1372556 Stapling machines UNITED STATES SURGICAL CORP 13 Oct 1971 [13 Oct 1970 (2)] 47716/71 Heading B4C [Also in Division A5] A surgical instrument comprises a hand instrument 10, Fig. 1, and a removable cartridge 12, Fig. 7, and in one operation successively (i) ligates an organic tubular structure by holding it in opposed jaws; (ii) sutures the tube at two locations by stapling; and (iii) severs the tube between the locations. The cartridge 12 comprises a pair of rails 102 on which a main body 100 is movable; two curved anvils 104 formed at the forward (left-hand as shown) ends of the rails 102; two parallel index tracks 114, Fig. 11, within the main body 100, in each of which a plurality of staples 112 is housed; two parallel ejector tracks 116 within the main body 100, along each of which a single staple 112 may be advanced by a slidable pusher element 106, the two pusher elements 106 being rigidly connected; means for feeding a single staple from each index track 114 to the adjacent ejector track 116 after each operation of the instrument; and a knife (110), Fig. 8 (not shown), slidable between the pusher elements 106 inside the main body 100. In use, the knife (110) and the pusher elements 106 are initially releasably locked in a rearward position inside the main body 100 by pairs (142), (144) and (108, 147), Fig. 8 (not shown), respectively, while the main body 100 is releasably locked in a rearward position on the rails 102 by parts 148, 150. The three stages of operation are then: (i) the main body 100, the pusher elements 106 and the knife (110) are advanced together until the tubular structure is ligated between the anvils 104 and the main body 100, and motion of the latter is halted thereby; (ii) the pusher elements 106 and the knife (110) advance until the tube is sutured by spaced staples, and the motion of the pusher elements 106 is halted thereby; (iii) the knife (110) advances and severs the tube. An ejector plate (140), Figs. 6, 8 (not shown), capable of limited motion with respect to the anvils 104 moves backward when the knife (110) is subsequently retracted and aids the ejection of the severed tube from the instrument. The hand instrument 10, Fig. 1, advances the movable parts of the cartridge 12 and includes connectors 26, 28, 30 for the knife (110), pusher elements 106 and main body 100 respectively. A pin 62 of the cartridge is held by a thumboperated lock 66 of the hand instrument, thereby securing the rails 102 of the cartridge 12 to the hand instrument 10. The knife connector 26 is mounted at one end of a rod 32, at the other end of which is a cap 34. Cap 34 is connected to a member 56 which may be made to pivot about a pin 58, thus advancing the cap 34, by moving a handle 18 in the direction 60 shown. Handle 18, which is pivoted about a pin 20, carries a cam 52 on an arm 50, and the cam 52 rolls against a surface 54 of the member 56. The surface 54 is shaped so that a substantially constant input force is required throughout the three stages of operation of the instrument. Pusher connector 28 is attached to one end of a tube 36 surrounding the rod 32, at the other end of which is a flange 38. Knife connector 26 and pusher connector 28 are biased together by a relatively strong (e.g. 60 pound) spring 48 between the cap 34 and the flange 38. These two connectors are biased to the rearward direction by a weaker (e.g. 8 pound) spring 40 between the flange 38 and an inner wall 42. The main body connector 30 is slidable on the tube 36 and is biased towards the other two connectors by a relatively weak (e.g. 4 pound) spring 44 between the connector 30 and an outer wall 46. Pivoting the handle 18 as shown thus advances the knife connector 26 against spring 40, and the main body connector 30 and the pusher connector 28 are then advanced by springs 44 and 48 respectively, until halted at the completion of the ligating and stapling operations respectively. In the cartridge 12, the staple-feed means comprises, at each side of the cartridge, a movable set 122, Fig. 11, of forwardly-projecting leaf springs 126, 127 ... attached to the main body 100, and a fixed similar set 124 of springs 128 ... attached to the rail 102. The forwardmost springs 126, 128 both project into the ejector track 116, the other springs project into the index track 114. Ramps 118 and 120 are attached to the main body 100. Prior to operating the instrument, a single staple is in each ejector track 116 against the spring 128, and a plurality of staples is in each index track 114 against the remaining springs of set 124. The other set 122 of springs advances with the main body 100, thereby advancing both the single staple and the plurality of staples through approximately one staple length. When the single staple has been ejected by pusher element 106, the main body 100 is retracted and the ramps 118 and 120 associated therewith transfer the forwardmost staple 112<SP>1</SP> of the plurality to the ejector track 116. Finally, all staples are held against the fixed set 124 of springs.