CA1058038A - Surgical stapling instrument - Google Patents
Surgical stapling instrumentInfo
- Publication number
- CA1058038A CA1058038A CA309,535A CA309535A CA1058038A CA 1058038 A CA1058038 A CA 1058038A CA 309535 A CA309535 A CA 309535A CA 1058038 A CA1058038 A CA 1058038A
- Authority
- CA
- Canada
- Prior art keywords
- staple
- cartridge
- thrust bar
- staples
- instrument
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Abstract
A B S T R A C T
A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient in order to effect a joining of the skin or fascia. The instrument is adapted to associate with a staple-carrying cartridge having a plurality of staples therein. The instrument is manually powered and includes a nose portion rotatably mounted in a hand held main body portion and adapted to mount the staple-carrying cartridge so that the stapling angle can be varied without rotating the hand-held portion of the stapler. A clutch means is provided for ensuring that the staple-advancing drive means of the instru-ment is only activated once per stapling operation. The instru-ment is further provided with means for preventing the insertion of a fresh staple-carrying cartridge until the instrument is in the readiness position for a driving stroke, and means for main-taining the unloaded instrument in its readines position until equipped with a cartridge.
A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient in order to effect a joining of the skin or fascia. The instrument is adapted to associate with a staple-carrying cartridge having a plurality of staples therein. The instrument is manually powered and includes a nose portion rotatably mounted in a hand held main body portion and adapted to mount the staple-carrying cartridge so that the stapling angle can be varied without rotating the hand-held portion of the stapler. A clutch means is provided for ensuring that the staple-advancing drive means of the instru-ment is only activated once per stapling operation. The instru-ment is further provided with means for preventing the insertion of a fresh staple-carrying cartridge until the instrument is in the readiness position for a driving stroke, and means for main-taining the unloaded instrument in its readines position until equipped with a cartridge.
Description
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This is a divisional of Canadian Patent Application Serial No. 181,498 filed September 20, 1973.
;' In Canadian Patent No. 953,997 issued September 3, 1977 to United States Surgical Corporation, there is disclosed :~ a surgical stapler for joining the disunited skin of a patient.
The surgical stapler disclosed in this application employs a staple-carrying cartridge comprising an anvil adapted to lie 1ush with the skin, a plurality of staples which are to be follded around the anvil, and a pusher for ejecting and bending j 10 the staples around the anvil. The surgical stapling instrument ;~
adapted to accept the staple-carrying cartridge in th-s application is powered~l by a pressurized gas. Later develop-,, ments of the gas-powered stapler and cartridge for applying !.;~" sur~ical staples to external skin and internal fascia and ~j ; , disclosed in U.S. Patent No. 3,662,939 issued May 16, 1972 ',~ to United States Surgical Corporation.
`~ Although these gas-powered instruments represent a .;, :
marked advanced over the state of the art, there are certain ~; disadvantages associated with the use of gas-powered units ;: ,................................................................... .. .
~ , 20 of this type~ One of the obvious disadvantages is the ~`
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necessity forlreplacing the gas cartridges af~er their con-~^ tents have been exhausted, and a second is the inconvenience .,:: ;
associated with storing and main~aining a supply of these ~ cartridges. Also, the powering mechanism is complex, is ; ; hence somewhat costly, and comprises numerous close-tolerance elements which tend to be susceptible to malfunction. For these and other obvious reasons, it would be advantageous to ~- have a ~imple surgical stapling instrument adapted to accept ~j staple~carry ng cartridges of the type disclosed in the above patent application and patent, but which is powered manually and without the intervention of a gaseous medium and , , .
-~- the disadvantages associated therewith.
~ 2 ~o~i~303~ `
: Accordingly, it is a broad object of the present ~: invention to provide a surgical stapling instrument for stapling the disunited skin or fascia of a patient which is manually ''?I powered and wholly operated by mechanical means.
~` It is a primary object of the present invention to .: provide a surgical stapler with means for ensuring that the ù s~aple-advancing drive means of the instrument is activated ~:
only once in each stapling operation.
These and other objects of the inven~ion, as well as many of the attendant advantages thereof, will become more ~' readily apparent when reference is made to the following description taken in conjuction with the accompanying drawings.
In accordance with the invention in one aspect there . ~ , .
is provided a surgic~l stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the ~ki.n or fascia, the instrument adapted to associate with a staple-carrying cartridge having ``
anvil means at one end thereof ancl adapted to house a plurality of staples therein, a pusher element slidably mounted therein `i:`'` 20 for ejecting staples from said cartridge and for forming said ;-staples around said anvil means, and means for advancing said ~.
staples in said cartridge, said surgical stapling instrument comprising: a main body portion; means for mounting said staple-carrying cartridge on said main body por~ion; drive means to activate said staple-advancing means for driving the .".~. ~, . , staples toward said anvil mean~ and for drivi.ng the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means;
~ . and cl~tch means for preventing said drive means for acti-" ~
vating said staple-advancing means more than once in each . stapling operation, said clutch means comprising two surfaces .
~" movable relative to one another with one of said two surfaces ~ i ~
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being sloped relative to the other, a roller positioned be-' :
~ tween said two surfaces, and a wedge memberr in one of said '~ two surfaces, said wedge member~adapted to permit said roller , means to move therepast only at the respective ends of the ; drive means stroke.
~; A t~pical embodiment of the surgical stapling instrument generally comprises a main body portion having a . . .
~ nose portion rotatably mounted therein and adapted to receive : ~ `
and mount a staple-carrying cartridge. The nose portion of .: :
1~ 10 the stapler houses the drive means for advancing and forming . : .
the staples. A pusher-activating means for driving the pusher ,~ element of the staple-carry~ng cartridge to eject and form the `, staples around the anvil means of the cartridge comprises ``' a thrust bar slidably mounted for reciprocative movement in the nose port~on of the stapler. The thrust bar is attached to and adapted to~move with a collar element slidably mounted ':'`!''` on the nose portion of the stapler. A trigger means comprises ....... . .
~ a handle which is pivotally mounted on the main body portion ~, . . .
of the stapler and has means for engaging the collar element so that the thrust bar is m~ved forward by squeezing the trigger. A ireturn spring attached to the trigger and to the main body portion of the stapler functions to return the thrust bar to its initial position after the thrust st~oke of , 3'f the bar has been completed.
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The drive means to activate the st~ple-advancing -~
means in the staple-carrying cartridge for driving the staples .
toward the anvil comprises pinion gears and pinion shafts also housed within the no~e portion of the stapler. The `
.. . ~ .
teeth of the pinion gears mesh with the teeth of a main gear '!` '.
which is a~apted to rotate in unison with a ratchet. The main gear and ratchet are rotatably mounted mn the rear nose .
~;, portion of the stapler. An index pawl pivotally attached to ~''``,' `
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the thrust bar and operatively associated with the ~atchet causes the ratchet, main gears, and pinions to rotate when the thrust bar is initially moved forward and thus activates the staple-advancing~ means in the cartridge.
As was the case in the above-mentioned application and patent, it is desirable to rotate the particular drive -screws of the staple-carrying cartridge 360 each time a staple is be~ng ejected by first overdriving and then return-driving the screws. Accordingly, and similar to the gear boxes ; " ' :
;~:, 10 disclosed in the above-mentioned application and patent, the -~ drive means for advancing staples of the present invention isadapted to be over-driven and then returned to a position wherein the drive screws of the cartridge are rotated exactly . . .
360. The return movement of the staple advancing drive means ;
; is accomplished by a spring p~wl which cooperates with the above-mentioned ratchet. This spring pawl also functions as ~. ., ``~';; a stop, preventing excessive return rotation of the ratchet.
Means are also providëdl-ifor~perventing~!;more.than~one staple from being placed in the ready positio~ of the staple-carrying cartridge during the stapling operation. This means comprises a clutch means which prevents -the return of the thrust bar to its initial position until it has completed a full stroke, thereby ejecting a staple from the staple-carrying cartridge. The clutch means includes a cam block mounted in the forward end of the nose portion of the stapler and having . ~. . ..
an inclined surface facing the thrust bar. The forward end of the thrust bar passes through the cam blook and operatively `;; engages a cylindrical roller positioned b-etween the thrust bar and the inclined surface of the cam blaok. The cam block ,. :. ;
~: 30 houses a spring-biased wedge which cooperates wi-th the i - cylindrical roller. The cooperation between these elements is such that the cylindrical ro~ller prevents the thrust bar '~"''' :
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from being returned to its initial position until it has completed a full driving thrust movement.
Means are further provided for preventing the for-ward movement of the thrust bar until a staple-carrying car--- tridge has been mounted on the s~apler. This means comprises ,.. .
- a cartridge interlock housed in the forward end of the nose portion of the stapler and spring biased into a position such ~` that it blocks the forward movement of the thrust bar until a cartridge is properly mounted. In its initial position, ,., , :.
~ 10 the forward end of the thrust bar abuts the rear face of the :, ~
;~; cartridge interloak. When the staple-carrying cartridge is ,.. ~ . . . .
" mounted, the cartridge interlock is forced upward by the : : :
staple-carrying cartridge, thereby registering an opening in the cartridge interlock with the forward end ofi the thrust bar such that the thrust bar is capable of ~eing moved for-ward and driving the pusher element of the staple-carrying cartridge to eject and form the staples.
'~` The forwardmost staple in the staple-carrying car-, ..................................................................... .
~, tridge is advanced into the ready position during the initial stage of the forward thrust stroke of the thrust har. At ` ~ this point, tnd ~ith the thrust ~ar partially advanced, it ~- is possible to remove the staple-carrying cartridge from the stapler. Under these circumstances, the clutch means prevents ; the thrust bar from returning to its initial position. `
Accordingly, the thrust bar must be fully advanced before it ~; will be automatically returned to i~s initial position. The `'~ surgeon or his attendant may not remember to follow this .
`~ procedure, however, and may attempt to mount a staple-carrying' ~ cartridge in the stapler while the thrust bar is in this `:~ 30 partially advanced position. This procedure could result in ,~ jamming the drive mechanisms of the staple-carrying cartridge -~; or other undesirable mechanical difficulty.
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To prevent such ~amming, means are provided for pre-venting a cartridge from being mounted unless the thrust bar has returned to its initial position. This means comprises . .. ;
a cartridge stop lock mounted in the forward end of the nose . portion of the stapler. When the thrust bar is in its initial ~ position, the cartridge stop lock is oriented so that a staple-.,, ~ carrying cartridge can be easily locked in the stapler. If , .
the thrust bar is not in its initial position, however, but . .; .
' rather is in a partially advanced position, the cartridge stop .~
lock is spr~mg biased into a blocking position so rlthat a staple-carrying cartridge cannot be fully mounted in the .;.~ .
,~r, stap~er.
While the initial movement of the trigger advances ~` .
~` the staples and the intermediate movement readies the car-~, tridge for the stapling operation, only the final stages of trigger movement effect the e~ection and formation of a ~j staple. Accordingly, it is desirable to alert the surgeon to the fact that a staple is about to be ejected so that the : .
~1 surgeon can be sure that the instrument is properly positioned.
. . .
In fact, the inventi~e instrument could be operated remo~e from the patient until the last stage of trigger movement, and ` only then oriented in readiness for a stapling operation. As i~
part of the present invention, the stapler is provided with a spring-biased wedge housed in the nose portion of the stapler . .:
which snaps into a notch on the top surface of the thrust bar with an audible "click" just before a staple is to be eject~d.
~` At the same time, the surgeon will also feel a slight but , ~
` noticeable change in the force required to squeeze the trigger, .~;,:;
~;~ thus further alerting him to the fact that a staple is about to be ejected.
. ::,,- . ;
-~ As just described, ~he drive means for advancing ; staples in the staple-carrying cartridge and for ejecting .,, ,.~ ..
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;' staples therefrom are housed in the nose portion of the i~ stapler which is rotatably mounted in the main body portion. --: Since the staple-carrying cartridge is mounted in the nose ....
portion and rotatable therewith, it is possible to change the stapling angle of the stapler by merely rotating the nose portion while maintaining the hand-held main body portion in "~` a fixed position.
Fig. 1 is a vertical cross section of the surgical ; stapling mnstrument of the present invention;
Fig. 2 is a horizontal cross section taken along .i` . :
` line 2-2 of Fig. l;
Fig. 3 is similar to Fig. 2 but shows a portion of ~ ;.:: , ' the stapler during the stapling operation;~:
`;~ Fig. 4 is a horizontal, fragmentary view of a portion of the staple-advancing drive mechanism of the stapler during ` the staplin~ operation;
~ ~ Fig. 5 is a vertical cross section of the stapler ,~, looking rearwardly;
; Fig. 6 is a side view, partially in section, of the . . .: ~, ~ ,20 staple-carrying cartridge mounting pertion of the stapler i~ after the ~artridge is mounted and ready for use;
"~, , ` Fig. 7 is a front view of the stapler with the $ ,-~
~` staple-carrying cartridge mounted and ready for use;
Fig. 8 is a vertical cross section taken along line ~`~ 8~8 of Fig. 2 and showing the clutch means;
` ~ Figs. 9-12 are sequential views showing the operation ...
~ - of the clutch means during a stapling operation;
, ~, . .
, Fig. 13 is a vertical cross section taken along line ~-~" 13-13 of Fig. 2 and showin~ the position of the cartridge interlock before the staple-carrying cartridge is inserted;
~,`; Fig. 14 is simiilar to Fig. 13 but shows the cartridge ,.. .. .
~` interlock after the insertion of the staple-carrying cartridge : ~;. .
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.. ,,: . :
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., which is shown in phantom lines;
Fig. 15 is a vertical cross sec~on taken along line 15-15 of Fig. 2 and showing the position of the cartridge stop lock before the thrust bar has been advanced;
Fig. 16 is similar to Fig. 15 but shows the cartridge stop lock after the ~hrust bar has been partially advanced;
,~i Fig. 17 shows the cooperation between the inclined ~-~, surfaces of the thrust bar and cartridge stop lock;
.....
Fig, 18 is a horizontal cross section taken along ~ 10 li~e 18-18 of Figl 1 and showing the location plate for ;` , locating the cartridge interlock, cartridge stop lock, and pusher-engaging portion of the thrust bar;
Fig. 19 is an enlarged view ~f the rear portion of ` a staple-carrying cartridge with its cover removed;
` Fig. 20 is a cross section taken ~long line 20-2~ of ;~ Fig. 19;
~` Fig. 21 is a vertical cross section of the front ,.~, portion of a staple-carrying cartridge; and Fig. 22 is a view of the front portion of the car-~, 20 tridge during the stapling operation with the cover removed.
, With reference first ~o Figs. 1-6, the surgical -stapler of the~present invèntion will be described in general terms. The spapler shown generally at 10 comprises housing ~ 12 having main body portion 14 and handle portion 16. Nose ", ` '~
portion 20 of stapler 10 is rotatably mounted in main ~ody portion,14 of housing 12. Nose portion 20 includes a front ~ !
section 22 extending out ofthousing 12 and adapted to mount staple-carrying cartridge 26. Nose portion 20 further includes .~"
` a rear section 24 located inside housing 12 and acting to `
--;` 30 housetthe--ldriving means for advancing, ejecting, and forming :. .
~ staples from the staple-carrying cartridge. Nose portion 20 ~
i, is conveniently formed in two parts, upper and lower, held ;
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together by a pair of screws 21 and held in relative alignment by dowel pins 23 and 25. Staple-carrying cartridge 26 is shown fitted into nose portion 20 of stapler lQ in Fig. 6.
The staples in staple-carrying cartridge 26 are advanced, ejected, and formed by mechanical means only and -~
i~` without the intervention of a gaseous medium. Accordingly, the .~ .,.,~ ..
power for advancing, ejecting, and forming the staples in car-tridge 26 comes from the manipulative force supplied to stapler 10 by the surgeon. This force is transmitted to the drive means of stapler 10 by means of trigger 28 which generally comprises a handle pivotally attached to housing 12. Pivoting of trigger 28 causes a thrust bar 30, the pusher-activating means, to drive the pusher element of staple-carr~ing cartridge 26 for~ard to eject and form a staple around the anvil means. At the same time, a ratchet 32 and .... . . .
` a main gear 34 housad in the rear portion 24 of nose 20 are ~ caused to rotate. Main gear 34, in turn, rotates a pair of ;~ pinion gears 3~ and pinion shafts 38 which associate with -the cartridge 26 to advance the staples.
~ 20 With reference now to Figs. 1 and 5, trigger 28 will ;} be described. Trigger 28 is pivotally mounted to housing 12 -,.:
by means of stud 40 and drive pin 42. Trigger 28 is of appropriate size and shape to be conveniently gripped by the operating hand of a surgeon. T~e trigger includes a rearward extending portion 44 to which is attached one end of a keturn spring 46. The other end of return spring 46 is attached to '`''~t housing 12 and functi~ns to return trigger 28 and thrust bar ~ 30 to their initial positions after staple forming has ;~ ~
., ." . .. .
occurred. Trigger 28 is of "Y" shape and includes a lower 30 hand-engaging portion 48 and an upper force-transmitting yoke ~`t', portion 50. Yoke 50 em~races a collar 52 slidingly mounted around the midsection of nose portion 20 and adapted to ,....................................................................... ..
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,' rotate therewith. Collar 52 includes a cylindrically-shaped . body member 54 having outwardly and radially extending flange portions 56 at each end. Yoke 50 is positioned around cylindrically-shaped body member 54 and bet~een flange por-; tions 56. Shoulder portions 55 and 57 of nose portion 20 limit the forward and riaarward movement, respectively, of ;
collar 52. Pivoting of trigger 28 results in longitudinally directed force's being exerted on collar 52 by yoke portion .. ..
50 ~f trigger 28. Accordingly, when the trigger is activated, ~ collar 52 simultaneously slides along the m dsection of nose ,~ ,.
20. Also, by this arrangement, collar 52 is free to rotate relative to trigger 28.
As best seen in Figs. 1, 3, and 17, the~`means for , ' f ; driving the pusher element of the staple-carrying cartridge ` to eject and form staples comprises thrust bar 30 which in-~
:. ~
cludes an elongated central section 58 having a wing portion 60 near the rear end thereof. A pusher-engaging extension ~: ~
62 and an inclined surface 64 are positioned at the forward-;~ most end of thrust bar 30. Inclined surface 64 is adapted ~; 20 to engage a stop lock mechanism which will be discussed ;~ i subsequently. A190 located near the front end of thrust bar i 30 is an elongated notch 66 which forms part of the clutch ~",. .
~;~; means of the present invention. Located near the rear end of ... ..
~ thrust bar 30 is a second notch 68 which engages the forward '!~' end of index pawl 70. Thrust bar 30 is slidingly mounted in , ~ ~
~` nose portion 20 and is adapted to rotate therewith. As ~
;~, ' illustrated in Fgg. 2, wing portion 60 of thrust bar 30 lies - near the mfidsection of collar 52, conveniently formed as two ~''i' .
~` semi-circular parts, and is rigidly attached to collar 52 by .::. .
~i 30 means of bolts 53. Accordingly, thrust bar 30 reciprocates .:~
; back and forth with collar 52 when trigger 28 is pivoted, and i:
~;~` collar 52 rotates with thrust bar 30 when nose portion 20 is ~; rotated.
~, -- 11 --.~,.~ . ,, ~: ,.,'; , : `
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;~` The staple-advancing drive means of the stapler 10 .. ..
~:! is arranged so that when thrust bar 30 is moved forward, the v' '~ elements forming a part of this arrangement are activated;
:, .
` that is, the forward motion of the pusher-activating element .
causes the rotation of the screws o staple-carrying car-tridge 26, thereby advancing the staples. And, as will be :, more fully described below, the staples are slightly over- -. .
driven during the forward stroke of thrust bar 30 and are then returned to their proper positions as will be discussed sub'sequently.
.... ,-; .
, With reference how to Figs. 1-4, the staple-drive ~; mechanism will be explained. The index pawl 70 is pivotally attached to the rear end of thrust bar 30. The transverse base portion 74 of spring 72 passes through aperture 76 in ~`~ thrust bar 30, and the inturned end of upstanding leg 78 o~
, spring 72 fits into one end of an aperture 80 in the rear ` end of thrust bar 30, and the inturned end of upstanding leg 82 fits through an aperture 84 in index pawl 70 and then into ~, the other end of aperture 80iint~hrustbbar 30. An upstanding ~'~t,-,, 20 leg 86 on the forward end of index pawl 70 fits i~to notch 68 in thrust bar 30O Notch 68 is trape~oidal in shape and has ' -`~ inclined surface 88. The combination of spring 72 and inclined ~; surface 88 of notch 68 allows index pawl 70 to pi~ot outwardly.
t~, Index pawl 70 rides along one wall of a six-tooth ~' ratchet 32 and engages one of the teeth thereof. The index pawl, pivotally mounted on thrust /ba~ 30, is biased toward ratchet 32 by spring ~2. Ratchet 32 is attached to, and ~ rotates with, a main gear 34. Ratchet 32 and maln gear 34 ;{,l are of unitary construction, as illustrated, and are r~tatably ~ 30 mounted in the rea~ end 24 of nose portion 20 by means of ;;;: . :
`; shaft 90. The teeth of main gear 34 mesh with the teeth of '' ~ - 12 -:., ~ ..
'.
.... . ., . . . . ~ . : .. :
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-two pinion gears 36, both of which are seen in the drawings.
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Pinion gears 36 are, in turn, attached to pinion sha~ts.38 ~` which are housed in, and extend longitudinally through, the nose portion 20 of stapler lO. A tapered cylindrical body portion 92 on the ratchet 32 and main gear 34 assembly pro-!`~ videss a stop for ~inion gears 36 which have a rear portion ~ 94 which abuts body portion 92 of the ratchet 32 and main .. . .
gea~ 34 assembly. (See Fig. l). T~is arrangement prevents ~` the pinion shafts from inadvertently being moved out of their ` 10 proper longitudinal position.
'~ !'' ~ Th~ust bar 30, index pawl 70, and ratchet 32 are - ~ arranged in such a manner that the forward stroke of thrust i~ bar 30 causes ratchet 32 and, accordingly, main gear 34 to move slightly more than 60. As noted previou~ly, it is ., ~ . . .
;~' desired to ultimately rotate the screws associated with staple-;~ carrying cartridge 26 precisely 360 for each staple-driving ~` operation. The staple-advancing drive means in stapler lO is arranged so that for each 60 turn of ratchet 32 and main gear 34, pinion shafts 38 and the screws in cartridge 26 are rotated ~, ....................................................................... .
360. However, to ensure that the staples are advanced in proper amount, it has been found desirakle to overdrive the ~; screws in cartridge 26, and thus the staples, and then to "
~.",~ :
:~, reverse the rotation of the screws so that ultima~ely they `
experience a net 360 rota~ion. It is for this reason that `^ six-tooth ratchet 32 is ~otated slightly more than 60. It ," , , .
~: becomes necessary, therefore, to provide me~ns for ~eturning ratchet 32 to its 60 position. The ratchet return is brought about by means of spring~T pawl 96 as will be dis- -:;
cussed subsequently.
With particular reference now to Figs. 2-4, the ;
.j ,~,. , - operation of the drive means for activating the staple-ad-~ ` vancing mechanism of the staple-carrying cartridge and for `` - 1 1:''''` : .
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d~iving the staples toward the anvil will be described. As shown in Fig. 2, thrust bar 30 is in its initial at-rest position. In this position, index pawl 70 is in engagement with ratchet 32. Too~h portion 102 of index pawl 70, which is the driving region thereof, i~ removed from the nearest tooth on ratchet 32 to allow for slight "play" before the ratchet 32 is rotated.
When thrust bar 30 moves forward during a stapling operation, index pawl 70 rotates ratchet 32. Ratchet 32 is . ~ . .
rotated in a clockwise direction as index pawl 70 is moved -~
forward with thrust bar 30. When ratchet 32 has been rotated ~ through approximately its desired maximum angle of slightly `- greater than 60, the back surface of an advancing tooth of ratchet 32 engages planar portion 104 near the end of index pawl 70 and forces tooth portion 102 of index pawl 70 out of , . .
engagement with ratchet 32. (See Fig. 4). The maximum angle through which ratchet 32 is rotated is greater than that needed to advance each staple one "staple unit". Thus, the staple-~` advanc ng drive means is momentarily overdriven; however, this condition is automatically corrected by spring pawl 96.
~i'` Referring now to Figs. 2 and 4, it can be seen that spring pawl 96 is attached to the rear end 24 of nose portion ,:
~-` 20 by means of a pin 97 and comprises an arcuate section ; ~ terminating at end 106. Spring pawl 96 contacts ratchet 32 ....~.1 ~:;` at two points in its initial position. First, end 106 of ~ ' ' ` i ~, spring p~wl 96 contacts one of the teeth of ratchet 32.
Second, a point on spring pawl 96 partially between end 106 and the arcuate section contacts the back surface of the . ,~. ~ , .
adjacent tooth. Accordingly, when ratchet 32 is momentarily overdriven, spring pawl 96 is cammed outward as shown in ..... .
~`~ Fig. 4; however, ratchet 32 is then immediately returned to .¢~:
~-~ an exactly 60 rotation by the biasing action of spring pawl . . .
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~ID5~3~3~3 96. It will be noted that the counterclockwi~e rotation of ratchet 32 terminates when end 106 of spring pawl 96 contacts - a tooth on ratchet 32. Accordingly, when thrust ~ar 30 and index pawl 70 are in the fully advanced position, shown in -:.
solid lines in Fig. 3, spring pa~l 96 has the same relation-ship to ratchet 32 as it did when thrust bar 30 and index ; pawl 70 were in their initial positions illustrated in Fig. 2.
: ' Ater the forward thrust of thrust bar 30 has bean completed and a staple ejected from the cartridge and formed c 10 in the patient, return spring 46 returns thrust bar 30 ~o its ; initial position. During this phase of operation, the end : , :: portion 106 of spring pawl 96 prevents counterclockwise rotation of ratchet 32. At the stage of the thrust bar re-,; turn stroke when sloped surface 107 on index pawl 70 contacts i~ , ~ a tooth on ratchet 32, the index pawl begins to be cammed , ~ .
against the force of spring 72. Further camming action then occurs when the tooth portion 102 of index pawl 70 contacts ~, the backside of a tooth of ratchet: 32. At this stage, index pawl 70 is pivoted outwardly into the position shown in . .
phantom lines in Fig. 3. This outward pivotal movement is ~ permitted by spring 72 and the inclined surface 88 of notch .. ,.-, :
68 of thrust bar 30. Finally, index pawl 70 reassumes ' the position shown in Fig. 2. At this point, stapler 10 is .~,,;, ., ready for another firing.
As previously stated, it is desirable to alert the surgeon to the fact that a staple is about to be ejected and ` formed so that the suryeon can be sure that cartridge 26 ."~, .................................................................. .. ..
;'" is properly positioned to effect a neat suture. This is accomplished by means of spring-baased means 115 housed in nose portion 20 ~f stapler 10. Spring~biased means 115 comprises an upper U-shaped member 116 which bears against housing 12 and a lower member 117 terminating in a V-shaped ~ `
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point which r~des along the top of thrust bar 30. Members 116 and 117 are spring biased apart b~ a coil spring 118. A
, notch ll9 is provided on the top surface of thrust bar 30, in alignment with member 117, and is adapted to receive the V-shaped pointed end of member 117 at a stage of the stapling ` operation just before a staple leaves the cartridge. At this stage, member 117 is snapped into notch ll9 on the top sur-~' face of thrust bar 30 by spring 118 with an audible "click". ~-, :
Further movement of thrust bar 30 in the forward direction forces member 117 upward against the force of spring 118 so ~....
~ that thrust bar 30 can continue its forward movement. This . ., ~ , .
~ sequence of events will also cause the surgeon to feel a ....................................................................... .
~ slight but noticeable change in the force required to squeeze ~; . .
the trigger, thus further alerting him tb the fact that a staple is about to be ~ected. Member 116 also functions to provide additional frictional resistance between houslng 12 and nose pcrtion 20 to avoid uncontrolled rotation between nose portion 20 and housing 12 duxing normal handling and use.
I~r~,. Turning now to Fig. 8, thexe is illustrated an end 20 view of a clutch means 120. Clutch means 120 includes a cam block 122 mounted in an opening 124 in forward end 22 of nose portion 20. Cam block 122 has an inclined surface 126 facing thrust bar 30 which passes through an opening 128 in cam block 122. Inclt~ned surface 126 is positioned relative to thrust bar 30 such that the spacing 130 between inclined ~, surface 126 and thrust bar 30 increases in the forward thrust ~-direction of the thrust bar. A cylindrical cam roller 132 :~
~' is positioned between inclined~lsurface 126 of cam block 122 and thrust bar 30. An elongated wedge ~ 134 is housed in ~I 30 an aperture 136 in cam block 122. The forward end of wedge 134 is "V" shaped and extends into opening 130 between in-~ clined surface 126 and thrust bar 30. The wedge pin 134 is '.,f.~'`' - 16 -:j.~, .
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:,., spring biased toward thrust bar 30 by means of a spring 138 housed in a recess 140 in cam block 122. Recess 140 lies perpendicular to aperture 136, and the end of spring 138, : .:
which is hook-shaped, is seated in a bore 142 through wedge 134. Cam roller 132 lies adjacent elongated notch 66 in thrust bar 30, and its movemént is confined by notch 66 as will be discussed subsequently. The cooperation between these elements is such that cylindrical roller 132 prevents thrust bar 30,!firbmibe,ing~re,tlurned to=iitsli~itial position u~t~ com-pletion of a full thrust stroke.
Figs. 9-12 are sequential views showing the operation t of clutch means 120 during a stapling operation. Turning first to Fig. 9, thrust bar 30 is shown in its initial position. In this position, cam roller 132 lies in a shallow cutout 144 positioned ~t the forwardmost end of notch 66. Cam roller 132 is positioned in the narrowest part of ,opening 130 and at the rear of clutch means 120. Spring-biased wedge pin 134 maintains the cam roller 132 toward the rear end of clutch means 120.
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~- 20 Turning now to Fig. 10, the clutch means 120 is , illastrated during the forward stroke of thrust bar 30. Cam roller 132 is sh~wn rotating in a counterclockwise direction. ,~
During this stage of thrust, the surface of cam rolleE~132 ~`~ contacts base 146 of notch 66 and inclined surface 126~ and . ~ :
;~` is rotated by the movement of thrust bar 30. This rotational ``;, movement is permitted since cam roller 132 is, in effect, ~", rotati~y~~"downhill" toward the widest part of opening 130.
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At the same time, cam roller 132 bears a~ainst spring-biased wedge 134 which restrains the longitudinal forward movement ,~
;~ 30 of cam roller 132 so that the cam roller is kept in the .. ,- ,~ , ~' .
~ narrowest part of opening 130. ~ ;
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Still referring to Fig. 10, it can be seen that an attempted return movement of thrust bar 30 to its initial position from its partially advanced position would cause the cam roller to rotate in a clockwise direction. T~is movement : .
; is not permitted by clutch means 120, however, since clockwise ::
: rotation of cam roller 132 causes cam roller 132 to "lock"
r,', itself between thrust bar 30 and incli~ad surface 126 of cam ~ block 122, thereby preventing all but the slightest movement ,;,,. :~
-~ of thrust bar 30 toward its initial position. This occurs because cam roller 132 is, in effect, rotating "uphill" to-ward the narrowest part of opening 130. Furthermore, cam roller 132 would no longer b~ bearing against spring-biased wedge 134.
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Turning now to Fig. 11, clutch means 120 is seen ,; at the forward end of the stroke of thrust bar 30. In this ~; position, cam roller 132 has been forced to the other ~iide ,,,:.. " :.
of wedge pin 134 by shoulder portion 148 of notch 66 and lies in the widest region of opening 130. Once cam roller 132 has so passed wedge 134, it is housed in an area wider than its diameter and hence is free to rotate in any direction.
Accordingly, cam roller 132 permits thrust bar 30 to move -' rearward toward its initial position. A portion of this operational sequenc~ is shown in Fig. 12 illustrating thrust ~`'" 2 bar 30 during its return stxoke. Here, base portion 146 of ~` n~tch 66 of thrust ~ar 30 may still lightly contact cam roller 132. However, cam roller 132 can freely rotate since opemmng 132 is sufficiently wide at ~his location. Near the end of ; the return movement of thrust bar 30 ~o its initial position, , j,,,~* !
`; cam roller 132 is moved into cutout 144 in notch 66 and is 3'~' then ~orced past wedge 134 by shoulder portion 150 of notch 66. CUtout portion 144 allows cam roller 132 to be moved past wedge 134 and back to its initial positioni~hown~;in ~jig. 9, , ~; 18 -. . :
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without "locking" before the completion of the return strokeO
Turning now to Fig. 13, there is sh~wn an end view of a cartridge interlock 152 in its initial blocking position which prevents the initiation of a thrust stroke until a cartridge is properly installed on the stapler. Cartridge in~erlock 152 lies in blocking and abutting relationship with the forwardmost end of thrust bar 30 when thrust bar 30 is in!its initial position. Cartridge interlock 152 is positioned ~,. .
, in an opening 154 in the forward end 22 of nose portion 20 ,~ 10 and comprises a body portion 156 and leg portions 158. As . ., :
shown in Fig. 13, cartridge interlock 152 is spring biased into its initial blocking position by a pair of coll springs 160.
~, In this position, leg portions 158 of cartridge interlock means 152 extend through o~n~ng5,1~5~In~a:l~o~at~9n~p~a~eL~Ç4 When a cartridge 26 is mounted on the stapler 10 as sh~wn in Fig. 6, cartridge interlock 152 is for0ed upward against the action of springs 160 and into the position illustrated in Fig. 14. In this position, opening 166 in cartridge ~i interlock I52 registers with thrust bar 30 and allows thrust .~l 20 bar 30 to pass therethrough. Accordingly, cartridge inter-;l lock 152 is in the position shown in Fig. 13 when a cartridge ~:, is absent and thrust bar 30 is in its initial posi~ion, and ~ ,~ ,. .. .. ..
is in the position shown in Fig. 14 the remainder of the time.
i~ Referring now to Fig. 15, there is shown an end -, ;
`-, view of a cartridge ~top lock 170 in its initial position. -, Cartridge stop lock 170 is adapted to prevent the mounting of `
a staple-carrying cartridge 26 in stapler 10 unless thrust bar 30 is in its fully retracted initial position. Cartridge , stop lock 170 is mouhted in an opening 172 in for~ard end 22 ~"~ 30 of nose portion 20. The cartridge stop lock 170 comprises ~; a body portion l74 and leg portions 176,~ Opening 178 in ~ -;:- .- .i cartri~ge stop lock 170 registers with thrust bar 30 when ~
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, thrust bar 30 is in its initial position. In the position shown in Fig. 1~, leg portions 176 are retracted above the bottom of location plate 164. Accordingly, staple-carrying cartridge 26 can be easily mounted on stapler 10.
As best seen in Fig. 17, the cartridge stop lock ~i 170 is held in its initial position by the inclined surface . . .
~;~, 64 of thrust bar 30 which engages a correspondingly inclin~d ,~1 surface 180 of cartridge stop lock 170 when thrust bar 30 `~ is in its initial position. After thrust bar 30 has left its initial position and is in the thrust or return portion of its .,~,~ -, stroke, cartridge stop lock 170 is spring b~ased downward by .,~ ,. . .
i',~ a pair of coil springs 182 and into the position shown in ,",;; :
~,,.fj ' Fig. 16~ In this position, leg portions 176 extend through i~i; openings 184 in location plate 164 and below the bottom ~;
thereof to prevent the mounting of staple-carrying cartridge ~ 26 until thrust bar 30 has been returned to its initial 3j~ , ~, position. The return of thrust bar 30 to its initial position caa~es cartridge stop lock 170 to be forced upward against the ` , action of springs 182 as best shown in Fig. 17, wherein the initial positions of thrust bar 30 and stop lock cartridge~;
170 are shown in phantom lines.
Fig. 18 shows a top view of the location plate 164, with thrust bar 30 in its initial position. Location plate ~3~
~j 164 is housed in an opening 185 in the forward end 22 of nose ~c ,~, portion 20. As previously described, location plate 164 has ~ ~,. 1,, i .
~` openings 165 and 184 therein for receiving leg portions 158 ~' and 176 of cartridge interlock 152 and cartridge stop lock :
~ 170, respe~tively. Location plate 164 a3~so has a longitudi~
3 nally extending opening 186 which receives pusher-engaging :...................................................................... .
extension 62 and thereby allows thrust bar 30 to reciprocate.
.
With reference now to Figs. 6, 7, 19, and 20, the association of the staple-carrying cartridge 26 with the ; r ; - 20 -.:, ................................................................... :
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, stapler 10 will be explained. Staple-carrying cartridge 26, as can be seen in the ~igures, is detachably mounted on nose , portion 20. Staple-carrying cartridge 26 is elongated and has a pair of upwardly extending spaced tabs 202 at its rear end.
~;` The spacing between tabs 202 is sufficient to allow pusher-:,~.,; I
; engaging extension 62 to freely slide thereb~ween, and tabs 202 are dimensiQned and positioned so as to engage surface 203 at the rearmost end of location plate 164. Therefore, ~ ~ .
when tabs 202 engage surface 203, staple-carrying cartridge 26lcannot be inadvertently pulled out of the nose, and cartridge 26 is fixed against forward movement during the ~ii stapling operation.
'~',t`' Staple-carrying cartridge 26 is mounted in stapler ~ 10 by inserting the end of cartridge 26 into opening 110 in ; ~ nose portion 20. The rearward end of staple-carrying car-~`~ tridge 26 engages a leaf spring 108 which urges the cartridge `26 upwaxdly until tabs 202 are positively locked into their associated indentations in the body of nose portion 20.
~- With cartridge 26 in this position, the rearward ends 228 of the dri~e screws 218 forming a part of staple-carrying car-tridge 26 are engaged by slots 39 of pinion shafts 38. The ~
cartridge 26 is removed from the stapler 10, when exhausted "
of staples, by reversing the insertion steps.
With specific reference now to Figs. 19-22, the construction and operation of the staple-carrying cartridge ; 26 will be explained. The cartridge 26 is de~ined by a main body 200 and has an anvil 204 at its forwardmost region projecting out as an exten~ion of the top of cover plate 206. '~
Staple-carrying cartridge 26 houses a plurality of staples ~
` 30 208, whose crossbars 210 lie transverse to the length of -cartridge 28 and whose points 212 face anvil 204. A pusher-~ ., . ~ , element 214 covers staples 208 and is slidingly mounted within .' '. , ;8038 indentations 216 in cover plate 206. Pusher element 214 is adapted to be engaged by pusher-engaging extension 62 of thrust bar 30 and serves both to eject staples 208 Erom the cartridge 26 and to form the ejected staples around anvil 204.
The means for advancing staples 208 along the length of cartridge 26 comprises a pair of drive screws 218. Screws ` 218 are provided with threads 220 for guiding and propelling staples 208 along main body ledges 222 between the lateral walls 221. The pusher element 214 is guided between the tops ~i 10 of screws 218 and the bottom of cover plate 206, and serves to hold each of the st~ples 208 against ledges 222, except r during the driving operation. Then, the forwardmost staple 208 is advanced out of the screw-guiding threads 220 by means of inclined surfaces 224, at the forward ends of ledges 222, ' ::
into the plane of pusher element 214, and is propelled forward, ;, . -.
i~ out of the main body portion and against anvil 204.
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Each screw 218 is prov~ded at its rearwardmost end ~-with an extension 226 fitted at its extremity with a flat projection 228. Screws 218 are th~eaded so that when they, .,j~.", ~-l 20 by mea~s of projections 226 associating with pinion shaft i 38, are rotated through 360, each staple 208 moves one --~
staple unit. A "staple unit" is defined as that distance ~:~ which is required to move the second staple from its re~diness ,,.j .
position ~nko-~7a~posit-ione~readyh~ojbe fired. IThus~ ~n~ig. 21, ~` onetstap~e~unit~-isas~own at '7a".
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In operation, while pusher element 214 is moving forward by thrust bar 30, and after the forwardmost staple -~ has been raised 3nto the plane of the pusher, pusher element ;;~ 214 makes contact with the staple as illustrated in Fig. 22.
~ 30 Then, the staple is ejected and formed in the disunited skin `~^;; or fascia of the patient.
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Above there have been described specific embodiments of the present invention. It should be noted, however, that the above des^ription was given for illustrative purpose~ only :~ and that many alterations and modifications may be practiced by those skilled in the art without departing from the spirit or the scope of the present invention. It is the intent, ,; therefore, that the present invention no-t be limited to the ::
j~;' above but be limited only as defined in the appended claims.
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This is a divisional of Canadian Patent Application Serial No. 181,498 filed September 20, 1973.
;' In Canadian Patent No. 953,997 issued September 3, 1977 to United States Surgical Corporation, there is disclosed :~ a surgical stapler for joining the disunited skin of a patient.
The surgical stapler disclosed in this application employs a staple-carrying cartridge comprising an anvil adapted to lie 1ush with the skin, a plurality of staples which are to be follded around the anvil, and a pusher for ejecting and bending j 10 the staples around the anvil. The surgical stapling instrument ;~
adapted to accept the staple-carrying cartridge in th-s application is powered~l by a pressurized gas. Later develop-,, ments of the gas-powered stapler and cartridge for applying !.;~" sur~ical staples to external skin and internal fascia and ~j ; , disclosed in U.S. Patent No. 3,662,939 issued May 16, 1972 ',~ to United States Surgical Corporation.
`~ Although these gas-powered instruments represent a .;, :
marked advanced over the state of the art, there are certain ~; disadvantages associated with the use of gas-powered units ;: ,................................................................... .. .
~ , 20 of this type~ One of the obvious disadvantages is the ~`
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necessity forlreplacing the gas cartridges af~er their con-~^ tents have been exhausted, and a second is the inconvenience .,:: ;
associated with storing and main~aining a supply of these ~ cartridges. Also, the powering mechanism is complex, is ; ; hence somewhat costly, and comprises numerous close-tolerance elements which tend to be susceptible to malfunction. For these and other obvious reasons, it would be advantageous to ~- have a ~imple surgical stapling instrument adapted to accept ~j staple~carry ng cartridges of the type disclosed in the above patent application and patent, but which is powered manually and without the intervention of a gaseous medium and , , .
-~- the disadvantages associated therewith.
~ 2 ~o~i~303~ `
: Accordingly, it is a broad object of the present ~: invention to provide a surgical stapling instrument for stapling the disunited skin or fascia of a patient which is manually ''?I powered and wholly operated by mechanical means.
~` It is a primary object of the present invention to .: provide a surgical stapler with means for ensuring that the ù s~aple-advancing drive means of the instrument is activated ~:
only once in each stapling operation.
These and other objects of the inven~ion, as well as many of the attendant advantages thereof, will become more ~' readily apparent when reference is made to the following description taken in conjuction with the accompanying drawings.
In accordance with the invention in one aspect there . ~ , .
is provided a surgic~l stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the ~ki.n or fascia, the instrument adapted to associate with a staple-carrying cartridge having ``
anvil means at one end thereof ancl adapted to house a plurality of staples therein, a pusher element slidably mounted therein `i:`'` 20 for ejecting staples from said cartridge and for forming said ;-staples around said anvil means, and means for advancing said ~.
staples in said cartridge, said surgical stapling instrument comprising: a main body portion; means for mounting said staple-carrying cartridge on said main body por~ion; drive means to activate said staple-advancing means for driving the .".~. ~, . , staples toward said anvil mean~ and for drivi.ng the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means;
~ . and cl~tch means for preventing said drive means for acti-" ~
vating said staple-advancing means more than once in each . stapling operation, said clutch means comprising two surfaces .
~" movable relative to one another with one of said two surfaces ~ i ~
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being sloped relative to the other, a roller positioned be-' :
~ tween said two surfaces, and a wedge memberr in one of said '~ two surfaces, said wedge member~adapted to permit said roller , means to move therepast only at the respective ends of the ; drive means stroke.
~; A t~pical embodiment of the surgical stapling instrument generally comprises a main body portion having a . . .
~ nose portion rotatably mounted therein and adapted to receive : ~ `
and mount a staple-carrying cartridge. The nose portion of .: :
1~ 10 the stapler houses the drive means for advancing and forming . : .
the staples. A pusher-activating means for driving the pusher ,~ element of the staple-carry~ng cartridge to eject and form the `, staples around the anvil means of the cartridge comprises ``' a thrust bar slidably mounted for reciprocative movement in the nose port~on of the stapler. The thrust bar is attached to and adapted to~move with a collar element slidably mounted ':'`!''` on the nose portion of the stapler. A trigger means comprises ....... . .
~ a handle which is pivotally mounted on the main body portion ~, . . .
of the stapler and has means for engaging the collar element so that the thrust bar is m~ved forward by squeezing the trigger. A ireturn spring attached to the trigger and to the main body portion of the stapler functions to return the thrust bar to its initial position after the thrust st~oke of , 3'f the bar has been completed.
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The drive means to activate the st~ple-advancing -~
means in the staple-carrying cartridge for driving the staples .
toward the anvil comprises pinion gears and pinion shafts also housed within the no~e portion of the stapler. The `
.. . ~ .
teeth of the pinion gears mesh with the teeth of a main gear '!` '.
which is a~apted to rotate in unison with a ratchet. The main gear and ratchet are rotatably mounted mn the rear nose .
~;, portion of the stapler. An index pawl pivotally attached to ~''``,' `
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the thrust bar and operatively associated with the ~atchet causes the ratchet, main gears, and pinions to rotate when the thrust bar is initially moved forward and thus activates the staple-advancing~ means in the cartridge.
As was the case in the above-mentioned application and patent, it is desirable to rotate the particular drive -screws of the staple-carrying cartridge 360 each time a staple is be~ng ejected by first overdriving and then return-driving the screws. Accordingly, and similar to the gear boxes ; " ' :
;~:, 10 disclosed in the above-mentioned application and patent, the -~ drive means for advancing staples of the present invention isadapted to be over-driven and then returned to a position wherein the drive screws of the cartridge are rotated exactly . . .
360. The return movement of the staple advancing drive means ;
; is accomplished by a spring p~wl which cooperates with the above-mentioned ratchet. This spring pawl also functions as ~. ., ``~';; a stop, preventing excessive return rotation of the ratchet.
Means are also providëdl-ifor~perventing~!;more.than~one staple from being placed in the ready positio~ of the staple-carrying cartridge during the stapling operation. This means comprises a clutch means which prevents -the return of the thrust bar to its initial position until it has completed a full stroke, thereby ejecting a staple from the staple-carrying cartridge. The clutch means includes a cam block mounted in the forward end of the nose portion of the stapler and having . ~. . ..
an inclined surface facing the thrust bar. The forward end of the thrust bar passes through the cam blook and operatively `;; engages a cylindrical roller positioned b-etween the thrust bar and the inclined surface of the cam blaok. The cam block ,. :. ;
~: 30 houses a spring-biased wedge which cooperates wi-th the i - cylindrical roller. The cooperation between these elements is such that the cylindrical ro~ller prevents the thrust bar '~"''' :
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from being returned to its initial position until it has completed a full driving thrust movement.
Means are further provided for preventing the for-ward movement of the thrust bar until a staple-carrying car--- tridge has been mounted on the s~apler. This means comprises ,.. .
- a cartridge interlock housed in the forward end of the nose portion of the stapler and spring biased into a position such ~` that it blocks the forward movement of the thrust bar until a cartridge is properly mounted. In its initial position, ,., , :.
~ 10 the forward end of the thrust bar abuts the rear face of the :, ~
;~; cartridge interloak. When the staple-carrying cartridge is ,.. ~ . . . .
" mounted, the cartridge interlock is forced upward by the : : :
staple-carrying cartridge, thereby registering an opening in the cartridge interlock with the forward end ofi the thrust bar such that the thrust bar is capable of ~eing moved for-ward and driving the pusher element of the staple-carrying cartridge to eject and form the staples.
'~` The forwardmost staple in the staple-carrying car-, ..................................................................... .
~, tridge is advanced into the ready position during the initial stage of the forward thrust stroke of the thrust har. At ` ~ this point, tnd ~ith the thrust ~ar partially advanced, it ~- is possible to remove the staple-carrying cartridge from the stapler. Under these circumstances, the clutch means prevents ; the thrust bar from returning to its initial position. `
Accordingly, the thrust bar must be fully advanced before it ~; will be automatically returned to i~s initial position. The `'~ surgeon or his attendant may not remember to follow this .
`~ procedure, however, and may attempt to mount a staple-carrying' ~ cartridge in the stapler while the thrust bar is in this `:~ 30 partially advanced position. This procedure could result in ,~ jamming the drive mechanisms of the staple-carrying cartridge -~; or other undesirable mechanical difficulty.
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To prevent such ~amming, means are provided for pre-venting a cartridge from being mounted unless the thrust bar has returned to its initial position. This means comprises . .. ;
a cartridge stop lock mounted in the forward end of the nose . portion of the stapler. When the thrust bar is in its initial ~ position, the cartridge stop lock is oriented so that a staple-.,, ~ carrying cartridge can be easily locked in the stapler. If , .
the thrust bar is not in its initial position, however, but . .; .
' rather is in a partially advanced position, the cartridge stop .~
lock is spr~mg biased into a blocking position so rlthat a staple-carrying cartridge cannot be fully mounted in the .;.~ .
,~r, stap~er.
While the initial movement of the trigger advances ~` .
~` the staples and the intermediate movement readies the car-~, tridge for the stapling operation, only the final stages of trigger movement effect the e~ection and formation of a ~j staple. Accordingly, it is desirable to alert the surgeon to the fact that a staple is about to be ejected so that the : .
~1 surgeon can be sure that the instrument is properly positioned.
. . .
In fact, the inventi~e instrument could be operated remo~e from the patient until the last stage of trigger movement, and ` only then oriented in readiness for a stapling operation. As i~
part of the present invention, the stapler is provided with a spring-biased wedge housed in the nose portion of the stapler . .:
which snaps into a notch on the top surface of the thrust bar with an audible "click" just before a staple is to be eject~d.
~` At the same time, the surgeon will also feel a slight but , ~
` noticeable change in the force required to squeeze the trigger, .~;,:;
~;~ thus further alerting him to the fact that a staple is about to be ejected.
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-~ As just described, ~he drive means for advancing ; staples in the staple-carrying cartridge and for ejecting .,, ,.~ ..
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;' staples therefrom are housed in the nose portion of the i~ stapler which is rotatably mounted in the main body portion. --: Since the staple-carrying cartridge is mounted in the nose ....
portion and rotatable therewith, it is possible to change the stapling angle of the stapler by merely rotating the nose portion while maintaining the hand-held main body portion in "~` a fixed position.
Fig. 1 is a vertical cross section of the surgical ; stapling mnstrument of the present invention;
Fig. 2 is a horizontal cross section taken along .i` . :
` line 2-2 of Fig. l;
Fig. 3 is similar to Fig. 2 but shows a portion of ~ ;.:: , ' the stapler during the stapling operation;~:
`;~ Fig. 4 is a horizontal, fragmentary view of a portion of the staple-advancing drive mechanism of the stapler during ` the staplin~ operation;
~ ~ Fig. 5 is a vertical cross section of the stapler ,~, looking rearwardly;
; Fig. 6 is a side view, partially in section, of the . . .: ~, ~ ,20 staple-carrying cartridge mounting pertion of the stapler i~ after the ~artridge is mounted and ready for use;
"~, , ` Fig. 7 is a front view of the stapler with the $ ,-~
~` staple-carrying cartridge mounted and ready for use;
Fig. 8 is a vertical cross section taken along line ~`~ 8~8 of Fig. 2 and showing the clutch means;
` ~ Figs. 9-12 are sequential views showing the operation ...
~ - of the clutch means during a stapling operation;
, ~, . .
, Fig. 13 is a vertical cross section taken along line ~-~" 13-13 of Fig. 2 and showin~ the position of the cartridge interlock before the staple-carrying cartridge is inserted;
~,`; Fig. 14 is simiilar to Fig. 13 but shows the cartridge ,.. .. .
~` interlock after the insertion of the staple-carrying cartridge : ~;. .
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., which is shown in phantom lines;
Fig. 15 is a vertical cross sec~on taken along line 15-15 of Fig. 2 and showing the position of the cartridge stop lock before the thrust bar has been advanced;
Fig. 16 is similar to Fig. 15 but shows the cartridge stop lock after the ~hrust bar has been partially advanced;
,~i Fig. 17 shows the cooperation between the inclined ~-~, surfaces of the thrust bar and cartridge stop lock;
.....
Fig, 18 is a horizontal cross section taken along ~ 10 li~e 18-18 of Figl 1 and showing the location plate for ;` , locating the cartridge interlock, cartridge stop lock, and pusher-engaging portion of the thrust bar;
Fig. 19 is an enlarged view ~f the rear portion of ` a staple-carrying cartridge with its cover removed;
` Fig. 20 is a cross section taken ~long line 20-2~ of ;~ Fig. 19;
~` Fig. 21 is a vertical cross section of the front ,.~, portion of a staple-carrying cartridge; and Fig. 22 is a view of the front portion of the car-~, 20 tridge during the stapling operation with the cover removed.
, With reference first ~o Figs. 1-6, the surgical -stapler of the~present invèntion will be described in general terms. The spapler shown generally at 10 comprises housing ~ 12 having main body portion 14 and handle portion 16. Nose ", ` '~
portion 20 of stapler 10 is rotatably mounted in main ~ody portion,14 of housing 12. Nose portion 20 includes a front ~ !
section 22 extending out ofthousing 12 and adapted to mount staple-carrying cartridge 26. Nose portion 20 further includes .~"
` a rear section 24 located inside housing 12 and acting to `
--;` 30 housetthe--ldriving means for advancing, ejecting, and forming :. .
~ staples from the staple-carrying cartridge. Nose portion 20 ~
i, is conveniently formed in two parts, upper and lower, held ;
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together by a pair of screws 21 and held in relative alignment by dowel pins 23 and 25. Staple-carrying cartridge 26 is shown fitted into nose portion 20 of stapler lQ in Fig. 6.
The staples in staple-carrying cartridge 26 are advanced, ejected, and formed by mechanical means only and -~
i~` without the intervention of a gaseous medium. Accordingly, the .~ .,.,~ ..
power for advancing, ejecting, and forming the staples in car-tridge 26 comes from the manipulative force supplied to stapler 10 by the surgeon. This force is transmitted to the drive means of stapler 10 by means of trigger 28 which generally comprises a handle pivotally attached to housing 12. Pivoting of trigger 28 causes a thrust bar 30, the pusher-activating means, to drive the pusher element of staple-carr~ing cartridge 26 for~ard to eject and form a staple around the anvil means. At the same time, a ratchet 32 and .... . . .
` a main gear 34 housad in the rear portion 24 of nose 20 are ~ caused to rotate. Main gear 34, in turn, rotates a pair of ;~ pinion gears 3~ and pinion shafts 38 which associate with -the cartridge 26 to advance the staples.
~ 20 With reference now to Figs. 1 and 5, trigger 28 will ;} be described. Trigger 28 is pivotally mounted to housing 12 -,.:
by means of stud 40 and drive pin 42. Trigger 28 is of appropriate size and shape to be conveniently gripped by the operating hand of a surgeon. T~e trigger includes a rearward extending portion 44 to which is attached one end of a keturn spring 46. The other end of return spring 46 is attached to '`''~t housing 12 and functi~ns to return trigger 28 and thrust bar ~ 30 to their initial positions after staple forming has ;~ ~
., ." . .. .
occurred. Trigger 28 is of "Y" shape and includes a lower 30 hand-engaging portion 48 and an upper force-transmitting yoke ~`t', portion 50. Yoke 50 em~races a collar 52 slidingly mounted around the midsection of nose portion 20 and adapted to ,....................................................................... ..
. : ~
, -.:
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,' rotate therewith. Collar 52 includes a cylindrically-shaped . body member 54 having outwardly and radially extending flange portions 56 at each end. Yoke 50 is positioned around cylindrically-shaped body member 54 and bet~een flange por-; tions 56. Shoulder portions 55 and 57 of nose portion 20 limit the forward and riaarward movement, respectively, of ;
collar 52. Pivoting of trigger 28 results in longitudinally directed force's being exerted on collar 52 by yoke portion .. ..
50 ~f trigger 28. Accordingly, when the trigger is activated, ~ collar 52 simultaneously slides along the m dsection of nose ,~ ,.
20. Also, by this arrangement, collar 52 is free to rotate relative to trigger 28.
As best seen in Figs. 1, 3, and 17, the~`means for , ' f ; driving the pusher element of the staple-carrying cartridge ` to eject and form staples comprises thrust bar 30 which in-~
:. ~
cludes an elongated central section 58 having a wing portion 60 near the rear end thereof. A pusher-engaging extension ~: ~
62 and an inclined surface 64 are positioned at the forward-;~ most end of thrust bar 30. Inclined surface 64 is adapted ~; 20 to engage a stop lock mechanism which will be discussed ;~ i subsequently. A190 located near the front end of thrust bar i 30 is an elongated notch 66 which forms part of the clutch ~",. .
~;~; means of the present invention. Located near the rear end of ... ..
~ thrust bar 30 is a second notch 68 which engages the forward '!~' end of index pawl 70. Thrust bar 30 is slidingly mounted in , ~ ~
~` nose portion 20 and is adapted to rotate therewith. As ~
;~, ' illustrated in Fgg. 2, wing portion 60 of thrust bar 30 lies - near the mfidsection of collar 52, conveniently formed as two ~''i' .
~` semi-circular parts, and is rigidly attached to collar 52 by .::. .
~i 30 means of bolts 53. Accordingly, thrust bar 30 reciprocates .:~
; back and forth with collar 52 when trigger 28 is pivoted, and i:
~;~` collar 52 rotates with thrust bar 30 when nose portion 20 is ~; rotated.
~, -- 11 --.~,.~ . ,, ~: ,.,'; , : `
~ .
;~` The staple-advancing drive means of the stapler 10 .. ..
~:! is arranged so that when thrust bar 30 is moved forward, the v' '~ elements forming a part of this arrangement are activated;
:, .
` that is, the forward motion of the pusher-activating element .
causes the rotation of the screws o staple-carrying car-tridge 26, thereby advancing the staples. And, as will be :, more fully described below, the staples are slightly over- -. .
driven during the forward stroke of thrust bar 30 and are then returned to their proper positions as will be discussed sub'sequently.
.... ,-; .
, With reference how to Figs. 1-4, the staple-drive ~; mechanism will be explained. The index pawl 70 is pivotally attached to the rear end of thrust bar 30. The transverse base portion 74 of spring 72 passes through aperture 76 in ~`~ thrust bar 30, and the inturned end of upstanding leg 78 o~
, spring 72 fits into one end of an aperture 80 in the rear ` end of thrust bar 30, and the inturned end of upstanding leg 82 fits through an aperture 84 in index pawl 70 and then into ~, the other end of aperture 80iint~hrustbbar 30. An upstanding ~'~t,-,, 20 leg 86 on the forward end of index pawl 70 fits i~to notch 68 in thrust bar 30O Notch 68 is trape~oidal in shape and has ' -`~ inclined surface 88. The combination of spring 72 and inclined ~; surface 88 of notch 68 allows index pawl 70 to pi~ot outwardly.
t~, Index pawl 70 rides along one wall of a six-tooth ~' ratchet 32 and engages one of the teeth thereof. The index pawl, pivotally mounted on thrust /ba~ 30, is biased toward ratchet 32 by spring ~2. Ratchet 32 is attached to, and ~ rotates with, a main gear 34. Ratchet 32 and maln gear 34 ;{,l are of unitary construction, as illustrated, and are r~tatably ~ 30 mounted in the rea~ end 24 of nose portion 20 by means of ;;;: . :
`; shaft 90. The teeth of main gear 34 mesh with the teeth of '' ~ - 12 -:., ~ ..
'.
.... . ., . . . . ~ . : .. :
., _~
-two pinion gears 36, both of which are seen in the drawings.
.:; .
Pinion gears 36 are, in turn, attached to pinion sha~ts.38 ~` which are housed in, and extend longitudinally through, the nose portion 20 of stapler lO. A tapered cylindrical body portion 92 on the ratchet 32 and main gear 34 assembly pro-!`~ videss a stop for ~inion gears 36 which have a rear portion ~ 94 which abuts body portion 92 of the ratchet 32 and main .. . .
gea~ 34 assembly. (See Fig. l). T~is arrangement prevents ~` the pinion shafts from inadvertently being moved out of their ` 10 proper longitudinal position.
'~ !'' ~ Th~ust bar 30, index pawl 70, and ratchet 32 are - ~ arranged in such a manner that the forward stroke of thrust i~ bar 30 causes ratchet 32 and, accordingly, main gear 34 to move slightly more than 60. As noted previou~ly, it is ., ~ . . .
;~' desired to ultimately rotate the screws associated with staple-;~ carrying cartridge 26 precisely 360 for each staple-driving ~` operation. The staple-advancing drive means in stapler lO is arranged so that for each 60 turn of ratchet 32 and main gear 34, pinion shafts 38 and the screws in cartridge 26 are rotated ~, ....................................................................... .
360. However, to ensure that the staples are advanced in proper amount, it has been found desirakle to overdrive the ~; screws in cartridge 26, and thus the staples, and then to "
~.",~ :
:~, reverse the rotation of the screws so that ultima~ely they `
experience a net 360 rota~ion. It is for this reason that `^ six-tooth ratchet 32 is ~otated slightly more than 60. It ," , , .
~: becomes necessary, therefore, to provide me~ns for ~eturning ratchet 32 to its 60 position. The ratchet return is brought about by means of spring~T pawl 96 as will be dis- -:;
cussed subsequently.
With particular reference now to Figs. 2-4, the ;
.j ,~,. , - operation of the drive means for activating the staple-ad-~ ` vancing mechanism of the staple-carrying cartridge and for `` - 1 1:''''` : .
.
~al519~3~
d~iving the staples toward the anvil will be described. As shown in Fig. 2, thrust bar 30 is in its initial at-rest position. In this position, index pawl 70 is in engagement with ratchet 32. Too~h portion 102 of index pawl 70, which is the driving region thereof, i~ removed from the nearest tooth on ratchet 32 to allow for slight "play" before the ratchet 32 is rotated.
When thrust bar 30 moves forward during a stapling operation, index pawl 70 rotates ratchet 32. Ratchet 32 is . ~ . .
rotated in a clockwise direction as index pawl 70 is moved -~
forward with thrust bar 30. When ratchet 32 has been rotated ~ through approximately its desired maximum angle of slightly `- greater than 60, the back surface of an advancing tooth of ratchet 32 engages planar portion 104 near the end of index pawl 70 and forces tooth portion 102 of index pawl 70 out of , . .
engagement with ratchet 32. (See Fig. 4). The maximum angle through which ratchet 32 is rotated is greater than that needed to advance each staple one "staple unit". Thus, the staple-~` advanc ng drive means is momentarily overdriven; however, this condition is automatically corrected by spring pawl 96.
~i'` Referring now to Figs. 2 and 4, it can be seen that spring pawl 96 is attached to the rear end 24 of nose portion ,:
~-` 20 by means of a pin 97 and comprises an arcuate section ; ~ terminating at end 106. Spring pawl 96 contacts ratchet 32 ....~.1 ~:;` at two points in its initial position. First, end 106 of ~ ' ' ` i ~, spring p~wl 96 contacts one of the teeth of ratchet 32.
Second, a point on spring pawl 96 partially between end 106 and the arcuate section contacts the back surface of the . ,~. ~ , .
adjacent tooth. Accordingly, when ratchet 32 is momentarily overdriven, spring pawl 96 is cammed outward as shown in ..... .
~`~ Fig. 4; however, ratchet 32 is then immediately returned to .¢~:
~-~ an exactly 60 rotation by the biasing action of spring pawl . . .
, ,i .
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.
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~ID5~3~3~3 96. It will be noted that the counterclockwi~e rotation of ratchet 32 terminates when end 106 of spring pawl 96 contacts - a tooth on ratchet 32. Accordingly, when thrust ~ar 30 and index pawl 70 are in the fully advanced position, shown in -:.
solid lines in Fig. 3, spring pa~l 96 has the same relation-ship to ratchet 32 as it did when thrust bar 30 and index ; pawl 70 were in their initial positions illustrated in Fig. 2.
: ' Ater the forward thrust of thrust bar 30 has bean completed and a staple ejected from the cartridge and formed c 10 in the patient, return spring 46 returns thrust bar 30 ~o its ; initial position. During this phase of operation, the end : , :: portion 106 of spring pawl 96 prevents counterclockwise rotation of ratchet 32. At the stage of the thrust bar re-,; turn stroke when sloped surface 107 on index pawl 70 contacts i~ , ~ a tooth on ratchet 32, the index pawl begins to be cammed , ~ .
against the force of spring 72. Further camming action then occurs when the tooth portion 102 of index pawl 70 contacts ~, the backside of a tooth of ratchet: 32. At this stage, index pawl 70 is pivoted outwardly into the position shown in . .
phantom lines in Fig. 3. This outward pivotal movement is ~ permitted by spring 72 and the inclined surface 88 of notch .. ,.-, :
68 of thrust bar 30. Finally, index pawl 70 reassumes ' the position shown in Fig. 2. At this point, stapler 10 is .~,,;, ., ready for another firing.
As previously stated, it is desirable to alert the surgeon to the fact that a staple is about to be ejected and ` formed so that the suryeon can be sure that cartridge 26 ."~, .................................................................. .. ..
;'" is properly positioned to effect a neat suture. This is accomplished by means of spring-baased means 115 housed in nose portion 20 ~f stapler 10. Spring~biased means 115 comprises an upper U-shaped member 116 which bears against housing 12 and a lower member 117 terminating in a V-shaped ~ `
~ '' . , .
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.
point which r~des along the top of thrust bar 30. Members 116 and 117 are spring biased apart b~ a coil spring 118. A
, notch ll9 is provided on the top surface of thrust bar 30, in alignment with member 117, and is adapted to receive the V-shaped pointed end of member 117 at a stage of the stapling ` operation just before a staple leaves the cartridge. At this stage, member 117 is snapped into notch ll9 on the top sur-~' face of thrust bar 30 by spring 118 with an audible "click". ~-, :
Further movement of thrust bar 30 in the forward direction forces member 117 upward against the force of spring 118 so ~....
~ that thrust bar 30 can continue its forward movement. This . ., ~ , .
~ sequence of events will also cause the surgeon to feel a ....................................................................... .
~ slight but noticeable change in the force required to squeeze ~; . .
the trigger, thus further alerting him tb the fact that a staple is about to be ~ected. Member 116 also functions to provide additional frictional resistance between houslng 12 and nose pcrtion 20 to avoid uncontrolled rotation between nose portion 20 and housing 12 duxing normal handling and use.
I~r~,. Turning now to Fig. 8, thexe is illustrated an end 20 view of a clutch means 120. Clutch means 120 includes a cam block 122 mounted in an opening 124 in forward end 22 of nose portion 20. Cam block 122 has an inclined surface 126 facing thrust bar 30 which passes through an opening 128 in cam block 122. Inclt~ned surface 126 is positioned relative to thrust bar 30 such that the spacing 130 between inclined ~, surface 126 and thrust bar 30 increases in the forward thrust ~-direction of the thrust bar. A cylindrical cam roller 132 :~
~' is positioned between inclined~lsurface 126 of cam block 122 and thrust bar 30. An elongated wedge ~ 134 is housed in ~I 30 an aperture 136 in cam block 122. The forward end of wedge 134 is "V" shaped and extends into opening 130 between in-~ clined surface 126 and thrust bar 30. The wedge pin 134 is '.,f.~'`' - 16 -:j.~, .
; ~, . .
, ., : .
: ~ : , . : , ~5~3~3~
:,., spring biased toward thrust bar 30 by means of a spring 138 housed in a recess 140 in cam block 122. Recess 140 lies perpendicular to aperture 136, and the end of spring 138, : .:
which is hook-shaped, is seated in a bore 142 through wedge 134. Cam roller 132 lies adjacent elongated notch 66 in thrust bar 30, and its movemént is confined by notch 66 as will be discussed subsequently. The cooperation between these elements is such that cylindrical roller 132 prevents thrust bar 30,!firbmibe,ing~re,tlurned to=iitsli~itial position u~t~ com-pletion of a full thrust stroke.
Figs. 9-12 are sequential views showing the operation t of clutch means 120 during a stapling operation. Turning first to Fig. 9, thrust bar 30 is shown in its initial position. In this position, cam roller 132 lies in a shallow cutout 144 positioned ~t the forwardmost end of notch 66. Cam roller 132 is positioned in the narrowest part of ,opening 130 and at the rear of clutch means 120. Spring-biased wedge pin 134 maintains the cam roller 132 toward the rear end of clutch means 120.
~, ., ;.
~- 20 Turning now to Fig. 10, the clutch means 120 is , illastrated during the forward stroke of thrust bar 30. Cam roller 132 is sh~wn rotating in a counterclockwise direction. ,~
During this stage of thrust, the surface of cam rolleE~132 ~`~ contacts base 146 of notch 66 and inclined surface 126~ and . ~ :
;~` is rotated by the movement of thrust bar 30. This rotational ``;, movement is permitted since cam roller 132 is, in effect, ~", rotati~y~~"downhill" toward the widest part of opening 130.
.. j : .
At the same time, cam roller 132 bears a~ainst spring-biased wedge 134 which restrains the longitudinal forward movement ,~
;~ 30 of cam roller 132 so that the cam roller is kept in the .. ,- ,~ , ~' .
~ narrowest part of opening 130. ~ ;
... .
~ - 17 -"; :
. `; , , : ~,.' : '. ,~ ' ' `' :
~L05~ 3~3 :
Still referring to Fig. 10, it can be seen that an attempted return movement of thrust bar 30 to its initial position from its partially advanced position would cause the cam roller to rotate in a clockwise direction. T~is movement : .
; is not permitted by clutch means 120, however, since clockwise ::
: rotation of cam roller 132 causes cam roller 132 to "lock"
r,', itself between thrust bar 30 and incli~ad surface 126 of cam ~ block 122, thereby preventing all but the slightest movement ,;,,. :~
-~ of thrust bar 30 toward its initial position. This occurs because cam roller 132 is, in effect, rotating "uphill" to-ward the narrowest part of opening 130. Furthermore, cam roller 132 would no longer b~ bearing against spring-biased wedge 134.
, ,, :
Turning now to Fig. 11, clutch means 120 is seen ,; at the forward end of the stroke of thrust bar 30. In this ~; position, cam roller 132 has been forced to the other ~iide ,,,:.. " :.
of wedge pin 134 by shoulder portion 148 of notch 66 and lies in the widest region of opening 130. Once cam roller 132 has so passed wedge 134, it is housed in an area wider than its diameter and hence is free to rotate in any direction.
Accordingly, cam roller 132 permits thrust bar 30 to move -' rearward toward its initial position. A portion of this operational sequenc~ is shown in Fig. 12 illustrating thrust ~`'" 2 bar 30 during its return stxoke. Here, base portion 146 of ~` n~tch 66 of thrust ~ar 30 may still lightly contact cam roller 132. However, cam roller 132 can freely rotate since opemmng 132 is sufficiently wide at ~his location. Near the end of ; the return movement of thrust bar 30 ~o its initial position, , j,,,~* !
`; cam roller 132 is moved into cutout 144 in notch 66 and is 3'~' then ~orced past wedge 134 by shoulder portion 150 of notch 66. CUtout portion 144 allows cam roller 132 to be moved past wedge 134 and back to its initial positioni~hown~;in ~jig. 9, , ~; 18 -. . :
~6)5l3~38 .
without "locking" before the completion of the return strokeO
Turning now to Fig. 13, there is sh~wn an end view of a cartridge interlock 152 in its initial blocking position which prevents the initiation of a thrust stroke until a cartridge is properly installed on the stapler. Cartridge in~erlock 152 lies in blocking and abutting relationship with the forwardmost end of thrust bar 30 when thrust bar 30 is in!its initial position. Cartridge interlock 152 is positioned ~,. .
, in an opening 154 in the forward end 22 of nose portion 20 ,~ 10 and comprises a body portion 156 and leg portions 158. As . ., :
shown in Fig. 13, cartridge interlock 152 is spring biased into its initial blocking position by a pair of coll springs 160.
~, In this position, leg portions 158 of cartridge interlock means 152 extend through o~n~ng5,1~5~In~a:l~o~at~9n~p~a~eL~Ç4 When a cartridge 26 is mounted on the stapler 10 as sh~wn in Fig. 6, cartridge interlock 152 is for0ed upward against the action of springs 160 and into the position illustrated in Fig. 14. In this position, opening 166 in cartridge ~i interlock I52 registers with thrust bar 30 and allows thrust .~l 20 bar 30 to pass therethrough. Accordingly, cartridge inter-;l lock 152 is in the position shown in Fig. 13 when a cartridge ~:, is absent and thrust bar 30 is in its initial posi~ion, and ~ ,~ ,. .. .. ..
is in the position shown in Fig. 14 the remainder of the time.
i~ Referring now to Fig. 15, there is shown an end -, ;
`-, view of a cartridge ~top lock 170 in its initial position. -, Cartridge stop lock 170 is adapted to prevent the mounting of `
a staple-carrying cartridge 26 in stapler 10 unless thrust bar 30 is in its fully retracted initial position. Cartridge , stop lock 170 is mouhted in an opening 172 in for~ard end 22 ~"~ 30 of nose portion 20. The cartridge stop lock 170 comprises ~; a body portion l74 and leg portions 176,~ Opening 178 in ~ -;:- .- .i cartri~ge stop lock 170 registers with thrust bar 30 when ~
:, ~. ' :' ! - 19 .' ` 'i .
::'. .
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te~
. ;'. . ' ' ' ` ' ' . ' '' '' . '' " ~ ' '` ~ ~ ' : ,. . ' . : ' , . . :, ~D58~8 .
, thrust bar 30 is in its initial position. In the position shown in Fig. 1~, leg portions 176 are retracted above the bottom of location plate 164. Accordingly, staple-carrying cartridge 26 can be easily mounted on stapler 10.
As best seen in Fig. 17, the cartridge stop lock ~i 170 is held in its initial position by the inclined surface . . .
~;~, 64 of thrust bar 30 which engages a correspondingly inclin~d ,~1 surface 180 of cartridge stop lock 170 when thrust bar 30 `~ is in its initial position. After thrust bar 30 has left its initial position and is in the thrust or return portion of its .,~,~ -, stroke, cartridge stop lock 170 is spring b~ased downward by .,~ ,. . .
i',~ a pair of coil springs 182 and into the position shown in ,",;; :
~,,.fj ' Fig. 16~ In this position, leg portions 176 extend through i~i; openings 184 in location plate 164 and below the bottom ~;
thereof to prevent the mounting of staple-carrying cartridge ~ 26 until thrust bar 30 has been returned to its initial 3j~ , ~, position. The return of thrust bar 30 to its initial position caa~es cartridge stop lock 170 to be forced upward against the ` , action of springs 182 as best shown in Fig. 17, wherein the initial positions of thrust bar 30 and stop lock cartridge~;
170 are shown in phantom lines.
Fig. 18 shows a top view of the location plate 164, with thrust bar 30 in its initial position. Location plate ~3~
~j 164 is housed in an opening 185 in the forward end 22 of nose ~c ,~, portion 20. As previously described, location plate 164 has ~ ~,. 1,, i .
~` openings 165 and 184 therein for receiving leg portions 158 ~' and 176 of cartridge interlock 152 and cartridge stop lock :
~ 170, respe~tively. Location plate 164 a3~so has a longitudi~
3 nally extending opening 186 which receives pusher-engaging :...................................................................... .
extension 62 and thereby allows thrust bar 30 to reciprocate.
.
With reference now to Figs. 6, 7, 19, and 20, the association of the staple-carrying cartridge 26 with the ; r ; - 20 -.:, ................................................................... :
. , ~:
~,~ . ' . : ~;
;. ..
; ~05~613~
, stapler 10 will be explained. Staple-carrying cartridge 26, as can be seen in the ~igures, is detachably mounted on nose , portion 20. Staple-carrying cartridge 26 is elongated and has a pair of upwardly extending spaced tabs 202 at its rear end.
~;` The spacing between tabs 202 is sufficient to allow pusher-:,~.,; I
; engaging extension 62 to freely slide thereb~ween, and tabs 202 are dimensiQned and positioned so as to engage surface 203 at the rearmost end of location plate 164. Therefore, ~ ~ .
when tabs 202 engage surface 203, staple-carrying cartridge 26lcannot be inadvertently pulled out of the nose, and cartridge 26 is fixed against forward movement during the ~ii stapling operation.
'~',t`' Staple-carrying cartridge 26 is mounted in stapler ~ 10 by inserting the end of cartridge 26 into opening 110 in ; ~ nose portion 20. The rearward end of staple-carrying car-~`~ tridge 26 engages a leaf spring 108 which urges the cartridge `26 upwaxdly until tabs 202 are positively locked into their associated indentations in the body of nose portion 20.
~- With cartridge 26 in this position, the rearward ends 228 of the dri~e screws 218 forming a part of staple-carrying car-tridge 26 are engaged by slots 39 of pinion shafts 38. The ~
cartridge 26 is removed from the stapler 10, when exhausted "
of staples, by reversing the insertion steps.
With specific reference now to Figs. 19-22, the construction and operation of the staple-carrying cartridge ; 26 will be explained. The cartridge 26 is de~ined by a main body 200 and has an anvil 204 at its forwardmost region projecting out as an exten~ion of the top of cover plate 206. '~
Staple-carrying cartridge 26 houses a plurality of staples ~
` 30 208, whose crossbars 210 lie transverse to the length of -cartridge 28 and whose points 212 face anvil 204. A pusher-~ ., . ~ , element 214 covers staples 208 and is slidingly mounted within .' '. , ;8038 indentations 216 in cover plate 206. Pusher element 214 is adapted to be engaged by pusher-engaging extension 62 of thrust bar 30 and serves both to eject staples 208 Erom the cartridge 26 and to form the ejected staples around anvil 204.
The means for advancing staples 208 along the length of cartridge 26 comprises a pair of drive screws 218. Screws ` 218 are provided with threads 220 for guiding and propelling staples 208 along main body ledges 222 between the lateral walls 221. The pusher element 214 is guided between the tops ~i 10 of screws 218 and the bottom of cover plate 206, and serves to hold each of the st~ples 208 against ledges 222, except r during the driving operation. Then, the forwardmost staple 208 is advanced out of the screw-guiding threads 220 by means of inclined surfaces 224, at the forward ends of ledges 222, ' ::
into the plane of pusher element 214, and is propelled forward, ;, . -.
i~ out of the main body portion and against anvil 204.
'.. ~ . .
Each screw 218 is prov~ded at its rearwardmost end ~-with an extension 226 fitted at its extremity with a flat projection 228. Screws 218 are th~eaded so that when they, .,j~.", ~-l 20 by mea~s of projections 226 associating with pinion shaft i 38, are rotated through 360, each staple 208 moves one --~
staple unit. A "staple unit" is defined as that distance ~:~ which is required to move the second staple from its re~diness ,,.j .
position ~nko-~7a~posit-ione~readyh~ojbe fired. IThus~ ~n~ig. 21, ~` onetstap~e~unit~-isas~own at '7a".
`? : :
In operation, while pusher element 214 is moving forward by thrust bar 30, and after the forwardmost staple -~ has been raised 3nto the plane of the pusher, pusher element ;;~ 214 makes contact with the staple as illustrated in Fig. 22.
~ 30 Then, the staple is ejected and formed in the disunited skin `~^;; or fascia of the patient.
.., ... : :
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.:
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:~:
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.,.
Above there have been described specific embodiments of the present invention. It should be noted, however, that the above des^ription was given for illustrative purpose~ only :~ and that many alterations and modifications may be practiced by those skilled in the art without departing from the spirit or the scope of the present invention. It is the intent, ,; therefore, that the present invention no-t be limited to the ::
j~;' above but be limited only as defined in the appended claims.
.. . . .
'`'', 10 '`~;' ~. ' ... .. .
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Claims (4)
1. A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the skin or fascia, the instrument adapted to associate with a staple-carrying cartridge having anvil means at one end thereof and adapted to house a plurality of staples therein, a pusher element slidably mounted therein for ejecting staples from said cartridge and for forming said staples around said anvil means, and means for advancing said staples in said cartridge, said surgical stapling instrument comprising: a main body portion; means for mounting said staple-carrying cartridge on said main body portion; drive means to activate said staple-advancing means for driving the staples toward said anvil means and for driving the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means; and clutch means for preventing said drive means for activating said staple-advancing means more than once in each stapling operation, said clutch means comprising two surfaces movable relative to one another with one of said two surfaces being sloped relative to the other, a roller positioned between said two surfaces, and a wedge member in one of said two surfaces, said wedge member adapted to permit said roller means to move therepast only at the respective ends of the drive means stroke.
2. The instrument defined in claim 1, wherein said drive means comprises a thrust bar slidingly mounted for reciprocative movement in said main body portion and wherein said clutch means prevents said thrust bar from returning to its initial rest position until said thrust bar has completed its forward thrust movement.
3. The instrument defined in claim 2 , wherein the sloped surface is inclined relative to said thrust bar and defines an opening therewith which increases in size in the direction of the forward thrust movement of said thrust bar, and wherein said roller is positioned between and cooperating with said sloped surface and said thrust bar.
4. The instrument defined in claim 3 , wherein said wedge member cooperating with said roller is spring-biased.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA309,535A CA1058038A (en) | 1972-09-29 | 1978-08-17 | Surgical stapling instrument |
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US00293470A US3819100A (en) | 1972-09-29 | 1972-09-29 | Surgical stapling instrument |
| CA181,498A CA1036886A (en) | 1972-09-29 | 1973-09-20 | Surgical stapling instrument |
| CA309,535A CA1058038A (en) | 1972-09-29 | 1978-08-17 | Surgical stapling instrument |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1058038A true CA1058038A (en) | 1979-07-10 |
Family
ID=27163052
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA309,535A Expired CA1058038A (en) | 1972-09-29 | 1978-08-17 | Surgical stapling instrument |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA1058038A (en) |
-
1978
- 1978-08-17 CA CA309,535A patent/CA1058038A/en not_active Expired
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