BR112013002338B1 - surgical instrument - Google Patents

Abstract

CIRCULAR STAPLING INSTRUMENTS WITH SECONDARY CUTTING ARRANGEMENTS AND METHODS FOR THE USE OF THEM. The present invention relates to surgical instruments. Various non-limiting embodiments may include an elongated stem (14) that has a distal end portion that is configured to operationally support a circular staple cartridge (30) therein. A tissue capture rod rotationally sustained on said elongated stem and having a distal portion that protrudes distally beyond the distal end portion of the elongated stem. At least one tissue capture element can be hingedly attached to said distal end portion of the tissue capture rod so that the tissue capture elements are selectively pivoted from a retracted position to implanted positions by applying a positioning movement at the same time. A rotary cutting element can be operationally supported adjacent to the tissue capture element and being selectively rotatable around the central axis by applying a cutting actuation movement to it.

Description

SURGICAL INSTRUMENT FIELD OF THE INVENTION

[0001] The present invention relates, in general, to surgical staples, and more particularly, to devices and methods for holding and / or protecting tissue adjacent the stapler head of a circular stapler.

BACKGROUND

[0002] In certain types of surgical procedures, the use of surgical staples has become the preferred method for joining tissues and, for this reason, specially configured surgical staplers have been developed for these applications. For example, intraluminal or circular staples have been developed for use in surgical procedures involving the lower colon and sections of the lower colon are sutured after a pathological portion has been excised. Circular clamps useful for performing such procedures are shown, for example, in US Patent Nos. 5,104,025; 5,205,459; 5,285,945; and 5,309,927 which are each incorporated herein by reference in their respective totalities.

[0003] In general, a conventional circular stapler typically consists of an elongated rod that has a proximal actuation mechanism and a distal stapler head mounted on the elongated rod. The distal stapler head commonly consists of a fixed stapling cartridge that contains a plurality of staples configured in a concentric circular assembly. A scalpel for round cutting is mounted inside the cartridge, concentrically in relation to the clamps, to obtain an axial path inside it. Extending axially from the center of the cartridge is a movable trocar rod, adapted to have a fixed clamp attached to it in a removable manner. The fixed gripper is configured to form the ends of the clamps as they are guided to it. The distance between a distal face of the staple cartridge and the fixed staple jaw is commonly controlled by an adjustment mechanism that is mounted on the proximal end of the staple rod to control the axial movement of the trocar. The tissues that are clamped between the staple cartridge and the fixed staple jaw are simultaneously stapled and cut when the trigger mechanism is activated by the surgeon.

[0004] Performing a lower colon procedure using a circular stapler, a portion of the intestine can be laparoscopically stapled using a conventional surgical stapler that is inserted through a trocar. The conventional surgical stapler serves to place multiple rows of staples on both sides of the pathological portion of the colon to be removed. The target or pathological section is simultaneously cut while the contiguous end of the colon is stapled. After removing the pathological portion, the surgeon typically inserts the fixed claw of the circular stapling instrument into the distal end of the lumen, distal from the staple line. This can be done by inserting the fixed jaw head in an entrance door cut in the distal lumen by the surgeon. The lower staple line is used to retain the colon tissue over the circular cartridge. This method seals both ends of the colon only to have the sealed portions cut from one end to the other and removed. These intermediate step clamp lines are only temporary and facilitate the next step in the procedure.

[0005] In certain cases, the fixed jaw can be positioned transanalally, placing the head of the fixed jaw at the distal end of the stapler, and inserting the instrument through the rectum. Since the fixed claw was installed in the distal portion of the intestine, the intestine is attached around the rod of the fixed claw through what is known as the "bag loop" suture. The proximal portion of the intestine is similarly secured around the stapler head by a purse-string suture.

[0006] Since the ends of the intestine have been trapped around their respective components, the surgeon, using an appropriate trocar sleeve, can employ a grasping device to hold the fixed claw rod and fix it to the trocar portion protruding from the stapler head. The surgeon then closes the gap between the fixed jaw and the cartridge, thus pinching the proximal and distal ends of the intestine in the gap. Then, the surgeon activates the stapler, causing several rows of staples to be conducted through both ends of the intestine and formed, in order to join the ends and form a tubular path. Simultaneously, as the staples are guided and formed, the concentric annular lamina blade is guided through the ends of intestinal tissue, cutting the ends adjacent to the internal row of staples. The surgeon then removes the stapler from the intestine and the procedure is complete.

[0007] Such procedures and devices require the surgeon to install two bag loop sutures that last as long as necessary to complete the surgical procedure. In addition, such procedures can sometimes cause "wrinkling" of the fabric during the fabric cutting / stapling process.

[0008] Several attempts have been made to retain the colon and other tissues around the stapling device. For example, US Patent Nos. 5,309,927; 6,117,148; and 7,094,247 have several provisions that, in general, employ fasteners, connecting elements, spring rings, etc. which are separate from the stapling device itself in an effort to secure the fabric in position. US Patent No. 5,669,918 discloses a mechanism that employs a claw-like arm to friction the fabric against the trocar shaft. Although such a device is essentially self-contained, the claw arms may ultimately be unable to effectively hold the tissue in position in practice.

[0009] Thus, there is a need for devices and methods to reduce the time required to complete the surgical procedure as well as address other deficiencies and challenges associated with retaining tissue in position using circular stapler provisions.

[00010] The aforementioned discussion is only intended to illustrate some of the disadvantages present in the field of the invention at the moment, and should not be taken as a denial of the scope of the embodiments.

BRIEF SUMMARY

[00011] In accordance with a general aspect of various non-limiting modalities of the present invention, a surgical instrument is provided which comprises an elongated rod that defines a central axis and has a distal end portion which is configured to operationally support a cartridge of circular staples in it. A tissue capture rod is rotationally supported on the elongated rod. The tissue capture rod has a distal portion that protrudes in a distal position beyond. the distal end portion of the elongated nail. At least one tissue capture element can be pivotally attached to the distal end portion of the tissue capture rod so that each tissue capture element is selectively pivoted from a retracted position to implanted positions by applying a movement positioning. A rotary cutting element is operationally supported adjacent to said tissue capture elements and is selectively rotatable around the central axis by applying a cutting actuation movement to it.

[00012] In accordance with another general aspect of various non-limiting modalities of the present invention, a surgical instrument is provided which comprises a cable assembly having an elongated stem protruding from it. The elongated rod defines a central axis and ends at a stapler head. In various non-limiting embodiments, the head of the stapler comprises a circular staple cartridge that has a closing face and an axially movable cutting element operably supported thereon. The surgical instrument further comprises a firing element which is operably supported on the elongated rod and is oriented to apply a firing movement to the circular staple cartridge. A fixed claw rod assembly operatively supported on said elongated rod and configured to receive actuation movements from the cable assembly to cause the fixed claw rod assembly to move axially on the elongated rod so that the portion The distal connection plate moves axially in relation to the closing face. A fixed claw is removably attached to the distal connection portion of the fixed claw rod assembly. a tissue capture rod is rotationally supported on the elongated rod. A plurality of tissue capture elements are hingedly attached to the distal end portion of the tissue capture rod and are selectively pivoted from a retracted position to implanted positions by applying a positioning motion to it. A rotary cutting element is operationally supported adjacent to said tissue capture elements and is selectively rotatable around the central axis by applying a cutting actuation movement to it.

[00013] In accordance with yet another general aspect of various non-limiting modalities of the present invention, a surgical procedure is provided to perform a circular anastomosis of a tubular organ. In several non-limiting modalities, the surgical procedure involves inserting a stapler head of a surgical instrument into the tubular organ in a position adjacent to the targeted portion of the same. The stapler head operationally holds a staple cartridge in it. The stapler head has a distal face. The procedure further comprises acquiring a proximal portion of the tubular organ that is adjacent to the targeted portion with a plurality of tissue capture elements from the surgical instrument. The procedure also includes retaining the proximal portion of the tubular organ adjacent to the distal face of the staple cartridge and rotatingly separating the targeted portion of the tubular organ from the retained proximal portion. In addition, in conjunction with various non-limiting modalities, the procedure comprises separating the targeted portion of the tubular organ from a distal portion of the tubular organ and inserting a fixed jaw into the distal portion of the tubular organ so that the connecting portion of the fixed jaw is it protrudes proximally out of the open end of the distal portion of the tubular organ. The procedure additionally comprises fixing the distal portion of the tubular organ to the fixed jaw and coupling the connection portion of the fixed jaw to the surgical instrument. The procedure further comprises extracting the fixed jaw proximally towards the head of the stapler so that a proximal end of the distal portion of the tubular organ and the retained proximal portion of the tubular organ are adjacent to each other and captured between the fixed jaw and the face closing and stapling the proximal end of the distal portion and the proximal portion retained together to form a repaired tubular organ. The procedure further comprises cutting through the proximal end of the distal portion and the retained proximal portion adjacent to the clamps.

BRIEF DESCRIPTION OF THE FIGURES

[00014] The attached drawings, which are incorporated into this specification and form part of it, illustrate modalities of the invention and, together with the general description provided above and the detailed description of the modalities provided below, serve to explain the principles of present invention.

[00015] Figure 1 is a perspective view of a circular stapling surgical instrument of various non-limiting modalities of the present invention;

[00016] Figure 1A is a cross-sectional view of the cable portion of various embodiments of the surgical stapling instrument of the present invention;

[00017] Figure 2 is a cross-sectional view of a distal end portion of the elongated rod of the circular stapling instrument of Figure 1;

[00018] Figure 2A is a partial cross-sectional view of the distal end of the elongated stem with a fixed claw attached to it;

[00019] Figure 2B is a partial cross-sectional view of the distal end of the elongated rod taken along line 2B-2B in Figure 2A;

[00020] Figure 2C is a cross-sectional view of a portion of the cable assembly of an embodiment of the present invention;

[00021] Figure 2D is a cross-sectional view of another portion of the elongated stem of various embodiments of the present invention;

[00022] Figure 3 is an end view of the elongated rod of Figure 2;

[00023] Figure 4 is a partial perspective view of the distal end portion of the elongated rod of Figures 2 and 3 with the tissue capture elements and the blade elements thereof in their radially positioned positions;

[00024] Figure 5 is a partial cross-sectional view of the distal end of the elongated nail with a fixed claw attached to it and inserted into a portion of a patient's tubular organ such as a colon;

[00025] Figure 6 is another cross-sectional view of the distal end of the elongated rod of Figure 5 with the fixed claw removed from it;

[00026] Figure 7 is another cross-sectional view of the distal end of the elongated shank of Figures 5 and 6 with the distal end portion of the cutter compartment axially advanced beyond the distal face of the staple cartridge supported on the distal end of the elongated shank ;

[00027] Figure 8 is another cross-sectional view of the distal end of the elongated rod of Figure 7 with tissue capture elements radially positioned outside the tissue capture compartment and piercing through a portion of the colon;

[00028] Figure 9 is another cross-sectional view of the distal end of the elongated stem of Figure 8 with the tissue capture elements removed from it back into the tissue capture compartment to position the perforated portion of the colon adjacent to the face. distal from the staple cartridge;

[00029] Figure 10 is another cross-sectional view of the distal end of the elongated rod of Figure 9 with the blade elements radially positioned outside the cutter compartment and piercing through another portion of the colon;

[00030] Figure 11 is another cross-sectional view of the distal end of the elongated rod of Figure 10 after the blade elements have been rotated to separate the retained perforated portion of the colon from a pathological portion of the colon;

[00031] Figure 12 is another cross-sectional view of the distal end of the elongated rod of Figure 11 with the blade elements removed back into their respective lumens in the cutter compartment;

[00032] Figure 13 is another cross-sectional view of the distal end of the elongated nail of Figure 12 after the fixed jaw has been attached to a distal portion of the colon and the fixed jaw rod of the same has been attached to the joint portion of the jaw fixed of the circular stapling instrument;

[00033] Figure 14 is another cross-sectional view of the distal end of the elongated rod of Figure 13 after the fixed jaw has been extracted adjacent to the distal face of the staple cartridge;

[00034] Figure 15 is another cross-sectional view of the distal end of the elongated nail of Figure 14 after the clamps have been positioned and the annular lamina has been axially advanced through the adjacent portions of the colon;

[00035] Figure 16 is another cross-sectional view of the distal end of the elongated nail in Figure 15 after the colon sections have been stapled together, but before they are removed from the colon;

[00036] Figure 17 is a perspective view of a circular stapling surgical instrument of various non-limiting modalities of the present invention;

[00037] Figure 18 is a cross-sectional view of a distal end portion of the elongated nail of the circular stapling instrument of Figure 17;

[00038] Figure 19 is an exploded view of the capture and positioning rods of various non-limiting modalities of the present invention;

[00039] Figure 20 is a partial perspective view of the capture rod of Figure 19 with its fabric arms in a retracted position;

[00040] Figure 21 is a partial cross-sectional view of the capture rod of Figures 19 and 20, with its fabric arms in a positioned position;

[00041] Figure 22 is a perspective view of the capture rod of Figure 21;

[00042] Figure 23 is a cross-sectional view of the elongated rod of various non-limiting embodiments of the present invention, with a fixed claw attached to it and inserted into a portion of a patient's colon;

[00043] Figure 24 is another cross-sectional view of the elongated nail in Figure 23, with the fixed claw removed and the capture arms positioned through a proximal portion of the colon that is adjacent to a target or pathological portion of the colon;

[00044] Figure 25 is a top cross-sectional view of the elongated nail of Figure 24 taken along line 25-25 in Figure 24 with the tissue capture arms extended across the proximal portion of the colon;

[00045] Figure 26 is a partial cross-sectional view of the elongated rod of Figures 24 and 25 with the target or pathological portion of the colon being removed with a grasping instrument;

[00046] Figure 27 is a top cross-sectional view of the elongated rod of Figure 26 taken along line 27-27 in Figure 26;

[00047] Figure 28 is a partial cross-sectional view of the elongated nail after the fixed jaw is inserted into a distal portion of the colon and attached to this by a bag loop suture arrangement;

[00048] Figure 29 is a cross-sectional view of the elongated rod of Figure 28 after the fixed jaw is coupled to the fixed jaw assembly of the same and extracted in relation to the clamping cartridge thereon;

[00049] Figure 30 is a cross-sectional view of the elongated rod of Figure 29 after the staple cartridge is fired and the annular cutting element advanced through the stapled tissue portions;

[00050] Figure 31 is a cross-sectional view of the elongated nail of Figure 30 being extracted from the colon after finishing the stapling procedure;

[00051] Figure 32 is a perspective view of another circular stapling surgical instrument of various non-limiting modalities of the present invention;

[00052] Figure 33 is a cross-sectional view of a distal end portion of the elongated rod of the circular stapling instrument of Figure 32;

[00053] Figure 34 is a partial perspective view of a portion of the detection compartment and hook of the elongated rod of Figure 33 with the detection elements thereof in a retracted position;

[00054] Figure 35 is another partial perspective view of the detection compartment and hook of Figure 34 with the detection elements thereof in a positioned orientation;

[00055] Figure 36 is a partial cross-sectional view of the distal end of the elongated nail with its detection elements in an orientation positioned in a colon;

[00056] Figure 37 is a top cross-sectional view of the elongated stem and colon of Figure 36 taken along line 37-37 in Figure 36;

[00057] Figure 38 is a perspective view of another circular stapling instrument of various non-limiting modalities of the present invention;

[00058] Figure 39 is a cross-sectional view of a distal end portion of the elongated nail of the circular stapling instrument of Figure 38 inserted into the proximal portion of a tubular organ such as a colon;

[00059] Figure 40 is an exploded view of distal end portions of a tissue capture rod, a positioning rod and a blade rod of various non-limiting embodiments of the present invention;

[00060] Figure 41 is a partial perspective view of the fabric capture rod of Figure 40 with its fabric arms in a retracted position;

[00061] Figure 42 is a perspective view of the capture rod of Figure 41 with its fabric arms in positioned positions;

[00062] Figure 43 is a partial cross-sectional view of a distal end portion of the elongated nail of the Figure 38 surgical instrument inserted into a proximal portion of the colon with the fixed jaw assembly removed from it;

[00063] Figure 44 is a partial cross-sectional view of the distal end portion of the elongated nail with the tissue capture arms positioned across a proximal portion of the colon;

[00064] Figure 45 is a top cross-sectional view of the distal end portion of the elongated stem taken along line 45-45 in Figure 44;

[00065] Figure 46 is another partial cross-sectional view of the distal end portion of the elongated nail after the tissue capture arms are positioned through the proximal portion of the colon and then moved to a retracted position in which the proximal portion perforated is trapped between the tissue capture arms and the tissue capture rod;

[00066] Figure 47 is a top cross-sectional view of the distal end portion of the elongated rod of Figure 46 taken along line 47-47 in Figure 46;

[00067] Figure 48 is a partial cross-sectional view of the distal end portion of the elongated nail with the pathological portion of the colon separated from the proximal portion and distal portion and removed from the colon by conventional claws;

[00068] Figure 49 is a partial cross-sectional view of the elongated nail after the fixed jaw is inserted into a distal portion of the colon and attached to it by a bag loop suture arrangement;

[00069] Figure 50 is a cross-sectional view of the elongated rod of Figure 49 after the fixed jaw is coupled to the fixed jaw assembly of the same and extracted in relation to the clamp cartridge therein;

[00070] Figure 51 is a cross-sectional view of the elongated rod of Figure 50 after the staple cartridge is fired and the annular cutting element advanced through the stapled tissue portions;

[00071] Figure 52 is a cross-sectional view of the elongated nail of Figure 51 being extracted from the colon after finishing the stapling procedure;

[00072] Figure 53 is a view of a portion of an open abdominal cavity of the patient illustrating various tissues and structures adjacent to a portion of the colon;

[00073] Figure 54 is another partial view of the open abdominal cavity of Figure 53;

[00074] Figure 55 is another view of the abdominal cavity of Figure 53 which illustrates the insertion of a trocar in the abdominal cavity to deliver a protective wrap modality of the present invention therein;

[00075] Figure 56 is another view of the abdominal cavity of Figure 55 in the form of a protective wrap extracted from the trocar sleeve by a conventional grasping device;

[00076] Figure 57 is another view of the abdominal cavity of Figure 56 that illustrates a method of positioning the protective wrap around the circumference of a portion of the colon to be treated; and

[00077] Figure 58 is another view of the abdominal cavity of Figure 57 after the protective wrap modality is positioned around the outer circumference of the colon portion to be treated.

DETAILED DESCRIPTION

[00078] The Applicant for the present application also holds the US patent applications identified below which were filed on the same date as the present application and which are each incorporated herein by reference in full, respectively:
US Patent Application Serial No. _______, entitled "Surgical Circular Stapler With Tissue Retention Arrangements", Lawyer Dossier No. END6741USNP / 100065;
US patent application serial number _______, entitled "Tissue Acquisition Arrangements and Methods For Surgical Stapling Devices", Lawyer Dossier No. END6739USNP / 100063;
US Patent Application Serial No. _______, entitled "Transwall Visualization Arrangements and Methods For Surgical Circular Staplers", Lawyer Dossier No. END6738USNP / 100062; and
US patent application serial number _______, entitled "Apparatus and Methods For Protecting Adjacent Structures During the Insertion of a Surgical Instrument Into a Tubular Organ", Lawyer Dossier No. END6737USNP / 100061.

[00079] Certain exemplary modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described here. One or more examples of three modalities are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting modalities, and that the scope of the various modalities of the present invention is defined only by the embodiments.

[00080] The reference from the beginning to the end of the specification of "various modalities", "some modalities", "a modality", or "the modality", or similar, means that an attribute, structure, or characteristics described together with the modality is included in at least one modality. Therefore, the appearance of the phrases "in various modalities", "in some modalities," "in one modality," or "in the modality", or similar, in places from beginning to end of the specification are not necessarily all referring to the same modality. In addition, the particular attributes, structures, or characteristics can be combined in any suitable way in one or more modalities. Therefore, the particular attributes, structures, or characteristics illustrated or described in conjunction with a modality can be combined, in whole or in part, with the structures of the attributes, or characteristics of one or more other modalities without limitation. These modifications and variations are intended to be included in the scope of the present invention.

[00081] The terms "proximal" and "distal" are used in the present invention with reference to a clinician manipulating the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the clinician, and the term "distal" refers to the portion located farthest from the clinician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and absolute.

[00082] Figure 1 illustrates a circular stapler 10 according to various non-limiting embodiments of the invention. In various embodiments, the circular stapler 10 includes a cable assembly 12 that has an elongated shank assembly 14 projecting from it that defines a central geometric axis A-A. The elongated stem assembly 14 includes a rigid outer wrap 16 that has a distal end portion 17 that forms a staple head 20. In various non-limiting embodiments, the staple head 20 is configured to operationally support a staple cartridge circular 30 on that. Such circular staple cartridges 30 are known in the art and can, in general, support one, two, or more misaligned and circumferentially separated rows of staples 36 therein. See Figures 2 and 3. The embodiment shown in Figure 3, for example, has two rows 32, 34, of staples 36. A conventional annular blade 40 is coaxially, and movably, supported on the staple head 20.

[00083] In certain implementations, the circular stapler 10 additionally includes a firing rod assembly 50 which is supported on the outer casing 16 for selective axial travel therein. See Figure 2. A distal end portion 52 of the firing rod assembly 50 has an external clip driver portion 54 thereto for engagement with each of the clips 36 in the outer row 32 of clips 36 in the clip cartridge 30. In addition In addition, the distal end portion 52 of the firing rod assembly 50 has an internal staple driver portion 56 that is configured to engage with each of the staples 36 in the inner row 34 of staples 36 in the staple cartridge 30. As may be be seen in Figure 2, for example, the distal end portion 52 of the firing rod assembly 50 has, in addition, a protrusion 58 that is configured to engage the annular blade 40. Thus, as will be discussed in more detail below, the axial advancement of the firing rod assembly 50 in a distal "DD" direction will cause the clamps 36 to be directed out of the clamp cartridge 30 as well as the annular blade 40 to be advanced in the distal position. As can be seen in Figure 2A, the trigger rod assembly 50 has a base portion 51 that is coupled to a fastener trigger rod 53.

[00084] In various non-limiting modes, the clamping trigger rod 53 interfaces operably with a trigger trigger 60 that is operably coupled to the cable assembly 12. See Figures 1 and 1A. As can be seen in Figures 1 and 1A, the trigger trigger 60 is pivotally coupled to the cable assembly 12 so that when the trigger trigger 60 is pivoted in the direction of the cable assembly 12, the shot 50 is moved in the distal DD direction. Such trigger trigger arrangements are known in the art and therefore will not be discussed in detail in the present invention. For example, an exemplary trigger trigger arrangement is revealed in patent application publication No. US 2008/0078806 A1, entitled "Surgical Stapling Instrument With Mechanical Indicator to Show Levels of Tissue Compression", the description of which is incorporated here reference title, in its entirety.

[00085] As shown in Figures 2 and 2A, several non-limiting embodiments include a capture compartment 70 that is coaxially supported on the firing rod assembly 50 and is axially movable in this regard. The capture compartment 70 has a plurality of capture lumens 72 in which each mobilely supports a hook or capture element 80. As can be seen in Figure 3, for example, a plurality of capture lumens of three sides 72 can be equally spaced around the circumference of the capture compartment 70. In the non-limiting embodiment shown in Figure 3, a total of eight (8) capture lumens 72 are equally spaced around the circumference of the capture compartment 70.

[00086] Each hook or catch element 80 can be manufactured, for example, from Nitinol, stainless steel series 300 or 400 (fully hardened or in three-quarters) and has a distal end portion 82 which, when advanced out of its respective catching lumen 72, slopes radially outward as shown in Figure 4. As can be seen in Figure 4, each hook element 80 has a tissue splinter 84 formed in the distal end portion 82 thereof. As can be seen in Figures 2 and 3, in various non-limiting modalities, a sleeve 78 is used to facilitate installation of the hook elements 80 in their respective lumens 72.

[00087] As can be seen in Figure 2A, each of the hook elements 80 is coupled to or protrudes from a capture ring 81 that has a pair of capture rods 83 attached to it. Capture rods 83 are attached to a hook spanner 90 that is operably supported on cable assembly 12. See Figures 1 and 2C. As the surgeon moves the hook spanner 90 in a distal direction (arrow 92 in Figures 1 and 2C), the capture compartment 70 moves in the distal position. Such movement of the catch compartment 70 causes the distal end portion 84 of each hook element 80 to be advanced distally out of its respective catch lumen 72. According to the distal end portion 84 of each hook element 80 is advanced out of the capture lumen 72, the natural tilting action of the hook element 80 causes the end portion 84 to tilt radially away from the central geometric axis AA as shown in Figure 4. The surgeon can retract the catches 70 and hook elements 80 in their starting positions (figure 2), moving hook key 90 in a proximal direction (arrow 94 in Figures 1 and 2C).

[00088] As can be seen in Figures 2, 2A, 2D, 3 and 4, in various non-limiting modalities, a cutter compartment 100 is coaxially supported in the capture compartment 70. The cutter compartment 100 is supported for axial travel selective in relation to the capture compartment 70 and for selective axial path along the central geometric axis AA. In various embodiments, a pair of compartment actuating rods 101 protrudes from the cutter compartment 100 to interface with a blade button 110 which is movably supported on the cable assembly 12. See Figures 1 and 2D. In various non-limiting embodiments, the blade button 110 is supported on the cable assembly 12 so that it can move axially (represented by arrows 112, 114 in Figures 1 and 2D) and can also be rotated in relation to the cable assembly 12 ( represented by arrow 116 in Figure 1). Compartment actuator rods 101 are attached to the blade knob 110 so that movement of the blade knob 110 in an axial direction moves the cutter compartment 100 axially in the catch compartment 70 and the rotation of the blade knob 110 also rotates the cutter compartment 100 around the central axis AA as will be discussed in more detail below.

[00089] In various non-limiting embodiments, the cutter compartment 100 includes at least one, and preferably a plurality of blade lumens 102 extending axially through the wall of the cutter compartment 100. As can be seen in Figure 3, for example, a plurality of blade lumens 102 can be equally spaced around the circumference of the cutter compartment 100. In the non-limiting embodiment shown in Figure 3, a total of eight (8) blade lumens 102 are equally spaced around around the circumference of the cutter compartment 100. As can be seen in Figures 2 and 4, each blade lumen 102 has a curved distal end portion 104 that opens radially outwardly.

[00090] In various non-limiting embodiments, a flexible blade element 120 is slidably received in each blade lumen 102. Each flexible blade element 120 has a sharp distal end 122 and is attached to or protrudes from a ring blade blade 123. A pair of blade actuator rods 125 is attached to blade ring 123 by a slide joint arrangement 127 that allows blade ring 123 to rotate relative to actuator rods 125. See Figure 2A. As can be seen in Figure 2C, blade actuator rods 125 (only one blade actuator rod 125 is shown in this view) are attached to a blade wrench 130 that is operably mounted on cable 12. The distal end 122 of each blade element 120 is substantially aimed to allow it to pierce through the fabric and to have at least one cutting edge 124 formed therein. When the blade wrench 130 is moved in the distal direction (arrow 132), the blade elements 120 are moved distally in the blade lumens 102 so that the sharp distal end 122 "naturally" flexes or tilts radially out of the curved distal end portion 104 of lumen 102 as shown in Figure 4. As used in this context, the term "naturally" means that the material may be pre-stretched or otherwise formed so that the distal end thereof is flex or tilt as it exits the lumen. Similarly, the movement of the blade wrench 130 in the proximal direction (represented by the arrow 134 in Figures 1 and 2C) causes each blade element 120 to be retracted back to its blade lumen 102. In various non-limiting modalities, blade elements 120 can be manufactured from, for example, Nitinol, 300 or 400 series stainless steel (fully stiffened or three-quarters).

[00091] As can be seen in Figure 2A, the firing rod assembly 50 has a distal end column 140 that protrudes from the base portion 51 and extends coaxially in the cutter compartment 100 for selective axial travel there. Various embodiments also include a bulkhead element 141 that is mounted on outer shell 116. To facilitate assembly, outer shell 16 may comprise a distal outer shell segment 16 and a proximal outer shell segment 16 'as shown in Figure 2A. In addition, a distal end column 142 extends from the bulkhead 51 and supports a distal fixed jaw connector 150. The distal fixed jaw connector 150 is coupled to a distal band assembly 151. The distal band assembly 151 is coupled to a control rod assembly 153 which interfaces with an adjustment knob 160 which is pivotally supported on the cable assembly 12. Such fixed clamp rod assemblies and control knob arrangements are well known. For example, the control rod and control button assembly may be configured as disclosed in published patent application No. US 2008/0078806 A1, entitled "Surgical Stapling Instrument With Mechanical Indicator To Show Levels of Tissue Compression" which is incorporated herein by reference.

[00092] As can be seen in Figure 2B, each of the compartment actuator rods 101 protrudes through a corresponding arcuate slot 145 in bulkhead 141. Slots 145 can be sized to define / limit the amount that the cutter compartment 100 can be rotated in relation to the central axis AA. For example, in a mode in which a total of eight (8) blade elements 120 are employed, slots 145 can be dimensioned to facilitate at least approximately 45 ° to 50 ° of arcuate or rotational travel of the cutter compartment 100 around of the central geometric axis AA. The bulkhead 141 may also have an opening 146 to allow the distal band assembly 151 to project through it. In addition, each of the blade actuator rods 125 extends through a corresponding entry 147 in bulkhead 141. Similarly, each of the capture rods 83 extends through a corresponding opening 148 in bulkhead 141. See Figure 2B.

[00093] Circular stapler 10 additionally includes a fixed jaw 170 as shown in Figure 5. In various non-limiting embodiments, the fixed jaw 170 includes a fixed jaw base 171 that has a series of staple forming pockets 172 there and a fixed claw rod 174 which is detachably attachable to the distal fixed claw connector 150. In particular, a coupling rod 176 protrudes from the proximal end 175 of the fixed claw rod 174 and is sized to be slidably received in a passage 152 in the distal fixed jaw connector 150. The fixed jaw 170 additionally has a fixed jaw cap 178 there as shown in Figures 5 and 13 which defines a tissue cavity 179 there.

[00094] An exemplary method of using a circular stapler 10 will be described with reference to Figures 5 to 16. The various modalities of the circular stapler 10 are particularly well suited for performing a circular anastomosis of a tubular organ such as, for example, the colon. Referring to Figure 5, the stapler head 20 is inserted into a proximal portion 201 of the colon 200 through the patient's anus 199. In applications where a pathological portion or colon target 202 is to be removed, the stapler head 20 is positioned adjacent to the pathological portion 202. See Figure 6.

[00095] Since the stapler head 20 has been inserted in the appropriate position in relation to the pathological portion 202, the cutter compartment 100 is advanced in the distal position by advancing the blade button 110 axially in a distal direction (represented by the arrows 112 in Figures 1 and 7). At this stage in the procedure, blade elements 120 were not advanced out of their respective blade 102 lumens. After that, the surgeon advances the capture compartment 70 in the distal position by moving the hook wrench 90 in the distal direction (arrow 92 in Figure 1). The movement of the catch compartment 70 in the distal direction causes the hook elements 80 to move axially out of their respective capture lumens 72. As the distal ends of the hook elements 80 come out of their respective capture lumens 72, the same naturally they flex radially outwardly to engage and pierce through the proximal portion 201 of colon 200. See Figure 8. Since hook elements 80 have drilled and engaged in proximal portion 201 of colon 200, the surgeon moves the hook spanner 90 in the proximal direction (represented by the arrow 94 in Figure 1) to retract the hook elements 80 in their respective capture lumens 72 as well as to retract the capture compartment 100 back to its starting position. The splinters 84 at the distal ends of the hook elements 80 pull the engaged proximal portion 201 to the position illustrated in Figure 9. In this way, the engaged proximal portion 201 of the colon 200 is pulled over a distal face 31 of the staple cartridge 30 and partially into the internal space 33 between the staple cartridge 30 and the cutter compartment 100.

[00096] Since the proximal engaged portion 201 of the colon 200 has been pulled into the position illustrated in Figure 9, the surgeon then extends the blade elements 120 out of their respective blade lumens 102 by advancing axially the button. blade 110 in the cable assembly 12 in the distal direction (represented by the arrow 112 in Figure 1). By moving the blade knob 110 distally, the blade elements 120 are advanced out of their blade lumens 102 and the curved portion 104 of each blade lumen 102 causes the blade element 120 to move there radially outwardly. as shown in Figure 10. Blade elements 120 project through the proximal portion 201 of colon 200 that is proximal to the pathological colon portion 202. See Figure 10. Thereafter, the pathological colon portion 202 can be separated from the portion proximal colon 201 by rotating blade knob 110 on handle assembly 12 (represented by arrow 116 in Figure 1). The rotation / actuation of the blade button 110 will cause the cutter compartment 100 and the blade elements 120 to rotate around the central geometric axis A-A and cut through the colon tissue. After the pathological portion 202 has been removed from the proximal colon portion 201 (figure 11), the surgeon can retract the blade elements 120 back to their respective blade lumens 102 by moving the blade button 110 in one direction (shown by the arrow 114 in Figure 1). See Figure 12.

[00097] The pathological portion 202 can be separated from the distal colon portion 208 (figure 13), by means of, for example, a conventional laparoscopic tissue separation device (not shown) that has been inserted through a trocar sleeve that extends into the abdominal cavity 601 which is adjacent to the pathological portion 202. The pathological colon portion 202 can then be removed through the trocar sleeve. The surgeon then guides the fixed claw 170 into the distal colon portion 206 so that the stem of the fixed claw 174 protrudes out of the distal colon portion 206 as shown in Figure 13. The surgeon then ties the end of the distal colon portion 206 around the fixed claw nail 174 using what is known in the art as a "pouch loop suture" 220. Since the distal colon portion 206 was sutured around the fixed claw nail 174, the coupling rod 176 of the fixed claw rod 174 is inserted into the passage 152 in the rod of the fixed claw assembly 150. The coupling rod 176 can be dimensioned in relation to the passage 152 to establish a friction fit with each other to retain the coupling rod 176 therein, and still allow the coupling rod 176 to be removed therefrom at a later time.

[00098] The surgeon then pulls the fixed claw 170 towards the stapler head 20 (in the proximal direction "PD") by turning the fixed claw control knob 160 in the appropriate direction until the colon portions 205, 210 are trapped between the fixed jaw 170 and the staple cartridge 30 as shown in Figure 14. Thereafter, the surgeon acts on the trigger trigger 60 to axially advance the trigger rod assembly 50 in the distal "DD" direction. As the firing rod assembly 50 is advanced distally, the outer clip driver portion 54 and the inner clip driver portion 56 serve to direct the clips 36 located in the outer row 32 and inner row 34, respectively, through the colon portions 205, 210 for the fixed claw forming pockets 172 on the fixed claw base 171. The firing rod assembly 50 also advances the annular blade 40 through the colon portion 205 to cut portion 201 thereof. See Figure 15. The additional advance of the annular blade 40 separates the colon portion 207 from the colon portion 208. The surgeon then moves the fixed claw 170 in the distal "DD" direction to release the stapled colon portions 205, 210 between the fixed claw base 171 and the face 31 of the staple cartridge 30. See Figure 16. Instrument 10 can then be removed from colon 200. The cut portion 201 remains on the staple head 20 and the portion of cut 207 remains in tissue cavity 179 in fixed jaw 170 as the surgeon pulls the instrument 10 out through the patient's anus 199. In this way, the cut portions 201, 207 of the colon 200 are removed from the repaired colon when the instrument is extracted from that.

[00099] Figure 17 illustrates another circular stapler 300 according to various non-limiting embodiments of the invention. Circular stapler 300 generally includes a cable assembly 312 that has an elongated rod 314 protruding from it. The elongated stem 314 can define a central geometric axis A-A. As can be seen in Figure 17, the elongated stem 314 includes a rigid outer casing 316 that supports a stapler head 320 therein. In various non-limiting embodiments, the staple head 320 is configured to support a circular staple cartridge 330 therein. Such circular staple cartridges 330 are known in the art and, in general, support one or two or more misaligned and circumferentially separated rows of staples 36 therein as described above in the present document. A conventional annular blade 340 is supported coaxially and movably on the staple cartridge 330. See Figure 18.

[000100] In certain implementations, the circular stapler 300 additionally includes a firing rod 350 which is operably supported on the rigid outer casing 316 for selective axial travel in this as discussed above. See Figure 18. A distal end portion 352 of firing rod 350 has an external clip driver portion 354 therein for engaging with each of the clips 36 in the outer row 32 of staples 36 in the staple cartridge 330. In addition, the distal end portion 352 of the firing rod 350 has an inner clip driver portion 356 configured to engage with each of the clips 36 in the inner row 34 of the clips 36 in the clip cartridge 330. As can be seen in Figure 18, for example, the distal end portion 352 of the firing rod 350 additionally has a portion having a flange 358 that is configured to engage the annular blade 340. Thus, as will be discussed in more detail below, the axial advance of the rod firing 350 in a distal "DD" direction, will cause the staples 36 to be directed out of the staple cartridge 330 as well as the annular blade 340 to be advanced distally.

[000101] In several non-limiting modes, the trigger rod 350 interfaces with a trigger trigger 360 that is operably coupled to the cable assembly 312. As can be seen in Figure 17, the trigger trigger 360 is in shape articulated coupled to the cable assembly 312 so that when the trigger trigger 360 is pivoted in the direction of the cable assembly 312, the trigger rod 350 is moved in the distal direction DD. As discussed above, such trigger trigger arrangements are known in the art and, therefore, will not be discussed in detail in this document.

[000102] As shown in Figure 18, several non-limiting embodiments also include a positioning rod 370 that is supported coaxially and pivotally on a tissue capture rod 380 that is non-pivotally supported on the elongated stem 316. The end proximal positioning rod 370 interfaces operably with a tissue capture button 310 which is pivotally supported on cable assembly 312. Positioning rod 370 interfaces with tissue capture button 310 in the manner described above relative to the blade button 110. Thus, rotation / actuation of the tissue capture button 310 on the cable assembly 312 will result in the rotation of the positioning rod 370 on the tissue capture rod 380 around the central geometric axis AA. More specifically and with reference to Figure 19, in various embodiments, a distal end 372 of the positioning rod 370 protrudes through an orifice 382 in the capture rod 380 and has a steering gear 374 attached thereto. A distal end 384 of the capture rod 380 is configured to operably support at least two tissue capture elements or tissue arms 400 therein. In the non-limiting embodiment shown in Figure 19, a total of four fabric arms 400 are hingedly attached to the distal end 384 of the fabric capture rod 380 by corresponding pins 386 so that each fabric arm 400 rotates around a corresponding "capture" geometry axis BB which is substantially parallel to the central geometry axis AA. See Figures 21 and 23.

[000103] As can be seen in Figures 19 and 22, each fabric arm 400 has a body portion 402 which can be manufactured, for example, from stainless steel (300 or 400 series), or titanium-steel or ceramic composite , etc. and it has a directed gear 404 attached to it or formed on it. The directed gear 404 of each tissue arm 400 is movably supported in a corresponding arm cavity 388 formed at the distal end 384 of the tissue capture rod 380. Each directed gear 404 is in interlaced engagement with the target gear 374 at the positioning rod 370. Thus, rotation of the positioning rod 370 will result in the pivoting position of the fabric arms 400 from the retracted position shown in Figure 20 to the positioned position shown in Figure 22. As can be seen in Figures 20 and 22, in various embodiments, each fabric arm 400 has an arcuate shape so that when fabric arms 400 are in a retracted position, as shown in Figure 20, they cooperate to create a round disc-like assembly 401 at the distal end of the tissue capture rod 380.

[000104] In various embodiments, the body portion 402 of each fabric arm 400 additionally has a fabric piercing tip 406 formed therein or otherwise secured thereto. In addition, an arm blade 408, which has a cutting edge 410 formed therein, is attached to or is otherwise formed in the body portion 402 of each fabric arm 400. In various embodiments, the arm blade 408 can be made of, for example, stainless steel (300 or 400 series), or titanium-steel or ceramic composite, etc. and be attached to the body portion 402 of the corresponding fabric arm 400, depending on the material, welding or other suitable fixation method. In the preferred embodiments, if the arm blade 408 is manufactured from any of the metal materials identified above, it may be desirable for such material to be stiffened. For example, a Rockwell hardness value of 38 to 52 may be desirable. In alternative modalities, the arm can be manufactured with a thin feature that could be crushed to a sharp edge. As will be appreciated as the present detailed description advances, the blade works more like scissors than a blade since it cuts when closed so that the fabric shears when 408 closes against 421. As can be seen in Figure 19, a shear plate 420 is attached to the distal end 382 of the arm rod 380 by threaded fasteners 422 that extend into threaded lock holes 424 in the arm rod 380. Also in various embodiments, a plurality of fabric capture pins 426 are equally spaced around the circumference of the tissue capture rod 380 and protrudes radially from it. The outer edge 421 of the shear plate 420 cooperates with the cutting edges 410 on the fabric arms 400 to shear the fabric that is drawn between these edges 410, 421 while the fabric arms 400 are moved to their retracted position.

[000105] In certain implementations, a distal end column 442 protrudes from a portion of the firing rod 350 which extends coaxially on the positioning rod 370 for selective axial travel therein. The distal end column 442 supports a distal fixed clamp connector 450 therein which is coupled to an adjustment knob 460 which is swiveled on cable assembly 312 in the various ways discussed above.

[000106] The circular stapler 300 additionally includes a fixed jaw 470 as shown in Figure 18. In various non-limiting embodiments, the fixed jaw 470 includes a fixed jaw base 471 that has a series of staple forming pockets 472 therein. The fixed jaw base 471 can additionally define a shear edge 473 to facilitate the shearing of tissue by the annular blade 340. The fixed jaw 470 additionally includes a fixed jaw stem 474 which is detachably fixable to the distal fixed jaw connector 450 In particular, a coupling rod 476 protrudes from the proximal end 475 of the fixed jaw stem 474 and is sized to be slidably received in a passage 452 on the rod of the fixed jaw assembly 450. See Figure 23. The assembly fixed jaw 470 additionally has a fixed jaw cap 478 on it which serves to define a tissue cavity 479 on it as shown in Figures 18 and 23. As can be seen in Figure 18, the disc-like assembly 401 is sized for extend to an entry 475 in the fixed claw base 471.

[000107] An exemplary method of using the circular stapler 300 will be described with reference to Figures 23 to 31. The various modalities of the circular stapler 300 are particularly well suited for performing a circular anastomosis of a tubular organ, such as a colon 200 Referring to Figure 23, stapler head 320 is inserted through patient anus 199 into a proximal portion 201 of colon 200. When a pathological or otherwise target portion 202 of colon 200 is to be removed, the head of stapler 320 is positioned in an area in which the pathological portion 202 must be separated from the proximal portion 201.

[000108] Since the stapler head 320 has been properly positioned in the colon, the tissue arms 400 can be positioned radially by turning the tissue capture button 310 in a first direction (represented by the arrow 311 in Figure 17) which also the positioning rod 370 rotates. Rotating the positioning rod 370 in the first direction also rotates the targeting gear 374 which is in interlaced engagement with the directed gear portions 404 of each fabric arm 400. Thus, the rotation of the gear direction 374 in the first direction causes the fabric arms 400 to be positioned radially. As the tissue arms 400 are radially positioned, the tissue drilling tips 406 of the same drill through the proximal portion 201 of the colon 200. See Figures 24 and 25. Since the tissue arms 400 have been positioned so that the tips of the colon perforating tissue 406 of the same perforated through the proximal portion 201 of colon 200, the surgeon can then turn the tissue capture button 310 in a second direction (represented by the arrow 313 in Figure 17) to move the tissue arms 400 to the stowed position. As the tissue arms 400 are retracted, they join the perforated proximal portion 201 of the colon 200 and pull it inward towards the tissue capture rod 380. As the joined colon 201 is extracted between the shear plate 420 and the tissue arms, the portion 201 of the colon 200 that is captured between the outer edge 421 of the shear plate 420 and the cutting edges 410 on the tissue arms 400 is separated from the pathological portion 202 of the colon 200. The retraction of the arms of tissue 400 causes colon 201 portion 200 to be impaled on tissue retention pins 426 and retained therein as shown in Figure 26. Thereafter, pathological portion 202 of colon 200 can be transected from distal colon portion 208 with the use of a conventional laparoscopic tissue separation instrument (not shown) inserted through a trocar sleeve inserted into the abdominal cavity 601. After the pathological portion 202 has been cut from the distal colon 208, after pathological ortion 202 can be removed through the trocar sleeve (not shown) with a conventional clamping instrument 600. See Figure 26.

[000109] The surgeon then guides the fixed claw 170 on the distal portion 208 of the colon 200 so that the fixed claw stem coupling stem 476 of the fixed claw stem 474 protrudes from the distal portion 208 of the colon 200 as shown in Figure 28. The surgeon then ties the end of the distal colon portion 208 around the fixed claw nail 474 using what is known in the art as a "bag loop suture" 220. Since the portion of distal colon 208 has been sutured around the fixed claw stem 474, the coupling stem 476 of the fixed claw stem 474 is inserted into passage 452 in the stem of the fixed claw assembly 450. The coupling stem 476 is dimensioned in relation to passage 152 to establish a friction fit with each other to retain coupling rod 176 therein, and still allow coupling rod 176 to be removed therefrom at a later time. See Figure 28.

[000110] The surgeon then pulls the fixed jaw 470 in the direction of the stapler head 420 (in the proximal direction "PD") by turning the fixed jaw control button 460 in the appropriate direction until the 205, 210 portions of the colon 200 are trapped between the fixed jaw 470 and the staple cartridge 330 as shown in Figure 29. Thereafter, the surgeon operates the trigger trigger 360 to axially advance the trigger rod 350 in the distal "DD" direction. As the firing rod 350 is advanced distally, the clip trigger portions 354, 356 serve to direct the clamps 36 through portions 205, 210 of the colon 200 to the fixed jaw formation pockets 472 on the fixed jaw 470. The rod firing 350 also advances the annular blade 340 through colon portions 205, 210 to separate portions 201, 207, respectively, from this. The surgeon can then move the fixed claw 470 in the distal "DD" direction to release the stapled colon portions 205, 210 between the fixed claw 470 and the stapler head 320. The instrument 300 can then be removed from the colon 200. See Figure 31. Separate portions 201, 207 of colon 200 remain on stapler head 320 and fixed jaw 470, respectively, as the surgeon extracts instrument 300 through the patient's anus. In this way, the separate portions 201, 207 of the colon 200 are removed from the repaired colon when the instrument 300 is extracted from it.

[000111] Circular stapling instruments are, in general, introduced through the anus and not the side of the pelvis abdomen. Such an entry method complicates the surgeon's ability to view the tumor, the necessary tumor margins and those margin edges in relation to the distal transection site to ensure that the stapler head has been properly positioned in the colon before beginning the transection. Figures 32 to 37 illustrate a circular stapler 700 according to various non-limiting modalities of the invention that can provide feedback to the surgeon during the insertion process. Circular stapler 700 generally includes a cable assembly 712 that has an elongated shank assembly 714 projecting from this. The elongated stem assembly 714 can define a central geometric axis A-A. As can be seen in Figure 32, the elongated stem assembly 714 includes a rigid outer casing 716 that has a distal end portion that supports a stapler head 720 therein. In various non-limiting embodiments, the staple head 720 is configured to operably support a circular staple cartridge 730 therein. Such circular staple cartridges 730 are known in the art and can, in general, support one, two or more than two misaligned and circumferentially separated rows of staples therein. In the non-limiting embodiment shown in Figure 33, the staple cartridge 730 supports two rows 732, 734 of staples 36 therein. A conventional ring blade 740 is supported coaxially and movably on the stapler head 720.

[000112] The circular stapler 700 additionally includes a firing rod 750 which is operably supported on the rigid outer casing 716 for selective axial travel there. See Figure 33. A distal end portion 752 of firing rod 750 has an external clamp driver portion 754 therein for engaging each of the clamps 36 in the outer row 732 of clamps 36 in the clamp cartridge 730. In addition, the distal end portion 752 of the firing rod assembly 750 has an internal staple driver portion 756 that is configured to engage with each of the staples 36 in the inner row 734 of staples 36 in the staple cartridge 730. As can be seen in Figure 33, for example, the distal end portion 752 of the firing rod 750 additionally has a portion that has a flange 758 that is configured to engage the annular blade 740. Thus, as will be discussed in more detail below, the axial advancement of the firing rod 750 in a distal "DD" direction, will cause the clamps 36 to be directed out of the clamp cartridge 730 as well as the annular blade 740 to be advanced distally.

[000113] In various non-limiting modes, the firing rod 750 interfaces with a firing trigger 60 that is operably coupled to the cable assembly 712. As can be seen in Figure 32, the firing trigger 60 is shaped articulated coupled to the cable assembly 712 so that when the trigger trigger 60 is rotated in the direction of the cable assembly 712, the trigger rod 750 is moved in the distal direction DD as discussed above.

[000114] As shown in Figure 33, several non-limiting modalities include a detection compartment and hook 770 that is coaxially supported on the firing rod 750 and axially movable therein. The detection and hook compartment 770 has a plurality of hook lumens 772 in which each movably supports a capture hook element 780 in that. As can be seen in Figure 34, for example, a plurality of three-sided hook lumens 772 can be equally spaced around the circumference of the detection and hook compartment 770. For example, in the non-limiting embodiment shown in Figure 34, a total of eight (8) lumens of hook 772 is equally spaced around the circumference of the detection compartment and hook 770. Each hook element 780 can be manufactured from, for example, Nitinol, 300 or 400 series stainless steel (fully stiffened or three rooms), etc. and has a distal end portion 782 which, when advanced out of its respective hook lumen 772, naturally flexes or tilts radially outwardly in the ways described above. As with other embodiments, each catch hook element 780 may have a fabric splinter 784 formed in the distal end portion 782 thereof. As can be seen in Figures 33 and 34, in various non-limiting modalities, the detection and hook compartment 770 includes a hook sleeve 778 that facilitates the installation of the capture hook elements 780 in their respective lumens 772.

[000115] In various non-limiting modalities, a proximal end portion of the detection and hook compartment 770 can interface operably with a hook switch 790 that is operably supported on cable 712. See Figure 32. As shown surgeon moves the hook switch 790 in a distal direction (arrow 792 in Figure 32), the detection and hook compartment 770 moves distally. In addition, each catch hook element 780 is advanced distally out of its respective hook lumen 772 as described above. The surgeon can retract the hook elements 780 in their initial positions by moving the hook key 790 in a proximal direction (arrow 794 in Figure 32).

[000116] A plurality of flexible sensing elements 781 is also supported in the detection compartment and hook 770. In particular, a plurality of detection lumens 774 is also provided in the detection compartment and hook 770. For example, in the non-limiting mode shown in Figure 34, a total of eight (8) detection lumens 774 is equally spaced around the circumference of the detection compartment and hook 770. In a non-limiting embodiment, each detection element 781 can be manufactured from, for example, polyethylene, nylon, nitinol, titanium etc. and have a distal end portion 783 which, when positioned outside its respective sensing lumen 774, naturally flexes or tilts radially outward as shown in Figure 35. In addition, a substantially blunt or rounded protuberance 785 can be provided at the end distal of each detection element 781. In one embodiment, the protrusion can be made of, for example, Sanoprene, Isoprene, natural rubber, polypropylene, polyethylene, nylon, etc. In other embodiments, the bulge 785 may comprise a light or light-emitting diode (LED). In these embodiments, a conductor can extend from a battery in the cable assembly 712 or another power source through a lumen in the sensing element 781 to the light 785.

[000117] In various non-limiting modalities, the proximal end portion of each detection element 770 can interface with a detection button 791 that is operably supported on cable assembly 712. See Figure 32. As the surgeon rotates the detection button 791 in a first direction (arrow 793 in Figure 32), the detection elements 781 are positioned distally outside their respective lumens in a radial direction away from the central geometric axis AA for positioned positions (figure 36). In various embodiments, for example, all detection elements 781 can be attached to a round sleeve (not shown) that is slidably supported on the outer casing 716. The round sleeve can also have a gear frame attached to it which is received in interlocking engagement with a gear (not shown) on the underside of detection button 791. Rotating detection button 791 in one direction moves the sleeve distally and therefore extends all detection elements 781. When the surgeon turns detection button 791 in a second direction (arrow 795 in Figure 32), detection elements 781 are pulled back into their respective detection lumens 774 to the stowed position. See Figure 34. Other targeting arrangements and switches could also be employed to selectively extend and retract the detection elements without departing from the spirit and scope of the present invention.

[000118] As can be seen in Figure 33, in various non-limiting modalities, a cutter compartment 800 is coaxially supported in the detection compartment and hook 770. The cutter compartment 800 is supported for axial selective travel in relation to the storage compartment. detection and hook 770 and for selective axial path along the central geometric axis AA. The cutter compartment 800 interfaces with a blade button 810 that is movably supported on the cable assembly 712. See Figure 32. In various non-limiting embodiments, the blade button 810 is supported on the cable assembly 712 so that can move axially (represented by arrows 812, 814 in Figure 32) and can also be rotated in relation to cable assembly 712 (represented by arrow 816 in Figure 32). The cutter compartment 800 can be attached to the blade button 810 in the various ways described above, so that the movement of the blade button 810 in an axial direction moves the cutter compartment 800 axially within the hook and detection compartment 770 and the rotation the blade button 810 also rotates the cutter compartment 800 around the central geometry axis AA.

[000119] In various non-limiting embodiments, the cutter compartment 800 includes a plurality of blade lumens 802 that extend axially across the wall of the cutter compartment 800. As discussed above in relation to other embodiments, the plurality of lumens of blade 802 may be equally spaced around the circumference of the cutter compartment 800. For example, in a non-limiting embodiment, a total of eight (8) lumens of blade 802 may be equally spaced around the circumference of the cutter compartment 800. As can be seen in Figure 33, each blade lumen 802 has a curved distal end portion 804 that opens radially outwardly.

[000120] In various non-limiting embodiments, a flexible blade element 820 is received slidably within each blade lumen 802. Each flexible blade element 820 has a sharp distal end 822 and a proximal end (not shown) that forms interface with a blade wrench 830 which is operatively mounted on cable 712 in the various ways described above. See Figure 32. The distal end 822 can be pointed substantially to allow it to pierce through the fabric and can have at least one cutting edge formed therein. When the blade wrench 830 is moved in the distal direction (arrow 832), the blade elements 820 are moved distally within the blade lumens 802, so that the sharp distal end 822 flexes or bends naturally radially to outside the curved distal end portion 804 of the lumen 802, as described above. Similarly, the movement of the blade wrench 830 in the proximal direction (represented by the arrow 834 in Figure 32) causes the blade elements 820 to be retracted back into their respective blade lumen 802. In several non-limiting modes, blade elements 820 can be manufactured from, for example, Nitinol, 300 or 400 series stainless steel (completely hardened three-quarters).

[000121] As can also be seen in Figure 33, several non-limiting modalities can also include a set of fixed claw shank 840 that is coaxially supported within the cutter compartment 800 for axial selective travel in it. The fixed jaw rod assembly 840 may comprise a distal end column 842 that protrudes from a portion of the firing rod 750. The distal end column 842 supports a distal fixed jaw connector 850 in it that protrudes in the distal position from the distal end column 842. The fixed jaw rod assembly 840 has a proximal end portion that interfaces with an adjustment knob 760 that is swiveled on the cable assembly 712, as discussed above with respect to other non-limiting modalities. The circular stapler 700 additionally includes a fixed jaw 170, as shown in Figure 32.

[000122] An exemplary method of using the circular stapler 700 will now be described. To begin the procedure, the surgeon inserts the elongated stem 714 through patient anus 199 into a proximal portion 201 of colon 200. Consequently, the surgeon can extend the detection elements 781, as shown in Figures 36 and 37, to "regulate "positioning the stapler head 720. This can be done by turning the detection button 791 in the proper direction. As protrusions 785 are forced radially into the colon portion wall 201, they create identifiable protrusions or deflections 203 or irregular areas that protrude outward and provide a means for the surgeon to visually observe where the head of the stapler 720 is located. Such identifiable features are distinct from the actual anatomy of the colon wall. The bulges that are substantially dull or rounded do not penetrate or damage the colon wall. Such protrusions 203 allow the surgeon to position the head of the stapler 720 in relation to the tumor or pathological portion 202 of the colon. If one or more of the 785 protrusions comprises light, the surgeon can view the lights through the colon wall, as shown in Figure 37.

[000123] Once the surgeon has located the head of the stapler 720 at the desired location within the proximal portion 201 of the colon 200, the surgeon can then retract the detection elements 781 in the hook and detection compartment 770 by turning the knob. of detection 791 in a direction that is opposite to the direction in which the detection elements 781 were extended. The capture hook elements 780 can then be extended to drill through and acquire the adjacent portions of the proximal colon wall 201. In alternative modalities, however, the surgeon may decide to keep the detection elements 781 in their extended positions, as shown in Figure 37. In doing so, the detection elements 781 can produce some "circumferential tension" in the colon wall, which can assist in the capture and perforation of the proximal colon wall 201 by the capture hook elements 780.

[000124] To make capture hooks 780 engage and penetrate the proximal colon portion 201, the surgeon advances the hook compartment and captures 770 in the distal position by moving the hook key 790 in the distal direction (arrow 792 in Figure 32). The movement of the hook and catch compartment 770 in the distal direction causes the catch hook elements 780 to move axially out of their respective hook lumens 772. As the distal ends of the catch hook elements 780 leave their respective lumens of hook 772, they move radially outward to engage and pierce through adjacent portions of the proximal colon wall 201. See Figure 37. Once hook elements 780 have pierced and engaged adjacent portions of the colon wall proximal 201, the surgeon moves the hook wrench 790 in the proximal direction (represented by the arrow 794 in Figure 32) to retract the capture hook elements 780 in their respective hook lumens 772, as well as retract the hook and capture compartment 770 back to your starting position. The splinters 784 at the distal ends of the catch hook elements 780 extract the engaged portions of the wall of the proximal colon 201 in a position similar to the position illustrated in Figure 9. Once the portions of the proximal colon portion 201 have been extracted in position illustrated in Figure 9, the surgeon can then complete the procedure by performing the same actions described above in relation to the circular stapler 10.

[000125] Figure 38 illustrates another circular stapler 900 according to various non-limiting embodiments of the invention. The circular stapler 900 generally includes a cable assembly 912 that has an elongated stem 914 protruding from it. The elongated stem 914 can define a central geometric axis A-A. As can be seen in Figure 38, the elongated stem 914 includes a rigid outer casing 916 that has a staple head 920 located at the distal end 917 thereof. In various non-limiting embodiments, the head of the stapler 920 is configured to operationally support a circular staple cartridge 930 therein. Such circular staple cartridges 930 are known in the art and can generally support one, two, or more than two circumferentially spaced and misaligned rows of staples 36 therein, as described earlier in this document. A conventional 940 annular blade is supported coaxially and movably within the head of the stapler 920. See Figure 39.

[000126] The circular stapler 900 additionally includes a firing rod 950 which is supported inside the rigid outer casing 916 for selective axial travel in it. See Figure 39. A distal end portion 952 of firing rod 950 has an outer clamp targeting portion 954 therein for engaging with each of the clamps 36 in the outer row 32 of clamps 36 in the clamp cartridge 930. In addition , the distal end portion 952 of the firing rod 950 has an inner clamp targeting portion 956 configured to engage with each of the clamps 36 in the inner row 34 of clamps 36 in the clamp cartridge 930. As can also be seen in Figure 39, for example, the distal end portion 952 of the firing rod assembly 950 additionally has a flange portion 958 that is configured to engage the annular blade 940. Thus, as will be discussed in greater detail below, the axial advance of the firing rod 950 in a distal "DD" direction will cause the clamps 36 to be directed out of the clamp cartridge 930, as well as the annular blade 940 to advance in the distal position.

[000127] In various non-limiting modes, the firing rod 950 can interface with a firing trigger 960 that is operationally coupled to the cable assembly 912. See Figure 38. As can be seen in Figure 38, the trigger The firing rod 960 can be pivotally coupled to the cable assembly 912 so that when the firing trigger 960 is pivoted towards the cable assembly 912, the firing rod 950 is moved in the distal direction DD. As discussed above, such trigger trigger arrangements are known in the art and, therefore, will not be discussed in detail in this document.

[000128] As shown in Figure 39, various non-limiting embodiments may also include a hollow 970 positioning rod that is supported coaxially within a hollow woven capture rod 980. The proximal end of the 970 positioning rod is operably fixed in an arm positioning button 910 that is swiveled on the cable assembly 912 in the various ways described above. In this way, the rotation of the arm positioning button 910 on the cable assembly 912 will result in the rotation of the positioning rod 970 around the central geometric axis A-A. More specifically, and with reference to Figure 40, in various embodiments, a distal end 972 of the positioning rod 970 protrudes through a hole 982 in the tissue capture rod 980 and has a drive gear 974 attached thereto. A distal end 984 of the tissue capture rod 980 is configured to operationally support at least one tissue capture element or arm 1000 therein. Two or more 1000 fabric arms are preferable. In the non-limiting embodiment shown in Figure 40, a total of four fabric arms 1000 are hingedly attached to the distal end 984 of the fabric capture rod 980 by corresponding pins 986.

[000129] Each fabric arm 1000 can have a body part 1002 that can be made from, for example, stainless steel (300 or 400 series), titanium, titanium-steel composite, ceramics, etc., and a directed gear 1004 attached to or formed in it. The directed gear 1004 of each fabric arm 1000 is movably supported within a corresponding arm cavity 988 formed at the distal end 984 of the fabric capture rod 980. Each directed gear 1004 is in interlocking engagement with the drive gear 974 positioning rod 970. Thus, rotation of the positioning rod 970 will result in the pivoting position of the fabric arms 1000 from the retracted position shown in Figure 41 to the positioned position shown in Figure 42. In various embodiments, body part 1002 each fabric arm 1000 may also have a fabric piercing tip 1006 formed therein or otherwise fixed to it.

[000130] In several embodiments, the blade rod 1010 is received coaxially within the positioning rod 970 and interfaces with a blade button 1020 (figure 38) rotatably supported on the cable assembly 912 so that the rotation of the blade button 1020 results in rotation of the blade shank 1010. The blade shank 1010 further has a distal end 1012 protruding from the distal ends 972, 984 of the positioning shank 970 and the tissue capture shank 980, respectively. See Figure 40. A 1030 blade can be removably attached to the distal end 1012 of the 1010 blade stem by, for example, pins 1032 or other suitable fasteners. In various embodiments, the blade 1030 can be substantially flat and have diametrically opposed tissue perforation points 1031, 1033 formed therein, as shown in Figure 40.

[000131] As can also be seen in Figure 39, various non-limiting embodiments may also include a fixed claw rod assembly 440 that includes a distal end column 442 that protrudes from a portion of the firing rod 950 that extends coaxially within the 970 positioning rod for selective axial travel in it. The distal end column 442 supports a distal fixed clamp connector 450 therein which is coupled to an adjustment knob 460 which is swiveled on cable assembly 312 in the various ways discussed above.

[000132] The circular stapler 900 further includes a fixed jaw 470, as shown in Figure 39. In various non-limiting embodiments, the fixed jaw 470 includes a fixed jaw base 471 that has a series of staple forming pockets 472 therein. The fixed claw base 471 can also define a shear edge 473 to facilitate the shearing of tissue by the annular blade 940. The fixed claw 470 can also include a fixed claw rod 474 that is removably attached to the connector distal fixed jaw 450. In particular, a coupling rod 476 protrudes from the proximal end 475 of the fixed jaw 474 and is sized to be slidably received in a passage 452 on the rod of the fixed jaw assembly 450. The jaw fixed 470 can also have a fixed claw lid 478 in it that serves to define a tissue cavity 479 in it, as shown in Figure 39.

[000133] An exemplary method of using the circular stapler 900 will be described with reference to Figures 39 and 43 to 51. Turning to Figure 39 first, the head of the stapler 920 is inserted into a tubular organ, such as colon 200 through the patient anus 199. The head of the stapler 920 is located in the proximal portion 201 of the colon 200 which is adjacent to a pathological portion 202. Consequently, the tissue arms 1000 are positioned radially by turning the arm positioning button 910 in a first direction (represented by the arrow 911 in Figure 38) which also rotates the positioning rod 970. Rotating the positioning rod 970 in the first direction also rotates the drive gear 974 which is in interlaced engagement with the directed gear portions 1004 of each fabric arm 1000. In this way, rotation of the 974 drive gear in the first direction causes the fabric arms 1000 to be positioned radially. As the tissue arms 1000 are positioned radially, the tissue piercing tips 1006 of the tissue pierce through the proximal portion 201 of the colon 200. See Figures 44 and 45. The surgeon can then turn the arm positioning button 910 in the opposite or second direction (represented by the arrow 913 in Figure 38) to retract the fabric arms 1000 in their stowed position (figure 20). As the tissue arms 1000 are retracted, the perforated proximal portion 201 of the colon 200 is carried by the tissue arms 1000 so that the portion 201 is contained between the tissue arms 1000 and the arm stem 980 in an adjacent confrontation position to the staple cartridge 930. Consequently, the surgeon can rotate the blade button 1020 to cause the blade 1030 to rotate and separate the pathological portion 202 of colon 200 from the proximal portion of colon 201. The pathological portion 202 can be moved from one distal portion 208 of the colon using a conventional laparoscopic tissue cutting instrument (not shown) inserted through a trocar sleeve (not shown) positioned in the abdominal cavity 601. After the pathological portion 202 has been removed from the proximal portion 201 from colon 200 and distal portion 208, the pathological portion 202 can be removed through the trocar sleeve with a conventional capture instrument 600. See Figure 48.

[000134] The surgeon can then orient the fixed jaw 470 within the distal portion 208 of the colon 200 so that the coupling rod of the fixed jaw 476 of the fixed jaw 474 protrudes out of the distal portion 208 of the colon. colon 200, as shown in Figure 49. The surgeon can then tie the end of the distal colon portion 208 around the fixed claw nail 474 using what is known in the art as a "bag loop suture" 220. Once the distal colon portion 208 has been sutured around the fixed claw stem, 474, the coupling stem 476 of the fixed claw stem 474 is inserted into passage 452 in the fixed claw stem assembly 450. A coupling rod 476 can be dimensioned in relation to passage 452 to establish a friction fit between them to retain coupling rod 476 therein, and still allow coupling rod 476 to be removed from it at another time. See Figure 49.

[000135] The surgeon then extracts the fixed claw 470 towards the head of the stapler 920 (in the proximal direction "PD") by turning the fixed claw control knob 460 in the proper direction until the 205, 210 portions of the colon 200 are obstructed between the fixed jaw 470 and the staple cartridge 930, as shown in Figure 50. Consequently, the surgeon activates the trigger trigger 960 to axially advance the trigger rod 950 in the distal "DD" direction. As the firing rod 950 is advanced in a distal position, the clip targeting portion 954 serves to direct the clamps 36 through the colon 205, 210 portions 200 in the fixed claw formation pockets 472 on the fixed claw base 471. A firing rod 950 also advances annular blade 940 to separate colon portions 201, 207 from colon portions 205, 210, respectively. The surgeon can then move the fixed claw 470 in the distal "DD" direction to release the stapled colon portions 205, 210 between the fixed claw 470 and the head of the stapler 920. Instrument 900 can then be removed from the colon 200. See Figure 51. The separate portion 207 is captured in the fixed jaw cavity 479 and the separate portion 201 is retained between the fabric arms 1000 and the arm stem 980. In this way, the cutting portions 201, 207 of the colon 200 are removed from the repaired colon when instrument 900 is removed from it.

[000136] As the surgeon performs the procedures described above or other related procedures in that region of the body, care must be taken to avoid inadvertently damaging adjacent soft tissues and bone structures. Figures 52 and 53 illustrate some of the adjacent bone and tissue structures that are adjacent to colon 200. In Figure 52, peritoneum 1100 was dissected to illustrate, for example, anal sphincter 1101, sacrotuberal ligament 1102, ischial tuberosity 1104 , the ischiorectal fossa 1106, levator ani muscle 1108, and the third sacral vertebra 1110. Figure 53 further illustrates the rectal fossa 1112, the sacrogenital fold 1114, the ureter 1116, the vas deferens 1118, the bladder 1120, the fossa paravesical 1122, and transcervical folds 1124. The surgeon must also be careful not to injure the muscles, nerves, vessels and arteries along the inner wall of the peritoneum 1100 when accessing the portion of colon 200 to be transected.

[000137] The Figures Figures 54 to 57 illustrate the use of a protective wrapper 1200 of a non-limiting embodiment of the present invention. In various embodiments, the wrapper 1200 can be manufactured from, for example, Kevlar, polyethylene, nylon, etc., and be stretched in a way that makes it naturally try to curl up. See Figure 55. In several embodiments, measurement or reference signals 1202 can be provided on wrapper 1200 to assist the surgeon in locating the operable portion of a surgical instrument (for example, the stapler head of a circular stapler) and to avoid accidental injury to adjacent nerves, vessels and tissue. In yet other embodiments, the wrapper 1200 can be manufactured from a sensitive magnetic film that would allow it to be magnetically attracted to the operable portion of the instrument, to protect adjacent anatomical structures and tissues from, for example, portions of the instrument that can damage tissues , muscles, bones, nerves, etc. adjacent, if the instrument portions are inadvertently brought into contact with them. In additionally alternative embodiments, the wrapper 1200 may have a ring or portion of magnetic interaction that is attached to the head of the stapler. In this way, at least a portion of the wrapper 1200 may be magnetic or otherwise have magnetic material attached to it.

[000138] The wrapper 1200 can be installed through a cannula 1252 of a conventional trocar 1250 that is inserted laparoscopically through the abdominal wall into the abdominal cavity, as shown in Figure 54. A conventional laparoscopic capture instrument 600 can be used as shown in Figures 54 and 55 to remove the wrapper 1200 from the trocar cannula 1252. Consequently, the surgeon can wrap the uncoiled wrapper 1200 around the colon 200 using conventional capture devices 600, as shown in Figure 56. Figure 57 illustrates the wrapper 1200 after it has been wrapped around the colon 200 and before starting the insertion of the circular stapling instrument into the colon. The natural wrapping nature of the wrap serves to retain it in an orientation wrapped around the colon 200.

[000139] The wrapper 1200 of the present invention can be effectively employed to protect adjacent tissues and organs during the use of any of the modalities mentioned above. See, for example, Figures 5 to 16, 23 to 31, 36, 39, and 43 to 51, with the wrapper 1200 being installed around colon 200 in the manner described above. In addition, the non-limiting modalities of the wrapper 1200 can be used effectively in conjunction with conventional and similar circular stapling devices without deviating from the character and scope of the present invention. For those types of instrument that employ lights on the detection elements or the like, the wrapper 1200 can be manufactured from, for example, light-sensitive film, which would cause portions of the wrapper 1200 to change color in those areas adjacent to the elements. illuminated detection sensors. See, for example, the non-limiting mode shown in Figure 36.

[000140] The various embodiments of the present invention represent a vast improvement over previous circular clamp arrangements and associated procedures. Although various modalities of the invention have been described, it will be evident, however, that various modifications, alterations and adaptations to these modalities can occur to those skilled in the art, from obtaining some or all of the advantages of the present invention. For example, according to various modalities, a single component can be replaced by multiple components, and multiple components can be replaced by a single component, to perform one or more specific functions. This request is, therefore, intended to cover all these modifications, alterations and adaptations, without departing from the scope and spirit of the presented invention, as defined by the embodiments.

[000141] Any patent, publication or other description material, in whole or in part, which is said to be incorporated into the present invention for reference purposes, is incorporated into the present invention only to the extent that the incorporated materials do not come into effect. conflict with existing definitions, statements or other description material presented in this description. Accordingly, and as far as necessary, the description as explicitly stated herein replaces any conflicting material incorporated herein by way of reference. Any material, or portion thereof, that is deemed to be incorporated by reference in the present invention, but which conflicts with definitions, statements, or other description materials existing herein will be incorporated here only to the extent that no conflict will appear between the embedded material and the existing description material.

[000142] The invention to be protected should not be interpreted as limited to the specific modalities presented. The modalities should therefore be considered illustrative rather than restrictive. Variations and changes can be made by others, without departing from the spirit of the present invention. Consequently, there is an express intention that all such equivalents, variations and alterations that fit the spirit and scope of the present invention, as defined in the embodiments, are covered by it.

Claims (12)

Surgical instrument, characterized by the fact that it comprises:
an elongated rod (914) defining a central axis and having a distal end portion (917) configured to operationally support a circular staple cartridge (930) therein;
a tissue capture rod (980) supported on the elongated rod and having a distal portion (984) that protrudes in a distal position in addition to the distal end portion of the elongated rod;
a plurality of tissue capture elements (1000) spaced circumferentially around the tissue capture rod, each pivotally articulated to the distal end portion of the tissue capture rod, so as to be selectively pivoting from a retracted position for positions implanted by applying a positioning movement to it; and
a rotary cutting element (1030) operationally supported adjacent to at least one tissue capture element and being selectively rotatable around the central axis by applying a cutting actuation movement to it. Surgical instrument, according to claim 1, characterized by the fact that it still comprises a positioning element operationally supported within the elongated stem and creating an operationally interface with each tissue capture element (1000), the positioning element configured to receive the positioning actuation movement to make the tissue capture elements move between the retracted and implanted positions. Surgical instrument, according to claim 2, characterized by the fact that the positioning element with comprises a positioning rod (970) that extends through the elongated rod and being selectively mobile in a rotating way in relation to it, the cross-engaging positioning with each of the tissue capture elements so that rotation of the positioning rod in one direction on the central axis causes the tissue capture elements to revolve from the retracted position to an implanted position and the rotation of the positioning rod in an opposite direction around the central axis causes the tissue capture elements to revolve from the implanted position to the retracted position. Surgical instrument according to claim 3, characterized by the fact that it still comprises a drive gear (974) at a distal end of the positioning rod (970) in cross engagement with a drive gear (1004) on each element of tissue capture. Surgical instrument according to claim 1, characterized by the fact that it still comprises a knife shank (1010) swiveled on the elongated shank, the knife shank having a distal end (1012) coupled to the rotating cutting element ( 1030) and being configured to receive the cutting actuation movement to cause the cutting element to rotate around the central axis. Surgical instrument according to claim 1, characterized by the fact that each of at least one tissue capture element has a tissue perforating tip (1006). Surgical instrument, according to claim 1, characterized by the fact that it still comprises an annular cutting element (940) which is operationally supported by the distal end portion of the elongated stem for selective axial movement in relation to it. Surgical instrument, according to claim 1, characterized by the fact that the tissue capture elements comprise four tissue capture elements (1000), each having an arcuate shaped body, so that when the tissue capture elements tissue are in the retracted position, the tissue capture elements form a continuous circular disk assembly at the distal end of the tissue capture rod in a position adjacent to the rotating cutting element. Surgical instrument according to claim 5, characterized by the fact that the cutting element comprises a flat blade that has at least one cutting edge formed in it. Surgical instrument, according to claim 9, characterized by the fact that the flat blade has diametrically opposite tips (1031) formed in it. Surgical instrument, according to claim 1, characterized by the fact that it still comprises:
a cable assembly (912), in which the elongated shaft protrudes from the cable assembly and ends at a stapler head (920) comprising:
a circular staple cartridge (930) that has a closing face; and
an axially movable cutting element (940);
a discharge element operably supported on the elongated rod and oriented to apply a discharge movement to said circular staple cartridge;
a fixed claw rod assembly (450) operably supported on the elongated rod and configured to receive actuation movements from the cable assembly to cause the fixed claw rod assembly to move axially on the elongated rod so that the distal connection portion thereof moves axially in relation to the closing face; and
a fixed claw (470) removably attached to the distal connection portion of the fixed claw rod assembly; Surgical instrument, according to claim 11, characterized by the fact that each tissue capture element has a tissue-piercing capture tip formed in it (1006).

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