to pivot the distal head 4320 along a curved staple path. .

As mentioned above, the stapling instruments disclosed herein are configured to staple tissue of a patient. They are also configured to cut tissue. 95 and 96, a stapling instrument 5000 includes a distal staple firing system, a tissue cutting system 5040, and an anvil 5060 configured to deform staples deployed by the staple firing system. A head 5020 is provided. Tissue cutting system 5040 includes a knife bar 5042 that includes a knife edge 5045 defined at a distal end 5044 thereof. In use, knife bar 5042 is laterally translatable through distal head 5020 during a tissue cutting stroke. The tissue cutting stroke of knife bar 5042 extends between a first non-actuated position and a second actuated position shown in FIG. 95. During a tissue cutting stroke, knife edge 5045 extends between tissue compression surface 5025 and tissue compression surface 5065 defined on anvil 5060. Knife edge 5045 may also extend into distal head 5020 and/or anvil 5060 during the tissue cutting stroke to ensure that the full thickness of tissue is transected.

In addition to the above, distal head 5020 defines a longitudinal head axis HA. During the tissue cutting stroke, knife bar 5042 moves perpendicular to longitudinal head axis HA. Tissue cutting system 5400 further includes a cutting actuator 5046 configured to engage knife bar 5042 and laterally displace knife bar 5042. Cutting actuator 5046 includes a distal end 5047 that includes a diagonal cam surface for engaging a corresponding cam surface 5043 defined on distal end 5044 of knife bar 5042. It is configured. Cutting actuator 5046 may also be configured to force knife bar 5042 in any suitable manner. In other embodiments, knife bar 5042 may be moved without cutting actuator 5046.

Referring to FIG. 98, stapling instrument 5100 includes a distal head 5120 that includes a staple forming anvil 5160. Stapling instrument 5100 further includes a staple delivery system 5190, a staple alignment system 5180, and a staple firing system 5150. Staple firing system 5150 includes a longitudinally movable staple drive 5151 to eject sets or clusters of staples 5130 from distal head 5120 during a staple firing stroke. 99 and 100, each staple 5130 includes a base 5131 and staple legs 5132 extending from the base 5131. Referring to FIGS. 100 and 101, staple drive 5151 drives the base of staple 5130 to force staple leg 5132 against shaped pocket 5162 (FIG. 97) defined within anvil 5160 during a staple firing stroke. 5131 is pressed. Referring to FIG. 102, at such point the staple drive 5151 returns to the starting or unfired point of the staple firing stroke so that another staple firing stroke can be performed.

As mentioned above, stapling instrument 5100 is configured to deploy staples during each staple firing stroke. Referring to FIG. 103, stapling instrument 5100 further includes a tissue cutting knife 5140 configured to cut tissue during and/or after each staple firing stroke. Staple firing system 5150 fires a first group or cluster of three staples 5130 positioned on a first side of cutting path CP generated by knife 5140 and positioned on a second side of cutting path CP. A second group or cluster of three staples 5130 is configured to be deployed. Although the staple firing system 5150 deploys the first group of staples and the second group of staples simultaneously, embodiments are also envisioned in which the first group is deployed before the second group of staples. Alternative embodiments are also envisioned in which the stapling instrument does not include a tissue cutting system or the tissue cutting system of the stapling instrument may be deactivated. Staple delivery system 5190 and staple alignment system 5180 are configured to reposition another set of staples 5130 within distal head 5120 after each staple firing stroke is performed so that another staple firing stroke can be performed. collaborate with In various examples, staples 5130 are reloaded during and/or after a tissue cutting stroke.

Referring primarily to FIGS. 97, 100 and 102, staple delivery system 5190 includes staple pusher 5191. Each staple pusher 5191 is configured to force a staple 5130 into a staple cavity 5121 defined within distal head 5120. In addition to the above, distal head 5120 includes six staple cavities 5121 each configured to receive staples 5130 from staple delivery system 5190. Staples 5130 are arranged in stacks or rows of six aligned with staple cavities 5121. Staple pusher 5191 presses against the base 5131 of the most proximal staple 5130 in each staple stack to force the most distal staple 5130 of each staple stack into the staple cavity 5121 during a push stroke. Although the staple pusher 5191 loads the staples 5130 into the staple cavity 5121 simultaneously, i.e., during a common push stroke, in an alternative embodiment, the staple pusher 5191 loads the staples 5130 into the staple cavity 5121. It may be configured to load sequentially. Referring to FIGS. 98 and 99, the staples 5130 in the staple stack are releasably attached to each other by, for example, at least one adhesive 5135. As shown in FIG. 100, the staples 5130 of each staple stack are adhered to each other at an angle transverse to the firing axis FA of the staple firing system drive 5151. Distal head 5120 includes a camming surface 5122 that orients and aligns staples 5130 with firing axis FA of staple firing system drive 5151 before a staple firing stroke of staple firing system 5150 is performed.

Staple drive 5151 and staple pusher 5191 move parallel to each other, or at least substantially parallel to each other. 97 and 103, due to the design of staple drive 5151 and staple pusher 5191, and/or other space constraints, stapling instrument 5100 cooperates with staple pusher 5191 to move staples 5130 to staple drive 5151. The staple alignment system further includes a staple pusher 5180 configured to align the staple pusher 5180 with the staple pusher 5180. Staple pusher 5191 pushes staples 5130 in the longitudinal direction, and staple pusher 5180 pushes staples 5130 in the lateral direction.

104-105D, stapling instrument 5200 includes an anvil that includes a staple firing system 5250 configured to deploy staples 5230, a tissue cutting system, and a molded pocket configured to deform staples 5230. 5260. Staple firing system 5250 includes a rotatable actuator 5252 configured to displace lateral staple drive 5254 along a linear or at least substantially linear lateral path. Each rotatable actuator 5252 has a cam 5253 configured to engage a shoulder 5255 defined on the staple drive 5254 and laterally displace the drive 5254, as shown in FIG. 105B. We are prepared. Staple firing system 5250 further includes one or more springs 5224 positioned intermediate lateral staple drive 5254 and frame 5222 of distal head 5220. As shown in FIG. 105C, the spring 5224 causes the staple drive 5254 to be lateralized by the rotatable actuator 5252 until the cam 5253 disengages from the shoulder 5255 of the drive 5254 during continued rotation of the actuator 5252. It is compressed when it is slid in the direction. Referring to FIG. 105D, at such point, springs 5224 resiliently return lateral staple drives 5254 again to their non-actuated positions.

104 and 105A, the staple firing drive 5250 further includes a longitudinal staple drive 5257 that is driven along a longitudinal staple firing path by the lateral staple drive 5254. Each lateral staple drive 5254 has a drive cavity 5256 defined therein that receives a portion of a longitudinal staple drive 5257 therein. More specifically, each longitudinal staple drive 5257 includes a cam portion positioned within the drive cavity 5256 that allows the lateral staple drive 5254 to move as shown in FIG. 105B. When moved laterally, it is driven longitudinally by a cam surface 5258 defined within drive cavity 5256. As a result of the above, rotational movement of rotatable actuator 5252 is translated into a lateral translation of lateral staple drive 5254, which is translated into a longitudinal translation of longitudinal staple drive 5257. The longitudinal movement of staple drive 5257 drives staple 5230 relative to anvil 5260 to deform staple 5230, as shown in FIG. 105B. Longitudinal staple drive 5257 includes a staple cradle 5251 defined therein that is configured to support staple 5230 as staple 5230 is being deformed.

Referring to FIG. 105C, in addition to the above, the return lateral movement of staple drives 5254 draws longitudinal staple drives 5257 back into their inactive position. More specifically, the drive cavity 5256 drives the longitudinal staple drives 5257 in the opposite direction until the staple drives 5257 are reset to their inactivated or unfired position, as shown in FIG. 105D. Further comprising a cam surface 5258' configured to drive. Notably, anvil 5260 is moved to the open position when longitudinal staple drive 5257 is retracted. At such point, the distal head 5220 may be moved relative to the tissue, the staples 5230 may be reloaded into the distal head 5220, and the anvil 5260 may be placed over the tissue, as shown in FIG. 105A. It may be reclamped and another staple firing stroke of the staple firing drive 5250 may be performed.

As described above, the connected rows of staples may be used to feed and refeed the staple firing system of the stapling instrument. In other instances, the entire staple cartridge may be used to feed and refeed the staple firing system. Referring to FIG. 106, stapling instrument 5300 includes a shaft 5310, a distal head 5320, and an articulation joint 5370 rotatably connecting distal head 5320 to shaft 5310. Stapling instrument 5300 further comprises a plurality of staple cartridges 5330'' stored in shaft 5310 and a cartridge pusher system configured to push staple cartridges 5330'' into distal head 5320. There is. Once the staple cartridge 5330'' is positioned within the distal head 5320, the staples 5330 (FIG. 107) contained within the staple cartridge 5330'' are separated by the staple firing system, as described in more detail below. and can be deployed. In various examples, the staple cartridge includes a cartridge body that is split and deployed with the staples, while in other examples, the staples are ejected from the cartridge body and the cartridge body is not implanted.

Referring to FIG. 107, in addition to the above, staple cartridge 5330'' includes a cartridge body 5333 that includes an opening defined therein. The opening has a first side 5334 configured to receive and store a first group of staples 5330 and a second side 5335 configured to receive and store a second group of staples 5330. Contains. A first group of staples 5330 is deployed on a first side of the tissue cutting path formed by the tissue cutting knife, and a second group of staples 5330 is deployed on a second side of the tissue cutting path. The staples 5330 are further arranged in a cluster of three staples 5330' that are deployed together, although a staple cluster may include any suitable number of staples. Five staple clusters 5330' are stored on a first side 5334 of the cartridge body 5333 and five staple clusters 5330' are stored on a second side 5335 of the cartridge body 5333, but any suitable number clusters may be used. Staple clusters 5330' are ejected from each side 5334 and 5335 of cartridge body 5333 and deformed against anvil 5360 during each staple firing stroke of the stapling system. In various alternative embodiments, staple clusters 5330' may be deployed sequentially from first side 5334 and second side 5335.

In addition to the above, although the staples 5330 of each staple cluster 5330' are attached to each other by at least one adhesive, the staple clusters 5330' themselves are not attached to each other and are instead aligned within the cartridge body 5333. It is stored in . In at least one alternative embodiment, the staples of adjacent staple clusters are releasably attached to each other. Referring now to FIG. 108, for example, cartridge body 5333 may be configured to releasably store therein a plurality of staple clusters 5430', each staple cluster 5430' comprising three staples. The three staples 5430 of each staple cluster 5430' are attached to each other by at least one adhesive 5435, and the staple clusters 5430' are attached to each other by at least one adhesive 5435. In such embodiments, staple clusters 5430' are attached to each other to form a staple strip 5430'', and one or more staple clusters 5430' are pulled apart from other staple clusters 5430' to form a staple strip 5430'' Load the staples into the machine. Although the staple cluster of the embodiments described above includes three staples, the staple cluster may include any suitable number of staples, such as, for example, two staples or more than three staples.

109 and 110, stapling instrument 5400 includes a shaft 5410, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and a shaft 5410 distal to the patient's tissue. a system configured to move the head; Stapling instrument 5400 further includes staple strip 5430'' of FIG. 108 stored within shaft 5410. Staple strip 5430'' may be stored within cartridge body 5333 as described above, or may be stored within shaft 5410 without a cartridge body. Staple strip 5430'' may include any suitable number of staples and/or staple clusters. In at least one example, staple strip 5430'' includes, for example, 588 staples.

111 and 112, stapling instrument 5500 includes a shaft 5510, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and a distal end relative to patient tissue. a system configured to move the head; Stapling instrument 5500 further includes a first staple strip 5530a'' and a second staple strip 5530b'' stored within shaft 5510. Staple strips 5530a'' and 5530b'' are comprised of staples 5430 arranged in staple clusters 5430'. Staple strips 5530a'' and 5530b'' are nested such that the bases of staples 5430 each face in opposite directions.

113 and 114, stapling instrument 5600 includes a shaft 5610, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and a shaft 5610 distal to the patient's tissue. a system configured to move the head; Stapling instrument 5600 further includes a first staple strip 5630a'' and a second staple strip 5630b'' stored within shaft 5610. Staple strips 5630a'' and 5630b'' are comprised of staples 5430 arranged in staple clusters 5430'. Staple strips 5630a'' and 5630b'' are placed side by side with the bases of staples 5430 facing in the same direction.

Referring again to FIG. 106, stapling instrument 5300 includes a system for forcing staple cartridge 5330'' from shaft 5310 and into distal head 5320. Notably, this cartridge pusher system forces staple cartridge 5330'' into distal head 5320 through articulation joint 5370. As a result, the size of staple cartridge 5330'' and/or staples 5330 may be limited by the spatial constraints of articulation joint 5370, particularly when distal head 5320 is articulated. 115-118 disclose a stapling instrument 5700 with a flexible staple strip that can deliver staples through an articulating joint and into a distal head. Stapling instrument 5700 includes a first staple strip 5730' with staples 5730 attached to a first carrier 5760'. More specifically, staples 5730 are attached to first carrier 5760' at tabs 5761'. Each staple 5730 includes a base 5731 and legs 5732 extending from the base, with the base 5731 connected to the first staple strip 5730' by a tab 5761'. Stapling instrument 5700 further includes a second staple strip 5730'' with staples 5730 attached to a second carrier 5760'' at tabs 5761''. Carriers 5760' and 5760'' each have an opening 5762 that is used to feed staple strips 5730' and 5730'' into the distal head of stapling instrument 5700, as described in more detail below. It has an array of

Staple strip 5730' is stored within the shaft of stapling instrument 5700. In its retracted state, staple strip 5730' is planar, or at least substantially planar. More specifically, referring to FIGS. 115 and 116, the staples 5730 are attached to the first carrier 5760' such that they are in the same plane as the first carrier 5760'. Stapling instrument 5700 further includes a staple delivery system that includes a drive wheel configured to force staple strip 5730' into the distal head of stapling instrument 5700. The drive wheel includes an array of drive pins extending thereabout that engage openings 5762 in the first carrier 5760' to drive the first carrier 5760' into the distal head. configured to drive. A second staple strip 5730'' is also stored within the shaft of stapling instrument 5700. In its retracted state, staple strip 5730'' is planar, or at least substantially planar. More specifically, referring to FIGS. 115 and 116, the staples 5730 are attached to the second carrier 5760'' such that they are in the same plane as the second carrier 5760''. Similar to above, the drive wheel of the staple delivery system engages the opening 5762 of the second carrier 5760'' and drives the second carrier 5760'' into the distal head of the stapling instrument 5700. is configured to do so.

Referring to FIGS. 115 and 118, staple strips 5730' and 5730'' can be driven on opposite sides with carriers 5760' and 5760'' of staple strips 5730' and 5730'' being engaged by a staple feeding system. They are stored in a face-to-face configuration. Referring to FIG. 116, when staple strips 5730' and 5730'' are fed into the distal head, staples 5730 are inserted into tabs 5761' and 5761'' of staple strips 5730' and 5730'', respectively. Bends downwards around. In at least one example, the frame of the distal head includes a camming surface configured to bend the staples 5730 downwardly. In certain examples, stapling instrument 5700 includes one or more actuators configured to bend staple 5730 downwardly around a mandrel positioned below tabs 5761' and 5761'', for example. Once displaced to the lower position, staple 5730 is removed from staple strips 5730' and 5730''. In at least one example, the frame of the distal head is configured to separate staples 5730 from tabs 5761' and 5761'' as staple strips 5730' and 5730'' are advanced into the distal head. one or more configured shear surfaces or knife edges. In certain examples, stapling instrument 5700 further comprises one or more shears that are actuated to separate staples 5730 from staple strips 5730' and 5730''. In either case, the separated staples are then positioned for deployment by the staple firing system of stapling instrument 5700.

In addition to the above, staple instrument 5700 is configured to separate clusters of staples from staple strips 5730' and 5730'' and then advance carriers 5760' and 5760'' of staple strips 5730' and 5730''. 5730' and 5730'', thereby allowing another cluster of staples to be separated from staple strips 5730' and 5730''. Referring to FIG. 118, when the staples 5730 are separated from the carriers 5760' and 5760'', the empty or stripped portions of the carriers 5760' and 5760'' are reinserted into the shaft of the stapling instrument 5700. Supplied. As a result, the act of feeding new staples 5730 into the staple firing system will also feed empty carriers 5760' and 5760'' back into the shaft.

Referring to FIG. 119, staple cluster 5830' includes four staples 5830 bonded together by at least one adhesive 5835. Each staple 5830 includes a base 5831 and two staple legs 5832 extending from the base 5831. Notably, legs 5832 are not coplanar with base 5831. Rather, base 5831 resides in the base plane and legs 5832 reside in the leg plane. Although the base plane is parallel or at least substantially parallel to the leg plane, embodiments are also envisioned where the base plane and the leg plane are not parallel. In either case, two of the staples 5830 of staple cluster 5830' are inwardly facing and two of the staples 5830 are outwardly facing. Staple 5830 faces outward when its base plane is closer to the center of staple cluster 5830' than its leg plane. Correspondingly, staple 5830 faces inward when its leg plane is closer to the center of staple cluster 5830' than its base plane.

In addition to the above, staple cluster 5830' includes two staples 5830 located on a first side of centerline CL and two staples 5830 located on a second side of centerline CL. Staples 5830 on a first side of staple cluster 5830' are connected by a first adhesive connector 5835, and staples 5830 on a second side of staple cluster 5830' are connected by a second adhesive connector 5835. There is. Additionally, staples 5830 on a first side of staple cluster 5830' are connected to staples 5830 on a second side of staple cluster 5830' by adhesive connectors 5835. As such, a staple cluster may include any suitable number of adhesive connectors. Adhesive connector 5835 releasably holds staples 5830 together. Although adhesive connector 5835 is broken before staple 5830 is implanted into patient tissue, alternative embodiments are also envisioned in which adhesive connector 5835 is not broken before staple 5830 is implanted into patient tissue. Adhesive connector 5835 is constructed from a biocompatible and/or bioabsorbable material, such as a bioabsorbable polymer.

Referring to FIG. 120, stapling instrument 5900 includes a shaft, a distal head 5920, a staple delivery system, a staple firing system, a tissue cutting system, an anvil closure system, and a distal head relative to patient tissue. a drive system configured to move the 5290. Distal head 5920 includes a first staple cavity 5921 and a second staple cavity 5921. Each staple cavity 5921 is configured to store a staple cluster 5930' or a row of staple clusters 5930' therein. Each staple cluster 5930' includes four staples 5930, but may include any suitable number of staples. Each staple 5930 includes a base 5931 and two staple legs 5932 extending from the base. The base 5931 and legs 5932 are coplanar, or at least substantially coplanar. Staples 5930 are releasably connected to each other by at least one adhesive.

In addition to the above, each staple cluster 5930' includes one or more guides 5935. Guide 5935 is defined on the lateral side of cluster 5930' and is configured to be received within a notch 5925 defined within staple cavity 5921. More specifically, guide 5935 is tightly received by the sidewalls of notch 5925 such that there is little, if any, relative lateral movement between cluster 5930' and distal head 5920. . To this end, the staple clusters 5930' remain aligned with the molded pockets of the anvil as the staples 5930 are deployed. Guide 5935 is constructed of a biocompatible and/or bioabsorbable material, such as a bioabsorbable polymer, and is implantable with staple 5930.

Referring to FIG. 121, stapling instrument 6000 includes, among other things, a shaft, a distal head 6020 including an anvil 6060, and a staple firing system. In this embodiment, the staple firing system loads staples 6030 into distal head 6020 and fires them by pressing them against anvil 6060. Distal head 6020 includes a staple cavity 6021 defined therein that is configured to store and guide staples 6030 as they are being pressed toward anvil 6060.

122-125, stapling instrument 6100 includes a shaft, a distal head 6120, a staple loading system, a staple firing system, an anvil drive system, a tissue grasping system, and a distal head 6120 distal to patient tissue. a tissue drive system configured to move the head 6120. The drive system of the stapling instrument 6100 includes a rotatable foot 6180 configured to grasp patient tissue and pull the distal head 6120 against the tissue, as described above. ing. Also as above, the tissue grasping system is configured to hold tissue during any suitable time when foot 6180 is extended and/or during operation of surgical instrument 6100. There is. Referring primarily to FIG. 125, the tissue grasping system includes a tissue holder 6170 configured to engage tissue of a patient. Tissue holder 6170 includes a rectangular body 6172 and a stem 6174 extending from body 6172. Tissue holder 6170 defines a tissue engaging surface 6175 that is less than the cross-sectional thickness 6125 of distal head 6120 shown in FIG. 124. The smaller area of the tissue engaging surface 6175 compared to the cross-sectional thickness 6125 allows the tissue holder 6170 to apply more gripping pressure to patient tissue than the distal head 6120 can apply for a given clamping force. can be added to. In at least one example, tissue engaging surface 6175 has an area that is about 25% of cross-sectional thickness 6125.

126-137, a stapling instrument 6200 includes a shaft, a distal head 6220, a staple firing system 6250, a tissue cutting system, an anvil drive system, and a stapling instrument 6200 that includes a shaft, a distal head 6220, a staple firing system 6250, a tissue cutting system, an anvil drive system, and a distal head 6220 for directing the distal head 6220 against patient tissue. a tissue drive system configured to move the tissue. 126 and 127, the tissue drive system includes a rotatable foot 6280 that is moved to an extended position (FIG. 126) and then retracted (FIG. 127). , grasp the patient tissue and move the distal head 6220 relative to the tissue. FIG. 128A also shows one of the feet 6280 in its extended position. The feet 6280 can be extended and then retracted simultaneously to move the distal head 6220 along a linear path, or extended and retracted separately to pivot the distal head 6220. However, only one foot 6280 is shown in FIG. 128A for illustrative purposes. FIG. 128, corresponding to FIG. 128A, shows anvil 6260 in a fully clamped state such that anvil 6260 and foot 6280 cooperate to grasp patient tissue. Additionally, FIG. 128 shows unformed staples 6230 positioned within staple cavities 6221 defined in distal head 6220 and staple firing system 6250 in an unfired state.

FIG. 129A, similar to FIG. 127, shows foot 6280 in a retracted position. FIG. 129, corresponding to FIG. 129A, shows anvil 6260 in a fully clamped condition and staple firing system 6250 in a fired condition. As shown in FIG. 129, legs 6232 of staple 6230 are fully deformed into a B-shaped configuration, although other deformed configurations of staple 6230 may be suitable. 131 and 133, staple firing system 6250 includes a firing bar 6255 and a plurality of staples 6230 stored within recesses 6252 defined in a side of firing bar 6255. A first row of staples 6230 is stored on a first side of firing bar 6255 and a second row of staples 6230 is stored on a second or opposite side of firing bar 6255. Each of the recesses 6252 is defined by a proximal staple cradle 6251 positioned therein and configured to press against the base 6231 of the staple 6230. FIG. 134 shows two staples 6230 positioned within staple cavities 6221 defined in distal head 6220 and firing bar 6255 of staple firing system 6250 in an unfired state.

Referring again to FIG. 134, the side of staple cavity 6221 includes a recess 6222 defined therein. The sides of the staple cavity 6221 also include a resistive surface 6223 located in the middle of the recess 6222. Staples stored within firing bar 6255 when firing bar 6255 is pushed distally to fire a first group of staples 6230 positioned within staple cavity 6221 during a first staple firing stroke. 6230 is pressed by resistive surface 6223. Referring to FIG. 136, when firing bar 6255 is retracted after the first firing stroke, staples 6230 catch on resistance surface 6223, thereby causing firing bar 6255 to slide relative to staples 6230. In such an example, as a result, the staples 6230 are aimed at the next distal set of recesses 6252 defined within the firing bar 6255, thereby presenting a new set of staples 6230 that are ejected from the staple cavity 6221. be done. 130 and 130A show the surgical instrument 6200 being reopened to release patient tissue so that the distal head 6220 can be repositioned relative to the patient tissue. Referring to FIG. 137, once distal head 6220 is properly repositioned, firing bar 6255 may be advanced distally to perform a second staple firing stroke. This process may be repeated to deploy all of the staples 6230 stored within firing bar 6255.

The stapling instruments disclosed herein can be configured to deploy staples in a suitable staple pattern. FIG. 138 shows one exemplary staple pattern that includes staples 6330 and staples 6330' positioned on either side of tissue cut line 6340. Each side of the tissue cut line 6340 includes an inner row of staples 6330 facing away from the cut line 6340 and an outer row of staples 6340 facing towards the cut line 6340. FIG. 139 shows another exemplary staple pattern that includes staples 6330, staples 6330', and staples 6430''. Staples 6430'' are arranged in rows on either side of tissue cutting line 6340. More specifically, the staples 6430'' are arranged in a staple row positioned intermediate both sets of inner row staples 6330 and outer row staples 6330'.

140 and 141, stapling instrument 6500 includes a shaft 6510, a distal head 6520, and an articulation joint 6270 rotatably connecting distal head 6520 to shaft 6510. Stapling instrument 6500 further includes a staple delivery system 6590 configured to produce and provide a continuous supply of staples 6530 to distal head 6520. Staple delivery system 6590 includes a spool 6592 operably coupled to an electric motor. Spool 6592 includes a metal wire 6594 wrapped around a central core. Wire 6594 is constructed of stainless steel and/or titanium, for example. Wire 6594 is fed through a passageway 6514 defined in shaft 6510 and articulation joint 6570. In use, motorized spool 6594 forces wire 6594 into distal head 6520. Distal head 6520 further includes a forming mandrel configured to transform wire 6594 into staple 6530, as described in more detail below. The mandrel is driven by an electric motor and/or actuator, but may be actuated in any suitable manner. Distal head 6520 includes a knife or shearing member configured to cut wire 6594, as described in more detail below. The shearing member is driven by an electric motor and/or an actuator, but may be actuated in any suitable manner. Once staple 6530 is formed and separated from wire 6594, staple 6530 can be deployed and deformed against anvil 6560 of stapling instrument 6500.

Referring to FIG. 141, surgical instrument 6500 further includes a staple forming system 6580 configured to create staples 6530 from wire 6594. Staple forming system 6580 includes a forming mandrel 6582 positioned within a forming cavity 6522 defined within distal head 6520. Staple forming system 6580 further includes a forming actuator 6584 configured to engage wire 6594 and deform wire 6594 within forming cavity 6522. At this point, forming mandrel 6582 is actuated to cut staple 6530 from wire 6594. After staple 6530 is deployed and/or moved out of mold cavity 6522, another staple 6530 may be molded within cavity 6522. In certain alternative embodiments, wire segments are cut from metal wire 6594 before being formed into staple 6530. In either case, staple 6530 can include, for example, a substantially U-shaped configuration. Alternatively, the wire segments may be shaped into a substantially V-shaped configuration. Additionally, stapling instrument 6500 may be configured to fabricate and deploy any suitable fasteners, such as, for example, tacks and/or clamps.

158 and 159, stapling instrument 7300 includes a shaft 7310, a distal head 7320, and an articulation joint 7370 rotatably connecting distal head 7320 to shaft 7310. In use, stapling instrument 7300 is inserted into patient P through trocar TC. Trocar TC includes a passageway extending therethrough that allows distal head 7320 and a portion of shaft 7310 to be inserted into the patient. In other examples, the distal head 7320 may be inserted into the patient through an open incision without a trocar. In either case, stapling instrument 7300 is configured to deploy staples from a staple cartridge inserted therein. Shaft 7310 includes a loading port 7312 that communicates with a cartridge passageway or channel extending through shaft 7310, articulation joint 7370, and distal head 7320. In use, a staple cartridge, such as staple cartridge 7330', is inserted into shaft 7310 through loading port 7312 and then pushed into distal head 7320. Stapling instrument 7300 further includes a cartridge pusher system configured to push staple cartridge 7330' into end effector 7300.

In various examples, in addition to the above, the staple cartridge 7330' is inserted into the stapling device 7300 such that the stapling device 7300 can be operated continuously without having to be removed from the patient to be reloaded. can be supplied to Each staple cartridge 7330' has staples stored therein having a first size, such as a first unfired height. In certain instances, it is desirable to create a staple line in which the staples all have the same size or unfired height. Such an example may occur when the tissue being stapled has a substantially uniform thickness. In other instances, it may be desirable to create staple lines in which the staples have different sizes or unfired heights. Such an example may occur when the tissue being stapled does not have a uniform thickness. For example, gastric tissue transected during a gastric reduction procedure typically does not have a consistent thickness. In such an example, a first staple cartridge 7330' may be loaded into the stapling instrument 7300 with staples having a first unfired height, and a second staple cartridge 7330'' may be loaded into the stapling instrument 7300 with staples having a first unfired height. A stapling instrument 7300 can be loaded with a firing height. The first unfired height is higher than the second unfired height, but the first unfired height may be lower than the second unfired height. Similarly, a third staple cartridge 7330''' is loaded into stapling instrument 7300 having staples having a third unfired height that is different from the first unfired height and the second unfired height. obtain.

In addition to the above, more than one staple cartridge may be loaded into stapling instrument 7300. Staple cartridges may be inserted into stapling instrument 7300 to be used in a particular order. For example, a staple cartridge with a shorter unfired height may be fired before a staple cartridge with a higher unfired height. Alternatively, staple cartridges with higher unfired heights may be fired before staple cartridges with shorter unfired heights. In either case, the most distal staple cartridge is used first and the most proximal staple cartridge is used last. Such a configuration allows a surgical procedure to be pre-planned with little, if any, lost time in loading the stapling instrument 7300 during the surgical procedure. Alternatively, staple cartridges may be fed to stapling instrument 7300 one at a time. Such a configuration provides the clinician with the opportunity to change the order in which the staple cartridges are ultimately used.

Although the loading port 7312 comprises an opening accessible from the exterior of the shaft 7310, the loading port 7312 may be defined within the handle of the stapling instrument 7300 or any other suitable location. In various examples, stapling instrument 7300 may further include a door configured to cover loading port 7312. In at least one example, the door may be sealed to prevent or inhibit fluids and/or contaminants from entering the stapling instrument 7300 when closed. In such instances, the door and/or housing of shaft 7310 may include one or more seals.

Referring primarily to FIG. 159, stapling instrument 7300 includes a system for stripping clusters of staples, such as staples 7330, from a distal-most staple cartridge. Stapling instrument 7300 further includes a staple firing system 7350 configured to deploy staples 7330 and deform staples 7330 relative to anvil 7360 during a staple firing stroke. Stapling instrument 7300 further includes a tissue drive system 7380 configured to move distal head 7320 relative to patient tissue after a staple firing stroke.

168 and 169, stapling instrument 7900 includes a shaft 7910, a distal head 7920, and an articulation joint 7970 rotatably connecting distal head 7920 to shaft 7910. Distal head 7920 is pivotable in any suitable direction, as described in more detail below. Similar to above, stapling instrument 7900 includes a cartridge configured to deliver staple cartridge 7930' to distal head 7920 through shaft 7910, articulation joint 7970, and cartridge passageway 7914 extending through distal head 7920. Equipped with a feeding system. Also similar to above, staples 7930 are stripped from the distal-most staple cartridge 7930' and then fired against anvil 7960. As described in more detail below, stapling instrument 7900 further comprises an articulation drive system 7980 configured to articulate distal head 7920.

In addition to the above, and referring again to FIGS. 168 and 169, the distal head 7920 is articulatable in several directions relative to the shaft 7910. Shaft 7910 extends along longitudinal shaft axis LA and distal head 7920 extends along longitudinal head axis HA. Head axis HA is aligned, or at least substantially aligned, with shaft axis LA when distal head 7920 is unarticulated. When distal head 7920 is articulated, head axis HA is transverse to shaft axis LA. Referring to FIG. 168, the distal head 7920 is laterally or laterally articulatable. In at least one such example, distal head 7920 articulates within a range including, for example, about 15 degrees to a first side of shaft axis LA and about 15 degrees to a second side of shaft axis LA. Exercise is possible. Articulation drive system 7980 is configured to drive or actively articulate distal head 7920 throughout this range of motion. Articulation drive system 7980 includes a first lateral drive 7982 mounted to distal head 7920 and a second lateral drive 7984 mounted to distal head 7920 on the opposite side of distal head 7920. , is provided. In use, first lateral drive 7982 is pushed and/or second lateral drive 7984 is pulled to articulate distal head 7920 in a first direction. Similarly, first lateral drive 7982 is pulled and/or second lateral drive 7984 is pushed to articulate distal head 7920 in a second direction. In at least one example, first lateral drive 7982 includes a first guidewire and second lateral drive 7984 includes a second guidewire. Such a guidewire is suitable for pulling the distal head 7920.

Referring to FIG. 169, the distal head 7920 is also articulatable in forward and/or backward directions. In at least one such example, the distal head 7920 is articulatable within a range including, for example, about 25 degrees in a posterior direction and about 25 degrees in a forward direction. In certain embodiments, not shown, articulation drive system 7980 is configured to actively articulate distal head 7920 in forward and backward (FIG. 169) directions. In an alternative embodiment, distal head 7920 may be passively articulated in anterior and posterior directions. In such embodiments, stapling instrument 7900 does not actively drive distal head 7920 relative to shaft 7910. Instead, the distal head 7920 can float in the front-back direction. Similarly, distal head 7920 may be passively articulated laterally with or without articulation drive system 7980. In either case, the distal head 7920 is articulable in both the anteroposterior and lateral planes and can take a composite angle with respect to the longitudinal axis LA of the shaft 7910.

In various embodiments, the surgical instrument 7900 includes a lock configured to hold the distal head 7920 in place that can be released to allow the distal head 7920 to move relative to the shaft 7910. You can prepare. In various examples, distal head 7920 may be passively articulated by pushing distal head 7920 against patient tissue within the surgical site when distal head 7920 is unlocked. Distal head 7920 may also be actively articulated when distal head 7920 is unlocked. In either case, once distal head 7920 is properly positioned, distal head 7920 may be locked in its articulated position. To return distal head 7920 to its non-articulated position, distal head 7920 may be unlocked and then realigned with shaft axis LA. In at least one example, stapling instrument 7900 includes one or more springs configured to bias distal head 7920 toward its unarticulated position. In any case, the articulation lock can prevent or at least suppress reverse drive of the distal head 7920 in response to external and/or internal forces and torques.

In addition to the above, articulation joint 7970 of stapling instrument 7000 allows distal head 7920 to be articulated about one or more axes. In various alternative embodiments, the shaft of the stapling instrument includes a first articulation joint that allows the distal head to articulate about a first articulation axis; a second articulation joint for allowing articulation about two articulation axes. The first articulation axis and the second articulation axis extend in orthogonal planes, but may extend in any suitable transverse plane. In various examples, the first and second articulation joints are passively articulated. In some examples, the first and second articulation joints are actively articulated. In at least one example, the first articulation joint is actively articulated and the second articulation joint is passively articulated.

Referring to FIG. 170, stapling instrument 8000 includes a damping system 8080 configured to control or slow articulation of distal head 7920. Buffer system 8080 includes a first link 8082, a second link 8084, and a dashpot 8085. First link 8082 is pinned to distal head 7920 at pivot 8081. First link 8082 is also pinned to second link 8084 at pivot 8083. Pivots 8081 and 8083 allow cushioning system 8080 to accommodate various articulation motions of distal head 7920. Dashpot 8085 includes a housing 8087 mounted to shaft 7910 and a buffer medium 8088 contained in a chamber defined within housing 8087. The second link 8084 includes a piston 8086 defined on its proximal end that is positioned within the housing opening and that when the distal head 7920 is articulated a cushioning medium 8086 Configured to move through. Buffer medium 8088 flows through and/or around piston 8086, thereby allowing but slowing relative movement between piston 8086 and housing 8097. Correspondingly, cushioning medium 8088 allows movement of distal head 7920 relative to shaft 7910, but slows it down. Sudden movements of the distal head 7920 may be difficult for the clinician to control and/or predict and may also result in the distal head 7920 impinging on patient tissue. Buffer medium 8088 may include any suitable medium, such as, for example, buffer grease.

Referring to FIG. 171, stapling instrument 8100 includes a damping system 8180 configured to control or slow articulation of distal head 7920. Buffer system 8180 includes link 8182 and dashpot 8185. Link 8182 is pinned to distal head 7920 at pivot 8181. First link 8082 is flexible, thereby allowing cushioning system 8180 to accommodate various articulation motions of distal head 7920. Dashpot 8185 includes a housing 8187 rotatably mounted to shaft 7910 and a buffer medium 8188 contained in a chamber defined within housing 8187. Link 8182 includes a piston 8186 defined on its proximal end that is positioned within the housing opening and moves through cushioning medium 8188 when distal head 7920 is articulated. It is configured as follows. Buffer medium 8188 flows through and/or around piston 8186, thereby allowing but slowing relative movement between 8186 and housing 8197. Correspondingly, cushioning medium 8188 allows movement of distal head 7920 relative to shaft 7910, but slows it down. Sudden movements of the distal head 7920 may be difficult for the clinician to control and/or predict and may also result in the distal head 7920 impinging on patient tissue. Buffer medium 8188 may include any suitable medium, such as, for example, buffer grease.

Referring to FIG. 172, stapling instrument 8100 is insertable into patient P through trocar TC and movable relative to target tissue T. Trocar TC may be moved relative to patient P to some extent, and stapling instrument 8100 may be moved relative to trocar TC to some extent. However, such movement may cause shaft 7910 to move over a wide range of angles. The distal head 7920 may be progressively articulated, eg, posteriorly, to keep the distal head 7920 aligned with the tissue as the distal head 7920 is advanced along the staple line. Referring to FIG. 173, the distal head 7920 is progressively articulated anteriorly and/or posteriorly to keep the axis of the distal head 7920 orthogonal, or at least substantially orthogonal, to the target tissue T. obtain. In various examples, distal head 7920 is actively articulated by an articulation drive system to adjust the angle between distal head 7920 and shaft 7910. In certain examples, distal head 7920 is passively articulated by an articulation drive system to adjust the angle between distal head 7920 and shaft 7910. In such instances, the distal head 7920 can adaptively float to follow the staple firing path.

34 and 35, stapling instrument 2500 includes a shaft 2510, a distal head 2520, and an articulation joint 2570 rotatably connecting distal head 2520 to shaft 2510. Shaft 2510 extends along longitudinal shaft axis LA and distal head 2520 extends along longitudinal head axis HA. Shaft axis LA and head axis HA are aligned when distal head 2520 is unarticulated, as shown in FIG. 34. Referring to FIG. 35, head axis HA is transverse to shaft axis LA when distal head 2520 is articulated. Stapling instrument 2500 further includes a damping system 2580 configured to control or slow articulation of distal head 2520. Buffer system 2580 includes a first link 2581, a second link 2582, and a dashpot 2585. First link 2581 is pinned to distal head 2520 at pivot 2584. First link 2581 is also pinned to second link 2582 at pivot 2583. Pivots 2583 and 2584 allow cushioning system 2580 to accommodate various articulation motions of distal head 2520. Referring to FIG. 34, when distal head 2520 is not articulated, first link 2581 is aligned with second link 2582 along the longitudinal axis. Referring to FIG. 35, when distal head 2520 is articulated, first link 2581 is transverse with respect to second link 2582.

Dashpot 2585 includes a housing attached to shaft 2510 and a buffer medium 2586 contained in a chamber defined within the housing. The second link 2582 includes a piston defined on its proximal end that is positioned within the housing opening and that provides cushioning when the distal head 2520 is articulated. It is configured to move through media 2586. Buffer medium 2586 flows through and/or around the piston, thereby slowing down relative movement between the piston and the housing. Correspondingly, cushioning medium 2586 allows but slows movement of distal head 2520 relative to shaft 2510. Cushioning medium 2586 may include any suitable medium, such as, for example, cushioning foam.

A stapling instrument 2000 is shown in FIG. 13 and is similar in many respects to stapling instrument 1000 and/or other stapling instruments disclosed herein, the majority of which include: For the sake of brevity, it is not discussed herein. Stapling instrument 2000 includes a handle 2100 that includes a housing 2110, a grip 2120, and a display 2130. Housing 2110 includes a connector 2170 configured to connect a shaft assembly, such as shaft assembly 1200, to handle 2100, for example. The handle 2100 further includes a replaceable battery pack 2160 that is releasably attached to the housing 2110 and removably positioned within a cavity 2115 defined within the housing 2110. Battery pack 2160 powers display 2130 and/or a motor drive system contained within handle 2100. Display 2130 is configured to allow a user to control operation of surgical instrument 2000, as described in more detail below.

In addition to the above, stapling instrument 2000 includes a staple firing system configured to apply a staple line to a patient's tissue, and display 2130 includes a control for evaluating the status of the staple firing system. Display 2130 may also indicate, for example, the speed at which stapling instrument 2000 is applying the staple line, the direction in which the staple line is being applied, and/or whether it is being met, exceeded, or about to be exceeded. A control device is provided for evaluating and/or changing any performance thresholds. Display 2130 includes a capacitive touch screen, but any suitable screen may be used.

Referring to FIG. 14, display 2130 includes status controls 2140. Status control 2140 includes a window 2141 that includes a window header 2142. Status control 2140 further includes an image window 2145 that displays information regarding the tissue being stapled, the staple firing path, and/or any information that the clinician may use to manipulate stapling instrument 2000. Configured to display other information. For example, the image window 2145 may show a staple firing path 2143 along which the stapling instrument 2100 is currently moving, and/or a staple firing path 2143 around a particular anatomical feature within patient tissue T, such as a blood vessel V, for example. is configured to display an alternative staple firing path 2143' to guide the user. Status control 2140 is a digital control and/or display that is in signal communication with the controller of stapling instrument 2000.

Referring to FIG. 17, display 2130 further includes a direction control 2190 configured to control the direction of the staple firing path. Direction control 2190 includes a window 2191 that includes a window header 2192 and an image window 2195. Image window 2195 is configured to display the orientation of the distal head of the stapling instrument relative to the original starting orientation. Image window 2195 includes a plurality of orientation lines 2194 indicating particular orientation angles, such as 15 degrees, 30 degrees, and 45 degrees, with respect to a starting orientation line 2194 bounded as 0 degrees. Image window 2195 further includes needle 2193 representing the orientation of the distal head of the stapling instrument relative to the direction of actuation of the stapling instrument. Direction control 2190 further includes an edit window 2198 that, when activated, allows the user to modify the direction of the staple path by manipulating needle 2193. The directional control 2190 further includes a save window 2199 that, when activated, allows the user to save input provided to the controller through the directional control 2190. At such point, stapling instrument 2000 can be moved along its new orientation. Status control 2190 is a digital control and/or display that is in signal communication with the controller of stapling instrument 2000.

Referring to FIG. 15, display 2130 further includes a speed control 2150 configured to control the speed at which stapling instrument 2000 forms a staple path. Speed control 2150 includes a window 2151 that includes a window header 2152 and an image window 2155. Image window 2155 includes an indicator 2153 configured to display the speed of the stapling instrument. For example, indicator 2153 can display the number of staple firing strokes that stapling instrument 2000 performs per minute. Image window 2155 further includes an up arrow control 2156 operable to increase the speed of the staple firing stroke and a down arrow control 2157 operable to decrease the speed of the staple firing stroke. Indicator 2153 may be configured to display the speed at which stapling instrument 2000 is being propelled across patient tissue by the tissue drive system. Other metrics regarding the speed of stapling instrument 2000 may also be used and displayed. Status control 2150 is a digital control and/or display that is in signal communication with the controller of stapling instrument 2000.

Referring to FIG. 16, the display 2130 further includes a failure threshold control 2180 configured to manage the failure threshold of the stapling instrument 2000 when it occurs. For example, a threshold of force required to perform a staple firing stroke may be used to establish a fault condition that requires input from a user. If the force required to perform a staple firing stroke exceeds a threshold, the controller of stapling instrument 2000 can alert the user via failure threshold control 2180 and/or stop stapling instrument 2000. be able to. Certain obstacles may be overridden or otherwise managed by the user to allow stapling instrument 2000 to continue applying the staple line. Fault threshold controls 2180 allow the user to manage these faults. Other faults may not be overridden. In such instances, the fault threshold control 2180 may indicate to the user that the fault cannot be overridden and/or how to resolve the fault so that operation of the stapling instrument 2000 can continue. is configured to be displayed. Fault threshold control 2180 includes a window 2181 that includes a window header 2182 and an image window 2185. Fault threshold control 2180 is a digital control and/or display that is in signal communication with the controller of stapling instrument 2000.

Referring now to FIG. 18, stapling instrument 2000 further comprises a visual capture system, discussed in more detail below, and display 2130 is configured to, among other things, display real-time video images from the visual capture system. It further includes an image window 2135. Display 2130 further includes a menu 2131 extending along the left side of image window 2135, although menu 2131 may be located at any suitable location on display 2130. Menu 2131 includes status control 2140, speed control 2150, fault threshold control 2180, and direction control 2190 as described above. Menu 2131 also includes settings controls 2132 that can be used to select and/or reconfigure windows and/or controls on display 2130. Menu 2131 further includes a stop control 2136 that can immediately stop advancement of stapling instrument 2100 along the staple firing path. Menu 2131 is a digital control and/or display that is in signal communication with the controller of stapling instrument 2100.

In addition to the above, and referring again to FIG. 18, display 2130 further includes a first view window 2133 and a second view window 2134. View windows 2133 and 2134 are positioned along the right side of image window 2135, but may be placed at any suitable location on display 2130. View windows 2133 and 2134 provide the user with alternative views of stapling instrument 2000. For example, first view window 2133 provides the user with a side view of stapling instrument 2000 at the surgical site, and second view window 2134 provides the user with a top view of stapling instrument 2000 at the surgical site. These additional views may be provided by one or more digital cameras on stapling instrument 2000 and/or from other surgical instruments, such as, for example, an endoscope within the surgical site. In such instances, other surgical instruments are in signal communication with the controller of stapling instrument 2000 to provide these additional images. In particular examples, the controller of stapling instrument 2000 may interpret data provided to the controller and generate additional images in windows 2133 and 2134 based on the provided data.

As mentioned above, the speed at which the staple firing system and/or tissue drive system of stapling instrument 2000 is operated may be controlled by speed control 2150 on display 2130. As mentioned above, in various examples the speed may be controlled manually or by input from a user. In other examples, the controller of stapling instrument 2000 can automatically control the speed. In such instances, the controller is configured to assess characteristics of the tissue being stapled, such as, for example, thickness and/or density, and adjust the speed of the staple firing system and/or tissue drive system accordingly. It is configured. For example, if the controller determines that the tissue being stapled is thick, i.e., near, at, or above the tissue thickness threshold, the controller may cause the stapling instrument to 2000 speed can be reduced. Similarly, if the controller determines that the tissue being stapled is dense, i.e., near, at, or above the tissue density threshold, the controller may cause the stapling instrument to 2000 speed can be reduced. Correspondingly, the controller may increase the speed of the stapling instrument 2000 if the controller determines that the tissue being stapled is, for example, thin, ie, less dense than normal. In addition to the above, with reference to FIG. 19, the speed control 2150 of the stapling instrument 2000 includes an automatic speed control 2158 in which the stapling instrument 2000 controls the speed of the stapling instrument 2000, and an automatic speed control 2158 in which the stapling instrument 2000 controls the speed of the stapling instrument 2000. manual speed control 2159;

Referring to FIG. 20, stapling instrument 2200 includes a display 2230. Stapling instrument 2200 is similar to stapling instrument 2000 in many respects, and display 2230 is similar to display 2130 in many respects, most of which will be described herein for brevity. Not discussed in the book. Display 2230 includes a menu 2231 and a central image window 2235. The central image window 2235 displays an image of the patient tissue T being stapled and the staple firing path 2243 along which the stapling instrument 2200 is moving. Staple firing path 2243 is displayed as a series of actuations or staple firing 2244. Each projection actuation 2244 indicates the path through which the tissue T is incised and the position relative to the tissue incision where the staple cluster 2245 is deployed within the tissue T. The projected actuation 2244 closest to the distal head of the stapling instrument 2200 is highlighted relative to the other projected actuations 2244 so that the user can distinguish between the next and subsequent projected staple firings. be able to. Such highlighting may include, for example, different colors and/or color brightness of the projection actuation 2244. In at least one example, the displayed actuation 2244 of the staple firing path 2243 may be made progressively less accentuated as one moves away from the distal head of the stapling instrument 2200.

In addition to the above, display 2230 is further configured to display one or more alternative staple firing paths. For example, display 2230 is configured to display alternative staple firing paths 2243' within central image window 2235. Similar to staple firing path 2243, staple firing path 2243' is labeled as a series of actuations, staple firing 2244'. Each projection actuation 2244' indicates the path through which tissue T is cut and the location within tissue T where staple clusters 2245 are deployed. Menu 2231 includes staple line controls 2240 that can be actuated by a user of stapling instrument 2200 to edit staple firing path 2243 to create alternative staple firing paths 2243'. Once the alternative staple firing path 2243' is established, it can be saved and the stapling instrument 2200 can be operated to follow the alternative staple firing path 2243'. As shown in FIG. 20, staple line control 2240 includes an operable edit subcontrol 2241 and an operable save subcontrol 2242 for modifying and saving the staple firing path as described above.

As discussed above, staple firing path 2243 is modifiable to alternative staple firing paths 2243'. Staple firing path 2243 and alternative staple firing path 2243' are displayed in an image overlaid on the video image from the camera. Although staple firing path 2243 and alternative staple firing path 2243' are displayed in the same image overlay or layer, they may be displayed in different image overlays or layers. In at least one such example, staple firing path 2243 is displayed within a first image overlay or layer, and alternative staple firing path 2243 is displayed in a second image overlay or layer that is different from the first image overlay. is displayed within. The screen of display 2230 is configured to receive input commands from a central image window 2235 that may drag staple firing path 2243 and/or alternative staple firing path 2243' within the image overlay. The screen of display 2230 is configured to be responsive to the user's finger so that the staple firing path can be modified by the user dragging his or her finger. Referring to FIG. 21, the screen of display 2230 is further configured to be responsive to stylus 2220, for example.

As mentioned above, display 2230 may be configured to display the current or intended staple firing path and one or more alternative staple firing paths. The controller of stapling instrument 2200 is configured to generate one or more alternative staple firing paths and display these alternative staple firing paths on display 2230. In various examples, the controller can determine alternative staple firing paths based on one or more attributes of the tissue T being stapled. For example, the controller can identify a blood vessel within the tissue T and provide or suggest an alternative staple firing path to guide the staple device 2200 around the blood vessel.

Referring to FIG. 22, display 2230 displays a plurality of staple firing paths configured to modify the staple firing path while stapling instrument 2200 is deploying the staple path and/or after stapling instrument 2200 is stopped. It has a menu containing controls. Display 2230 displays a menu 2231 that includes a plurality of actuatable controls configured to be used while stapling instrument 2200 is performing its series of staple firing strokes to generate a staple path. We are prepared. Menu 2231 includes view controls 2232 for, for example, changing the video image displayed within central image window 2235. In at least one such example, a video control may be used to toggle between different video feeds. Menu 2231 further includes controls for staple line 2240, described above, configured to modify the staple firing path. The staple firing system of stapling instrument 2200 may be activated by the user activating stapling control 2234 within menu 2231 and deactivated by the user activating stop control 2236 within menu 2231.

In addition to the above, the shaft assembly attached to the handle of stapling instrument 2200 can be rotated relative to the handle. The shaft assembly includes a rotatable slip joint configured to allow the distal head of the shaft assembly to rotate relative to the handle, although any suitable configuration may be used. As a result of this slip joint, a user of stapling instrument 2200 can selectively orient display 2230 relative to the distal head of stapling instrument 2200. In such an example, the user may maintain the orientation of the display 2230 relative to the patient, for example, even as the distal head is pivoted to follow the staple firing path. Similarly, FIGS. 144-146 show stapling instrument 1000 being inserted into patient P through trocar TC, and the rotatable interface between the handle display and shaft assembly of stapling instrument 1000 allows The handle display may be maintained in a constant orientation relative to itself by the clinician C even as the shaft assembly is rotated to follow the staple firing path FP.

Referring to FIGS. 147-150, stapling instrument 7000 includes a handle 7010 that includes a grip 7020 and a shaft assembly 1200 assembled to handle 7010. The handle 7010 further includes a display 7030 rotatably attached to the handle 7010 about a rotation joint 7035. Display 7030 is similar to display 2230 in many respects, most of which are not discussed herein for the sake of brevity. In use, display 7030 may be rotated relative to handle 7010 to maintain a preferred orientation of display 7030 relative to Clinician C and/or any other reference frame.

Figure 180 shows handle 1500 of surgical instrument 100 used by a clinician during a surgical procedure. Handle 1500 includes a central portion 110 bounded by one or more ergonomic grips 120 to facilitate handling of surgical instrument 100 by a clinician. Each ergonomic grip 120 is configured to fit in a clinician's hand for improved control and comfort. Handle 1500 includes one or more interactive controls 180 configured to provide navigation commands to the end effector of surgical instrument 100. In various examples, one or more interactive controls 180 are configured to provide user commands corresponding to selections of one or more items. Interactive controls 180 are positioned on handle 1500 in a location that allows for easy manipulation by a clinician, such as within reach of a clinician's thumb. In various examples, controls 180 are comprised of various types of switches and/or buttons, for example. In various examples, interactive controls 180 may include, for example, a toggle switch, an analog stick, a rocker, a D-pad, and/or any other device capable of facilitating communication of user commands to a controller of surgical instrument 100. Contains appropriate interactive controls.

Handle 1500 further includes a touch sensitive display 1510. A portion of the touch sensitive display 1510 displays a menu bar 1512 to the clinician. The options in menu bar 1512 represent various display modes for surgical instrument 100, including, but not limited to, view mode, position mode, and/or stapling mode. In various display modes, data and/or images related to the surgical procedure and/or the status of surgical instrument 100 are displayed. In view mode, touch sensitive display 1510 displays multiple views of the surgical site, including, for example, a side view and a top view. Although the side and top views are displayed in separate frames 1514, 1516 of touch-sensitive display 1510, they may be displayed in any suitable manner. The clinician can use the interactive controls 180 to focus on a particular view by switching the desired view to the magnified focus frame 1518, as described above. In various embodiments, the clinician can switch views by dragging the desired view toward the central frame 1518 using an input device 1530, such as a stylus or the clinician's finger, for example. Input device 1530 is described in further detail below.

To create a sterile environment for the surgical instrument 100, a sterile barrier 190 is draped over the handle 1500, as shown in FIG. 181. As explained in more detail below, sterilization barrier 190 is constructed from a transparent resilient material, such as plastic. Sterility barrier 190 extends around handle 1500 and over the proximal portion of shaft 200. Sterilization barrier 190 includes one or more preformed regions 192 configured to fit over interactive controls 180 . Preformed region 192 assists in aligning sterile barrier 190 over handle 1500 of surgical instrument 100. Sterilization barrier 190 is stretched over touch-sensitive display 1510 to create a smooth, uniform barrier, or at least a substantially smooth and uniform barrier. Attachment members 194, such as clips, secure sterilization barrier 190 in place around a perimeter 193 of touch-sensitive display 1510. Sterility barrier 190 fits loosely around the remaining components of handle 1500, and sterility barrier 190 is tightened around shaft 200 of surgical instrument 100, although any suitable configuration may be used. good. For example, covering handle 1500 with sterile barrier 190 protects various components of handle 1500 from exposure to body fluids and/or contaminants. Placing the sterilization barrier 190 over the handle 1500 and the proximal portion of the shaft 200 further provides a cost effective and quick means to sterilize and reuse the handle 1500 of the surgical instrument 100.

FIG. 182 shows a touch sensitive display assembly 500. Touch sensitive display assembly 500 includes sterilization barrier 190 and touch sensitive display 1510. In certain examples, touch-sensitive display 1510 functions as a projected capacitive sensor. Touch sensitive display 1510 includes an insulating layer 1511 of insulating material mounted on top of sensing mechanism 1513. In certain examples, insulating layer 1511 is attached to sensing mechanism 1513 by an adhesive, such as, for example, an optical adhesive. As mentioned above, sterilization barrier 190 is stretched over touch-sensitive display 1510 in a uniform or nearly uniform manner. Attachment member 194 (FIG. 181) holds sterile barrier 190 in its extended position in a manner that creates a gap 1520 between sterile barrier 190 and insulating layer 1511. Gap 1520 spans a distance of several millimeters between insulating layer 1511 and sterilization barrier 190, and gap 1520 is configured to prevent the formation of contact bubbles when sterilization barrier 190 contacts insulating layer 1511. ing.

Electrically conductive particles 191 are dispersed throughout sterilization barrier 190, imparting a specific capacitance to sterilization barrier 190. Sensing mechanism 1513 of touch-sensitive display assembly 500 comprises a plurality of pixels 1515 and a material, such as indium tin oxide, configured to form an electrode. As discussed in more detail with respect to FIG. 183, in various examples the electrodes are configured as orthogonal grids, although any suitable configuration may be used. In particular, sensing mechanism 1513 is configured to detect that sterilization barrier 190 has been installed. More specifically, sensing mechanism 1513 senses attachment of sterilization barrier 190 by a specific capacitance of sterilization barrier 190. When a clinician desires to utilize the functionality of touch-sensitive display 1510, input device 1530 is contacted with sterility barrier 190 at the desired contact point, as described above. Sensing mechanism 1513 is configured to detect the additional capacitance of input device 1530 and distinguish the capacitance of input device 1530 from the capacitance of sterilization barrier 190. Additionally, when input device 1530 is brought into contact with sterility barrier 190, conductive particles 191 of sterility barrier 190 are compressed or otherwise brought closer together. Such compression creates a higher density of conductive particles 191 in the area surrounding the contact points of input device 1530, thus resulting in higher capacitance. The change in charge at the point of contact within sensing mechanism 1513 causes pixel 1515 of sensing mechanism 1513 to be activated or energized near the point of contact.

Touch sensitive display 1510 is configured to function in the same and/or similar manner without sterilization barrier 190. In a particular example, input device 1530 consists of, for example, a clinician's finger surrounded by a latex glove. Medical latex gloves are usually thin enough so as not to compromise the conductivity of the clinician's fingers. If the gloves worn by the clinician are expected to attenuate the conductivity of the clinician's fingers, the settings of the touch sensitive display 1510 may be changed to increase the sensitivity of the sensing mechanism 1513.

183 shows the touch-sensitive display 1510 of FIG. 182 when the input device 1530 contacts the sterilization barrier 190 of the touch-sensitive display assembly 500. As mentioned above, in various examples the electrodes are configured as orthogonal grids, but any suitable configuration may be used. In such examples, the electrodes include an x electrode 1542 and a y electrode 1544. Touch-sensitive display 1510 includes a plurality of pixels 1515 arranged uniformly or nearly uniformly across sensing feature 1513, although any suitable arrangement may be used. Figure 183 further illustrates various groupings of activated pixel clusters 1517 and 1519. During its deactivated state, there is a low level of capacitance across all of the pixels 1515 (FIG. 182) within the touch-sensitive display 1510. When input member 1530 (FIG. 182) contacts sterilization barrier 190 and activates touch-sensitive display 1510, pixels 1515 associated with pixel clusters 1517 and 1519 are activated with a new, higher capacitance. Pixel 1515 in pixel clusters 1517 and 1519 is activated when input device 1530 remains in contact with sterile barrier 190. Sensing mechanism 1513 detects the position of active pixel clusters 1517, 1519 by scanning a matrix of x-electrodes 1542 and y-electrodes 1544.

FIG. 184 shows a graphical representation 1550 of the relationship between the position of active pixel clusters within the x-electrode 1542 of the touch-sensitive display 1510 and the capacitance detected by the sensing mechanism 1513. The first capacitance C ₁ represents the low level or unactivated capacitance that exists across the pixels 1515 of the touch sensitive display 1510 prior to application of the sterilization barrier 190. For reference, capacitance C ₀ represents a detected capacitance that is zero, and capacitance C ₁ represents a capacitance that is greater than zero. The second capacitance _C2 represents the threshold capacitance. Once the threshold capacitance C ₂ is exceeded, the surgical instrument 100 recognizes that the sterilization barrier 190 is attached to the touch sensitive display 1510. In graphical representation 1550, sterilization barrier 190 is attached to touch-sensitive display 1510 when the detected capacitance is above threshold capacitance _C2 . The third capacitance _C3 represents another threshold capacitance. When sensing mechanism 1513 detects a capacitance above a threshold capacitance _C3 , surgical instrument 100 recognizes that input device 1530 is in contact with sterility barrier 190. In graphical representation 1550, input device 1530 is in contact with sterility barrier 190 at two locations when the detected capacitance exceeds the threshold capacitance _C3 by a factor of two. When input device 1530 is removed from sterilization barrier 190, the capacitance detected by pixels 1515 in clusters 1517 and 1519 returns to a capacitance that is less than _C3 but greater than or equal to _C2 . When sterilization barrier 190 is removed from touch-sensitive display 1510, the capacitance detected by clusters 1517 and pixels 1515 within 1517 returns to a capacitance that is less than _C2 but greater than or equal to _C1 .

Returning to FIG. 182, touch sensitive display 1510 is alternatively a resistive sensitive display. In at least one such embodiment, sterility barrier 190 is constructed from a flexible material that allows sterility barrier 190 to flex in response to force F applied by input device 1530. In such embodiments, sensing mechanism 1513 of touch-sensitive display 1510 is configured to detect pressure generated from the location and force F applied by input device 1530. Various user commands are associated with particular locations on the touch-sensitive display 1510, and the location of the detected pressure corresponds to one of the various user commands.

Referring to FIG. 24, surgical instrument 2400 includes a display 2430. Stapling instrument 2400 is similar in many respects to stapling instruments 2000 and 2200, and display 2430 is similar in many respects to displays 2130 and 2230, most of which are for the sake of brevity. are not discussed herein. Display 2430 includes a touch screen that includes image display 2435. Image display 2435 presents an image of patient tissue T to be stapled. A user of stapling instrument 2400 may use stylus 2220 to draw one or more potential staple lines on tissue T, for example. For example, a user can draw a first staple line 2444 and a second staple line 2444'. The controller of stapling instrument 2400 may then require the user to select between two different staple lines 2444 and 2444' to be followed. Similarly, a user of stapling instrument 2400 can use a stylus to change staple line 2444 to an alternate staple line 2444'.

Referring again to FIG. 24, the image of tissue T can be a substantially two-dimensional image of the top of tissue T. In such an example, the controller is configured to map a two-dimensional staple firing path onto the tissue T. Referring to FIG. 25, the image of the tissue T may be a three-dimensional image overlooking the surface of the tissue T. In such an example, the controller is configured to map a three-dimensional staple firing path onto the tissue. In either case, the stylus 2220 and/or the patient's finger may be used to establish and/or modify the staple firing path. Referring now to FIGS. 26 and 27, the stapling instrument 2400 further includes a joystick 2450 configured to modify the staple firing path 2444 of the stapling instrument 2400. Joystick 2450 is attached to the handle of stapling instrument 2400 and is rotatable about an axis. When joystick 2450 is rotated to the right, ie, in a clockwise direction, staple firing path 2444 is curved to the right. Similarly, when joystick 2450 is rotated to the left, ie, in a counterclockwise direction, staple firing path 2444 is curved to the left. Other configurations of the joystick are also possible.

Referring again to FIGS. 26 and 27, joystick 2450 may be used to modify the staple firing path of stapling instrument 2400 while stapling instrument 2400 is paused or not firing staples. Joystick 2450 may also be used by a clinician to maneuver stapling instrument 2400 in real time while stapling instrument 2400 is firing staples. In various examples, at least a portion of stapling instrument 2400 is visible on display 2430 to assist a user in maneuvering stapling instrument 2400. For example, shaft 2410 of stapling instrument 2400 is visible within image display 2435. In various examples, a graphically generated depiction of stapling instrument 2400 may be presented in one or more windows of display 2430. By way of example, shaft 2410 and/or distal head 2420 of stapling instrument 2400 may be depicted in windows 2133 and 2134, for example.

As mentioned above, and now referring to FIG. 23, stapling instrument 2100 includes a handle 2110 that includes a grip 2120 and a display 2130 attached to the handle 2110. Display 2130 may include any suitable configuration, but the size of display 2130 may be limited by the spatial constraints of handle 2110. In various examples, stapling instrument 2100 may be part of surgical system 2300 that includes an off-board display 2330 in addition to or in place of on-board display 2130. A controller for stapling instrument 2100 is in signal communication with displays 2130 and 2330. Although the controller is in wireless communication with off-board display 2330, it may also be in wired communication with display 2330. In either case, the controller is configured to provide the same information to displays 2130 and 2330. However, displays 2130 and 2330 may be configured to organize this information differently due to their different sizes and/or shapes. In other examples, one of displays 2130 and 2330 may display more information than the other. In at least one such example, off-board display 2330 may display more information than on-board display 2130, eg, due to its larger size.

In addition to the above, onboard display 2130 includes a touch screen, but may be operated by controls located on handle 2110. Similarly, off-board display 2330 also includes a touch screen, but may be operated by other controls. Similar to above, the touch screens of displays 2130 and 2330 may be used to manipulate the staple firing path of stapling instrument 2100. In various examples, the clinician can use, for example, his or her finger to touch the touch screen and drag the staple firing path of the stapling instrument 2100 to a new position. In other examples, a tool, such as a stylus, may be used to touch the touch screen and manipulate the staple firing path. Additionally, both displays 2130 and 2330 are configured to control any other operations of stapling instrument 2100.

When the first overlay or layer is modified on one of displays 2130 and 2330, the controller of stapling instrument 2100 modifies the first overlay on the other display. Similarly, when the second overlay or layer is modified on one of displays 2130 and 2330, the controller of stapling instrument 2100 modifies the second overlay on the other display. Additionally, a user of stapling instrument 2100 can modify one overlay or layer on a display without modifying other overlays or layers on that or any display.

Although the staple firing path and/or other images projected into the on-board and off-board displays described above are very helpful in producing the desired staple firing path, the stapling instrument may It may include one or more projectors configured to display images on the patient tissue that may assist in generating the desired staple firing path. 160 and 161, stapling instrument 7400 includes a shaft 7410, a distal head 7420, and a projector 7490 mounted to distal head 7420. In at least one example, projector 7490 is clamped to distal head 7420. The projector 7490 is configured to project the image I onto the stomach S of the patient P. Projector 7490 is sized and configured to be inserted into a patient through a trocar TC, but may also be inserted into a patient through an open incision. Projector 7490 is positioned proximally to anvil 7460 of distal head 7420 but distally to the articulation joint that rotatably connects distal head 7420 to shaft 7410. There is. As a result, projector 7490 and the image it projects move with distal head 7420.

Referring to FIG. 162, stapling instrument 7500 includes a shaft 7510, a distal head 7520, and an articulation joint 7570 rotatably connecting distal head 7520 to shaft 7510. Stapling instrument 7500 further includes a projector 7590 extending parallel to shaft 7510. Projector 7590 includes a flexible tube attached to shaft 7510 and distal head 7520 and is configured to flex when distal head 7520 is articulated. As a result, image I projected by projector 7590 tracks the orientation of distal head 7520 and may be projected distally to anvil 7560 of stapling instrument 7500. Projector 7590 includes one lens and is configured to project one image I, but the projector includes more than one lens and/or projects more than one image onto patient tissue. Various alternative embodiments are envisioned that may be possible.

Referring again to FIG. 160, the projector 7490 includes a first lens 7492 and a second lens 7494. First lens 7492 and second lens 7494 are in signal communication with a controller of stapling instrument 7400 and are configured to project at least one image onto patient tissue. In a particular example, first lens 7492 and second lens 7494 project the same image. A first lens 7492 and a second lens 7494 are fixedly mounted within the projector 7490 to project an image at a common focal point, but the lenses project the image(s) at different focal points. It can also be projected. In various embodiments, the orientation of the first lens 7492 and/or the orientation of the second lens 7494 may be adjusted to modify focus. In at least one such embodiment, the projector 7490 includes a first motorized actuator system for changing the orientation of the first lens 7492 and a second motorized actuator system for changing the orientation of the second lens 7494. An electric actuator system.

In certain examples, in addition to the above, the first lens 7492 of the projector 7490 may be configured to project a first image onto patient tissue, and the second lens 7494 may be configured to project a second, i.e. It may be configured to project different images onto patient tissue. The controller of stapling instrument 7400 is configured to provide, change, and/or modify images projected by first lens 7492 and/or second lens 7494. In various examples, the images projected by the first lens 7492 and the second lens 7494 can present a two-dimensional image on the patient tissue. In other examples, the images projected by the first lens 7492 and the second lens 7494 can present a three-dimensional image on the patient tissue. Projecting a three-dimensional image may be facilitated by lenses 7492 and 7494 being oriented or orientable in different directions.

Referring to FIG. 165, stapling instrument 7700 includes a distal head 7720 disposed on a first side of patient tissue T and an anvil 7760 disposed on a second side of patient tissue T. Similar to other stapling instruments disclosed herein, stapling instrument 7700 deploys staples 7730 into tissue T and incise tissue T along incisions 7740 during a series of staple firing strokes. It is configured as follows. Stapling instrument 7700 further includes a projector 7770 configured to project image I onto tissue T. Image I of FIG. 165 represents the location of the next firing stroke, which includes two lateral areas where staple clusters are applied. Referring to FIG. 166, the image projected by projector 7770 includes a line specifying staple firing path FP and/or a line specifying alternative staple firing path FP'. These lines may be solid and/or dashed lines, for example. These lines may be the same color or different colors.

In addition to the above, the controller of stapling instrument 7700 is configured to modify the image projected by projector 7770 as stapling instrument 7700 moves or marches along the staple firing path. The controller can continually evaluate and determine where the next firing stroke should occur and can continually adapt the image projected by stapling instrument 7700. In various examples, the controller can update the projection image after each firing stroke, for example. In some examples, the controller can continuously project an image or a series of images using projector 7770, while in other examples, the controller can project one image or a series of images using projector 7770. Or a series of images can be projected intermittently. In at least one example, the controller can use projector 7770 to display an image before stapling instrument 7700 clamps the tissue. In such an example, the user of the stapling instrument 7700 is given the opportunity to pause or stop the stapling instrument 7700 before it performs another staple firing stroke.

Referring to FIG. 167, stapling instrument 7800 includes a distal head 7820 positioned on a first side of patient tissue T and an anvil 7860 positioned on a second side of patient tissue T. Similar to other stapling instruments disclosed herein, stapling instrument 7800 deploys staples 7830 into tissue T and incise tissue T along incisions 7840 during a series of staple firing strokes. It is configured as follows. Stapling instrument 7800 further includes a projector 7870 that includes a first lens 7872 and a second lens 7874. The first lens 7872 is configured to project a first image I ₁ onto patient tissue T, and the second lens 7874 is configured to project a second image I ₂ onto patient tissue T. has been done. Although image I ₁ depicts the location of the next staple cluster and image I ₂ depicts the cutting path of stapling instrument 7800, any suitable image may be projected. Images I ₁ and I ₂ may be solid and/or broken lines, for example. Image I ₁ may be the same color as image I ₂ or may be a different color.

As mentioned above, the stapling instruments disclosed herein can include at least one projector to project an image onto patient tissue and at least one camera to view patient tissue. 163 and 164, stapling instrument 7600 includes a shaft, a distal head, and a video system. The video system includes at least one image projector 7690 and a camera system 7670 including at least one camera, such as a first camera 7672 and a second camera 7674, in communication with a controller. A first camera 7672 is oriented in a first direction and focused on a first region F1 of patient tissue, and a second camera 7674 is oriented in a second direction and focused on a first region F1 of patient tissue. 2, that is, a different region F2. In various examples, the controller is configured to present both images on the surgical instrument display simultaneously or at different times so that the user can toggle between the images. In certain examples, the controller is configured to generate a composite image using images from the first and second cameras 7672 and 7674 and present the composite image on the surgical instrument display.

In addition to the above, first camera 7672 comprises a digital camera configured to provide a first digital video stream to the controller, and second camera 7674 comprises a digital camera configured to provide a second digital video stream. Equipped with a digital camera configured as follows. Camera system 7670 further includes a first actuator system configured to move first camera 7672 and/or a second actuator system configured to move second camera 7674. . In other embodiments, one or both of the orientations of cameras 7672 and 7674 are fixed. In any case, the image I projected by the projector 7690 onto the patient tissue may be captured by the first camera 7672 and/or the second camera 7674 and may be viewed by a user of the surgical instrument 7600 via the surgical instrument display. Visual recognition becomes possible.

In addition to the above, projector 7690 and/or any of the projectors disclosed herein are configured to emit light at any suitable wavelength. In various examples, projector 7690 emits visible, infrared, and/or ultraviolet light, for example. Among other things, visible light is useful for clinicians to see the color of tissue when visible light is reflected from tissue. Red or pink tissue may indicate vascularized healthy tissue, and dark or black tissue may indicate unhealthy tissue. In addition to the above, camera system 7670 is configured to capture visible, infrared, and/or ultraviolet light, for example. Infrared light indicates the presence of heat, such as from large blood vessels. Ultraviolet light, for example, indicates the presence of blood or hemorrhage. Additionally or alternatively, the projector may be configured to emit acoustic, subsonic, and/or ultrasonic waves, and the surgical instrument may detect waves reflected from patient tissue and One or more acoustic sensors may be included that are configured to generate data that can be used by the controller to generate a three-dimensional profile of the tissue.

Referring to FIG. 142, the stapling instruments described herein are configured to repeatedly fire staples into tissue of a patient, such as the patient's stomach S. Many of the stapling devices disclosed herein follow a desired or modified staple firing path FP during firing a staple, such as staple 6630, into patient tissue, and the staple firing It is self-driven, self-propelled, and/or self-steered in that it is sufficiently motorized to be able to propel itself along the path FP. Staples are continuously ejected from the stapling device as the stapling device moves along the staple firing path FP. In various examples, the staple firing system of the stapling instrument enters a pause between staple firing strokes while the stapling instrument is being moved along the staple firing path. However, such pauses are part of the continuous operation of the stapling instrument. As mentioned above and referring to FIG. 143, many of the stapling instruments described herein are configured to deploy clusters of staples, such as staple cluster 6630', during each staple firing stroke. There is. Although such staple clusters may include any suitable number of staples, each of the staple clusters 6630' shown in FIG. 143 includes three staples 6630 and is deployed on either side of the tissue incision 6640. ing. In at least one exemplary embodiment, seven staple clusters 6630' are deployed on each side of the tissue incision 6640 for every inch of staple firing path. In such an embodiment, 42 staples are deployed every inch, although any suitable number may be used. The stapling instrument can continue to deploy staples along the staple firing path without having to remove the stapling instrument from the patient as long as there are staples within the stapling instrument. In at least one example, the stapling instrument may be used for, for example, 84 to 98 shots before reloading is required. Such firing may be deployed, for example, between 504 and 588 staples.

In addition to the above, many of the stapling instruments disclosed herein are capable of at least partially pivoting during staple firing. As a result, such stapling instruments can follow complex and/or non-linear staple firing paths. Referring to FIG. 174, conventional stapling instruments have been configured to deploy a straight staple line portion 8230' comprised of staples 8230, for example. An overlap region 8235' within staple line portion 8230' was formed to pivot the staple line within the tissue. Such a configuration resulted in the formation of a high density of staples 8230 within the overlap region 8235', whereby the tissue within the overlap region 8235' was highly compressed. Additionally, overlap region 8235' represents a sharp turn in the staple firing path that can create a potential leak path within the staple line. Referring to FIG. 175, the stapling instruments disclosed herein can pivot after each firing stroke, thereby allowing for more gradual pivoting. For example, the stapling instrument can pivot after deploying each staple cluster 7930' and can do so without creating overlap between the staple clusters 7930'.

The stapling instruments disclosed herein may be used to perform any suitable surgical procedure. For example, referring to FIG. 179, the stapling instrument disclosed herein can be used during a gastric bypass procedure to create a gastric pocket SP, thereby effectively reducing the size of a patient's stomach S. can be done. According to the system of stapling instruments disclosed herein, these stapling instruments may produce a curved staple path 7930' that produces a curved gastric pocket SP. Referring to FIG. 178, conventional stapling instruments have produced a staple path that includes a straight portion 8230' forming a square stomach pocket SP or a stomach pocket SP with right-angled corners. The curved gastric pocket SP produced by the stapling devices disclosed herein is believed to be less leaky than the straight gastric pocket SP produced by conventional stapling devices.

As described in more detail herein, with reference to FIG. 177, the stapling instrument disclosed herein creates a gastric sleeve SS, thereby effectively reducing the size of the patient's stomach S. It can be used during gastric reduction procedures to reduce gastric size. In accordance with the system of stapling instruments disclosed herein, these stapling instruments may produce a curved staple path 7930' producing a curved gastric sleeve SS. Referring to FIG. 176, conventional stapling instruments have produced a stapling path that includes a straight gastric sleeve SS, or a straight portion 8230' forming a gastric sleeve SS with right-angled corners 8235'. . The curved gastric sleeve SS produced by the stapling devices disclosed herein is believed to have less leakage than the straight gastric sleeve SS produced by conventional stapling devices. Further details for producing the gastric sleeve SS are shown in FIG. 151, where the staple firing path FP is used to cut the gastric sleeve SS from the patient's stomach S.

In addition to the above, gastric bypass and gastric sleeve procedures aid in weight loss and are used to treat severe obesity. Both procedures work to significantly reduce the size of the stomach to limit food intake. Gastric bypass procedures involve creating a small section within the stomach to receive food and block off the rest of the stomach. Among other things, limiting the size of the stomach serves to limit the amount of fat and calories absorbed by the patient's body. Gastric bypass procedures create a direct pathway from a small segment of the stomach to the lower intestine. In such cases, this direct route would result in eliminating the use of the upper intestines in digestion.

The gastric sleeve procedure involves creating a sleeve-like pathway from the esophagus through the stomach to the upper intestine. Laparoscopic sleeve gastrectomy (LSG) is a type of gastric sleeve procedure that involves the transverse incision and sealing of a large portion of the stomach to create a small gastric reservoir or pocket. It has been found that, unlike gastric bypass procedures, LSG procedures do not cause a reduction in the absorption of nutrients and/or do not eliminate the use of any part of the intestine. However, the LSG procedure still works to significantly reduce the size of the patient's stomach. In such LSG procedures, a long, thin, flexible member, or bougie, may be used as a measurement tool. More specifically, a bougie may be used to determine or define the size and shape of the stomach that will become the gastric sleeve upon completion of the LSG procedure. Bougie B is shown in FIGS. 30 and 32. Bougies are manufactured in various sizes to accommodate different stomach sizes. The appropriate size of the bougie is often determined based on the size of the stomach and the expected size of the gastric sleeve. During the first step of the LSG procedure, the surgeon inserts the bougie through the patient's mouth, down the esophagus, and through the esophageal sphincter, ultimately reaching the patient's stomach. Once the bougie reaches the patient's stomach, the bougie is positioned so that the end of the bougie reaches the pyloric canal, the lower region of the stomach connected to the pylorus.

FIG. 28 shows the various parts of the gastric anatomy involved during the various steps of the LSG procedure. Specifically, FIG. 28 shows the stomach before the bougie B is inserted into the stomach S during the LSG procedure. As seen in FIG. 28, the omentum O, a double layer of adipose tissue, is connected to the outer layer of the stomach S. The mesh O includes two parts: the larger mesh and the smaller mesh. The greater omentum serves to store fatty deposits, and the lesser omentum connects the stomach S and intestines to the liver. The stomach S includes various shadow regions based on the tissue thickness of the stomach S. The tissue thickness of the stomach S forms a first shadow S _1a and a second shadow S _1b . The size and location of shadows S _1a and S _1b vary based on the thickness of the stomach S. As further shown in FIG. 28, the first shadow S _1a appears along the larger curvature GC of the stomach S, and the second shadow S _1b appears along the smaller curvature LC of the stomach S. ing. As explained in more detail below, shadows S _1a and S _1b are used to determine or estimate the thickness of the stomach S along the greater curvature GC and the lesser curvature LC, respectively. Once the thickness of the stomach S is determined or estimated, it is used to determine the appropriate size and placement of the bougie B relative to the calculated shadow line SL, as shown in FIG.

FIG. 33 shows another view of the stomach anatomy according to various embodiments. Similar to the stomach anatomy shown in FIG. 28, the tissue thickness of the stomach S forms a first shadow S ₁ and a second shadow S ₂ . Similar to the above description, the first shadow S ₁ occurs along the larger curve GC and the second shadow S ₂ occurs along the smaller curve LC. The first shadow S ₁ and the second shadow S ₂ intersect at a point S ₃ . During the gastric sleeve procedure, the position of the pylorus P _X and point S ₃ are used to determine the position of the cutting line C ¹ offset from the pylorus P _X at a distance A. As shown in FIG. 33 and described in further detail below, the sleeve diameter D is determined based on the estimated tissue thickness.

Figure 152 shows the various parts of the stomach involved during the various steps of the LSG procedure. Specifically, FIG. 152 shows the initial steps of the LSG procedure, in which the bougie B is inserted into the stomach S. At the beginning of the LSG procedure, the surgeon inserts Bougie B through the patient's mouth, down the esophagus E, and through the esophageal sphincter, ultimately reaching the patient's stomach. When the bougie B reaches the patient's stomach, the bougie B is positioned so that the end of the bougie B fits within the pyloric canal PC and stops at the pyloric sphincter PS. Further, as shown in FIG. 152, the bougie B is configured to sit according to the shape and length of the stomach S along the angular notch AN of the smaller curved portion LC. 153, with magnetic properties configured to interact with and guide the stapling instrument 7100 along a predetermined path parallel to the bougie 7210. Bougie 7210 may be used.

Referring again to FIG. 152, once the bougie is placed in its final position, a distance D ¹ is measured along the antrum PA of the greater curvature GC. The distance D ¹ is used to determine the position of the pylorus P _x and is also used to determine the position of the cutting line C ¹ . Bougie 7210 illustrated in FIG. 153 generates one or more magnetic fields that are used to guide stapling instrument 7100 to bougie 7210. Referring to FIG. 154, stapling instrument 7100 then follows the magnetic field along a path adjacent bougie 7210 to create cutting line C ¹ . As a result, the cutting line C ¹ extends upwardly through the patient's stomach S, following the shape and curvature of both the stomach S and the bougie 7210. Cut line C ¹ then proceeds upward through the patient's stomach S along a path adjacent to bougie 7210 until reaching His angle AH. Once cutting line C ¹ is established, stapling instrument 7100 applies staples, such as staples 7130, to the tissue along either side of cutting line C ¹ . The remaining portion of the stomach S that is still in communication with the esophagus is substantially the size and shape of the bougie 7210. A significant portion of the stomach S, starting at the antrum PA and ending at the angle of His AH, is excluded from participation in the digestive process. The excluded portion of the stomach S is shown in more detail in FIG. 154 and includes the larger curvature GC of the stomach S.

In some cases, the clinician can estimate the appropriate staple firing path within the patient's stomach by observing certain anatomical markers on the stomach and/or elsewhere within the surgical site. Referring to FIG. 152, stapling instruments disclosed herein, such as stapling instrument 7100, are configured to sense anatomical markers within a patient to determine an appropriate staple firing path. ing. In addition to the above, the stapling instruments disclosed herein include one or more cameras configured to sense or detect one or more anatomical markers and a stapling device configured to sense or detect one or more anatomical markers; a controller configured to calculate a staple firing path based on the staple firing path. In at least one example, the stapling instrument is configured to detect a smaller curve in the stomach and calculate a staple firing path within the gastric tissue that is parallel or at least substantially parallel to the smaller curve. ing. Other anatomical markers on the patient's stomach that may be detected and used to determine the staple firing path include, for example, the angular notch, the esophageal sphincter, the angle of His, the pyloric sphincter, and/or the antrum.

As mentioned above, the smaller curve of the stomach can be used to determine the staple firing path. However, in various cases the smaller curves are at least partially obscured by fat and/or connective tissue. However, for example, the smaller curve, the omentum, and any overlap between the smaller curve and the omentum can be visually distinguished. More specifically, the uncovered gastric tissue has a first color, the reticulum has a second color different from the first color, and the overlap between the two is It has a third color different from the first color and the second color. These colors are detectable by the stapling instrument to determine the appropriate staple firing path. In certain instances, the color of the gastric tissue beneath the omentum produces a shadow that is detectable by the stapling instrument. Other methods may be used to determine the appropriate location of the staple firing path.

In addition to the above, the gastric sleeve SS formed during the gastric bypass procedure must have a sufficiently large digestive passageway defined therein to allow food to pass through. As a result, and now referring to FIG. 29, the staple firing path through the patient's stomach S must be sufficiently spaced from the smaller curve of the stomach to form a sufficient digestive path D. The stapling instrument disclosed herein is adapted to detect the smaller curve of the stomach and calculate a staple firing path, e.g., a staple firing path SP ₁ that is a distance X away from the edge of the stomach S. , may be configured. In other examples, the stapling instruments disclosed herein detect the lesser omentum LO, bounded by the smaller curve of the stomach, and _e.g. The calculation may be performed assuming that the distance X is a predetermined distance apart.

As mentioned above, detecting the edges of the stomach S can be difficult. In certain examples, the stapling instruments disclosed herein include a camera system configured to observe the color of the stomach tissue and/or changes in the color of the stomach tissue to determine the edges of the stomach S. can be provided. In various examples, the stapling instruments disclosed herein may be configured to detect the edge of the stomach by assessing the thickness of the stomach tissue and/or changes in the thickness of the stomach tissue. A patient's stomach tissue is typically thinner around the periphery or edges of the stomach than in the middle, and the color of stomach tissue is often a function of its thickness. It recognized. In other words, the tissue around the periphery of the stomach appears to have a shaded or darker color because its thickness is thinner. This shaded region S ₁ is bounded in FIG. 29 by a distance Z ₁ . The distance Z ₁ also delimits the transition from the thinner tissue of the stomach S to the region T ₁ of full tissue thickness. In various examples, the surgical instruments disclosed herein are configured to determine the staple firing path SP ₁ by, for example, establishing the staple firing path SP ₁ a certain distance from the shadow region S ₁ . may be configured. In at least one example, the surgical instrument can establish the staple firing path SP ₁ at a certain distance from the midpoint between the reticulum LO and the edge of the shadow region S ₁ , for example.

In addition to the above, the stapling instrument controller disclosed herein may include an edge detection algorithm. The edge detection algorithm is configured to sense a first light intensity at a first location and a second light intensity at a second location on the stomach tissue. The edge detection algorithm calculates a first light intensity value for the first light intensity and a second light intensity value for the second light intensity, and then combines the first light intensity value with the second light intensity value. It is further configured to compare. Light intensity values can be on a scale of 1 to 100, where, for example, lower values represent darker tissue and higher values represent lighter tissue. The first location and the second location establish a sample line from which additional samples may be taken to establish an intensity gradient. To achieve this objective, the edge detection algorithm senses a third light intensity at a third location along the sample line, determines a third light intensity value at the third location, and determines a third light intensity value at the third location. The light intensity value is further configured to compare the light intensity value to the first light intensity value and the second light intensity value. The first position, the second position, and the third position are located sequentially along the sample line, and the algorithm also determines that the first light intensity value is greater than the second light intensity value. If the algorithm determines that the second light intensity value is greater than the third light intensity value, the algorithm then determines that, for example, a shading gradient exists between the first position and the third position; The third location may be determined to be closer to the edge of the stomach tissue than the first location. This method can be applied on a very large scale to map shading and/or color gradients of the entire gastric tissue or at least a portion of the gastric tissue.

As mentioned above, the thickness of the gastric tissue can affect the color or shading of the gastric tissue. Therefore, a stomach with thicker tissue (FIG. 29) will typically have a different color and/or shading than a stomach with thinner tissue (FIG. 31). The thinner tissue of FIG. 31 has a shaded region _S2 bounded by a distance _Z2 . The distance Z ₂ also delimits the transition from the thinner tissue of the stomach S ₂ to the region of full tissue thickness T ₂ . In various examples, the surgical instruments disclosed herein are configured to determine the staple firing path SP ₂ , for example, by establishing the staple firing path SP ₂ a certain distance from the shadow region S ₂ . may be configured. In at least one example, the surgical instrument can establish the staple firing path SP ₂ at a certain distance from the midpoint between, for example, the reticulum LO ₂ and the edge of the shadow region S ₂ .

The staple firing path SP ₁ establishes a first sleeve profile and the staple firing path SP ₂ establishes a second sleeve profile different from the first sleeve profile. The first sleeve profile has a first width, X, and the second sleeve profile has a second width, Y, different from the width. Regardless of the sleeve profile produced by the stapling devices disclosed herein, the tissue drive system of the stapling device is configured to propel the stapling device along a staple firing path that forms the desired gastric sleeve. It is composed of Such a stapling instrument is configured to identify an anatomical marker and steer the stapling instrument toward, away from, and/or parallel to the one or more anatomical markers. obtain.

In addition to the above, with reference to FIG. 153, a stapling instrument 7100 includes a shaft 7110, a distal head 7120, and an articulation joint 7170 rotatably connecting the distal head 7120 to the shaft 7110. . Stapling instrument 7100 makes an incision in the patient's stomach along path C1 and applies three rows of staples 7130 on each side of path C1. As mentioned above, bougie 7210 is configured to guide stapling instrument 7100 along a staple firing path. More specifically, bougie 7210 is configured to emit one or more magnetic fields that can be detected by stapling instrument 7100 and then used by stapling instrument 7100 to determine a staple firing path. . In at least one example, the bougie 7210 emits a strong magnetic field SMF and a weak magnetic field WMF that are emitted along the length of the bougie 7210 when emitted. Notably, weak magnetic field WMFs are interleaved with strong magnetic field SMFs.

Referring to FIG. 154, stapling instrument 7100 includes one or more sensors, such as Hall effect sensors, configured to detect strong magnetic fields SMF and weak magnetic fields WMF. The sensor is in communication with a controller of the stapling instrument 7100, which uses data from the sensor to detect the configuration of the strong magnetic field SMF and the weak magnetic field WMF and to direct the staple firing path between the magnetic fields SMF and WMF. The stapling instrument 7100 can be aligned so that the stapling instrument 7100 follows the bougie 7210 to produce the desired gastric sleeve profile. In at least one example, the strength of the strong magnetic field SMF is, for example, twice the strength of the weak magnetic field WMF. In other examples, the strength of the strong magnetic field SMF is, for example, 50% greater than the strength of the weak magnetic field WMF.

155 and 157, bougie 7210 includes an inner flexible core 7212 and a plurality of conductor windings configured to emit the magnetic fields SMF and WMF described above. The flexible core 7212 is constructed of an electrically non-conductive material, or at least a substantially electrically non-conductive material, such as rubber, for example. Flexible core 7212 is solid, but may include a tube. The conductor winding includes a winding circuit 7214 that emits a weak magnetic field WMF and a winding circuit 7216 that emits a strong magnetic field SMF. Winding circuit 7214 has fewer turns than winding circuit 7216 and produces a weaker magnetic field than winding circuit 7216 for a given current. Each winding circuit 7214 includes a conductive wire wrapped around the inner flexible core 7212 and in communication with the controller of the bougie 7210. Each winding circuit 7214 is different from other winding circuits 7214 and is also different from winding circuit 7216. Similarly, each winding circuit 7216 is separate and distinct from other winding circuits 7216 and is also separate and distinct from winding circuit 7214. Each conductive wire includes an inner conductive core and an insulating jacket extending around the conductive core. In an alternative embodiment, the conductive wire includes a conductive core embedded in a flexible core 7212. In either case, the bougie 7210 includes an outer jacket 7218 that is configured to seal the contents therein to prevent or inhibit fluid entry into the bougie 7210.

In use, in addition to the above, a voltage source is applied to winding circuits 7214 and 7216. The voltages applied to each winding circuit 7214 and 7216 are the same or at least substantially the same. Alternatively, a first voltage is applied to winding circuit 7214 and a second or different voltage is applied to winding circuit 7216. In various alternative embodiments, the winding circuits 7214 are not separate circuits; rather, they are part of one long circuit and a single current flows through each of the winding circuits 7214. Similarly, in various alternative embodiments, winding circuits 7216 are not separate circuits; rather, they are part of one long circuit such that a single current passes through each of winding circuits 7216. It flows. In any event, winding circuits 7214 and 7216 emit a magnetic field that extends around the entire circumference of bougie 7210 such that bougie 7210 can be used in any suitable manner for performing the surgical procedure described above. can be oriented or rotated.

As mentioned above, the bougie 7210 uses electricity to generate a magnetic field. In various alternative embodiments, the bougie may include a permanent magnet that generates a magnetic field. In at least one example, the bougie includes a strong permanent magnet that produces a strong magnetic field and a weak permanent magnet that produces a weak magnetic field. In at least one such example, strong and weak permanent magnets are arranged in an alternating manner to produce alternating strong and weak magnetic fields, SMF and WMF, as shown in FIG. 154, for example. That said, the bougie can generate one or more magnetic fields in any suitable manner.

Referring to FIG. 156, bougie 7310 includes an inner flexible core 7312 and a plurality of conductor windings configured to emit the magnetic fields SMF and WMF described above. The flexible core 7312 is constructed of an electrically non-conductive material, or at least a substantially electrically non-conductive material such as rubber, for example. The conductor winding includes a winding circuit 7314 configured to emit a weak magnetic field WMF and a winding circuit 7316 configured to emit a strong magnetic field SMF. Winding circuit 7314 has fewer turns than winding circuit 7316 and will produce a weaker magnetic field than winding circuit 7316 for a given current. Each winding circuit 7314 includes a conductive wire wrapped around an inner flexible core 7312 and in communication with a controller of bougie 7310. The windings of circuit 7314 are more compact, or denser, than the windings of circuit 7214. For example, the windings of circuit 7214 extend longitudinally as they wrap around core 7212, whereas the windings of circuit 7314 do not extend longitudinally, or at least do not substantially extend. . Similarly, the windings of circuit 7316 are more compact, or denser, than the windings of circuit 7216. A dense or compact winding, for example, may produce a dense or compact magnetic field that may be more discernible to the stapling instrument 7100.

Although the surgical instrument systems described herein are operated by electric motors, the surgical instrument systems described herein may be operated in any suitable manner. In certain examples, the motors disclosed herein may comprise part of a robot control system. For example, U.S. patent application Ser. some examples are disclosed in more detail.

The surgical instrument systems described herein have been described in connection with staple deployment and deformation. However, embodiments described herein are not limited thereto. Various embodiments are envisioned that deploy fasteners other than staples, such as, for example, clamps or tacks. Additionally, various embodiments are envisioned that utilize any suitable means for sealing tissue. For example, end effectors according to various embodiments may include electrodes configured to heat and seal tissue. Further, for example, an end effector according to certain embodiments can apply vibrational energy to seal tissue.

Example 1 - Surgical stapler for stapling patient tissue. The surgical stapler includes a handle with a display, a shaft extending from the handle, and an end effector extending from the shaft. The end effector includes a staple cartridge that includes a plurality of staples removably stored therein. The end effector further includes an anvil configured to deform the staple. The surgical stapler includes a firing mechanism configured to reciprocally eject staples from a staple cartridge along a firing path, a camera configured to capture real-time images of patient tissue, and a camera configured to capture real-time images of patient tissue; and a controller configured to generate an image overlay and display the image overlay over the real-time image on the display.

Example 2 - The surgical device of Example 1, wherein the controller is configured to generate an alternative firing path, and the controller is configured to display the alternative firing path on a display. stapler.

Example 3 - The surgical stapler of Example 2, wherein the controller is configured to display alternative firing paths as part of the image overlay.

Example 4 - The surgical stapler of Example 2, wherein the controller is configured to display the alternative firing path as part of a second image overlay over the real-time image.

Example 5 - An implementation in which the image overlay includes a first image overlay, and the controller is configured to display an alternative firing path as part of a second image overlay over the first image overlay. Surgical stapler according to Example 2.

Example 6 - The method of Example 1, wherein the controller is configured to generate a plurality of alternative firing paths, and the controller is configured to display the alternative firing paths on the display. Surgical stapler.

Example 7 - The surgical stapler of Example 6, wherein the controller is configured to display alternative firing paths as part of the image overlay.

Example 8 - As described in Examples 1, 2, 3, 4, 5, 6, or 7, wherein the display comprises a touch screen and the user of the surgical stapler may modify the firing path by manipulating the touch screen. surgical stapler.

Example 9 - The method of Example 1, 2, 3, 4, 5, 6, 7, or 8 further comprising a motorized drive system configured to move the end effector relative to patient tissue along the firing path. Surgical stapler as described.

Example 10 - Surgical stapler for stapling patient tissue. The surgical stapler includes a handle with a display, a shaft extending from the handle, and an end effector extending from the shaft. The end effector includes a staple cartridge that includes a plurality of staples removably stored therein. The end effector further includes an anvil configured to deform the staple. The surgical stapler includes a firing system configured to eject staples from a staple cartridge along a firing path, a camera configured to capture a tissue image of patient tissue, and an image overlay representing the firing path. and a controller configured to generate and display an image overlay over the tissue image on the display.

Example 11 - The surgical method of Example 11, wherein the controller is configured to calculate an alternative firing path, and the controller is configured to display the alternative firing path on a display. stapler.

Example 12 - The surgical stapler of Example 11, wherein the controller is configured to display alternative firing paths as part of the image overlay.

Example 13 - The surgical stapler of Example 11, wherein the controller is configured to display the alternative firing path as part of a second image overlay over the tissue image.

Example 14 - An implementation in which the image overlay includes a first image overlay, and the controller is configured to display an alternative firing path as part of a second image overlay over the first image overlay. The surgical stapler according to Example 11.

Example 15 - The method of Example 10, wherein the controller is configured to calculate a plurality of alternative firing paths, and the controller is configured to display the alternative firing paths on the display. Surgical stapler.

Example 16 - The surgical stapler of Example 15, wherein the controller is configured to display alternative firing paths as part of the image overlay.

Example 17 - As described in Examples 10, 11, 12, 13, 14, 15, or 16, wherein the display comprises a touch screen and the user of the surgical stapler may modify the firing path by manipulating the touch screen. surgical stapler.

Example 18 - The method of Example 10, 11, 12, 13, 14, 15, 16, or 17 further comprising a motorized drive system configured to move the end effector relative to patient tissue along the firing path. Surgical stapler as described.

Example 19 - Surgical stapler for stapling patient tissue. The surgical stapler includes a handle with a display, a shaft extending from the handle, and an end effector extending from the shaft. The end effector includes a group of staples and an anvil configured to deform the staples. The surgical stapler includes a firing system configured to deploy staples along a firing path, a vision system configured to capture a tissue image of patient tissue, and generate an image overlay representing the firing path. and a controller configured to display an image overlay over the tissue image on the display.

Example 20 - The surgical stapler of Example 19, wherein the display includes a touch screen and a user of the surgical stapler may modify the firing path by manipulating the touch screen.

Example 21 - The surgical stapler of Example 19 or 20, further comprising a motorized drive system configured to move the end effector relative to the tissue along the firing path.

The entire disclosure below is incorporated herein by reference.
- U.S. Patent No. 5,403,312, entitled "ELECTROSURGICAL HEMOSTATIC DEVICE," issued April 4, 1995;
- U.S. Patent No. 7,000,818, entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS," issued February 21, 2006;
- U.S. Patent No. 7,422,139, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK," issued September 9, 2008;
- U.S. Patent No. 7,464,849, entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS," December 16, 2008 Issue,
- U.S. Patent No. 7,670,334, entitled "SURGICAL INSTRUMENT HAVING AN ARTICULATION END EFFECTOR," issued March 2, 2010;
- U.S. Patent No. 7,753,245, entitled "SURGICAL STAPLINING INSTRUMENTS," issued July 13, 2010;
- U.S. Patent No. 8,393,514, entitled "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE," issued March 12, 2013;
- U.S. Patent Application No. 11/343,803, entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES," now U.S. Pat.
- U.S. Patent Application No. 12/031,573, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES," filed February 14, 2008;
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- U.S. Patent Application No. 12/235,782, entitled "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT," now U.S. Pat.
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- U.S. patent application Ser. Filed on February 24th, currently US Patent No. 8,220,688 ,
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- U.S. patent application Ser.
- U.S. Patent Application Publication No. 2007/0175955, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM," filed on January 31, 2006, and
- U.S. Patent Application Publication No. 2010/0264194, entitled "SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR," filed April 22, 2010, currently U.S. Patent No. 8,308,040.

Although various devices are described herein with particular embodiments, modifications and changes may be made to those embodiments. The particular features, structures or characteristics may be combined in any suitable manner in one or more embodiments. Therefore, a particular feature, structure, or feature illustrated or described with respect to one embodiment may, without limitation, be combined in whole or in part with the feature, structure, or feature of one or more other embodiments. It's fine. Also, although materials are disclosed for particular components, other materials may be used. Further, a single component may be replaced with multiple components, and multiple components may be replaced with a single component to perform a given function(s), according to various embodiments. May be replaced. The foregoing description and the following claims are intended to cover all such modifications and variations.

The devices disclosed herein may be designed to be discarded after a single use, or may be designed to be used multiple times. However, in any case, the device can be reconditioned for reuse after at least one use. Reconditioning can include, but is not limited to, any combination of disassembling the device, followed by cleaning or replacing certain parts of the device, and subsequent reassembly of the device. Specifically, the reconditioning facility and/or surgical team may disassemble the device, clean and/or replace certain parts of the device, and then reassemble the device for subsequent use. I can do it. Those skilled in the art will appreciate that reconditioning the device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. The use of such techniques, and the resulting reconditioned devices, are all within the scope of this application.

The devices disclosed herein may be processed prior to surgery. Initially, new or used instruments may be obtained and cleaned as necessary. The instruments can then be sterilized. In one sterilization technique, instruments are placed in closed, sealed containers, such as plastic bags or TYVEK bags. The container and device can then be placed in a field of radiation that can penetrate the container, such as gamma rays, x-rays, and/or high-energy electrons. Radiation can kill bacteria on instruments and in containers. After this, the sterilized instruments can be stored in a sterile container. The sealed container can keep the instrument sterile until it is opened at a medical facility. The device may also be sterilized using any other technique known in the art, including, but not limited to, beta radiation, gamma radiation, ethylene oxide, hydrogen peroxide plasma, and/or water vapor.

While the invention has been described as having a representative design, the invention may be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles.

Any patent, publication, or other disclosure document that is incorporated by reference in whole or in part into this specification does not include any prior definitions, views, or other disclosures in which the incorporated material is set forth in this disclosure. It is incorporated herein only to the extent consistent with the content thereof. As such, and to the extent necessary, disclosure expressly set forth herein shall supersede any conflicting disclosure herein incorporated by reference. Although incorporated herein by reference, any content, or portion thereof, that is inconsistent with current definitions, views, or other disclosures herein shall be incorporated by reference. It shall be incorporated only to the extent that there is no conflict with the disclosure content of .

[Mode of implementation]
(1) A surgical stapler for stapling patient tissue,
a handle with a display;
a shaft extending from the handle;
An end effector extending from the shaft,
a staple cartridge including a plurality of staples removably stored therein;
an end effector comprising: an anvil configured to deform the staple;
a firing mechanism configured to reciprocally eject the staples from the staple cartridge along a firing path;
a camera configured to capture real-time images of the patient tissue;
a controller configured to generate an image overlay representative of the firing path and display the image overlay on the display over the real-time image.
(2) The controller is configured to generate an alternative firing path, and the controller is configured to display the alternative firing path on the display. surgical stapler.
3. The surgical stapler of embodiment 2, wherein the controller is configured to display the alternative firing path as part of the image overlay.
(4) The surgical stapler of embodiment 2, wherein the controller is configured to display the alternative firing path as part of a second image overlay over the real-time image.
(5) the image overlay includes a first image overlay, and the controller is configured to display the alternative firing path as part of a second image overlay over the first image overlay; Embodiment 3. The surgical stapler of embodiment 2.

(6) The controller is configured to generate a plurality of alternative firing paths, and the controller is configured to display the alternative firing paths on the display. The surgical stapler described in .
7. The surgical stapler of embodiment 6, wherein the controller is configured to display the alternative firing path as part of the image overlay.
8. The surgical stapler of claim 1, wherein the display includes a touch screen, and a user of the surgical stapler can modify the firing path by manipulating the touch screen.
9. The surgical stapler of embodiment 1, further comprising a motorized drive system configured to move the end effector along the firing path and relative to the patient tissue.
(10) A surgical stapler for stapling patient tissue,
a handle with a display;
a shaft extending from the handle;
An end effector extending from the shaft,
a staple cartridge including a plurality of staples removably stored therein;
an end effector comprising an anvil configured to deform the staple;
a firing system configured to eject the staples from the staple cartridge along a firing path;
a camera configured to capture a tissue image of the patient tissue;
a controller configured to generate an image overlay representative of the firing path and display the image overlay on the display over the tissue image.

(11) The controller is configured to calculate an alternative firing path, and the controller is configured to display the alternative firing path on the display. surgical stapler.
12. The surgical stapler of embodiment 11, wherein the controller is configured to display the alternative firing path as part of the image overlay.
13. The surgical stapler of claim 11, wherein the controller is configured to display the alternative firing path as part of a second image overlay over the tissue image.
(14) The image overlay includes a first image overlay, and the controller is configured to display the alternative firing path as part of a second image overlay over the first image overlay. 12. The surgical stapler of embodiment 11.
(15) The controller is configured to calculate a plurality of alternative firing paths, and the controller is configured to display the alternative firing paths on the display. The surgical stapler described in .

16. The surgical stapler of embodiment 15, wherein the controller is configured to display the alternative firing path as part of the image overlay.
17. The surgical stapler of claim 10, wherein the display includes a touch screen, and a user of the surgical stapler can modify the firing path by manipulating the touch screen.
18. The surgical stapler of embodiment 10, further comprising a motorized drive system configured to move the end effector along the firing path and relative to the patient tissue.
(19) A surgical stapler for stapling patient tissue, comprising:
a handle with a display;
a shaft extending from the handle;
an end effector extending from the shaft,
a group of staples;
an end effector comprising: an anvil configured to deform the staple;
a firing system configured to deploy the staple along a firing path;
a vision system configured to capture a tissue image of the patient tissue;
a controller configured to generate an image overlay representative of the firing path and display the image overlay on the display over the tissue image.
20. The surgical stapler of claim 19, wherein the display includes a touch screen, and a user of the surgical stapler can modify the firing path by manipulating the touch screen.

21. The surgical stapler of embodiment 19, further comprising a motorized drive system configured to move the end effector relative to the tissue along the firing path.

Claims (18)

A surgical stapler for stapling patient tissue, the surgical stapler comprising:
a handle with a display;
a shaft extending from the handle;
An end effector extending from the shaft,
a staple cartridge including a plurality of staples removably stored therein;
an end effector comprising an anvil configured to deform the staple;
a firing mechanism configured to reciprocally eject the staples from the staple cartridge along a firing path;
a camera configured to capture real-time images of the patient 's tissue;
a controller configured to generate an image overlay representative of the firing path and display the image overlay on the display over the real-time image, the surgical stapler comprising:
the firing path displayed on the display indicates the path through which tissue is to be incised and the position relative to the tissue incision when the staple is deployed within the tissue;
The surgical stapler wherein the display includes a touch screen and a user of the surgical stapler may modify the firing path by manipulating the touch screen. The surgical device of claim 1, wherein the controller is configured to generate an alternative firing path, and the controller is configured to display the alternative firing path on the display. stapler. The surgical stapler of claim 2, wherein the controller is configured to display the alternative firing path as part of the image overlay. The surgical stapler of claim 2, wherein the controller is configured to display the alternative firing path as part of the image overlay over the real-time image. The image overlay includes a first image overlay displaying the firing path and a second image overlay, and the controller displays a portion of the second image overlay over the first image overlay. The surgical stapler of claim 2, wherein the surgical stapler is configured to display the alternative firing path as . 2. The controller of claim 1, wherein the controller is configured to generate a plurality of alternative firing paths, and the controller is configured to display the alternative firing paths on the display. Surgical stapler. The surgical stapler of claim 6, wherein the controller is configured to display the alternative firing path as part of the image overlay. The surgical stapler of claim 1, further comprising a motorized drive system configured to move the end effector along the firing path and relative to tissue of the patient. A surgical stapler for stapling patient tissue, the surgical stapler comprising:
a handle with a display;
a shaft extending from the handle;
An end effector extending from the shaft,
a staple cartridge including a plurality of staples removably stored therein;
an end effector comprising an anvil configured to deform the staple;
a firing system configured to eject the staples from the staple cartridge along a firing path;
a camera configured to capture a tissue image of the patient 's tissue;
a controller configured to generate an image overlay representative of the firing path and display the image overlay over the tissue image on the display, the surgical stapler comprising:
the firing path displayed on the display indicates the path through which tissue is to be incised and the position relative to the tissue incision when the staple is deployed within the tissue;
The surgical stapler wherein the display includes a touch screen and a user of the surgical stapler may modify the firing path by manipulating the touch screen. The surgical device of claim 9 , wherein the controller is configured to calculate an alternative firing path, and the controller is configured to display the alternative firing path on the display. stapler. The surgical stapler of claim 10 , wherein the controller is configured to display the alternative firing path as part of the image overlay. The surgical stapler of claim 10 , wherein the controller is configured to display the alternative firing path as part of the image overlay over the tissue image. The image overlay includes a first image overlay displaying the firing path and a second image overlay, and the controller displays a portion of the second image overlay over the first image overlay. The surgical stapler of claim 10 , wherein the surgical stapler is configured to display the alternative firing path as . 10. The controller of claim 9 , wherein the controller is configured to calculate a plurality of alternative firing paths, and the controller is configured to display the alternative firing paths on the display. Surgical stapler. The surgical stapler of claim 14 , wherein the controller is configured to display the alternative firing path as part of the image overlay. The surgical stapler of claim 9 , further comprising a motorized drive system configured to move the end effector along the firing path and relative to tissue of the patient. A surgical stapler for stapling patient tissue, the surgical stapler comprising:
a handle with a display;
a shaft extending from the handle;
an end effector extending from the shaft,
a group of staples;
an end effector comprising: an anvil configured to deform the staple;
a firing system configured to deploy the staple along a firing path;
a vision system configured to capture a tissue image of the patient 's tissue;
a controller configured to generate an image overlay representative of the firing path and display the image overlay on the display over the tissue image, the surgical stapler comprising:
the firing path displayed on the display indicates the path through which tissue is to be incised and the position relative to the tissue incision when the staple is deployed within the tissue;
The surgical stapler wherein the display includes a touch screen and a user of the surgical stapler may modify the firing path by manipulating the touch screen. The surgical stapler of claim 17 , further comprising a motorized drive system configured to move the end effector relative to the tissue along the firing path.

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