BR112019000643B1 - SURGICAL INSTRUMENT WITH A DEFORMABLE HYDRAULIC LIMB CONFIGURED TO CONTAIN A FLUID - Google Patents

Abstract

A surgical instrument and method of operating on tissue includes a shaft assembly and an end effector. The end actuator extends in a longitudinal direction from the shaft assembly and has a first jaw, a second jaw, and a deformable hydraulic member. The second jaw is movably mounted relative to the first jaw and is configured to transition between an open configuration and a closed configuration. The first and second jaws are thus configured to have the tissue between them positioned in the closed configuration. Collapsible hydraulics are configured to contain a fluid. With the fluid contained in the collapsible hydraulic member, the collapsible hydraulic member is configured to cut tissue positioned between the first and second jaws in the closed configuration.

Description

BACKGROUND OF THE INVENTION

[0001] In some cases, endoscopic surgical instruments may be preferred over devices for traditional open surgery, as a smaller incision can reduce recovery time and complications in the postoperative period. Consequently, some endoscopic surgical instruments may be suitable for placing a distal end actuator at a desired surgical site via the cannula of a trocar. These distal end actuators can engage tissue in a variety of ways to achieve a diagnostic or therapeutic effect (e.g., endocutter, gripper, cutter, stapler, clipper, access device, drug/gene therapy delivery device, and device for application of energy through the use of ultrasonic vibration, RF, laser, etc.). Endoscopic surgical instruments may include a drive shaft between the end actuator and a portion of the handle, which is manipulated by the clinician. Such a drive shaft may enable insertion to a desired depth and rotation about the longitudinal axis of the drive shaft, thereby facilitating positioning of the end actuator in the patient. Positioning an end actuator can be further facilitated by the inclusion of one or more articulated joints or features, allowing the end actuator to be selectively pivoted or otherwise deflected with respect to the longitudinal axis of the drive shaft.

[0002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers function to clamp fabric layers, cut through the trapped fabric layers, and cause the staples to pass through the fabric layers to substantially seal the cut fabric layers to one another near their cut ends. Merely exemplary surgical staplers are shown in US Patent No. 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers", issued February 21, 1989; in US Patent No. 5,415,334, entitled "Surgical Stapler and Staple Cartridge", issued May 16, 1995; in US Patent No. 5,465,895, entitled "Surgical Stapler Instrument", issued November 14, 1995; in US Patent No. 5,597,107, entitled "Surgical Stapler Instrument", issued January 28, 1997; in US Patent No. 5,632,432, entitled "Surgical Instrument", issued May 27, 1997; in US Patent No. 5,673,840, entitled "Surgical Instrument", issued October 7, 1997; in US Patent No. 5,704,534, entitled "Articulation Assembly for Surgical Instruments", issued January 6, 1998; in US Patent No. 5,814,055, entitled "Surgical Clamping Mechanism", issued September 29, 1998; US Patent No. 6,978,921 entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", issued December 27, 2005; in US Patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", issued February 21, 2006; in US Patent No. 7,143,923 entitled "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil", issued December 5, 2006; US Patent No. 7,303,108 entitled "Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack", issued December 4, 2007; in US Patent No. 7,367,485 entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", issued May 6, 2008; in US Patent No. 7,380,695 entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", issued June 3, 2008; in US Patent No. 7,380,696, entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism", issued on June 3, 2008; US Patent No. 7,404,508, entitled "Surgical Stapling and Cutting Device", issued July 29, 2008; in US Patent No. 7,434,715 entitled "Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout", issued October 14, 2008; US Patent No. 7,721,930 entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010; US Patent No. 8,408,439 entitled "Surgical Stapling Instrument with An Articulatable End Effector", issued April 2, 2013; and US Patent No. 8,453,914, entitled "Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly", issued June 4, 2013. The description of each of the foregoing US patents is incorporated into the present invention by way of reference.

[0003] Although the aforementioned surgical staplers are described as used in endoscopic procedures, it should be understood that these surgical staplers may also be used in open procedures and/or other non-endoscopic procedures. By way of example only, a surgical stapler may be inserted through a thoracotomy and thus between the patient's ribs to reach one or more organs in a thoracic surgical procedure that does not use a trocar as a conduit for the stapler. Such procedures may include using the stapler to cut and close off a blood vessel leading to a lung. For example, the vessels leading to an organ can be cut and closed with a stapler before removing the organ from the thoracic cavity. Of course, surgical staplers can be used in a number of other scenarios and procedures.

[0004] Examples of surgical staplers that may be particularly suitable or used through a thoracotomy are disclosed in US Patent Application No. 14/810,786 entitled "Surgical Staple Cartridge with Compression Feature at Knife Slot" filed on July 29, 2015 ; US Patent Publication No. 2014/0243801 entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks", published August 28, 2014; US Patent Publication No. 2014/0239041 entitled "Lockout Feature for Movable Cutting Member of Surgical Instrument", published August 28, 2014; US Patent Publication No. 2014/0239042 entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler", published August 28, 2014; US Patent Publication No. 2014/0239036 entitled "Jaw Closure Feature for End Effector of Surgical Instrument", published August 28, 2014; US Patent Publication No. 2014/0239040 entitled "Surgical Instrument with Articulation Lock having a Detenting Binary Spring", published August 28, 2014; US Patent Publication No. 2014/0239043 entitled "Distal Tip Features for End Effector of Surgical Instrument", published August 28, 2014; US Patent Publication No. 2014/0239037 entitled "Staple Forming Features for Surgical Stapling Instrument", published August 28, 2014; US Patent Publication No. 2014/0239038 entitled "Surgical Instrument with Multi-Diameter Shaft", published August 28, 2014; and/or US Patent Publication No. 2014/0239044 entitled "Installation Features for Surgical Instrument End Effector Cartridge", published August 28, 2014. The disclosure of each of the foregoing US Patent Applications is incorporated into the present invention by way of reference.

[0005] Although various types of surgical stapling instruments and associated components have been produced and used, it is believed that no one prior to the inventor(s) has produced or used the invention described in the appended embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

[0006] The attached drawings, which are incorporated into this descriptive report and which form part of it, illustrate embodiments of the invention and, together with the general description provided above, and the detailed description of the embodiments provided below, serve to explain the principles of the present invention.

[0007] Figure 1 is a perspective view of an exemplary jointed surgical instrument having an exemplary first end actuator;

[0008] Figure 2 represents a perspective view of the end actuator of Figure 1, with the end actuator in an open configuration;

[0009] Figure 3 shows an exploded perspective view of the end actuator of Figure 2;

[0010] Figure 4 represents a cross-sectional view of the end of the end actuator of Figure 2, taken along line 4-4 of Figure 2;

[0011] Figure 5 represents a perspective view of a second exemplary end actuator, with the end actuator in an open configuration;

[0012] Figure 6A is a schematic representation of a liver having a vessel extending through the hepatic tissue;

[0013] Figure 6B is a schematic representation of the end actuator of Figure 5 cutting through the liver tissue of Figure 6A without fracturing the vessel;

[0014] Figure 6C is a schematic representation of the vessel of Figure 6B exposed from the fractured liver tissue of Figure 6A;

[0015] Figure 6D is a schematic representation of the end actuator of Figure 5 clamping the exposed vessel of Figure 6C;

[0016] Figure 6E is a schematic representation of the vessel of Figure 6D exposed and stapled;

[0017] Figure 6F is a schematic representation of the liver of Figure 6A having a portion of the liver tissue and the vessel cut therefrom;

[0018] Figure 7 is a side elevation view of another exemplary jointed surgical stapling instrument having a third exemplary end actuator;

[0019] Figure 8 represents a perspective view of the end actuator of Figure 7, with the end actuator in an open configuration;

[0020] Figure 9A represents a side elevation view of the end actuator of Figure 8, with the end actuator in the open configuration;

[0021] Figure 9B represents a side elevation view of the end actuator of Figure 8, with the end actuator in a closed configuration and a deformable hydraulic member in a contracted state;

[0022] Figure 9C represents a side elevation view of the end actuator of Figure 8, with the end actuator in the closed configuration and the deformable hydraulic member in an expanded state;

[0023] Figure 10 represents a perspective view of a fourth exemplary end actuator, with the end actuator in an open configuration;

[0024] Figure 11A represents a side elevation view of the end actuator of Figure 10, with the end actuator in the open configuration;

[0025] Figure 11B represents a side elevation view of the end actuator of Figure 10, with the end actuator in a closed configuration and a deformable hydraulic member in a contracted state;

[0026] Figure 11C represents a side elevation view of the end actuator of Figure 10, with the end actuator in the closed configuration and the deformable hydraulic member in an expanded state;

[0027] Figure 12A represents a top view of a lower grip of the end actuator of Figure 10 with the deformable hydraulic member in the contracted state and a mechanical pressure regulator;

[0028] Figure 12B represents a top view of a lower grip of the end actuator of Figure 10 with the deformable hydraulic member extending towards the expanded state;

[0029] Figure 12C represents a top view of a lower grip of the end actuator of Figure 10 with the deformable hydraulic member in the expanded state;

[0030] Figure 13A represents a schematic top view of an exemplary fifth end actuator with a lower grip having a deformable hydraulic member in a contracted state and an electromechanical pressure regulator;

[0031] Figure 13B represents the schematic top view of the end actuator of Figure 13A, with the deformable hydraulic member in an expanded state;

[0032] Figure 14A represents an elevation view of the distal end of the end actuator of Figure 10 with the deformable hydraulic member in the contracted state;

[0033] Figure 14B represents an elevation view of the distal end of the end actuator of Figure 10 with the deformable hydraulic member in the expanded state;

[0034] Figure 15 represents an elevation view of the distal end of an exemplary sixth end actuator with a deformable hydraulic member in an expanded state;

[0035] Figure 16A represents an elevation view of the distal end of an exemplary seventh end actuator with an upper deformable hydraulic member in a contracted state and a lower deformable hydraulic member in a contracted state;

[0036] Figure 16B depicts an elevation view of the distal end of the end actuator of Figure 16A, with the upper and lower fracture balloons in an expanded state;

[0037] Figure 17 represents a perspective view of an exemplary eighth end actuator, with the end actuator in an open configuration and having a pair of upper deformable hydraulic members and a pair of lower deformable hydraulic members;

[0038] Figure 18A represents a side elevation view of the end actuator of Figure 17, in the open configuration;

[0039] Figure 18B represents a side elevation view of the end actuator of Figure 17, with the end actuator in a closed configuration and the upper and lower pairs of deformable hydraulic members in a contracted state;

[0040] Figure 18C represents a side elevation view of the end actuator of Figure 17, with the end actuator in the closed configuration and the upper and lower pairs of deformable hydraulic members in an expanded state;

[0041] Figure 19A represents an elevation view of the distal end of the end actuator of Figure 17, with the end actuator in the closed configuration and the pairs of upper and lower deformable hydraulic members in the contracted state;

[0042] Figure 19B represents an elevation view of the distal end of the end actuator of Figure 17, with the end actuator in the closed configuration and the pairs of upper and lower deformable hydraulic members in the expanded state;

[0043] Figure 20 is a side elevation view of an exemplary surgical instrument having an exemplary ninth end actuator with a deformable hydraulic member;

[0044] Figure 21A represents an enlarged side elevation view of the deformable hydraulic member of Figure 20 in a contracted state;

[0045] Figure 21B represents an enlarged side elevation view of the deformable hydraulic member of Figure 20 in an expanded state;

[0046] Figure 22A is a schematic representation of a liver and the deformable hydraulic member of Figure 20;

[0047] Figure 22B is a schematic representation of the liver of Figure 22A, with the hydraulic deformable member of Figure 20 inserted into the liver in the contracted state; It is

[0048] Figure 22C is a schematic representation of the liver of Figure 22A, with the deformable hydraulic member of Figure 20 inserted into the liver in an expanded state, therefore cutting through a portion of the liver tissue.

[0049] The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the invention may be embodied in a variety of other ways, including those not necessarily depicted in the drawings. The accompanying drawings incorporated in and forming a part of the specification illustrate various aspects of the present invention and, together with the description, serve to explain the principles of the invention; it being understood, however, that this invention is not specifically limited to the arrangements shown.

DETAILED DESCRIPTION

[0050] The following description of specific examples of the invention should not be used to limit the scope of the present invention. Other examples, features, aspects, embodiments and advantages of the invention will become apparent to those skilled in the art from the following description, which is, by way of illustration, one of the best contemplated modes for carrying out the invention. As will be understood, the invention may have other different and obvious aspects, all without departing from the invention. Consequently, the drawings and descriptions are to be considered as illustrative and not restrictive in nature.

I. Sample surgical stapler

[0051] Figure 1 depicts an exemplary surgical stapling and cutting instrument 10 that includes a cable assembly 20, a drive shaft assembly 30, and an end actuator 40. The end actuator 40 and the distal portion of the assembly of drive shaft 30 are sized for insertion, in an unhinged state as depicted in Figure 1, through a trocar cannula into a surgical site in a patient to perform a surgical procedure. By way of example only, such a trocar could be inserted into the patient's abdomen, between two of the patient's ribs, or elsewhere. In some cases, instrument 10 is used without a trocar. For example, the end actuator 40 and the distal portion of the drive shaft assembly 30 can be inserted directly through a thoracotomy or other type of incision. It should be understood that terms such as "proximal" and "distal" are used in the present invention in reference to a physician holding the handle assembly 20 of the instrument 10. As such, the end actuator 40 is distal to the handle assembly. 20 more proximal. It will be further understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in relation to the drawings. However, surgical instruments are used in many orientations and positions, and such terms are not intended to be limiting and absolute.

A. Sample Cable Assembly and Drive Shaft Assembly

[0052] As shown in Figure 1, the handle assembly 20 of the present example comprises a pistol grip 22, a closing trigger 24 and a firing trigger 26. Each trigger 24, 26 can be selectively pivotable towards and away of pistol grip 22 as will be described in more detail below. The cable assembly 20 further includes an anvil release button 25, a trigger bar reverse switch 27, and a removable battery pack 28. Other suitable configurations for the cable assembly 20 will become apparent to those skilled in the art. technique considering the teachings of the present invention.

[0053] As shown in Figures 1 and 2, the drive shaft assembly 30 of the present example comprises an outer closure tube 32, a pivot section 34 and a closure ring 36, which is further coupled to an end actuator 40. Closure tube 32 extends the length of drive shaft assembly 30. Closure ring 36 is positioned distal to pivot section 34. Closure tube 32 and closure ring 36 are configured to translate longitudinally with respect to the cable assembly 20. The longitudinal translation of the closure tube 32 is communicated to the closure ring 36 through the hinge section 34.

[0054] The pivot section 34 is operable to laterally deflect the closure ring 36 and the end actuator 40 laterally in the opposite direction to the longitudinal axis LA of the drive shaft assembly 30 at a desired angle α. In the present example, the articulation is controlled through a articulation control knob 35 that is located at the proximal end of the drive shaft assembly 30. The knob 35 is rotatable about an axis that is perpendicular to the longitudinal axis LA of the drive shaft assembly 30. The closure ring 36 and end actuator 40 pivot about an axis that is perpendicular to the longitudinal axis LA of the drive shaft assembly 30 in response to rotation of the knob 35 The hinge section 34 is configured to communicate longitudinal translation from the closure tube 32 to the closure ring 36, regardless of whether the hinge section 34 is in a straight configuration or in a hinged configuration.

[0055] In some versions, the articulation section 34 and/or the articulation control knob 35 are/is constructed and operable in accordance with at least some of the teachings of US Publication No. 2014/0243801, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks", published on August 28, 2014, the description of which is incorporated herein by reference. The hinge section 34 may also be constructed and operable in accordance with at least some of the teachings of US Publication No. 2015/0374360, entitled "Articulation Drive Features for Surgical Stapler", published December 31, 2015, the description of which is here incorporated by reference. Other suitable shapes that the pivot section 34 and pivot knob 35 can take will be apparent to those skilled in the art in view of the teachings of the present invention.

[0056] As shown in Figures 1 to 2, the drive shaft assembly 30 of the present example also includes a rotation knob 31. The rotation knob 31 is operable to rotate the entire drive shaft assembly 30 and the actuator end point 40, with respect to the cable assembly 20 about the longitudinal axis LA defined by the driveshaft assembly 30. Of course, the driveshaft assembly 30 can have a variety of other components, features and functionality, in addition to , or instead of, any of the elements mentioned above. By way of example only, at least part of the driveshaft assembly 30 is constructed in accordance with at least some of the teachings of US Patent Application No. 2014/0239038, entitled "Surgical Instrument with Multi-Diameter Shaft", published in August 28, 2014, the description of which is incorporated herein by reference. Other suitable configurations of driveshaft assembly 30 will become apparent to those skilled in the art considering the teachings of the present invention.

B. Example End Actuator

[0057] As also shown in Figures 2 to 4, the end actuator 40 of the present example includes a lower jaw 50 and a pivotable anvil 60. The anvil 60 includes a pair of integral outwardly extending pins 66 that are disposed in corresponding curved slots 54 of lower jaw 50. Anvil 60 is pivotal towards and away from lower jaw 50 between an open position (shown in Figure 2) and a closed position (shown in Figure 1). The use of the term "pivot" (and similar terms with "pivot" as the base) should not be read as necessarily necessitating pivotal motion about a fixed axis. For example, in the present example, the anvil 60 rotates about an axis that is defined by the pins 66, which slide along the curved slots 54 of the lower jaw 50 as the anvil 60 moves towards the lower jaw 50. In such versions, the pivot axis translates along the path defined by the slots 54 while the anvil 60 simultaneously rotates around this axis. Additionally or alternatively, the pivot axis can slide along the slots 54, with the anvil 60 then pivoting about the pivot axis after the pivot axis slides a certain distance along the slots 54. It should be understood that such pivotal sliding/translating movement is encompassed within terms such as "pivot", "pivots", "pivoting". "swivel", "hinged" and the like. Naturally, some versions can provide for pivotal movement of the anvil 60 about an axis which remains fixed and does not translate within a slot or groove, etc.

[0058] The bottom jaw 50 of the present example defines a groove 52 that is configured to receive a staple cartridge 70. The staple cartridge 70 can be inserted into the groove 52, the end actuator 40 can be actuated, and then the staple cartridge 70 can be removed and replaced with another staple cartridge 70. The lower jaw 50 thereby releasably retains the staple cartridge 70 in alignment with the anvil 60 for actuation of the end actuator 40. In some versions, the lower grip 50 is constructed in accordance with at least some of the teachings of Patent Application No. 2014/0239044, entitled "Installation Features for Surgical Instrument End Effector Cartridge", published on August 28, 2014, whose description is here incorporated by reference. Other suitable shapes that the lower jaw 50 can take will become apparent to those skilled in the art based on the teachings of the present invention.

[0059] As best seen in Figure 3, the staple cartridge 70 of the present example comprises a cartridge body 71 and a tray 76 attached to the underside of the cartridge body 71. The upper side of the cartridge body 71 has a platform 73, against which tissue can be pressed when anvil 60 is in a closed position. Cartridge body 71 further defines a longitudinally extending channel 72 and a plurality of clip pockets 74. A clip 77 is positioned in each clip pocket 74. A clip driver 75 is also positioned in each clip pocket 74, under a corresponding clip 77, and above the tray 76. As will be described in more detail below, the clip drivers 75 are operable to translate upwardly into clip pockets 74 to thereby drive the clips 77 upward through of the staple pockets 74 and for engagement with the anvil 60. The staple drivers 75 are moved upward by a wedge slider 78, which is captured between the cartridge body 71 and the tray 76, and which translates longitudinally through the body. of cartridge 71. The wedge slider 78 includes a pair of obliquely angled cam surfaces 79 that are configured to engage clip drivers 75 and thereby drive the clip drivers 75 upward as the wedge slider moves. 78 translates longitudinally through cartridge 70.

[0060] By way of example only, the staple cartridge 70 can be constructed and operable in accordance with at least some of the teachings of US Patent Publication No. 2014/0239042 entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler ", published August 28, 2014, the description of which is incorporated herein by reference and/or US Publication No. 2014/0239044, entitled "Installation Features for Surgical Instrument End Effector Cartridge", published August 28, 2014, the description of which is incorporated herein by reference. Other suitable shapes that the staple cartridge 70 can assume will become apparent to those skilled in the art in view of the teachings of the present invention.

[0061] The anvil 60 of the present example comprises a longitudinally extending groove 62 and a plurality of staple forming pockets 64. The groove 62 is configured to align with the groove 72 of the staple cartridge 70 when the anvil 60 is in position. a closed position. Each staple forming pocket 64 is positioned to lie over a corresponding staple pocket 74 of staple cartridge 70 when the anvil 60 is in a closed position. The staple forming pockets 64 are configured to deform the staple legs 77 as the staple legs 77 are driven through the fabric and into the anvil 60. In particular, the staple forming pockets 64 are configured to flex the staple legs 77 to attach the formed clips 77 to the fabric. Just by way of example, the anvil 60 can still be constructed in accordance with at least some of the teachings of US publication No. 2014/0239037, entitled "Staple Forming Features for Surgical Stapling Instrument", published on August 28, 2014, whose description is incorporated herein by reference. Other suitable shapes that the anvil 60 can take will be apparent to those skilled in the art in view of the teachings of the present invention.

[0062] In the present example, the knife member 80 is configured to translate through the end actuator 40. As best seen in Figure 3, a knife member 80 is attached to the distal end of a trigger arm 82, which extends through a portion of the driveshaft assembly 30. The knife member 80 is positioned in the grooves 62, 72 of the anvil 60 and the staple cartridge 70. The knife member 80 includes a distally presented cutting edge 84 that is configured to cut tissue that is compressed between the anvil 60 and the platform 73 of the staple cartridge 70 as the knife member 80 travels distally through the end actuator 40. The knife member 80 also drives the wedge slider 78 distally as the knife member 80 translates distally through the end actuator 40, thereby pushing the staples 77 through the tissue and against the anvil 60 for formation.

C. Exemplifying anvil performance

[0063] In the present example shown in Figures 1 to 4, the anvil 60 is driven to the lower jaw 50 by advancing the lock ring 36 distally with respect to the end actuator 40. The lock ring 36 cooperates with the anvil 60 through a cam action 60 toward the lower jaw 50 in response to distal translation of the closure ring 36 with respect to the end actuator 40. Likewise, the closure ring 36 can cooperate with the anvil 60 to open the anvil 60 away from lower jaw 50 in response to proximal translation of lock ring 36 with respect to end actuator 40. By way of example only, lock ring 36 and anvil 60 may interact in accordance with at least some of the teachings of US Patent Application No. 2014/0239036 entitled "Jaw Closure Feature for End Effector of Surgical Instrument", published August 28, 2014, the description of which is incorporated herein by reference; and/or in accordance with at least some of the teachings of US Patent Publication No. 2015/0374373, entitled "Jaw Opening Feature for Surgical Stapler", filed December 31, 2015, the disclosure of which is incorporated herein by reference. Exemplary features that may be used to provide longitudinal translation of the closure ring 36 relative to the end actuator 40 will be described in more detail below.

[0064] In the present example, the closure trigger 24 is pivotable towards the pistol grip 22 to actuate the closure tube 32 and the closure ring 36 distally. Various suitable components that can be used to convert the pivotal movement of the closure trigger 24 toward the gun handle 22 to the distal translation of the closure tube 32 and the closure ring 36 relative to the handle assembly 20 will be apparent to those versed in the technique in view of the teachings contained herein. When the closing trigger 24 reaches a fully pivoted state such that the anvil 60 is in a fully closed position with respect to the lower jaw 50, the locking features on the cable assembly 20 lock the closed position of the trigger 24 and the tube. 32, thereby locking the anvil 60 in a fully closed position with respect to the lower jaw 50. These locking features are released by actuation of the anvil release button 25. Other suitable features that may be used to actuate the anvil 60 will be apparent to those skilled in the art in view of the teachings of the present invention.

D. Actuation of the exemplary trigger bar

[0065] In the present example, the instrument 10 includes motorized components that are configured to actuate the firing arm 82 distally in response to the linkage of the firing trigger 26 in the direction of the pistol grip 22. In some versions, a motor not shown is contained in pistol grip 22 and is powered by battery 28. This motor is coupled with a transmission assembly not shown which converts rotary motion of a motor drive shaft into linear translation of firing arm 82. In some versions, the trigger arm 82 can only be advanced distally when anvil 60 is in a fully closed position relative to lower jaw 50. After trigger arm 82 is advanced distally to cut tissue and drive staples 77, trigger arm 82 trigger arm 82 can be automatically reversed to trigger trigger arm 82 proximally back to the retracted position. Alternatively, the operator can actuate the trigger arm reversing switch 27, which can reverse the trigger assembly for the trigger arm 82 in order to retract the trigger arm 82 to a proximal position.

[0066] By way of example only, the features that are operable to provide the motorized actuation of the firing arm 82 can be configured and operable in accordance with at least some of the teachings of US patent No. 8,210,411, entitled "Motor- Driven Surgical Instrument", filed on July 3, 2012, the description of which is incorporated herein by reference; and/or US Publication No. 2015/0272575 entitled "Surgical Instrument Comprising a Sensor System", published October 1, 2015, the description of which is incorporated herein by reference. Other suitable components, features, and configurations that can be used to provide motorization of trigger arm 82 will be apparent to those skilled in the art in view of the teachings of the present invention. It should also be understood that some other versions may provide for manual actuation of trigger arm 82, so that a motor may be omitted. By way of example only, trigger arm 82 can be manually actuated in accordance with at least some of the teachings of any other reference cited herein.

[0067] It should also be understood that other components or features of the instrument 10 may be configured and operated in accordance with the various references cited in the present invention. Additional exemplary modifications that can be provided for instrument 10 will be described in more detail below. Various suitable ways in which the teachings below can be incorporated into instrument 10 will be apparent to those skilled in the art. Similarly, various suitable ways in which the teachings below can be combined with the various teachings of the cited references in the present invention will be apparent to those skilled in the art. It should also be understood that the teachings below are not limited to the instrument 10 or the devices taught in the references cited in the present invention. The teachings below can be readily applied to many other types of instruments, including instruments that would not be classified as surgical staplers. Various other suitable devices and scenarios to which the teachings below can be applied will become apparent to those skilled in the art based on the teachings of the present invention.

II. Exemplary surgical stapler with a crushing surface

[0068] Although the surgical instrument 10 described above provides an example of an end actuator 40 that can be used to clip and cut tissue within a patient, it should be understood that the human body includes a wide variety of tissues located in regions distinct, sometimes difficult regions to be accessed by the whole patient. For example, a liver that includes parenchyma tissue including vessels or ducts that run through it. In settings where the liver includes a tumor, it may be desirable to resect the portion of the liver that contains the tumor. The resection can be anatomical (eg, resection of the right or left side of the liver, including the lobes on that side) or non-anatomical (eg, resection of just a single lobe or wedge of liver tissue). This resection process can involve at least three types of steps—a first step to dissect the tissue (eg, liver parenchyma) around the vessels or ducts, to thereby isolate or reveal the vessels or ducts; a second step for connecting these vessels or ducts; and a third step to cut the connected vessels or ducts.

[0069] One method of liver resection includes the well-known Kelly grip method, in which a Kelly-style forceps is used to compress the liver parenchyma tissue and thereby dissect the parenchyma tissue through a squashing action. However, treatments may require many instruments to accommodate such a wide variety of tissues and vessels or ducts within the human body, thereby increasing the time and complexity associated with assessing tissue status, selecting and/or changing instruments, and performing the resection. Therefore, it may be desirable to provide a variation of surgical instrument 10 with an end actuator 112 having a pair of crushing surfaces 114, 116 that are configured to sever tissue by crushing tissue; while also providing an adjacent staple cartridge 118 for selectively ligating one or more vessels or ducts passing through the tissue. Thus, a single surgical instrument will enable the operator to more quickly assess tissue and proceed with tissue dissection and/or ligation of vessels and ducts.

[0070] Surgical instrument variation 10 is described below in the context of dissecting liver tissue (e.g., liver parenchyma) with crushing surfaces 114, 116 and using staples to ligate associated vessels or ducts (e.g., portal vein, hepatic vein branches, hepatic artery branches, extrahepatic vessels, etc.). In some cases (eg, in the case of hepatic vein branches and hepatic artery branches, etc.), the vessel or duct that is sealed by the clamps is exposed when the operator crushes the hepatic tissue with the surfaces 114, 116. In in some other cases (for example, in the case of the portal vein and extrahepatic vessels, etc.), the vessel or duct that is sealed by the clamps is separated from the liver tissue that the operator crushed with the surfaces 114, 116. After the tip actuator 112 and method of treatment is provided in the context of liver resection, it should be understood that the tip actuator 112 can alternatively be configured to treat any tissue in the human body with similar characteristics. It should also be understood that the features discussed below can be easily incorporated into the surgical instrument 10 discussed above. For this purpose, similar numbers indicate similar features described above in greater detail.

A. Sample End Actuator and Crushing Surface

[0071] Figure 5 shows an end actuator 112 having an upper crushing surface 114, a lower crushing surface 116 and a staple cartridge 118. Since the end actuator 112 can be incorporated into a variation of surgical instrument 10, it should be understood that end actuator 112 may be used in conjunction with cable assembly 20 (see Figure 1) and driveshaft assembly 30 (see Figure 1) discussed above in more detail. Except where otherwise described below, end actuator 112, in conjunction with drive shaft assembly 20 (see Figure 1) and drive shaft assembly 30 (see Figure 1), is configured and operable similar to the actuator to end actuator 40 (see Figure 1).

[0072] The end actuator 112 of the present example also includes a lower jaw 120 and an upper jaw 122. The upper jaw 122 forms an anvil 124 and is pivotally mounted with respect to the lower jaw 120 to receive tissue between them . More particularly, the anvil 124 is pivotal toward and away from the lower jaw 120 between an open position and a closed position, for example, in response to pivotal movement of the trigger 24 (see Figure 1) toward and away from the grip. from gun 22 (see Figure 1). This pivotal action of the anvil 124 can be provided in the same manner as described above with reference to the anvil 60. By way of example only, the staple firing, staple forming, and tissue cutting features can be configured and operable in accordance with at least some of the teachings of US Patent Application No. 14/884,272, entitled "Method of Applying Staples to Liver and Other Organs", filed on October 15, 2015, the description of which is incorporated herein by reference.

B. Exemplary method of tissue resection with a crushing surface

[0073] Figures 6A to 6F show an example of using the tip actuator 112 for resecting tissue, such as liver parenchyma tissue 200, and for connecting a vessel or duct 202 therein. As noted above, the vessel or duct 202 may comprise a hepatic vein or a hepatic artery. It should also be understood that the method may further include the use of end actuator 112 to connect other vessels such as the portal vein and extrahepatic vessels, etc.

[0074] As shown in Figure 6B, the operator positions the end actuator 112 so that the tissue 200, including the blood vessel or duct 202, is situated between the upper and lower jaws 120, 122. compresses the fabric 200 between the lower and upper crushing surfaces 114, 116 of the lower and upper jaws 120, 122, respectively, to apply the predetermined crushing pressure to the fabric 200. By way of example only, the jaws 120, 122 may be actuated in this manner by pivoting trigger 24 (see Figure 1) towards gun grip 22 see Figure 1. It should be understood that jaws 120, 122 need not necessarily be actuated for a fully closed configuration. In some cases, the operator can rely on tactile feedback via trigger 24 (see Figure 1) and gun grip 22 (see Figure 1) to determine whether or not the operator has achieved a desired gap between the jaws 120, 122 to properly crush tissue 200 without undesirably damaging vessel or duct 202. Additionally or alternatively, the operator can rely on visual feedback.

[0075] In either case, the crushing pressure applied by the jaws 120, 122 effectively cuts through the tissue 200 and the operator then removes the end actuator 112 from the tissue 200 to see if any vessels or ducts 202 are present. As shown in Figure 6C, the vessel or duct 202 remains intact and is left exposed, extending between the cut portions of fabric 200.

[0076] In some cases, the operator can leave the vessel or duct 202 intact. However, in the present example, the operator turns on the vessel or duct 202 to complete the resection of a cut portion of tissue 200, as shown in Figures 6D and 6E. The connection includes placing at least some of the overlapping clamps 77 within the vessel or duct 202 as discussed above in greater detail. It should be understood, therefore, that the same end actuator 112 can be used to crush (and thus cut) the liver tissue 200 and also connect a vessel or duct 202 in the tissue 200. In the present example, after the vessel is connected or duct 202, the operator removes the end actuator 112 from the liver tissue 200 and cuts the vessel or duct 202 with another surgical instrument (not shown) known in the art for cutting tissue, such as conventional blades or scissors, etc. Thereby, the operator completes the resection of a straight portion of tissue 200 and the corresponding portion of vessel or duct 202, as shown in Figure 6F. Applied clips 77 seal a cut end 318 of vessel or duct 202.

[0077] As described above, the operator removes the end actuator 112 to view the vessel 202, as shown in Figure 6C. Alternatively, the operator can apply the predetermined crushing pressure (or as determined based on tactile and/or visual feedback, as noted above) as shown in Figure 6B, and immediately thereafter ligate any remaining tissue therein, as the tissue of the vessel or duct 202. Thus, it is not necessary to view such tissue prior to ligation, but the operator may find such visualization desirable in one or more liver resection procedures. It must be considered that the resection described above is merely illustrative and is not limited to the hepatic tissue. It should be understood that tissue resection with tip actuator 112 can be performed on other tissues within the patient as desired by the user.

III. Sample surgical instrument with hydraulically actuated crushing surface

[0078] Although the versions of the surgical instrument 10 described above provide several examples of an end actuator 40, 112 that can be used to clip and cut tissue in a patient, such as by crushing and fracturing tissue with crushing surfaces 114, 116, it will be understood that alternative crushing surfaces may alternatively be configured to cut tissue. One such fabric cutting method may include hydraulically engaging one or more crushing surfaces against the fabric to cut the fabric. Hydraulic engagement can be passive, such as by a deformable hydraulic member that is simply directed against tissue; or the hydraulic engagement can be active, as by a deformable hydraulic member that is expanded against the fabric after initially engaging the fabric. Obviously, the hydraulic coupling can also be some combination of active and passive in other embodiments. It should be considered, therefore, that any such structures described herein can be readily combined to achieve various ways of crushing and fracturing tissue.

[0079] As used in the present invention, the term "deformable" refers to any change in shape of the hydraulic member with fluid contained therein from a resultant pressure on the fluid. Such pressure can be applied passively by forcing the fabric against the hydraulic member and thereby deforming the hydraulic member to the fabric. Pressure can also be actively applied from within the hydraulic member by introducing fluid into the hydraulic member. Furthermore, the term "contains" in relation to the fluid within the collapsible hydraulic member generally refers to having fluid therein during use and broadly includes containing a predetermined amount of fluid within the collapsible hydraulic member or a variable amount of fluid within of the deformable hydraulic member. Accordingly, the terms "deformable" and "contains" are not intended to limit the invention described herein. In some versions, the hydraulic member is formed at least in part from an extensible material. In some other versions, the hydraulic member is deformable yet not extensible. Various suitable materials that can be used to form the hydraulic member will be apparent to those skilled in the art in view of the teachings of the present invention.

[0080] End actuators 212, 312, 412, 512, 612, 712, 812 are described below in the context of dissection of hepatic tissue (eg, liver parenchyma) and, in some cases, with the use of staples to connect associated vessels or ducts (eg, portal vein, hepatic vein branches, hepatic artery branches, extrahepatic vessels, etc.). Although the following description of the 212, 312, 412, 512, 612, 712, 812 end actuators and related methods of treatment are provided in the context of liver resection, it will be understood that the 212, 312, 412, 512, 612, 712, 812 may alternatively be configured to treat any tissue in the human body with similar characteristics. It should also be understood that the features discussed below can be readily incorporated into variations of the Surgical Instrument 10 discussed above and/or the Surgical Instruments 210, 410, 810 discussed below. For this purpose, similar numbers indicate similar features described above in greater detail.

A. Example end actuator with a staple cartridge that has a central deformable member

[0081] Figures 7 to 8 show a surgical instrument 210 with a handle assembly 211, an exemplary third end actuator 212, and a drive shaft assembly 30 extending therebetween to generally support and operate the end actuator end at 212 as discussed above in more detail. End actuator 212 includes a hydraulically collapsible member 213 that extends longitudinally along a central portion of the platform 73 between the upper and upper jaws 220, 222. In the present example, the hydraulically collapsible member 213 is attached to the platform 73 and Detachably connects to end actuator 212 via a fluid coupling (not shown) for replacement with clip cartridge 70. Alternatively, deformable hydraulic member 213 may be attached to a reusable portion of end actuator 212 for reuse.

[0082] The deformable hydraulic member 213 of the present example is configured to actively fracture the tissue to sever a portion of the tissue upon receipt of a fluid therein. For this purpose, the deformable hydraulic member 213 is more particularly a deformable hydraulic balloon 213. The balloon 213 is in fluid communication with a fluid reservoir 215, which contains a fluid, such as a liquid or gas. The fluid reservoir 215 of the present example is supported within the cable assembly 211 and is in fluid communication with the collapsible hydraulic bladder 213 through a supply conduit 217. Alternatively, the fluid reservoir 215 may be positioned at another portion of the surgical instrument 210 or even exterior of the surgical instrument 210. In both cases, the collapsible hydraulic balloon 213 is configured to expand from a contracted state to an expanded state by introducing fluid into the collapsible hydraulic balloon 213 from the fluid reservoir 215. Thus, as the collapsible water balloon 213 expands, a crushing surface 214 of the collapsible water balloon 213 forcibly engages the tissue and fractures the tissue against another crushing surface 216 on the anvil 224 as discussed in more detail below.

[0083] In some versions, the collapsible hydraulic balloon 213 is operatively connected to a fluid actuator 226 in the cable assembly 211 and is configured to be manipulated by the operator to selectively inflate the collapsible hydraulic balloon 213 towards the expanded state. Of course, it should be understood that other mechanisms for selectively inflating the collapsible hydraulic balloon 211 could alternatively be used.

[0084] The cable assembly 211 further includes an example of a pressure control system 319 that is in fluid communication with the deformable hydraulic balloon 213. In some versions, more fluid from the fluid reservoir 215 than necessary can be introduced in the collapsible hydraulic balloon 213 during expansion towards the expanded state. In fact, excess fluid can overflow collapsible hydraulic bladder 319 beyond a predetermined maximum expansion pressure. The pressure control system 319 is therefore further configured to limit the expansion pressure to the predetermined maximum expansion pressure and will be discussed below with respect to Figures 12A to 12C in more detail.

[0085] In use, Figure 9A illustrates the upper and lower jaws 220, 222 in the open configuration and configured to receive tissue between the crushing surfaces 214, 216 of the deformable hydraulic balloon 213 and the anvil 224. When the tissue is received in the open configuration, the upper jaw 222 rotates towards the lower jaw 220 for the closed configuration with the tissue captured between them. The operator then selectively manipulates fluid actuator 226 (see Figure 7) to direct fluid from fluid reservoir 215 (see Figure 7) and into collapsible hydraulic balloon 213, thereby expanding the balloon. collapsible hydraulic 213 from the contracted state, as shown in Figure 9B, to the expanded state, as shown in Figure 9C.

[0086] During this expansion of the hydraulic balloon 213, the crushing surface 214 on the deformable hydraulic balloon 213 compresses the tissue against the crushing surface 216 on the anvil 224. The compression continues until tissue fracture or fluid pressure, as monitored through the 319 pressure control system (see Figure 12A), reach the predetermined maximum expansion pressure. By using one deformable surface of the balloon 213 to crush the tissue instead of using two non-deformable surfaces, there can be a reduced risk of inadvertently crushing or cutting the vessels or ducts 202 in the tissue. In the context of liver or other similar tissue, after the tissue has been crushed, the staple cartridge 70 is fired to ligate the vessels or ducts 202 that have been exposed as a result of the crush (see Figure 6F).

B. Example end actuator with a central deformable member and pressure control system

[0087] Figures 10 to 11C show an exemplary fourth end actuator 312 and a drive shaft assembly 30. The end actuator 312 includes a deformable hydraulic member 313 that extends longitudinally along a central portion of a lower jaw 320 below an upper jaw 322. Note that the end actuator 312 does not include the staple cartridge 70 as shown above, but it can still be used to fracture and sever tissue. In the present example, deformable hydraulic member 313 is supported by lower jaw 320 and releasably connects to end actuator 312 via a fluid coupling (not shown) for replacement. Alternatively, deformable hydraulic member 313 can be attached to lower jaw 320 for reuse.

[0088] The deformable hydraulic member 313 of the present example is configured to actively fracture the tissue to cut a portion of the tissue upon receipt of a fluid in the hydraulic member 313. For this purpose, the deformable hydraulic member 313 is more particularly a hydraulic balloon collapsible 313. The hydraulic bladder 313 is in fluid communication with a pump 332. The pump 332 is formed by a piston 334 and a fluid reservoir 315, which contains a fluid, such as a liquid or gas. The pump 332 of the present example is supported within the lower jaw 322 of the end actuator 312 and is in fluid communication with the collapsible hydraulic bladder 313 through a supply conduit 317. The collapsible hydraulic bladder 313 is configured to expand from a state contracted to an expanded state by activating the pump 332 to introduce fluid into the collapsible hydraulic balloon 313 from the fluid reservoir 315. Thus, as the collapsible hydraulic balloon 313 expands, a crushing surface 314 of the forcibly collapsible hydraulic balloon 313 engages the tissue and fractures the tissue against another crushing surface 316 on an underside of the upper jaw 322 as discussed below in more detail. In some versions, pump 332 is operatively connected to fluid actuator 226 (see Figure 7) at cable assembly 211 to selectively direct movement of piston 334.

[0089] The end actuator 312 further includes a pressure control system 319 that is fluidly connected to the deformable hydraulic balloon 313. As discussed above, in some versions, more fluid from the fluid reservoir 315 than necessary can be introduced into collapsible hydraulic balloon 313 during expansion towards the expanded state beyond the predetermined maximum expansion pressure. The pressure control system 319 is thus configured to limit the expansion pressure to the predetermined maximum expansion pressure.

[0090] The pressure control system 319 of this example further includes a pressure relief vessel 327 with a resilient body 328 that is configured to expand from a contracted state to an expanded state. The resilient body 328 is fluidly connected to the collapsible hydraulic bladder 313 through a discharge conduit 330 for fluid communication therebetween. The resilience of the body 328 is adjusted up to the predetermined maximum expansion pressure so that the collapsible hydraulic bladder 313 generally begins to expand under a lower pressure than the resilient body 328. However, when the fluid pressure within the collapsible hydraulic bladder 313 builds up to the predetermined maximum expansion pressure, the resilient body 328 of the pressure relief vessel 327 begins to expand from its contracted state to limit the pressure in the collapsible hydraulic bladder 313.

[0091] In the present example, body 328 is extensible, and as such, the extensible resilience of body 328 defines the pressure threshold at which body 328 will begin to expand. In some other versions, the body 328 is non-extensible, but a resilient member (eg, spring bundle, stent-like cage, etc.) is engaged with the body; and the resilience of the resilient member defines the pressure threshold at which body 328 will begin to expand. Other suitable ways in which the resilient body 328 can be configured to only expand after the fluid pressure reaches a predetermined threshold value will become apparent to those skilled in the art in view of the teachings of the present invention. It should also be understood that one or more pressure sensitive valves (e.g., interposed between the discharge conduits 330, the supply conduit 317, and/or the pressure relief vessel 327) may be used to set a limit value of fluid pressure to selectively provide relief to collapsible hydraulic bladder 313. As such, pressure relief reservoir 327 is not intended to be unnecessarily limited to the example described herein.

[0092] It should be understood from the foregoing that, should additional fluid flow from the fluid reservoir 315 or additional downward pressure be applied to the collapsible hydraulic bladder 313, the resilient body 328 will expand to maintain the pressure of the predetermined maximum expansion pressure within the collapsible hydraulic bladder 313. If the forces acting on the collapsible hydraulic bladder 313 reduce the decrease upon expansion of the pressure relief vessel 327, the resilient body 328 contracts to maintain the maximum expansion pressure predetermined until the resilient body 328 returns to the contracted state. When the resilient body 328 returns to the contracted state, the expansion pressure of the collapsible hydraulic bladder 313 can then decrease below the predetermined maximum expansion pressure. The pressure relief vessel 327 is then configured to limit the expansion pressure of the collapsible hydraulic balloon 313 to less than or equal to the predetermined maximum expansion pressure to inhibit tissue damage, such as the vessel or ducts 202 (see Figures 6A to 6F).

[0093] In use, Figure 11A shows the upper and lower jaws 320, 322 in the open configuration for receiving tissue between the crushing surfaces 314, 316 of the collapsible hydraulic balloon 313 and the upper jaw 322. Once the fabric is received in the open configuration, the upper jaw 322 rotates toward the lower jaw 320 for the closed configuration with the tissue captured therebetween. The operator then selectively manipulates fluid actuator 226 (see Figure 7) to direct fluid from fluid reservoir 315 (see Figure 10) and into collapsible hydraulic bladder 313, thereby expanding the bladder. collapsible hydraulic 313 from the contracted state, as shown in Figure 11B, to the expanded state, as shown in Figure 11C.

[0094] During this expansion, the crushing surface 314 on the collapsible hydraulic balloon 313 compresses the tissue against the crushing surface 316 on the upper jaw 322. Referring to Figures 12A to 12C, the compression continues until tissue fracture or pressure of the fluid, as monitored by the 319 pressure control system (see Figure 121c), reaches the predetermined maximum expansion pressure. By way of example, fluid actuator 219 (see Figure 7) is a portion of a fluid delivery system 322, which also includes a piston 334 in fluid reservoir 315 that forcibly directs fluid into the collapsible hydraulic bladder. 313 as shown in Figures 12A to 12B. When the fluid pressure within the collapsible hydraulic bladder 313 results in the predetermined maximum expansion pressure, the resilient body 328 expands to receive fluid from the collapsible hydraulic bladder 313 as shown in Figure 12C. Thus, the pressure relief system 319 maintains the fluid pressure at or below the predetermined maximum expansion pressure until the fluid from the fluid reservoir 315 is completely discharged.

[0095] In the aforementioned example, the end actuator 312 includes a combination pump 332 and pressure relief system 319. However, it should be understood that these two features need not necessarily be used in combination. For example, some variations of end actuator 312 may simply include a pump 332, to provide active expansion of balloon 313, and not include pressure relief system 319. As yet another purely illustrative alternative, some variations may include a system pressure relief system 319 and does not include the pump 332. It should be understood, therefore, that some passive versions of the balloon 313 (e.g., such as the balloon 213) may be used with a pressure relief system 319. In any case , and as noted above in relation to the end actuator 212, the deformability of the balloon 313 can provide a reduced risk of inadvertent crushing of the vessels or ducts 202 in the tissue. In other words, a deformable crush surface provided by balloon 313 may be less likely to inadvertently crush or cut a vessel or duct 202 compared to a non-deformable crush surface. This effect can be further enhanced in versions where a pressure relief system 319 is included. It should be understood, therefore, that the pressure relief system 319 can be adjusted to provide pressure relief when fluid pressures reach a level that is just below a pressure level associated with crushing the vessels or pipelines 202.

[0096] Figures 13A to 13B illustrate another sample surgical instrument 410 that has a fifth sample end actuator 412 connected to the drive shaft assembly 30 and an alternative pressure control system 419. The pressure control system 419 includes a valve 436, a pressure sensor 437 and a controller 438, such as a microcontroller. Valve 436 is in fluid communication between fluid reservoir 315 and collapsible hydraulic bladder 313. Pressure sensor 437 is operatively connected to collapsible hydraulic bladder 313 and is configured to measure fluid pressure therein. Controller 438 is operatively connected to valve 436, piston 334, and pressure sensor 437 to direct fluid through pump 332, monitor pressure within collapsible hydraulic bladder 313, and stop further fluid flow when balloon collapsible hydraulic 313 reaches predetermined maximum expansion pressure.

[0097] In use, valve 436 is initially opened so that piston 334 forces fluid into collapsible hydraulic bladder 313 for expansion. While monitoring the pressure of the fluid within the collapsible hydraulic bladder 313, the controller 438 continues to drive the pump 332 to thereby direct the fluid into the collapsible hydraulic bladder 313 through the open valve 436. When the fluid pressure reaches the expansion pressure predetermined maximum expansion pressure, controller 438 directs piston 334 to stop further fluid flow and closes valve 436 to inhibit fluid pressure from exceeding the predetermined maximum expansion pressure. In the event that additional force, such as from tissue, engages the deformable hydraulic bladder 313 during tissue fracture, the controller 438 may still open valve 436 and retract piston 334. Thus, fluid is removed from the hydraulic balloon deformable 313 until the fluid pressure therein reduces to the predetermined maximum expansion pressure. Pressure control system 419 is thus configured to add and/or remove fluid by monitoring the pressure of the fluid while in the contracted and expanded states, respectively, shown in Figures 14A to 14B.

C. Exemplary end actuator with a central deformable member including a side edge flap

[0098] Figure 15 shows a fifth exemplary end actuator 512 configured to actively crush tissue when expanded from a contracted state to an expanded state. End actuator 512 generally operates like the other end actuators described herein, but includes a collapsible hydraulic balloon 513 having a pair of side edge flaps 540 for an enlarged crushing surface 514. More particularly, the balloon Collapsible hydraulic 513 in the expanded state is generally T-shaped and includes the pair of side edge flaps 540 which respectively extend outwardly along each side edge 542 extending longitudinally along the bottom jaw 320. The flaps side-edge flaps 540 cover the side-edges 542 to increase the surface area of the crushing surface 514 and inhibit the fabric from directly contacting the side-edges 542. In some exemplary uses, such a side-edge flap 540 can thus reduce the amount of tissue damage that might otherwise occur from tissue directly in contact with the relatively rigid, non-deformable side edges 542.

D. Example end actuator with a pair of central deformable members

[0099] Figures 16A to 16B show an exemplary seventh end actuator 612 with a collapsible hydraulic balloon 513 for operation, as discussed above. In addition, end actuator 612 also includes another collapsible hydraulic member 644, which is in the form of another collapsible hydraulic balloon 644, which extends longitudinally along an underside of an upper gripper 622. The collapsible hydraulic bladder 622 644 includes crushing surface 516, which is configured to cooperate with crushing surface 514 to fracture tissue therebetween.

[0100] In use, the fabric is captured between the upper and upper grips 320, 622 in the closed configuration. The user manipulates the fluid actuator 226 (see Figure 7) thereby causing the upper and lower pair of collapsible hydraulic balloons 513, 644 to simultaneously expand from the contracted state to the expanded state. The crushing surfaces 514, 516 thus compress the tissue therebetween to fracture the tissue to sever a portion of the tissue. Alternatively, the lower and upper collapsible hydraulic balloons 513, 644 may be independently expandable and/or one of the lower and upper collapsible hydraulic balloons 513, 644 may be expandable before and/or after the other depending on usage. Therefore, the invention is not intended to be unnecessarily limited to concurrent expansion.

[0101] In another example, the deformable hydraulic balloons 513, 644 can be replaced with one or more passive deformable hydraulic members that simply contain a predetermined amount of fluid without those contracted and expanded states. In other words, passive deformable hydraulic members neither receive fluid nor release fluid therefrom, but simply retain fluid contained therein and deform to tissue in compression. In use, the operator simply moves the upper and lower jaws 320, 322, 622 towards the closed configuration and, in doing so, fractures the tissue between the crushing surfaces 514, 516. It will be understood that any deformable hydraulic members discussed herein can be configured for active expansion uses or passive state. In versions where the balloons 513, 644 are passive, the balloons 513, 644 can be fluidly isolated from one another or in fluid communication with one another. In versions where the balloons 513, 644 are passive and in fluid communication with one another, fluid from one balloon 513, 644 can be transferred to the other balloon 513, 644 when the balloons 513, 644 rest against the tissue to crush the tissue. This can allow the balloons 513, 644 to each have substantially equal hydrostatic pressure.

[0102] As a further example, the upper and upper jaws 320, 622 can be closed around the fabric while the balloons 513, 644 are in an unexpanded state. Thus, in this closed configuration the jaws 320, 622 can define a gap therebetween to receive the fabric. Balloons 513, 644 can then be expanded while grippers 320, 622 maintain the closed configuration. Consequently, deformable hydraulic balloons 513, 644 that actively expand from the contracted state to the expanded state can, in whole or in part, pass through the gap to fracture the tissue. In contrast, passive deformable hydraulic members can similarly define a gap in the closed configuration that is small enough to rupture tissue without expansion.

E. Example end actuator with a pair of upper side deformable members and a pair of lower side deformable members

[0103] Figure 17 shows an exemplary eighth end actuator 712 extending from the drive shaft assembly 30 with the replaceable staple cartridge 70. The end actuator 712 includes a lower claw 220 with a pair of lower side edges 745 end actuator 712 further includes a longitudinally extending upper jaw 222 with a pair of longitudinally extending upper side edges 746. To fracture tissue and inhibit tissue from coming directly into contact with side edges 745, 746, end actuator 712 a pair of lower collapsible hydraulic members 747 and a pair of upper collapsible hydraulic members 748. In some active versions, the lower and upper collapsible hydraulic members 747, 748 are collapsible hydraulic balloons configured to expand from a contracted state toward a collapsed state. expanded to fracture the tissue and cover the side edges 745, 746. It should be appreciated that such lower and upper collapsible hydraulic balloons 747, 748 can be inflated and operatively maintained as discussed above in relation to other balloons discussed in the present invention. In some passive versions, lower and upper deformable hydraulic members 747, 748 hold a predetermined amount of fluid respectively in each member 747, 748 to crush the tissue without transitioning between contracted and expanded states.

[0104] In use as shown in Figures 18A to 18B, the lower and upper jaws 220, 222 in the open configuration and configured to receive tissue between the crushing surfaces 714, 716 of lower and upper deformable hydraulic balloons 747, 748. When tissue is received in the open configuration, the upper grip 222 rotates towards the lower grip 220 for the closed configuration with the fabric captured between them. The operator then selectively manipulates fluid actuator 226 (see Figure 7) to direct fluid from fluid reservoir 215 (see Figure 7) and into upper and lower collapsible hydraulic balloons 747, 748, thereby expanding the lower and upper collapsible hydraulic balloons 747, 748 from the contracted state as shown in Figure 18B to the expanded state as shown in Figure 18C.

[0105] During this expansion, as shown in Figures 19A to 19B, the lower and upper crushing surfaces 714, 716 on the lower and upper deformable hydraulic balloons 747, 748, respectively, compress the tissue between them. Lower and upper collapsible hydraulic balloons 747, 748 also atraumatically propel tissue away from upper and lower side edges 745, 746 to inhibit unintentional tissue damage during the operation. Compression continues until tissue fracture or fluid pressure, as monitored by the 319 Pressure Control System (see Figure 12A), reaches the predetermined maximum expansion pressure. In the context of liver or other similar tissue, the staple cartridge 70 is fired to ligate and transect the vessels or ducts 202 (see Figure 6F).

F. Exemplary End Actuator with a Deformable Member for Tissue Insertion Fracture

[0106] Figures 20 to 21B show yet another exemplary surgical instrument 810 having an end actuator 812 that includes a collapsible hydraulic member in the form of a hydraulic catheter 850. The hydraulic catheter 850 includes a central tube 852 defining a lumen 854 that extends through it. Lumen 854 is configured to receive a guidewire (not shown) to direct the site of hydraulic catheter 850 in use. Additionally, or alternatively, the hydraulic catheter 850 can be guided by a guiding catheter and/or any other suitable guiding device. It should be understood, therefore, that lumen 854 and a corresponding guidewire are merely optional.

[0107] The hydraulic catheter 850 catheter further includes a collapsible hydraulic bladder 856. The fluid is stored within a fluid reservoir 815, which is in fluid communication with the collapsible hydraulic bladder 856. The fluid reservoir 815 is configured to deliver the fluid to the collapsible hydraulic balloon 856 to expand the collapsible hydraulic balloon from the contracted state shown in Figure 21A toward the expanded state shown in Figure 21B.

[0108] In use, the operator inserts the guide wire (not shown) into the tissue to the location where the operator wishes to position the collapsible hydraulic balloon 856 as shown in Figure 22A. Alternatively, the operator achieves positioning as shown in Figure 22A with the use of a guiding catheter and/or some other guiding device. Once the hydraulic balloon 856 is properly positioned, and as shown in Figure 22B, the operator inserts the collapsible hydraulic balloon 856 into the tissue (and along the guidewire, if a guidewire is used). When the collapsible hydraulic balloon 856 is in the desired position, the operator directs fluid from the fluid reservoir 815 and into the collapsible hydraulic balloon 856. In turn, the collapsible hydraulic balloon 856 expands from the contracted state to the expanded state and fractures. of fabric to cut the portion of fabric shown in Figure 22C.

IV. Exemplary combinations

[0109] The following examples refer to various non-exhaustive ways in which the teachings of the present invention can be combined or applied. It is to be understood that the examples below are not intended to restrict the coverage of any embodiments that may be presented at any time in this application or in subsequent filings to this application. No waiver of rights is intended. The following examples are provided for illustrative purposes only. It is contemplated that the various teachings of the present invention may be arranged and applied in various other ways. It is also contemplated that some variations may omit certain features referred to in the examples below. Therefore, none of the aspects or features referred to below should be considered critical, unless explicitly stated otherwise at a later date by the inventors or a successor of interest to the inventors. If any embodiments are presented in the present application or in subsequent filings relating to this application that include additional features in addition to those referenced below, it is not presumed that those additional features have been added for any reason related to patentability.

Example 1

[0110] Surgical instrument characterized by the fact that it comprises: (a) a drive shaft assembly; and (b) an end actuator extending in a longitudinal direction from the drive shaft assembly, the end actuator comprising: (i) a first jaw, (ii) a second jaw movably mounted on with respect to the first gripper and configured to transition between an open configuration and a closed configuration, such that the first and second gripper are configured to have tissue positioned therebetween in the closed configuration, and (iii) a first deformable hydraulic member that engages extends longitudinally and positioned adjacent to at least one of the first and second jaws, the first hydraulically deformable member being configured to contain a fluid, the first hydraulically deformable member with the fluid contained therein being configured to fracture the positioned tissue between the first and second jaws in the closed configuration.

Example 2

[0111] The surgical instrument of Example 1 in which the first deformable hydraulic member extends longitudinally between the first and second claws in the closed configuration.

Example 3

[0112] The surgical instrument of any one or more of Examples 1 and 2 wherein the first deformable hydraulic member contains the fluid.

Example 4

[0113] The surgical instrument of Example 3 in which the first deformable hydraulic member extends along the first claw.

Example 5

[0114] The surgical instrument of Example 4 in which the end actuator further includes a second deformable hydraulic member extending longitudinally along the second claw, the second deformable hydraulic member containing the fluid, and the first and the second deformable members are configured to fracture the tissue therebetween in the closed configuration.

Example 6

[0115] The surgical instrument of any one or more of Examples 4 and 5 wherein the first gripper includes a longitudinally extending edge, and wherein the first deformable hydraulic member is positioned along at least a portion of the edge.

Example 7

[0116] The surgical instrument of any one or more of Examples 3 to 6, further comprising a staple cartridge received within the second jaw, the staple cartridge comprising: i a platform facing the second jaw, ii a a plurality of clip openings formed across the platform, and iii a plurality of clips respectively positioned within the plurality of clip openings, the first hydraulically deformable member extending longitudinally along the platform.

Example 8

[0117] The surgical instrument of any one or more of Examples 1 to 7, wherein the first deformable hydraulic member is configured to expand from a contracted state to an expanded state, and wherein the first deformable hydraulic member is configured to fracturing the tissue positioned between the first and second prongs as the expandable member expands from the contracted state to the expanded state.

Example 9

[0118] The surgical instrument of Example 8 in which the first deformable hydraulic member extends along the first claw.

Example 10

[0119] The surgical instrument of Example 9 in which the end actuator further includes a second deformable hydraulic member that extends longitudinally along the second claw, the second deformable hydraulic member being configured to contain the fluid, and being that the first and second deformable members are configured to fracture the tissue therebetween in the closed configuration as the first hydraulic deformable member expands from the contracted state to the expanded state.

Example 11

[0120] The surgical instrument of Example 10 in which the second deformable member is configured to expand from the contracted state to the expanded state, and the first and second deformable members are configured to fracture the tissue between them in the closed configuration as the first and second hydraulic deformable members expand from the contracted state to the expanded state.

Example 12

[0121] The surgical instrument of any one or more of Examples 9 to 11 wherein the first claw includes a longitudinally extending edge, and wherein the first deformable hydraulic member is positioned along at least a portion of the edge.

Example 13

[0122] The surgical instrument of any one or more of Examples 8 to 12 further comprising a staple cartridge received within the second jaw, the staple cartridge comprising: (i) a platform facing the second jaw, ( ii) a plurality of clip openings formed through the platform; and (iii) a plurality of clips respectively positioned within the plurality of clip openings, the first hydraulically deformable member extending longitudinally along the platform.

Example 14

[0123] The surgical instrument of any one or more of Examples 8 to 13, further comprising a pressure control system comprising: (i) a fluid actuator configured to direct fluid to the first deformable member to expand the first deformable member from the contracted state to the expanded state, (ii) a pressure sensor operatively connected to the first deformable member and configured to sense a measured pressure within the first deformable member, and (iii) a controller operatively connected to the actuator pressure sensor and the controller is configured to monitor the measured pressure within the first collapsible member through the pressure sensor and to cease directing fluid into the first collapsible member through the fluid actuator when the measured pressure increases to a predetermined maximum pressure.

Example 15

[0124] The surgical instrument of any one or more of Examples 1 to 14 in which the end actuator further includes a pressure relief reservoir fluidly connected to the first deformable member, wherein the first deformable member is configured to contain the fluid up to a predetermined maximum pressure, and wherein an excess pressure greater than the predetermined maximum pressure is configured to direct fluid from the first collapsible member to the pressure relief vessel such that the collapsible member and the pressure relief vessel are configured to maintain the pressure within the first deformable member equal to or less than the predetermined maximum pressure.

Example 16

[0125] A staple cartridge, comprising: (a) a platform; (b) a plurality of openings for staples formed through the platform; (c) a plurality of clips respectively positioned within the plurality of clip openings; and (d) a hydraulically deformable member positioned along the platform and configured to contain a fluid therein, the first hydraulically deformable member with fluid contained therein configured to fracture the tissue.

Example 17

[0126] The surgical instrument of Example 16 in which the first deformable hydraulic member is configured to expand from a contracted state to an expanded state upon receiving the fluid therein.

Example 18

[0127] A method of operating on a tissue with a deformable hydraulic member configured to contain a fluid, the method comprising directing the deformable hydraulic member against a portion of the tissue, thereby fracturing the portion of the tissue to cut the tissue.

Example 19

[0128] The method of Example 18 further comprising expanding the deformable hydraulic member from a contracted state to an expanded state.

Example 20

[0129] The method of Example 19 wherein the tissue is a liver parenchymal tissue, and the method further includes inserting the deformable hydraulic member into the liver parenchymal tissue.

V. Other components

[0130] It should be understood that any one or more of the teachings, expressions, modalities, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. which are described in the present invention. The teachings, expressions, modalities, examples, etc. described above should therefore not be seen in isolation from each other. Various suitable ways in which the teachings of the present invention may be combined will become readily apparent to those skilled in the art in view of the teachings of the present invention. Such modifications and variations are intended to be included within the scope of the appended embodiments.

[0131] It should be understood that any patent, publication, or other descriptive material incorporated into the present invention by way of reference, in whole or in part, are incorporated into the present invention only to the extent that the incorporated material does not conflict with the definitions, statements or other disclosed material set forth in this description. Accordingly, and to the extent necessary, the description as explicitly set forth herein supersedes any conflicting material incorporated into the present invention by way of reference. Any material, or portion thereof, incorporated herein by reference but which conflicts with existing definitions, statements, or other descriptive materials presented herein, is incorporated herein only to the extent that there is no conflict between the material incorporated and existing descriptive material.

[0132] Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in robotic-assisted medical treatments and procedures. By way of example only, various teachings of the present invention can be readily incorporated into a robotic surgical system such as the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, California, USA. Similarly, those skilled in the art will recognize that various teachings herein can be readily combined with various teachings from any of the following: US Patent No. 5,792,135, entitled "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity" , issued August 11, 1998, the description of which is incorporated herein by reference; US Patent No. 5,817,084, entitled "Remote Center Positioning Device with Flexible Drive", issued October 6, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent No. 5,878,193, entitled "Automated Endoscope System for Optimal Positioning", issued March 2, 1999, the disclosure of which is incorporated herein by reference; U.S. Patent No. 6,231,565, entitled "Robotic Arm DLUS for Performing Surgical Tasks", issued May 15, 2001, the description of which is incorporated herein by reference; US Patent No. 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument", issued August 31, 2004, the disclosure of which is incorporated herein by reference; US Patent No. 6,364,888, entitled "Alignment of Master and Slave in a Minimally Invasive Surgical Apparatus", issued April 2, 2002, the description of which is incorporated herein by reference; US Patent No. 7,524,320 entitled "Mechanical Actuator Interface System for Robotic Surgical Tools", issued April 28, 2009, the description of which is incorporated herein by reference; US Patent No. 7,691,098, entitled "Platform Link Wrist Mechanism", issued April 6, 2010, the description of which is incorporated herein by reference; US Patent No. 7,806,891, entitled "Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery," issued October 5, 2010, the description of which is incorporated herein by reference; in US Publication No. 2013/0012957 entitled "Automated End Effector Component Reloading System for Use with a Robotic System", published January 10, 2013, the description of which is incorporated herein by reference; in US Publication No. 2012/0199630 entitled "Robotically-Controlled Surgical Instrument with ForceFeedback Capabilities", published August 9, 2012, the description of which is incorporated herein by reference; in US Publication No. 2012/0132450 entitled "Shiftable Drive Interface for Robotically-Controlled Surgical Tool", published May 31, 2012, the description of which is incorporated herein by reference; in US Publication No. 2012/0199633 entitled "Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements", published August 9, 2012, the description of which is incorporated herein by reference; in US Publication No. 2012/0199631 entitled "Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds", published August 9, 2012, the description of which is incorporated herein by reference; in US Publication No. 2012/0199632 entitled "Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector", published August 9, 2012, the description of which is incorporated herein by reference; in US Publication No. 2012/0203247 entitled "Robotically-Controlled Surgical End Effector System", published August 9, 2012, the description of which is incorporated herein by reference; in US Publication No. 2012/0211546 entitled "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot", published August 23, 2012; in US Publication No. 2012/0138660 entitled "Robotically-Controlled Cable-Based Surgical End Effectors", published June 7, 2012, the description of which is incorporated herein by reference; and/or US Publication No. 2012/0205421 entitled "Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems", published August 16, 2012, the description of which is incorporated herein by reference.

[0133] Versions of what was described above can be designed to be discarded after a single use, or they can be designed to be used multiple times. Versions may, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts, and subsequent reassembly. Specifically, some versions of the device can be disassembled into any number of particular parts, or device parts can be selectively replaced or removed in any combination. By cleaning and/or replacing specific parts, some versions of the device can be reassembled for subsequent use in an overhaul facility or by an operator immediately prior to a surgical procedure. Those skilled in the art will understand that refurbishing a device can use a variety of disassembly, cleaning/replacement, and reassembly techniques. The use of these techniques, as well as the resulting refurbished device, are all within the scope of this application.

[0134] Just as an example, the versions described here can be sterilized before and/or after a procedure. In a sterilization technique, the device is placed in a closed, sealed container, such as a plastic or TYVEK bag. The container and device can then be placed in a field of radiation, such as gamma radiation, X-rays or high-energy electrons, which can penetrate the container. Radiation can kill bacteria in the device and container. The sterilized device can then be stored in a sterile container for later use. The device may also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide or water vapor.

[0135] Having shown and described various embodiments of the present invention, further adaptations of the methods and systems described in the present invention can be carried out through suitable modifications by a person skilled in the art without departing from the scope of the present invention. Several such possible modifications have been mentioned, and others will be apparent to those skilled in the art. For example, the examples, modalities, geometry, materials, dimensions, proportions, steps and the like discussed above are illustrative and are not binding. Accordingly, the scope of the present invention is to be considered in accordance with the terms of the following embodiments and it is understood that the same is not limited to the details of structure and operation shown and described in the specification and drawings.

Claims (15)

1. Surgical instrument, comprising: (a) a drive shaft assembly (30); and (b) an end actuator (212, 312, 412, 512, 612, 712, 812) extending in a longitudinal direction from the drive shaft assembly (30), the end actuator (212, 312, 412, 512, 612, 712, 812) comprising: (i) a first gripper (220), (ii) a second gripper (222) movably mounted relative to the first gripper (220) and configured to transition between a configuration open and a closed configuration such that the first and second grippers (220, 222) are configured to have tissue positioned between them in the closed configuration, and (iii) a first collapsible hydraulic balloon (213, 313, 513, 747) extending longitudinally and positioned adjacent to at least one of the first and second grippers (220, 222), wherein the first collapsible hydraulic balloon (213, 313, 513, 747) is configured to contain a fluid, characterized in that the first balloon The deformable hydraulic device (213, 313, 513, 747) with the fluid contained therein comprises a first crushing surface (214, 314, 514, 714) that is configured to engage and fracture tissue positioned between the first and second jaws (220, 222) in the closed configuration. 2. Surgical instrument according to claim 1, characterized in that the first deformable hydraulic balloon (213, 313, 513, 747) extends longitudinally between the first and second claws (220, 222) in the closed configuration. 3. Surgical instrument according to claim 1, characterized by the fact that the first deformable hydraulic balloon (213, 313, 513, 747) contains the fluid. 4. Surgical instrument according to claim 3, characterized in that the first deformable hydraulic balloon (213, 313, 513, 747) extends along the first claw (220). 5. Surgical instrument according to claim 4, characterized in that the end actuator (212, 312, 412, 512, 612, 712, 812) further includes a second deformable hydraulic balloon (644) extending longitudinally to the along the second gripper (222), wherein the second collapsible hydraulic balloon (644) contains the fluid, and wherein the first and second collapsible balloons (213, 313, 513, 747; 644) are configured to fracture the tissue between them in closed configuration. 6. Surgical instrument according to claim 4, characterized in that the first claw (220) includes an edge (745) extending longitudinally, and in which the first deformable hydraulic balloon (747) is positioned along least a portion of the rim (745). 7. Surgical instrument according to claim 3, characterized in that it further comprises a staple cartridge (70) received within the first claw (220), the staple cartridge (70) comprising: (i) a platform ( 73) facing the second jaw (222), (ii) a plurality of clip openings (74) formed across the platform (73), and (iii) a plurality of clips (77) respectively positioned within the plurality of clip openings (74), wherein the first deformable hydraulic balloon (213, 313, 513, 747) extends longitudinally along the platform (73). 8. Surgical instrument according to claim 1, characterized in that the first deformable hydraulic balloon (213, 313, 513, 747) is configured to expand from a contracted state to the expanded state, and in which the first collapsible hydraulic balloon (213, 313, 513, 747) is configured to fracture the tissue positioned between the first and second claws (220, 222) as the first collapsible hydraulic balloon (213, 313, 513, 747) expands from the contracted state to the expanded state. 9. Surgical instrument according to claim 8, characterized in that the first deformable hydraulic balloon (213, 313, 513, 747) extends along the first claw (220). 10. Surgical instrument according to claim 9, characterized in that the end actuator (212, 312, 412, 512, 612, 712, 812) further includes a second deformable hydraulic balloon (644) extending longitudinally to the along the second jaw (222), wherein the second collapsible hydraulic balloon (644) is configured to contain the fluid, and wherein the first and second collapsible balloons (213, 313, 513, 747; 644) are configured to fracture the woven therebetween in the closed configuration as the first deformable hydraulic balloon (213, 313, 513, 747) expands from the contracted state to the expanded state. 11. Surgical instrument according to claim 10, characterized in that the second deformable balloon (644) is configured to expand from the contracted state to the expanded state, and in which the first and second deformable balloons (213, 313 , 513, 747; 644) are configured to fracture the tissue between them in the closed configuration as the first and second collapsible balloons (213, 313, 513, 747; 644) expand from their contracted state to their expanded state. 12. Surgical instrument according to claim 9, characterized in that the first claw (220) includes a longitudinally extending edge (745), and in which the first deformable hydraulic balloon (747) is positioned along the least a portion of the rim (745). 13. Surgical instrument according to claim 8, characterized in that it further comprises a staple cartridge (70) received within the first claw (220), the staple cartridge (70) comprising: (i) a platform ( 73) facing the second jaw (222), (ii) a plurality of clip openings (74) formed across the platform (73), and (iii) a plurality of clips (77) respectively positioned within the plurality of clip openings (74), wherein the first deformable hydraulic balloon (213, 313, 513, 747) extends longitudinally along the platform (73). 14. Surgical instrument according to claim 8, characterized in that it further comprises a pressure control system (319, 419) comprising: (i) a fluid actuator (226) configured to direct fluid into the first collapsible hydraulic balloon (213, 313, 513, 747) for expanding the first collapsible hydraulic balloon (213, 313, 513, 747) from the contracted state to the expanded state, (ii) a pressure sensor (437) so connected operational to the first collapsible hydraulic balloon (213, 313, 513, 747) and configured to sense a measured pressure within the first collapsible hydraulic balloon (213, 313, 513, 747), and (iii) a controller (438) so connected operational to the fluid actuator (226) and the pressure sensor (437), wherein the controller (438) is configured to monitor the measured pressure inside the first collapsible hydraulic balloon (213, 313, 513, 747) via the pressure sensor (213, 313, 513, 747). pressure (437) and cease directing the fluid into the first collapsible hydraulic balloon (213, 313, 513, 747) via the fluid actuator (226) when the measured pressure increases to a predetermined maximum pressure. 15. Surgical instrument according to claim 1, characterized in that the end actuator (212, 312, 412, 512, 612, 712, 812) further includes a pressure relief reservoir (327) fluidly connected to the first collapsible hydraulic balloon (213, 313, 513, 747), wherein the first collapsible hydraulic balloon (213, 313, 513, 747) is configured to contain the fluid to a predetermined maximum pressure, and wherein a greater excess pressure than the predetermined maximum pressure is configured to direct fluid from the first collapsible hydraulic balloon (213, 313, 513, 747) to the pressure relief reservoir (327) so that the first collapsible hydraulic balloon (213, 313, 513 , 747) and the pressure relief vessel (327) are configured to maintain the pressure within the first collapsible hydraulic bladder (213, 313, 513, 747) equal to or less than the predetermined maximum pressure.