FR2542188A1 - Surgical clamp for linear mechanical suturing of viscera of the thoracic and abdominal cavities - Google Patents

Surgical clamp for linear mechanical suturing of viscera of the thoracic and abdominal cavities Download PDF

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Publication number
FR2542188A1
FR2542188A1 FR8304186A FR8304186A FR2542188A1 FR 2542188 A1 FR2542188 A1 FR 2542188A1 FR 8304186 A FR8304186 A FR 8304186A FR 8304186 A FR8304186 A FR 8304186A FR 2542188 A1 FR2542188 A1 FR 2542188A1
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head
extension
sliding
surgical forceps
support
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FR2542188B1 (en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously

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  • Life Sciences & Earth Sciences (AREA)
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  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

The invention relates to a surgical clamp for the mechanical and linear suturing by staples of the viscera of the abdominal and thoracic cavities for example, comprising a clamp body 1 extended by a canon 2 used to guide a locking ring 3 of an orientable and removable head 6 provided with a sliding support 17 for a staple loader 19 and an anvil 20, the support 17 being brought up to the anvil in order to clamp the viscera by means of a handle 21 hinged to the body 1, the latter acting on a sliding element 16 held inside the canon 2 extended by a sliding element 18 held inside the extension 12 of the head 6 connected to the support 17, then, after release of the handle 21 when the elements 16 and 18 are locked and lowering of a part 30, the action of the handle acts via the part 30 on the pushers 32 and 34 sliding in the elements 16 and 18 and allowing, by means of the hammer 44, the staples to be ejected and closed on the anvil 20 after piercing the viscera.

Description

La présente invention concerne une pince chirurgicale pour suturer mécaniquement et de façon linéaire par agrafes, des viscères de cavités abdominales et thoraciques par exemple. The present invention relates to a surgical clamp for suturing mechanically and linearly by staples, viscera of abdominal and thoracic cavities for example.

On connais différenles pinces chirurgicales pour la suture mécanique linéaire d'organes des cavités abdominales et thoraciques telles que décrites dans les brevets FR 1 237 035, 1 278 616, 1 448 441, 1 479 134, 1 540 226, DE 618 922, US 3 080 564, les pinces décrites et revendiquées présentent toutes une tête d'agrafage fixée au corps de pince, de ce fait elles ne sont pas interchangeables ni orientables, ce qui limite leur utilisation dans bien des cas, dîautre part elles sont d'un emploi malaisé car elles nécessitent lors de l'intervention une manipulation par les deux mains du praticien. Various surgical clips are known for the linear mechanical suture of organs of the abdominal and thoracic cavities as described in patents FR 1 237 035, 1 278 616, 1 448 441, 1 479 134, 1 540 226, DE 618 922, US 3 080 564, the clamps described and claimed all have a stapling head attached to the clamp body, therefore they are not interchangeable or steerable, which limits their use in many cases, on the other hand they are of a difficult job because they require during the intervention manipulation by both hands of the practitioner.

L'invention a pour but de palier aux inconvénients préce- demment exposes. The object of the invention is to overcome the disadvantages previously described.

L'invention a pour objet une pince chirurgicale pour sutures mécaniques linéaires de viscères de cavités abdominales et thoraciques comportant un corps de pince prolongé par un canon servant de guide à une bague de verrouillage extérieure et intérieurement à un élément coulissant dans lequel est maintenu un poussoir mobile, en l'extrémité du canon une gorge de retenue est aménagée pour recevoir une arete#aména,gée en extrémité du prolongement d'une tête orientable et amovible comportant un support coulissant de chargeur d'agrafes, une enclume et un marteau prolongé par un poussoir coulissant maintenu à l'intérieur d'un élément relié au support, ledit élément est maintenu et coulisse à l'intérieur du prolongement /du canon de la tête, il est en alignement avec l'élément ainsi que les poussoirs entre eux de sorte à ce que par action d'une poignée ~ articulée sur le corps celle-ci provoque en un premier temps le déplacement des éléments pour rapprocher et immobiliser par un dispositif de verrouillage continu le support coulissant et le chargeur d'agrafes vers l'enclume jusqu'à pincement du viscère à suturer placé entre le chargeur et l'enclume puis en un deuxième temps aprés retour en arrière au moyen d'un ressort et abaissement d'une pièce solidaire de ladite poignée le déplacement de s poussoir s par action de iite pNpee pour expulser les agrafes du chargeur par le marteau et provoquer leur fermeture sur l'enclume aprés transpercement dlrviscère, lors du déverrouillage les poussoirs et les éléments coulissants étant repoussés à leur position initiale au moyen d'un ressort maintenu à l'intérieur du prolongement de la tête. The invention relates to a surgical forceps for linear mechanical sutures of viscera of abdominal and thoracic cavities having a clamp body extended by a barrel serving as a guide to an outer locking ring and internally to a sliding element in which is maintained a pusher mobile, at the end of the barrel a retaining groove is arranged to receive a ridge # arranged at the end of the extension of a directional and removable head having a sliding staple loader support, an anvil and a hammer extended by a sliding pusher held inside an element connected to the support, said element is held and slides inside the extension / barrel of the head, it is in alignment with the element and the pushers between them; so that by action of a handle ~ articulated on the body it causes in a first time the movement of the elements for close and immobilize the sliding support and the staple magazine by means of a continuous locking device towards the anvil until the suturing viscera are squeezed between the magazine and the anvil, then in a second step afterwards by a spring and lowering of a piece integral with said handle the movement of s pushers by action pNpee said to expel the staples of the loader by the hammer and cause their closure on the anvil after piercing the rviscere, when unlocking the pushers and the sliding elements being pushed back to their initial position by means of a spring held inside the extension of the head.

D'autres caractéristiques et avantages de l'invention ressortiront plus clairement de la description qui va suivre faite en regard des dessins joints donnés i titre d'exemple non limitatif > ou
- la figure 1 est une vue générale de la pince,
- la figure 2 un type de dispositif de verrouillage de la tête,
- la figure 3 une variante de dispositif de verrouillage de la tête,
- la figure 4s le détail de verrouillage continu de l'élément permettant le déplacement du support coulissant du chargeur.Other characteristics and advantages of the invention will emerge more clearly from the following description given with reference to the accompanying drawings given as a non-limiting example.
FIG. 1 is a general view of the clamp,
FIG. 2 a type of locking device for the head,
FIG. 3 a variant of a device for locking the head,
- Figure 4s the continuous locking detail of the element for moving the sliding support of the charger.

Telle que représentée figures 1 2 et 4 > la pince comporte un corps 1 prolongé par un canon 2 sur lequel coulisse une bague de verrouillage 3 celle-ci en sa partie inférieure coté corps 1 est dotée d'une gachette 4 coulissant dans la rainure 5 aménagée dans le corps et ce afin de déverrouiller la tête orientable 6et permettre son orientation, la course de la gachette 4 par action d'un des doigts du praticien étant limitée lorsque celui-ci vient en butée sur le corps 1, de sorte à permettre seulement le déverrouillage de ladite tête sans toutefois permettre son extraction,en extrémité 7 de la bague 3 un ressort de rappel 8 est maintenu afin de pousser la bague 3 lors du relachement de la gachette 4 et ce aprés orientation de la tête 6, le verrouillage de la tête 6 à la position désirée étant obtenu par l'emboftement de dents 9 aménagées sur le pourtour intérieur 10 de la bague 3 dans les rainurés 11 aménagées sur le pourtour extérieur du prolongement 12 de la tête 6. As shown in Figures 1 2 and 4> the clamp comprises a body 1 extended by a barrel 2 on which slides a locking ring 3 thereof in its lower part side body 1 is provided with a trigger 4 sliding in the groove 5 arranged in the body and in order to unlock the orientable head 6 and allow its orientation, the stroke of the trigger 4 by action of one of the practitioner's fingers being limited when the latter abuts on the body 1, so as to allow only the unlocking of said head without allowing its extraction, end 7 of the ring 3 a return spring 8 is maintained in order to push the ring 3 when releasing the trigger 4 and after orientation of the head 6, the locking of the head 6 at the desired position being obtained by the embotement of teeth 9 arranged on the inner periphery 10 of the ring 3 in the grooves 11 arranged on the outer periphery of the extension 12 d e the head 6.

Afin de permettre la mise en place d'une tête 6 sur le canon 2 la bague coulissante 3 est repoussée manuellement vers le corps 1 de sorte à dégager la gorge de retenue 13 de la tête 6 aménagée sur le canon 2 pour qu'aprés coulissement du prolongement 12 sur le canon 2 l'ar8te 14 en bout dudit prolongement s'emboue dans la gorge de retenue 13 et ce par simple effet de ressort dû à la matière constituant le prolongement 12 et engendré par des rainures 15 disposées sur le pourtour dudit prolongement 12. In order to allow the installation of a head 6 on the barrel 2 the sliding ring 3 is manually pushed towards the body 1 so as to clear the retaining groove 13 of the head 6 arranged on the barrel 2 so that after sliding of the extension 12 on the barrel 2 the edge 14 at the end of said extension engulfs in the retaining groove 13 and this by simple spring effect due to the material constituting the extension 12 and generated by grooves 15 disposed on the periphery of said extension 12.

A l'intérieur du canon 2 coulisse un élément 16,ce dernier a pour foncion de provoquer le déplacement du support 17 de chargeur d'agrafes 19 au moyen de l'élément 18 coulissant dans le prolongement de tête 12 et ce de manière à rapprocher le chargeur d'agrafes 19 vers l'enclume 20, le déplacement de l'élément 16 est obtenu au moyen de la poignée 21 articulée sur le corps 1 dotéed'un ressort de rappel 22, lorsque ladite poignée est actionnée celle-ci en son extrémité 23 prend appui sur un élément coulissant 24 maintenu sur le corps 1 et sur un côté duquel des dents 25 sont aménagées afin de constituer avec le cliquet articulé 26 doté d'un ressort 26A un verrouillage continu durant le déplacement progressif de l'élément 16 relié à l'élément coulissant 24 par l'âme 27, ledit verrouillage pouvant être libéré par action d'un bouton poussoir 23. En fin de rapprochement du support 17 de chargeur d'agrafes 19 sur l'enclume 20, le viscère à suturer placé entre le chargeur 19 et l'enclume 20 subit une pression obtenue au moyen du ressort de compression 29 maintenu dans l'ëlé- ment coulissant 24, par relachement de la poignée 21 rappelée par le ressort 22, alors que le support 17 de chargeur est maintenu en position de pincement et seulement à ce moment-là, la pièce 30 solidaire et coulissant dans la poignée 21 au moyen du bouton 31 est placée en face du poussoir 32 du corps de pince 1 coulissant dans l'élément 16 de manière à ce que par action de la poignée 21 la pièce 30 prenne appui sur l'extrémité 33 dudit poussoir 32 et provoque son déplace ment ainsi que celui du poussoir 34 solidaire et coulissant dans l'éIe:rnent. 18 de la tete 6 pour engendrer l'expulsion des agrafes con- tenues dans le chargeur 19 et leur fermeture sur ltenclume 20 aprés transpercement du viscère, par le marteau- 44 fixé en extrémité 45 du poussoir 34, la pièce 30 lors de l'action de la poignée 21 pendant le déplacement du support 17 de.chargeur d'agrafes 19 en position haute permet le libre passage de l'extrémité du poussoir 32.  Inside the barrel 2 slides an element 16, the latter function of causing the displacement of the staple magazine support 19 by means of the sliding element 18 in the extension of the head 12 and so as to bring closer the staple magazine 19 towards the anvil 20, the displacement of the element 16 is obtained by means of the handle 21 hinged to the body 1 provided with a return spring 22, when said handle is actuated thereof in its end 23 is supported on a sliding member 24 held on the body 1 and on one side of which teeth 25 are arranged to constitute with the hinged pawl 26 with a spring 26A a continuous lock during the progressive movement of the element 16 connected to the sliding element 24 by the core 27, said locking being released by the action of a pushbutton 23. At the end of bringing the support 17 of the staple magazine 19 closer to the anvil 20, the suturing viscera square between the magazine 19 and the anvil 20 is subjected to a pressure obtained by means of the compression spring 29 held in the sliding element 24, by releasing the handle 21 which is biased by the spring 22, whereas the magazine support 17 is maintained in the pinching position and only at this moment, the piece 30 integral and sliding in the handle 21 by means of the button 31 is placed in front of the pusher 32 of the gripper body 1 sliding in the element 16 so that that by action of the handle 21 the piece 30 bears on the end 33 of said pusher 32 and causes its displacement and that of the pusher 34 integral and sliding in the éIe: rnent. 18 of the head 6 to cause the expulsion of the staples contained in the loader 19 and their closure on the hoop 20 after piercing of the viscera, by the hammer-44 fixed at the end 45 of the pusher 34, the piece 30 when the action of the handle 21 during the displacement of the staple loader support 19 in the high position allows the free passage of the end of the pusher 32.

De sorte à permettre l'alDaisselnent de dela pièce 30, lors de l'opération de pincement par le support coulissant 17 du chargeur d'agrafes 19, les poussoirs 32 et 34 sont en même temps déplacés et ce grâce à une goupille 35 en appui sur l'cxtrémité 36 d'une lumière 37 aménagée sur l'él~rnent 16 et la goupille 38 solidaire du poussoir 34 en appui sur les extrémités 39 des lumières se faisant face 40, la goupille 38 servant notamment d'appui au ressort 41 de rappel contenu entre l'élément 18 et le prolongement 12 permettant l'ouverture et dégagement du support 17 du chargeur d'agrafes 19 lorsque le cliquet 26 est désolidarisé des dents 25. In order to allow the addition of the piece 30, during the pinching operation by the sliding support 17 of the staple magazine 19, the pushers 32 and 34 are at the same time displaced by means of a pin 35 in support. on the end 36 of a light 37 arranged on the el ~ rnent 16 and the pin 38 secured to the pusher 34 resting on the ends 39 of the lights facing each other 40, the pin 38 serving in particular to support the spring 41 of return contained between the element 18 and the extension 12 allowing the opening and release of the support 17 of the staple magazine 19 when the pawl 26 is disengaged from the teeth 25.

Sans sortir du cadre de l'invention et telle que représentée figure 3, l'orientation de la tête et son maintien peuvent être réalisés au moyen d'un ressort à friction 42 logé dans un évidement 43 prévu à cet effet à l'intérieur de la bague 3,de ce fait les dents 9 et rainures il ainsi que la ga#chette 4 sont supprimées.  Without departing from the scope of the invention and as shown in FIG. 3, the orientation of the head and its retention can be achieved by means of a friction spring 42 housed in a recess 43 provided for this purpose inside the the ring 3, thus the teeth 9 and grooves 11 and the bracket 4 are removed.

Claims (1)

REVENDIGA TIONS 1 ) Pince chirurgicale pour sutures mécaniques linéaires des viscères de cavités abdominales et thoraciques caractérisée par le fait qu'elle comporte un corps de pince 1 prolongé par un canon 2 servant de guide à une bague de verrouillage 3 extérieure et intérieurement à un élément coulissant 16 dans lequel est maintenu un poussoir mobile 32, en l'extrémité du canon 2 une gorge de retenue 13 est réalisée pour recevoir une arête 14 aménagée en extrémité du prolongement 12 d'une tête orientable et amovible 6 comportant un support coulissant 17 de chargeur d'agrafes 19, une enclume 20 et un marteau 44 prolongé par un poussoir 34 coulissant et maintenu à l'intérieur dgun élément 18 relié au support 17, ledit élément 18 est maintenu et coulisse à l'intérieur du prolongement 12 de la tête 6, il est en alignement avec l'élément 16 ainsi que les poussoirs 32 et 34 entre eux de sorte à ce que par action d'une poignée 21 articulée sur le corps 1 celle-ci provoque en un premier temps le déplacement des éléments 16 et 18 pour rapprocher et immobiliser par un dispositif de verrouillage continu le support 17 et chargeur d'agrafes 19 vers l'enclume 20 jusqu'à pincement du viscère à suturer placé entre le chargeur 19 et l'enclume 20 puis en un deuxième temps aprés retour en arrière au moyen d'un ressort 22 et abaissement d'une pièce 30 solidaire de ladite poignée 21 l'action de cette dernière agisse sur les poussoirs 32 et 34 pour expulser les agrafes du chargeur 19 par le marteau 44 et provoquer leur fermeture sur l'enclume 20 aprés transpercement du viscère, lors du déverrouillage les poussoirs 32 et 34 et les éléments 16 et 18 étant repoussés à leur position initiale au moyen d'un ressort 41 maintenu à l'intérieur du prolongement 12. 1) Surgical forceps for linear mechanical sutures of viscera of abdominal and thoracic cavities, characterized in that it comprises a clamp body 1 extended by a barrel 2 serving to guide an outer locking ring 3 and internally to a sliding element 16 in which is maintained a movable pusher 32, at the end of the barrel 2 a retaining groove 13 is formed to receive a ridge 14 arranged at the end of the extension 12 of a swiveling and adjustable head 6 having a sliding support 17 staples 19, an anvil 20 and a hammer 44 extended by a pusher 34 sliding and held inside an element 18 connected to the support 17, said element 18 is held and slides inside the extension 12 of the head 6, it is in alignment with the element 16 as well as the pushers 32 and 34 between them so that by action of a handle 21 articulated on the body 1 thereof p Rocoque first movement of the elements 16 and 18 to bring and immobilize by a continuous locking device the support 17 and staple magazine 19 to the anvil 20 to pinch the suture viscus placed between the charger 19 and the anvil 20 and in a second time after returning back by means of a spring 22 and lowering a piece 30 secured to said handle 21 the action of the latter acts on the pushers 32 and 34 to expel the staples of the loader 19 by the hammer 44 and cause them to close on the anvil 20 after piercing the viscera, when unlocking the pushers 32 and 34 and the elements 16 and 18 being pushed back to their initial position by means of a spring 41 maintained at the inside the extension 12. 20) Pince chirurgicale selon la revendication 1 caractérisée par llem- boitement de la ba#gue de verrouillage 3 sur le prolongement 12 de la tête 6 une fois l'arête 14 placée dans la gorge de retenue 13 empéchant l'extraction de ladite tête 6. 20) Surgical forceps according to claim 1, characterized by the engagement of the locking plate 3 on the extension 12 of the head 6 once the edge 14 is placed in the retaining groove 13 preventing the extraction of said head 6 . 3 ) Pince chirurgicale selon les revendications 1 et 2 caractérisée par le verrouillage de la tête 6 à une position désirée engendrée par l'emboitement de dents 9 aménagées sur le pourtour intérieur 10 de la bague 3 en l'extrémité opposée au corps I dans des rainures Il amé- nagée s sur le pourtour extérieur du prolongement 12 de la tête Ss k déverrouillage de la tête 6 permettant son orientation étant obtenu par le déplacement limité de la bague 3 au moyen d'une gachette 4 coulissant dans une rainure 5 aménagée sur le corps 1. 3) Surgical forceps according to claims 1 and 2 characterized by the locking of the head 6 to a desired position generated by the engagement of teeth 9 arranged on the inner periphery 10 of the ring 3 at the end opposite the body I in grooves It is arranged on the outer periphery of the extension 12 of the head Ss k unlocking the head 6 allowing its orientation being obtained by the limited displacement of the ring 3 by means of a trigger 4 sliding in a groove 5 arranged on the body 1. 4 ) Pince chirurgicale selon la revendication 1 caractérisée par le maintien à une orientation désirée de la tête 6 au moyen d'un ressort à friction 42. 4) Surgical forceps according to claim 1 characterized by maintaining a desired orientation of the head 6 by means of a friction spring 42. 5 ) Pince chirurgicale selon la revendication 1 caractérisée par le maintien de la bague 3 sur le prolongement 12 de la tête 6 engendré par un ressort de compression 8 en appui sur l'extrémité du canon Z et en l'extrémité 7 de la bague 3. 5) Surgical forceps according to claim 1 characterized by maintaining the ring 3 on the extension 12 of the head 6 generated by a compression spring 8 bearing on the end of the barrel Z and the end 7 of the ring 3 . S ) Pince chirurgicale selon la revendication B caractérisée par les poussoirs 32 et 34 se déplaçant en même temps que les éléments 16 et 18 lors du rapprochement du support 17 de chargeur d'agrafes 19 au moyen de goupilles 35 et 38 en appui sur les extrémités 36 et 39 de lumières 37 et 40. S) Surgical forceps according to claim B characterized by the pushers 32 and 34 moving together with the elements 16 and 18 on approaching the staple feeder support 19 by means of pins 35 and 38 resting on the ends 36 and 39 lights 37 and 40. 7 ) Pince chirurgicale selon les revendications 1 et 6 caractérisée par la goupille 38 servant d'appui à un ressort de rappel 41 des éléments 16 et 13 et poussoirs 32 et 34 contenu entre l'élément 18 et le prolongement 12 8") Pince chirurgicale selon la revendication I caractérisée par le verrouillage continu lors du déplacement progressif des éléments 16 et 18 et poussoirs 32 et 34 au moyen de dents 25 aménagées sur un élément coulissant 24 maintenu sur le corps 1 et relié à l'élément 16 s'emboitant sur un cliquet articulé 26 maintenu en position par un ressort 26A. 7) Surgical forceps according to claims 1 and 6 characterized by the pin 38 serving to support a return spring 41 of the elements 16 and 13 and pushers 32 and 34 contained between the element 18 and the extension 12 8 ") Surgical forceps according to claim I characterized by the continuous locking during the progressive displacement of the elements 16 and 18 and pushers 32 and 34 by means of teeth 25 arranged on a sliding element 24 held on the body 1 and connected to the element 16 fitting on an articulated pawl 26 held in position by a spring 26A. 9 ) Pince chirurgicale selon la revendication 1 caractérisée par la compression du viscère à suturer au moyen d'un ressort de compression 29 maintenu à l'intérieur de l'élément 24 en appui sur le prolongement coulissant de l' me 27 à l'intérieur dudit élément 24.  9) Surgical forceps according to claim 1 characterized by compression of the suturing viscus by means of a compression spring 29 held within the element 24 resting on the sliding extension of the me 27 inside said element 24.
FR8304186A 1983-03-11 1983-03-11 SURGICAL FORCEPS FOR LINEAR MECHANICAL SUTURES OF VISCARS OF THE THORACIC AND ABDOMINAL CAVITIES Expired FR2542188B1 (en)

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FR8304186A FR2542188B1 (en) 1983-03-11 1983-03-11 SURGICAL FORCEPS FOR LINEAR MECHANICAL SUTURES OF VISCARS OF THE THORACIC AND ABDOMINAL CAVITIES

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FR2542188B1 FR2542188B1 (en) 1985-08-16

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EP0479131A1 (en) * 1990-10-05 1992-04-08 United States Surgical Corporation Controlled closure mechanism for a surgical stapling instrument
EP0537570A2 (en) * 1991-10-18 1993-04-21 United States Surgical Corporation Apparatus for applying surgical fasteners
EP0537571A2 (en) * 1991-10-18 1993-04-21 United States Surgical Corporation Apparatus for applying surgical fasteners
EP0539762A1 (en) * 1991-10-30 1993-05-05 American Cyanamid Company Linear surgical stapling instrument
EP0579038A1 (en) * 1992-06-30 1994-01-19 United States Surgical Corporation Apparatus for applying surgical fasteners
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US5476479A (en) * 1991-09-26 1995-12-19 United States Surgical Corporation Handle for endoscopic surgical instruments and jaw structure
US5483952A (en) * 1991-09-26 1996-01-16 United States Surgical Corporation Handle for surgical instruments
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US5579978A (en) * 1991-10-18 1996-12-03 United States Surgical Corporation Apparatus for applying surgical fasteners
US5706998A (en) * 1995-07-17 1998-01-13 United States Surgical Corporation Surgical stapler with alignment pin locking mechanism
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US5810240A (en) * 1996-03-15 1998-09-22 United States Surgical Corporation Surgical fastener applying device
US5893506A (en) * 1994-03-01 1999-04-13 United States Surgical Corporation Surgical stapler with anvil sensor and lockout
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