CN111655205A

CN111655205A - Surgical instrument configured to determine a firing path

Info

Publication number: CN111655205A
Application number: CN201880082814.0A
Authority: CN
Inventors: T·S·威登豪斯; D·C·耶茨; F·E·谢尔顿四世; J·L·哈里斯
Original assignee: Ethicon LLC
Current assignee: Ethicon LLC
Priority date: 2017-12-21
Filing date: 2018-12-07
Publication date: 2020-09-11
Anticipated expiration: 2038-12-07
Also published as: BR112020012401A2; JP2021507740A; JP7346416B2; CN111655205B

Abstract

A surgical instrument for treating stomach tissue of a patient is disclosed. The surgical instrument includes a handle including a display; a shaft extending distally from the handle; and an end effector extending distally from the shaft. The surgical system includes a tissue treatment system configured to treat stomach tissue along a path; an imaging system configured to capture a tissue image of stomach tissue; and a controller configured to determine an edge of the stomach tissue, generate an image representing at least a portion of the edge of the stomach tissue, and display the image on the display along with at least a portion of the tissue image.

Description

Surgical instrument configured to determine a firing path

Background

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

Drawings

Various features of the embodiments described herein, along with their advantages, may be understood from the following description in conjunction with the following drawings:

FIG. 1 is a perspective view of a surgical stapling instrument in accordance with 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 in accordance with at least one embodiment;

FIG. 9 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 10 is a perspective view of a 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 in accordance with at least one embodiment;

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

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

FIG. 16 illustrates a failure 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 used to control the staple firing path of the stapling instrument;

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

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

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

FIG. 25 shows the display of FIG. 24 being used to change staple firing paths as a 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 being guided along the staple firing path;

FIG. 28 shows a patient's stomach;

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

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

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

FIG. 32 is a cross-sectional view of the 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 front 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 in accordance with at least one embodiment;

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

FIG. 38 is a partial cross-sectional view of the stapling instrument of FIG. 37, showing the tissue drive system engaged with tissue of a patient;

FIG. 39 is a partial cross-sectional view of the stapling instrument of FIG. 37, showing the tissue drive system urging tissue of the patient in a first direction;

FIG. 40 is a partial cross-sectional view of the stapling instrument of FIG. 37, showing the tissue drive system urging tissue of the patient in a second direction;

FIG. 41 is a partial cross-sectional view of the stapling instrument of FIG. 37, showing the tissue drive system disengaged from patient tissue;

FIG. 42 is a partial front view of a drive system including a synchronization mechanism in accordance with at least one embodiment;

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

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

FIG. 45 is a graph showing two synchronized end effector drives;

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

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

FIG. 48 is a table illustrating synchronization of end effectors of a surgical stapling instrument according to at least one embodiment;

FIG. 49 is a block diagram 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 in accordance with 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 the 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 operational steps of a tissue drive system of a surgical stapling instrument, in accordance with at least one embodiment;

FIGS. 60A-60D further illustrate the operational steps of the tissue actuation system of FIGS. 59A-59D;

FIG. 61 is a partial perspective view of a surgical stapling instrument including a tissue drive system in accordance with 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 in accordance with 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 being released;

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

FIG. 71 is a partial cross-sectional view of the suturing apparatus of FIG. 70 showing the first and second feet 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 stapling instrument 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 operational steps of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 76 is a perspective view, partially in section, of a surgical stapling instrument in accordance with at least one embodiment;

FIGS. 77A-77D illustrate the operative 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 front view of a surgical stapling instrument including a tissue drive device in accordance with at least one embodiment;

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

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

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

FIG. 81 is a partial front view of the stapling instrument of FIG. 79, showing the foot in an extended configuration;

FIG. 81A illustrates the position of a foot corresponding to the tissue driving device of FIG. 81;

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

FIG. 82A illustrates the position of a foot corresponding to the tissue driver of 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 drive device of the stapling instrument of FIG. 79;

FIG. 85 shows 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 that includes a tissue driving device in accordance with at least one embodiment;

FIG. 88 is a tissue driving device of a surgical stapling instrument according to at least one embodiment;

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

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

91A-91D illustrate steps in operation of a surgical stapling instrument that includes 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 illustrates the tissue driving device of FIG. 92 in an extended configuration;

FIG. 94 is a perspective view, partially in section, of a surgical stapling instrument in accordance with at least one embodiment;

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

FIG. 96 shows 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 according to at least one embodiment;

FIG. 99 is a partial perspective view of the staple of FIG. 98 in isolation;

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 in accordance with 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 perspective view, partially in section, of a surgical stapling instrument in accordance with at least one embodiment;

105A-105D illustrate the operational steps of the suturing system of FIG. 104;

FIG. 106 is a partial perspective view of a surgical stapling instrument in accordance with 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 clip 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 in accordance with 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 in accordance with 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 in accordance with at least one embodiment;

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

FIG. 119 is a perspective view of a staple cluster in accordance with 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 a deployable staple cluster in accordance with at least one embodiment;

FIG. 122 is a partial perspective view of a surgical stapling instrument that includes a tissue driving device in accordance with at least one embodiment;

FIG. 123 is a partial perspective view of the stapling instrument of FIG. 122, showing the tissue drive device 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 driver of FIG. 122;

FIG. 126 is a cross-sectional end view of a surgical stapling instrument including a tissue driving 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 the 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 firing 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 shows 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 in accordance with 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 can 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 making and deploying staples;

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

FIG. 143 is a staple firing schedule in accordance with at least one embodiment;

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

fig. 147 illustrates a surgical stapling instrument for use during a surgical procedure in accordance with at least one embodiment;

FIG. 148 is a partial front elevational 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 a potential result of a gastric sleeve procedure using the surgical stapling instrument disclosed herein;

figure 152 shows the guide inserted into a patient's stomach;

FIG. 153 shows 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, in accordance with 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 in accordance with at least one embodiment;

FIG. 159 illustrates certain operative 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 in accordance with at least one embodiment;

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

fig. 162 illustrates a surgical stapling system including a projector according to 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 shows a projection system using the stitching system of FIG. 163;

FIG. 165 illustrates a projection image on tissue of a patient according to at least one embodiment;

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

FIG. 168 is a partial front view of a surgical stapling instrument including an articulatable end effector in accordance with at least one embodiment;

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

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

FIG. 171 is a partial front view of a surgical stapling instrument including an end effector dampener in accordance with at least one embodiment;

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

FIG. 173 illustrates the suturing apparatus of FIG. 171 being 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 touch-sensitive display of the sterile barrier and handle of FIG. 181;

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

FIG. 184 is a graph illustrating the relationship between the position 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 12/21 in 2017 and each incorporated herein by reference in its entirety:

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

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

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

-U.S. patent application serial No. 15/850,495 entitled "platform inertia compensation A FIRING PATH DISPLAY";

-U.S. patent application serial No. 15/850,480 entitled "SELF-identification stable testing apparatus";

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

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

-U.S. patent application Ser. No. 15/850,505 entitled "STAPLING INSTRUMENTS 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 serial No. 15/850,562 entitled "SURGICAL INSTRUMENT COMPLEMENTING SEQUENCED SYSTEMS";

-U.S. patent application serial No. 15/850,587 entitled "stable internal composition A STAPLE FEEDING SYSTEM";

-U.S. patent application serial No. 15/850,508 entitled "SURGICAL STAPLER COMPRISING STORABLE CARTRIDGES HAVINGDIFFERENT STAPLE SIZES";

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

-U.S. patent application serial 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 19.12.2017 and each 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 ASURGICAL INSTRUMENTS ATTACHMENT ASSEMBLY";

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

-U.S. patent application serial No. 15/847,325 entitled "minor teeth structured FOR interacting usable with lubricant interface";

-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 "Rolling ATTACHMENT COMPRISING EXTERIOR DRIVE ACTUATOR"; and

U.S. design patent application serial No. 29/630,115 entitled "minor inertia ASSEMBLY".

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

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

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

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

-U.S. patent application Ser. No. 15/843,558 entitled "SURGICAL ENDEFECTORS WITH PIVOTAL JAWS CONFIRED TO TOUCHAT THEIR RESPECTIVE DISTAL ENDS WHEN FULLY CLOSED";

-U.S. patent application Ser. No. 15/843,528 entitled "SURGICAL END EFFECTORS WITH JAW STIFFERENER ARRANGEMENTSCONFILED TO PERMITTER MONITORING OF FIRING MEMBER";

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

-U.S. patent application Ser. No. 15/843,556 entitled "DYNAMIC CLAMPING ASSEMBLIES WITH IMPROVED WEARCHARACTERISTERISTICS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGILINSTRUNTS";

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

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

U.S. patent application Ser. No. 15/843,508 entitled "HANDHELD ELECTRICAL APPARATUS SURGICALLY INSTRUMENTS WITH IMPROVEDMOTOR CONTROL ARRANGEMENTS FOR POSITIONING COMPONENTS OF AN ADAPTER COUPLEDTHERETO";

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

-U.S. patent application serial 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 2017 on 29.6 and each incorporated herein by reference in its entirety:

-U.S. patent application Ser. No. 15/636,829 entitled "CLOSED LOOP Circuit CONTROL technical FOR robust structural determination";

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

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

U.S. patent application Ser. No. 15/636,854 entitled "Rolling minor INSTRUMENT WITH CLOSED LOOP FEEDBACCKECHNIQUES 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 2017 on 28/6 and each 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 COMPLIMENTING AN ARTICULATION SYSTEM RATIO";

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

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

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

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

-U.S. patent application serial No. 15/636,029 entitled "minor incorporation a shift incorporation a usage garrangement";

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

U.S. patent application Ser. No. 15/635,981 entitled "SURGICAL STAPLING INSTRUMENTS COMPLEMENTING SHORTED STAPLECARTRIDGE NOSES";

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

-U.S. patent application serial No. 15/635,663 entitled "METHOD FOR organizing a SURGICAL INSTRUMENT";

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

U.S. patent application Ser. No. 15/635,549 entitled "SURGICAL INSTRUMENTS WITH OPEN AND CLOSURE JAWS AND AXIALLYMOVABLE FILING MEMBER THAT IS INITIALLY PARKED IN CLOSURE PROXIMITY TO THE JAWSPRIOR TO FILING";

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

-U.S. patent application serial No. 15/635,578 entitled "SURGICAL END EFFECTORS WITH IMPROVED JAW APERTUREARRANGEMENTS";

-U.S. patent application Ser. No. 15/635,594 entitled "SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVILWITH 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 SURGICALENT JAW IN PIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICALIN STRUCTURENT 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 serial No. 15/635,521 entitled "SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT";

-U.S. design patent application serial No. 29/609,087 entitled "platform formulation and artificial";

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

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

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

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

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

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

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

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

-U.S. patent application serial No. 15/634,076 entitled "stable formation POCKET arget argements";

-U.S. patent application serial No. 15/634,090 entitled "stable formation POCKET arget argements";

-U.S. patent application serial 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 applicants of the present application own the following U.S. patent applications filed on 21/12/2016 and 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 ASSEMBLED LINESTEREOF";

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

-U.S. patent application serial No. 15/386,221 entitled "LOCKOUT arragements FOR minor END efffectors";

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

-U.S. patent application serial No. 15/386,198 entitled "LOCKOUT arragements FOR minor END effects and minor TOOL associations";

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

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

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

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

-U.S. patent application serial No. 15/385,950 entitled "minor teeth WITH close STROKE mechanism details";

-U.S. patent application serial No. 15/385,945 entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES 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 JAW OPENING DISTANCE";

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

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

-U.S. patent application serial No. 15/385,955 entitled "SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOPARAMENTS";

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 PREVENTINGFIRING SYSTEM ACTION UNLESS AN UNSPENT STAPLE CARTRIDGE IS PRESENT";

-U.S. patent application serial No. 15/385,947 entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES 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 DIFFERENTYLES OF STAPLES";

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

-U.S. patent application serial No. 15/385,901 entitled "STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL compris ingwindows 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/ORSPENT CARTRIDGE LOCKOUT";

-U.S. patent application serial No. 15/385,905 entitled "fixing ASSEMBLY assembling a LOCKOUT";

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

-U.S. patent application serial No. 15/385,908 entitled "fixing ASSEMBLY assembling a FUSE";

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

-U.S. patent application serial No. 15/385,920 entitled "stable formation POCKET arget argements";

-U.S. patent application serial 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 OFSTAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT";

-U.S. patent application serial No. 15/385,893 entitled "bialterall ASYMMETRIC STAPLE formatting POCKET pair";

-U.S. patent application serial No. 15/385,929 entitled "close measure WITH CAM SURFACE area FOR SURFACE lines measure WITH SEPARATE AND DISTINCT close AND FIRING SYSTEMS";

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

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

-U.S. patent application serial No. 15/385,917 entitled "STAPLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT clamingbudardhs";

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

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

-U.S. patent application serial No. 15/385,915 entitled "fixing 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 serial No. 15/385,924 entitled "SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS";

-U.S. patent application serial No. 15/385,912 entitled "minor appliances WITH JAWS THAT ARE able to pivot a bout AFIXED AXIS AND index SEPARATE AND DISTINCT close AND FIRING SYSTEMS";

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

-U.S. patent application serial No. 15/385,906 entitled "fixing MEMBER PIN CONFIGURATIONS";

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

-U.S. patent application serial No. 15/386,192 entitled "STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAPSETTING featurs";

-U.S. patent application serial No. 15/386,206 entitled "STAPLE CARTRIDGE WITH DEFORMABLE DRIVER replacement patents";

-U.S. patent application Ser. No. 15/386,226 entitled "DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLIES BLIESOF 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 PORTION FOR DISPOSABLE LOADING UNIT FOR SURGICAL STAPLING INSTRUMENTS";

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

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

-U.S. patent application Ser. No. 15/385,890 entitled "SHAFT ASSEMBLY COMPRISING SEPARATELY ACTIVABLE ANDRETRACTABLE SYSTEMS";

-U.S. patent application Ser. No. 15/385,891 entitled "SHAFT ASSEMBLY COMPRISING A CLUTCH CONGURED TO ADAPT THEUTPUT 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 ANARTICULATE STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM";

-U.S. patent application serial No. 15/385,894 entitled "SHAFT association comprisinga locout";

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

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

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

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

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

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

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

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

U.S. patent application Ser. No. 15/385,928 entitled "PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN AMOYABLE 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 GFEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS";

-U.S. patent application serial No. 15/385,932 entitled "article subaltern minor END EFFECTOR WITH ASYMMETRIC SHAFTARRANGEMENT";

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

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

-U.S. patent application serial No. 15/385,935 entitled "LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FORLOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATEDCONFIGURATION"; and

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

the applicants of the present application have the following U.S. patent applications filed on 24/6/2016 and each of which is incorporated herein by reference in its entirety:

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

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

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

-U.S. patent application serial No. 15/191,788 entitled "STAPLE CARTRIDGE comprisingoverdriven stamps"; and

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

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

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

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

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

The applicants of the present application have the following patent applications filed on 1/4/2016 and 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 serial 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 GRIPPORTION", now U.S. patent application publication 2017/0281165;

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

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

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

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 selection OF diagnosis 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 entitled "SURGICAL STAPLING SYSTEM COMPRISING A SPECT CARTRIDGELOCKOUT," now U.S. patent application publication 2017/0281185;

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 INSTRUMENTS COMPLEMENTING MULTIPLE LOCKOUTS", now U.S. patent application publication 2017/0281155;

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

U.S. patent application Ser. No. 15/089,253 entitled "SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OFSTAPLES 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 serial No. 15/089,336 entitled "STAPLE CARTRIDGES WITH atraumatc featurs," now U.S. patent application publication 2017/0281164;

-U.S. patent application serial No. 15/089,312 entitled "CIRCULAR STAPLING SYSTEM comprisingan available tisssue support", now U.S. patent application publication 2017/0281189;

-U.S. patent application serial No. 15/089,309 entitled "CIRCULAR STAPLING SYSTEM comprisingrotary 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 30/12/2015 and each incorporated herein by reference in its entirety:

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

-U.S. patent application serial No. 14/984,525 entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL 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 IRCUITS", 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 9/2/2016 and each incorporated herein by reference in its entirety:

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

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

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 entitled "SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLY ARTICULATABLE RELATIVE TO AN ELONGGATE SHAFT ASSEMBLY", now U.S. patent application publication 2017/0224331;

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

-U.S. patent application serial No. 15/019,227 entitled "american filing WITH SINGLE american filing for" now U.S. patent application publication 2017/0224334;

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

U.S. patent application Ser. No. 15/019,230 entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAMARRANGEMENTS", now U.S. patent application publication 2017/0224335; 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 12.2.2016, each of which is incorporated herein by reference in its entirety:

-U.S. patent application serial No. 15/043,254 entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS";

-U.S. patent application serial No. 15/043,259 entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS";

-U.S. patent application serial No. 15/043,275 entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS"; and

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

The applicants of the present application have the following patent applications filed on 18/6/2015 and each incorporated herein by reference in its entirety:

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

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

U.S. patent application Ser. No. 14/742,914 entitled "Movable filing bed SUPPORT FOR easily organizing and organizing appliances INSTRUMENTS," now U.S. patent application publication 2016/0367255;

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

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 ARTICULATABLESSURGICAL INSTRUMENTS," now U.S. patent application publication 2016/0367245.

The applicants of the present application have the following patent applications filed 3/6/2015 and each incorporated herein by reference in its entirety:

-U.S. patent application serial No. 14/640,746 entitled "POWERED minor instroment", now U.S. patent 9,808,246;

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

U.S. patent application Ser. No. 14/640,832 entitled "ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADAJUST CLOSURES FOR MULTIPLE TISSUE TYPE", now U.S. patent application publication 2016/0256154;

U.S. patent application Ser. No. 14/640,935 entitled "OVERAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TOMEASURE 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 INCREASING OF MOTORFOR POWER SURGICAL INSTRUMENTS", now U.S. patent application publication 2016/0256153;

-U.S. patent application Ser. No. 14/640,859 entitled "TIME DEPENDENT EVALTION OF SENSOR DATA TO DETERMINEMITABILITY, CREPE, AND VISCELATIC ELEMENTS OF MEASURES", now U.S. patent application publication 2016/0256187;

-U.S. patent application serial 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 entitled "CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITHIN MODULAR SHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE", now U.S. patent application publication 2016/0256155;

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 CARTRIDGEINTO A SURGICAL STAPLE/FASTENER," now U.S. patent application publication 2016/0256160;

-U.S. patent application serial No. 14/640,799 entitled "SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON available shift short", 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 applicants of the present application have the following patent applications filed on day 27 of month 2 of 2015 and each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/633,576 entitled "SURGICAL INSTRUMENT SYSTEM COMPLISING AN INSPECTION STATION", now U.S. patent application publication 2016/0249919;

U.S. patent application Ser. No. 14/633,546 entitled "SURGICAL APPATUS CONFIRED TO ASSESS WHETHER A PERFORMANCE PARAMETER OF THE SURGICAL APPATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND", now U.S. patent application publication 2016/0249915;

U.S. patent application Ser. No. 14/633,560 entitled "SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONEOR 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 RESOLUTION FOR RCHARGING A BATTERY", now U.S. patent application publication 2016/0249918;

U.S. patent application Ser. No. 14/633,555 entitled "SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENTS NEEDS TOBE SERVICED," now U.S. patent application publication 2016/0249916;

U.S. patent application Ser. No. 14/633,542 entitled "REINFORCED BATTERY FOR A SURGICAL INSTRUMENT," now U.S. patent application publication 2016/0249908;

U.S. patent application Ser. No. 14/633,548 entitled "POWER ADAPTER FOR A SURGICAL INSTRUMENT," now U.S. patent application publication 2016/0249909;

-U.S. patent application serial No. 14/633,526 entitled "adaptive minor insert HANDLE", now U.S. patent application publication 2016/0249945;

U.S. patent application serial No. 14/633,541 entitled "MODULAR station association" and now U.S. patent application publication 2016/0249927; and

U.S. patent application Ser. No. 14/633,562 entitled "SURGICAL APPATUS CONFIGURED TO TRACK AN END-OF-LIFEPARAMETER," now U.S. patent application publication 2016/0249917.

The applicants of the present application own the following patent applications filed on 12/18/2014 and each incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 14/574,478 entitled "SURGICAL INSTRUMENT SYSTEM COMPLEMENTS SYSTEM ENDEFECTOR AND MEANS FOR ADJUSE THE FIRING STROKE OF A FIRING MEMBER", now U.S. patent 9,844,374;

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

-U.S. patent application serial No. 14/575,139 entitled "DRIVE ARRANGEMENTS FOR article minor letters", now U.S. patent 9,844,375;

-U.S. patent application serial No. 14/575,148 entitled "LOCKING argemenets FOR detecting short SHAFT electromagnetic assembly END effects", 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 ANDMOVABLE FIRING BEAM SUPPORT ARRANGEMENTS", now U.S. patent application publication 2016/0174975;

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

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

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

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

U.S. patent application Ser. No. 13/782,295 entitled "Integrated Surgical Instruments With reduced Path for Signal Communication", now U.S. Pat. No. 9,700,309;

U.S. patent application Ser. No. 13/782,323 entitled "Rotary Power engineering Joints For scientific Instruments," now U.S. Pat. No. 9,782,169;

U.S. patent application Ser. No. 13/782,338 entitled "thumb Switch arrays For Surgical Instruments," now U.S. patent application publication 2014/0249557;

U.S. patent application Ser. No. 13/782,499 entitled "Electrical scientific Device with Signal Relay arrangement", now U.S. patent application publication 9,358,003;

U.S. patent application Ser. No. 13/782,460 entitled "Multiple Processor Motor Control for Modular surgical instruments," now U.S. Pat. No. 9,554,794;

U.S. patent application Ser. No. 13/782,358 entitled "journal 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 straight End Effect During Removal Throughocar", now U.S. patent application publication 9,468,438;

U.S. patent application Ser. No. 13/782,518 entitled "Control Methods for scientific Instruments with RemovableImplements", now U.S. patent application publication 2014/0246475;

U.S. patent application serial No. 13/782,375 entitled "road Powered Surgical Instruments With Multiple details 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 3/14 of 2013 and each incorporated herein by reference in its entirety:

-U.S. patent application serial No. 13/803,097 entitled "article subaltern minor incorporation 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 SURGICALINSTRUNT", now U.S. patent application publication 9,332,987;

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

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

-U.S. patent application serial No. 13/803,210 entitled "SENSOR array FOR SYSTEM position SYSTEM FOR detecting INSTRUMENTS", now U.S. patent 9,808,244;

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

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

U.S. patent application Ser. No. 13/803,117 entitled "ARTICULATION CONTROL FOR ARTICULATED SURGICAL STRUTRUNTS", 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 STRUCTURAL", 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 3/7/2014 and incorporated herein by reference in their entirety:

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

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

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

-U.S. patent application serial No. 14/226,099 entitled "serilization version CIRCUIT", now U.S. patent 9,826,977;

-U.S. patent application Ser. No. 14/226,094 entitled "VERIFICATION OF NUMBER OF Battery improvements/Process 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 CICUITAND WAKE UP CONTROL", now U.S. patent application publication 2015/0272574;

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

U.S. patent application Ser. No. 14/226,093 entitled "FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICALINSTRUMENTS", 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 entitled "SURGICAL INSTRUMENT CONTROL A SAFETYPROSSOR", now U.S. Pat. No. 9,690,362;

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

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 INSTRUMENTS SYSTEM," now U.S. patent application publication 2015/0272557;

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

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

U.S. patent application Ser. No. 14/226,111 entitled "SURGICAL STAPLING INSTRUMENTT SYSTEM", now U.S. Pat. No. 9,750,499; 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 5/9/2014 and each incorporated herein by reference in its entirety:

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

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

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

-U.S. patent application serial No. 14/478,895 entitled "MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR's socket OR interrupt," now U.S. patent 9,757,128;

-U.S. patent application Ser. No. 14/479,110 entitled "polar 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 serial No. 14/479,115 entitled "MULTIPLE MOTOR CONTROL FOR power MEDICAL DEVICE", now U.S. patent 9,788,836; and

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

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

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

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

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

U.S. patent application Ser. No. 14/248,588 entitled "POWER 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 ROTATURE DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS", now U.S. patent 9,801,626;

U.S. patent application Ser. No. 14/248,587 entitled "POWER 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 SURGICALINSTRUNT", now U.S. patent application publication 2014/0305990; and

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

The applicant of the present application also owns the following patent applications filed on 16.4.2013 and each incorporated herein by reference in its entirety:

U.S. provisional patent application serial No. 61/812,365 entitled "minor entering WITH MULTIPLE FUNCTIONS BY entering MOTOR";

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

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

-U.S. provisional patent application serial No. 61/812,385 entitled "minor ACTUATION HANDLE WITH major ACTUATION motor and valve CONTROL"; and

U.S. provisional patent application serial No. 61/812,372 entitled "minor entering WITH MULTIPLE FUNCTIONS BY entering 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 illustrated in the accompanying 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 understand that the embodiments described and illustrated herein are non-limiting examples and that specific structural and functional details disclosed herein are representative and illustrative. Variations and changes may be made to these embodiments without departing from the scope of the claims.

The term "comprises" (and any form of "comprising", such as "comprises" and "comprising)", "has" (and "has)", such as "has" and "has)", "contains" (and any form of "containing", such as "comprises" and "containing)", and "containing" (and any form of "containing", such as "containing" and "containing", are open-ended verbs. Thus, a surgical system, device, or apparatus that "comprises," "has," "contains," or "contains" one or more elements possesses those one or more elements, but is not limited to possessing 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 be further appreciated that for simplicity and clarity, spatial terms such as "vertical," "horizontal," "up," and "down" 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 conjunction 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, and the like. The working portion or end effector portion of the instrument may be inserted directly into a 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.

Various surgical instruments configured to secure tissue of a patient are disclosed herein. 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 the 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 may 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 an end effector having staples. As also discussed in more detail below, two or more of the drive systems can be operably 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 further includes a plurality of electric motors configured to operate a drive system of the stapling instrument 1000. Three electric motors 1130, 1140, and 1150 are shown, but the surgical instrument 1000 may include any suitable number of electric motors. Each electric motor is operably coupled with the rotatable output. For example, electric motor 1130 is operably coupled to rotatable output 1135, electric motor 1140 is operably coupled to rotatable output 1145, and electric motor 1150 is operably coupled to rotatable output 1155. The handle 1100 also includes a battery 1160 that supplies power to the electric motors 1130, 1140, and 1150, for example. Referring to fig. 11, battery 1160 includes, for example, 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 be capable of supplying power to the control system and/or display of the handle 1110, which will be described in greater detail below.

The 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 the sake of brevity. The handle 1100 'includes a battery compartment that is accessible through a door 1115'. The door 1115' allows the batteries in the battery compartment to be replaced. A 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 the sake of brevity. The handle 1100 "includes a plug 1115" configured to be able to supply power to the handle 1100 ", for example, from a generator and/or a wall outlet. In various instances, the handle 1100 "can be powered by, for example, an internal source (such as by the battery 1160) and, for example, an external source (such as by the 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 handle 1170 comprise a rotatable bayonet interconnect; however, any suitable interconnect may be used. The shaft assembly 1200 also includes a rotatable input 1235 configured to operably couple 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 operably couple with the rotatable output 1145 and a rotatable input 1255 configured to operably couple with the rotatable output 1155 when the shaft assembly 1200 is assembled to the handle 1100.

In addition to the above, the outer shaft housing 1210 also includes a distal connector 1290. The end effector 1300 includes a shaft portion 1310 including an end effector connector 1390 configured to engage with a distal connector 1290 to couple the end effector 1300 to the shaft assembly 1200. The 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 arrangement 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 electrical circuit extending through the handle 1100, the shaft assembly 1200, and the end effector 1300. The electrical circuit includes conductors in the handle 1100, shaft assembly 1200, and end effector 1300 that are placed in electrical communication with each other 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 the 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 comprise 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 comprise 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 further includes a distal head 1320 rotatably coupled to the shaft portion 1310 about an articulation joint 1370. The end effector 1300 further 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 by the anvil drive system toward the tissue compression surface 1325 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 and move the stapling apparatus 1000 relative to patient tissue.

Referring primarily to fig. 3, the end effector 1300 includes a rotatable drive shaft 1330 that can be used to selectively open the anvil 1360, operate the tissue drive system (fig. 4-6) to reposition the distal head 1320 relative to the patient's tissue, and close the anvil 1360 (fig. 7) prior to the stapling instrument 1000 performing 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 drive shaft 1330 is in its first position, key 1332 is positioned within a keyway 1333 defined in 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 a drive collar 1361 of the anvil drive system.

Referring to fig. 4-6, the tissue drive system includes a first foot 1380a and a second foot 1380 b. 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 foot 1380a while retracting the second foot 1380b, and similarly, extend the second foot 1380b while retracting the first foot 1380 a. Fig. 4 shows the first foot 1380a in an extended position and the second foot 1380b in a retracted position. As a result of the foregoing, 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 can be configured to simultaneously extend the first and

second feet

1380a, 1380b and/or simultaneously retract the first and

second feet

1380a, 1380 b.

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 drive gear 1331, a transfer gear 1382a operatively intermeshed with spur gear 1381a, and a spur gear 1383a operatively intermeshed with transfer gear 1382a such that rotation of shaft 1330 is transferred to spur gear 1383 a. The first gear train also includes a shaft gear 1384a operatively intermeshed with the spur gear 1383 a. Referring primarily to fig. 5 and 6, shaft gear 1384a is fixedly mounted to transmission shaft 1385a such that rotation of spur gear 1383a is transmitted to transmission shaft 1385 a. The first gear train further includes a bevel gear 1386a fixedly mounted to the transmission shaft 1385a, a side bevel gear 1387a operatively intermeshed with the bevel gear 1386a, and a pinion gear 1388a fixedly mounted to the side bevel gear 1387a such that the pinion gear 1388a rotates with the side bevel gear 1387 a. Referring primarily to fig. 6, the pinion gear 1388a operably intermeshes with a rack 1389a mounted to the first leg 1380a, which converts rotational input motion into translational motion of the first leg 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 two spur gears, as described below. The second gear train includes a spur gear 1381b operatively intermeshed with drive gear 1331 and a spur gear 1383b operatively intermeshed with spur gear 1381b such that rotation of shaft 1330 is transferred to spur gear 1383 b. The second gear train also includes a shaft gear 1384b operatively intermeshed with the spur gear 1383 b. Referring primarily to fig. 5, a shaft gear 1384b is fixedly mounted to the transmission shaft 1385b such that rotation of the spur gear 1383b is transmitted to the transmission shaft 1385 b. The second gear train further includes a bevel gear 1386b fixedly mounted to the transmission shaft 1385b, a side bevel gear 1387b operatively intermeshed with the bevel gear 1386b, and a pinion gear 1388b fixedly mounted to the side bevel gear 1387b such that the pinion gear 1388b rotates with the side bevel gear 1387 b. The pinion 1388b is operably intermeshed with a rack 1389b mounted to the second foot 1380b which converts rotational input motion to translational motion of the second foot 1380 b.

The presence of the transfer gear 1382a in the first gear train and the absence of a corresponding transfer gear in the second gear train causes the first and

second feet

1380a, 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 or opposite direction, the first leg 1380a retracts and the second leg 1380b extends. As described above, the first and

second feet

1380a, 1380b are configured to grasp and pull the end effector 1300 relative to tissue as the feet extend and retract. Although 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 the tissue by the tissue drive system, the drive shaft 1330 translates longitudinally 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 drive shaft 1330 can stop before it disengages from the tissue drive system. In other instances, drive shaft 1330 may continue to rotate as it disengages from the tissue drive system and translates into engagement with 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 is threadably engaged with threads 1365 in aperture 1366. When drive collar 1361 is rotated in a first direction by drive shaft 1330, drive collar 1361 pushes anvil 1360 away from

feet

1380a and 1380b to open anvil 1360. Once the anvil 1360 has been sufficiently opened, the drive shaft 1330 can 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 drive collar 1361 is rotated in a second or opposite direction, at this point, drive collar 1361 pulls anvil 1360 toward

feet

1380a and 1380b to close or grip anvil 1360, as shown in fig. 7. Once the anvil 1360 has been closed, the staple firing system of the stapling instrument 1000 can be actuated. At this point, the anvil 1360 is reopened 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 push rod 1334 through the drive collar 1361. Additionally, it is noted that drive collar 1361 includes a proximal flange 1367 and a distal flange 1368 extending therefrom. The flange 1367 and 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 strokes of the anvil 1360. The anvil 1360 includes a tissue gripping surface that extends normal, or at least substantially normal, to the longitudinal axis 1369 and moves longitudinally relative to the distal head 1320. The anvil 1360 includes movable jaws, and the

feet

1380a and 1380b of the tissue drive system include another movable jaw positioned opposite the 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, while longer gaps may result in longer dwells. Other embodiments are contemplated in which there is no or minimal clearance between drive gear 1331 and 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. Stapling instrument 1000 includes a cartridge drive system configured to advance 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 are described in more detail below. In any event, the end effector 1300 can be detached from the shaft assembly 1200, and the 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 there are staples or staple cartridges stored in the end effector 1300. The shaft assembly 1200 is intended to have a greater number of uses than the end effector 1300. Thus, a used end effector 1300 may be replaced with another end effector 1300 without replacing 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 replacing 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 create relative motion between the end effector and the patient's tissue, and then clamp the anvil again. 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 operatively intermeshed with the bevel gear 2833, and a spur gear 2835 operatively 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 the spur gear 2835 and rotates with the spur gear, an output gear 2837 operatively intermeshed with the pinion 2836, and a cam 2838 fixedly mounted to the output gear 2837 and rotates with the output gear. Due to the above, rotation of the drive shaft 2830 rotates the cam 2838, which is converted to reciprocating motion of the drive shaft 2830 as described below.

In addition to the above, the drive system 2800 includes a rotatable shifter 2840 that includes a cam arm 2848 and a shifter arm 2849 that is rotatable about a pivot 2841. In use, the cam 2838 is configured to engage the cam arm 2848 of the shifter 2840 and rotate the 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 pushes the drive shaft 2830 upward. A spring 2820 is positioned between the shoulder 2839 and the frame 2819 of the stapling instrument, the spring being compressed and storing 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 reciprocating movement of the drive shaft 2830 between its first and second positions may be used to operate a reciprocating drive system in an end effector of a 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 operatively coupled with the electric motor 2930, and a second drive system 2950 operatively coupled with 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 that operably intermeshes with drive gear 2932. Input gear 2942 is fixedly mounted to drive shaft 2943 such that drive shaft 2943 rotates with input gear 2942. The first drive system 2940 also includes a barrel cam 2944 that is slidably mounted to the drive shaft 2943 and rotates with the drive shaft 2943. The barrel cam 2944 includes an aperture 2945 defined therein that includes a non-circular profile configured to transmit rotation between the drive shaft 2943 and the barrel cam 2944, but allow relative translation therebetween, for example. The barrel cam 2944 also includes a cam slot 2949 defined therearound 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 is rotated in a first direction and proximally when the barrel cam 2944 is rotated in a second or opposite direction. The first drive system 2940 further includes a drive shaft 2946 extending from a barrel cam 2944 configured to drive the first end effector function.

Second drive system 2950 includes an input gear 2952 that operatively intermeshes with drive gear 2932. The input gear 2952 is fixedly mounted to the drive shaft 2953 such that the drive shaft 2953 rotates with the input gear 2952. The second drive system 2950 also includes a barrel cam 2954 that is slidably mounted to the drive shaft 2953 and rotates with the drive shaft 2953. The barrel cam 2954 includes an aperture 2955 defined therein that includes a non-circular profile configured to transmit rotation between the drive shaft 2953 and the barrel cam 2954, but allow relative translation therebetween, for example. The barrel cam 2954 further includes a cam slot 2959 defined therearound 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 is rotated in a first direction and proximally when the barrel cam 2954 is rotated in a second or opposite direction. The second drive system 2950 also includes a drive shaft 2956 extending from a barrel cam 2954 configured to drive a second end effector function.

When the electric motor 2930 of the drive system 2900 is rotated in a first direction, the first drive shaft 2946 is advanced distally and the second drive shaft 2956 is retracted proximally. Accordingly, when the electric motor 2930 is operated in a 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 the drive shaft 2946 and the drive shaft 2956 are advanced distally simultaneously.

Referring to fig. 92 and 93, a stapling instrument 4500 includes a tissue drive arrangement 4590 including a first foot 4580a and a second foot 4580 b. First leg 4580a includes a rack 4583a defined thereon, second leg 4580b includes a rack 4583b defined thereon, and tissue drive 4500 further includes a pinion 4593 in meshing engagement with rack 4583a and rack 4583 b. Pinion 4593 is rotatable back and forth about an axis to reciprocally extend and retract

feet

4580a and 4580b and thereby drive the stapling instrument relative to the patient's tissue. The tissue drive arrangement 4590 further comprises a first actuator 4592 pinned to the pinion 4593 at a pivot joint 4591 and a second actuator 4594 pinned to the pinion 4593 at a pivot joint 4595. In use, first actuator 4592 is pushed and/or second actuator 4594 is pulled to rotate pinion 4593 in a first direction, extend second foot 4580b and retract first foot 4580 a. Accordingly, first actuator 4592 is pulled and/or second actuator 4594 is pushed to rotate pinion 4593 in a second direction, extend first foot 4580a and retract second foot 4580 b. Notably, foot 4580a and foot 4580b are displaced linearly and in opposite directions. That is,

feet

4580a and 4580b are configured such that when one of

feet

4580a and 4580b is retracting to draw tissue, the other foot slides or moves relative to the tissue as it extends.

As described above, the

feet

1380a and 1380b of the stapling instrument 1000 extend and retract along a linear path. In such cases, the

feet

1380a and 1380b may slide over the tissue as the tissue extends, and then grasp and pull the tissue as the tissue retracts. The

feet

1380a and 1380b may include teeth extending therefrom having a profile that facilitates the

feet

1380a and 1380b sliding relative to tissue when moving in one direction and grasping tissue when moving in an opposite direction. In at least one instance, 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, which has a steeper angle, bites 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 the

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 can 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. Tissue drive system 4200 includes a first foot 4280a and a second foot 4280b movably connected by a link 4282. The link 4282 is coupled to the first foot 4280a at pivot joint 4281a and to the second foot 4280b at pivot joint 4281 b. The

feet

4280a and 4280b move proximally and distally through an input end 4290 comprising a drive shaft 4292 connected to a link 4282 at a pivot joint 4283. The pivot joints 4281a, 4281b, and 4283 allow the

feet

4280a and 4280b to lift or float upward when extending across tissue.

As mentioned above, the stapling instruments disclosed herein, including the tissue drive systems, are configured to drive or advance themselves across patient tissue as they staple and cut the patient tissue along the staple firing path. In various circumstances, the thickness of the tissue can 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 left-right direction. Referring again to fig. 88 and 89, the degrees of freedom provided by

pivot joints

4281a, 4281b and 4283 allow

feet

4280a and 4280b to tilt in response to these changes in tissue thickness. For example, the

foot portions

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. Thus, 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

feet

4280a and 4280b are inclined in the same direction. This arrangement may have a simpler drive system. In any event, the

feet

4280a and 4280b may self-flatten in response to changes in tissue thickness and may have a desired traction on the tissue.

Referring now to fig. 87, the stapling instrument 4100 includes a distal stapling head 4120 that is similar to the stapling instrument 1000 and includes a tissue drive system 4190 that includes a foot 4180. The tissue drive system 4190 includes a rocker link 4192 that is 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 leg portions 4193 is pivotally connected to the foot portion 4180 about a pivot pin 4195. In use, the tissue drive system 4190 rocks the rocker arm linkage 4192 back and forth to extend and retract the feet 4180 along a non-linear or curved path. Feet 4180 are extended and retracted together, but embodiments are contemplated in which the feet move in opposite directions. Further, in addition to the above, the foot 4180 may be angled about the pivot pin 4195 to accommodate variations in tissue thickness. In various circumstances, the tissue drive system 4190 can lift the foot 4180 away from the tissue, for example, for 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, a surgical instrument 2700 includes a distal head 2720 that includes an anvil 2760, a tissue drive foot 2780, and a tissue drive device 2790. Tissue drive device 2790 includes a positioning bar 2791 attached to drive foot 2780 at pivot joint 2781. The positioning rod 2791 is displaceable along the longitudinal axis to engage and disengage the drive foot 2780 from the patient tissue T (fig. 38) and (fig. 41). 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 withdrawn into the distal head 2720, the drive foot 2780 is locked in place or prevented from rotating. More specifically, the distal head 2720 includes a control slot 2724 defined therein, and the foot 2780 includes two control pins 2784 slidably positioned in the control slot 2724 that are configured to prevent rotation of the drive foot 2780 when the drive foot 2780 is in its withdrawn position (fig. 37 and 41) and to allow rotation of the drive foot 2780 when the 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. Tissue drive device 2790 includes a first driver 2792 and a second driver 2793 configured to rotate foot 2780 about pivot joint 2781. The first driver 2792 includes a pusher end positioned within a first socket 2782 defined in the drive foot 2780, and the second driver 2793 includes a pusher end positioned within a second socket 2783 defined on an opposite side of the drive foot 2780. Referring to fig. 40, the first driver 2792 can be displaced toward the tissue to rotate the drive foot 2780 in a first direction. Referring to fig. 39, the second driver 2793 can be displaced toward the tissue to rotate the drive foot in a second or opposite direction. In use, the drive foot 2780 can be rotated back and forth by the tissue drive device 2790 to produce relative motion between the distal head 2720 and tissue in a forward or rearward direction.

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

In addition to the above, referring to fig. 79-82, tissue drive device 3990 further includes a coupling lever 3996 including a first end slidably positioned in a cam slot 3999 (fig. 83 and 85) defined on a second side of or in a face of drive wheel 3994. In at least one instance, the coupling lever 3996 includes a pin that rides in the cam slot 3999. The coupling lever 3996 also includes a second end that is pivotally mounted to the foot 3980 at a pivot joint 3998. As the drive wheel 3994 rotates, the side walls of the cam slot 3999 push the first end of the link 3996 through the path or movement shown in fig. 84. This path is also shown in fig. 79A, 80A, 81A and 82A, which tracks the motion of tissue drive 3990 and foot 3980 shown in fig. 79, 80, 81 and 82, respectively. Fig. 79 illustrates the foot 3980 in a retracted position, and fig. 79A illustrates a dot P on the foot motion path FM that represents the position of the foot 3980 along the foot motion path FM. Fig. 80 shows the foot 3980 extended, and fig. 80A shows the dot P advancing along the 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 the 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 stud 3920 includes a pin 3927 extending into the longitudinal slot 3997 that cooperates to limit or constrain the movement of the coupling rod 3996. Fig. 84 and 85 map three corresponding positions labeled 1, 2, and 3 along the 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 actuation device 3990 includes a four-bar linkage in which feet 3980 are vacated when extended. To facilitate this movement, each foot 3980 includes a slot 3981 defined therein, the side walls of which slide relative to a pin 3921 extending 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 illustrates an alternative embodiment of the 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 lever 3996 has passed that point, the coupling lever 3996 cannot return along the original path past position 1. The cam path 4099 includes a second shoulder 4092 corresponding to position 2 and fig. 80A, and once the coupling lever 3996 has passed this point, the coupling lever 3996 cannot return along the original path past position 2. The cam path 4099 also includes a third shoulder 4093 corresponding to position 3 and fig. 81A, and once the coupling lever 3996 has passed this point, the coupling lever 3996 cannot return along the original path past position 3.

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

Referring to fig. 52-56, the stapling instrument 3100 includes a tissue drive 3190 that is configured to extend and retract the drive foot 3180, and also extend and retract the teeth 3193. The tissue drive 3190 includes an input shaft 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 sidewalls of the slot 3182 transfers the motion of the input rod 3191 to the drive foot 3180. Each of the grooves 3182 extends along an axis that is transverse and non-parallel to the longitudinal axis of the distal head 3120, which thus produces the desired motion 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 feet 3180 in a retracted position in which they 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 lever 3191 moves further away from its fully retracted position, the input lever 3191 begins to extend the drive foot 3180, as shown in fig. 54. Notably, the teeth 3193 do not protrude through the window 3183 when the drive foot 3180 is extended. However, once the input lever 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 tooth 3193 to protrude through the window 3183. Thus, the teeth 3193 can 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, the tissue may be sutured and/or incised. The above-described process may be repeated to move the stapling instrument 3100 along the entire staple firing path.

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

Referring primarily to fig. 57 and 58, drive foot 3270 and 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, referring to fig. 58, the actuator plate 3260 pushes on the joint 3213 that rotatably connects the first connector 3272 and the second connector 3282, which causes the lateral foot 3280 to displace outward. In addition, the distal head 3220 constrains lateral movement of the drive foot 3270 and, thus, the drive foot 3270 from moving laterally when the lateral drive foot 3280 is extended laterally. However, referring to fig. 60A-60D, alternative embodiments are contemplated in which the drive foot 3270 can also move laterally. In either case, a biasing member (such as a torsion spring positioned in and/or coupled to the joint 3213), for example, can laterally retract the drive foot after the pushing force is removed 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 the staple firing path. Fig. 60A-60D also illustrate a series of steps that may be repeated by the surgical instrument 3200 to move the stapling instrument 3200 along the staple firing path.

Referring to fig. 61 and 62, the 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 actuator 3370, actuator 3370 is displaced and/or compressed, which causes connector 3375 to extend laterally and push corresponding drive foot 3380 laterally. When the compressive force is removed from the actuator 3370, the connector 3375 resiliently contracts and pulls the drive foot 3380 inward. The drive foot 3380 can include tissue gripping features defined thereon that are configured to push and/or pull on patient tissue as the drive foot 3380 moves laterally. Thus, the drive foot 3380 may produce relative motion between the distal head 3320 and the patient's 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 feet 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 the patient tissue. FIG. 91 illustrates the foot 4480 in a retracted position. Fig. 91B shows the extended foot 4480. Fig. 91C shows the foot 4480 in a fully extended position. Fig. 91D shows the foot 4480 retracted. As the feet 4480 extend, the feet 4480 drive the distal head 4420 relative to the patient tissue. Notably, the feet 4480 are synchronized such that the feet extend and retract together, and in such instances, the feet 4480 can 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 that includes a staple firing system 3850, an anvil 3860, and a tissue drive system. The tissue drive system includes first and

second feet

3880a, 3880b and is configured to selectively extend and retract the

feet

3880a, 3880b to move the stapling instrument 3800 along the staple firing path FP. The tissue drive system is configured to move or advance the stapling instrument 3800 along a straight and/or curved staple firing path. As seen in fig. 77A and 77B, the tissue drive system is configured to simultaneously extend and retract the first and second feet 3880a, 3880B 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 a first direction. Similarly, referring to fig. 77D, the tissue drive system can extend and retract the second foot portion 3880b while not extending and retracting the first foot portion 3880a to rotate the distal head portion 3820 in the second direction.

As described above, the tissue drive system is configured to rotate the distal head 3820 of the stapling instrument 3800 by operating one of the

feet

3880a and 3880b, but not the other. Alternatively, the tissue drive system may be configured 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 3880b in opposite directions. In such instances, the distal head 3820 can follow a small or small radius of curvature in the staple firing path FP.

Referring to fig. 63 and 64, the stapling instrument 3400 includes a distal head 3420 that includes 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 mount 3482 that extends through an aperture defined in the center of drive wheel 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 motion between the distal head 3420 and the patient tissue and to move the distal head 3420 along the staple firing path.

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

In addition to the above, the tissue drive system is configured to rotate the drive wheels 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 further configured to rotate the wheels 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 further configured to rotate only one of the drive wheels 4680 without rotating the other drive wheel 4680 to rotate the distal head 4620 along the curved staple firing path. In addition, the tissue drive system is further configured to rotate the drive wheel 4680 in the opposite direction to rotate the distal head 4620 along a curved staple firing path having a small or small 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 operably 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 non-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 be operated independently with respect to each other. Similar to the drive wheel 4680, the tissue drive system is configured to rotate the lateral drive wheels 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 can be configured to rotate any suitable combination of the drive wheel 4670 and the 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 comprises a distal head 2620 that includes a staple firing system 2650, an anvil 2660, and a tissue drive system. The tissue drive system includes two

drive wheels

2670 and 2680 that can be independently rotated at the same time or different times 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 the drive wheel 2670 and the drive wheel 2680, respectively; however, the tissue drive system may have any suitable number of electric motors to drive the drive wheel 2670 and the drive wheel 2680. In use, the electric motor can be operated to rotate the drive wheel 2670 and the drive wheel 2680 to produce relative motion between the distal head 2620 and the patient tissue and to move the distal head 2620 along the staple firing path.

Referring now to fig. 75A-75D, the stapling instrument 3700 includes a distal head 3720 that includes an anvil 3760 and a tissue drive system that includes a tissue drive foot 3780. The stapling instrument 3700 is similar in many respects to the stapling instrument 1000, most of which will not be discussed herein for the sake of brevity. Anvil 3760 is movable relative to foot 3780 between a closed or clamped position (fig. 75A and 75D) and an open or unclamped position (fig. 75B and 75C). When the anvil 3760 is open, referring to fig. 75B, the drive foot 3780 may extend to engage and grip tissue. Referring to fig. 75C, the drive foot 3780 is then retracted to produce relative motion between the distal head 3720 and the 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 circumstances, the drive foot 7580 is configured to apply a vacuum to tissue in order to grip and pull the tissue. In at least one such case, the vacuum system is closed, for example, during the operational steps shown in fig. 75A and 75B, and opened during the operational steps shown in fig. 75C and 75D. In such cases, the vacuum can also hold tissue in the distal head 7520 when the anvil 7560 is closed, although other embodiments are contemplated in which the vacuum is closed during the operational step shown in fig. 75D.

Referring now to fig. 65-69, the stapling instrument 3500 includes a distal head 3520 that includes an anvil 3560 and a tissue drive system that includes a vacuum supply line 3570, two vacuum graspers 3580, and two grasper 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 contracts and extends when a vacuum is delivered to an internal plenum of the bellows 3591. When bellows 3591 is contracted, these bellows extend 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 transmitted to the grasper apertures 3582 defined in the tissue engaging surface 3585 of the grasper 3580. This vacuum pressure differential at gripper apertures 3582 can hold patient tissue against tissue engaging surface 3585.

As described above, extension of the grasper 3580 corresponds to application of a vacuum pressure differential to the tissue. When the vacuum supply line 3570 no longer supplies a vacuum pressure differential to the bellows 3591, the bellows 3591 will elastically re-expand and contract and correspondingly retract the gripper 3580, as shown in fig. 67. Similarly, bellows 3591 may also re-extend and retract gripper 3580 when the vacuum pressure differential is reduced. In either case, the vacuum pressure differential at the gripper apertures 3582 may decrease as the gripper 3580 retracts. In some cases, the residual vacuum pressure differential at gripper aperture 3582 may be sufficient to pull patient tissue into tissue chamber 3525 in distal head 3520. In other cases, the residual vacuum pressure differential at gripper apertures 3582 alone may not be sufficient to pull patient tissue into tissue chamber 3525. Accordingly, the grasper 3580 includes a flexible tooth 3586 extending from its tissue engaging surface 3585. 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 teeth 3586 extend from tissue engaging surface 3585 also facilitates such 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 apertures 3582.

Once the patient tissue is positioned within tissue chamber 3525, the tissue can be sutured and/or incised. The supply line 3570 does not supply a vacuum pressure differential during the stapling and/or cutting operation, as doing so may 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 can then be reopened, the distal head 3520 can be moved relative to the tissue, and the vacuum supply can be used to re-extend the tissue gripper 3580 so that the process described above can be repeated, as shown in fig. 69.

Referring to fig. 70-73, the stapling instrument 3600 includes a distal stapling head 3620 that includes a staple firing system 3650, an anvil 3660, a tissue cutting system 3640 and further includes a tissue grasping system that 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 the sake of brevity. That is, the tissue gripping 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 drive 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 drive 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 communicate 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 communicate 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 a 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 may be selectively extended and retracted. In some cases,

feet

3680a and 3680b extend and retract together simultaneously and simultaneously, while in

other cases feet

3680a and 3680b extend and retract at different times.

An alternative embodiment of a stapling instrument 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 driving foot 3680' that has more vacuum holes 3682 defined therein than the tissue driving foot 3680 of the stapling instrument 3600.

Referring now to fig. 47A-47G, the stapling instrument 3000 includes a distal head 3020 that includes a staple firing system, an anvil closure system that includes an anvil 3060, a tissue drive device that includes at least one drive foot 3080, and a tissue holder 3070 that is configured to releasably hold tissue. Referring to fig. 47A, the anvil 3060 is movable from a clamped position to an undamped position to unclamp the patient tissue T. Referring to fig. 47B, the tissue holder 3070 can engage the patient tissue T to hold the tissue in place as the drive feet 3080 are extended, as shown in fig. 47C and 47D. The tissue holder 3070 can engage tissue when the anvil 3060 is opened and/or after the 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 draw the distal head 3020 relative to the tissue and position the distal head 3020 at a new position 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 point, the cycle can 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 grip the patient tissue. Also similar to the above, a vacuum pressure differential from the vacuum source 3090 can be used to extend the drive foot 3080. That is, the drive foot 3080 can be extended using any suitable mechanism.

Referring again to fig. 78, the stapling instrument 3900 further comprises a tissue holder 3970. The tissue holder 3970 can be used with the drive foot 3980 in the same or similar manner as the tissue holder 3070 is used with the drive foot 3080.

For example, fig. 45, 46, 48, and 49 illustrate operational sequences of a stapling instrument that may be used with the stapling instruments disclosed herein (such as stapling instrument 4000 and/or stapling instrument 3900 described above). The stapling instrument 4000 is similar in many respects to other stapling instruments disclosed herein, most of which will not be discussed herein for the sake of brevity. The stapling instrument 4000 includes an anvil drive system 4060, a staple firing system 4050, a tissue cutting system 4040, a tissue gripping system 4090, and a tissue drive system 4080 configured to move the stapling instrument 4000 relative to patient tissue. Fig. 49 shows the operational steps of the stapling instrument 4000, which are carried out 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 understood that adjacent operational steps may occur simultaneously or with at least some amount of overlap, as shown in fig. 46 and discussed in more detail below. Further, the operational steps of fig. 49 may be rearranged in any suitable order.

Referring again to fig. 49, operation 4001 comprises loading a staple cartridge into the stapling instrument 4000 and/or pushing the staple cartridge into position within the stapling instrument 4000. Operation 4002 comprises removing staples from the staple cartridge and operation 4003 comprises placing the staples in place within a staple firing drive 4050. If desired, operation 4004 comprises articulating an end effector of the stapling instrument 4000. That is, operation step 4004 may also occur before and/or during

steps

4001, 4002, and/or 4003. Operation 4005 comprises positioning the end effector on tissue of a patient, and operation 4006 comprises operating an 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 the tissue cutting system 4040. Operation 4007 occurs before operation 4008, but step 4007 and step 4008 may occur simultaneously or with some amount of overlap. Operation 4009 comprises retracting the knife using the tissue cutting system 4040, and this step follows operation 4008. Operation 4010 comprises 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 an anvil drive system 4060. In such cases, the stapling instrument 4000 can hold tissue even if the anvil is opened due to the tissue grasping system. Operation 4012 comprises advancing a foot of tissue drive system 4080. Operation 4013 comprises actuating the tissue gripping system 4090 to loosen tissue, and operation 4014 comprises retracting a foot of the tissue drive system 4080 and advancing the stapling instrument 4000 relative to the tissue.

In addition to the above, FIG. 46 shows 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 position may occur simultaneously or with at least some overlap. Similarly, steps 4002 and/or 4003 comprising advancing staples into position within the staple firing drive means 4050 may occur simultaneously or with some overlap with the following steps: for example, step 4011 of opening the anvil, step 4010 of gripping tissue with tissue gripping system 4090, step 4012 of extending the foot of tissue drive system 4080, step 4013 of releasing tissue with gripping system 4090, and/or step 4014 of retracting the foot of tissue drive system 4080. Further, the step 4001 of reloading another staple cartridge into position within the stapling instrument 4000 may occur simultaneously with or have some overlap with the step 4008 of cutting the tissue and/or the step 4009 of retracting the tissue cutting knife.

In addition to the above, fig. 45 illustrates an actuation cycle of anvil drive system 4060 and tissue drive system 4080 of stapling instrument 4000. The actuation period in fig. 45 is plotted against time t, where a 0 or zero demarcation line on the horizontal time axis represents the beginning of the cyclic sequence of the stapling instrument 4000. Referring to the actuation cycle of the anvil drive system 4060, peak 4006 is associated with step 4006 described above, which includes closing or clamping the anvil to the 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 comprising extending the foot of tissue drive system 4080, and peak 4014 is associated with step 4014 comprising retracting the foot of tissue drive system 4080 and driving stapling instrument 4000 relative to the patient tissue. When comparing the actuation cycles of anvil drive system 4060 and tissue drive system 4080, it can be seen that the anvil is open or opening as the foot is extended. Further, it can be seen that the anvil is open when the foot is retracted and the anvil is closed 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 instrument 4000 sequentially while performing 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 latch certain drive systems and prevent those drive systems 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 instrument 4000 are motorized and in communication with the controller of the stapling instrument 4000, and thus the controller can be used to lock the drive systems. The controller includes a microprocessor, for example, configured to enable electrical latching of one or more drive systems during operation of one or more other drive systems. FIG. 48 is a chart showing which operational steps are prevented from being performed during the performance of other operational steps. For example, during step 4001, in which the staple cartridge is loaded into position, all other operational steps are locked out or prevented from occurring except for step 4004, which articulates the end effector of the stapling instrument 4000, step 4005, which positions the stapling instrument 4000 relative to the tissue, and step 4011, which releases 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 suturing apparatus 4000.

Referring to fig. 90A-90D, the stapling instrument 4300 includes a distal head 4320 that includes a staple firing system 4350, an anvil drive system that includes an anvil 4360, and a tissue cutting system 4340. The stapling instrument 4300 is similar in many respects to the stapling instrument 1000 and the stapling instrument 4400, most of which will not be discussed herein for the sake of brevity. The stapling instrument 4300 further includes

upper foot portions

4370a and 4370b and

lower foot portions

4380a and 4380 b. Similar to the foot 4480 of the stapling instrument 4400, the feet 4370A, 4370B, 4380A, and 4380B can be rotated between an extended position (fig. 90A) and a retracted (fig. 90B-90D) position to move the distal head 4320 relative to the patient tissue T. Referring to fig. 90A, feet 4370A and 4380A comprise a synchronized first pair of feet that move together and grasp the patient tissue as it moves to its extended position. In such instances, foot 4370a and foot 4380a move toward each other to apply a compressive force or pressure to the tissue. When

feet

4370a and 4380a are retracted, referring to fig. 90B,

feet

4370a and 4380a pull on the tissue to move distal head 4320 relative to the tissue. Once the

feet

4370a and 4380a have been retracted, referring to FIG. 90C, the staple firing system 4350 and the tissue cutting system 4340 staple and sever 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 before the tissue cutting system 4340. That is, cutting tissue prior to stapling can result in unnecessary bleeding. It is noted, however, that the

foot portions

4370a and 4380a apply a clamping pressure to the tissue while the stapling instrument 4300 staples and cuts the tissue. Once the tissue has been stapled and incised, referring to FIG. 90D,

feet

4370a and 4380a are moved away from the tissue to loosen the tissue.

As described above,

feet

4370a and 4380a are operably coupled together such that the feet move together in pairs. The two feet rotate together in pairs, clamp together in pairs, and unclamp together in pairs. Various alternative embodiments are contemplated wherein only one of the

feet

4370a and 4380a is moved to clamp and unclamp the tissue; however, the

feet

4370a and 4380a will still rotate together as a pair. The synchronized second pair of feet, including

feet

4370b and 4380b, move in the same manner as the synchronized first pair of feet, including

feet

4370a and 4380a, and therefore, for the sake of brevity, a discussion of their 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 grip 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 fully synchronized. In at least one such instance, the first pair of feet extends and retracts independently of the second pair of feet to rotate the distal head 4320 along the curved staple path.

As noted above, the stapling instruments disclosed herein are configured to staple tissue of a patient. These stapling instruments are also configured to cut the tissue. Referring to fig. 95 and 96, the stapling instrument 5000 comprises a distal head 5020 that comprises a staple firing system, a tissue cutting system 5040, and an anvil 5060 that is configured to deform staples deployed by the staple firing system. The tissue cutting system 5040 includes a knife bar 5042 that includes a knife edge 5045 defined at a distal end 5044 thereof. In use, the knife bar 5042 is configured to translate laterally through the distal head 5020 during a tissue cutting stroke. The tissue cutting stroke of the knife bar 5042 extends between a first, unactuated position, shown in fig. 95, and a second, actuated position. During a tissue cutting stroke, the knife edge 5045 extends between a tissue compression surface 5025 and a tissue compression surface 5065 defined on the anvil 5060. The blade 5045 may also extend into the distal head 5020 and/or the 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 the tissue cutting stroke, the knife bar 5042 moves orthogonally relative to the longitudinal head axis HA. The tissue cutting system 5400 further includes 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 camming surface configured to engage a corresponding camming surface 5043 defined on a distal end 5044 of the knife bar 5042. The cutting actuator 5046 may also be configured to advance the knife bar 5042 in any suitable manner. In other embodiments, the knife bar 5042 may move without the cutting actuator 5046.

Referring to fig. 98, the stapling instrument 5100 includes a distal head 5120 that includes a staple forming anvil 5160. The stapling instrument 5100 further includes a staple feed system 5190, a staple alignment system 5180, and a staple firing system 5150. The staple firing system 5150 includes staple drivers 5151 that are longitudinally movable 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 a staple leg 5132 extending from the base 5131. Referring to fig. 100 and 101, the staple drivers 5151 are 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 the staple firing stroke. At this point, referring to FIG. 102, the staple drivers 5151 return to the beginning or unfired point of the staple firing stroke so that another staple firing stroke can 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 also includes a tissue cutting knife 5140 that is 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 first cluster of three staples 5130 positioned on a first side of the cutting path CP formed by the knife 5140 and a second set or second cluster of three staples 5130 positioned on a second side of the cutting path CP. The staple firing system 5150 deploys the first staple set and the second staple set simultaneously; 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 can 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 within the distal head 5120 such that another staple firing stroke can be performed. In various circumstances, the staples 5130 can be reloaded during and/or after the tissue cutting stroke.

Referring primarily to fig. 97, 100, and 102, the staple advancement 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 a staple 5130 from a staple feeding system 5190. The staples 5130 are arranged in six stacks or columns that are 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 the staples 5130 into the staple cavities 5121; however, in alternative embodiments, the staple pusher 5191 can be configured to sequentially load the staples 5130 into the staple cavities 5121. Referring to fig. 98 and 99, the staples 5130 within a 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 that is 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 drivers 5151 and staple pushers 5191 move parallel, or at least substantially parallel, to one another. Due to the design and/or other spatial constraints of the staple drivers 5151 and staple pushers 5191, referring to fig. 97 and 103, the stapling instrument 5100 further includes a staple alignment system that includes a staple pusher 5180 that is configured to work in conjunction with the staple pusher 5191 to align the staples 5130 with the staple drivers 5151. The staple pusher 5191 pushes the staples 5130 longitudinally, and the staple pusher 5180 pushes the staples 5130 laterally.

Referring to fig. 104-105D, the stapling instrument 5200 includes a distal head 5220 that includes a staple firing system 5250 configured to deploy staples 5230, a tissue cutting system, and an anvil 5260 that includes forming pockets configured to deform the staples 5230. The staple firing system 5250 comprises 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 comprises a cam 5253 that is configured to engage a shoulder 5255 defined on the staple drivers 5254 and laterally displace the drivers 5254, as shown in fig. 105B. The staple firing system 5250 further comprises 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 springs 5224 resiliently return the lateral staple drivers 5254 to their unactuated positions.

Referring to fig. 104 and 105A, the staple firing drive 5250 further comprises longitudinal staple drivers 5257 that are 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 that receives a portion of the longitudinal staple drivers 5257 therein. More specifically, each longitudinal staple driver 5257 includes a cam portion positioned in the drive cavity 5256 that is longitudinally driven by a cam surface 5258 defined in the drive cavity 5256 as the lateral staple drivers 5254 are laterally moved, as shown in fig. 105B. As a result of the above, rotational movement of the rotatable actuator 5252 is converted into lateral translation of the lateral staple drivers 5254, which is converted into longitudinal translation of the longitudinal staple drivers 5257. The longitudinal movement of the staple drivers 5257 drives the staples 5230 against the anvil 5260 to deform the staples 5230 as illustrated in FIG. 105B. The longitudinal staple drivers 5257 comprise staple supports 5251 defined therein that are 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 drivers 5254 retracts the longitudinal staple drivers 5257 to their unactuated position. More specifically, the drive cavity 5256 further comprises camming surfaces 5258' configured to drive the longitudinal staple drivers 5257 in opposite directions until the staple drivers 5257 are reset in their unactuated or unfired positions, as illustrated in fig. 105D. Notably, when the longitudinal staple drivers 5257 are retracted, the anvil 5260 is moved to an 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 onto the tissue, as illustrated in fig. 105A, wherein another staple firing stroke of the staple firing drive 5250 can be performed.

As described above, the connected rows of staples can be used to feed and re-feed the staple firing system of the stapling instrument. In other instances, the entire staple cartridge can be used to feed and re-feed the staple firing system. Referring to fig. 106, the stapling instrument 5300 includes a shaft 5310, a distal head 5320, and an articulation joint 5370 that rotatably connects the distal head 5320 to the shaft 5310. The stapling instrument 5300 further includes a plurality of staple cartridges 5330 "stored in a 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 comprises a cartridge body that is disassembled and deployed with the 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, a staple cartridge 5330 "comprises a cartridge body 5333 comprising apertures defined therein. The apertures include 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 deployed on a first side of a tissue incision path formed by a tissue cutting blade, and a second set of staples 5330 is deployed on a second side of the tissue incision path. The staples 5330 are further arranged in a cluster 5330' of three staples deployed together, but the cluster of staples can include 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 can be used. The staple cluster 5330' is ejected from each

side

5334 and 5335 of the cartridge body 5333 and deforms against the anvil 5360 during each staple firing stroke of the stapling system. In various alternative embodiments, the staple clusters 5330' can be deployed sequentially from the first side 5334 and the 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 one another, 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, cartridge body 5333 can, for example, be configured 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, staple clusters 5430 ' are attached to one another to form staple strips 5430 ", wherein one or more staple clusters 5430 ' are separated from other staple clusters 5430 ' to load staples into distal head 5320. Although the staple cluster of the above-described embodiments includes three staples, the staple cluster may include any suitable number of staples, including, for example, two staples or more than three staples.

Referring to fig. 109 and 110, the 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. Stapling instrument 5400 also includes staple strips 5430 "of fig. 108 stored in shaft 5410. The strip of staples 5430 "can be stored within the cartridge body 5333, as described above, or can be stored within the shaft 5410 without a cartridge body. Strip 5430 "may include any suitable number and/or cluster of staples. In at least one instance, staple strip 5430 "includes, for example, 588 staples.

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 the tissue of a patient. The stapling instrument 5500 also includes a first strip of staples 5530a "and a second strip of staples 5530 b" stored in a shaft 5510. Strip staples 5530a "and 5530 b" are comprised of staples 5430 arranged in staple clusters 5430'. The nailing strips 5530a "and 5530 b" are nested such that the bases of the nails 5430 face in opposite directions.

Referring to fig. 113 and 114, the 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 the patient's tissue. Stapling instrument 5600 also includes a first staple bar 5630a "and a second staple bar 5630 b" stored in shaft 5610. Staple strips 5630a "and 5630 b" are comprised of staples 5430 arranged in staple clusters 5430'. Strips 5630a "and 5630 b" 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 advancing system advances the staple cartridge 5330 "through the articulation joint 5370 into the distal head 5320. Thus, the size of the staple cartridge 5330 "and/or the staples 5330 can 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 includes a first staple bar 5730 'that includes staples 5730 attached to a first carrier 5760'. More specifically, the spike 5730 is attached to the first carrier 5760 'at a tab 5761'. Each spike 5730 includes a base 5731 and a leg 5732 extending therefrom, wherein base 5731 is connected to first spike strip 5730 'by a tab 5761'. The stapling instrument 5700 also includes a second spike 5730 "that includes a spike 5730 attached to a second carrier 5760" at a tab 5761 ". Carriers 5760 'and 5760 "each include an array of apertures 5762 for feeding staple strips 5730' and 5730" into the distal head of stapling instrument 5700, as described in greater detail below.

Staple strips 5730' are stored in the shaft of the stapling instrument 5700. In the stored condition of spike 5730', the spike 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 includes a staple feeding system including a drive wheel configured to push a staple bar 5730' in the distal head of the stapling instrument 5700. The drive wheel includes an array of drive pins extending thereabout configured to engage the apertures 5762 of the first carrier 5760 'and drive the first carrier 5760' into the distal head. Second staple strip 5730 "is also stored in the shaft of stapling instrument 5700. In the stored condition 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 staple feeding 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 nail feeding system on opposite sides. Referring to fig. 116, as splines 5730 ' and 5730 "are fed into the distal head, splines 5730 bend downward around tabs 5761 ' of spline 5730 ' and tabs 5761" of spline 5730 ", respectively. In at least one instance, the frame of the distal head includes a cam surface configured to bend the spike 5730 downward. In some instances, the stapling instrument 5700 includes one or more actuators configured to bend the staples 5730 downward about a mandrel positioned below tabs 5761' and 5761 ", for example. Once displaced to the downward position of spikes 5730, these spikes are separated from spike 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 splines 5730 from tabs 5761 'and 5761 "as splines 5730' and 5730" are advanced into the distal head. In some instances, stapling instrument 5700 also includes one or more shears that are actuated to separate staples 5730 from staple strips 5730' and 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 a staple cluster from staple strips 5730 'and 5730 ", and then advance carriers 5760' of staple strips 5730 'and carriers 5760" of staple strips 5730 "so that another staple cluster can be separated from staple strips 5730' and 5730". Referring to fig. 118, once the staples 5730 have been separated from the carriers 5760 'and 5760 ", the empty or stripped portions of the carriers 5760' and 5760" are fed back into the shaft of the stapling instrument 5700. Thus, the motion of feeding a new staple 5730 into the staple firing system also feeds the empty carriers 5760' and 5760 "into the shaft.

Referring to fig. 119, a staple cluster 5830' includes four staples 5830 adhered together by at least one adhesive 5835. Each staple 5830 includes a base 5831 and two staple legs 5832 extending from the base 5831. Notably, the staple legs 5832 are not coplanar with the base 5831. In contrast, the base 5831 exists in a base plane and the staple legs 5832 exist in a leg plane. The base plane is parallel, or at least substantially parallel, to the leg plane, but embodiments are envisaged in which the base plane and the leg plane are not parallel. In either case, two of the staples 5830 of staple cluster 5830' face inwardly, while two of the staples 5830 face outwardly. A staple 5830 faces outward when its base plane is closer to the center of the staple cluster 5830' than its leg plane. Accordingly, the staples 5830 face inwardly when the leg planes of the staples 5830 are closer to the center of the staple cluster 5830' than the base planes 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. Adhesive connectors 5835 releasably hold staples 5830 together. The adhesive connectors 5835 break before the staples 5830 are implanted in the patient tissue; however, alternative embodiments are contemplated in which the adhesive connectors 5835 do not break before the staples 5830 are implanted in the patient tissue. 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 closure 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 staple cluster 5930 'or a column of staple clusters 5930' therein. Each staple cluster 5930' includes four staples 5930, but it can include any suitable number of staples. Each staple 5930 includes a base 5931 and two staple legs 5932 extending therefrom. The base 5931 and the leg 5932 are coplanar or at least substantially coplanar. The staples 5930 are releasably attached to one another by at least one adhesive.

In addition to the above, each staple cluster 5930' includes one or more guides 5935. Guides 5935 are defined on the sides of the cluster 5930' and are configured to be received within notches 5925 defined in the staple cavities 5921. More specifically, the guide 5935 is closely received by the side walls 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 cluster 5930' remains 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 can be implanted with the staple 5930.

Referring to fig. 121, in addition, the stapling instrument 6000 includes a shaft, a distal head 6020 that includes an anvil 6060, and a staple firing system. In this embodiment, the staple firing system loads the 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 the staples 6030 as they are pushed toward the anvil 6060.

Referring to fig. 122-125, the stapling instrument 6100 includes a shaft, a distal head 6120, a staple loading system, a staple firing system, an anvil drive system, a tissue grasping system, and a tissue drive system configured to move the distal head 6120 relative to the patient tissue. The drive system of the stapling instrument 6100 includes a rotatable foot 6180 configured, similar to above, to grip tissue of the 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 while the feet 6180 are extended 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 as shown in fig. 124. Because of the smaller area of the tissue engaging surface 6175 compared to the cross-sectional thickness 6125, the tissue holder 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 the tissue engaging surface 6175 is about 25% of the 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 the patient's tissue. Referring to fig. 126 and 127, the tissue drive system includes a rotatable foot 6280 that moves to an extended position (fig. 126) and then retracts (fig. 127) to grip 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 can be extended and retracted simultaneously to move the distal head 6220 along a linear path, or separately to rotate the distal head 6220, although only one foot 6280 is shown in fig. 128A for illustrative purposes. Fig. 128, which corresponds to fig. 128A, shows the anvil 6260 in a fully clamped state such that the anvil 6260 and the feet 6280 cooperate to grip 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 the 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 legs 6232 of the staples 6230 have been fully deformed into the B-shaped configuration; however, other deformed configurations of the staples 6230 may be suitable. Referring to fig. 131 and 133, a staple firing system 6250 includes a firing bar 6255 and a plurality of staples 6230 stored within recesses 6252 defined in the 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 that is configured to push the base 6231 of a staple 6230 positioned therein. Fig. 134 illustrates two staples 6230 in an unfired state positioned in staple cavities 6221 defined in the distal head 6220 and firing bar 6255 of the staple firing system 6250.

Referring again to fig. 134, the sides of the staple cavities 6221 include recesses 6222 defined therein. The sides of the staple cavities 6221 also include drag surfaces 6223 positioned intermediate the recesses 6222. When the firing bar 6255 is pushed 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 pushed by the drag surface 6223. Referring to fig. 136, when the firing bar 6255 is retracted after the first firing stroke, the staples 6230 catch on the drag surface 6223 causing the firing bar 6255 to slide 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 the surgical instrument 6200 being reopened to release patient tissue such that the distal head 6220 may 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 6330' positioned on both sides of the 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 including staples 6330, staples 6330', and staples 6430 ". The staples 6430 "are arranged in rows on both sides of the tissue cut line 6340. More specifically, the staples 6430 "are arranged in a row of staples positioned intermediate both the inner and outer groups of staples 6330, 6330'.

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 further comprises a staple feeding system 6590 configured to produce and supply continuously fed staples 6530 to the distal head 6520. The staple feeding system 6590 includes a spool 6592 operatively coupled to an electric motor. The spool 6592 includes a 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 passage 6514 defined in the shaft 6510 and the articulation joint 6570. In use, the motorized reel 6592 pushes the wire 6594 into the distal head 6520. As described in more detail below, the distal head 6520 further comprises a forming mandrel configured to deform the wire 6594 into the staples 6530. The spindle is driven by an electric motor and/or actuator, but may be actuated in any suitable manner. As also described in more detail below, the distal head 6520 comprises a knife or cutting member configured to cut the wire 6594. The cutting member is driven by an electric motor and/or actuator, but may be actuated in any suitable manner. Once the staples 6530 have been formed and separated from the wire 6594, the staples 6530 can be deployed and deformed against the anvil 6560 of the stapling instrument 6500.

Referring to fig. 141, the surgical instrument 6500 further comprises a staple forming system 6580 configured to form staples 6530 from the 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 a staple 6530 has been deployed and/or moved out of the forming cavity 6522, another staple 6530 may be formed within the cavity 6522. In certain alternative embodiments, the wire segments are cut from the wire 6594 before being formed into the staples 6530. In either case, the staple 6530 may comprise, for example, a substantially U-shaped configuration. Alternatively, the line segments may be shaped in a substantially V-shaped configuration. Further, for example, the stapling instrument 6500 may be configured to manufacture and deploy any suitable fastener, such as a tack and/or a clamp.

Referring to fig. 158 and 159, the suturing apparatus 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 body of patient P through trocar TC. Trocar TC includes a passageway extending therethrough that allows distal head 7320 and a portion of shaft 7310 to be inserted into a patient. In other instances, the distal head 7320 may be inserted into the 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 passage extending 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, e.g., through loading port 7312, and then pushed into distal head 7320. The stapling instrument 7300 further includes a cartridge pusher system configured to push the staple cartridge 7330' into the end effector 7300.

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

In addition to the above, more than one staple cartridge may be loaded into the stapling instrument 7300. The staple cartridges may be inserted into the stapling instrument 7300 such that the staple cartridges 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 staple cartridge is used first, and the most proximal staple cartridge is used last. This arrangement allows for pre-planning of the surgical procedure, thereby wasting little time (if any) to load the stapling instrument 7300 during the surgical procedure. Alternatively, the staple cartridges may be fed into the 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 cartridges.

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 suturing apparatus 7300 can also include a door configured to cover the loading port 7312. In at least one instance, the door can be sealed when closed to prevent or inhibit the ingress of fluids and/or contaminants into the stapling apparatus 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 a cluster of staples (such as staples 7330), for example, from a distal-most staple cartridge. 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 includes a tissue drive system 7380 configured to move the distal head 7320 relative to the patient tissue after a staple firing stroke.

Referring to fig. 168 and 169, the suturing apparatus 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 feeding system configured to feed a staple cartridge 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, staples 7930 are peeled away from the distal-most staple cartridge 7930' and then fired against anvil 7960. As described in greater detail below, the suturing apparatus 7900 further includes an articulation drive system 7980 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 articulating 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 is capable of articulation laterally or in a side-to-side direction. In at least one such instance, the distal head 7920 is capable of articulation within a range that includes 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, for example. The articulation drive system 7980 is configured to drive or actively articulate the distal head 7920 through this 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 comprises a first wire and the second lateral driver 7984 comprises a second wire. Such a wire is suitable for pulling the distal head 7920.

Referring to fig. 169, the distal head 7920 is also capable of articulating in a forward and/or rearward direction. In at least one such instance, the distal head 7920 is capable of articulation within a range that includes, for example, about 25 degrees in a rearward direction and about 25 degrees in a forward direction. In certain embodiments, although not shown, the articulation drive system 7980 is configured to actively articulate the distal head 7920 in a forward direction and a rearward (fig. 169) direction. In alternative embodiments, the distal head 7920 may be passively articulated in a forward and rearward direction. In such embodiments, the suturing apparatus 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 a 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 and left-right planes and can be at compound angles 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 the distal head 7920 to move relative to the shaft 7910. In various circumstances, when the distal head 7920 is unlocked, the distal head 7920 can 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 can then be locked in its articulated position. To return the distal head 7920 to its unarticulated position, the distal head 7920 can 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 unarticulated position. In any event, the articulation lock can prevent or at least inhibit backdriving of the distal head 7920 in response to external and/or internal forces and torques.

In addition to the above, the articulation joint 7970 of the stapling instrument 7000 allows the distal head 7920 to articulate 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 articulation axis and the second articulation axis extend in orthogonal planes, but may extend in any suitable transverse plane. In each case, 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. Damping system 8080 includes a first link 8082, a second link 8084, and a damper 8085. The first link 8082 is pinned to the distal head 7920 at a pivot 8081. The first link 8082 is also pinned to the second link 8084 at a pivot 8083. The pivot 8081 and pivot 8083 allow the damping system 8080 to accommodate various articulation motions of the distal head 7920. Damper 8085 includes a housing 8087 mounted to shaft 7910 and a damping medium 8088 contained in a chamber defined in housing 8087. The second link 8084 includes a piston 8086 defined on a proximal end thereof that is positioned in the housing bore and is configured to move through a damping medium 8088 when the distal head 7920 is articulated. The damping medium 8088 flows through and/or around the piston 8086, thereby allowing but slowing relative movement between the piston 8086 and the housing 8097. Accordingly, the damping medium 8088 allows but slows the movement of the distal head 7920 relative to the shaft 7910. Abrupt 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 impact patient tissue. For example, damping medium 8088 may include any suitable medium, such as damping grease.

Referring to fig. 171, the suturing apparatus 8100 includes a damping system 8180 configured to control or slow the articulation of the distal head 7920. Damping system 8180 includes a connector 8182 and a damper 8185. Link 8182 is pinned to distal head 7920 at pivot 8181. The first connector 8082 is flexible, allowing the damping system 8180 to accommodate various articulation motions of the distal head 7920. Damper 8185 includes a housing 8187 rotatably mounted to shaft 7910 and a damping medium 8188 contained within a chamber defined in housing 8187. The link 8182 includes a piston 8186 defined on a proximal end thereof that is positioned in the housing aperture and is configured to move through the damping medium 8188 as the distal head 7920 articulates. Damping medium 8188 flows through and/or around piston 8186, allowing but slowing 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. Abrupt 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 impact patient tissue. For example, damping medium 8188 may include any suitable medium, such as damping grease.

Referring to fig. 172, a suturing apparatus 8100 can be inserted into a patient P through a trocar TC and can be moved relative to a target tissue TC. To some extent, trocar TC can move relative to patient P, and also to some extent, stapling instrument 8100 can move relative to trocar TC. However, such movement may cause the shaft 7910 to move 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, for example, 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 circumstances, 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 instances, 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 instances, the distal head 7920 can adaptively float to follow the staple firing path.

Referring to fig. 34 and 35, the stapling instrument 2500 includes a shaft 2510, a distal head 2520, and an articulation joint 2570 rotatably connecting the distal head 2520 to the shaft 2510. The shaft 2510 extends along a longitudinal shaft axis LA, and the 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 a first connection 2581, a second connection 2582, and a damper 2585. First link 2581 is pinned to distal head 2520 at pivot 2584. First link 2581 is also pinned to second link 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 distal head 2520 is not articulated, first connector 2581 is aligned with second connector 2582 along the longitudinal axis. Referring to fig. 35, as distal head 2520 is articulated, first connector 2581 is transverse to second connector 2582.

The dampener 2585 includes a housing mounted to the shaft 2510 and a dampening medium 2586 contained in a chamber defined in the housing. Second connector 2582 includes a piston defined on a proximal end thereof that is positioned in the housing bore and is configured to move through damping medium 2586 as distal head 2520 is articulated. Damping medium 2586 flows through and/or around the piston, allowing but slowing relative movement between the piston and the housing. Accordingly, the damping medium 2586 allows but slows the movement of the distal head 2520 relative to the 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 the sake of brevity. The stapling instrument 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 connect a shaft assembly (such as shaft assembly 1200) to, for example, the handle 2100. The handle 2100 also includes a replaceable battery pack 2160 that is releasably attached to the housing 2110 and removably positionable within a cavity 2115 defined in the housing 2110. Battery pack 2160 supplies power to display 2130 and/or a motor drive system housed within 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 evaluating the status of the staple firing system. The display 2130 also includes controls, for example, for evaluating and/or modifying the speed at which the staple line is applied, the direction in which the staple line is applied, and/or any performance thresholds that have been reached, exceeded, or are about to be exceeded by the stapling instrument 2000. 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. The status control 2140 includes a window 2141 that includes a window header 2142. The state control 2140 further includes an image window 2145 that is configured to display information regarding the tissue being stapled, the staple firing path, and/or any other information available to the clinician for operating the 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 the staple path around certain anatomical features in the patient tissue T (such as the blood vessel V). The status control 2140 is a digital control and/or display and is in signal communication with the controller of the stapling instrument 2000.

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

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

Referring to fig. 16, the display 2130 also includes failure threshold controls 2180 that are configured to manage failure thresholds of the stapling instrument 2000 when they occur. For example, a threshold amount 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 the user and/or stop the stapling instrument 2000 via a failed threshold control 2180. The user may override or otherwise manage certain malfunctions, which may allow the stapling instrument 2000 to continue applying staple lines. Failure threshold controls 2180 allow the user to manage these failures. Other faults may not be covered. In such cases, the fault threshold control 2180 is configured to be able to display to the user how the fault cannot be covered and/or how to resolve the fault 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 failure threshold control 2180 is a digital control and/or display and is in signal communication with the controller of the stapling instrument 2000.

Turning now to fig. 18, the stapling instrument 2000 further includes a visual acquisition system, discussed in more detail below, and the display 2130 further includes an image window 2135 configured to display real-time video images or the like from the visual acquisition system. Display 2130 also includes menu 2131 extending along the left side of image window 2135; however, menu 2131 may be placed in any suitable location on display 2130. Menu 2131 includes the above-described status controls 2140, speed controls 2150, fault threshold controls 2180, and direction controls 2190. Menu 2131 also includes setup controls 2132 that can be used to select and/or rearrange windows and/or controls on display 2130. The menu 2131 also includes a stop control 2136 that can immediately stop the progression of the stapling instrument 2100 along the staple firing path. The menu 2131 is a digital control and/or display and is in signal communication with a controller of the 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 located 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 an alternative view of the stapling instrument 2000. For example, the first view window 2133 provides a side view of the stapling instrument 2000 in the surgical site to the user, and the second view window 2134 provides a top view of the stapling instrument 2000 in the surgical site to the user. These additional views may be provided by one or more digital cameras on the stapling instrument 2000 and/or from other surgical instruments (such as an endoscope), for example, in the surgical site. 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, a controller of stapling instrument 2000 can interpret 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 the 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 the stapling instrument 2000 may automatically control the speed. In such cases, the controller is configured to assess a characteristic of the tissue being stapled, such as its thickness and/or density, for example, and adjust the speed of the staple firing system and/or the tissue drive system accordingly. For example, if the controller determines that the tissue being stapled is thick, 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, the controller may speed up the stapling instrument 2000. In addition to the above, referring to fig. 19, the speed control 2150 of the stapling instrument 2000 includes options for the user to select between an automatic speed control 2158, in which the stapling instrument 2000 controls the speed of the stapling instrument 2000, and a manual speed control 2159, in which the user controls the speed of the stapling instrument 2000.

Referring to fig. 20, the stapling instrument 2200 includes a display 2230. The stapling instrument 2200 is similar in many respects to the stapling instrument 2000 and the display 2230 is similar in many respects to the display 2130, most of which will not be discussed herein for the sake of brevity. The display 2230 includes a menu 2231 and a central 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. Each projected actuation 2244 shows the path that tissue T will be incised and the location at which the staple cluster 2245 will be deployed 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 the other projected actuations 2244 so that the user can distinguish between an upcoming staple firing and a subsequent projected staple firing. Such highlighting may include, for example, different colors and/or color intensities of the projected actuation 2244. In at least one instance, the display actuation 2244 of the staple firing path 2243 can gradually decrease in intensity as it moves away from the distal head of the stapling instrument 2200.

In addition to the above, the display 2230 can be 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 central image window 2235. Similar to staple firing path 2243, staple firing path 2243 'is shown as a series of actuations or staple firings 2244'. Each projected actuation 2244' shows the path along which the tissue T is to be cut and the location at which the staple cluster 2245 is to be deployed in the tissue T. The menu 2231 includes staple line controls 2240 that can be actuated by a user of the stapling instrument 2200 to edit the staple firing path 2243 to form an alternative staple firing path 2243'. Once the alternate staple firing path 2243 'has been established, it may be saved and the stapling instrument 2200 may be operated to follow the alternate staple firing path 2243'. As shown in fig. 20, the staple line control 2240 includes an actuatable editing sub-control 2241 and an actuatable saving 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 an 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, staple firing paths 2243 are displayed in a first image stack or layer, and alternative staple firing paths 2243 are 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 a staple firing path 2243 and/or an 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 fingers such that the staple firing path can be modified by the user dragging his or her fingers. 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 expected staple firing path and one or more alternative staple firing paths. The controller of the stapling instrument 2200 is configured to generate one or more alternative staple firing paths and display these alternative staple firing paths on the 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 that manipulates the stapling instrument 2200 around blood vessels within the tissue T may identify those blood vessels and provide or suggest an alternative staple firing path.

Referring to fig. 22, the display 2230 includes a menu including a plurality of controls configured to modify the staple firing path as 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 is performing a series of staple firing strokes to form a staple path. For example, the menu 2231 includes a view control 2232 to change the video images displayed in the center image window 2235. In at least one such case, the video control can be used to toggle back and forth between different video feeds. The menu 2231 also includes a staple line control 2240, as described above, that is configured to modify the staple firing path. The staple firing system of the stapling instrument 2200 can be activated by the user actuating the stapling control 2234 in the menu 2231 and deactivated by the user actuating the 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. Due to this sliding joint, a user of the stapling instrument 2200 may 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 though 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 and the shaft assembly of the stapling instrument 1000, clinicians C can maintain the handle displays in a constant orientation relative to the clinicians 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 that includes a grip 7020 and a shaft assembly 1200 assembled to the handle 7010. The handle 7010 also comprises 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 the sake of brevity. In use, the display 7030 can be rotated relative to the handle 7010 to maintain a suitable orientation of the display 7030 relative to the clinician C and/or any other frame of reference.

Fig. 180 illustrates 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 a clinician's hand to enhance control and comfort. The handle 1500 includes one or more interactive controls 180 configured to provide navigation commands to the end effector of the surgical instrument 100. In various instances, the one or more interactive controls 180 are configured to be capable of providing user commands corresponding to selection of one or more items. Interactive control 180 is positioned on handle 1500 at a location that allows the clinician to easily perform operations, such as a location within the reach of the clinician's thumb. In various instances, the controls 180 are comprised of, for example, various types of switches and/or buttons. In various instances, interactive controls 180 include, for example, a toggle switch, a simulated lever, a rocker, a cross key, and/or any other suitable interactive controls capable of facilitating communication of user commands to the 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 nail mode. In various display modes, data and/or images relating to the surgical procedure and/or the state of the surgical instrument 100 are displayed. In view mode, the touch sensitive display 1510 displays multiple views of the surgical site, including, for example, a side view and a top view. The side and top views are shown in

separate frames

1514, 1516 of the touch-sensitive display 1510, although the side and top views can be displayed in any suitable manner. As described above, the clinician can focus on a particular view by switching the desired view into an enlarged centralized frame 1518 using interactive controls 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 the clinician's stylus or finger. The input device 1530 is described in more detail below.

To create a sterile environment for the surgical instrument 100, a sterile barrier 190 is overlaid over the handle 1500, as shown in fig. 181. As will be discussed in more detail below, the sterility barrier 190 is constructed, for example, of a light-transmissive elastomeric material (such as plastic). The sterile barrier 190 extends around the handle 1500 and onto a proximal portion of the shaft 200. Sterile barrier 190 includes one or more preformed regions 192 configured to fit over interactive control 180. The preformed region 192 facilitates alignment of the sterile barrier 190 over the handle 1500 of the surgical instrument 100. The sterile barrier 190 is stretched over the touch sensitive display 1510 to form a smooth, uniform barrier or at least a substantially smooth, uniform barrier. An attachment member 194, such as a clamp, for example, secures the sterile barrier 190 in place around the perimeter 193 of the touch-sensitive display 1510. The sterile barrier 190 fits loosely around the remaining components of the handle 1500, and the sterile barrier 190 is cinched 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 various components of the handle 1500 from exposure to bodily fluids and/or contaminants. Covering the sterile barrier 190 over the proximal portion of the handle 1500 and 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 illustrates a touch sensitive display assembly 500. The touch sensitive display assembly 500 includes a sterile barrier 190 and a touch sensitive display 1510. In some cases, touch sensitive display 1510 functions 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 is stretched over the touch-sensitive display 1510 in a uniform or nearly uniform manner. Attachment members 194 (fig. 181) hold sterile barrier 190 in its stretched position in a manner that creates a gap 1520 between sterile barrier 190 and insulating layer 1511. Gap 1520 spans a distance of several millimeters between insulation 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 insulation layer 1511.

The conductive particles 191 are dispersed throughout the sterile barrier 190, providing the sterile barrier 190 with a specific capacitance. Sensing mechanism 1513 of touch sensitive display assembly 500 includes, for example, a plurality of pixels 1515 and a material configured to form an electrode, such as indium tin oxide. In various instances, 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, sensing mechanism 1513 is configured to be able to detect when sterile barrier 190 is attached. More specifically, sensing mechanism 1513 detects attachment of sterile barrier 190 by a particular capacitance of 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. Sensing mechanism 1513 is configured to be able to detect the additional capacitance of input device 1530 and distinguish the capacitance of input device 1530 from the capacitance of 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 produces a higher density of conductive particles 191, and thus a higher capacitance, in the area around the contact points of the input device 1530. Pixels 1515 of sensing mechanism 1513 are activated or energized near the point of contact due to the change in charge at the point of contact in sensing mechanism 1513.

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 1530 consists of a clinician's finger surrounded by a latex glove, for example. Medical latex gloves are typically thin enough not to interfere with the conductive qualities of the clinician's fingers. Where the glove worn by the clinician is expected to degrade the conductive quality of the clinician's fingers, the settings of the touch sensitive display 1510 can 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 sterility barrier 190 of the touch-sensitive display assembly 500. As noted 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 activated pixel clusters 1517 and activated pixel clusters 1519. During the inactive state of touch sensitive display 1510, there is a low level of capacitance across all pixels 1515 (FIG. 182) in the touch sensitive display. When input member 1530 (fig. 182) contacts sterile barrier 190 and activates touch-sensitive display 1510, pixels 1515 associated with

pixel clusters

1517 and 1519 are activated to have a new higher capacitance. As input device 1530 continues to contact sterile barrier 190, pixels 1515 in

pixel clusters

1517 and 1519 become activated. Sensing mechanism 1513 detects the position of

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 the active pixel cluster within the x-electrode 1542 of the touch-sensitive display 1510 and the capacitance detected by the sensing mechanism 1513. A first capacitor C₁Indicating a low level or unactivated capacitance present on pixels 1515 of touch-sensitive display 1510 prior to application of sterile barrier 190. By way of reference, the capacitance C₀Represents a detected zero capacitance, and a capacitance C₁Representing a capacitance greater than zero. Second capacitor C₂Indicating the threshold capacitance. When the threshold capacitance C is exceeded₂At this time, the surgical instrument 100 identifies that the sterile barrier 190 is attached to the touch-sensitive display 1510. In graphical representation 1550, when the detected capacitance is above the threshold capacitance C₂When attached to the touch sensitive display 1510, the sterile barrier 190 is attached. Third capacitor C₃Representing another threshold capacitance. When sensing mechanism 1513 detects a capacitance greater than threshold C₃Electricity (D) fromWhen so desired, the surgical instrument 100 recognizes that the input device 1530 is in contact with the sterile barrier 190. In graphical representation 1550, when the detected capacitance exceeds a threshold capacitance C₃Twice, the input 1530 is in contact with the sterile barrier 190 in two locations. 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 below C₃But greater than or equal to C₂The capacitance of (c). When sterile barrier 190 is removed from touch-sensitive display 1510, the capacitance detected by clusters 1517 and pixels 1515 in clusters 1517 returns below C₂But greater than or equal to C₁The capacitance of (c).

Returning to fig. 182, touch sensitive display 1510 is alternatively a resistive sensitive display. In at least one such embodiment, the sterile barrier 190 is constructed of a flexible material to allow the sterile barrier 190 to flex in response to a 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 capable of detecting the location and pressure resulting from the force F applied by the input device 1530. Various user commands are associated with a particular location on touch-sensitive display 1510, and the location of the detected pressure will correspond to one of the various user commands.

Referring to fig. 24, the 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 the sake of brevity. The display 2430 comprises a touch screen that includes an image display 2435. The image display 2435 provides an image of patient tissue T to be sutured. A user of the stapling instrument 2400 may use the stylus 2220 to pull one or more potential staple lines, for example, over the tissue T. For example, a 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 of the two different staple lines 2444 and 2444' to follow. Similarly, a user of the stapling instrument 2400 can use a stylus to modify the staple line 2444 to an alternative staple line 2444'.

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 above tissue T. Referring to fig. 25, the image of the tissue T may be a three-dimensional image viewed over the surface of the tissue T. In such cases, the controller is configured to map a three-dimensional staple firing path above the tissue T. In either case, 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 that is configured to modify a staple firing path 2444 of the stapling instrument 2400. The joystick 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 curves to the right. Accordingly, when the lever 2450 is rotated to the left or in a counterclockwise direction, the staple firing path 2444 curves to the 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 paused or unfired with staples. The clinician may also use the joystick 2450 to steer the stapling instrument 2400 in real time as the stapling instrument 2400 is firing staples. In various circumstances, 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 can 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 can be shown, for example, in window 2133 and window 2134.

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

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, 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 the stapling instrument 2100. In various circumstances, the clinician can touch these touch screens, e.g., with their fingers, and drag the staple firing path of the stapling instrument 2100 into a new position. In other cases, tools such as styluses, 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 the stapling instrument 2100.

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

While the staple firing paths and/or other images projected into the above-described on-board and off-board displays are highly conducive to producing a desired staple firing path, the stapling instrument can include one or more projectors configured to display images onto patient tissue that can assist a user of the stapling instrument in producing a desired staple firing path. Referring to fig. 160 and 161, the stapling apparatus 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. The projector 7490 is configured to project an image I onto the stomach S of the patient P. The projector 7490 is sized and configured to be inserted into a patient through a trocar TC, but may be inserted into the 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 image it projects move with the distal head 7420.

Referring to fig. 162, the stapling instrument 7500 includes a shaft 7510, a distal head 7520, and an articulation joint 7570 that rotatably couples 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. The projector 7590 includes a flexible tube mounted to a shaft 7510 and a distal head 7520 and is configured to bend as the distal head 7520 articulates. Thus, the image I projected by the projector 7590 tracks the orientation of the distal head 7520 and may be projected distally relative to the anvil 7560 of the 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 may project more than one image onto the patient tissue.

Referring again to fig. 160, the 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 lens 7492 and the second lens 7494 are fixedly mounted in the projector 7490 such that they project images at a common focal point, but they 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 apparatus 7400 is configured to be capable of supplying, altering and/or modifying the image projected by the first lens 7492 and/or the second lens 7494. In various instances, the images projected by the first lens 7492 and the second lens 7494 may provide a two-dimensional image on patient tissue. In other cases, the images projected by the first lens 7492 and the second lens 7494 may provide a three-dimensional image on patient tissue. By orienting or being able to orient the lens 7492 and the lens 7494 in different directions, it may be advantageous to project a three-dimensional image.

Referring to fig. 165, the stapling instrument 7700 includes a distal head 7720 positioned on a first side of the patient tissue T and an anvil 7760 positioned on a second side of the patient tissue T. Similar to the 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 includes a projector 7770 configured to project the image I onto the tissue T. Image I in fig. 165 represents the position of the next firing stroke, which includes the two lateral regions in which the staple cluster will be applied. Referring to fig. 166, the image projected by the projector 7770 includes lines designating staple firing paths FP and/or lines designating alternative staple firing paths FP'. These lines may be, for example, solid and/or dashed lines. The lines may be of the same color or different colors.

In addition to the above, the controller of the stapling instrument 7700 is configured to modify the images projected by the projector 7770 as the stapling instrument 7700 is moved or advanced along the staple firing path. The controller may continuously evaluate and determine where the next firing stroke should occur, and also continuously adjust the images 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 display an image using the projector 7770 before the stapling instrument 7700 grips tissue. In such instances, the user of the stapling instrument 7700 has the opportunity to pause or stop the stapling instrument 7700 before it makes another staple firing stroke.

Referring to fig. 167, the stapling instrument 7800 includes a distal head 7820 positioned on a first side of a patient's tissue T and an anvil 7860 positioned on a second side of the patient's tissue T. Similar to the other stapling instruments disclosed herein, the stapling instrument 7800 is configured to deploy staples 7830 into tissue T and incise the tissue T along an incision 7840 during a series of staple firing strokes. The stapling 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 enable a first image I₁Projected onto patient tissue T, and a second lens 7874 is configured to enable a second image I₂Projected onto the patient tissue T. Image I₁The position of the next staple cluster is shown, and image I₂The cutting path of the stapling instrument 7800 is shown, but any suitable image may be projected. Image I₁And I₂May be, for example, solid and/or dashed lines. Image I₁May be associated with image I₂The same color or a different color.

As described above, the stapling instrument disclosed herein can 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, the stapling instrument 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 that includes at least one camera, such as a first camera 7672 and a second camera 7674, for example, in communication with the controller. The first camera 7672 points in a first direction and focuses on a first region F1 of the patient's tissue, and the second camera 7674 points in a second direction and focuses on a second or different region F2 of the patient's tissue. In various instances, the controller is configured to present two images on the surgical instrument display at the same time or at different times so that the user can toggle back and forth between the images. In some cases, the controller is configured to generate and present a composite image on the surgical instrument display using images from the first camera 7672 and the second camera 7674.

In addition to the above, the first camera 7672 comprises a digital camera configured to be capable of providing a first digital video stream to the controller, and the second camera 7674 comprises a digital camera configured to be capable of providing 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 the camera 7672 and the camera 7674 are fixed. In any case, the image I projected onto the patient tissue by the projector 7690 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 instances, the projector 7690 emits, for example, visible light, infrared light, and/or ultraviolet light. In addition, when visible light is reflected off of the tissue, the visible light is useful for the clinician to view the color of the 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 capture, for example, visible light, infrared light, and/or ultraviolet light. Infrared light indicates, for example, the presence of heat, such as from a large blood vessel. Ultraviolet light indicates the presence of blood or bleeding, for example. In addition to or in lieu of the above, the projector may be configured to emit acoustic, infrasonic, and/or ultrasonic waves, and the surgical instrument may include one or more acoustic sensors configured to detect waves reflected off 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 instruments described herein are configured to repeatedly fire staples into tissue of a patient, such as a patient' S stomach S. Many of the stapling instruments disclosed herein are self-driven, self-advancing, and/or self-steering in that they are sufficiently electrically powered so that they can follow and advance 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, the staples are continuously ejected from the stapling instrument. In various circumstances, a staple firing system of the stapling instrument enters a dwell state between staple firing strokes as the stapling instrument moves along a staple firing path. However, such stops are part of the continuous operation of the stapling instrument. As described above, referring to fig. 143, many stapling instruments described herein are configured to deploy a staple cluster, such as staple cluster 6630', for example, during each staple firing stroke. Such staple clusters may include any suitable number of staples, but each staple cluster 6630' shown in fig. 143 includes three staples 6630 and is deployed on both sides of the tissue cut 6640. In at least one exemplary embodiment, seven staple clusters 6630' are deployed on each side of the tissue cut 6640 for each inch of the staple firing path. In such embodiments, 42 staples are deployed per inch, although 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 to 98 firings before having to be reloaded, for example. Such firing may deploy, for example, 504 to 588 staples.

In addition to the above, many of the stapling instruments disclosed herein can be at least partially rotated between staple firings. Accordingly, such stapling instruments may follow complex and/or non-linear staple firing paths. Referring to fig. 174, prior stapling instruments have been configured to deploy linear staple line portions 8230', such as staples 8230. 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'. In addition, the overlap region 8235' represents a sharp turn in the staple firing path, which can create a potential leak path in the staple line. Referring to FIG. 175, the stapling instruments disclosed herein can be rotated much more gradually because they can be rotated after each firing stroke. For example, the stapling instrument can be rotated after deployment of each staple cluster 7930 ', and can do so without creating overlap between staple clusters 7930'.

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

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

In addition to the above, gastric bypass surgery and gastric sleeve surgery help to 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 creating a small section of stomach for receiving food and obstructing 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 stomach segment to the lower intestine. Thus, in such cases, this direct route eliminates the use of the upper intestine during digestion.

Gastric sleeve surgery involves creating 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 the 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., bougie, may be used as a measurement tool. More specifically, the bougie may be used to determine or define the size and shape of the stomach that becomes the gastric sleeve at the completion of the LSG procedure. Bougies B are shown in fig. 30 and 32. Bougies are manufactured in a variety of sizes to accommodate different stomach sizes. The appropriate size of bougie is typically determined based on the stomach size and the expected gastric sleeve size. During the initial steps of the LSG procedure, the surgeon inserts a bougie through the patient's mouth, down the esophagus, and through the esophageal sphincter to finally reach the patient's stomach. Once the bougie reaches the patient's stomach, the bougie is placed so that the end of the bougie reaches the pyloric canal, which is the lower region of the stomach that connects to the pylorus.

Fig. 28 illustrates various portions of the stomach anatomy involved during various steps of the LSG procedure. In particular, fig. 28 shows the stomach prior to insertion of the bougie B into the stomach S during the LSG procedure. As shown in fig. 28, omentum O, which is a double layer of adipose tissue, is attached to the outer layer of stomach S. Omentum O includes two portions, the greater omentum and the lesser omentum. The greater omentum serves to store fatty deposits, and the smaller omentum connects the stomach S and intestine to the liver. The stomach S includes a plurality of regions shaded based on the tissue thickness of the stomach S. The tissue thickness of the stomach S forms a first shadow S_1aAnd a second shadow S_1a. Shadow S_1aAnd S_1bVaries according to the thickness of the stomach S. As further shown in FIG. 28, a first shadow S_1aAlong the greater curvature GC of the stomach S, and a second shade S_1bAlong the lesser curvature LC of the stomach S. As discussed in more detail below, the shading S_1aAnd S_1bFor determining or estimating the thickness of the stomach S along the major and minor curves GC and LC, respectively. Once the thickness of the stomach S is determined or estimated, the thickness is used to determine the bougie B relative to the calculated hatching S as shown in FIG. 28_LTo the appropriate size and location.

Fig. 33 illustrates another view of the stomach anatomy according to various embodiments. Similar to the stomach anatomy shown in FIG. 28, the tissue thickness of the stomach S forms a first shadow S₁And a second shadow S₂. Similar to that discussed above, the first shade S₁Appears along the major bend GC and is shaded with a second shade S₂Along the small bend LC. First shade S₁And the second shadow S₂At point S₃Where they intersect. During gastric sleeve surgery, the pylorus P_xAnd point S₃Is used for determining the position of the pylorus P_xCutting line C offset by a certain distance A¹The position of (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 the LSG procedure. In particular, fig. 152 shows an early step of the LSG procedure, wherein a bougie B is inserted into the stomach S. At the beginning of the LSG procedure, the surgeon inserts a bougie through the patient's mouth, down the esophagus E and through the esophageal sphincter to finally reach the patient's stomach. Once the bougie B reaches the patient's stomach, the bougie B is positioned such that the end of the bougie B rests in the pyloric canal PC and stops at the 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 lesser curvature LC. As will be described in greater detail below with reference to fig. 153, a bougie 7210 can be used that includes magnetic properties configured to interact with a stapling instrument 7100 and guide the stapling instrument along a predetermined path along the sides of the bougie 7210.

Referring again to FIG. 152, once the bougie is placed in its final position, the distance D is measured along the pyloric antrum PA of the greater curvature GC¹. Distance D¹For determining pylorus P_xAnd for determining the cutting line C¹The position of (a). The stylet 7210 shown in fig. 153 creates one or more magnetic fields that are used to guide the suturing apparatus 7100 to the stylet 7210. Then, referring to fig. 154, the suturing apparatus 7100 follows a magnetic field along a path adjacent to the bougie 7210 to form a cut line C¹. Thus, the cutting line C¹Extends upwardly through the patient' S stomach S along the shape and curvature of both the stomach S and bougie 7210. The cut line C1 then continues along a path adjacent the bougie 7210 up through the patient' S stomach S until reaching the His angle AH. After the cutting line C is established¹While, the suturing apparatus 7100 follows cut line C¹Applies staples (such as staple 7130) to the tissue. The remainder of the stomach S that remains 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 the greater curvature GC of the stomach S.

In some cases, a clinician may estimate the appropriate staple firing path in the patient's stomach by observing certain anatomical landmarks on the stomach and/or at other locations within the surgical site. Referring to fig. 152, a stapling instrument (such as stapling instrument 7100) disclosed herein, for example, is configured to sense anatomical landmarks within 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 the lesser curvature of the stomach and calculate a staple firing path in the stomach tissue that is parallel, or at least substantially parallel, to the lesser curvature. Other anatomical landmarks of the patient's stomach that may be detected and used to determine the staple firing path include, for example, the angular notch, esophageal sphincter, angle of His, pyloric sphincter, and/or the pyloric antrum.

As described above, the lesser curvature of the stomach may be used to determine the staple firing path. In each case, however, the lesser curvature is at least partially obscured by fat and/or connective tissue. That is, the lesser curvature, the lesser omentum, and any overlap between the lesser curvature and the lesser omentum, for example, may be visually distinguished. More specifically, the uncovered stomach tissue has a first color, the omentum has a second color different from the first color, and the overlap between the uncovered stomach and the omentum has a third color different from the first color and the second color. These colors can be detected by the stapling instrument to determine the appropriate staple firing path. In some cases, the color of the stomach tissue under the omentum produces a shadow that can be detected by the stapling instrument. Other methods may be used to determine the appropriate position 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 an adequate digestive tract D. The stapling instruments disclosed herein can be configured to detect the lesser curvature of the stomach and calculate a staple firing path, such as staple firing path SP₁E.g., it is at a distance X from the edge of the stomach S. In other cases, thisThe stapling instrument disclosed herein can be configured to detect the lesser omentum LO adjacent to the lesser curvature of the stomach and fire the staples along a staple firing path SP₁Calculated, for example, as a preset or predetermined distance X from the periphery of the stomach S.

As described above, detecting the margins of the stomach S can be difficult. In certain instances, the stapling instrument disclosed herein can include a camera system configured to be able to observe the color of the stomach tissue and/or changes in the color of the stomach tissue in order to determine the margins of the stomach S. In various instances, the stapling instruments disclosed herein can be configured to detect the margins of the stomach by evaluating the thickness of the stomach tissue and/or changes in the thickness of the stomach tissue. The tissue of a patient's stomach is generally thinner around the periphery or edges of the stomach than in the middle of the stomach, and it has been observed that the color of stomach tissue generally depends on its thickness. In other words, the tissue surrounding the periphery of the stomach appears to have a shade or darker color due to its thinner thickness. In fig. 29, the shaded area S₁By a distance Z₁And (4) defining. Distance Z₁Also defined is a region T from the thinner tissue of the stomach S to the entire tissue thickness₁The transition of (2). In various instances, the surgical instruments disclosed herein can be configured to be capable of being deployed, for example, by establishing a shadow region S₁Staple firing path SP at a distance₁To determine the staple firing path SP₁. In at least one instance, the surgical instrument can establish a location, such as with the retina LO and shadow region S₁Has a certain distance of the middle point between the edges₁。

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 for the first light intensity and a second light intensity value for the second light intensity, and then compare the first light intensity value to the second light intensity value. For example, the light intensity value may range between 1 and 100, with lower values indicating darker tissue and higher values indicating brighter tissue. The first and second locations establish a sample line along which additional samples may 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, second and third locations are located sequentially 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 and third locations, and the third location is closer to the edge of the stomach tissue than the first location. The method can be applied on a very large scale to map shadow gradients and/or color gradients of the entire stomach tissue or at least a portion 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 generally have a different color and/or shade than a stomach with thinner tissue (fig. 31). The thinner tissue in FIG. 31 has a distance of Z₂Defined shaded area S₂. Distance Z₂Also defining a secondary stomach S₂To the whole tissue thickness region T₂The transition of (2). In various instances, the surgical instruments disclosed herein can be configured to be capable of being deployed, for example, by establishing a shadow region S₂Staple firing path SP at a distance₂To determine the staple firing path SP₂. In at least one instance, the surgical instrument can establish a surgical interaction with, for example, the retina LO₂And a shaded area S₂Has a certain distance of the middle point between the edges₂。

Nail firing path SP₁Establishing a first sleeve profile and staple firing path SP₂A second sleeve profile different from the first sleeve profile is established. 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 instrument disclosed herein, the tissue drive system of the stapling instrument is configured to advance the stapling instrument along a staple firing path, which creates a desired stomachA sleeve. Such a stapling instrument may be configured to recognize anatomical landmarks and orient itself 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 rows of staples 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 can be configured to emit one or more magnetic fields that can be detected by the stapling instrument 7100 and then used by the stapling instrument 7100 to determine a staple firing path. In at least one instance, the bougie 7210 emits a strong magnetic field SMF and a weak magnetic field WMF that, when emitted, are emitted 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 one or more sensors, such as hall effect sensors, for example, configured to detect strong magnetic fields SMF and weak magnetic fields WMF. The sensors communicate with a controller of the stapling instrument 7100 that can use data from the sensors to detect placement of the strong magnetic field SMF and the weak magnetic field WMF and 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 high magnetic field SMF is twice the strength of the low magnetic field WMF. In other cases, for example, the intensity of the high magnetic field SMF is 50% stronger than the intensity of the low 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 emit the magnetic fields SMF and WMF described above. Flexible core 7212 is constructed of, for example, a non-conductive material or an at least substantially non-conductive material such as rubber. 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. Winding circuit 7214 has fewer windings than winding circuit 7216 and produces a weaker magnetic field than winding circuit 7216 for a given current. Each winding circuit 7214 includes a conductive wire that is wound around the inner flexible core 7212 and is 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 comprises a conductive core embedded in flexible core 7212. In either case, the bougie 7210 includes an outer jacket 7218 configured to seal the contents therein to prevent or inhibit the entry of fluids into 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 voltage applied to each of the winding circuit 7214 and the winding circuit 7216 is the same or at least substantially the same. Alternatively, a first voltage is applied to winding circuit 7214 and a second or different voltage is applied to winding circuit 7216. In various alternative embodiments, winding circuit 7214 is not a separate circuit; rather, 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

circuitry

7214 and 7216 emit magnetic fields that extend around the entire circumference of the bougie 7210, and thus, the bougie 7210 can be oriented or rotated in any suitable manner to perform the surgical procedures described above.

As described above, the bougie 7210 generates a magnetic field using electricity. In various alternative embodiments, the bougie may include a permanent magnet that generates a magnetic field. In at least one instance, the bougie includes a strong permanent magnet that produces a strong magnetic field and a weak permanent magnet that produces a weak magnetic field. In at least one such case, the strong and weak permanent magnets are arranged in an alternating manner to produce alternating strong and weak magnetic fields SMF and WMF as shown, for example, 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 emit the magnetic fields SMF and WMF described above. The flexible core 7312 is constructed of, for example, a non-conductive material or an at least substantially non-conductive material such as rubber. The conductor winding includes winding circuitry 7314 configured to emit a weak magnetic field WMF and winding circuitry 7316 configured to emit a strong magnetic field SMF. Winding circuit 7314 has fewer windings than winding circuit 7316 and will produce a weaker magnetic field for a given current than winding circuit 7316. Each winding circuit 7314 includes a conductive wire that is wound around an inner flexible core 7312 and communicates with the controller of the bougie 7310. The windings of circuit 7314 are more compact or denser 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 substantially do not extend longitudinally. Similarly, the windings of circuit 7316 are more compact or denser than the windings of circuit 7216. For example, dense or compact windings may generate a dense or compact magnetic field, which may be more readily discernable 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 certain instances, the motors disclosed herein may comprise a portion or portions of a robotic control system. For example, U.S. patent application serial No. 13/118,241 (now U.S. patent 9,072,535), entitled "SURGICAL INSTRUMENTS WITH robotic SURGICAL INSTRUMENTS," discloses several examples of robotic SURGICAL instrument systems in more detail.

The surgical instrument systems described herein have been described in connection with the deployment and deformation of staples; however, the embodiments described herein are not so limited. For example, various embodiments are contemplated in which fasteners other than staples, such as clamps or tacks, are deployed. Moreover, various embodiments are also contemplated that utilize any suitable means for sealing tissue. For example, an end effector according to various embodiments may include an electrode configured to heat and seal tissue. In addition, for example, an end effector according to certain embodiments may apply vibrational energy to seal tissue.

Examples

Example 1-a surgical stapler for stapling stomach tissue of a patient, comprising a handle comprising a display; a shaft extending from the handle; and an end effector extending from the shaft. The end effector includes a plurality of staples and an anvil configured to deform the staples. The surgical stapler further includes a firing system configured to deploy staples along a firing path; a vision system configured to capture a tissue image of stomach tissue; and a controller configured to determine an edge of the stomach tissue, generate an image overlay representing at least a portion of the edge of the stomach tissue, and display the image overlay over at least a portion of the tissue image on the display.

Example 2-the surgical stapler of example 1, wherein the controller is further configured to generate a gastric sleeve stapling template comprising a firing path.

Example 3-the surgical stapler of example 2, wherein the gastric sleeve suture template is part of the image laminate.

Example 4-the surgical stapler of examples 2 or 3, wherein the gastric sleeve suture template is part of a second image stack generated by the controller.

Example 5-the surgical stapler of examples 1, 2, or 3, wherein the edge of the stomach tissue comprises a lesser curvature of the patient's stomach.

Example 6-the surgical stapler of examples 1, 2, 3, or 4, wherein the edge of the stomach tissue comprises a boundary between a lesser curvature of the patient's stomach and the omentum.

Example 7-the surgical stapler of examples 1, 2, 3,4, or 5, wherein the tissue image comprises a static image of stomach tissue.

Example 8-the surgical stapler of examples 1, 2, 3,4, 5, 6, or 7, wherein the tissue image comprises a dynamic image of stomach tissue.

Example 9-the surgical stapler of example 8, wherein the controller is configured to adapt the image stack to a dynamic tissue image.

Example 10-the surgical stapler of examples 1, 2, 3,4, 5, 6, 7,8, or 9, wherein the controller is configured to identify at least one tissue target on the tissue image and align the image overlay with the at least one tissue target.

Example 11-the surgical stapler of examples 1, 2, 3,4, 5, 6, 7,8, 9, or 10, wherein the vision system and the controller utilize visible light to determine the stomach tissue margins.

Example 12-the surgical stapler of examples 1, 2, 3,4, 5, 6, 7,8, 9,10, or 11, wherein the vision system and the controller utilize infrared light to determine the stomach tissue margins.

Example 13-the surgical stapler of examples 1, 2, 3,4, 5, 6, 7,8, 9,10, 11, or 12, wherein the vision system and the controller utilize ultraviolet light to determine the stomach tissue margins.

Example 14-the surgical stapler of examples 1, 2, 3,4, 5, 6, 7,8, 9,10, 11, 12, or 13, wherein the vision system comprises a wave transmitter configured to transmit electromagnetic waves and a receiver configured to receive electromagnetic waves reflected from patient tissue.

Example 15-the surgical stapler of example 14, wherein the controller comprises a microprocessor configured to determine the tissue edge using the reflected magnetic waves.

Example 16-a surgical stapler for stapling stomach tissue of a patient, comprising a handle comprising a display, a shaft extending from the handle, a plurality of staples, and an end effector extending from the shaft, wherein the end effector comprises an anvil configured to deform the staples. The surgical stapler further includes a firing system configured to deploy staples along a firing path; an imaging system configured to capture a tissue image of stomach tissue; and a controller configured to determine an edge of the stomach tissue, generate an image representing at least a portion of the edge of the stomach tissue, and display the image on the display along with at least a portion of the tissue image.

Example 17-a surgical instrument for treating stomach tissue of a patient, comprising a handle comprising a display; a shaft extending from the handle; and an end effector extending from the shaft. The surgical instrument further includes a tissue cutting system configured to cut stomach tissue along the path; an imaging system configured to capture a tissue image of stomach tissue; and a controller configured to determine an edge of the stomach tissue, generate an image representing at least a portion of the edge of the stomach tissue, and display the image on the display along with at least a portion of the tissue image.

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

-U.S. patent 5,403,312 entitled "ELECTROSURURGICAL HEMOSTATIC DEVICE" published on 4.4.1995;

-us patent 7,000,818 entitled "SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS" published on 21.2.2006;

-U.S. patent 7,422,139 entitled "MOTOR-driving warming and warming insulation WITH TACTILE POSITION FEEDBACK fed", published 9.9.2008;

-U.S. patent 7,464,849 entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS" published on 16.12.2008;

-U.S. patent 7,670,334 entitled "SURGICAL INSTRUMENT HAVATING ANARTICULATING END EFFECTOR" published on 3, 2.2010;

-U.S. patent 7,753,245 entitled "SURGICAL STAPLING INSTRUMENTS" published on 13.7.2010;

-us patent 8,393,514 entitled "SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE" published on 12.3.3.2013;

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

-U.S. patent application serial No. 12/031,573 entitled "SURGICAL CUTTING AND FASTENING INSTRUMENTS HAVARING RF ELECTRORDES" filed on 14.2.2008;

-U.S. patent application serial No. 12/031,873 entitled "END efffectors FOR a SURGICAL CUTTING and applying in insurment" filed on 15.2.2008 (now U.S. patent 7,980,443);

-U.S. patent application serial No. 12/235,782 entitled "MOTOR-driver basic CUTTING insert", now U.S. patent 8,210,411;

U.S. patent application Ser. No. 12/249,117 entitled "POWER SURGICAL CUTTING AND STAPLING APPATUS WITH MANUALLYRACTABLE FIRING SYSTEM", now U.S. patent 8,608,045;

-U.S. patent application serial No. 12/647,100, now U.S. patent 8,220,688, entitled "MOTOR-drive MOTOR vehicle current CONTROL system WITH ELECTRIC ACTUATOR direct CONTROL association system", filed 24.12.2009;

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

-U.S. patent application serial No. 13/036,647 entitled "SURGICAL STAPLING INSTRUMENT" filed on 28.2.2011, now U.S. patent 8,561,870;

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

-U.S. patent application serial No. 13/524,049, now U.S. patent 9,101,358, entitled "article subacable minor intumentcomprising A FIRING DRIVE", filed on 15/6/2012;

-U.S. patent application serial No. 13/800,025 entitled "STAPLE CARTRIDGE TISSUE thicknownstess sensorstem" filed on 3, 13, 2013, now U.S. patent 9,345,481;

-U.S. patent application serial No. 13/800,067 entitled "STAPLE CARTRIDGE TISSUE thicknownstess sensorstem" filed on 3, 13, 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 31.1.2006; and

U.S. patent application publication 2010/0264194 entitled "SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR" filed on 22.4.2010, now U.S. Pat. No. 8,308,040.

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, the particular features, structures, or characteristics shown or described in connection with one embodiment may be combined, in whole or in part, with the features, structures, or characteristics of one or more other embodiments, without limitation. In addition, where materials for certain components are disclosed, other materials may also be used. Further, 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 foregoing detailed description and the following claims are intended to cover all such modifications and variations.

The device disclosed herein may be designed to be disposed of after a single use, or it may be designed to be used multiple times. In either case, however, the device may be reconditioned for reuse after at least one use. Reconditioning can include any combination of the following steps, including, but not limited to, disassembly of the device, followed by cleaning or replacement of particular pieces of the device, and subsequent reassembly of the device. In particular, the reconditioning facility and/or surgical team can remove the device, and after cleaning and/or replacement of particular components of the device, the device can 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 conditioning apparatus are within the scope of the present application.

The devices disclosed herein may be processed prior to surgery. First, new or used instruments may be obtained 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 field of radiation that can penetrate the container, such as gamma radiation, X-rays, and/or high energy electrons. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in a sterile container. Sealing the container may keep the instrument sterile until the container is opened in a 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 invention has been described as having an exemplary design, the present invention may be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention 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. Thus, 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 for stapling stomach tissue of a patient, comprising:

a handle comprising a display;

a shaft extending from the handle;

an end effector extending from the shaft, wherein the end effector comprises:

a plurality of staples; and

an anvil configured to deform the staples;

a firing system configured to deploy the staples along a firing path;

a vision system configured to capture a tissue image of the stomach tissue; and

a controller configured to determine an edge of the stomach tissue, generate an image overlay representing at least a portion of the edge of the stomach tissue, and display the image overlay over at least a portion of the tissue image on the display.

2. The surgical stapler of claim 1, wherein said controller is further configured to generate a gastric sleeve stapling template comprising said firing path.

3. The surgical stapler of claim 2, wherein the gastric sleeve stapling template is part of the image stack.

4. The surgical stapler of claim 2, wherein the gastric sleeve stapling template is part of a second image stack generated by the controller.

5. The surgical stapler of claim 1, wherein the edge of the stomach tissue comprises a lesser curvature of a patient's stomach.

6. The surgical stapler of claim 1, wherein the edge of the stomach tissue comprises a boundary between a lesser curvature of the patient's stomach and a lesser omentum.

7. The surgical stapler of claim 1, wherein the tissue image comprises a static image of the stomach tissue.

8. The surgical stapler of claim 1, wherein the tissue image comprises a dynamic image of the stomach tissue.

9. The surgical stapler of claim 8, wherein the controller is configured to adapt the image stack to the dynamic tissue image.

10. The surgical stapler of claim 9, wherein said controller is configured to identify at least one tissue target on said tissue image and align said image overlay with said at least one tissue target.

11. The surgical stapler of claim 1, wherein said vision system and said controller utilize visible light to determine stomach tissue margins.

12. The surgical stapler of claim 1, wherein the vision system and the controller utilize infrared light to determine stomach tissue margins.

13. The surgical stapler of claim 1, wherein said vision system and said controller utilize ultraviolet light to determine stomach tissue margins.

14. The surgical stapler of claim 1, wherein the vision system comprises:

a wave emitter configured to be capable of emitting an electromagnetic wave; and

a receiver configured to receive electromagnetic waves reflected from patient tissue.

15. The surgical stapler of claim 14, wherein the controller comprises a microprocessor configured to determine the tissue edge using reflected magnetic waves.

16. A surgical stapler for stapling stomach tissue of a patient, comprising:

a handle comprising a display;

a shaft extending from the handle;

a plurality of staples;

an end effector extending from the shaft, wherein the end effector comprises an anvil configured to deform the staples;

a firing system configured to deploy the staples along a firing path;

an imaging system configured to capture a tissue image of the stomach tissue; and

a controller configured to determine an edge of the stomach tissue, generate an image representing at least a portion of the edge of the stomach tissue, and display the image on the display along with at least a portion of the tissue image.

17. A surgical instrument for treating stomach tissue of a patient, comprising:

a handle comprising a display;

a shaft extending from the handle;

an end effector extending from the shaft;

a tissue cutting system configured to cut the stomach tissue along a path;