CA1162814A - Surgical instruments - Google Patents

Abstract

ABSTRACT OF THE DISCLOSURE

A staple cartridge for use with a surgical stapling instrument has a nose portion and a pair of substantially parallel elongate limbs extending from the nose portion. The limbs define an uninter-rupted slit therebetween extending the entire length and height of the limbs. Seating means are provided in each of the limbs for at least one longitudinally extending row of surgical staples. Longitudinal pas-sage means are provided in each of the limbs for re-ceiving a travelling pusher means operative sequentially to expel staples from the seating means.

Description

~6;2~4 This is a divisio~ of Canadian Application Serial No. 369,043, filed January 22, 1981.
This invention relates to an instrument for use in applying surgical fasteners such as staples, clips and the like to living tissue. More particularly, the invention relates to a surgical stapling instrument for use in forming a plurality of laterally spaced rows of staples in an internal body organ. Typically, such an instrument comprises a pair of cooperating elongate jaw members, one of which in use carries a staple cartridge with at least two laterally spaced rows of staples and the other of which carries an anvil with staple-closing depressions aligned with the rows of staples in the cartridge. A pusher bar and knife assembly is provided which is moved longitudinally along the jaws to sequentially eject staples from the cartridge by a camming action, through the agency of staple pushers carried by the cartridge in association with the individual staples, and to close the staples against the anvil thereby forming laterally spaced lines of staples in tissue gripped between the jaws, while the knife, which trails the pusher bars, cuts the tissue along a line between the staple rows.
One instrument of this type is disclosed, for example, in Canadian Patent No. 888,867.

, With instruments of the above type, the staple cartridges and associated anvils, pusher bars and knife assemblies have commonly been made of disposable plastics and low cost metal stampings while the frames, namely the basic instruments have more generally been constructed for repeated usage necessitating continual sterilization of these elements between each use. In recent years, in order to obvia-te the need for such repeated steril-ization of instruments, the tendency in the surgical field has been towards the introduction of fully self-contained disposable instruments which are used for only a single operation and then discarded.
Obviously, therefore in the design of such dispos-able instruments, economics is a factor and it is desirable to design such instruments to utilize readily available economic materials of minimum material weight and to employ production techniques of optimum economy.
With stapling instruments of the type described, relatively large forces are involved in clamping the tissue to be fastened and in ejecting the individual staples, causing these to penetrate the gripped tissue and to be closed against the anvil. Such forces tend both to separate the jaws vertically and to laterally distort the jaws thereby hindering accurate stapling. This problem is of course accentuated if relatively light-weight dis-posable materials are to be used for manfacture ofthe jaw frames.
It is an object of the present invention to provide an instrument of the character described for applying surgical fasteners, in which optimum alignment and stabilization of the jaws is obtained during application and securing of the fasteners.

Another object of the invention is to provide a novel form of instrument for use in apply-ing surgical fasteners to living tissue and which is particularly suited to use in surgical stapling 5 procedures.
It is a further object of the invention to provide a surgical stapling or like fastening in-strument having a design which allows the instrument to be manufactured in the main from relatively light lO weight disposable materials while still providing proper alignment and stabilization of the jaws during stapling.

In accordance with the invention, there is provided a staple cartridge for use with a surgical stapling instrument, the cartridge comprises a nose portion, a pair of substantially parallel elongate limbs extending from the nose portion, the limbs de-20 fining an uninterrupted slit therebetween extending the entire length and height of the limbs, seating means in each of the limbs for at least one longi-tudinally extending row of surgical staples and longi-tudinal passage means in each of the limbs for receiving 25 a travelling pusher means operative sequentially to expel staples from the seating means.
The shoes are located on the pusher bar and knife blade assembly in the region of the pusher bar cams and the knife blade and their effect is to 30 provide localized support for the jaws in the region of these elements as they progress along the iaws, . ~

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thereby providing proper jaw alignment in the region of the individual staples as these are sequentially acted upon by the pusher bars. Further, the shoes are not only laterally but also vertically confined in the passageways and thereby serve to resist vertical jaw-opening forces during staple formation.
Conveniently, the jaw passageways are formed towards the outside of the respective jaws and the shoes are carried on upper and lower exten-sions of the knife carrier which is made of relative-ly rigid material affording adequate lateral support to the shoes and hence to the jaws at the point of stapling as the shoes move therealong. To allow passage of the vertically extended knife carrier along the jaws, the staple cartridge and the anvil which are supported on the inner facing surfaces of the respective jaws are each composed of two lateral-ly spaced elongate members carried by the respective jaws so that the extended knife carrier can move through spaces formed between the respective elongate members.
By utilizing the aforementioned shoes locally to support the jaws and provide both lateral and vertical stabilization in the region of the pusher bar cams and knife blade as these elements ride along the jaws, the adverse effects of the previously mentioned forces are substantially minimized and the jaws themselves can therefore be made of light-weight construction so that an instru-ment designed in accordance with the invention lendsitself to manufacture in disposable materials.

Figure 1 is a side view of a surgical stapling instrument in the assembled and closed condition;
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Figure 2 is a side view of the instrument in an open condition;
Figure 3 is an exploded view of the instru-ment;
Figure 4 is a side view of a pusher bar and knife assembly;
Figure 5 is an underneath plan view of the pusher bar and knife assembly;
Figure 6 is a section on line 6-6 of Figure l;
Figure 7 is a section on line 7-7 of Fgure l; with parts of the instrument removed;
Figure 8 is an underneath view of a dispos-able staple cartridge;
Figure 9 is a side view of the cartridge;
Figure 10 is a section on line 10-10 of Figure 9;
Figure 11 is a top view of an elongate anvil member;
Figure 12 is a side view of the anvil member;
Figure 13 is a section on line 13 13 of Figure 12; and Figure 14 is a section on line 14-14 of Figure 1.

It is to be noted that the general con-struction and principle of operation of the illus-trated instrument is similar to the instrument described in Canadian Patent No. 888,867, previously referred to. Accordingly, the following description will only cleal in detail with modified features of the instrument.

i28~4 The present instrument, generally indicated by reference 10 includes an upper frame 12 and a lower frame 14. The forward end portion of upper frame 12 defines an elongate upper jaw 16 while the forward end portion of the lower frame 14 defines an elongate lower jaw 20. The portion of lower frame 14 rearward of jaw 20 fits into a channel-shaped handle member 22 having a pivot bar 24 at its rear end which is received in notches 28 at the rear end of upper frame member 12. Intermediate its length, upper frame member 12 has laterally projecting lugs 13 whch fit in complimentary openings 15 formed in a bifurcated locking handle 26. The handle 26 can be used to open and close the frames about the pivot means 24, 28 between the open condition shown in Figure 2 and the locked condition shown in Figure 1.
To this end, handle 26 has slots 17 providing camming surfaces 19 which cooperate with laterally projecting lugs 21 on handle member 22. The instrument further includes a sliding pusher bar and knife assembly 30 comprising a central knife carrier 32 and laterally spaced pusher bars 34 and 36 on either side the knife carrier, the pusher bars terminating at their forward ends in inclined pusher bar cams 38 and 40, respectively, and the knife carrier including an inclined knife 42 situated just to the rear of the pusher bar cams.
In use, a disposable staple cartridge 44, containing four laterally spaced longitudinal rows of staples, is inserted into the lower jaw 20 while two anvil members 72 having staple shaping depres-sions in their outer surfaces, complimentary to the positioning of the individual staples in the staple cartridge, are placed on the upper jaw 16. The instrument is inserted into a patients body and manipulated such -that tissue to be cut and sutured is inserted between the jaws, an incision to receive one of the jaws having previously been made in the tissue, if re~uired. The jaws are then closed and locked by handle 26 to firmly grip the tissue between the opposing staple cartridge and anvil surfaces.
The pusher bar and knife assembly which is initially in a rearward position relative to the jaws, is then pushed forwardly causing the pusher bar cams to enter longitudinal slits in the staple cartridge, in which slits are accommodated rows of individual staple pushers. The pusher bar cams cooperate sequentially with camming surfaces on the individual staple pushers to force the staples successively from the cartridge, through the gripped tissue and into engagement with the anvil depressions which thereby, in conjunction with the cams, produce staple-closing forces. The design of the cartridge is such that each slit carries two mutually stag-gered rows of staples so that in all, four staple rows are formed in the gripped tissue. The knife 42 which trails the pusher bars cams slightly and rides in central longitudinal slits in the cartridge and anvill cuts the gripped tissue along a line between the two pairs of staple rows.
To provide lateral support for the jaws and to resist forces tending to vertically open the jaws during stapling, each jaw is provided with a longitudinal passageway and the knife blade carrier 32 which is a relatively rigid member, preferably of metal, carries upper and lower laterally aligned shoes which ride in these passageways and provide the requirled local support to the jaws in the region '~,, of the pusher bar cams and knife blade as these elements travel along the staple car-tridge.
Thus, it will be seen, particularly in Figuies 6, 7 and 14 that the lower frame 14 is formed with a cartridge-receiving channel 46 and an outer longitudinal passageway 48 of generally T-shaped cross-section extending from the base of the channel 46. Upper frame 12 has inwardly directed longitudinally extending shoulders 50 for mounting the anvils as will be described, the construction of the upper frame being such that a longitudinally extending passageway 52 of generally rectangular section is formed beneath the shoulders.
The pusher bar and knife assembly 30, see particularly Figures 3, 4 and 5, has conventional-type laterally spaced pusher bars 34 and 36 terminat-ing in slightly offset inclined pusher bar cams 38 and 40. The central knife carrier 32, as indicated, has an inclined knife 42 just to -the rear of the pusher bar cams and the knife carrier is extended vertically above and below the pusher bars. On upper and lower terminal portions of the knife carrier which project forwardly of the knife, are situated lower and upper shoes 54 and 56, respec-tively, the vertical spacing between the shoes cor-responding to the vertical spacing between the passageways 48 and 52 in the lower and upper frames when the frames are locked together. The lower shoe 54 has a substantially T-shaped cross section cor~
responding to the cross-sectional shape of passageway 48 so that this shoe fits in passageway 48 with minimal clearance to allow substantially friction-free passage of the shoe along the passageway, and upper shoe 56 is likewise shaped to fit in passage-way 52 with minimal clearance to provide substantially . .

friction-free passage. It will be noted tha-t the shoes 52 and 54 are longitudinally located in prox-imity to the pusher ~ar cams 38 and 40 so as to in use, provide support for the jaws 16 and 20 in the region of the cams substantially at points where the forces created by cooperation of the pusher bar cams and the individual staple pushers in the cartridge approach a maximum. Further, by locating the shoes both laterally and vertically in the respective passageways, both lateral alignment of the jaws and resistance to vertical jaw opening during stapling is obtained.
At the rear end of assembly 30, the pusher bars and knife carrier are mounted in known manner in a suitable carrying block 31 having an operating knob 33 or the like.
The staple cartridge 44 as shown in Figures 8, 9 and 10 is generally of similar character to the known type as described in the aforementioned Canadian Patent No. 888,867 insofar as the number of staple rows, and design and location of the individual staple pushers is concerned. For a fuller descrip-tion of these elements and the manner in which staple ejection is effected by interaction of the pusher bar cams and the individual staple pushers, reference may therefore be made to this patent. In the present case, the cartridge 44 has a solid nose portion 58 and a pair of longitudinal ribs 60 and 62 extending rearwardly from the nose portion and definin~ a slit 64 therebetween right through the cartridge for passage of the knife carrier 32. The inner facing surfaces of the ribs 60 and 62 again have bumps 66 to laterally locate the knife carrier and the ribs are themselves longitudinally slit to accommodate the staple pushers and the opposed, staggered rows of staples. Friction pieces 68 are again provided to inhibit inadvertent forward motion of the pusher bars. Thus, the significant difference ' between the present cartridge and that described in Canadian Patent No. 888,867 is that in the present case slit 64 extends right through the cartridge (to the rear of the nose portion) to allow passage of the vertically extended knife carrier. In use, as indicated, the cartridge 44 sits in the cartridge receiving channel 46 of the upper jaw with the nose portion 58 projecting forwardly of the jaw and positive longitudinal location of the cartridge being effected by means of a projecting cartridge lug 70 and a complimentary cut-out in one of the side walls of channel 46.
While the instrument has been herein described as utilizing a separate staple cartridge 44 in like manner to the instrument described in Canadian Patent No. 888,867, it is contemplated within the scope of the present invention, for the staple cartridge to be formed as an integral part of lower jaw 20.
The anvil means in the present instance, see Figures 11, 12 and 13, comprises a pair of like individual elongate anvils 72 which sit with a friction fit on the shoulders 50 of the upper jaw, as seen in Figures 1, 3 and 14, whereby a slit is provided between the anvils allowing passage for the vertically extended knife carrier. Each individual anvil comprises an anvil surface 76 with staple-shaping depressions 78, an outer wall 80 and a shorter inner wall 82. The inner and outer walls are slightly inwardly -tapered to provide the friction fit on shoulders 50 and the outer walls each have depressions 51 aligning with complimentary depressions .

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in the side walls of the lower jaw for longitu-dinally locating the individual anvils and accurate-ly aligning the staple shaping depressions with the individual staples in cartridge 44.
While the instrument as described includes separate anvils 72 which fit on the shoulders 50 of upper jaw 16, it is also possible, particularly in the manufacture of a low-cost disposable instrument, to dispense with the anvils themselves and form the staple shaping depressions, directly in the under-surfaces of shoulders 50 of the upper jaw.
Assembly of the various components of the instrument is effected in the following manner with particular reference to Figures 1 to 3. Initially, with a cartridge 44 correctly positioned on jaw 20 of lower frame 14, the forward end of pusher assembly 30 is inserted from the back into lower frame 14, with lower shoe 54 fitting in passageway 48, and assembly 30 is moved forwardly along frame 14 until the pusher bars enter the lontitudinally slit ribs 60 and 62 of cartridge 44 and are arrested by the friction pieces 68. This position of pusher assembly 30 relative to frame 14 is shown in Figures 1 and 2.
Frame 14 with the inserted pusher assembly 30 is then fitted into handle member 22, suitable compli-mentary locating means (not shown) being provided on the frame and handle member to longitudinally align these elements and prevent forward movement of frame 14 in member 22 during staple ejection.
Anvils 72 are fitted on jaw 16 and lugs 13 of frame 12 are fitted into openings 15 of handle 26. Then with handle 26 tilted upwardly, as shown in Figure 2, notches 28 are engaged with pivot bar 24 to complete the assembly of the instrument.

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In use, the instrument in the assembled open condition, substantially as shown in Figure 2, is inserted into a body cavity/ so that tissue to be stapled is accepted between jaws 16 and 20 and the instrument is then locked by manipulation of handle 26 and cooperation of camming surfaces 19 with lugs 21. It will be noted that openings 55 (see Figure 3) are provided in shoulders 50 of the upper frame 12 which allow shoes 56 to enter channel 52 as the instrument is closed. With tissue gripped between the jaws and the instrument in the condition as shown in Figure 1, stapling is effected in the manner described in the aforementioned patent by pushing forwarding on knob 33.
When stapling is completed, the pusher assembly 30 is retracted to the initial positon, allowing shoes 56 to be removed from channel 52 through openings 55, so that the instrument can be opened.
It will be appreciated, since the shoes 54 and 56 are accurately laterally aligned and carried by a relatively rigid member, that during stapling, as the shoes move along the passageways 48 and 52 with minimal clearance, they provide adequate localized support to the jaws in the region of operation of the pusher bar cams and the particular individual staple pushers being actuated. Due to the cross-sectional shape of the shoes and passage-ways, such support resists forces tending both laterally to distort the jaws and to open the jaws vertically and accordingly the present construction lends itself to manufac-turing the jaws in relatively light weight disposable ma-terials. It is to be understood however that the construc-tion can also be used in instruments manufactured from more convention-al materials.

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While only a single preferred embodiment of the invention has been described in detail, it is to be understood that the invention is not limited to its specific features and modifications are possible within the scope of the attached claims.
Thus, while the invention has been particularly described in relation to its application in a surgical stapling instrument, the invention is not limited to this application. The invention may be applied to other fastening instruments having opposed jaws which require stabilization while fastening means are applied to living tissue gripped between the jaws. For example, the invention may be applied to instruments for applying certain types of surgical clips or instruments for applying surgical fastening devices of the type set out in U.S. Patent No.
4,060,089.

Claims (3)

The embodiments of the invention in which an exclusive property or privilege is claimed are de-fined as follows:

1. A staple cartridge for use with a surgical stapling instrument, said cartridge compris-ing a nose portion, a pair of substantially parallel elongate limbs extending from said nose portion, said limbs defining an uninterrupted slit therebetween extending the entire length and height of said limbs, seating means in each of said limbs for at least one longitudinally extending row of surgical staples and longitudinal passage means in each of said limbs for receiving a travelling pusher means operative sequential-ly to expel staples from said seating means.

2. A staple cartridge as defined in claim 1 including a series of individual staple pushers in each of said passage means, said staple pushers having camming surfaces for cooperating with said pusher means to expel staples from said seating means.

3. A staple cartridge as defined in claim 1 wherein said seating means in each of said limbs in-cludes means for accommodating two mutually staggered rows of staples.