CN111655170B

CN111655170B - Surgical stapler including storable cartridges having different staple sizes

Info

Publication number: CN111655170B
Application number: CN201880082803.2A
Authority: CN
Inventors: F·E·谢尔顿四世; J·L·哈里斯; J·R·摩根
Original assignee: Ethicon LLC
Current assignee: Ethicon LLC
Priority date: 2017-12-21
Filing date: 2018-12-13
Publication date: 2024-06-07
Anticipated expiration: 2038-12-13
Also published as: JP7334160B2; BR112020012348A2; JP2021506513A; CN111655170A

Abstract

A surgical stapler includes a stored or storable staple cartridge. The staple cartridges may have different unfired dimensions. In at least one instance, the first stored staple cartridge includes first staples having a first unfired height and the second stored staple cartridge includes second staples having a second unfired height different from the first unfired height.

Description

Surgical stapler including storable cartridges having different staple sizes

Background

The present invention relates to surgical instruments and, in various arrangements, to surgical stapling and severing instruments designed to staple and sever tissue and staple cartridges for use therewith.

Drawings

The various features of the embodiments described herein, together with their advantages, may be understood from the following description taken in conjunction with the following drawings:

FIG. 1 is a perspective view of a surgical stapling instrument according to at least one embodiment;

FIG. 2 is a cross-sectional view of the suturing apparatus of FIG. 1 taken along line 2-2 of FIG. 1;

FIG. 3 is a partial perspective view of the drive system of the stapling instrument of FIG. 1;

FIG. 4 is a plan view of the drive system of FIG. 3;

FIG. 5 is a front view of the drive system of FIG. 3 shown in a first operating configuration;

FIG. 6 is a side elevational view of the drive system of FIG. 3 shown in the first operating configuration of FIG. 5;

FIG. 7 is a side elevational view of the drive system of FIG. 3 shown in a second operating configuration;

FIG. 8 is a partial perspective view of a surgical stapling instrument according to at least one embodiment;

FIG. 9 is a partial perspective view of a surgical stapling instrument according to at least one embodiment;

FIG. 10 is a perspective view of the handle housing of the stapling instrument of FIG. 8;

Fig. 11 is a perspective view of a battery according to at least one embodiment;

FIG. 12 is a perspective view of the handle of the stapling instrument of FIG. 1;

FIG. 13 is a partial perspective view of a surgical stapling instrument including a display according to at least one embodiment;

FIG. 14 illustrates a status control on the display of FIG. 13;

FIG. 15 illustrates a speed control on the display of FIG. 13;

FIG. 16 illustrates a fault threshold control on the display of FIG. 13;

FIG. 17 illustrates a directional control on the display of FIG. 13;

FIG. 18 illustrates the display of FIG. 13 and the speed control of FIG. 15;

FIG. 19 illustrates the display and speed control of FIG. 13;

FIG. 20 illustrates the display of FIG. 13 and a staple path control for altering the staple firing path of the stapling instrument;

FIG. 21 illustrates the display of FIG. 13 and the staple path control of FIG. 21 for controlling the staple firing path of the stapling instrument;

FIG. 22 illustrates the display of FIG. 13 and controls for stopping the stapling instrument along the staple firing path;

FIG. 23 illustrates a surgical instrument system including an external or off-board display according to at least one embodiment;

FIG. 24 illustrates a display of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 25 illustrates the display of FIG. 24 for changing the staple firing path as the gastric sleeve is formed during a gastric volume reduction procedure;

FIG. 26 illustrates a lever for changing the staple firing path on the display of FIG. 24;

FIG. 27 illustrates the stapling instrument guided along a staple firing path;

FIG. 28 shows the stomach of a patient;

FIG. 29 is a cross-sectional view of the patient's stomach;

FIG. 30 is a cross-sectional view of a target inserted into the stomach of FIG. 29;

FIG. 31 is a cross-sectional view of a patient's stomach, the stomach being thinner than the stomach of FIG. 29;

FIG. 32 is a cross-sectional view of a target inserted into the stomach of FIG. 31;

FIG. 33 illustrates various anatomical features that may be referenced during a gastric sleeve procedure;

FIG. 34 is a partial elevation view of a surgical stapling instrument including a shaft, an end effector, and an articulation joint in accordance with at least one embodiment;

FIG. 35 is a partial front view of the stapling instrument of FIG. 34, showing the end effector in an articulated position;

FIG. 36 is a bottom cross-sectional view of an end effector of a surgical stapling instrument according to at least one embodiment;

FIG. 37 is a partial cross-sectional view of a surgical stapling instrument including a tissue drive system according to at least one embodiment;

FIG. 38 is a partial cross-sectional view of the suturing apparatus of FIG. 37 illustrating the tissue drive system engaged with tissue of a patient;

FIG. 39 is a partial cross-sectional view of the suturing apparatus of FIG. 37 illustrating a tissue drive system pushing patient tissue in a first direction;

FIG. 40 is a partial cross-sectional view of the suturing apparatus of FIG. 37 illustrating a tissue drive system pushing patient tissue in a second direction;

FIG. 41 is a partial cross-sectional view of the suturing apparatus of FIG. 37 illustrating the tissue drive system disengaged from patient tissue;

FIG. 42 is a partial front view of a drive system including a synchronization mechanism according to at least one embodiment;

FIG. 43 illustrates the synchronization mechanism of FIG. 42 actuating an end effector drive system;

FIG. 44 illustrates a drive system configured to reciprocally drive a plurality of end effector drive systems;

FIG. 45 shows a graph of two synchronized end effector drives;

FIG. 46 is a table showing synchronization of four end effector drives;

FIGS. 47A-47G illustrate steps in the operation of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 48 is a table showing synchronization of end effectors of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 49 is a module for operating a surgical stapling instrument in accordance with at least one embodiment;

FIG. 50 is a partial perspective view of an end effector including a tissue drive system shown extended according to at least one embodiment;

FIG. 51 is a partial perspective view of the tissue drive system of FIG. 50 retracted;

FIG. 52 is a partial cross-sectional view of the end effector of FIG. 50, showing the tissue drive system in a retracted configuration;

FIG. 53 is a partial cross-sectional view of the end effector of FIG. 50, showing the tissue drive system in a lowered configuration;

FIG. 54 is a partial cross-sectional view of the end effector of FIG. 50, showing the tissue drive system extended;

FIG. 55 is a partial cross-sectional view of the end effector of FIG. 50, showing teeth of the tissue drive system in a protruding configuration;

FIG. 56 is a partial cross-sectional view of the end effector of FIG. 50, showing the drive system retracted;

FIG. 57 is a partial perspective view of a tissue drive system according to at least one embodiment;

FIG. 58 is a partial perspective view of the tissue drive system of FIG. 57 in an extended configuration;

FIGS. 59A-59D illustrate steps of operation of a tissue drive system of a surgical stapling instrument in accordance with at least one embodiment;

FIGS. 60A-60D further illustrate steps of operation of the tissue drive system of FIGS. 59A-59D;

FIG. 61 is a partial perspective view of a surgical stapling instrument including a tissue drive system according to at least one embodiment;

FIG. 62 is a partial perspective view of the tissue drive system of FIG. 61 in an extended configuration;

FIG. 63 is a perspective view, partially in section, of a surgical stapling instrument including a tissue drive system in accordance with at least one embodiment;

FIG. 64 is a bottom cross-sectional plan view of the suturing apparatus of FIG. 63;

FIG. 65 is a partial cross-sectional view of a surgical stapling instrument including a vacuum system according to at least one embodiment;

FIG. 66 is a partial detail view of the tissue drive system of the stapling instrument of FIG. 65;

FIG. 67 is a partial cross-sectional view of the stapling instrument of FIG. 65, showing tissue being pulled into an end effector of the stapling instrument;

FIG. 68 is a partial detail view of the tissue drive system of FIG. 66;

FIG. 69 is a partial cross-sectional view of the stapling instrument of FIG. 65, showing tissue released;

FIG. 70 is a partial cross-sectional view of a surgical stapling instrument including a vacuum system according to at least one embodiment;

FIG. 71 is a partial cross-sectional view of the suturing apparatus of FIG. 70 showing the first and second legs of the suturing apparatus in a retracted configuration;

FIG. 72 is a partial cross-sectional view of the stapling instrument of FIG. 70, showing the first drive foot in an extended position;

FIG. 73 is a vacuum manifold of the suturing apparatus of FIG. 70 in fluid communication with a first drive foot;

FIG. 74 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment;

FIGS. 75A-75D illustrate steps in the operation of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 76 is a partial cutaway perspective view of a surgical stapling instrument according to at least one embodiment;

FIGS. 77A-77D illustrate the operational steps for manipulating the stapling instrument of FIG. 76;

FIG. 78 is a cross-sectional end view of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 79 is a partial elevation view of a surgical stapling instrument including a tissue drive apparatus in accordance with at least one embodiment;

FIG. 79A illustrates the position of the foot of the tissue driver corresponding to FIG. 79;

FIG. 80 is a partial front view of the suturing apparatus of FIG. 79 illustrating an extended foot;

FIG. 80A illustrates a position of a foot of the tissue drive apparatus corresponding to FIG. 80;

FIG. 81 is a partial front view of the suturing apparatus of FIG. 79 illustrating the foot in an extended configuration;

FIG. 81A illustrates the position of the foot of the tissue drive apparatus corresponding to FIG. 81;

FIG. 82 is a partial front view of the suturing apparatus of FIG. 79 illustrating the foot retracted;

FIG. 82A illustrates a position of a foot of the tissue drive apparatus corresponding to FIG. 82;

FIG. 83 is a partial cross-sectional view of the tissue driving device of the stapling instrument of FIG. 79;

FIG. 84 illustrates the kinematics of the tissue driving device of the stapling instrument of FIG. 79;

FIG. 85 illustrates a cam capable of producing the kinematics of FIG. 84;

FIG. 86 is a perspective view of a cam capable of producing the kinematics of FIG. 84;

FIG. 87 is a partial perspective view of a surgical stapling instrument including a tissue drive apparatus in accordance with at least one embodiment;

FIG. 88 is a tissue driving device of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 89 shows the tissue driving device of FIG. 88 in an extended configuration;

FIGS. 90A-90D illustrate the steps of operation of a surgical stapling instrument including a tissue driving device in accordance with at least one embodiment;

FIGS. 91A-91D illustrate the steps of operation of a surgical stapling instrument including a tissue driving device in accordance with at least one embodiment;

FIG. 92 is a tissue driving device of a surgical stapling instrument according to at least one embodiment;

FIG. 93 shows the tissue driving device of FIG. 92 in an extended configuration;

FIG. 94 is a partial cutaway perspective view of a surgical stapling instrument according to at least one embodiment;

FIG. 95 is a partial elevation view of a surgical stapling instrument including a tissue cutting member in accordance with at least one embodiment;

FIG. 96 illustrates the tissue cutting member of FIG. 95 moved through a tissue cutting stroke;

FIG. 97 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 98 is a perspective view of two connected staples in accordance with at least one embodiment;

FIG. 99 is a partial perspective view of the staple of FIG. 98 shown separated;

FIG. 100 is a partial cross-sectional view of a staple firing system of the stapling instrument of FIG. 97 including a staple firing chamber according to at least one embodiment;

FIG. 101 illustrates staples fired by the staple firing system of FIG. 100;

FIG. 102 illustrates another staple loaded into the staple firing chamber of FIG. 100;

FIG. 103 is a bottom cross-sectional end view of the suturing apparatus of FIG. 97;

FIG. 104 is a partial cutaway perspective view of a surgical stapling instrument according to at least one embodiment;

FIGS. 105A-105D illustrate steps in the operation of the suturing system of FIG. 104;

FIG. 106 is a partial perspective view of a surgical stapling instrument according to at least one embodiment;

FIG. 107 is an exploded perspective view of a staple holder for use with the stapling instrument of FIG. 106;

FIG. 108 is a plan view of a staple holder according to at least one embodiment;

FIG. 109 is an end view of the staple holder of FIG. 108 positioned in a surgical stapling instrument;

FIG. 110 is a perspective view of the staple holder of FIG. 108;

FIG. 111 is an end view of a staple holder positioned in a surgical stapling instrument according to at least one embodiment;

FIG. 112 is a perspective view of the staple holder of FIG. 111;

FIG. 113 is an end view of a staple holder positioned in a surgical stapling instrument according to at least one embodiment;

FIG. 114 is a perspective view of the staple holder of FIG. 113;

FIG. 115 is a partial plan view of a nailing strip in a deployed configuration according to at least one embodiment;

FIG. 116 is an end view of the nailing strip of FIG. 115 in its expanded configuration;

FIG. 117 is an end view of the nailing strip of FIG. 115 in its folded configuration;

FIG. 118 is a perspective view of the nailing strip of FIG. 115 deployed;

FIG. 119 is a perspective view of a staple cluster according to at least one embodiment;

FIG. 120 is a partial perspective view of the staple cluster of FIG. 119 loaded into a surgical stapling instrument;

FIG. 121 is a partial perspective view of a surgical stapling instrument including deployable staple clusters in accordance with at least one embodiment;

FIG. 122 is a partial perspective view of a surgical stapling instrument including a tissue drive apparatus according to at least one embodiment;

FIG. 123 is a partial perspective view of the stapling instrument of FIG. 122 illustrating the tissue driving apparatus in an extended configuration;

FIG. 124 illustrates a cross-sectional width of the distal head of the stapling instrument of FIG. 122;

FIG. 125 is a cross-sectional view of the tissue gripping surface of the tissue driving device of FIG. 122;

FIG. 126 is a cross-sectional end view of a surgical stapling instrument including a tissue drive device shown in an extended configuration in accordance with at least one embodiment;

FIG. 127 is a cross-sectional end view of the stapling instrument of FIG. 126, showing the tissue driving device in a retracted configuration;

FIG. 128 illustrates a firing drive of a surgical stapling instrument shown in an unfired configuration in accordance with at least one embodiment;

FIG. 128A illustrates the tissue driving device of the stapling instrument of FIG. 128 shown in an extended configuration;

FIG. 129 illustrates the firing drive of FIG. 128 shown in a fired configuration;

FIG. 129A shows the tissue driving device of FIG. 128A in a retracted configuration;

FIG. 130 illustrates the firing drive of FIG. 128 shown in its unfired configuration;

FIG. 130A illustrates the tissue driving device of FIG. 128A in its retracted configuration;

FIG. 131 is a perspective view of a staple loading system of a surgical stapling instrument according to at least one embodiment;

FIG. 132 is a plan view of the staple loading system of FIG. 131;

FIG. 133 is a partial front view of the staple loading system of FIG. 131;

FIG. 134 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in an unfired configuration;

FIG. 135 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in a fired configuration;

FIG. 136 is a partial cross-sectional view of the stapling instrument of FIG. 131 retracted to its unfired configuration;

FIG. 137 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in its unfired configuration;

FIG. 138 illustrates a staple pattern that may be produced by a surgical stapling instrument in accordance with at least one embodiment;

FIG. 139 illustrates a staple pattern that may be produced by a surgical stapling instrument in accordance with at least one embodiment;

FIG. 140 illustrates a surgical stapling instrument in accordance with at least one embodiment;

FIG. 141 illustrates the operational steps of the stapling instrument of FIG. 140 for producing and deploying staples;

FIG. 142 shows a staple line in a patient's stomach;

FIG. 143 is a staple firing process according to at least one embodiment;

FIGS. 144-146 illustrate the stapling instrument of FIG. 1 used during a surgical procedure;

FIG. 147 illustrates a surgical stapling instrument used during a surgical procedure in accordance with at least one embodiment;

FIG. 148 is a partial elevation view of the surgical stapling instrument of FIG. 147;

FIG. 149 is a partial perspective view of the suturing apparatus of FIG. 147 in a first configuration;

FIG. 150 is a partial perspective view of the suturing apparatus of FIG. 147 in a second configuration;

FIG. 151 illustrates potential results of a gastric sleeve procedure using the surgical stapling instrument disclosed herein;

FIG. 152 shows a guide inserted into a patient's stomach;

FIG. 153 illustrates a guide for defining a staple firing path in a patient's stomach;

FIG. 154 shows the guide of FIG. 153 used to form a gastric sleeve during a gastric bypass procedure;

FIG. 155 is a partial cross-sectional view of the guide of FIG. 153;

FIG. 156 is a partial perspective view of a guide shown with some components removed according to at least one embodiment;

FIG. 157 is a schematic view of the guide of FIG. 153;

FIG. 158 is a perspective view of a surgical stapling system including a loadable staple cartridge according to at least one embodiment;

FIG. 159 illustrates certain operational components of the suturing system of FIG. 158;

FIG. 160 is an end view of a surgical stapling instrument including a projection system including two lenses according to at least one embodiment;

FIG. 161 illustrates the stapling instrument of FIG. 160 used during a surgical procedure;

FIG. 162 illustrates a surgical stapling system including a projector in accordance with at least one embodiment;

FIG. 163 illustrates a surgical stapling system including a vision system and a projection system in accordance with at least one embodiment;

FIG. 164 illustrates a projection system of the suturing system of FIG. 163 in use;

FIG. 165 illustrates a projected image on tissue of a patient in accordance with at least one embodiment;

FIG. 166 illustrates a staple firing path projected onto tissue of a patient in accordance with at least one embodiment;

FIG. 167 illustrates a surgical stapling instrument that includes a first projector configured to project a first portion of a staple firing path onto tissue of a patient and a second projector configured to project a second portion of the staple firing path onto tissue of the patient in accordance with at least one embodiment.

FIG. 168 is a partial elevation view of a surgical stapling instrument including an articulatable end effector according to at least one embodiment;

FIG. 169 is a partial elevational view of the surgical stapling instrument of FIG. 168;

FIG. 170 is a partial elevation view of a surgical stapling instrument including an articulatable end effector and a damper configured to reduce unintended movement of the end effector in accordance with at least one embodiment;

FIG. 171 is a partial elevation view of a surgical stapling instrument including an end effector damper according to at least one embodiment;

FIG. 172 illustrates the suturing apparatus of FIG. 171 used in a surgical procedure;

FIG. 173 illustrates the suturing apparatus of FIG. 171 used in a surgical procedure;

FIG. 174 illustrates a staple firing path formed by a surgical stapling instrument that includes a longitudinal end effector;

FIG. 175 illustrates a staple firing path formed by the surgical stapling instrument disclosed herein;

FIG. 176 illustrates a staple firing path formed by a surgical stapling instrument that includes a longitudinal end effector;

FIG. 177 illustrates a staple firing path formed by the surgical stapling instrument disclosed herein;

FIG. 178 illustrates a staple firing path formed by a surgical stapling instrument that includes a longitudinal end effector;

FIG. 179 illustrates a staple firing path formed by the surgical stapling instrument disclosed herein;

FIG. 180 is a perspective view of a handle of a surgical instrument according to at least one embodiment;

FIG. 181 is a perspective view of the handle of the surgical instrument of FIG. 180 enclosed in a sterile barrier;

FIG. 182 is a partial cross-sectional view of the sterility barrier and the touch-sensitive display of the handle of FIG. 181;

FIG. 183 is a plan view of the touch sensitive display of FIG. 182, showing an electrode grid in which a plurality of pixels are activated; and

Fig. 184 is a graph illustrating the relationship between the location of the active pixel of fig. 183 and the capacitance detected by the touch sensitive display of fig. 182.

Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.

Detailed Description

The applicant of the present application owns the following U.S. patent applications filed on 2017, 12, 21, and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/850,431 entitled "CONTINUOUS USE SELF-PROPELLED STAPLING INSTRUMENT";

U.S. patent application Ser. No. 15/850,461, entitled "SURGICAL INSTRUMENT COMPRISING SPEED CONTROL";

U.S. patent application Ser. No. 15/850,433, entitled "SURGICAL INSTRUMENT COMPRISING A PROJECTOR";

U.S. patent application Ser. No. 15/850,495, entitled "STAPLE INSTRUMENT COMPRISING A FIRING PATH DISPLAY";

U.S. patent application Ser. No. 15/850,480, entitled "SELF-GUIDING STAPLING INSTRUMENT";

U.S. patent application Ser. No. 15/850,522 entitled "SURGICAL INSTRUMENT CONFIGURED TO DETERMINE FIRING PATH";

U.S. patent application Ser. No. 15/850,542, entitled "SURGICAL INSTRUMENT COMPRISING AN END EFFECTOR DAMPENER";

U.S. patent application Ser. No. 15/850,579, entitled "SURGICAL INSTRUMENT COMPRISING SYNCHRONIZED DRIVE SYSTEMS";

U.S. patent application Ser. No. 15/850,505, entitled "STAPLING INSTRUMENT COMPRISING A TISSUE DRIVE";

U.S. patent application Ser. No. 15/850,534, entitled "SURGICAL INSTRUMENT COMPRISING A TISSUE GRASPING SYSTEM";

U.S. patent application Ser. No. 15/850,562, entitled "SURGICAL INSTRUMENT COMPRISING SEQUENCED SYSTEMS";

U.S. patent application Ser. No. 15/850,587, entitled "STAPLING INSTRUMENT COMPRISING A STAPLE FEEDING SYSTEM";

U.S. patent application Ser. No. 15/850,526, entitled "SURGICAL INSTRUMENT HAVING A DISPLAY COMPRISING IMAGE LAYERS";

U.S. patent application Ser. No. 15/850,529, entitled "SURGICAL INSTRUMENT COMPRISING A DISPLAY";

U.S. patent application Ser. No. 15/850,500, entitled "SURGICAL INSTRUMENT COMPRISING AN ARTICULATABLE DISTAL HEAD"; and

U.S. patent application Ser. No. 15/850,518, entitled "SURGICAL INSTRUMENT COMPRISING A PIVOTABLE DISTAL HEAD".

The applicant of the present application owns the following U.S. patent applications filed on 2017, 12, 19, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/847,306, entitled "METHOD FOR DETERMINING THE POSITION OF A ROTATABLE JAW OF A SURGICAL INSTRUMENT ATTACHMENT ASSEMBLY";

U.S. patent application Ser. No. 15/847,297, entitled "SURGICAL INSTRUMENTS WITH DUAL ARTICULATION DRIVERS";

U.S. patent application Ser. No. 15/847,325 entitled "SURGICAL TOOLS CONFIGURED FOR INTERCHANGEABLE USE WITH DIFFERENT CONTROLLER INTERFACES";

U.S. patent application Ser. No. 15/847,293, entitled "SURGICAL INSTRUMENT COMPRISING CLOSURE AND FIRING LOCKING MECHANISM";

U.S. patent application Ser. No. 15/847,315, entitled "ROBOTIC ATTACHMENT COMPRISING EXTERIOR DRIVE ACTUATOR"; and

U.S. design patent application Ser. No. 29/630,115, entitled "SURGICAL INSTRUMENT ASSEMBLY".

The applicant of the present application owns the following U.S. patent applications filed on date 2017, 12, 15, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/843,485, entitled "SEALED ADAPTERS FOR USE WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/843,518, entitled "END EFFECTORS WITH POSITIVE JAW OPENING FEATURES FOR USE WITH ADAPTERS FOR ELECTROMECHANICAL SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/843,535, entitled "SURGICAL END EFFECTORS WITH CLAMPING ASSEMBLIES CONFIGURED TO INCREASE JAW APERTURE RANGES";

U.S. patent application Ser. No. 15/843,558, entitled "SURGICAL END EFFECTORS WITH PIVOTAL JAWS CONFIGURED TO TOUCH AT THEIR RESPECTIVE DISTAL ENDS WHEN FULLY CLOSED";

U.S. patent application Ser. No. 15/843,528, entitled "SURGICAL END EFFECTORS WITH JAW STIFFENER ARRANGEMENTS CONFIGURED TO PERMIT MONITORING OF FIRING MEMBER";

U.S. patent application Ser. No. 15/843,567, entitled "ADAPTERS WITH END EFFECTOR POSITION SENSING AND CONTROL ARRANGEMENTS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/843,556, entitled "DYNAMIC CLAMPING ASSEMBLIES WITH IMPROVED WEAR CHARACTERISTICS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/843,514, entitled "ADAPTERS WITH FIRING STROKE SENSING ARRANGEMENTS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/843,501, entitled "ADAPTERS WITH CONTROL SYSTEMS FOR CONTROLLING MULTIPLE MOTORS OF AN ELECTROMECHANICAL SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/843,508, entitled "HANDHELD ELECTROMECHANICAL SURGICAL INSTRUMENTS WITH IMPROVED MOTOR CONTROL ARRANGEMENTS FOR POSITIONING COMPONENTS OF AN ADAPTER COUPLED THERETO";

U.S. patent application Ser. No. 15/843,682, entitled "SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER FIRING RATE OF A SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/843,689 entitled "SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER"; and

U.S. patent application Ser. No. 15/843,704, entitled "METHODS OF OPERATING SURGICAL END EFFECTORS".

The applicant of the present application owns the following U.S. patent applications filed on 2017, 6, 29, and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/636,829 entitled "CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/636,837, entitled "CLOSED LOOP VELOCITY CONTROL TECHNIQUES BASED ON SENSED TISSUE PARAMETERS FOR ROBOTIC SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/636,844 entitled "CLOSED LOOP VELOCITY CONTROL OF CLOSURE MEMBER FOR ROBOTIC SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/636,854, entitled "ROBOTIC SURGICAL INSTRUMENT WITH CLOSED LOOP FEEDBACK TECHNIQUES FOR ADVANCEMENT OF CLOSURE MEMBER DURING FIRING"; and

U.S. patent application Ser. No. 15/636,858, entitled "SYSTEM FOR CONTROLLING ARTICULATION FORCES".

The applicant of the present application owns the following U.S. patent applications filed on date 28 of 2017, 6, and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/635,693, entitled "SURGICAL INSTRUMENT COMPRISING AN OFFSET ARTICULATION JOINT";

U.S. patent application Ser. No. 15/635,729, entitled "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO";

U.S. patent application Ser. No. 15/635,785, entitled "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO";

U.S. patent application Ser. No. 15/635,808, entitled "SURGICAL INSTRUMENT COMPRISING FIRING MEMBER SUPPORTS";

U.S. patent application Ser. No. 15/635,837, entitled "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE TO A FRAME";

U.S. patent application Ser. No. 15/635,941, entitled "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE BY A CLOSURE SYSTEM";

U.S. patent application Ser. No. 15/636,029, entitled "SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A HOUSING ARRANGEMENT";

U.S. patent application Ser. No. 15/635,958, entitled "SURGICAL INSTRUMENT COMPRISING SELECTIVELY ACTUATABLE ROTATABLE COUPLERS";

U.S. patent application Ser. No. 15/635,981, entitled "SURGICAL STAPLING INSTRUMENTS COMPRISING SHORTENED STAPLE CARTRIDGE NOSES";

U.S. patent application Ser. No. 15/636,009, entitled "SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A CLOSURE TUBE PROFILE";

U.S. patent application Ser. No. 15/635,663, entitled "METHOD FOR ARTICULATING A SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/635,530, entitled "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITH AXIALLY SHORTENED ARTICULATION JOINT CONFIGURATIONS";

U.S. patent application Ser. No. 15/635,549, entitled "SURGICAL INSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLY MOVABLE FIRING MEMBER THAT IS INITIALLY PARKED IN CLOSE PROXIMITY TO THE JAWS PRIOR TO FIRING";

U.S. patent application Ser. No. 15/635,559, entitled "SURGICAL INSTRUMENTS WITH JAWS CONSTRAINED TO PIVOT ABOUT AN AXIS UPON CONTACT WITH A CLOSURE MEMBER THAT IS PARKED IN CLOSE PROXIMITY TO THE PIVOT AXIS";

U.S. patent application Ser. No. 15/635,578, entitled "SURGICAL END EFFECTORS WITH IMPROVED JAW APERTURE ARRANGEMENTS";

U.S. patent application Ser. No. 15/635,594, entitled "SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVIL WITH A TISSUE LOCATING ARRANGEMENT IN CLOSE PROXIMITY TO AN ANVIL PIVOT";

U.S. patent application Ser. No. 15/635,612, entitled "JAW RETAINER ARRANGEMENT FOR RETAINING A PIVOTABLE SURGICAL INSTRUMENT JAW IN PIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICAL INSTRUMENT JAW";

U.S. patent application Ser. No. 15/635,621, entitled "SURGICAL INSTRUMENT WITH POSITIVE JAW OPENING FEATURES";

U.S. patent application Ser. No. 15/635,631, entitled "SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER";

U.S. patent application Ser. No. 15/635,521, entitled "SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT";

U.S. design patent application Ser. No. 29/609,087, entitled "STAPLE FORMING ANVIL";

U.S. design patent application Ser. No. 29/609,083, entitled "SURGICAL INSTRUMENT SHAFT"; and

U.S. design patent application Ser. No. 29/609,093, entitled "SURGICAL FASTENER CARTRIDGE".

The applicant of the present application owns the following U.S. patent applications filed on date 27 of 2017, 6, and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/634,024, entitled "SURGICAL ANVIL MANUFACTURING METHODS";

U.S. patent application Ser. No. 15/634,035, entitled "SURGICAL ANVIL ARRANGEMENTS";

U.S. patent application Ser. No. 15/634,046 entitled "SURGICAL ANVIL ARRANGEMENTS";

U.S. patent application Ser. No. 15/634,054, entitled "SURGICAL ANVIL ARRANGEMENTS";

U.S. patent application Ser. No. 15/634,068, entitled "SURGICAL FIRING MEMBER ARRANGEMENTS";

U.S. patent application Ser. No. 15/634,076, entitled "STAPLE FORMING POCKET ARRANGEMENTS";

U.S. patent application Ser. No. 15/634,090, entitled "STAPLE FORMING POCKET ARRANGEMENTS";

U.S. patent application Ser. No. 15/634,099, entitled "SURGICAL END EFFECTORS AND ANVILS"; and

U.S. patent application Ser. No. 15/634,117, entitled "ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS".

The applicant of the present application owns the following U.S. patent applications filed on date 2016, 12, 21, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/386,185, entitled "SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIES THEREOF";

U.S. patent application Ser. No. 15/386,230, entitled "ARTICULATABLE SURGICAL STAPLING INSTRUMENTS";

U.S. patent application Ser. No. 15/386,221, entitled "LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS";

U.S. patent application Ser. No. 15/386,209 entitled "SURGICAL END EFFECTORS AND FIRING MEMBERS THEEOF";

U.S. patent application Ser. No. 15/386,198, entitled "LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE TOOL ASSEMBLIES";

U.S. patent application Ser. No. 15/386,240 entitled "SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR";

U.S. patent application Ser. No. 15/385,939, entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN";

U.S. patent application Ser. No. 15/385,941, entitled "SURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGEMENTS FOR SHIFTING BETWEEN CLOSURE SYSTEMS WITH CLOSURE STROKE REDUCTION FEATURES AND ARTICULATION AND FIRING SYSTEMS";

U.S. patent application Ser. No. 15/385,943, entitled "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS";

U.S. patent application Ser. No. 15/385,950, entitled "SURGICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUCTION FEATURES";

U.S. patent application Ser. No. 15/385,945, entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN";

U.S. patent application Ser. No. 15/385,946, entitled "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS";

U.S. patent application Ser. No. 15/385,951 entitled "SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASING A JAW OPENING DISTANCE";

U.S. patent application Ser. No. 15/385,953 entitled "METHODS OF STAPLING TISSUE";

U.S. patent application Ser. No. 15/385,954 entitled "FIRING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATURES FOR SURGICAL END EFFECTORS";

U.S. patent application Ser. No. 15/385,955 entitled "SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOP ARRANGEMENTS";

U.S. patent application Ser. No. 15/385,948, entitled "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS";

U.S. patent application Ser. No. 15/385,956 entitled "SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES";

U.S. patent application Ser. No. 15/385,958, entitled "SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTING FIRING SYSTEM ACTUATION UNLESS AN UNSPENT STAPLE CARTRIDGE IS PRESENT";

U.S. patent application Ser. No. 15/385,947, entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN";

U.S. patent application Ser. No. 15/385,896 entitled "METHOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT";

U.S. patent application Ser. No. 15/385,898, entitled "STAPLE FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF STAPLES";

U.S. patent application Ser. No. 15/385,899, entitled "SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CONTROL";

U.S. patent application Ser. No. 15/385,901 entitled "STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRISING WINDOWS DEFINED THEREIN";

U.S. patent application Ser. No. 15/385,902 entitled "SURGICAL INSTRUMENT COMPRISING A CUTTING MEMBER";

U.S. patent application Ser. No. 15/385,904 entitled "STAPLE FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND/OR SPENT CARTRIDGE LOCOUT";

U.S. patent application Ser. No. 15/385,905 entitled "FIRING ASSEMBLY COMPRISING A LOCKOUT";

U.S. patent application Ser. No. 15/385,907 entitled "SURGICAL INSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUT AND A FIRING ASSEMBLY LOCKOUT";

U.S. patent application Ser. No. 15/385,908 entitled "FIRING ASSEMBLY COMPRISING A FUSE";

U.S. patent application Ser. No. 15/385,909 entitled "FIRING ASSEMBLY COMPRISING A MULTIPLE FAILED-STATE FUSE";

U.S. patent application Ser. No. 15/385,920 entitled "STAPLE FORMING POCKET ARRANGEMENTS";

U.S. patent application Ser. No. 15/385,913, entitled "ANVIL ARRANGEMENTS FOR SURGICAL STAPLE/FASTENERS";

U.S. patent application Ser. No. 15/385,914, entitled "METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT";

U.S. patent application Ser. No. 15/385,893, entitled "BILATERALLY ASYMMETRIC STAPLE FORMING POCKET PAIRS";

U.S. patent application Ser. No. 15/385,929, entitled "CLOSURE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SURGICAL INSTRUMENTS WITH SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS";

U.S. patent application Ser. No. 15/385,911, entitled "SURGICAL STAPLE/FASTENERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND FIRING SYSTEMS";

U.S. patent application Ser. No. 15/385,927 entitled "SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CARTRIDGES";

U.S. patent application Ser. No. 15/385,917 entitled "STAPLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAMPING BREADTHS";

U.S. patent application Ser. No. 15/385,900 entitled "STAPLE FORMING POCKET ARRANGEMENTS COMPRISING PRIMARY SIDEWALLS AND POCKET SIDEWALLS";

U.S. patent application Ser. No. 15/385,931, entitled "NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FOR SURGICAL STAPLE/FASTENERS";

U.S. patent application Ser. No. 15/385,915, entitled "FIRING MEMBER PIN ANGLE";

U.S. patent application Ser. No. 15/385,897 entitled "STAPLE FORMING POCKET ARRANGEMENTS COMPRISING ZONED FORMING SURFACE GROOVES";

U.S. patent application Ser. No. 15/385,922, entitled "SURGICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES";

U.S. patent application Ser. No. 15/385,924 entitled "SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS";

U.S. patent application Ser. No. 15/385,912, entitled "SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXIS AND INCLUDE SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS";

U.S. patent application Ser. No. 15/385,910 entitled "ANVIL HAVING A KNIFE SLOT WIDTH";

U.S. patent application Ser. No. 15/385,906 entitled "FIRING MEMBER PIN CONFIGURATIONS";

U.S. patent application Ser. No. 15/386,188, entitled "STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES";

U.S. patent application Ser. No. 15/386,192, entitled "STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES";

U.S. patent application Ser. No. 15/386,206, entitled "STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES";

U.S. patent application Ser. No. 15/386,226 entitled "DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLIES OF SURGICAL STAPLING INSTRUMENTS";

U.S. patent application Ser. No. 15/386,222, entitled "SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITH POSITIVE OPENING FEATURES";

U.S. patent application Ser. No. 15/386,236 entitled "CONNECTION PORTIONS FOR DISPOSABLE LOADING UNITS FOR SURGICAL STAPLING INSTRUMENTS";

U.S. patent application Ser. No. 15/385,887, entitled "METHOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICAL INSTRUMENT AND,ALTERNATIVELY,TO A SURGICAL ROBOT";

U.S. patent application Ser. No. 15/385,889, entitled "SHAFT ASSEMBLY COMPRISING A MANUALLY-OPERABLE RETRACTION SYSTEM FOR USE WITH A MOTORIZED SURGICAL INSTRUMENT SYSTEM";

U.S. patent application Ser. No. 15/385,890 entitled "SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE SYSTEMS";

U.S. patent application Ser. No. 15/385,891, entitled "SHAFT ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO ADAPT THE OUTPUT OF A ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEMS";

U.S. patent application Ser. No. 15/385,892, entitled "SURGICAL SYSTEM COMPRISING A FIRING MEMBER ROTATABLE INTO AN ARTICULATION STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM";

U.S. patent application Ser. No. 15/385,894 entitled "SHAFT ASSEMBLY COMPRISING A LOCKOUT";

U.S. patent application Ser. No. 15/385,895 entitled "SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULATION LOCKOUTS";

U.S. patent application Ser. No. 15/385,916, entitled "SURGICAL STAPLING SYSTEMS";

U.S. patent application Ser. No. 15/385,918, entitled "SURGICAL STAPLING SYSTEMS";

U.S. patent application Ser. No. 15/385,919 entitled "SURGICAL STAPLING SYSTEMS";

U.S. patent application Ser. No. 15/385,921, entitled "SURGICAL STAPLE/FASTENER CARTRIDGE WITH MOVABLE CAMMING MEMBER CONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES";

U.S. patent application Ser. No. 15/385,923 entitled "SURGICAL STAPLING SYSTEMS";

U.S. patent application Ser. No. 15/385,925, entitled "JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCEMENT OF A FIRING MEMBER IN A SURGICAL END EFFECTOR UNLESS AN FIRED CARTRIDGE IS INSTALLED IN THE END EFFECTOR";

U.S. patent application Ser. No. 15/385,926, entitled "AXIALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR APPLYING CLOSURE MOTIONS TO JAWS OF SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/385,928, entitled "PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN A MOVABLE JAW AND ACTUATOR SHAFT OF A SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 15/385,930, entitled "SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERATING OPENING FEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS";

U.S. patent application Ser. No. 15/385,932 entitled "ARTICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFT ARRANGEMENT";

U.S. patent application Ser. No. 15/385,933, entitled "ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLE LINKAGE DISTAL OF AN ARTICULATION LOCK";

U.S. patent application Ser. No. 15/385,934, entitled "ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR IN AN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM";

U.S. patent application Ser. No. 15/385,935, entitled "LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATED CONFIGURATION"; and

U.S. patent application Ser. No. 15/385,936 entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES";

the applicant of the present application owns the following U.S. patent applications filed on date 2016, 6, 24, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/191,775, entitled "STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES";

U.S. patent application Ser. No. 15/191,807 entitled "STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPED STAPLES";

U.S. patent application Ser. No. 15/191,834 entitled "STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME";

U.S. patent application Ser. No. 15/191,788, entitled "STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES"; and

U.S. patent application Ser. No. 15/191,818, entitled "STAPLE CARTRIDGE COMPRISING OFFSET LONGITUDINAL STAPLE ROWS".

U.S. design patent application Ser. No. 29/569,218, entitled "SURGICAL FASTENER";

U.S. design patent application Ser. No. 29/569,227, entitled "SURGICAL FASTENER";

U.S. design patent application Ser. No. 29/569,259, entitled "SURGICAL FASTENER CARTRIDGE"; and

U.S. design patent application Ser. No. 29/569,264, entitled "SURGICAL FASTENER CARTRIDGE".

The applicant of the present application owns the following patent applications filed on date 2016, 4 and 1, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/089,325, entitled "METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM," now U.S. patent application publication 2017/0281171;

U.S. patent application Ser. No. 15/089,321, entitled "MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY", now U.S. patent application publication 2017/0281163;

U.S. patent application Ser. No. 15/089,326, entitled "SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD", now U.S. patent application publication 2017/0281172;

U.S. patent application Ser. No. 15/089,263, entitled "SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP PORTION," now U.S. patent application publication 2017/0281165;

U.S. patent application Ser. No. 15/089,262, now U.S. patent application publication 2017/0281161, entitled "ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT SYSTEM";

U.S. patent application Ser. No. 15/089,277, entitled "SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC DRIVE MEMBER", now U.S. patent application publication 2017/0281166;

U.S. patent application Ser. No. 15/089,296, now U.S. patent application publication 2017/0281168, entitled "INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SURGICAL END EFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS";

U.S. patent application Ser. No. 15/089,258, entitled "SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION", now U.S. patent application publication 2017/0281178;

U.S. patent application Ser. No. 15/089,278, entitled "SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVE CUTTING OF TISSUE", now U.S. patent application publication 2017/0281162;

U.S. patent application Ser. No. 15/089,284, entitled "SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT", now U.S. patent application publication 2017/0281186;

U.S. patent application Ser. No. 15/089,295, entitled "SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSION LOCKOUT", now U.S. patent application publication 2017/0281187;

U.S. patent application Ser. No. 15/089,300, entitled "SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT", now U.S. patent application publication 2017/0281179;

U.S. patent application Ser. No. 15/089,196, entitled "SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT", now U.S. patent application publication 2017/0281183;

U.S. patent application Ser. No. 15/089,203, entitled "SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT", now U.S. patent application publication 2017/0281184;

U.S. patent application Ser. No. 15/089,210, now U.S. patent application publication 2017/0281185, entitled "SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGE LOCOUT";

U.S. patent application Ser. No. 15/089,324, entitled "SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM", now U.S. patent application publication 2017/0281170;

U.S. patent application Ser. No. 15/089,335, entitled "SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS," now U.S. patent application publication 2017/0281155;

U.S. patent application Ser. No. 15/089,339, now U.S. patent application publication 2017/0281173, entitled "SURGICAL STAPLING INSTRUMENT";

U.S. patent application Ser. No. 15/089,253, entitled "SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OF STAPLES HAVING DIFFERENT HEIGHTS", now U.S. patent application publication 2017/0281177;

U.S. patent application Ser. No. 15/089,304, entitled "SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET", now U.S. patent application publication 2017/0281188;

U.S. patent application Ser. No. 15/089,331, entitled "ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLE/FASTENERS", now U.S. patent application publication 2017/0281180;

U.S. patent application Ser. No. 15/089,336, entitled "STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES", now U.S. patent application publication 2017/0281164;

U.S. patent application Ser. No. 15/089,312, entitled "CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUE SUPPORT", now U.S. patent application publication 2017/0281189;

U.S. patent application Ser. No. 15/089,309, entitled "CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM", now U.S. patent application publication 2017/0281169; and

U.S. patent application Ser. No. 15/089,349, entitled "CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL", now U.S. patent application publication 2017/0281174.

The applicant of the present application also owns the following identified U.S. patent applications filed on 12 months 30 of 2015, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/984,488, entitled "MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE IN POWERED SURGICAL INSTRUMENTS," now U.S. patent application publication 2017/0189018;

U.S. patent application Ser. No. 14/984,525, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS," now U.S. patent application publication 2017/0189019; and

U.S. patent application Ser. No. 14/984,552, entitled "SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROL CIRCUITS," now U.S. patent application publication 2017/0189020.

The applicant of the present application also owns the following identified U.S. patent applications filed on date 2016, 2 and 9, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/019,220, now U.S. patent application publication 2017/0224333, entitled "SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLATABLE END EFFECTOR";

U.S. patent application Ser. No. 15/019,228, now U.S. patent application publication 2017/0224342, entitled "SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS";

U.S. patent application Ser. No. 15/019,196, entitled "SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT", now U.S. patent application publication 2017/0224330;

U.S. patent application Ser. No. 15/019,206, now U.S. patent application publication 2017/0224331, entitled "SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLY ARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY";

U.S. patent application Ser. No. 15/019,215, now U.S. patent application publication 2017/0224332, entitled "SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION ARRANGEMENTS";

U.S. patent application Ser. No. 15/019,227, now U.S. patent application publication 2017/0224334, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATION LINK ARRANGEMENTS";

U.S. patent application Ser. No. 15/019,235, now U.S. patent application publication 2017/0224336, entitled "SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEN ARTICULATION SYSTEMS";

U.S. patent application Ser. No. 15/019,230, now U.S. patent application publication 2017/0224335, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAM ARRANGEMENTS"; and

U.S. patent application Ser. No. 15/019,245, entitled "SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTION ARRANGEMENTS", now U.S. patent application publication 2017/0224343.

The applicant of the present application also owns the following identified U.S. patent applications filed on date 2016, 2, 12, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 15/043,254, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/043,259, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 15/043,275, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS"; and

U.S. patent application Ser. No. 15/043,289, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS".

The applicant of the present application owns the following patent applications filed on 18 th month 6 2015, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/742,925, now U.S. patent application publication 2016/0367256, entitled "SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS";

U.S. patent application Ser. No. 14/742,941, entitled "SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES," now U.S. patent application publication 2016/0367248;

U.S. patent application Ser. No. 14/742,914, entitled "MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS," now U.S. patent application publication 2016/0367255;

U.S. patent application Ser. No. 14/742,900, now U.S. patent application publication 2016/0367254, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAM STRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT";

U.S. patent application Ser. No. 14/742,885, entitled "DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS," now U.S. patent application publication 2016/0367246; and

U.S. patent application Ser. No. 14/742,876, entitled "PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLE SURGICAL INSTRUMENTS", now U.S. patent application publication 2016/0367245.

The applicant of the present application owns the following patent applications filed on 3/6/2015, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/640,746, entitled "POWERED SURGICAL INSTRUMENT," now U.S. patent 9,808,246;

U.S. patent application Ser. No. 14/640,795, entitled "MULTIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWERED SURGICAL INSTRUMENTS," now U.S. patent application publication 2016/02561185;

U.S. patent application Ser. No. 14/640,832, entitled "ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURE RATES FOR MULTIPLE TISSUE TYPES," now U.S. patent application publication 2016/0256154;

U.S. patent application Ser. No. 14/640,935, entitled "OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION", now U.S. patent application publication 2016/0256071;

U.S. patent application Ser. No. 14/640,831, entitled "MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTOR FOR POWERED SURGICAL INSTRUMENTS," now U.S. patent application publication 2016/0256153;

U.S. patent application Ser. No. 14/640,859, now U.S. patent application publication 2016/0256187, entitled "TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINE STABILITY,CREEP,AND VISCOELASTIC ELEMENTS OF MEASURES";

U.S. patent application Ser. No. 14/640,817, entitled "INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS," now U.S. patent application publication 2016/0256186;

U.S. patent application Ser. No. 14/640,844, now U.S. patent application publication 2016/0256155, entitled "CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITHIN MODULAR SHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE";

U.S. patent application Ser. No. 14/640,837, entitled "SMART SENSORS WITH LOCAL SIGNAL PROCESSING," now U.S. patent application publication 2016/0256163;

U.S. patent application Ser. No. 14/640,765, entitled "SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A SURGICAL STAPLE/FASTENER", now U.S. patent application publication 2016/0256160;

U.S. patent application Ser. No. 14/640,799, entitled "SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON A ROTATABLE SHAFT," now U.S. patent application publication 2016/0256162; and

U.S. patent application Ser. No. 14/640,780, entitled "SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING," now U.S. patent application publication 2016/0256161.

The applicant of the present application owns the following patent applications filed on 27 of 2 nd month 2015, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/633,576, entitled "SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION," now U.S. patent application publication 2016/0249949;

U.S. patent application Ser. No. 14/633,546, entitled "SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCE PARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND", now U.S. patent application publication 2016/0249115;

U.S. patent application Ser. No. 14/633,560, entitled "SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONE OR MORE BATTERIES", now U.S. patent application publication 2016/0249910;

U.S. patent application Ser. No. 14/633,566, entitled "CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A BATTERY", now U.S. patent application publication 2016/0249218;

U.S. patent application Ser. No. 14/633,555, now U.S. patent application publication 2016/024996, entitled "SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TO BE SERVICED";

U.S. patent application Ser. No. 14/633,542, entitled "REINFORCED BATTERY FOR A SURGICAL INSTRUMENT," now U.S. patent application publication 2016/0249508;

U.S. patent application Ser. No. 14/633,548, entitled "POWER ADAPTER FOR A SURGICAL INSTRUMENT," now U.S. patent application publication 2016/024909;

U.S. patent application Ser. No. 14/633,526, entitled "ADAPTABLE SURGICAL INSTRUMENT HANDLE," now U.S. patent application publication 2016/0249945;

U.S. patent application Ser. No. 14/633,541, entitled "MODULAR STAPLING ASSEMBLY," now U.S. patent application publication 2016/0249977; and

U.S. patent application Ser. No. 14/633,562, entitled "SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER", now U.S. patent application publication 2016/0249117.

The applicant of the present application owns the following patent applications filed on date 2014, 12, 18, and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/574,478, now U.S. patent 9,844,374, entitled "SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER";

U.S. patent application Ser. No. 14/574,483, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS," now U.S. patent application publication 2016/0174969;

U.S. patent application Ser. No. 14/575,139, now U.S. patent 9,844,375, entitled "DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 14/575,148, entitled "LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITH ARTICULATABLE SURGICAL END EFFECTORS," now U.S. patent application publication 2016/0174976;

U.S. patent application Ser. No. 14/575,130, entitled "SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLE ABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE, now U.S. patent application publication 2016/0174972;

U.S. patent application Ser. No. 14/575,143, entitled "SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS," now U.S. patent application publication 2016/0174983;

U.S. patent application Ser. No. 14/575,117, entitled "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS", now U.S. patent application publication 2016/0174975;

U.S. patent application Ser. No. 14/575,154, now U.S. patent application publication 2016/0174973, entitled "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAM SUPPORT ARRANGEMENTS";

U.S. patent application Ser. No. 14/574,493, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM"; now U.S. patent application publication 2016/0174970; and

U.S. patent application Ser. No. 14/574,500, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM," now U.S. patent application publication 2016/0174971.

The applicant of the present application owns the following patent applications filed on 1-3 of 2013, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 13/782,295, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE Pathways FOR SIGNAL COMMUNICATION," now U.S. patent 9,700,309;

U.S. patent application Ser. No. 13/782,323, now U.S. patent 9,782,169, entitled "ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL Instruments";

U.S. patent application Ser. No. 13/782,338, now U.S. patent application publication 2014/024957, entitled "THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL Instruments";

U.S. patent application Ser. No. 13/782,499, entitled "Electromechanical SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT," now U.S. patent application publication 9,358,003;

U.S. patent application Ser. No. 13/782,460, now U.S. patent 9,554,794, entitled "MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR Surgical INSTRUMENTS";

U.S. patent application Ser. No. 13/782,358, entitled "JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS," now U.S. patent application publication 9,326,767;

U.S. patent application Ser. No. 13/782,481, entitled "SENSOR STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR", now U.S. patent application publication 9,468,438;

U.S. patent application Ser. No. 13/782,518, entitled "CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMENT PORTIONS," now U.S. patent application publication 2014/024675;

U.S. patent application Ser. No. 13/782,375, entitled "ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM," now U.S. patent application publication 9,398,911; and

U.S. patent application Ser. No. 13/782,536, entitled "SURGICAL INSTRUMENT SOFT STOP," now U.S. patent application publication 9,307,986.

The applicant of the present application also owns the following patent applications filed on 14 days 3.2013, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 13/803,097, entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE," now U.S. patent 9,687,230;

U.S. patent application Ser. No. 13/803,193, entitled "CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT," now U.S. patent application publication 9,332,987;

U.S. patent application Ser. No. 13/803,053, now U.S. patent application publication 2014/0263564, entitled "INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 13/803,086, entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK", now U.S. patent application publication 2014/0263541;

U.S. patent application Ser. No. 13/803,210, now U.S. patent 9,808,244, entitled "SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 13/803,148, entitled "MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT", now U.S. patent application publication 2014/0263554;

U.S. patent application Ser. No. 13/803,066, now U.S. patent 9,629,623, entitled "DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS";

U.S. patent application Ser. No. 13/803,117, entitled "ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS," now U.S. patent application publication 9,351,726;

U.S. patent application Ser. No. 13/803,130, entitled "DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS," now U.S. patent application publication 9,351,727; and

U.S. patent application Ser. No. 13/803,159, entitled "METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT," now U.S. patent application publication 2014/0277017.

The applicant of the present application also owns the following patent applications filed on 7.3.2014 and incorporated herein by reference in their entirety:

U.S. patent application Ser. No. 14/200,111, now U.S. patent 9,629,629, entitled "CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS".

The applicant of the present application also owns the following patent applications filed on month 3 and 26 of 2014, each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/226,106, entitled "POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS," now U.S. patent application publication 2015/0272582;

U.S. patent application Ser. No. 14/226,099, now U.S. patent 9,826,977, entitled "STERILIZATION VERIFICATION CIRCUIT";

U.S. patent application Ser. No. 14/226,094, entitled "VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT," now U.S. patent application publication 2015/0272580;

U.S. patent application Ser. No. 14/226,117, entitled "POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL," now U.S. patent application publication 2015/0272574;

U.S. patent application Ser. No. 14/226,075, now U.S. patent 9,743,929, entitled "MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES";

U.S. patent application Ser. No. 14/226,093, entitled "FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS," now U.S. patent application publication 2015/0272569;

U.S. patent application Ser. No. 14/226,116, entitled "SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION", now U.S. patent application publication 2015/0272571;

U.S. patent application Ser. No. 14/226,071, now U.S. Pat. No. 9,690,362, entitled "SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR";

U.S. patent application Ser. No. 14/226,097, now U.S. patent 9,820,738, entitled "SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS";

U.S. patent application Ser. No. 14/226,126, entitled "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS," now U.S. patent application publication 2015/0272572;

U.S. patent application Ser. No. 14/226,133, entitled "MODULAR SURGICAL INSTRUMENT SYSTEM", now U.S. patent application publication 2015/0272557;

U.S. patent application Ser. No. 14/226,081, entitled "SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT," now U.S. patent 9,804,618;

U.S. patent application Ser. No. 14/226,076, now U.S. patent 9,733,663, entitled "POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION";

U.S. patent application Ser. No. 14/226,111, now U.S. patent 9,750,499, entitled "SURGICAL STAPLING INSTRUMENT SYSTEM"; and

U.S. patent application Ser. No. 14/226,125, entitled "SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT," now U.S. patent application publication 2015/0280384.

The applicant of the present application also owns the following patent applications filed on 5.9 of 2014 and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/479,103, entitled "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE," now U.S. patent application publication 2016/0066912;

U.S. patent application Ser. No. 14/479,119, now U.S. patent 9,724,094, entitled "ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION";

U.S. patent application Ser. No. 14/478,908, entitled "MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION," now U.S. patent 9,737,301;

U.S. patent application Ser. No. 14/478,895, now U.S. patent 9,757,128, entitled "MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR' S OUTPUT OR INTERPRETATION";

U.S. patent application Ser. No. 14/479,110, entitled "POLARITY OF HALL MAGNET TO DETECT MISLOADED CARTRIDGE," now U.S. patent application publication 2016/0066915;

U.S. patent application Ser. No. 14/479,098, entitled "SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION," now U.S. patent application publication 2016/0066911;

U.S. patent application Ser. No. 14/479,115, now U.S. patent 9,788,836, entitled "MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE"; and

U.S. patent application Ser. No. 14/479,108, entitled "LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION," now U.S. patent application publication 2016/0066913.

The applicant of the present application also owns the following patent applications filed on date 2014, 4, 9, and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/248,590, now U.S. patent 9,826,976, entitled "MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS";

U.S. patent application Ser. No. 14/248,581, now U.S. patent 9,649,110, entitled "SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT";

U.S. patent application Ser. No. 14/248,595, now U.S. patent 9,844,368, entitled "SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRUMENT";

U.S. patent application Ser. No. 14/248,588, entitled "POWERED LINEAR SURGICAL STAPLE/FASTENER", now U.S. patent application publication 2014/0309666;

U.S. patent application Ser. No. 14/248,591, entitled "TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT," now U.S. patent application publication 2014/0305991;

U.S. patent application Ser. No. 14/248,584, entitled "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS", now U.S. patent 9,801,626;

U.S. patent application Ser. No. 14/248,587, entitled "POWERED SURGICAL STAPLE/FASTENER", now U.S. patent application publication 2014/0309665;

U.S. patent application Ser. No. 14/248,586, entitled "DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT," now U.S. patent application publication 2014/0305990; and

U.S. patent application Ser. No. 14/248,607, entitled "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS," now U.S. patent 9,814,460.

The applicant of the present application also owns the following patent applications filed on date 16 of 2013, 4, each of which is incorporated herein by reference in its entirety:

U.S. provisional patent application Ser. No. 61/812,365 entitled "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR";

U.S. provisional patent application Ser. No. 61/812,376, entitled "LINEAR CUTTER WITH POWER";

U.S. provisional patent application Ser. No. 61/812,382 entitled "LINEAR CUTTER WITH MOTOR AND PISTOL GRIP";

U.S. provisional patent application Ser. No. 61/812,385 entitled "SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS AND MOTOR CONTROL"; and

U.S. provisional patent application Ser. No. 61/812,372 entitled "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR".

Numerous specific details are set forth herein to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments described in the specification and shown in the drawings. Well-known operations, components and elements have not been described in detail so as not to obscure the embodiments described in the specification. The reader will appreciate that the embodiments described and illustrated herein are non-limiting examples, so that it can be appreciated that the specific structural and functional details disclosed herein may be representative and exemplary. Modifications and changes may be made to these embodiments without departing from the scope of the claims.

The term "include" (and any form of "include"), such as "include" and "comprise", "have" (and any form of "have"), such as "have" and "have", "include", any form of "contain" (and "contain") such as "contain" and "contain" (and "contain") are open-system verbs. Thus, a surgical system, apparatus, or device that "comprises," "has," "contains," or "contains" one or more elements has those one or more elements, but is not limited to having only those one or more elements. Likewise, an element of a system, apparatus, or device that "comprises," "has," "includes" or "contains" one or more features has those one or more features, but is not limited to having only those one or more features.

The terms "proximal" and "distal" are used herein with respect to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician, and the term "distal" refers to the portion located away from the clinician. It will also be appreciated that for simplicity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein may be used in a variety of surgical procedures and applications, including, for example, in connection with open surgery. With continued reference to this detailed description, the reader will further appreciate that the various instruments disclosed herein can be inserted into the body in any manner, such as through a natural orifice, through an incision or puncture formed in tissue, etc. The working portion or end effector portion of the instrument may be inserted directly into the patient or may be inserted through an access device having a working channel through which the end effector and elongate shaft of the surgical instrument may be advanced.

Disclosed herein are various surgical instruments configured to secure tissue of a patient. As discussed in more detail below, such surgical instruments include an end effector and a plurality of drive systems configured to perform various end effector functions. Such drive systems can include, for example, an anvil drive system configured to clamp tissue within an end effector, a staple firing system configured to deploy staples into tissue, and/or a tissue cutting system configured to cut tissue. Such drive systems can also include, for example, an articulation drive system configured to articulate the end effector, a tissue drive system configured to move the end effector relative to tissue, and/or a staple loading system configured to reload the end effector with staples. As also discussed in more detail below, two or more of these drive systems can be operatively coupled to a common drive system such that the drive systems are operated in synchronization.

A stapling instrument 1000 is shown in fig. 1. The stapling instrument 1000 includes a handle 1100, a shaft assembly 1200 extending from the handle 1100, and an end effector 1300 extending from the shaft assembly 1200. The handle 1100 includes a frame 1110 and grip portions 1120 positioned on opposite sides of the frame 1110. The handle 1100 also includes a plurality of electric motors configured to operate the drive system of the stapling instrument 1000. Three electric motors 1130, 1140, and 1150 are shown, but surgical instrument 1000 may include any suitable number of electric motors. Each electric motor is operably coupled with a rotatable output. For example, an electric motor 1130 is operably coupled to the rotatable output 1135, an electric motor 1140 is operably coupled to the rotatable output 1145, and an electric motor 1150 is operably coupled to the rotatable output 1155. The handle 1100 also includes a battery 1160 that supplies power, for example, to the electric motors 1130, 1140, and 1150. Referring to fig. 11, battery 1160 includes, for example, a lithium battery 18650, but may include any suitable battery. Referring primarily to fig. 12, the battery 1160 is positioned in a battery compartment 1115 defined in the handle frame 1110, but may be stored in any suitable location. The battery 1160 is also configured to supply power to the control system and/or display of the handle 1110, which will be described in more detail below.

Handle 1100' is shown in fig. 8 and 10. The handle 1100' is similar in many respects to the handle 1100, most of which will not be discussed herein for brevity. Handle 1100 'includes a battery compartment accessible through door 1115'. The door 1115' allows for replacement of the batteries in the battery compartment. Handle 1100 is shown in fig. 9. The handle 1100 "is similar in many respects to the handle 1100, most of which will not be discussed herein for brevity. The handle 1100 "includes a plug 1115" configured to be able to supply power to the handle 1100 "from, for example, a generator and/or a wall outlet. In various cases, handle 1100″ may be powered by, for example, an internal source (such as by battery 1160) and, for example, an external source (such as by plug 1115 ").

Referring again to fig. 1, the handle frame 1110 includes a connector 1170. The shaft assembly 1200 includes an outer housing 1210 that includes a shaft connector 1270 that is configured to engage with a handle connector 1170 to couple the shaft assembly 1200 to the handle 1100. The shaft connector 1270 and the shank 1170 include rotatable bayonet interconnections; however, any suitable interconnect may be used. The shaft assembly 1200 also includes a rotatable input 1235 configured to be operably coupled with the rotatable output 1135 when the shaft assembly 1200 is assembled to the handle 1100. Similarly, the shaft assembly 1200 also includes a rotatable input 1245 configured to be operably coupled to the rotatable output 1145 and a rotatable input 1255 configured to be operably coupled to the rotatable output 1155 when the shaft assembly 1200 is assembled to the handle 1100.

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

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

Referring again to fig. 1, the end effector 1300 also includes a distal head 1320 rotatably coupled to the shaft portion 1310 about an articulation joint 1370. The end effector 1300 also includes an articulation drive system configured to articulate the distal head 1320 relative to the shaft portion 1310. The distal head 1320 includes an anvil 1360 that is movable between an open position and a closed position. In use, the anvil 1360 can be moved toward the tissue compression surface 1325 by an anvil drive system to clamp or compress tissue within the end effector 1300. As will be discussed below in connection with fig. 3-7, the tissue compression surface 1325 is defined on a tissue drive system configured to engage patient tissue and move the stapling instrument 1000 relative to the patient tissue.

Referring primarily to fig. 3, the end effector 1300 includes a rotatable drive shaft 1330 that is operable to selectively open the anvil 1360, operate a tissue drive system (fig. 4-6) to reposition the distal head 1320 relative to patient tissue, and close the anvil 1360 (fig. 7) before the stapling instrument 1000 performs a staple firing stroke. The drive shaft 1330 is driven by an electric motor, and further, the drive shaft 1330 is translatable between a first position wherein a key 1332 extending from the drive shaft 1330 is operably engaged with the tissue drive system (fig. 4-6) and a second position wherein the key 1332 is operably engaged with the anvil drive system (fig. 7). When the drive shaft 1330 is in its first position, the key 1332 is positioned within a keyway 1333 defined in a drive gear 1331 of the tissue drive system. When the drive shaft 1330 is in its second position, the key 1332 is positioned within a keyway 1363 defined in the drive collar 1361 of the anvil drive system.

Referring to fig. 4-6, the tissue drive system includes a first leg 1380a and a second leg 1380b. The feet 1380a, 1380b can be extended to engage patient tissue and then retracted to pull the distal head 1320 of the end effector 1300 relative to the patient tissue. The tissue drive system is configured to extend the first leg 1380a while retracting the second leg 1380b, and similarly, to extend the second leg 1380b while retracting the first leg 1380 a. Fig. 4 shows the first leg 1380a in an extended position and the second leg 1380b in a retracted position. Because of the above, the tissue drive system can be configured to advance the end effector 1300 across tissue to form a staple firing path within the tissue. In various alternative embodiments, the tissue drive system may be configured to extend the first leg 1380a and the second leg 1380b simultaneously and/or retract the first leg 1380a and the second leg 1380b simultaneously.

In addition to the above, the tissue drive system includes a first gear train configured to transmit rotation of the drive shaft 1330 to the first gear 1380a and a second gear train configured to transmit rotation of the drive shaft 1330 to the second gear 1380 b. The first gear train includes a spur gear 1381a operatively intermeshed with the drive gear 1331, a transfer gear 1382a operatively intermeshed with the spur gear 1381a, and a spur gear 1383a operatively intermeshed with the transfer gear 1382a such that rotation of the shaft 1330 is transferred to the spur gear 1383a. The first gear train also includes a shaft gear 1384a operably intermeshed with the spur gear 1383a. Referring primarily to fig. 5 and 6, the shaft gear 1384a is fixedly mounted to the transfer shaft 1385a such that rotation of the spur gear 1383a is transferred to the transfer shaft 1385a. The first gear train further includes a bevel gear 1386a fixedly mounted to the transfer shaft 1385a, a side bevel gear 1387a operably intermeshed with the bevel gear 1386a, and a pinion 1388a fixedly mounted to the side bevel gear 1387a such that the pinion 1388a rotates with the side bevel gear 1387 a. Referring primarily to fig. 6, pinion 1388a is operably intermeshed with a rack 1389a mounted to first foot 1380a that converts rotational input motion into translational motion of first foot 1380 a.

The second gear train is similar in many respects to the first gear train except that the second gear train does not include a transfer gear intermediate the two spur gears, as described below. The second gear train includes a spur gear 1381b operably intermeshed with the drive gear 1331 and a spur gear 1383b operably intermeshed with the spur gear 1381b such that rotation of the shaft 1330 is transferred to the spur gear 1383b. The second gear train also includes a shaft gear 1384b operably intermeshed with the spur gear 1383b. Referring primarily to fig. 5, a shaft gear 1384b is fixedly mounted to the transfer shaft 1385b such that rotation of the spur gear 1383b is transferred to the transfer shaft 1385b. The second gear train also includes a bevel gear 1386b fixedly mounted to the transfer shaft 1385b, a side bevel gear 1387b operably intermeshed with the bevel gear 1386b, and a pinion 1388b fixedly mounted to the side bevel gear 1387b such that the pinion 1388b rotates with the side bevel gear 1387 b. Pinion 1388b is operably intermeshed with a rack 1389b mounted to the second leg 1380b that converts rotational input motion into translational motion of the second leg 1380 b.

The presence of transfer gear 1382a in the first gear train and the absence of a corresponding transfer gear in the second gear train causes the first leg 1380a and the second leg 1380b to move in opposite directions in response to rotation of the drive shaft 1330. For example, when the drive shaft 1330 rotates in a first direction, the first leg 1380a extends and the second leg 1380b retracts. Accordingly, when the drive shaft 1330 rotates in a second direction or an opposite direction, the first leg 1380a retracts and the second leg 1380b extends. As described above, the first and second legs 1380a, 1380b are configured to grasp and pull the end effector 1300 relative to tissue as the first and second legs extend and retract. While the motion of the feet 1380a, 1380b may be linear, other embodiments are disclosed herein that provide, for example, different motions (such as arcuate motions).

Once the end effector 1300 has been properly moved relative to tissue by the tissue drive system, the drive shaft 1330 is longitudinally translated out of engagement with the tissue drive system and into engagement with the anvil drive system, as shown in fig. 7. In various circumstances, rotation of the drive shaft 1330 may be stopped before it is disengaged from the tissue drive system. In other cases, the drive shaft 1330 may continue to rotate as it disengages from the tissue drive system and translates into engagement with the drive collar 1361. In either case, the drive collar 1361 includes a threaded aperture 1362 defined therein that includes threads 1365. The anvil 1360 includes a push rod 1364 extending therefrom that includes an end that threadably engages threads 1365 in an aperture 1366. When the drive collar 1361 is rotated in a first direction by the drive shaft 1330, the drive collar 1361 pushes the anvil 1360 away from the feet 1380a and 1380b to open the anvil 1360. Once the anvil 1360 has been fully opened, the drive shaft 1330 may be displaced to engage the tissue drive system and move the end effector 1300 relative to the tissue. The drive shaft 1330 may then be reengaged with the anvil drive system. When the drive collar 1361 is rotated in a second direction or an opposite direction, at this point the drive collar 1361 pulls the anvil 1360 toward the feet 1380a and 1380b to close or clamp the anvil 1360, as shown in fig. 7. Once the anvil 1360 has been closed, the staple firing system of the stapling instrument 1000 may be actuated. At this point, the anvil 1360 is re-opened by the anvil drive system and the cycle described above may be repeated.

Notably, the drive shaft 1330 extends along a longitudinal axis 1339 that is collinear with a longitudinal axis 1369 that extends through a push rod 1364 of the anvil drive system. This arrangement allows the drive shaft 1330 to be operably connected to the pushrod 1334 through the drive collar 1361. Additionally, it is noted that the drive collar 1361 includes a proximal flange 1367 and a distal flange 1368 extending therefrom. The flange 1367 and the flange 1368 serve as stops that limit the longitudinal travel of the anvil 1360 in the proximal and distal directions, respectively. Thus, the flanges 1367 and 1368 define the limits of the opening and closing travel of the anvil 1360. The anvil 1360 includes a tissue gripping surface that extends orthogonally, or at least substantially orthogonally, to the longitudinal axis 1369 and that moves longitudinally relative to the distal head 1320. Anvil 1360 includes a movable jaw and feet 1380a and 1380b of the tissue drive system include another movable jaw positioned opposite anvil 1360.

Referring again to fig. 3, there is a longitudinal gap between the drive gear 1331 of the tissue drive system and the drive collar 1361 of the anvil drive system. Thus, there may be a dwell in operation when shifting between the tissue drive system and the anvil drive system. Shorter gaps may result in shorter dwells and longer gaps may result in longer dwells. Other embodiments are contemplated in which there is no or very little clearance between the drive gear 1331 and the drive collar 1361, and thus operational dwell may be eliminated.

Referring again to fig. 1, the end effector 1300 includes a plurality of staple cartridges 1400 stored therein. The stapling instrument 1000 includes a cartridge drive system configured to push a staple cartridge 1400 into an end effector 1300. Thus, the cartridge drive system can be used to reload the end effector 1300 without removing the stapling instrument 1000 from the surgical site. However, once the supply of staple cartridge 1400 in end effector 1300 is exhausted, stapling instrument 1000 may have to be removed from the surgical site for reloading unless stapling instrument 1000 includes a system for loading the cartridge during operation of stapling instrument 1000. Such embodiments will be described in more detail below. In any event, the end effector 1300 can be separated from the shaft assembly 1200 and an unspent end effector 1300 can then be attached to the shaft assembly 1200 to reload the stapling instrument 1000.

Referring again to fig. 1, each end effector 1300 is intended to have as many uses as staples or staple cartridges stored in the end effector 1300. Shaft assembly 1200 is intended to have a greater number of uses than end effector 1300. Thus, a used end effector 1300 may be replaced with another end effector 1300 without the need to replace the shaft assembly 1200. In at least one instance, for example, each end effector 1300 is intended to be used 10 times, while the shaft assembly is intended to be used 100 times. The handle 1100 is intended to have a greater number of uses than the shaft assembly 1200 and/or the end effector 1300. Accordingly, the used shaft assembly 1200 may be replaced without the need to replace the handle 1100. In at least one instance, for example, the shaft assembly 1200 is intended to be used 100 times, while the handle 1100 is intended to be used 500 times.

As described above, the stapling instrument 1000 includes a drive system configured to reciprocally open or unclamp the anvil and produce relative movement between the end effector and the patient tissue and then again clamp the anvil. Fig. 42 and 43 illustrate another exemplary embodiment of a reciprocating drive system that may be used. The drive system 2800 includes a rotatable drive shaft 2830 and a drive gear 2831 fixedly mounted to the drive shaft 2830. The drive system 2800 also includes a spur gear 2832 operably intermeshed with the drive gear 2831 such that rotation of the drive shaft 2830 is transmitted to the spur gear 2832. The drive system 2800 also includes a bevel gear 2833 mounted to and rotating with the spur gear 2832, a side bevel gear 2834 operably intermeshed with the bevel gear 2833, and a spur gear 2835 operably intermeshed with a gear mounted to a face of the bevel gear 2834. The drive system 2800 also includes a pinion 2836 fixedly mounted to and rotating with the spur gear 2835, an output gear 2837 operatively intermeshed with the pinion 2836, and a cam 2838 fixedly mounted to and rotating with the output gear 2837. As described above, rotation of the drive shaft 2830 rotates the cam 2838, which is translated into reciprocating motion of the drive shaft 2830 as described below.

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

Fig. 44 illustrates another exemplary embodiment of a reciprocating drive system. The drive system 2900 includes an electric motor 2930, a first drive system 2940 operably coupled to the electric motor 2930, and a second drive system 2950 operably coupled to the electric motor 2930. The electric motor 2930 includes a rotatable output shaft 2931 and a drive gear 2932 fixedly mounted to the output shaft 2931. First drive system 2940 includes an input gear 2942 operatively intermeshed with drive gear 2932. The input gear 2942 is fixedly mounted to the drive shaft 2943 such that the drive shaft 2943 rotates with the input gear 2942. First drive system 2940 also includes a barrel cam 2944 slidably mounted to drive shaft 2943 and rotating with drive shaft 2943. The barrel cam 2944 includes an aperture 2945 defined therein that includes a non-circular profile, for example, configured to transmit rotation between the drive shaft 2943 and the barrel cam 2944, but permit relative translation therebetween. The barrel cam 2944 also includes a cam slot 2949 defined thereabout that interacts with a cam pin 2919 mounted to the frame 2910 such that as the barrel cam 2944 rotates, the barrel cam 2944 also translates. The barrel cam 2944 translates distally when the barrel cam 2944 rotates in a first direction and translates proximally when the barrel cam 2944 rotates in a second or opposite direction. First drive system 2940 also includes a drive shaft 2946 extending from barrel cam 2944 configured to drive the first end effector function.

Second drive system 2950 includes an input gear 2952 operatively intermeshed with drive gear 2932. Input gear 2952 is fixedly mounted to drive shaft 2953 such that drive shaft 2953 rotates with input gear 2952. The second drive system 2950 also includes a barrel cam 2954 slidably mounted to the drive shaft 2953 and rotating with the drive shaft 2953. The barrel cam 2954 includes an aperture 2955 defined therein that includes a non-circular profile, for example, configured to transmit rotation between the drive shaft 2953 and the barrel cam 2954, but permit relative translation therebetween. The barrel cam 2954 also includes a cam slot 2959 defined thereabout that interacts with a cam pin 2919 mounted to the frame 2910 such that as the barrel cam 2954 rotates, the barrel cam 2944 also translates. The barrel cam 2954 translates distally when the barrel cam 2954 rotates in a first direction and translates proximally when the barrel cam 2954 rotates in a second or opposite direction. Second drive system 2950 also includes a drive shaft 2956 extending from barrel cam 2954 configured to drive the second end effector function.

When the electric motor 2930 of the drive system 2900 rotates in a first direction, the first drive shaft 2946 advances distally and the second drive shaft 2956 retracts proximally. Accordingly, when the electric motor 2930 is operated in the second or opposite direction, the first drive shaft 2946 is retracted proximally and the second drive shaft 2956 is advanced distally. Other embodiments are contemplated in which drive shaft 2946 and drive shaft 2956 are advanced distally simultaneously.

Referring to fig. 92 and 93, the stapling instrument 4500 includes a tissue driving device 4590 that includes a first foot 4580a and a second foot 4580b. The first foot 4580a includes a rack 4583a defined thereon, the second foot 4580b includes a rack 4583b defined thereon, and the tissue drive apparatus 4500 further includes a pinion 4593 in meshing engagement with the rack 4583a and the rack 4583 b. Pinion 4593 is rotatable back and forth about an axis to reciprocally extend and retract foot 4580a and foot 4580b and, thus, drive the stapling instrument relative to the patient's tissue. The tissue drive 4590 further includes a first actuator 4592 pinned to the pinion 4593 at the pivot joint 4591 and a second actuator 4594 pinned to the pinion 4593 at the pivot joint 4595. In use, the first actuator 4592 is pushed and/or the second actuator 4594 is pulled to rotate the pinion 4593 in a first direction, extend the second foot 4580b and retract the first foot 4580a. Accordingly, the first actuator 4592 is pulled and/or the second actuator 4594 is pushed to rotate the pinion 4593 in the second direction, extend the first foot 4580a and retract the second foot 4580b. Notably, the feet 4580a and 4580b are displaced linearly and in opposite directions. That is, the feet 4580a and 4580b are configured such that when one of the feet 4580a and 4580b is retracting to pull tissue, the other foot slides or moves relative to the tissue as the tissue extends.

As described above, the feet 1380a and 1380b of the stapling instrument 1000 extend and retract along a linear path. In such cases, feet 1380a and 1380b may slide over tissue as it extends, and then grasp and pull the tissue as it retracts. The feet 1380a and 1380b may include teeth extending therefrom that have contours that facilitate sliding of the feet 1380a and 1380b relative to tissue when moved in one direction and grasping tissue when moved in an opposite direction. In at least one case, the teeth are substantially triangular, for example, but include a shallow angle on a first side and a steeper angle on the other side. In such cases, the shallow angle allows the first side to slide relative to the tissue, while the second side, having a steeper angle, engages or grabs the tissue as the feet 1380a and 1380b retract.

As described above, the feet 1380a and 1380b are driven along a linear path by the racks 1389a and 1389b defined thereon. In some cases, the linear motion of feet 1380a and 1380b may be closely guided with little, if any, float or deviate from linear motion. In various embodiments, referring now to fig. 88 and 89, the foot of the tissue drive system may include one or more joints that provide at least one additional degree of freedom that allows the foot to deviate from a purely linear path. The tissue drive system 4200 includes a first foot 4280a and a second foot 4280b movably connected by a connector 4282. The connector 4282 is coupled to the first foot 4280a at a pivot joint 4281a and to the second foot 4280b at a pivot joint 4281 b. Foot 4280a and foot 4280b move proximally and distally through input 4290 comprising a drive shaft 4292 connected to connector 4282 at pivot joint 4283. The pivot joints 4281a, 4281b, and 4283 allow the feet 4280a and 4280b to lift or float upward as they extend across tissue.

As described above, the stapling instruments including the tissue drive systems disclosed herein are configured to drive themselves or advance themselves across patient tissue as the stapling instruments staple and cut patient tissue along a staple firing path. In various circumstances, the thickness of the tissue may vary along the length of the staple firing path. In other words, the thickness of the tissue may increase and/or decrease in the anterior-posterior direction and/or the lateral side-to-side direction. Referring again to fig. 88 and 89, the degrees of freedom provided by pivot joints 4281a, 4281b, and 4283 allow foot 4280a and foot 4280b to tilt in response to these changes in tissue thickness. For example, the feet 4280a and 4280b may be inclined in the front-rear direction and/or in the left-right direction. Further, the foot 4280a and the foot 4280b may be inclined independently of each other. Accordingly, the foot 4280a and the foot 4280b may be inclined in the same direction or in different directions. That is, alternative embodiments are contemplated in which foot 4280a and foot 4280b are inclined in the same direction. This arrangement may have a simpler drive system. In any event, feet 4280a and 4280b may flatten themselves in response to changes in tissue thickness and may have a desired traction on the tissue.

Referring now to fig. 87, a stapling instrument 4100 includes a distal stapling head 4120 that is similar to stapling instrument 1000 and includes a tissue drive system 4190 that includes feet 4180. The tissue drive system 4190 includes a rocker arm connector 4192 rotatably mounted within the stapling head 4120 about a pivot pin 4124. The rocker arm connector 4192 includes a leg 4193 and the pivot pin 4124 extends through an aperture 4194 defined in the leg 4193. Each of the legs 4193 is pivotally connected to the foot 4180 about a pivot pin 4195. In use, the tissue drive system 4190 swings the rocker arm connector 4192 back and forth to extend and retract the foot 4180 along a non-linear or curved path. Extending and retracting the feet 4180 together, but embodiments are contemplated in which the feet move in opposite directions. Further, in addition to the above, the feet 4180 may be inclined about the pivot pins 4195 to accommodate variations in tissue thickness. In various circumstances, the tissue drive system 4190 may lift the feet 4180 away from the tissue, for example, during at least a portion of the tissue drive stroke (such as at the end of the tissue drive stroke).

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

Referring to fig. 38-40, the drive foot 2780 is configured to engage patient tissue T and drive the distal head 2720 relative to the tissue to reposition the distal head 2720 relative to the tissue. The tissue drive 2790 includes a first driver 2792 and a second driver 2793 configured to rotate the foot 2780 about the pivot joint 2781. The first driver 2792 includes a push end that is positioned within a first socket 2782 defined in the drive foot 2780, and the second driver 2793 includes a push end that is positioned within a second socket 2783 defined on an opposite side of the drive foot 2780. Referring to fig. 40, the first driver 2792 is displaceable toward tissue to rotate the drive foot 2780 in a first direction. Referring to fig. 39, the second driver 2793 is displaceable toward tissue to rotate the drive foot in a second direction or in an opposite direction. In use, the drive foot 2780 can be rotated back and forth by the tissue drive device 2790 to produce relative movement between the distal head 2720 and tissue in a forward or rearward direction.

Referring now to fig. 78-85, a stapling instrument 3900 includes a distal head 3920 comprising a staple firing system 3950 configured to staple tissue of a patient, an anvil 3960 configured to clamp the patient tissue against a tissue compression surface 3925 and deform staples deployed by the staple firing system 3950, and a foot 3980 configured to produce relative movement between the distal head 3920 and the tissue when the anvil 3960 is in a undamped position. The suturing apparatus 3900 further includes a tissue drive 3990 configured to extend and retract the foot 3980. Referring primarily to fig. 83 and 84, the tissue driving device 3990 includes a rotatable drive shaft 3992 and helical teeth 3993 fixedly mounted to the drive shaft 3992 such that the helical teeth 3993 rotate with the drive shaft 3992. The helical teeth 3993 are in meshing engagement with a gear face 3995 defined on one side of the drive wheel 3994. The drive wheel 3994 is rotatably mounted about a pin 3991 that is mounted to the distal head 3920. Due to the above, the drive wheel 3994 rotates in response to the rotation of the drive shaft 3992.

In addition to the above, referring to fig. 79-82, tissue drive device 3990 further includes a coupling rod 3996 that includes a first end slidably positioned in a cam slot 3999 (fig. 83 and 85) defined on a second side of drive wheel 3994 or in a face of the drive wheel. In at least one instance, the coupling lever 3996 includes a pin that rides in the cam slot 3999. Coupling lever 3996 also includes a second end pivotally mounted to foot 3980 at pivot joint 3998. As the drive wheel 3994 rotates, the side wall of the cam groove 3999 pushes the first end of the coupling lever 3996 through the path or motion shown in fig. 84. This path is also shown in fig. 79A, 80A, 81A and 82A, which track the movement of tissue drive 3990 and foot 3980 shown in fig. 79, 80, 81 and 82, respectively. Fig. 79 shows foot 3980 in a retracted position, and fig. 79A shows a dot P on foot motion path FM, which represents the position of foot 3980 along foot motion path FM. Fig. 80 shows extended foot 3980, and fig. 80A shows dot P propelled along foot motion path FM. FIG. 81 shows foot 3980 in a fully extended position and dot P further advanced along foot motion path FM. Fig. 82 shows foot 3980 returned to its retracted position. At this point, the motion of foot 3980 may be repetitive or reciprocating.

In addition to the above, the coupling rod 3996 includes a longitudinal slot 3997 defined therein, and the staple head 3920 includes a pin 3927 extending into the longitudinal slot 3997 that cooperate to limit or restrict movement of the coupling rod 3996. Fig. 84 and 85 map three corresponding positions labeled 1,2, and 3 along cam slot 3999 and firing motion path FM. Position 1 corresponds to point P in fig. 79A, position 2 corresponds to point P in fig. 80A, and position 3 corresponds to point P in fig. 81A. In various instances, tissue drive 3990 comprises four bar links, wherein feet 3980 are emptied when extended. To facilitate this movement, each foot 3980 includes a slot 3981 defined therein with sidewalls that slide relative to a pin 3921 that extends into slot 3981. The pin 3921/slot 3981 arrangement allows the foot 3980 to translate and rotate during a tissue drive stroke cycle.

Fig. 86 shows an alternative embodiment of a cam path 4099 that includes a shoulder that prevents reverse movement of the coupling rod 3996 within the slot 3999. For example, the cam path 4099 includes a first shoulder 4091 corresponding to position 1 and fig. 79A, and once the coupling rod 3996 has passed this point, the coupling rod 3996 cannot return past position 1 along the original path. The cam path 4099 includes a second shoulder 4092 corresponding to position 2 and fig. 80A and once the coupling rod 3996 has passed this point, the coupling rod 3996 cannot return to pass position 2 along the original path. The cam path 4099 also includes a third shoulder 4093 corresponding to position 3 and fig. 81A, and once the coupling rod 3996 has passed this point, the coupling rod 3996 cannot return to pass through position 3 along the original path.

Referring to fig. 50-56, the suturing apparatus 3100 includes a distal head 3120 including an anvil 3160 and a tissue-driving foot 3180. Referring to fig. 50, the drive foot 3180 can be extended to engage tissue of a patient, and then referring to fig. 51, the drive foot can be retracted to move the distal head 3120 relative to the patient tissue. Each drive foot 3180 includes an array of racks or teeth 3193 configured to engage patient tissue, the array of racks or teeth also being movable between an extended position and a retracted position. Fig. 51 shows the teeth 3193 extending from the drive foot 3180 as the drive foot 3180 is retracted from the extended position. More specifically, as the drive foot 3180 is retracted from its fully extended position, the teeth 3193 protrude from a tissue compression surface 3125 defined on the drive foot 3180. On the other hand, referring to fig. 50, when the driving foot 3180 is extended, the teeth 3193 do not protrude from the tissue compression surface 3125, which allows the driving foot 3180 to slide relative to the patient's tissue while extending.

Referring to fig. 52-56, the suturing apparatus 3100 includes a tissue drive 3190 configured to extend and retract the drive foot 3180 and also extend and retract the teeth 3193. The tissue drive 3190 includes an input rod 3191 that extends into and is movable within a cavity 3181 defined in each drive foot 3180. The input lever 3191 moves the drive foot 3180 through a circuitous non-linear path that includes a raised retracted position (fig. 52 and 56), a lowered retracted position (fig. 53), a lowered extended position (fig. 54), and a raised extended position (fig. 55). The input lever 3191 includes pins 3192 extending therefrom that extend into slots 3182 defined in the drive foot 3180. As discussed in more detail below, the interaction between the pin 3192 and the side walls of the slot 3182 transfers the motion of the input lever 3191 to the drive foot 3180. Each of the slots 3182 extends along an axis that is transverse to and non-parallel to the longitudinal axis of the distal head 3120, which thus produces the desired movement of the drive foot 3180 and the teeth 3193.

When the input lever 3191 is in the fully retracted position, as shown in fig. 52, the input lever 3191 positions the drive legs 3180 in the retracted position where the drive legs are raised. In this position, the teeth 3193 protrude through windows 3183 defined in the drive foot 3180. When the input lever 3191 moves out of its fully retracted position, see fig. 53, the pin 3192 interacts with the side walls of the slot 3182 and cams the drive foot 3180 downward. At this point, the teeth 3193 no longer protrude through the window 3183. As the input rod 3191 moves further away from its fully retracted position, the input rod 3191 begins to extend the drive foot 3180, as shown in fig. 54. Notably, when the drive foot 3180 is extended, the teeth 3193 do not protrude through the window 3183. However, once the input rod 3191 is retracted, as shown in fig. 55, the pin 3192 interacts with the side walls of the slot 3182 to raise the drive foot 3180, which causes the teeth 3193 to protrude through the window 3183. Thus, the teeth 3193 may engage or grasp patient tissue and pull the tissue relative to the distal head 3120 until the drive foot 3180 is fully retracted, as shown in fig. 56. At this point, tissue may be sutured and/or incised. The above process may be repeated to move the stapling apparatus 3100 along the entire staple firing path.

Referring to fig. 57-59D, the stapling instrument 3200 includes a distal stapling head 3220 including tissue driving feet 3270 which extend outwardly and retract inwardly along the same path by, for example, a tissue driving system (such as the tissue driving system of stapling instrument 1000). That is, the stapling head 3220 further includes a lateral drive foot 3280 that moves with the drive foot 3270, but is also laterally movable relative to the drive foot 3270, as shown in fig. 57 and 58. Accordingly, lateral drive foot 3280 may extend along one path, as shown in fig. 59A and 59B, laterally, and then retract along a different path, as shown in fig. 59C and 59D. In addition, the drive foot 3270 and the drive foot 3280 can pull the distal head 3220 in two different directions relative to patient tissue, which provides greater control over the relative movement between the distal stapling head 3220 and patient tissue.

Referring primarily to fig. 57 and 58, the drive foot 3270 and the drive foot 3280 are rotatably coupled in pairs. Each pair includes an actuator plate 3260, a first connector 3272 pivotably coupled to a drive foot 3270 about a pivot 3271, and a second connector 3282 pivotably coupled to a lateral drive foot 3280 about a pivot 3281. When a downward force is applied to the actuator plate 3260, see fig. 58, the actuator plate 3260 pushes on the tab 3213 rotatably connecting the first and second connectors 3272, 3282, which causes the lateral foot portion 3280 to displace outwardly. Further, distal head 3220 constrains lateral movement of drive foot 3270, and thus, drive foot 3270 does not undergo lateral movement when lateral drive foot 3280 extends laterally. However, referring to fig. 60A-60D, alternative embodiments are contemplated in which the drive foot 3270 is also laterally movable. In either case, a biasing member (such as a torsion spring positioned in and/or coupled to the tab 3213) may, for example, retract the drive foot laterally after removing the pushing force from the actuator plate 3260. Fig. 59A-59D illustrate a series of steps that may be repeated by the surgical instrument 3200 to move the stapling instrument 3200 along a staple firing path. Fig. 60A-60D also illustrate a series of steps that may be repeated by the surgical instrument 3200 to move the surgical instrument 3200 along the staple firing path.

Referring to fig. 61 and 62, surgical instrument 3300 includes a distal head 3320 and a laterally-extendable drive foot 3380. The drive foot 3380 is coupled to the distal head 3320 via a flexible connector 3375 and an actuator 3370. When a compressive force is applied to the actuator 3370, the actuator 3370 is displaced and/or compressed, which causes the connector 3375 to extend laterally and push the corresponding drive foot 3380 laterally. When the compressive force is removed from the actuator 3370, the connector 3375 resiliently contracts and pulls the drive legs 3380 inward. The drive foot 3380 may include a tissue gripping feature defined thereon that is configured to push and/or pull patient tissue when the drive foot 3380 is moved laterally. Thus, the drive foot 3380 may create relative motion between the distal head 3320 and the patient tissue.

Referring to fig. 91A-91D, the stapling instrument 4400 includes a distal head 4420 which includes a tissue cutting drive 4440, a staple firing drive 4450, and a tissue drive including a foot 4480. Each foot 4480 is rotatably mounted to the distal head 4420 about a pivot pin 4481 and is rotatable to drive the distal head 4420 relative to patient tissue. Fig. 91 shows foot 4480 in a retracted position. Fig. 91B shows an extended foot 4480. Fig. 91C shows foot 4480 in a fully extended position. Fig. 91D shows foot 4480 retracted. As the foot 4480 extends, the foot 4480 drives the distal head 4420 relative to patient tissue. Notably, the feet 4480 are synchronized such that the feet extend and retract together, and in such cases, the feet 4480 may drive the distal head 4420 along a straight line, or at least substantially straight line. That is, one of the feet 4480 may extend while the other foot 4480 retracts. In such cases, the foot 4480 may rotate the distal head 4420 along a curved path.

Referring to fig. 76 and 77A-77D, the stapling instrument 3800 includes a distal head 3820 which includes a staple firing system 3850, an anvil 3860, and a tissue drive system. The tissue drive system includes a first foot 3880a and a second foot 3880b and is configured to selectively extend and retract the foot 3880a and the foot 3880b to move the stapling instrument 3800 along a staple firing path FP. The tissue drive system is configured to move or travel the stapling instrument 3800 along straight and/or curved staple firing paths. Referring to fig. 77A and 77B, the tissue drive system is configured to extend and retract the first foot 3880a and the second foot 3880B simultaneously an equal or at least nearly equal amount to move the distal firing head 3220 along a straight firing path. Referring to fig. 77C and 77D, the tissue drive system is further configured to extend and retract only one of the feet 3880a and 3880b to rotate the distal firing head 3220. For example, referring to fig. 77C, the tissue drive system can extend and retract the first foot 3880a while not extending and retracting the second foot 3880b to rotate the distal head 3820 in the first direction. Similarly, referring to fig. 77D, the tissue drive system can extend and retract the second foot 3880b while not extending and retracting the first foot 3880a to rotate the distal head 3820 in the second direction.

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

Referring to fig. 63 and 64, the stapling instrument 3400 includes a distal head 3420 comprising a staple firing system 3450, an anvil 3460, and a tissue drive system. The tissue drive system includes two drive wheels 3480 and a shaft 3481 rotatably supported by a mount 3482 that extends through an aperture defined in the center of the drive wheels 3480. The drive wheel 3480 is fixedly mounted to the pin 3481 such that the drive wheel 3480 rotates together. Each drive wheel 3480 includes an array of teeth extending therearound, and at least one of the drive wheels 3480 is in meshing engagement with a drive shaft of an electric motor. The teeth extending around the drive wheel 3480 are also suitably configured to engage and grip patient tissue. In use, the electric motor can be operated to rotate the drive wheel 3480 to produce relative movement between the distal head 3420 and patient tissue and move the distal head 3420 along the staple firing path.

Referring to fig. 94, the stapling instrument 4600 comprises a distal head 4620 comprising a staple firing system 4650, an anvil 4660, and a tissue drive system. The tissue drive system includes a drive wheel 4680 that drives two drive wheels, each rotatably supported by a separate pin extending through the center thereof. Thus, the drive wheels 4680 may be independently rotated. Each drive wheel 4680 includes an array of teeth extending therearound that are in meshing engagement with the drive shaft of the electric motor. In other words, the tissue drive system includes two electric motors configured to individually rotate the drive wheels 4680. Similar to above, the teeth extending around drive wheel 4680 are also suitably configured to engage and grip patient tissue. In use, the electric motor is operable to rotate the drive wheel 4680 to produce relative movement between the distal head 4620 and patient tissue and to move the distal head 4620 along a staple firing path, as described in more detail below.

In addition to the above, the tissue drive system is configured to rotate the drive wheel 4680 in the same direction and at the same speed to move the distal head 4620 along a straight staple firing path. The tissue drive system is also configured to rotate the wheel 4680 in the same direction but at different speeds to rotate the distal head 4620 along a curved staple firing path. In such cases, the distal head 4620 may be gradually rotated. The tissue drive system is also configured to rotate only one of the drive wheels 4680 while not rotating the other drive wheel 4680 to rotate the distal head 4620 along a curved staple firing path. In addition, the tissue drive system is also configured to rotate the drive wheel 4680 in an opposite direction to rotate the distal head 4620 along a curved staple firing path having a small or smaller radius of curvature.

The tissue drive system also includes a lateral drive wheel 4670 positioned laterally relative to the drive wheel 4680. Similar to the above, each lateral drive wheel 4670 is operatively coupled to a different electric motor. Thus, the tissue drive system of the stapling instrument 4600 includes four electric motors that can be operated simultaneously or not simultaneously. The lateral drive wheels 4670 can operate independently of the drive wheels 4680, but these lateral drive wheels can operate simultaneously with one or both of the drive wheels 4680. Further, the lateral drive wheels 4670 can operate independently with respect to each other. Similar to drive wheel 4680, the tissue drive system is configured to rotate the lateral drive wheel 4670 together at the same speed, at different speeds, and/or in different directions to move the distal head 4620 along the staple firing path. Further, the tissue drive system is configured to rotate any suitable combination of drive wheel 4670 and drive wheel 4680 in any suitable direction and at any suitable speed to move the stapling instrument 4600 along a desired staple firing path.

Referring to fig. 36, the stapling instrument 2600 includes a distal head 2620 which includes a staple firing system 2650, an anvil 2660, and a tissue drive system. The tissue drive system includes two drive wheels 2670 and two drive wheels 2680, the two drive wheels 2670 and the two drive wheels 2680 being independently rotatable simultaneously or not simultaneously to move the distal head 2620 along the staple firing path. Each drive wheel 2670 is rotatable about an axis 2671 and each drive wheel 2680 is rotatable about an axis 2681; however, axis 2671 is not parallel to axis 2681. In fact, axis 2671 and axis 2681 are orthogonal, but may be oriented in any suitable direction. The tissue drive system includes four electric motors configured to rotate drive wheels 2670 and 2680, respectively; however, the tissue drive system may have any suitable number of electric motors to drive the drive wheels 2670 and 2680. In use, the electric motor can be operated to rotate the drive wheels 2670 and 2680 to produce relative movement between the distal head 2620 and patient tissue and move the distal head 2620 along the staple firing path.

Referring now to fig. 75A-75D, a stapling instrument 3700 includes a distal head 3720 including an anvil 3760 and a tissue drive system including a tissue drive foot 3780. Stapling instrument 3700 is similar in many respects to stapling instrument 1000, most of which will not be discussed herein for brevity. Anvil 3760 is movable relative to foot 3780 between a closed or clamped position (fig. 75A and 75D) and an open or undamped position (fig. 75B and 75C). When the anvil 3760 is opened, referring to fig. 75B, the drive foot 3780 can extend to engage and grip tissue. Referring to fig. 75C, the drive foot 3780 is then retracted to create relative movement between the distal head 3720 and patient tissue. Referring to fig. 75D, anvil 3760 can be moved toward its closed position as drive foot 3780 is retracted and/or after drive foot 3780 is retracted. The drive foot 7580 may have teeth to grip tissue and/or have any suitable means for gripping and pulling tissue. In various instances, the drive foot 7580 is configured to apply a vacuum to tissue in order to grasp and pull the tissue. In at least one such case, the vacuum system is turned off, for example, during the operational steps shown in fig. 75A and 75B, and turned on during the operational steps shown in fig. 75C and 75D. In such cases, the vacuum may also hold tissue in the distal head 7520 when the anvil 7560 is closed, but other embodiments are contemplated in which the vacuum is closed during the operational steps shown in fig. 75D.

Referring now to fig. 65-69, a stapling instrument 3500 includes a distal head 3520 comprising an anvil 3560, a tissue drive system comprising a vacuum supply line 3570, two vacuum grippers 3580, and two gripper extenders 3590. Vacuum supply line 3570 includes a manifold 3571 configured to deliver a vacuum pressure differential to two gripper extenders 3590 and two vacuum grippers 3580. Each gripper extender 3590 includes a bellows 3591 in communication with a manifold 3571 that collapses and extends when vacuum is delivered to the internal plenum of the bellows 3591. When the bellows 3591 are contracted, they extend the gripper 3580 to the position shown in fig. 65. Each bellows 3591 is in fluid communication with a cavity 3581 defined in the grasper 3580, which allows a vacuum pressure differential to be transferred to a grasper aperture 3582 defined in the tissue engaging surface 3585 of the grasper 3580. This vacuum pressure differential at the grasper bore 3582 may hold patient tissue against the tissue engaging surface 3585.

As described above, extension of the grasper 3580 corresponds to applying a vacuum pressure differential to tissue. When vacuum supply line 3570 no longer supplies a vacuum pressure differential to bellows 3591, bellows 3591 will elastically re-extend and retract and correspondingly retract grippers 3580, as shown in fig. 67. Similarly, bellows 3591 can also re-extend and retract grippers 3580 as the vacuum pressure differential decreases. In either case, the vacuum pressure differential at the gripper aperture 3582 may decrease as the gripper 3580 retracts. In some cases, the remaining vacuum pressure differential at the grasper bore 3582 may be sufficient to pull patient tissue into the tissue chamber 3525 in the distal head 3520. In other cases, the remaining vacuum pressure differential at the gripper aperture 3582 alone may be insufficient to pull patient tissue into the tissue chamber 3525. Accordingly, the grasper 3580 includes flexible teeth 3586 extending from a tissue-engaging surface 3585 thereof. When the grasper 3580 is extended, see fig. 66, the flexible teeth 3586 slide over the patient tissue without hooking, or at least significantly hooking, the patient tissue. The lateral angle at which the teeth 3586 extend from the tissue engaging surface 3585 also facilitates this relative movement. When the grasper 3580 is retracted, see fig. 68, the teeth 3586 bite into the patient tissue and pull the patient tissue into the tissue chamber 3525. Again, this is facilitated by the angle of the teeth 3586 and can compensate for the loss of vacuum pressure differential at the gripper aperture 3582.

Once patient tissue is positioned in tissue chamber 3525, the tissue can be stapled and/or incised. The supply line 3570 does not supply a vacuum pressure differential during the stapling and/or cutting operation because doing so can extend the grasper 3580 and move tissue. That is, if there is another way to hold tissue in place, for example, the vacuum supply may be turned on during the stapling and/or cutting operation. In either case, the anvil 3560 may then be reopened, the distal head 3520 may be moved relative to the tissue, and the vacuum supply may be used to re-extend the tissue grasper 3580 so that the above process may be repeated, as shown in fig. 69.

70-73, The stapling instrument 3600 includes a distal stapling head 3620 which includes a staple firing system 3650, an anvil 3660, a tissue cutting system 3640, and further includes a tissue grasping system which utilizes a vacuum pressure differential. The stapling instrument 3600 is similar in many respects to the stapling instrument 3500, most of which will not be discussed herein for brevity. That is, the tissue grasping system includes two separate and distinct vacuum supply lines—a first supply line 3670a in communication with a first bellows 3690a in fluid communication with a first tissue driving foot 3680a via a foot manifold 3685a, and, in addition, a second supply line 3670b in communication with a second bellows 3690b in fluid communication with a second tissue driving foot 3680b via a foot manifold 3685 b. Foot manifold 3685a includes an array of manifold apertures 3686 that communicate with foot apertures 3682 defined in first foot 3680a and transmit a vacuum pressure differential to foot apertures 3682 when a vacuum is provided to first supply line 3670 a. Foot manifold 3685b includes an array of manifold apertures 3686 that communicate with foot apertures 3682 defined in second foot 3680b and transmit a vacuum pressure differential to foot apertures 3682 when a vacuum is provided to second supply line 3670 b. The stapling instrument 3600 further includes a control system configured to selectively apply vacuum to the first supply line 3670a and the second supply line 3670b such that the first drive foot 3680a and the second drive foot 3680b are selectively extendable and retractable. In some cases, feet 3680a and 3680b extend and retract simultaneously together, while in other cases feet 3680a and 3680b extend and retract at different times.

An alternative embodiment of a suturing apparatus 3600' is shown in fig. 74. The stapling instrument 3600' is similar in many respects to the stapling instrument 3600. That is, the instrument 3600 'includes a larger tissue-driven foot 3680' that has more vacuum holes 3682 defined therein than the tissue-driven foot 3680 of the stapling instrument 3600.

Referring now to fig. 47A-47G, a stapling instrument 3000 includes a distal head 3020 comprising a staple firing system, an anvil closure system comprising an anvil 3060, a tissue drive device comprising at least one drive foot 3080, and a tissue holder 3070 configured to releasably retain tissue. Referring to fig. 47A, the anvil 3060 is movable from a clamped position to an undamped position to unclamp patient tissue T. Referring to fig. 47B, tissue gripper 3070 may engage patient tissue T to hold the tissue in place as drive foot 3080 is extended, as shown in fig. 47C and 47D. Tissue gripper 3070 may engage tissue when anvil 3060 is open and/or after anvil 3060 has been opened. In either case, referring to fig. 47E, the tissue holder 3070 is disengaged from the tissue before the drive foot 3080 is retracted to pull the distal head 3020 relative to the tissue and position the distal head 3020 at a new location along the staple firing path, as shown in fig. 47F. At this point, referring to fig. 47G, the patient tissue is clamped by the anvil 3060 and the staple firing system is operated to staple the tissue. At this time, the above cycle may be repeated.

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

Referring again to fig. 78, suturing apparatus 3900 further includes a tissue holder 3970. Tissue grip 3970 may be used with drive foot 3980 in the same or similar manner as tissue grip 3070 is used with drive foot 3080.

For example, fig. 45, 46, 48, and 49 illustrate a sequence of operation of a stapling instrument that can be used with the stapling instruments disclosed herein (such as stapling instrument 4000 and/or stapling instrument 3900 described above). The suturing apparatus 4000 is similar in many respects to other suturing apparatuses disclosed herein, most of which will not be discussed herein for brevity. The stapling instrument 4000 comprises an anvil drive system 4060, a staple firing system 4050, a tissue cutting system 4040, a tissue grasping system 4090, and a tissue drive system 4080 configured to move the stapling instrument 4000 relative to patient tissue. Fig. 49 illustrates the operational steps of the stapling apparatus 4000, which are performed in the order presented. For example, step 4003 follows step 4002, and step 4002 follows step 4001, and so on. That is, it should be appreciated that adjacent operational steps may occur simultaneously or have at least some amount of overlap, as shown in FIG. 46 and discussed in more detail below. Furthermore, the operational steps of fig. 49 may be rearranged in any suitable order.

Referring again to fig. 49, operation 4001 includes loading a staple cartridge into stapling instrument 4000 and/or pushing the staple cartridge into place within stapling instrument 4000. Operation 4002 includes removing staples from the staple cartridge and operation 4003 includes placing the staples in position within the staple firing drive 4050. Operation 4004 includes articulating an end effector of the stapling apparatus 4000, if desired. That is, operation 4004 may also occur before and/or during steps 4001, 4002 and/or 4003. Operation 4005 includes positioning an end effector on tissue of a patient, and operation 4006 includes operating anvil drive system 4060 to clamp an anvil on the tissue. Operation 4005 may also occur before operation 4004.

In addition to the above, operation 4007 comprises forming staples against an anvil, and operation 4008 comprises deploying a knife of tissue cutting system 4040. Operation 4007 occurs before operation 4008, but steps 4007 and 4008 may occur simultaneously or with some amount of overlap. Operation 4009 includes retracting the knife using the tissue cutting system 4040, and this step follows operation 4008. Operation 4010 includes using tissue gripping system 4090 to grip and hold patient tissue positioned within an end effector of stapling instrument 4000. Operation 4011 comprises unclamping the anvil using anvil drive system 4060. In such cases, the stapling instrument 4000 can hold tissue even if the anvil is opened due to the tissue gripping system. Operation 4012 includes advancing a foot of tissue drive system 4080. Operation 4013 includes actuating tissue gripping system 4090 to loosen tissue, and operation 4014 includes retracting the foot of tissue drive system 4080 and advancing stapling instrument 4000 relative to the tissue.

In addition to the above, FIG. 46 illustrates that certain operational steps may occur simultaneously or with some amount of overlap. For example, the step 4011 of opening the anvil and the step 4001 of loading the staple cartridge into place can occur simultaneously or with at least some overlap. Similarly, steps 4002 and/or 4003, including advancing staples into position within the staple firing drive 4050, may occur simultaneously or with some overlap with: for example, step 4011 of opening the anvil, step 4010 of grasping tissue with tissue grasping system 4090, step 4012 of extending the foot of tissue driving system 4080, step 4013 of releasing tissue with grasping system 4090, and/or step 4014 of retracting the foot of tissue driving system 4080. In addition, the step 4001 of reloading another staple cartridge into place within the stapling instrument 4000 may occur simultaneously with or with some overlap with the step 4008 of cutting tissue and/or the step 4009 of retracting the tissue cutting knife.

In addition to the above, fig. 45 illustrates an actuation cycle of the anvil drive system 4060 and the tissue drive system 4080 of the stapling instrument 4000. The actuation period in fig. 45 is plotted against time t, with a 0 or zero demarcation line on the horizontal time axis representing the beginning of the cycling sequence of the stapling apparatus 4000. Referring to the actuation cycle of the anvil drive system 4060, the peaks 4006 are associated with step 4006 described above, which includes closing or clamping the anvil to tissue. Similarly, dwell 4011 is associated with step 4011 described above, which includes opening or loosening the tissue. Referring now to the actuation cycle of tissue drive system 4080, peak 4012 is associated with step 4012 which comprises extending the foot of tissue drive system 4080, and peak 4014 is associated with step 4014 which comprises retracting the foot of tissue drive system 4080 and driving stapling instrument 4000 relative to patient tissue. In comparing the actuation cycles of anvil drive system 4060 and tissue drive system 4080, it can be seen that the anvil is open or is opening as the foot is extended. In addition, it can be seen that the anvil opens when the foot is retracted and closes at the beginning of the next cycle of the stapling instrument 4000.

As described above, it may be desirable to perform certain operational steps of the stapling apparatus 4000 sequentially and to perform other operational steps simultaneously. However, in some cases, it may not be desirable to perform certain operational steps at this time. Thus, the stapling instrument 4000 is configured to lock certain drive systems and prevent them from being operated while other drive systems of the stapling instrument 4000 are being operated. The latch may comprise, for example, a mechanical latch and/or an electrical latch. All of the drive systems of the stapling apparatus 4000 are motorized and communicate with the controller of the stapling apparatus 4000, and thus the controller can be used to latch the drive systems. The controller includes a microprocessor, for example, configured to be able to electrically latch one or more other drive systems during operation of the one or more drive systems. Fig. 48 is a graph showing which operation steps are prevented from being performed during the execution of other operation steps. For example, during step 4001, in which the staple cartridge is loaded into place, all other operational steps are blocked or prevented from occurring except for step 4004, which articulates the end effector of stapling instrument 4000, step 4005, which positions stapling instrument 4000 relative to tissue, and step 4011, which unclamps the anvil. In this example, the staple firing system 4050, the tissue drive system 4080, and the tissue gripping system 4090 are latched. This is just one example. This may be done if it is determined that unlocking other steps during step 4001 is not detrimental or unacceptably detrimental to the operation of the stapling instrument 4000.

Referring to fig. 90A-90D, the stapling instrument 4300 includes a distal head 4320 which includes a staple firing system 4350, an anvil drive system including an anvil 4360, and a tissue cutting system 4340. The suturing apparatus 4300 is similar in many respects to the suturing apparatus 1000 and the suturing apparatus 4400, most of which will not be discussed herein for brevity. The suturing apparatus 4300 further includes upper and lower feet 4370a, 4370b, 4380a, 4380b. Similar to the foot 4480 of the stapling instrument 4400, the feet 4370A, 4370B, 4380A, and 4380B are rotatable between an extended position (fig. 90A) and a retracted (fig. 90B-90D) position to move the distal head 4320 relative to patient tissue T. Referring to fig. 90A, foot 4370A and foot 4380A include a synchronized first pair of feet that move together and grasp patient tissue as it moves to its extended position. In such cases, foot 4370a and foot 4380a move toward each other to apply a compressive force or pressure to the tissue. When the feet 4370a and 4380a retract, see fig. 90B, the feet 4370a and 4380a pull on the tissue to move the distal head 4320 relative to the tissue. Once the foot 4370a and foot 4380a have been retracted, see FIG. 90C, the staple firing system 4350 and the tissue cutting system 4340 staple and cut the patient's tissue. The staple firing system 4350 and the tissue cutting system 4340 operate simultaneously; however, the staple firing system 4350 can be operated prior to the tissue cutting system 4340. That is, cutting the tissue prior to suturing can result in unnecessary bleeding. Notably, however, while the suturing apparatus 4300 is suturing and cutting tissue, the foot 4370a and foot 4380a apply clamping pressure to the tissue. Once the tissue has been sutured and incised, referring to fig. 90D, foot 4370a and foot 4380a are moved away from the tissue to loosen the tissue.

As described above, foot 4370a and foot 4380a are operably coupled together such that the two feet move together in pairs. The two feet rotate together in pairs, grip together in pairs and release together in pairs. Various alternative embodiments are contemplated in which only one of foot 4370a and foot 4380a is moved to clamp and unclamp the tissue; however, feet 4370a and 4380a will still rotate together as a pair. The synchronized second pair of feet, including foot 4370b and foot 4380b, moves in the same manner as the synchronized first pair of feet, including foot 4370a and foot 4380a, and thus, for brevity, a discussion of its movement will not be repeated. That is, the motion of the first pair of feet is synchronized with the motion of the second pair of feet. More specifically, the second pair of feet extends while the first pair of feet extends, the second pair of feet is clamped to hold tissue while the first pair of feet is clamped, the second pair of feet is retracted while the first pair of feet is retracted, and the second pair of feet is released while the first pair of feet is released. In some cases, the motions of the first and second pairs of feet are not synchronized or not completely synchronized. In at least one such instance, the first pair of feet extend and retract independently of the second pair of feet to rotate the distal head 4320 along the curved staple path.

As described above, the suturing apparatus disclosed herein is configured to suture tissue of a patient. These stapling instruments are also configured to cut the tissue. Referring to fig. 95 and 96, the stapling instrument 5000 includes a distal head 5020 which includes a staple firing system, a tissue cutting system 5040, and an anvil 5060 configured to deform staples deployed by the staple firing system. The tissue cutting system 5040 includes a knife bar 5042 including a knife edge 5045 defined at a distal end 5044 thereof. In use, the knife bar 5042 can translate laterally through the distal head 5020 during a tissue cutting stroke. The tissue cutting stroke of knife bar 5042 extends between a first unactuated position, as shown in fig. 95, and a second actuated position. During a tissue cutting stroke, knife edge 5045 extends between tissue compression surface 5025 and tissue compression surface 5065 defined on anvil 5060. The knife edge 5045 may also extend into the distal head 5020 and/or anvil 5060 during a tissue cutting stroke to ensure that the entire thickness of tissue is transected.

In addition to the above, the distal head 5020 defines a longitudinal head axis HA. During a tissue cutting stroke, knife bar 5042 moves orthogonally relative to longitudinal head axis HA. The tissue cutting system 5400 further comprises a cutting actuator 5046 configured to engage the knife bar 5042 and laterally displace the knife bar 5042. The cutting actuator 5046 includes a distal end 5047 including an angled cam surface configured to engage a corresponding cam surface 5043 defined on the distal end 5044 of the knife bar 5042. The cutting actuator 5046 may also be configured to urge the knife bar 5042 in any suitable manner. In other embodiments, the knife bar 5042 may be movable in the absence of the cutting actuator 5046.

Referring to fig. 98, the stapling instrument 5100 includes a distal head 5120 which includes a staple forming anvil 5160. The stapling instrument 5100 further includes a staple feeding system 5190, a staple alignment system 5180, and a staple firing system 5150. The staple firing system 5150 includes a staple driver 5151 that is configured to move longitudinally to eject a group or cluster of staples 5130 from the distal head 5120 during a staple firing stroke. Referring to fig. 99 and 100, each staple 5130 includes a base 5131 and staple legs 5132 extending from the base 5131. Referring to fig. 100 and 101, the staple driver 5151 is configured to push the base 5131 of the staples 5130 to push the staple legs 5132 against the forming pockets 5162 (fig. 97) defined in the anvil 5160 during a staple firing stroke. At this time, referring to fig. 102, the staple driver 5151 returns to the starting or unfired point of the staple firing stroke so that another staple firing stroke may be performed.

As described above, the stapling instrument 5100 is configured to deploy staples during each staple firing stroke. Referring to fig. 103, the stapling instrument 5100 further includes a tissue cutting blade 5140 configured to cut tissue during and/or after each staple firing stroke. The staple firing system 5150 is configured to deploy a first set or cluster of three staples 5130 positioned on a first side of a cutting path CP formed by the knife 5140 and a second set or cluster of three staples 5130 positioned on a second side of the cutting path CP. The staple firing system 5150 deploys both the first staple set and the second staple set; however, embodiments are contemplated in which the first set is deployed before the second set of staples. Alternative embodiments are contemplated wherein the stapling instrument does not include a tissue cutting system, or the tissue cutting system of the stapling instrument may be deactivated. After each staple firing stroke is performed, the staple feeding system 5190 and the staple alignment system 5180 cooperate to reposition another set of staples 5130 in the distal head 5120 such that another staple firing stroke can be performed. In various circumstances, the staples 5130 are reloaded during and/or after the tissue cutting stroke.

Referring primarily to fig. 97, 100 and 102, the staple feeding system 5190 includes a staple pusher 5191. Each staple pusher 5191 is configured to push a staple 5130 into a staple cavity 5121 defined in the distal head 5120. In addition to the above, the distal head 5120 includes six staple cavities 5121, each configured to receive staples 5130 from the staple feeding system 5190. The staples 5130 are arranged in six stacks or columns aligned with the staple cavities 5121. The staple pusher 5191 pushes the base 5131 of the proximal-most staple 5130 in each staple stack to push the distal-most staple 5130 of each staple stack into the staple cavity 5121 during the pushing stroke. The staple pusher 5191 simultaneously (i.e., during a common pushing stroke) loads staples 5130 into the staple cavities 5121; however, in alternative embodiments, the staple pusher 5191 can be configured to sequentially load staples 5130 into the staple cavities 5121. Referring to fig. 98 and 99, the staples 5130 within the staple stack are releasably attached to one another, such as by at least one adhesive 5135. As shown in FIG. 100, the staples 5130 of each staple stack adhere to one another at an angle transverse to the firing axis FA of the staple firing system driver 5151. The distal head 5120 includes a cam surface 5122 that orients and aligns the staples 5130 with the firing axis FA of the staple firing system driver 5151 prior to performing a staple firing stroke of the staple firing system 5150.

The staple driver 5151 and the staple pusher 5191 move parallel or at least substantially parallel to each other. Due to the design and/or other spatial constraints of the staple driver 5151 and the staple pusher 5191, referring to fig. 97 and 103, the stapling instrument 5100 further comprises a staple alignment system comprising a staple pusher 5180 configured to work with the staple pusher 5191 to align staples 5130 with the staple driver 5151. The staple pusher 5191 longitudinally pushes the staples 5130 and the staple pusher 5180 laterally pushes the staples 5130.

Referring to fig. 104-105D, the stapling instrument 5200 includes a distal head 5220 comprising a staple firing system 5250 configured to deploy staples 5230, a tissue cutting system, and an anvil 5260 comprising forming pockets configured to deform the staples 5230. The staple firing system 5250 includes a rotatable actuator 5252 that is configured to displace the lateral staple drivers 5254 along a linear, or at least substantially linear, lateral path. Each rotatable actuator 5252 includes a cam 5253 configured to engage a shoulder 5255 defined on the staple driver 5254 and laterally displace the driver 5254, as shown in fig. 105B. The staple firing system 5250 also includes one or more springs 5224 positioned intermediate the lateral staple drivers 5254 and the frame 5222 of the distal head 5220. As the staple driver 5254 is slid laterally by the rotatable actuator 5252, the spring 5224 is compressed until the cam 5253 is disengaged from the shoulder 5255 of the driver 5254 during continued rotation of the actuator 5252, as shown in fig. 105C. At this point, referring to fig. 105D, the spring 5224 resiliently returns the lateral staple driver 5254 to its unactuated position.

Referring to fig. 104 and 105A, the staple firing drive 5250 also includes a longitudinal staple driver 5257 that is driven along a longitudinal staple firing path by the lateral staple drivers 5254. Each lateral staple driver 5254 includes a drive cavity 5256 defined therein which receives a portion of the longitudinal staple driver 5257 therein. More specifically, each longitudinal staple driver 5257 includes a cam portion positioned in the drive chamber 5256 that is driven longitudinally by a cam surface 5258 defined in the drive chamber 5256 as the lateral staple drivers 5254 are moved laterally, as shown in fig. 105B. As described above, the rotational movement of the rotatable actuator 5252 is converted to lateral translation of the lateral staple driver 5254, which is converted to longitudinal translation of the longitudinal staple driver 5257. The longitudinal movement of the staple drivers 5257 drives the staples 5230 against the anvil 5260 to deform the staples 5230 as shown in fig. 105B. The longitudinal staple driver 5257 includes a staple holder 5251 defined therein that is configured to support the staples 5230 as the staples 5230 are deformed.

In addition to the above, referring to fig. 105C, the return lateral movement of the staple driver 5254 retracts the longitudinal staple driver 5257 to its unactuated position. More specifically, the drive cavity 5256 also includes a cam surface 5258' that is configured to drive the longitudinal staple drivers 5257 in an opposite direction until the staple drivers 5257 are reset in their unactuated or unfired position, as shown in fig. 105D. Notably, when the longitudinal staple drivers 5257 are retracted, the anvil 5260 is moved to the open position. At this point, the distal head 5220 can be moved relative to the tissue, the staples 5230 can be reloaded into the distal head 5220 and the anvil 5260 can be reclamped to the tissue as shown in fig. 105A, wherein another staple firing stroke of the staple firing drive 5250 can be performed.

As described above, the array of attached staples may be used to feed and re-feed the staple firing system of the stapling instrument. In other cases, the entire staple cartridge may be used to feed and re-feed the staple firing system. Referring to fig. 106, the suturing apparatus 5300 includes a shaft 5310, a distal head 5320, and an articulation joint 5370 rotatably connecting the distal head 5320 to the shaft 5310. The stapling instrument 5300 further comprises a plurality of staple cartridges 5330 "stored in the shaft 5310 and a cartridge pusher system configured to push the staple cartridges 5330" into the distal head 5320. Once the staple cartridge 5330 "is positioned in the distal head 5320, the staples 5330 (fig. 107) contained in the staple cartridge 5330" can be separated and deployed by a staple firing system, as discussed in more detail below. In various instances, the staple cartridge includes a cartridge body that is disassembled and deployed with staples, while in other instances, the staples are ejected from the cartridge body and the cartridge body is not implanted.

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

In addition to the above, the staples 5330 of each staple cluster 5330' are attached to each other by at least one adhesive; however, the staple clusters 5330' themselves are not attached to each other, but are stored side-by-side in the cartridge body 5333. In at least one alternative embodiment, the staples of adjacent staple clusters are releasably attached to each other. Referring now to fig. 108, the cartridge body 5333 can be configured, for example, to releasably store a plurality of staple clusters 5430 'therein, wherein each staple cluster 5430' comprises three staples. The three staples 5430 of each staple cluster 5430 'are attached to each other by at least one adhesive 5435 and the staple clusters 5430' are also attached to each other by at least one adhesive 5435. In such embodiments, the staple clusters 5430' are attached to one another to form a staple strip 5430″ with one or more staple clusters 5430' separated from other staple clusters 5430' to load staples into the distal head 5320. Although the staple clusters of the above embodiments include three staples, the staple clusters may include any suitable number of staples including, for example, two staples or more than three staples.

With reference to fig. 109 and 110, a stapling instrument 5400 includes a shaft 5410, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and a system configured to move the distal head relative to tissue of a patient. The stapling instrument 5400 further comprises a staple strip 5430 "of fig. 108 stored in a shaft 5410. The nailing strip 5430 "can be stored in the cartridge body 5333 as described above or can be stored in the shaft 5410 without a cartridge body. Nailing strip 5430 "can include any suitable number of nails and/or clusters of nails. In at least one instance, nailing strip 5430 "includes, for example, 588 nails.

Referring to fig. 111 and 112, the stapling instrument 5500 includes a shaft 5510, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and a system configured to move the distal head relative to tissue of a patient. The stapling instrument 5500 also includes a first staple strip 5530a "and a second staple strip 5530b" stored in the shaft 5510. The nailing strips 5530a "and 5530b" are comprised of staples 5430 arranged in staple clusters 5430'. The strips 5530a "and 5530b" nest such that the bases of staples 5430 face in opposite directions.

Referring to fig. 113 and 114, a stapling instrument 5600 includes a shaft 5610, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and a system configured to move the distal head relative to tissue of a patient. The stapling instrument 5600 further includes a first nailing strip 5630a "and a second nailing strip 5630b" stored in the shaft 5610. Nailing strips 5630a "and 5630b" are comprised of staples 5430 arranged in staple clusters 5430'. Nailing strips 5630a "and 5630b" are arranged in a side-by-side fashion such that the bases of staples 5430 face in the same direction.

Referring again to fig. 106, the stapling instrument 5300 includes a system for pushing the staple cartridge 5330″ from the shaft 5310 into the distal head 5320. Notably, the cartridge pushing system pushes the staple cartridge 5330 "through the articulation joint 5370 into the distal head 5320. Accordingly, the staple cartridge 5330″ and/or the size of the staples 5330 may be limited by the spatial constraints of the articulation joint 5370, particularly when the distal head 5320 is articulated. Fig. 115-118 disclose a stapling instrument 5700 that includes a flexible staple strip that can feed staples through an articulation joint into a distal head. The stapling instrument 5700 comprises a first staple bar 5730 'comprising staples 5730 attached to a first carrier 5760'. More specifically, staples 5730 are attached to first carrier 5760 'at tabs 5761'. Each spike 5730 includes a base 5731 and a spike leg 5732 extending from the base, wherein the base 5731 is connected to a first spike 5730 'by a tab 5761'. The stapling instrument 5700 further comprises a second nailing strip 5730 "comprising nails 5730 attached to a second carrier 5760" at tabs 5761 ". Carriers 5760 'and 5760 "each include an array of apertures 5762 for feeding nailing strips 5730' and nailing strips 5730" into the distal head of a stapling instrument 5700, as described in more detail below.

The nailing strip 5730' is stored in the shaft of the stapling instrument 5700. In the stored state of nailing strip 5730', the nailing strip is planar or at least substantially planar. More specifically, referring to fig. 115 and 116, staples 5730 are attached to first carrier 5760 'such that the staples are coplanar with first carrier 5760'. The stapler 5700 further comprises a staple feeding system including a drive wheel configured to push a staple strip 5730' in the distal head of the stapling instrument 5700. The drive wheel includes an array of drive pins extending therearound that are configured to engage apertures 5762 of the first carrier 5760 'and drive the first carrier 5760' into the distal head. A second nailing strip 5730 "is also stored in the shaft of the stapling instrument 5700. In the stored state of nailing strip 5730 "the nailing strip is planar or at least substantially planar. More specifically, referring to fig. 115 and 116, staples 5730 are attached to second carrier 5760 "such that the staples are coplanar with second carrier 5760". Similar to the above, the drive wheel of the stapling system is configured to engage the aperture 5762 of the second carrier 5760 "and drive the second carrier 5760" into the distal head of the stapling instrument 5700.

Referring to fig. 115 and 118, nailing strips 5730' and 5730 "are stored in a face-to-face arrangement such that carriers 5760' and 5760" of nailing strips 5730' and 5730 "can be engaged and driven by a nailing feeding system on opposite sides. Referring to fig. 116, as nailing strips 5730' and 5730 "are fed into the distal head, nailing 5730 bends downward around the tabs 5761' of nailing strip 5730' and the tabs 5761" of nailing strip 5730", respectively. In at least one instance, the frame of the distal head includes a cam surface configured to bend the staples 5730 downward. In some cases, stapling instrument 5700 includes one or more actuators configured to, for example, bend staples 5730 downward about a mandrel positioned below tabs 5761' and 5761″. Once displaced to the downward position of staples 5730, the staples are separated from staple strips 5730' and 5730 ". In at least one instance, the frame of the distal head includes one or more shearing surfaces or blades configured to separate the staples 5730 from the tabs 5761 'and 5761″ as the staples 5730' and 5730 "are advanced into the distal head. In some instances, stapling instrument 5700 further comprises one or more shears that are actuated to separate staples 5730 from staple strips 5730' and staple strips 5730 ". In either case, the separated staples are then positioned for deployment by the staple firing system of the stapling instrument 5700.

In addition to the above, stapling instrument 5700 is configured to separate staple clusters from staple strips 5730 'and 5730", and then advance carrier 5760' of staple strip 5730 'and carrier 5760" of staple strip 5730 "such that another staple cluster can be separated from staple strips 5730' and 5730". Referring to fig. 118, once staples 5730 have been separated from carriers 5760 'and 5760", the empty or stripped portions of carriers 5760' and 5760" are fed back into the shaft of stapling instrument 5700. Thus, the movement of feeding new staples 5730 into the staple firing system also feeds empty carriers 5760' and 5760 "into the shaft.

Referring to fig. 119, the staple cluster 5830' includes four staples 5830 adhered together by at least one adhesive 5835. Each pin 5830 includes a base 5831 and two legs 5832 extending from the base 5831. Notably, the staple legs 5832 are not coplanar with the base 5831. Instead, the base 5831 is present in the base plane and the staple legs 5832 are present in the leg plane. The base plane is parallel or at least substantially parallel to the leg plane, but embodiments are contemplated in which the base plane and the leg plane are not parallel. In either case, two of the staples 5830 of the staple cluster 5830' face inward and two of the staples 5830 face outward. The staples 5830 face outward when the base plane of the staples 5830 are closer to the center of the staple cluster 5830' than the leg planes thereof. Accordingly, the pins 5830 face inward when the leg plane of the pins 5830 is closer to the center of the pin cluster 5830' than the base plane thereof.

In addition to the above, the staple cluster 5830' includes two staples 5830 located on a first side of the centerline CL and two staples 5830 located on a second side of the centerline CL. The staples 5830 on a first side of the staple cluster 5830 'are connected by a first adhesive connector 5835 and the staples 5830 on a second side of the staple cluster 5830' are connected by a second adhesive connector 5835. In addition, the staples 5830 on a first side of the staple cluster 5830 'are connected to the staples 5830 on a second side of the staple cluster 5830' by adhesive connectors 5835. That is, the staple cluster may include any suitable number of adhesive connectors. An adhesive connector 5835 releasably holds the pins 5830 together. The adhesive connector 5835 breaks before the pin 5830 is implanted in the patient's tissue; however, alternative embodiments are contemplated in which the adhesive connector 5835 does not break prior to the staples 5830 being implanted in the patient's tissue. The adhesive connector 5835 is constructed of, for example, a biocompatible and/or bioabsorbable material (such as a bioabsorbable polymer).

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

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

Referring to fig. 121, in addition, a stapling instrument 6000 includes a shaft, a distal head 6020 including an anvil 6060, and a staple firing system. In this embodiment, a staple firing system loads staples 6030 into the distal head 6020 and fires the staples by pushing the staples against the anvil 6060. The distal head 6020 includes staple cavities 6021 defined therein that are configured to store and guide staples 6030 as they are pushed toward the anvil 6060.

Referring to fig. 122-125, a stapling instrument 6100 includes a shaft, a distal head 6120, a staple loading system, a staple firing system, an anvil drive system, a tissue gripping system, and a tissue drive system configured to move the distal head 6120 relative to patient tissue. The drive system of the suturing apparatus 6100 includes a rotatable foot 6180, similar to that described above, configured to grasp tissue of a patient and pull the distal head 6120 relative to the tissue. Also similar to the above, the tissue gripping system is configured to hold tissue as the foot 6180 extends and/or during any suitable time during operation of the surgical instrument 6100. Referring primarily to fig. 125, the tissue gripping system includes a tissue holder 6170 configured to engage tissue of a patient. The tissue holder 6170 includes a rectangular body 6172 and a shaft 6174 extending from the body 6172. The tissue holder 6170 defines a tissue engaging surface 6175 that is less than the cross-sectional thickness 6125 of the distal head 6120 shown in fig. 124. Because of the smaller area of the tissue engagement surface 6175 as compared to the cross-sectional thickness 6125, the tissue retainer 6170 can apply a greater gripping pressure to the patient tissue than the distal head 6120 for a given clamping force. In at least one instance, the area of tissue-engaging surface 6175 is about 25% of cross-sectional thickness 6125.

Referring to fig. 126-137, the stapling instrument 6200 includes a shaft, a distal head 6220, a staple firing system 6250, a tissue cutting system, an anvil drive system, and a tissue drive system configured to move the distal head 6220 relative to tissue of a patient. Referring to fig. 126 and 127, the tissue drive system includes a rotatable foot 6280 that is moved to an extended position (fig. 126) and then retracted (fig. 127) to grasp patient tissue and move the distal head 6220 relative to the tissue. Fig. 128A also shows one of the feet 6280 in an extended position. The feet 6280 may be extended and retracted simultaneously to move the distal head 6220 along a linear path, or extended and retracted separately to rotate the distal head 6220, but for illustration purposes only one foot 6280 is shown in fig. 128A. Fig. 128, which corresponds to fig. 128A, illustrates the anvil 6260 in a fully clamped state such that the anvil 6260 and the foot 6280 cooperate to grasp patient tissue. Further, fig. 128 illustrates the unformed staples 6230 positioned in the staple cavities 6221 defined in the distal head 6220 and the staple firing system 6250 in an unfired state.

Similar to fig. 127, fig. 129A shows foot 6280 in its retracted position. Fig. 129, which corresponds to fig. 129A, illustrates the anvil 6260 in a fully clamped state and the staple firing system 6250 in a fired state. As shown in fig. 129, the leg portion 6232 of the staple 6230 has been fully deformed into a B-shaped configuration; however, other deformed configurations of staples 6230 can be suitable. Referring to fig. 131 and 133, the staple firing system 6250 includes a firing bar 6255 and a plurality of staples 6230 stored within recesses 6252 defined in a side of the firing bar 6255. A first column of staples 6230 is stored in a first side of the firing bar 6255 and a second column of staples 6230 is stored in a second, or opposite side of the firing bar 6255. Each of the recesses 6252 is defined by a proximal staple holder 6251 configured to push the base 6231 of a staple 6230 positioned therein. FIG. 134 illustrates two staples 6230 positioned in an unfired state in staple cavities 6221 defined in a distal head 6220 and a firing bar 6255 of a staple firing system 6250.

Referring again to fig. 134, the sides of the staple cavity 6221 include recesses 6222 defined therein. The sides of the staple cavities 6221 also include a drag surface 6223 positioned intermediate the depressions 6222. As the firing bar 6255 is urged distally during a first staple firing stroke to fire the first set of staples 6230 positioned in the staple cavities 6221, the staples 6230 stored in the firing bar 6255 are urged by the drag surface 6223. Referring to FIG. 136, as the firing bar 6255 is retracted after a first stroke release, the staples 6230 become lodged on the traction surfaces 6223 such that the firing bar 6255 slides relative to the staples 6230. Thus, in such circumstances, the staples 6230 enter the next set of distal recesses 6252 defined in the firing bar 6255, thereby presenting a new set of staples 6230 to be ejected from the staple cavities 6221. Fig. 130 and 130A illustrate a surgical instrument 6200 that is re-opened to release patient tissue such that the distal head 6220 can be repositioned relative to the patient tissue. Referring to fig. 137, once the distal head 6220 has been properly repositioned, the firing bar 6255 can be advanced distally to perform a second staple firing stroke. This process can be repeated to deploy all of the staples 6230 stored in the firing bar 6255.

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

Referring to fig. 140 and 141, the stapling instrument 6500 includes a shaft 6510, a distal head 6520, and an articulation joint 6270 that rotatably connects the distal head 6520 to the shaft 6510. The stapling instrument 6500 also includes a staple feeding system 6590 configured to produce continuously fed staples 6530 and supply them to the distal head 6520. The staple feeding system 6590 includes a spool 6592 operably coupled to an electric motor. Spool 6592 includes wire 6594 wound around a central core. Wire 6594 is constructed of, for example, stainless steel and/or titanium. The wire 6594 is fed through a passageway 6514 defined in the shaft 6510 and the articulation joint 6570. In use, motorized reel 6592 pushes wire 6594 into distal head 6520. Distal head 6520 further includes a forming mandrel configured to deform wire 6594 into staples 6530, as described in more detail below. The spindle is driven by an electric motor and/or actuator, but may be actuated in any suitable manner. As also described in greater detail below, the distal head 6520 includes a knife or cutting member configured to cut the wire 6594. The shear member is driven by an electric motor and/or actuator, but may be actuated in any suitable manner. Once staple 6530 has been formed and separated from wire 6594, staple 6530 can be deployed against anvil 6560 of stapling instrument 6500 and deformed.

Referring to fig. 141, surgical instrument 6500 further includes staple forming system 6580 configured to form staples 6530 from wire 6594. The staple forming system 6580 includes a forming mandrel 6582 positioned in a forming cavity 6522 defined in the distal head 6520. The staple forming system 6580 also includes a forming actuator 6584 configured to engage the wire 6594 and deform the wire 6594 within the forming cavity 6522. At this point, forming mandrel 6582 is actuated to sever staple 6530 from wire 6594. After staple 6530 has been deployed and/or removed from forming cavity 6522, another staple 6530 can be formed within cavity 6522. In certain alternative embodiments, a wire segment is cut from wire 6594 before the segment is formed into staple 6530. In either case, staple 6530 can comprise, for example, a substantially U-shaped configuration. Alternatively, the wire segments may be shaped into a substantially V-shaped configuration. Further, for example, the stapling instrument 6500 can be configured to make and deploy any suitable fasteners, such as tacks and/or clamps.

Referring to fig. 158 and 159, the stapling instrument 7300 includes a shaft 7310, a distal head 7320, and an articulation joint 7370 that rotatably connects the distal head 7320 to the shaft 7310. In use, the suturing apparatus 7300 is inserted into the patient P through the trocar TC. The trocar TC includes a passageway extending therethrough that allows insertion of the distal head 7320 and a portion of the shaft 7310 into a patient. In other cases, distal head 7320 may be inserted into a patient through an open incision without a trocar. In either case, the stapling instrument 7300 is configured to deploy staples from a staple cartridge inserted therein. The shaft 7310 includes a loading port 7312 that communicates with a cartridge passageway or channel that extends through the shaft 7310, the articulation joint 7370 and the distal head 7320. In use, a staple cartridge (such as staple cartridge 7330') is inserted into shaft 7310, for example, through loading port 7312, and then pushed into distal head 7320. The stapling instrument 7300 further comprises a cartridge pusher system configured to push the staple cartridge 7330' into the end effector 7300.

In various circumstances, in addition to the above, the staple cartridge 7330' can be fed into the stapling instrument 7300 such that the stapling instrument 7300 can be operated continuously without being removed from the patient for reloading. Each staple cartridge 7330' has staples stored therein having a first size (such as a first unfired height). In some instances, it is desirable to form staple lines having staples that are all the same size or unfired height. Such a situation may occur when the tissue being sutured has a substantially uniform thickness. In other cases, it may be desirable to form staple lines having staples of different sizes or unfired heights. Such situations may occur when the tissue being sutured does not have a uniform thickness. For example, transected stomach tissue during a gastric volume reduction procedure typically does not have a consistent thickness. In such instances, a first staple cartridge 7330' may be loaded into the stapling instrument 7300, which has staples of a first unfired height, and a second staple cartridge 7330 "may be loaded into the stapling instrument 7300, which has staples of a second unfired height. The first unfired height is higher than the second unfired height, but the first unfired height may be lower than the second unfired height. Similarly, a third staple cartridge 7330' "having staples of a third unfired height different from the first unfired height and the second unfired height can be loaded into the stapling instrument 7300.

In addition to the above, more than one staple cartridge may be loaded into stapling instrument 7300. Staple cartridges may be inserted into stapling instrument 7300 such that they are used in a particular order. For example, a staple cartridge having a lower unfired height may be fired prior to firing a staple cartridge having a higher unfired height. Alternatively, a staple cartridge having a higher unfired height may be fired prior to firing a staple cartridge having a lower unfired height. In any event, the most distal cartridge is used first and the most proximal cartridge is used last. This arrangement allows for a pre-planned surgical procedure whereby little, if any, time is wasted loading the stapling instrument 7300 during the surgical procedure. Alternatively, staple cartridges may be fed into stapling instrument 7300 one at a time. Such an arrangement provides the clinician with an opportunity to change the order of end use of the staple cartridge.

The loading port 7312 includes an opening accessible from the exterior of the shaft 7310, but the loading port 7312 may be defined in the handle of the stapling instrument 7300 or in any other suitable location. In various instances, the stapling instrument 7300 can further comprise a door configured to cover the loading port 7312. In at least one instance, the door may be sealed when closed to prevent or inhibit fluid and/or contaminants from entering the stapling instrument 7300. In such cases, the door and/or housing of shaft 7310 may include one or more seals.

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

Referring to fig. 168 and 169, the stapling instrument 7900 includes a shaft 7910, a distal head 7920, and an articulation joint 7970 that rotatably connects the distal head 7920 to the shaft 7910. As described in more detail below, the distal head 7920 can pivot in any suitable direction. Similar to the above, the stapling instrument 7900 includes a cartridge feed system configured to feed staple cartridges 7930' into the distal head 7920 through a cartridge passageway 7914 extending through the shaft 7910, the articulation joint 7970, and the distal head 7920. Also similar to above, the staples 7930 are stripped from the distal-most staple cartridge 7930' and then fired against the anvil 7960. As described in more detail below, the stapling instrument 7900 further includes an articulation drive system 7980 that is configured to articulate the distal head 7920.

In addition to the above, referring again to fig. 168 and 169, the distal head 7920 is capable of articulation in several directions relative to the shaft 7910. The shaft 7910 extends along a longitudinal shaft axis LA, and the distal head 7920 extends along a longitudinal head axis HA. When the distal head 7920 is not articulated, the head axis HA is aligned, or at least substantially aligned, with the shaft axis LA. When the distal head 7920 is articulated, the head axis HA is transverse to the shaft axis LA. Referring to fig. 168, the distal head 7920 can be laterally or in a side-to-side direction. In at least one such instance, the distal head 7920 can articulate, for example, through a range including about 15 degrees from a first side of the shaft axis LA and about 15 degrees from a second side of the shaft axis LA. The articulation drive system 7980 is configured to drive the distal head 7920 or actively articulate the distal head through the range of motion. The articulation drive system 7980 includes a first lateral driver 7982 mounted to the distal head 7920 and a second lateral driver 7984 mounted to the distal head 7920 on an opposite side of the distal head 7920. In use, the first lateral driver 7982 is pushed and/or the second lateral driver 7984 is pulled to articulate the distal head 7920 in a first direction. Accordingly, the first lateral driver 7982 is pulled and/or the second lateral driver 7984 is pushed to articulate the distal head 7920 in the second direction. In at least one instance, the first lateral driver 7982 includes a first wire and the second lateral driver 7984 includes a second wire. Such a wire is suitable for pulling on the distal head 7920.

Referring to fig. 169, the distal head 7920 can also be articulated in an anterior and/or posterior direction. In at least one such instance, the distal head 7920 can articulate through a range that includes, for example, about 25 degrees in a posterior direction and about 25 degrees in an anterior direction. In certain embodiments, although not shown, the articulation drive system 7980 is configured to actively articulate the distal head 7920 in an anterior direction and a posterior direction (fig. 169). In alternative embodiments, the distal head 7920 may be passively articulated in the anterior and posterior directions. In such embodiments, the stapling instrument 7900 does not actively drive the distal head 7920 relative to the shaft 7910. Conversely, the distal head 7920 may float in the anterior-posterior direction. Similarly, the distal head 7920 may be passively articulated in the left-right direction with or without the articulation drive system 7980. In any event, the distal head 7920 can be articulated in both the anterior-posterior plane and the left-right plane, and can be at a compound angle relative to the longitudinal axis LA of the shaft 7910.

In various embodiments, the surgical instrument 7900 can include a lock configured to hold the distal head 7920 in place, which can be released to allow movement of the distal head 7920 relative to the shaft 7910. In various cases, when the distal head 7920 is unlocked, the distal head 7920 may be passively articulated by pushing the distal head 7920 against patient tissue within the surgical site. The distal head 7920 may also be actively articulated when the distal head 7920 is unlocked. In either case, once the distal head 7920 has been properly positioned, the distal head 7920 may then be locked in its articulated position. To return the distal head 7920 to its non-articulated position, the distal head 7920 may be unlocked and then realigned with the shaft axis LA. In at least one instance, the stapling instrument 7900 includes one or more springs configured to bias the distal head 7920 into its non-articulated position. In any event, the articulation lock may prevent or at least inhibit backdrive of the distal head 7920 in response to external and/or internal forces and torque.

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

Referring to fig. 170, the stapling instrument 8000 includes a damping system 8080 that is configured to control or slow the articulation of the distal head 7920. The damping system 8080 includes a first connector 8082, a second connector 8084, and a damper 8085. The first connector 8082 is pinned to the distal head 7920 at pivot 8081. The first connector 8082 is also pinned to the second connector 8084 at pivot 8083. The pivot 8081 and pivot 8083 allow the damping system 8080 to accommodate various articulation of the distal head 7920. The damper 8085 includes a housing 8087 mounted to the shaft 7910 and a damping medium 8088 contained in a chamber defined in the housing 8087. The second connector 8084 includes a piston 8086 defined on a proximal end thereof, the piston being positioned in the housing aperture and configured to move through the damping medium 8088 when the distal head 7920 is articulated. Damping medium 8088 flows through and/or around piston 8086, allowing but slowing down the relative movement between piston 8086 and housing 8097. Accordingly, the damping medium 8088 allows for, but slows down, movement of the distal head 7920 relative to the shaft 7910. Sudden movement of the distal head 7920 may be difficult for a clinician to control and/or anticipate and may cause the distal head 7920 to strike patient tissue. For example, the damping medium 8088 may comprise any suitable medium, such as damping grease.

Referring to fig. 171, the stapling instrument 8100 includes a damping system 8180 configured to control or slow the articulation of the distal head 7920. Damping system 8180 includes a connection 8182 and a damper 8185. The connector 8182 is pinned to the distal head 7920 at pivot 8181. The first connector 8082 is flexible, allowing the damping system 8180 to accommodate various articulation of the distal head 7920. The damper 8185 includes a housing 8187 rotatably mounted to the shaft 7910 and a damping medium 8188 contained in a chamber defined in the housing 8187. The connector 8182 includes a piston 8186 defined on a proximal end thereof, the piston positioned in the housing aperture and configured to move through the damping medium 8188 when the distal head 7920 articulates. Damping medium 8188 flows through and/or around piston 8186, thereby allowing but slowing down the relative movement between 8186 and housing 8197. Accordingly, the damping medium 8188 allows but slows the movement of the distal head 7920 relative to the shaft 7910. Sudden movement of the distal head 7920 may be difficult for a clinician to control and/or anticipate and may cause the distal head 7920 to strike patient tissue. For example, damping medium 8188 may include any suitable medium, such as damping grease.

Referring to fig. 172, a suturing apparatus 8100 is insertable into a patient P through a trocar TC and movable relative to target tissue TC. To some extent, the trocar TC may be movable relative to the patient P, and also to some extent, the suturing apparatus 8100 may be movable relative to the trocar TC. However, such movement may result in movement of the shaft 7910 through a wide range of angles. To maintain the distal head 7920 in alignment with the tissue as the distal head 7920 is advanced along the staple line, the distal head 7920 may be articulated, e.g., gradually rearward. Referring to fig. 173, the distal head 7920 can be gradually articulated forward and/or backward to maintain the axis of the distal head 7920 orthogonal or at least substantially orthogonal to the target tissue T. In various cases, the distal head 7920 is actively articulated by an articulation drive system to adjust the angle between the distal head 7920 and the shaft 7910. In some cases, the distal head 7920 is passively articulated by an articulation drive system to adjust the angle between the distal head 7920 and the shaft 7910. In such cases, the distal head 7920 may adaptively float to follow the staple firing path.

Referring to fig. 34 and 35, the suturing apparatus 2500 includes a shaft 2510, a distal head 2520, and an articulation joint 2570 rotatably connecting the distal head 2520 to the shaft 2510. Shaft 2510 extends along a longitudinal shaft axis LA, and distal head 2520 extends along a longitudinal head axis HA. When the distal head 2520 is not articulated, the shaft axis LA and the head axis HA are aligned as shown in fig. 34. Referring to fig. 35, when the distal head 2520 is articulated, the head axis HA is transverse to the shaft axis LA. The stapling instrument 2500 further comprises a damping system 2580 configured to control or slow the articulation of the distal head 2520. Damping system 2580 includes first connector 2581, second connector 2582, and damper 2585. First connection 2581 is pinned to distal head 2520 at pivot 2584. The first connector 2581 is also pinned to the second connector 2582 at pivot 2583. The pivots 2583 and 2584 allow the damping system 2580 to accommodate various articulation of the distal head 2520. Referring to fig. 34, when the distal head 2520 is not articulated, the first connector 2581 is aligned with the second connector 2582 along the longitudinal axis. Referring to fig. 35, when the distal head 2520 is articulated, the first connector 2581 is transverse to the second connector 2582.

The damper 2585 includes a housing mounted to the shaft 2510 and a damping medium 2586 contained in a chamber defined in the housing. The second connector 2582 includes a piston defined on a proximal end thereof, the piston positioned in the housing aperture and configured to move through the damping medium 2586 when the distal head 2520 is articulated. Damping medium 2586 flows through and/or around the piston, allowing but slowing down the relative movement between the piston and the housing. Accordingly, damping medium 2586 allows but slows movement of distal head 2520 relative to shaft 2510. For example, damping medium 2586 may include any suitable medium, such as damping foam.

The stapling instrument 2000 is illustrated in fig. 13, and is similar in many respects to the stapling instrument 1000 and/or other stapling instruments disclosed herein, most of which will not be discussed herein for brevity. The suturing apparatus 2000 comprises a handle 2100 comprising a housing 2110, a grip 2120 and a display 2130. The housing 2110 includes a connector 2170 configured to enable connection of a shaft assembly (such as the shaft assembly 1200) to, for example, the handle 2100. The handle 2100 also includes a replaceable battery pack 2160 releasably attached to the housing 2110 and removably positioned within a cavity 2115 defined in the housing 2110. The battery pack 2160 supplies power to the display 2130 and/or the motor drive system housed within the handle 2100. As discussed in more detail below, the display 2130 is configured to allow a user to control the operation of the surgical instrument 2000.

In addition to the above, the stapling instrument 2000 includes a staple firing system configured to apply staple lines in tissue of a patient, and the display 2130 includes controls for assessing the status of the staple firing system. The display 2130 also includes controls for, for example, assessing and/or modifying the speed at which the stapling instrument 2000 applies staple lines, the direction in which the staple lines are applied, and/or any performance threshold that has been reached, exceeded, or is about to be exceeded. The display 2130 includes a capacitive touch screen; however, any other suitable screen may be used.

Referring to fig. 14, display 2130 includes a status control 2140. Status control 2140 includes window 2141 that includes window title 2142. Status control 2140 also includes an image window 2145 configured to display information regarding the tissue being stapled, the staple firing path, and/or any other information available to the clinician for operating stapling instrument 2000. For example, the image window 2145 is configured to display a staple firing path 2143 along which the stapling instrument 2100 is currently moving and/or an alternative staple firing path 2143' that will guide a staple path around certain anatomical features in patient tissue T, such as a blood vessel V. Status control 2140 is a digital control and/or a display and is in signal communication with a controller of stapling instrument 2000.

Referring to fig. 17, the display 2130 further includes a direction control 2190 configured to control the direction of the staple firing path. The directional control 2190 includes a window 2191 that includes a window title 2192 and an image window 2195. The image window 2195 is configured to display an orientation of the distal head of the stapling instrument relative to an initial starting orientation. The image window 2195 includes a plurality of orientation lines 2194 that indicate certain directional angles, such as 15 degrees, 30 degrees, and 45 degrees, for example, relative to the starting orientation line 2194 that is defined as 0 degrees. The image window 2195 also includes a needle 2193 that represents an orientation of the distal head of the stapling instrument relative to an initial orientation of the stapling instrument. The direction control 2190 also includes an edit window 2198 that, once activated, allows the user to change the direction of the staple path by manipulating the needle 2193. The direction control 2190 also includes a save window 2199 that, once activated, allows a user to save input provided to the controller through the direction control 2190. At this point, the stapling instrument 2000 may be moved in its new orientation. Status controls 2190 are digital controls and/or displays and are in signal communication with the controller of stapling instrument 2000.

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

Referring to fig. 16, display 2130 further includes a failure threshold control 2180 configured to manage failure thresholds of stapling instrument 2000 when such failure thresholds occur. For example, a threshold value of force required to perform a staple firing stroke may be used to establish a fault condition requiring user input. If the force required to perform the staple firing stroke exceeds a threshold, the controller of the stapling instrument 2000 can alert a user via a failure threshold control 2180 and/or cause the stapling instrument 2000 to stop. The user may override or otherwise manage certain faults, which may allow the stapling instrument 2000 to continue applying staples. The failure threshold control 2180 allows the user to manage these failures. Other faults may not be covered. In such cases, the failure threshold control 2180 is configured to be able to display to a user that the failure cannot be covered and/or how to resolve the failure so that operation of the stapling instrument 2000 may continue. The failure threshold control 2180 includes a window 2181 that includes a window title 2182 and an image window 2185. The fault threshold control 2180 is a digital control and/or display and is in signal communication with a controller of the stapling instrument 2000.

Turning now to fig. 18, the stapling instrument 2000 further comprises a visual acquisition system, discussed in more detail below, and the display 2130 further comprises an image window 2135 configured to display real-time video images or the like from the visual acquisition system. The display 2130 also includes a menu 2131 extending along the left side of the image window 2135; however, menu 2131 may be placed in any suitable location on display 2130. Menu 2131 includes status controls 2140, speed control 2150, fault threshold control 2180, and direction control 2190 described above. Menu 2131 also includes setting controls 2132 that may be used to select and/or rearrange windows and/or controls on display 2130. Menu 2131 also includes a stop control 2136 that can immediately stop the progress of stapling instrument 2100 along the staple firing path. Menu 2131 is a digital control and/or display and is in signal communication with a controller of stapling instrument 2100.

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

As described above, the speed at which the staple firing system and/or the tissue drive system of the stapling instrument 2000 operates can be controlled by a speed control 2150 on the display 2130. In various cases, as described above, the speed may be controlled manually or by input from a user. In other cases, the controller of stapling instrument 2000 can automatically control the speed. In such cases, the controller is configured to evaluate, for example, characteristics of the tissue being stapled, such as its thickness and/or density, and adjust the speed of the staple firing system and/or the tissue driving system accordingly. For example, if the controller determines that the tissue being stapled is thicker, or is approaching, at, or exceeding a tissue thickness threshold, the controller may slow the speed of the stapling instrument 2000. Similarly, for example, if the controller determines that the tissue being stapled is dense, or is approaching, at, or exceeding a tissue density threshold, the controller may slow the speed of the stapling instrument 2000. Accordingly, for example, if the controller determines that the tissue being stapled is thinner or less dense than normal tissue, the controller may speed up the stapling instrument 2000. In addition to the above, referring to fig. 19, speed control 2150 of stapling instrument 2000 includes an option for a user to select between an automatic speed control 2158 in which stapling instrument 2000 controls the speed of stapling instrument 2000 and a manual speed control 2159 in which the user controls the speed of stapling instrument 2000.

Referring to fig. 20, the suturing apparatus 2200 includes a display 2230. The stapling instrument 2200 is similar in many respects to stapling instrument 2000 and the display 2230 is similar in many respects to display 2130, most of which will not be discussed herein for brevity. Display 2230 includes menu 2231 and center image window 2235. The central image window 2235 displays an image of the patient tissue T being stapled and the staple firing path 2243 along which the stapling instrument 2200 is moving. The staple firing path 2243 is shown as a series of actuations or staple firings 2244. The actuation 2244 of each projection shows the path the tissue T will be incised and the location of the staple cluster 2245 to deploy into the tissue T relative to the tissue incision. The projected actuation 2244 closest to the distal head of the stapling instrument 2200 is highlighted relative to other projected actuations 2244 so that a user can distinguish between an upcoming staple firing and a subsequent projected staple firing. Such highlighting may include, for example, a different color and/or color brightness of the projected actuation 2244. In at least one instance, the intensity of the display actuation 2244 of the staple firing path 2243 may gradually decrease as it moves away from the distal head of the stapling instrument 2200.

In addition to the above, the display 2230 is configured to display one or more alternative staple firing paths. For example, the display 2230 is configured to display an alternative staple firing path 2243' in the center image window 2235. Similar to the staple firing path 2243, the staple firing path 2243 'is shown as a series of actuations or staple firings 2244'. The actuation 2244' of each projection shows the path that the tissue T is to be cut and the location in which the staple cluster 2245 is to be deployed in the tissue T. Menu 2231 includes a staple line control 2240 that is actuatable by a user of stapling instrument 2200 to edit staple firing path 2243 to form an alternate staple firing path 2243'. Once the alternative staple firing path 2243 'has been established, the alternative staple firing path may be preserved and the stapling instrument 2200 may be operated to follow the alternative staple firing path 2243'. As shown in fig. 20, the staple line control 2240 includes an actuatable editing sub-control 2241 and an actuatable save sub-control 2242 for modifying and saving the staple firing path as described above.

As described above, the staple firing path 2243 can be modified to an alternative staple firing path 2243'. The staple firing path 2243 and the alternative staple firing path 2243' are displayed in an image that overlays the video image from the camera. The staple firing path 2243 and the alternative staple firing path 2243' are shown in the same image stack or layer, but may be shown in different image stacks or layers. In at least one such instance, the staple firing path 2243 is displayed in a first image stack or layer and the alternative staple firing path 2243 is displayed in a second image stack or layer that is different from the first image stack. The screen of the display 2230 is configured to receive input commands from the central image window 2235 that can drag the staple firing path 2243 and/or the alternative staple firing path 2243' within one or more image stacks. The screen of the display 2230 is configured to be responsive to the user's finger such that the staple firing path can be modified by the user dragging his finger. Referring to fig. 21, the screen of the display 2230 is further configured to be responsive to, for example, a stylus 2220.

As described above, the display 2230 can be configured to display a current or anticipated staple firing path and one or more alternative staple firing paths. The controller of the stapling apparatus 2200 is configured to generate one or more alternative staple firing paths and display these alternative staple firing paths on a display 2230. In various circumstances, the controller can determine an alternative staple firing path based on one or more properties of the tissue T being stapled. For example, a controller can identify blood vessels within the tissue T and provide or propose alternative staple firing paths that manipulate the stapling instrument 2200 about those blood vessels.

Referring to fig. 22, the display 2230 includes a menu including a plurality of controls configured to modify the staple firing path when the stapling instrument 2200 deploys the staple path and/or after the stapling instrument 2200 has stopped. The display 2230 includes a menu 2231 that includes a plurality of actuatable controls configured to be used when the stapling instrument 2200 performs a series of staple firing strokes thereof to form staple paths. For example, menu 2231 includes view control 2232 to change the video image displayed in center image window 2235. In at least one such case, the video control can be used to toggle between different video feeds. Menu 2231 also includes a staple line control 2240, as described above, configured to modify the staple firing path. The staple firing system of the stapling instrument 2200 can be initiated by a user actuating a stapling control 2234 in a menu 2231 and stopped by a user actuating a stop control 2236 in the menu 2231.

In addition to the above, the shaft assembly attached to the handle of the stapling instrument 2200 may be rotatable relative to the handle. The shaft assembly includes a rotatable slip joint configured to allow the distal head of the shaft assembly to rotate relative to the handle, although any suitable arrangement may be used. Because of this sliding joint, a user of the stapling instrument 2200 can selectively orient the display 2230 relative to the distal head of the stapling instrument 2200. In such cases, the user may, for example, maintain the orientation of the display 2230 relative to the patient even if the distal head is rotating to follow the staple firing path. Similarly, fig. 144-146 illustrate the stapling instrument 1000 inserted into a patient P through a trocar TC, and due to the rotatable interface between the handle display of the stapling instrument 1000 and the shaft assembly, the clinician C can maintain the handle display in a constant orientation relative to the clinician C themselves even though the shaft assembly is rotating to follow the staple firing path FP.

Referring to fig. 147-150, the stapling instrument 7000 includes a handle 7010 comprising a grip 7020 and a shaft assembly 1200 assembled to the handle 7010. The handle 7010 also includes a display 7030 rotatably attached to the handle 7010 about a rotational joint 7035. The display 7030 is similar in many respects to the display 2230, most of which will not be discussed herein for brevity. In use, the display 7030 can be rotated relative to the handle 7010 to maintain the proper orientation of the display 7030 relative to the clinician C and/or any other frame of reference.

Fig. 180 shows a handle 1500 of the surgical instrument 100 for use by a clinician during a surgical procedure. The handle 1500 includes a central portion 110 that abuts one or more ergonomic grips 120 to facilitate manipulation of the surgical instrument 100 by a clinician. Each ergonomic grip 120 is configured to fit the clinician's hand to enhance control and comfort. The handle 1500 includes one or more interactive controls 180 configured to provide navigation commands to an end effector of the surgical instrument 100. In various cases, the one or more interactive controls 180 are configured to be capable of providing user commands corresponding to selection of one or more items. The interactive control 180 is positioned on the handle 1500 in a position that allows the clinician to easily operate, such as a position within reach of the clinician's thumb. In various cases, control 180 is comprised of, for example, various types of switches and/or buttons. In various instances, interactive controls 180 include, for example, toggle switches, analog levers, rockers, cross-keys, and/or any other suitable interactive control capable of facilitating communication of user commands to a controller of surgical instrument 100.

The handle 1500 also includes a touch sensitive display 1510. A portion of the touch sensitive display 1510 displays a menu bar 1512 to the clinician. The options of menu bar 1512 represent various display modes of surgical instrument 100, including, but not limited to, a view mode, a position mode, and/or a staple mode. In various display modes, data and/or images relating to the state of the surgical procedure and/or surgical instrument 100 are displayed. In view mode, touch-sensitive display 1510 displays multiple views of the surgical site, including, for example, side and top views. The side and top views are shown in separate frames 1514, 1516 of the touch-sensitive display 1510, although the side and top views may be displayed in any suitable manner. As described above, the clinician can focus on a particular view by switching the desired view into the enlarged centralized frame 1518 using the interactive control 180. In various embodiments, the clinician may switch between views, for example, by dragging a desired view toward the center frame 1518 using an input device 1530 (such as a clinician's stylus or finger). The input device 1530 is described in more detail below.

To create a sterile environment for surgical instrument 100, a sterile barrier 190 is overlaid over handle 1500, as shown in fig. 181. As will be discussed in more detail below, the sterility barrier 190 is constructed of, for example, a light transmissive elastomeric material, such as plastic. The sterility barrier 190 extends around the handle 1500 and onto a proximal portion of the shaft 200. The sterility barrier 190 includes one or more preformed areas 192 configured to fit over the interactive control 180. The preformed region 192 aids in aligning the sterility barrier 190 on the handle 1500 of the surgical instrument 100. The sterile barrier 190 stretches over the touch sensitive display 1510 to form a smooth, uniform barrier or at least a substantially smooth, uniform barrier. Attachment members 194 (such as clamps) secure, for example, the sterile barrier 190 in place around the perimeter 193 of the touch sensitive display 1510. The sterility barrier 190 fits loosely around the remaining components of the handle 1500, and the sterility barrier 190 tightens around the shaft 200 of the surgical instrument 100, although any suitable arrangement may be used. For example, covering the handle 1500 with the sterile barrier 190 protects the various components of the handle 1500 from exposure to bodily fluids and/or contaminants. The covering of the sterility barrier 190 over the handle 1500 and the proximal portion of the shaft 200 also provides a cost effective and quick means for the handle 1500 of the surgical instrument 100 to be sterilized and reused.

Fig. 182 shows a touch sensitive display assembly 500. Touch sensitive display assembly 500 includes a sterile barrier 190 and a touch sensitive display 1510. In some cases, the touch sensitive display 1510 acts as a projected capacitive sensor. The touch sensitive display 1510 includes an insulating layer 1511 of insulating material mounted on top of the sensing mechanism 1513. In some cases, insulating layer 1511 is mounted to sensing mechanism 1513, for example, by a bonding adhesive such as an optical bonding adhesive. As described above, the sterile barrier 190 stretches over the touch sensitive display 1510 in a uniform or nearly uniform manner. Attachment member 194 (fig. 181) holds sterile barrier 190 in its stretched position in a manner that forms a gap 1520 between sterile barrier 190 and insulating layer 1511. Gap 1520 spans a distance of a few millimeters between insulating layer 1511 and sterile barrier 190, and gap 1520 is configured to prevent formation of contact bubbles when sterile barrier 190 is in contact with insulating layer 1511.

Conductive particles 191 are dispersed throughout sterile barrier 190, providing a specific capacitance to sterile barrier 190. The sensing mechanism 1513 of the touch-sensitive display assembly 500 includes, for example, a plurality of pixels 1515 and a material configured to be able to form electrodes, such as indium tin oxide. In various cases, the electrodes are arranged in an orthogonal grid, as discussed in more detail with reference to fig. 183, although any suitable arrangement may be used. In addition, the sensing mechanism 1513 is configured to be able to detect when the sterile barrier 190 is attached. More specifically, the sensing mechanism 1513 detects the attachment of the sterile barrier 190 by a specific capacitance of the sterile barrier 190. When the clinician wants to utilize the functionality of the touch sensitive display 1510, the input device 1530 as described above is brought into contact with the sterile barrier 190 at the desired point of contact. The sensing mechanism 1513 is configured to detect additional capacitance of the input device 1530 and distinguish the capacitance of the input device 1530 from the capacitance of the sterile barrier 190. Further, when the input device 1530 is brought into contact with the sterile barrier 190, the conductive particles 191 of the sterile barrier 190 are compressed or brought closer together. This compression creates a higher density of conductive particles 191, and thus a higher capacitance, in the area surrounding the contact point of the input device 1530. Due to the change in charge at the contact point in the sensing mechanism 1513, the pixel 1515 of the sensing mechanism 1513 is activated or energized near the contact point.

The touch sensitive display 1510 is configured to function in the same and/or similar manner without the sterility barrier 190. In some cases, the input device 1530 is comprised of a clinician's finger surrounded by latex gloves, for example. Medical latex gloves are typically thin enough so as not to interfere with the conductive qualities of the clinician's fingers. In anticipation of the clinician wearing gloves attenuating the conductive quality of the clinician's finger, the setting of the touch sensitive display 1510 may be altered to increase the sensitivity of the sensing mechanism 1513.

Fig. 183 shows the touch-sensitive display 1510 of fig. 182 when the input device 1530 contacts the sterile barrier 190 of the touch-sensitive display assembly 500. As described above, in each case, the electrodes are arranged in an orthogonal grid, but any suitable arrangement may be used. In such cases, the electrodes include an x electrode 1542 and a y electrode 1544. The touch sensitive display 1510 includes a plurality of pixels 1515 arranged in a uniform or nearly uniform manner across the sensing mechanism 1513, although any suitable arrangement may be used. Fig. 183 also shows various groupings of active pixel clusters 1517 and active pixel clusters 1519. During the inactive state of the touch sensitive display 1510, there is a low level capacitance across all pixels 1515 (fig. 182) in the touch sensitive display. When the input member 1530 (fig. 182) contacts the sterile barrier 190 and activates the touch sensitive display 1510, the pixels 1515 associated with pixel clusters 1517 and 1519 are activated to have a new higher capacitance. As the input device 1530 continues to make contact with the sterile barrier 190, the pixels 1515 in the pixel clusters 1517 and 1519 become activated. The sensing mechanism 1513 detects the position of the active pixel clusters 1517, 1519 by scanning a matrix of x-electrodes 1542 and y-electrodes 1544.

FIG. 184 shows a graphical representation 1550 of the relationship between the location of active pixel clusters within x-electrode 1542 of touch-sensitive display 1510 and the capacitance detected by sensing mechanism 1513. The first capacitance C ₁ indicates a low level or inactive capacitance that was present on the pixel 1515 of the touch-sensitive display 1510 prior to application of the sterile barrier 190. By way of reference, capacitance C ₀ represents a zero capacitance detected, and capacitance C ₁ represents a capacitance greater than zero. The second capacitance C ₂ indicates a threshold capacitance. When threshold capacitance C ₂ is exceeded, surgical instrument 100 recognizes that sterile barrier 190 is attached to touch-sensitive display 1510. In graphical representation 1550, sterile barrier 190 is attached to touch-sensitive display 1510 when the detected capacitance is above threshold capacitance C ₂. The third capacitance C ₃ represents another threshold capacitance. When sensing mechanism 1513 detects a capacitance greater than threshold capacitance C ₃, surgical instrument 100 identifies that input device 1530 is in contact with sterile barrier 190. In graphical representation 1550, input device 1530 is in contact with sterile barrier 190 in two locations when the detected capacitance exceeds threshold capacitance C ₃ twice. When the input device 1530 is removed from the sterile barrier 190, the capacitance detected by the pixels 1515 in the cluster 1517 and the cluster 1519 returns to a capacitance below C ₃ but above or equal to C ₂. When the sterile barrier 190 is removed from the touch sensitive display 1510, the capacitance detected by the pixels 1515 in the cluster 1517 and the cluster 1517 returns to a capacitance below C ₂ but above or equal to C ₁.

Returning to fig. 182, touch sensitive display 1510 is alternatively a resistance sensitive display. In at least one such embodiment, the sterility barrier 190 is constructed of a flexible material to allow the sterility barrier 190 to flex in response to the force F applied by the input device 1530. In such embodiments, the sensing mechanism 1513 of the touch-sensitive display 1510 is configured to be able to detect the position and pressure generated by the force F applied by the input device 1530. The various user commands are associated with a particular location on the touch-sensitive display 1510, and the location of the detected pressure will correspond to one of the various user commands.

Referring to fig. 24, surgical instrument 2400 includes a display 2430. Stapling instrument 2400 is similar in many respects to stapling instrument 2000 and stapling instrument 2200, and display 2430 is similar in many respects to display 2130 and display 2230, most of which will not be discussed herein for brevity. The display 2430 includes a touch screen that includes an image display 2435. Image display 2435 provides an image of patient tissue T to be sutured. A user of the stapling instrument 2400 can use the stylus 2220 to pull one or more potential staple lines, for example, on the tissue T. For example, the user may pull on first staple line 2444 and second staple line 2444'. The controller of the stapling instrument 2400 may then require the user to select one between two different staple lines 2444 and 2444' to follow. Similarly, a user of the stapling instrument 2400 can modify the staple line 2444 into an alternative staple line 2444' using a stylus.

Referring again to fig. 24, the image of the tissue T may be a substantially two-dimensional image of the top of the tissue T. In such cases, the controller is configured to map a two-dimensional staple firing path on the tissue T. Referring to fig. 25, the image of the tissue T may be a three-dimensional image viewed on the surface of the tissue T. In such cases, the controller is configured to map a three-dimensional staple firing path on the tissue T. In either case, the stylus 2220 and/or the patient's finger may be used to establish and/or modify the staple firing path. Referring to fig. 26 and 27, the stapling instrument 2400 further includes a lever 2450 configured to modify the staple firing path 2444 of the stapling instrument 2400. The lever 2450 is mounted to the handle of the stapling instrument 2400 and is rotatable about an axis. As the lever 2450 is rotated to the right or in a clockwise direction, the staple firing path 2444 flexes to the right. Accordingly, as the lever 2450 is rotated left or in a counterclockwise direction, the staple firing path 2444 flexes left. Other arrangements of the joystick are possible.

Referring again to fig. 26 and 27, the lever 2450 can be used to modify the staple firing path of the stapling instrument 2400 when the stapling instrument 2400 is suspended or not firing staples. The clinician may also use the joystick 2450 to maneuver the stapling instrument 2400 in real-time while the stapling instrument 2400 is firing staples. In various instances, at least a portion of the stapling instrument 2400 is visible on the display 2430 to assist a user in manipulating the stapling instrument 2400. For example, the shaft 2410 of the stapling instrument 2400 is visible in the image display 2435. In various instances, a graphical depiction of the suturing apparatus 2400 may be provided in one or more windows of the display 2430. For example, the shaft 2410 and/or distal head 2420 of the stapling instrument 2400 may be shown, for example, in the windows 2133 and 2134.

As described above, referring now to FIG. 23, the suturing apparatus 2100 includes a handle 2110 including a grip 2120 and a display 2130 mounted on the handle 2110. The display 2130 may comprise any suitable configuration, but the size of the display 2130 may be limited due to the space constraints of the handle 2110. In various instances, the stapling instrument 2100 can be part of a surgical system 2300 that comprises an off-board display 2330 in addition to or in place of the on-board display 2130. The controller of the stapling instrument 2100 is in signal communication with a display 2130 and a display 2330. The controller is in wireless communication with the off-board display 2330, but may be in wired communication with the display 2330. In either case, the controller is configured to be able to provide the same information to display 2130 and display 2330. That is, due to the different sizes and/or shapes of the displays 2130 and 2330, the displays 2130 and 2330 may be configured to be able to arrange the information differently. In other cases, one of the display 2130 and the display 2330 may display more information than the other. In at least one such instance, for example, off-board display 2330 may display more information than on-board display 2130 due to its larger size.

In addition to the above, the on-board display 2130 includes a touch screen, but is operable by controls positioned on the handle 2110. Similarly, the off-board display 2330 also includes a touch screen, but may be operated by other controls. Similar to the above, the touch screens of display 2130 and display 2330 can be used to manipulate the staple firing path of stapling instrument 2100. In various circumstances, the clinician may touch these touch screens, for example, using his fingers and drag the staple firing path of the stapling instrument 2100 into a new position. In other cases, a tool such as a stylus, for example, may be used to touch these touch screens and manipulate the staple firing path. Further, both display 2130 and display 2330 are configured to control any other operation of stapling instrument 2100.

When modifying the first stack or layer on one of the displays 2130 and 2330, the controller of the stapling instrument 2100 modifies the first stack on the other display. Similarly, when modifying a second stack or layer on one of the displays 2130 and 2330, the controller of the stapling instrument 2100 modifies the second stack on the other display. In addition, a user of the stapling instrument 2100 may modify one stack or layer on a display without modifying the display or other stacks or layers on either display.

While the staple firing path and/or other images projected in the on-board and off-board displays described above are highly helpful in producing a desired staple firing path, the stapling instrument can comprise one or more projectors configured to display images onto patient tissue, which can assist a user of the stapling instrument in producing a desired staple firing path. Referring to fig. 160 and 161, a stapling instrument 7400 includes a shaft 7410, a distal head 7420, and a projector 7490 mounted to the distal head 7420. In at least one instance, the projector 7490 is clamped to the distal head 7420. Projector 7490 is configured to project image I onto stomach S of patient P. Projector 7490 is sized and configured to be inserted into a patient through trocar TC, but may be inserted into a patient through an open incision. The projector 7490 is positioned proximally relative to the anvil 7460 of the distal head 7420 but distally relative to an articulation joint that rotatably connects the distal head 7420 to the shaft 7410. Thus, the projector 7490, and the projected image thereof, move with the distal head 7420.

Referring to fig. 162, a stapling instrument 7500 includes a shaft 7510, a distal head 7520, and an articulation joint 7570 that rotatably connects the distal head 7520 to the shaft 7510. The stapling instrument 7500 also includes a projector 7590 that extends along an edge of the shaft 7510. Projector 7590 includes a flexible tube mounted to shaft 7510 and distal head 7520 and is configured to bend when distal head 7520 is articulated. Thus, the image I projected by projector 7590 tracks the orientation of distal head 7520 and may be projected distally relative to anvil 7560 of stapling instrument 7500. Projector 7590 includes a lens and is configured to project an image I; however, various alternative embodiments are contemplated in which the projector includes more than one lens and/or more than one image may be projected onto patient tissue.

Referring again to fig. 160, projector 7490 includes a first lens 7492 and a second lens 7494. The first lens 7492 and the second lens 7494 are in signal communication with a controller of the stapling instrument 7400 and are configured to project at least one image onto patient tissue. In some cases, the first lens 7492 and the second lens 7494 project the same image. The first and second lenses 7492, 7494 are fixedly mounted in the projector 7490 such that the first and second lenses project images at a common focal point, but the first and second lenses may project one or more images at different focal points. In various embodiments, the orientation of the first lens 7492 and/or the orientation of the second lens 7494 may be adjusted to alter the focus. In at least one such embodiment, the projector 7490 includes a first motorized actuator system for changing the orientation of the first lens 7492 and a second motorized actuator system for changing the orientation of the second lens 7494.

In some cases, in addition to the above, the first lens 7492 of the projector 7490 may be configured to project a first image onto patient tissue and the second lens 7494 may be configured to project a second image or a different image onto patient tissue. The controller of the stapling instrument 7400 can be configured to supply, change, and/or modify images projected by the first lens 7492 and/or the second lens 7494. In various cases, the images projected by the first and second lenses 7492, 7494 may provide a two-dimensional image on patient tissue. In other cases, the images projected by the first and second lenses 7492, 7494 may provide a three-dimensional image on patient tissue. By orienting or enabling the lens 7492 and the lens 7494 in different directions, projection of a three-dimensional image may be facilitated.

Referring to fig. 165, the stapling instrument 7700 includes a distal head 7720 positioned on a first side of patient tissue T and an anvil 7760 positioned on a second side of patient tissue T. Similar to other stapling instruments disclosed herein, the stapling instrument 7700 is configured to deploy staples 7730 into tissue T and cut into tissue T along an incision 7740 during a series of staple firing strokes. The stapling instrument 7700 further comprises a projector 7770 configured to project an image I onto the tissue T. Image I in fig. 165 represents the location of the next firing stroke, which includes two lateral regions where clusters of staples will be applied. Referring to fig. 166, the image projected by projector 7770 includes lines that designate a staple firing path FP and/or lines that designate an alternative staple firing path FP'. These lines may be, for example, solid lines and/or dashed lines. The lines may be the same color or different colors.

In addition to the above, the controller of the stapling apparatus 7700 is configured to modify images projected by the projector 7770 as the stapling apparatus 7700 moves or advances along a staple firing path. The controller may continuously evaluate and determine where the next firing stroke should occur and also continuously adjust the image projected by the stapling instrument 7700. In various circumstances, the controller may update the projected image after each firing stroke, for example. In some cases, the controller may use projector 7770 to continuously project an image or series of images, while in other cases, the controller may use projector 7770 to intermittently project an image or series of images. In at least one instance, the controller can use the projector 7770 to display an image before the stapling instrument 7700 grasps tissue. In such cases, the user of the stapling instrument 7700 has the opportunity to pause or stop the stapling instrument 7700 before it takes another staple firing stroke.

Referring to fig. 167, a stapling instrument 7800 includes a distal head 7820 positioned on a first side of patient tissue T and an anvil 7860 positioned on a second side of patient tissue T. Similar to other stapling instruments disclosed herein, stapling instrument 7800 is configured to deploy staples 7830 into tissue T and cut into tissue T along incision 7840 during a series of staple firing strokes. Suture instrument 7800 also includes a projector 7870 that includes a first lens 7872 and a second lens 7874. The first lens 7872 is configured to project the first image I ₁ onto the patient tissue T and the second lens 7874 is configured to project the second image I ₂ onto the patient tissue T. Image I ₁ shows the position of the next staple cluster and image I ₂ shows the cutting path of stapling instrument 7800, but any suitable image may be projected. Images I ₁ and I ₂ may be, for example, solid and/or dashed lines. Image I ₁ may be the same color as image I ₂ or a different color.

As described above, the suturing apparatus disclosed herein may include at least one projector for projecting an image onto patient tissue and at least one camera for viewing the patient tissue. Referring to fig. 163 and 164, a suturing apparatus 7600 includes a shaft, a distal head, and a video system. The video system includes at least one image projector 7690 and a camera system 7670 including, for example, at least one camera in communication with a controller, such as a first camera 7672 and a second camera 7674. The first camera 7672 is directed in a first direction and focused on a first region F1 of patient tissue and the second camera 7674 is directed in a second direction and focused on a second or different region F2 of patient tissue. In various cases, the controller is configured to present two images on the surgical instrument display simultaneously or at different times such that the user can toggle between the images. In some cases, the controller is configured to generate a composite image using the images from the first camera 7672 and the second camera 7674 and present the composite image on the surgical instrument display.

In addition to the above, the first camera 7672 includes a digital camera configured to provide a first digital video stream to the controller, and the second camera 7674 includes a digital camera configured to provide a second digital video stream. The camera system 7670 also includes a first actuator system configured to enable movement of the first camera 7672 and/or a second actuator system configured to enable movement of the second camera 7674. In other embodiments, one or more of the orientations of camera 7672 and camera 7674 are fixed. In any event, the image I projected by the projector 7690 onto the patient tissue can be captured by the first camera 7672 and/or the second camera 7674 and can be viewed by a user of the surgical instrument 7600 through the surgical instrument display.

In addition to the above, projector 7690 and/or any of the projectors disclosed herein are configured to emit light of any suitable wavelength. In various cases, projector 7690 emits, for example, visible light, infrared light, and/or ultraviolet light. In addition, visible light is useful for a clinician to view the color of tissue as it reflects off of tissue. Red or pink tissue indicates healthy vascularized tissue, while dark or black tissue may indicate unhealthy tissue. Also in addition to the above, the camera system 7670 is configured to be capable of capturing, for example, visible light, infrared light, and/or ultraviolet light. Infrared light indicates, for example, the presence of heat, such as heat from large blood vessels. Ultraviolet light indicates, for example, the presence of blood or bleeding. In addition to or in lieu of the above, the projector may be configured to emit sound, infrasonic and/or ultrasonic waves, and the surgical instrument may include one or more acoustic sensors configured to detect waves reflected off of the patient tissue and generate data that may be used by the controller to generate a three-dimensional profile of the patient tissue.

Referring to fig. 142, the stapling instrument described herein is configured to repeatedly fire staples into tissue of a patient, such as the patient' S stomach S. Many of the stapling instruments disclosed herein are self-driven, self-propelled, and/or self-steering in that they are sufficiently motorized that they can follow and propel themselves along an intended or modified staple firing path FP as staples, such as staples 6630, are fired into, for example, patient tissue. As the stapling instrument moves along the staple firing path FP, staples are continuously ejected from the stapling instrument. In various circumstances, the staple firing system of the stapling instrument enters a dwell state between staple firing strokes as the stapling instrument is moved along the staple firing path. However, such dwell is part of the continued operation of the stapling instrument. As described above, referring to FIG. 143, many of the stapling instruments described herein are configured to deploy staple clusters, such as staple cluster 6630', for example, during each staple firing stroke. Such staple clusters may include any suitable number of staples, but each of the staple clusters 6630' shown in fig. 143 includes three staples 6630 and is deployed on both sides of the tissue incision 6640. In at least one exemplary embodiment, seven staple clusters 6630' are deployed on each side of the tissue cutout 6640 for each inch of the staple firing path. In such embodiments, 42 staples per inch are deployed, but any suitable number may be used. As long as staples are present in the stapling instrument, the stapling instrument can continue to deploy staples along the staple firing path without removing the stapling instrument from the patient. In at least one instance, the stapling instrument can be used for 84 firings to 98 firings, for example, before having to be reloaded. Such firing may deploy, for example, 504 to 588 staples.

In addition to the above, many of the stapling instruments disclosed herein can be rotated at least partially between staple firings. Thus, such stapling instruments can follow complex and/or nonlinear staple firing paths. Referring to fig. 174, previous stapling instruments are configured to deploy a linear staple line portion 8230', e.g., made up of staples 8230. In order to rotate the staple line within the tissue, an overlap region 8235 'is formed in the staple line portion 8230'. This arrangement creates a high density of staples 8230 in the overlap region 8235 'thereby highly compressing the tissue in the overlap region 8235'. Further, the overlap region 8235' represents a sharp turn in the staple firing path, which may create a potential leakage path in the staple line. Referring to fig. 175, the stapling instruments disclosed herein can be rotated much more gently because they can be rotated after each firing stroke. For example, the stapling instrument can be rotated after each staple cluster 7930 'is deployed, and can do so without creating overlap between the staple clusters 7930'.

The stapling instruments disclosed herein may be used to perform any suitable surgical procedure. For example, referring to fig. 179, the suturing apparatus disclosed herein may be used to create a gastric pouch SP during gastric bypass surgery and thus effectively reduce the size of a patient' S stomach S. Since these stapling instruments can form a curved staple path 7930', the curved staple path forms a curved gastric pouch SP. Referring to fig. 178, the previous stapling instrument will create a staple path that includes linear portions 8230' that form a square gastric pouch SP or a gastric pouch SP with right angle corners. It is believed that the extent of leakage of the curved gastric pouch SP produced by the suturing apparatus disclosed herein will be less than the extent of leakage of the linear gastric pouch SP produced by previous suturing apparatuses.

As described in greater detail herein, referring to fig. 177, the suturing apparatus disclosed herein may be used to create a gastric sleeve SS during a gastric volume reduction procedure and thus effectively reduce the size of a patient' S stomach S. Because of the system of suturing apparatuses disclosed herein, these suturing apparatuses may form a curved staple path 7930', which curved staple path 7930' forms a curved gastric sleeve SS. Referring to fig. 176, the previous suturing apparatus will create a staple path that includes linear portions 8230 'that form a linear gastric sleeve SS or a gastric sleeve SS with a right angle corner 8235'. It is believed that the degree of leakage of the curved gastric sleeve SS produced by the suturing apparatus disclosed herein is less than the degree of leakage of the linear gastric sleeve SS produced by the prior suturing apparatus. Additional details for forming the gastric sleeve SS are shown in fig. 151, wherein the staple firing path FP is used to sever the gastric sleeve SS from the patient' S stomach S.

In addition to the above, gastric bypass surgery and gastric sleeve surgery help reduce weight and are used to treat severe obesity. Both procedures are used to greatly reduce the size of the stomach in order to limit food intake. Gastric bypass surgery involves forming a small section within the stomach for receiving food and occluding the rest of the stomach. In addition, limiting the size of the stomach serves to limit the amount of fat and calories absorbed into the patient. Gastric bypass surgery creates a direct path from the small gastric segment to the lower intestine. Thus, in such cases, the direct route eliminates the use of the upper intestine during digestion.

Gastric sleeve surgery involves forming a sleeve-like path from the esophagus through the stomach and to the upper intestine. Laparoscopic Sleeve Gastrectomy (LSG) is a type of gastric sleeve procedure that involves transecting and sealing a substantial portion of the stomach to form a small gastric reservoir or pouch. Unlike gastric bypass surgery, it has been found that LSG surgery does not cause reduced absorption of nutrients and/or does not eliminate use of any portion of the intestine. However, LSG surgery still serves to significantly reduce the size of the patient's stomach. In such LSG procedures, a long and thin flexible member, i.e., a bougie, may be used as a measurement tool. More specifically, a bougie may be used to determine or define the size and shape of the stomach that becomes a gastric sleeve upon completion of an LSG procedure. Bougie B is shown in fig. 30 and 32. Bougies are manufactured in a variety of sizes to accommodate different stomach sizes. The appropriate size of the bougie is typically determined based on the stomach size and the expected stomach sleeve size. During the initial step of an LSG procedure, the surgeon inserts a bougie through the patient's mouth, down the esophagus, and through the esophageal sphincter to ultimately reach the patient's stomach. Once the bougie reaches the patient's stomach, the bougie is placed such that the end of the bougie reaches the pyloric canal, which is the lower region of the stomach that is connected to the pylorus.

Fig. 28 illustrates various portions of the stomach anatomy involved during various steps of an LSG procedure. Specifically, fig. 28 shows the stomach prior to insertion of bougie B into stomach S during an LSG procedure. As shown in fig. 28, the omentum O, which is a double layer of adipose tissue, is attached to the outer layer of the stomach S. The omentum O comprises two parts, a large omentum and a small omentum. The large omentum is used to store fat deposits, and the small omentum connects the stomach S and intestines to the liver. The stomach S includes a plurality of regions based on shadows of tissue thickness of the stomach S. The tissue thickness of the stomach S forms a first shade S _1a and a second shade S _1a. The size and position of shadows S _1a and S _1b vary depending on the thickness of stomach S. As further shown in fig. 28, a first shade S _1a occurs along the greater curvature GC of the stomach S and a second shade S _1b occurs along the lesser curvature LC of the stomach S. As discussed in more detail below, shadows S _1a and S _1b are used to determine or estimate the thickness of stomach S along the greater bend GC and lesser bend LC, respectively. Once the thickness of the stomach S is determined or estimated, the thickness is used to determine the appropriate size and location of the bougie B relative to the calculated shadow line S _L as shown in fig. 28.

Fig. 33 illustrates another view of a gastric anatomy in accordance with various embodiments. Similar to the gastric anatomy shown in fig. 28, the tissue thickness of the stomach S forms a first shade S ₁ and a second shade S ₂. Similar to that discussed above, the first shadow S ₁ appears along the major bend GC and the second shadow S ₂ appears along the minor bend LC. The first shadow S ₁ and the second shadow S ₂ intersect at a point S ₃. During a gastric sleeve procedure, the position of pylorus P _x and point S ₃ are used to determine the position of cut line C ¹ that is offset from pylorus P _x by a distance A. As shown in fig. 33 and described in more detail below, the sleeve diameter D is determined based on the estimated tissue thickness.

Fig. 152 shows various portions of the stomach involved in various steps of an LSG procedure. Specifically, graph 152 shows an early step of an LSG procedure in which a bougie B is inserted into the stomach S. At the beginning of an LSG procedure, the surgeon inserts a bougie through the patient's mouth, down to the esophagus E, and through the esophageal sphincter to ultimately reach the patient's stomach. Once bougie B reaches the patient's stomach, bougie B is positioned such that the end of bougie B stays in pyloric canal PC and stops at pyloric sphincter PS. As also shown in fig. 152, bougie B is configured to be positioned along the shape and length of stomach S and along the angular notch AN of the lesser curvature LC. As will be described in greater detail below with reference to fig. 153, a bougie 7210 may be used that includes magnetic properties configured to interact with a suturing apparatus 7100 and guide the suturing apparatus along a predetermined path along an edge of the bougie 7210.

Referring again to fig. 152, once the bougie is placed in its final position, the distance D ¹ is measured along the pyloric antrum PA of the large bend GC. Distance D ¹ is used to determine the position of pylorus P _x and to determine the position of cut line C ¹. The bougie 7210 shown in fig. 153 forms one or more magnetic fields for guiding the suturing apparatus 7100 to the bougie 7210. Then, referring to FIG. 154, the stapling instrument 7100 follows the magnetic field along a path adjacent to the bougie 7210 to form a cut line C ¹. Thus, cut line C ¹ extends upwardly through the patient' S stomach S along the shape and curvature of both the stomach S and the bougie 7210. Then, cut line C1 continues to pass upwardly through the patient' S stomach S along a path adjacent to bougie 7210 until the angle of His AH is reached. When cut line C ¹ is established, the stapling instrument 7100 applies staples (such as staples 7130) to tissue along both sides of cut line C ¹. The remainder of the stomach S, which is still in communication with the esophagus, is substantially the size and shape of the bougie 7210. A substantial portion of the stomach S, beginning at the pyloric antrum PA and ending at the His angle AH, is eliminated from participating in the digestive process. The eliminated portion of the stomach S is shown in more detail in fig. 154 and includes a greater curvature GC of the stomach S.

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

As described above, the curvature of the stomach may be used to determine the staple firing path. However, in various cases, the small curve is at least partially obscured by fat and/or connective tissue. That is, the small curve, small omentum, and any overlap between the small curve and small omentum, for example, may be visually distinguished. More specifically, the uncovered stomach tissue has a first color, the small omentum has a second color that is different from the first color, and the overlap between the uncovered stomach and the small omentum has a third color that is different from the first and second colors. These colors can be detected by the stapling instrument to determine the proper staple firing path. In some cases, the color of the stomach tissue below the omentum is creating shadows that can be detected by the suturing apparatus. Other methods may be used to determine the proper location of the staple firing path.

In addition to the above, the gastric sleeve SS formed during gastric bypass surgery must have a sufficiently large digestive pathway defined therein for food to pass therethrough. Thus, referring now to fig. 29, the staple firing path through the patient' S stomach S must be sufficiently spaced from the lesser curvature of the stomach to form a sufficient digestive tract D. The stapling instruments disclosed herein can be configured to detect a small curve of the stomach and calculate a staple firing path, such as staple firing path SP ₁, which is, for example, a distance X from the edge of the stomach S. In other cases, the stapling instruments disclosed herein can be configured to detect the small omentum LO abutting the lesser curvature of the stomach and calculate the staple firing path SP ₁ to be a preset or predetermined distance X, for example, from the edge of the stomach S.

As described above, detecting the margin of the stomach S may be difficult. In some cases, the stapling instruments disclosed herein can include a camera system configured to be able to observe the color of stomach tissue and/or changes in stomach tissue color in order to determine the edge of the stomach S. In various instances, the stapling instruments disclosed herein can be configured to detect the edge of the stomach by assessing the thickness of the stomach tissue and/or changes in the thickness of the stomach tissue. The tissue of a patient's stomach is typically thinner around the periphery or rim of the stomach than in the middle of the stomach, and it has been observed that the color of stomach tissue is typically dependent on its thickness. In other words, the tissue surrounding the stomach perimeter appears to have a shadow or darker color due to its thinner thickness. In fig. 29, the hatched area S ₁ is defined by the distance Z ₁. Distance Z ₁ also defines the transition from the thinner tissue of stomach S to the entire tissue thickness region T ₁. In various circumstances, the surgical instruments disclosed herein can be configured to determine the staple firing path SP ₁, for example, by establishing the staple firing path SP ₁ a distance from the shaded region S ₁. In at least one instance, the surgical instrument can establish a staple firing path SP ₁ that is, for example, a distance from a midpoint between the small omentum LO and the edges of the shadow region S ₁.

In addition to the above, the controller of the stapling instrument disclosed herein can include an edge detection algorithm. The edge detection algorithm is configured to sense a first light intensity at a first location and a second light intensity at a second location on the stomach tissue. The edge detection algorithm is further configured to calculate a first light intensity value of the first light intensity and a second light intensity value of the second light intensity, and then compare the first light intensity value with the second light intensity value. For example, the light intensity value may be in a range between 1 and 100, with lower values representing darker tissue and higher values representing lighter tissue. The first location and the second location establish a sample line along which additional samples can be taken to establish an intensity gradient. To this end, the edge detection algorithm is further configured to sense a third light intensity at a third location along the sample line, determine a third light intensity value at the third location, and compare the third light intensity value to the first light intensity value and the second light intensity value. The first location, the second location, and the third location are sequentially positioned along the sample line, and if the algorithm determines that the first light intensity value is greater than the second light intensity value and the second light intensity value is greater than the third light intensity value, then the algorithm may, for example, determine that a shadow gradient exists between the first location and the third location, and the third location is closer to an edge of the stomach tissue than the first location. The method can be applied very largely to map the shade gradient and/or the color gradient of the whole stomach tissue or at least a part of the stomach tissue.

As described above, the thickness of the stomach tissue may affect the color or shade of the stomach tissue. Thus, a stomach with thicker tissue (FIG. 29) will typically have a different color and/or shade than a stomach with thinner tissue (FIG. 31). The thinner tissue in fig. 31 has a shaded region S ₂ defined by a distance Z ₂. Distance Z ₂ also defines the transition from the thinner tissue of stomach S ₂ to the entire tissue thickness region T ₂. In various circumstances, the surgical instruments disclosed herein can be configured to determine the staple firing path SP ₂, for example, by establishing the staple firing path SP ₂ a distance from the shaded region S ₂. In at least one instance, the surgical instrument can establish a staple firing path SP ₂ that is, for example, a distance from a midpoint between the small omentum LO ₂ and the edges of the shadow region S ₂.

The staple firing path SP ₁ establishes a first sleeve profile and the staple firing path SP ₂ establishes a second sleeve profile that is different than the first sleeve profile. The first sleeve profile includes a first width X and the second sleeve profile includes a second width Y different from the width X. Regardless of the sleeve profile generated by the stapling instruments disclosed herein, the tissue drive system of the stapling instrument is configured to advance the stapling instrument along the staple firing path, which forms the desired gastric sleeve. Such suturing apparatuses may be configured to identify anatomical landmarks and orient themselves toward, away from, and/or parallel to one or more anatomical landmarks.

In addition to the above, referring to fig. 153, the stapling instrument 7100 includes a shaft 7110, a distal head 7120, and an articulation joint 7170 that rotatably connects the distal head 7120 to the shaft 7110. The stapling instrument 7100 cuts into the patient's stomach along path C1 and applies three staple rows 7130 on each side of path C1. As described above, the bougie 7210 is configured to guide the stapling instrument 7100 along a staple firing path. More specifically, the bougie 7210 is configured to emit one or more magnetic fields that are detectable by the stapling instrument 7100, which are then used by the stapling instrument 7100 to determine staple firing paths. In at least one instance, the bougie 7210 emits a strong magnetic field SMF and a weak magnetic field WMF that, when emitted, emit along the length of the bougie 7210. Notably, the weak magnetic field WMF is positioned in an alternating manner in the middle of the strong magnetic field SMF.

Referring to fig. 154, the stapling instrument 7100 includes, for example, one or more sensors, such as hall effect sensors, configured to detect high magnetic fields SMF and low magnetic fields WMF. The sensor communicates with a controller of the stapling instrument 7100, which can use data from the sensor to detect the placement of the strong magnetic field SMF and the weak magnetic field WMF, and to align the staple firing path with the fields SMF and WMF such that the stapling instrument 7100 follows the bougie 7210 to form a desired gastric sleeve profile. In at least one case, for example, the strength of the strong magnetic field SMF is twice the strength of the weak magnetic field WMF. In other cases, for example, the strength of the strong magnetic field SMF is 50% stronger than the strength of the weak magnetic field WMF.

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

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

As described above, the bougie 7210 utilizes electrical power to generate a magnetic field. In various alternative embodiments, the bougie may comprise a permanent magnet that generates a magnetic field. In at least one instance, the bougie includes a strong permanent magnet that generates a strong magnetic field and a weak permanent magnet that generates a weak magnetic field. In at least one such case, the strong permanent magnets and the weak permanent magnets are arranged in an alternating manner to produce alternating strong magnetic fields SMF and weak magnetic fields WMF, such as shown in fig. 154. That is, the bougie may generate one or more magnetic fields in any suitable manner.

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

The surgical instrument systems described herein are actuated by an electric motor; the surgical instrument systems described herein may be actuated in any suitable manner. In some cases, the motors disclosed herein may include a portion or portions of a robotic control system. For example, U.S. patent application Ser. No. 13/118,241 (now U.S. patent 9,072,535), entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS," discloses several examples of robotic surgical instrument systems in greater detail.

The surgical instrument systems described herein have been described in connection with the deployment and modification of staples; however, the embodiments described herein are not limited thereto. For example, various embodiments are contemplated for deploying fasteners other than staples, such as clips or tacks. Further, various embodiments utilizing any suitable means for sealing tissue are also contemplated. For example, end effectors according to various embodiments may include electrodes configured to heat and seal tissue. Additionally, for example, end effectors in accordance with certain embodiments may apply vibrational energy to seal tissue.

Examples

Example 1-a surgical stapler comprising a shaft, a distal head extending from the shaft, a cartridge channel comprising an external opening, and a plurality of staple cartridges stored in the cartridge channel, wherein the staple cartridges are configured to be inserted into the cartridge channel through the external opening.

Embodiment 2-the surgical stapler of embodiment 1, wherein the shaft comprises an outer housing, and wherein the outer opening is defined in the outer housing.

Embodiment 3-the surgical stapler of embodiment 1 or 2, further comprising a handle, wherein the shaft extends from the handle, and wherein the external opening is defined in the handle.

Embodiment 4-the surgical stapler of embodiments 1, 2, or 3, further comprising a door configured to selectively cover the outer opening.

Embodiment 5-the surgical stapler of embodiment 4, wherein the door is configured to seal the external opening.

Embodiment 6-the surgical stapler of embodiment 1,2, 3, 4, or 5, wherein the cartridge channel extends within the shaft and the distal head.

Embodiment 7-the surgical stapler of embodiment 1,2, 3, 4, 5, or 6, further comprising an articulation joint rotatably connecting the distal head to the shaft, wherein the cartridge channel extends through the articulation joint into the distal head.

Embodiment 8-the surgical stapler of embodiment 1,2, 3, 4, 5, 6, or 7, wherein the plurality of staple cartridges comprises a first staple cartridge comprising staples having a first size and a second staple cartridge comprising staples having a second size, wherein the first size and the second size are different.

Embodiment 9-the surgical stapler of embodiment 8, wherein the plurality of staple cartridges includes a third staple cartridge comprising staples having a third size, and wherein the third size is different from the first size and the second size.

Embodiment 10-the surgical stapler of embodiments 8 or 9, wherein the plurality of staple cartridges includes another first staple cartridge.

Example 11-the surgical stapler of examples 8, 9, or 10, wherein the first size is greater than the second size, and wherein the first staple cartridge is loaded into the cartridge channel before the second staple cartridge such that the first staple cartridge is deployed before the second staple cartridge.

Example 12-the surgical stapler of examples 8, 9, or 10, wherein the first size is greater than the second size, and wherein the second staple cartridge is loaded into the cartridge channel before the first staple cartridge such that the second staple cartridge is deployed before the first staple cartridge.

Embodiment 13-the surgical stapler of embodiment 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12, wherein the plurality of staple cartridges comprises a first staple cartridge comprising staples having a first unfired height and a second staple cartridge comprising staples having a second unfired height, wherein the first unfired height and the second unfired height are different.

Embodiment 14-the surgical stapler of embodiment 13, wherein the plurality of staple cartridges includes a third staple cartridge comprising staples having a third unfired height, and wherein the third unfired height is different from the first unfired height and the second unfired height.

Embodiment 15-the surgical stapler of embodiment 13 or 14, wherein the plurality of staple cartridges includes another first staple cartridge.

Embodiment 16-the surgical stapler of embodiment 13, 14, or 15, wherein the first unfired height is greater than the second unfired height, and wherein the first staple cartridge is loaded into the cartridge channel before the second staple cartridge such that the first staple cartridge is deployed before the second staple cartridge.

Embodiment 17-the surgical stapler of embodiment 13, 14, or 15, wherein the first unfired height is greater than the second unfired height, and wherein the second staple cartridge is loaded into the cartridge channel prior to the first staple cartridge such that the second staple cartridge is deployed prior to the first staple cartridge.

Embodiment 18-the surgical stapler of embodiments 1,2, 3,4, 5,6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, or 17, wherein the plurality of staple cartridges comprises a first staple cartridge comprising staples having a first unfired width and a second staple cartridge comprising staples having a second unfired width, wherein the first unfired width and the second unfired width are different.

Example 19-a surgical fastening instrument comprising a shaft, a distal head extending from the shaft, a cartridge channel comprising an external opening, and a plurality of fastener cartridges configured to be inserted into the cartridge channel through the external opening. The plurality of fastener cartridges includes a first fastener cartridge including fasteners having a first unfired height and a second fastener cartridge including fasteners having a second unfired height, wherein the first unfired height and the second unfired height are different.

Example 20-a surgical fastening instrument comprising a shaft, a distal head extending from the shaft, a cartridge channel comprising an external opening, and a plurality of fastener cartridges stored within the cartridge channel. The plurality of fastener bins includes a first fastener bin including fasteners having a first unformed height and a second fastener bin including fasteners having a second unformed height, wherein the first unformed height and the second unformed height are different.

The entire disclosures of the following patents are hereby incorporated by reference:

U.S. patent 5,403,312 entitled "ELECTROSURGICAL HEMOSTATIC DEVICE" issued 4/1995;

U.S. patent 7,000,818 entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS" published on month 21 of 2006;

U.S. patent 7,422,139 entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK" published 9/2008;

U.S. patent 7,464,849 entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS" issued on 12/16/2008;

-us patent 7,670,334 entitled "SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR" published 3/2/2010;

U.S. patent 7,753,245 entitled "SURGICAL STAPLING INSTRUMENTS" issued on month 7 of 2010;

U.S. patent 8,393,514 entitled "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE" published on 3.3.12 days 2013;

U.S. patent application Ser. No. 11/343,803, now U.S. patent 7,845,537, entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES";

U.S. patent application Ser. No. 12/031,573, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES," filed on 1,2, 14, 2008;

U.S. patent application Ser. No. 12/031,873, entitled "END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT," filed on 2 months 15 of 2008 (now U.S. patent 7,980,443);

U.S. patent application Ser. No. 12/235,782, now U.S. Pat. No. 8,210,411, entitled "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT";

U.S. patent application Ser. No. 12/249,117, now U.S. patent 8,608,045, entitled "POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM";

U.S. patent application Ser. No. 12/647,100, entitled "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY," filed 12 months 24 in 2009, now U.S. patent 8,220,688;

U.S. patent application Ser. No. 12/893,461, now U.S. patent 8,733,613, filed on 9/month 29 of 2012, entitled "STAPLE CARTRIDGE";

U.S. patent application Ser. No. 13/036,647, now U.S. Pat. No. 8,561,870, entitled "SURGICAL STAPLING INSTRUMENT", filed on 28/2/2011;

U.S. patent application Ser. No. 13/118,241, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS," now U.S. patent 9,072,535;

U.S. patent application Ser. No. 13/524,049, now U.S. patent 9,101,358, filed 6/15/2012 entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE";

U.S. patent application Ser. No. 13/800,025, now U.S. patent 9,345,481, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," filed on day 13, 3, 2013;

U.S. patent application Ser. No. 13/800,067, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," filed on day 13 of 3, 2013, now U.S. patent application publication 2014/0263552;

U.S. patent application publication 2007/0175955 entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM" filed on 1 month 31 2006; and

U.S. patent application publication 2010/0264194, now U.S. patent 8,308,040, filed on 4/22/2010, entitled "SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR".

While various devices have been described herein in connection with certain embodiments, many modifications and variations to these embodiments may be implemented. The particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, a particular feature, structure, or characteristic shown or described in connection with one embodiment may be combined, in whole or in part, with features, structures, or characteristics of one or more other embodiments without limitation. In addition, where materials for certain components are disclosed, other materials may be used. Furthermore, according to various embodiments, a single component may be replaced with multiple components, and multiple components may also be replaced with a single component, to perform a given function or functions. The above detailed description and the following claims are intended to cover all such modifications and variations.

The devices disclosed herein may be designed to be disposed of after a single use, or they may be designed for multiple uses. In either case, however, the device may be reconditioned for reuse after at least one use. Dressing may include any combination of steps including, but not limited to, disassembly of the device, subsequent cleaning or replacement of specific components of the device, and subsequent reassembly of the device. In particular, the finishing facility and/or surgical team may disassemble the device, and after cleaning and/or replacing certain components of the device, the device may be reassembled for subsequent use. Those skilled in the art will appreciate that the finishing assembly may be disassembled, cleaned/replaced, and reassembled using a variety of techniques. The use of such techniques and the resulting finishing assembly are within the scope of the application.

The devices disclosed herein may be treated prior to surgery. First, new or used instruments are available and cleaned as needed. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container (such as a plastic or TYVEK bag). The container and instrument may then be placed in a radiation field, such as gamma radiation, X-rays, and/or energetic electrons, that may penetrate the container. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container. The sealed container may keep the instrument sterile until the container is opened in the medical facility. The device may also be sterilized using any other technique known in the art including, but not limited to, beta radiation, gamma radiation, ethylene oxide, plasma peroxide, and/or steam.

While this application has been described as having an exemplary design, the present application may be further modified within the spirit and scope of this disclosure. Thus, the present application is intended to cover any variations, uses, or adaptations of the application using its general principles.

Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. Accordingly, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Claims

1. A surgical stapler, comprising:

A shaft;

A distal head extending from the shaft;

A cartridge channel, the cartridge channel comprising an external opening; and

A plurality of staple cartridges stored in the cartridge channel, wherein the staple cartridges are configured to be insertable into the cartridge channel through the external opening;

An articulation joint rotatably connecting the distal head to the shaft, wherein the cartridge channel extends through the articulation joint into the distal head.

2. The surgical stapler of claim 1, wherein the shaft comprises an outer housing, and wherein the outer opening is defined in the outer housing.

3. The surgical stapler of claim 1, further comprising a handle, wherein said shaft extends from said handle, and wherein said external opening is defined in said handle.

4. The surgical stapler of claim 1, further comprising a door configured to selectively cover said external opening.

5. The surgical stapler of claim 4, wherein the door is configured to seal the external opening.

6. The surgical stapler of claim 1, wherein the cartridge channel extends within the shaft and the distal head.

7. The surgical stapler of claim 1, wherein the plurality of staple cartridges comprises:

a first staple cartridge comprising staples having a first size; and

A second staple cartridge comprising staples having a second size, wherein the first size and the second size are different.

8. The surgical stapler of claim 7, wherein said plurality of staple cartridges comprises a third staple cartridge comprising staples having a third size, and wherein the third size is different from said first size and said second size.

9. The surgical stapler of claim 7, wherein said plurality of staple cartridges comprises another of said first staple cartridges.

10. The surgical stapler of claim 7, wherein said first size is greater than said second size, and wherein a first staple cartridge is loaded into said cartridge channel before said second staple cartridge such that said first staple cartridge is deployed before said second staple cartridge.

11. The surgical stapler of claim 7, wherein said first size is greater than said second size, and wherein a second staple cartridge is loaded into said cartridge channel prior to said first staple cartridge such that said second staple cartridge is deployed prior to said first staple cartridge.

12. The surgical stapler of claim 1, wherein the plurality of staple cartridges comprises:

a first staple cartridge comprising staples having a first unfired height; and

A second staple cartridge comprising staples having a second unfired height, wherein the first unfired height and the second unfired height are different.

13. The surgical stapler of claim 12, wherein said plurality of staple cartridges comprises a third staple cartridge comprising staples having a third unfired height, and wherein the third unfired height is different from said first unfired height and said second unfired height.

14. The surgical stapler of claim 12, wherein said plurality of staple cartridges comprises another of said first staple cartridges.

15. The surgical stapler of claim 12, wherein said first unfired height is greater than said second unfired height, and wherein a first staple cartridge is loaded into said cartridge channel before said second staple cartridge such that said first staple cartridge is deployed before said second staple cartridge.

16. The surgical stapler of claim 12, wherein said first unfired height is greater than said second unfired height, and wherein a second staple cartridge is loaded into said cartridge channel prior to said first staple cartridge such that said second staple cartridge is deployed prior to said first staple cartridge.

17. The surgical stapler of claim 1, wherein the plurality of staple cartridges comprises:

a first staple cartridge comprising staples having a first unfired width; and

A second staple cartridge comprising staples having a second unfired width, wherein the first unfired width and the second unfired width are different.