JP2016025898A - Surgical stapling and cutting device, and use method of the device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical stapling and a cutting device, having a junction type surgical end part effector for overcoming drawbacks.SOLUTION: A medical device comprises: a control handle having a junction joint actuator; a surgical end part effector; and a passive junction joint for connecting the end part effector to the control handle. In a non-operation state, the junction joint actuator holds the passive junction joint, and by the passive junction joint, the end part effector to a junction position which is substantially fixed. In an operation state, the passive junction joint is released to a free junction state, and the end part effector is freely connected to the control handle according to external force applied to the end part effector.SELECTED DRAWING: Figure 4

Description

  The present invention relates to the field of medical devices, and more particularly to the field of surgical stapler instruments that can cut tissue between staple lines while applying the staple lines to the tissue, and further improvements to the stapler instrument. And an improvement in the process of forming the various components of these stapler instruments, including articulated shafts. This device can be used, inter alia, for stapling and cutting tissue during endoscopic or laparoscopic surgical procedures.

  Endoscopic surgical instruments are often preferred over traditional open surgical devices. This is because smaller incisions tend to reduce post-operative recovery time and complications. As a result, significant developments have been made in the operating range of endoscopic surgical instruments suitable for accurately positioning the distal end effector at the desired surgical site through the cannula of the trocar. These distal end effectors engage the tissue in a variety of ways to provide diagnostic or therapeutic effects (eg, end cutters, graspers, cutters, staplers, clip appliers, access devices, drugs / Gene therapy device, energy device using ultrasound, RF, laser, etc.).

The positioning of the end effector is forced by the trocar. Generally, these endoscopic surgical instruments have a long shaft between the end effector and the handle portion that the surgeon manipulates. This long shaft allows insertion to the desired depth and rotation around the long axis of the shaft, thereby allowing some positioning of the end effector. This positioning is often sufficient by judicious placement of the trocar, for example by using a gripper via another trocar. For example, Knodel et al. Surgical stapling and cutting instruments such as U.S. Pat. No. 5,465,895, which is incorporated herein by reference, are examples of endoscopic surgical instruments that successfully position an end effector by insertion and rotation.
US Pat. No. 5,465,895

Manufactured by United States Surgical Corporation, Green et al. The staplers described in U.S. Pat. Nos. 6,644,532 and 6,250,532 are responsive to actuation of a lever that moves correspondingly along a single surface in the same step. And an end effector that pivots in steps along a single plane. See FIGS. 31 and 32. However, the United States Surgical Corporation stapler is limited by the predetermined angle that can be achieved and the left and right rotation limits (-45 ° to + 45 °) and requires two hands to operate.
US Pat. No. 6,644,532 US Pat. No. 6,250,532

  Rather than being limited to insertion and rotation, it is desirable to further adjust the positioning of the end effector of the endoscopic surgical instrument depending on the operating characteristics. In particular, it is often desirable to point the end effector to an axis that traverses the long axis of the instrument shaft. This lateral movement of the end effector relative to the instrument shaft is conventionally referred to as "joint". This articulated positioning allows the surgeon to more easily engage tissue in some cases. Also advantageously, articulated positioning allows the endoscope to be placed behind the end effector without being blocked by the instrument shaft.

  The non-joint stapling and cutting instrument described above is highly practical and can be successfully used in many surgical procedures, but enhances this action with the ability to articulate the end effector, and thereby in use. It would be desirable to give surgeons greater flexibility. Articulated surgical instruments typically move one or more longitudinally through the articulating joint within the instrument shaft to fire staples from the cartridge and cut tissue between the innermost staple lines. Use the launch bar. One common problem with these surgical instruments is the control of the firing bar through the articulating joint. The end actuating body is arranged with a space in the vertical direction from the shaft in the articulation joint so that the shaft and the edge of the end actuating body do not collide during the articulation. This gap is either filled with support material or structured so that the launch bar joints do not come off when a single or multiple launch bars are subjected to a longitudinal firing load. Must-have. What is needed is a tidal structure that guides and supports one or more firing bars through articulating joints, or a supporting structure that bends or curves when the end effector is articulated.

  Schulze et al. U.S. Pat. No. 5,673,840 issued to U.S. Pat. No. 6,057,028 is made of an elastomeric material or a plastic material and discloses a flexible articulated joint. This bends at the flexible joint or “flex neck”. The firing bar is supported and guided through a hollow tube in the flex neck. The flex neck is part of the occlusion closure mechanism and moves longitudinally relative to the end effector, shaft and firing bar when the occlusion closes on the tissue. The firing bar then moves longitudinally within the flex neck as the staples are fired and the tissue is cut.

Oberlin et al. U.S. Pat. No. 5,797,537 (owned by Richard-Allan Medical Industries, Inc.) discloses an articulating joint that pivots around a pin rather than bending around a flex joint. Yes. In this instrument, the firing bar is supported between support plates arranged in a pair of spaces. This plate has one end connected to the shaft and the other end connected to the end working body. At least one of these connections is a slidable connection. The support plate extends through the articulation joint near the flexible drive member at the articulation surface, the support plate bends through the gap in the articulation surface, and the flexible launch bar aligns the tip thereof When connected in one direction from position, it bends against the support plate. U. S. Milliman et al. From Surgical. U.S. Pat. No. 6,330,965 teaches the use of a support plate fixedly attached to the shaft and slidably attached to the end effector.
US Pat. No. 5,797,537 US Pat. No. 6,330,965

  These known support plates guide the firing bar through articulated joints, but it is believed that performance can be enhanced. For example, in many cases it is desirable for the firing bar to accelerate rapidly during firing to ensure sufficient momentum to effectively cut tissue. The firmly attached support plate tends to move in response and causes the firing bar to jump out of the articulating joint. As a further example, it is desirable for the instrument to operate in the same manner regardless of whether it is articulated. Increased friction during articulation is undesirable and confuses the surgeon if it is necessary to use a variation in firing force.

  As a result, there is a significant need for an improved articulation mechanism for a surgical instrument mechanism that enhances support to the firing bar via the articulation joint.

  Accordingly, it is an object of the present invention to overcome the above-mentioned drawbacks of common types of known devices and methods and to use a surgical stapling and cutting device and articulated device that provide an articulated surgical end effector. Is to provide a method.

  In view of the above and other objects, in accordance with the present invention, a medical device end effector coupling assembly is provided that includes a passive articulation joint that couples the end effector to a control handle.

  In view of the objectives of the present invention, in a medical device having an end effector coupled to a control handle, an actuating body coupling assembly is provided that includes a passive articulating joint for coupling the end effector to the control handle. Yes.

  In view of the objects of the present invention, there is also provided a medical device comprising a control handle and a surgical end effector coupled to the control handle via a passive articulation connection.

  In view of the object of the present invention, there is also provided a medical device comprising a control handle and a surgical end effector passively connected to the control handle.

  In view of the objects of the present invention, there is also provided a control handle having a first portion of a passive articulating joint and a surgical end effector having a second portion of the passive articulating joint, the passive articulating joint. A medical device is provided in which the first and second portions connect the end effector to the control handle.

  In view of the objects of the present invention, there is also provided a medical device comprising a surgical end effector having a control handle and a passive articulating joint coupling the end effector to the control handle.

  In view of the objectives of the present invention, there is also provided a medical device comprising a control handle, a surgical end effector, and a passive articulating joint connecting the end effector to the control handle.

  In view of the objects of the present invention, there is also a control handle having articulated joint actuators in a non-actuated state and an actuated state, a surgical end effector, and a passive coupling the surgical end effector to the control handle. Medical devices having articulated joints are provided. The articulated joint actuator holds the passive articulated joint when in an inactive state, thereby placing the end effector in a substantially fixed articulated position, and when in an actuated state, the articulated joint actuator The end actuating body is freely connected to the control handle in accordance with an external force acting on the end actuating body.

  In view of the objectives of the present invention, there is also a control having a stapled stapling device, a surgical stapling end actuator having at least one of a bladed cutting device, and a stapler closure actuator that closes the stapling device when actuated. A handle, a staple firing actuator that performs at least one of fastening a staple upon actuation and cutting of tissue with a cutting device, an articulated joint actuator having a non-actuated state and an actuated state, and a handle for controlling the end effector The end effector is provided with a passive articulating joint coupled to the end actuating body when the articulating joint is activated and the articulating joint actuator is not actuated. Depending on the force applied to the end effector. It is connected to.

  In accordance with one aspect of the present invention, the surgical instrument has a handle portion that releases the lock and allows firing while connected to the end effector connection. This release and firing mechanism is transmitted to the articulation mechanism via the shaft. The articulation mechanism corresponds to the force applied by the user to the end effector and allows the end effector to be articulated out of the longitudinal axis line of the shaft. The launch mechanism corresponds to the launch operation and is coupled to move through the articulation mechanism and the end effector. The firing support device allows the firing mechanism to support and hold the firing mechanism in place when articulation occurs.

  According to another feature of the invention, the control handle comprises an articulated joint actuator having a non-actuated state and an actuated state, and the end effector has a locked articulated state and an articulated lock having an unlocked articulated state. The articulated joint actuator changes the articulation lock from the locked articulated state to the non-engaged articulated state when the non-actuated state changes to the actuated state, and The lock is changed from the non-locking connection state to the locking connection state.

  According to a further feature of the present invention, the stapler closure actuator and the staple firing actuator are different from the articulated joint actuator.

  According to an additional feature of the invention, at least one first flexible beam coupling the control handle to the staple firing actuator via a passive articulation joint, and the end effector to the control handle via a passive articulation joint. At least a second flexible beam is provided for longitudinal connection. The first and second flexible beams bend corresponding to the articulation of the passive articulation joint.

  According to a further feature of the present invention, the control handle has a first longitudinal axis, the end effector has a second longitudinal axis, the control handle, the end effector, and the passive linkage joint. At least one of which has an alignment device. In an exemplary embodiment, the alignment device biases the end effector to substantially align the first and second longitudinal axes when the articulating joint actuator is actuated. The alignment device may be a centrally biased device. In such an embodiment, the central biasing device is a spring-loaded plunger set disposed on opposite sides of the first longitudinal axis, which individually presses the end effectors to provide the first longitudinal axis. The second vertical axis is aligned.

  Another advantage of the present invention is that the movable distal end effector is centrally biased. This means that the distal end is first free from a stable position and then passively moves to a new position by pressing the end effector against an environmental structure such as surrounding tissue. When the actuator that releases the end effector from the stable position is released, the central biasing device, preferably at least one biasing spring, in particular, is opposed and thus has two biasing forces in the central direction. With the bias spring pressed, the distal end effector returns to the central position. Alternatively, the central biasing device may be a spring-loaded plunger set located on either side of the end effector in the clevis and individually pressing the end effector toward the center position Good.

  According to a further feature of the present invention, the articulating joint actuator has a pull lock with teeth facing distally, and the passive articulating joint is in this state when the articulating joint actuator is in an inoperative state. A gear having teeth facing proximally that interengage with teeth facing distally. Further, the articulated joint actuator disengages the teeth facing the distal side from the teeth facing the proximal side when the articulated joint actuator is in the non-actuated state. Release the articulation lock.

  According to a further feature of the present invention, actuation of the distal movement is caused by pull-to-release and release-relock triggers. This trigger that controls passive movement is normally locked. This lock is released by being pulled on the trigger. When the distal end effector is in the desired position, the user releases the trigger to lock the distal end effector in the new position.

  The device according to the invention is a surgical stapler and cutter, or in particular other endoscopic devices that can be used to staple portions of tissue together and cut tissue when desired. In one embodiment of the end effector, means for performing both stapling and cutting functions are generally retained within the distal end effector of the device.

  Again, another advantage of the present invention is that the handle is electronically controlled, universal and motorized. The handle includes a microprocessor programmed for multiple product configurations. For example, in the case of a stapler, the handle is programmed for a 30 mm, 45 mm, or 60 mm staple cartridge. The distal shaft of the stapler has a proximal end that plugs into the universal handle. The distal shaft comprises an electrical contact array, which contacts correspondingly with the matching array on the handle side in the connected position. This contact is unique for each of the various distal shafts, and the handle “recognizes” the shaft and runs the appropriate program for that shaft. The handle is programmed to include safe lockout, stapler delivery speed, stroke distance, and other logic. With such modularity, a single handle having a plurality of end effectors can be manufactured to match the shaft.

  The operation of the device is performed using an electric motor. The device may also be via a flexible drive shaft by a plurality of electric motors, by a hydraulic or pneumatic motor, or in any manner that allows the actuation assembly to be included uniquely or entirely in the distal portion of the device. It can be driven by transmitting energy.

  The work done by any of these means can be a single thing like screw drive, gear drive, wedge, toggle, cam, belt, pulley, cable, bearing, or push rod, or a combination of these It can be converted into a desired movement. In particular, screw drives are used to convert electric motor motion into linear motion. In one embodiment, a screw drive motor is provided on the handle. A flexible rotating cable is connected from the motor to the threaded shaft. Thus, when the motor rotates in either direction, the rotation of the flexible cable is transmitted to the screw drive shaft, and the stapling actuator and cutting slide are placed on the drive shaft, so the distal movement of the slide To perform both functions. In the second embodiment, the entire motor is provided in the end working body and has a shaft connected to the slide drive shaft directly or via a transmission gear. In this case, what is needed in the handle is an on / off and drive shaft direction actuator, the former is for switching the motor on and off, and the latter is for determining the direction in which the motor spins. Is.

  This device has a carriage driven by a screw drive and performs many functions, including functions such as closing the stapler engagement, advancing the cutting blade, and firing staples. The carriage is not the only way to perform these tasks. Secondary or many work sources provide the work necessary to perform any of these functions.

  In a second embodiment of the end effector, the entire stapling and cutting actuating device is self-contained and is located distal to the motion joint.

  The entire actuation device can be inserted and manipulated by a multi-axis “ball” or “universal” joint that performs any movement or restriction desired by the operator.

  Furthermore, the entire actuation device is completely free from the handle and can be gripped again from another angle, allowing for better positional flexibility.

  According to a further feature of the present invention, the passive articulating joint is a ball joint having a ball, a cup device, and a ball-cup locking device that locks the ball and the cup device together and releases the locking. Yes, the ball-cup locking device is in a locked state when the control handle is in an inoperative state and is unlocked when the control handle is in an activated state. The end effector has one of the ball and cup device and the control handle has the other of the ball and cup device. The ball is removably coupled to the cup device.

  According to a further feature of the present invention, the end effector has two ends in the longitudinal direction and the balls are two balls. Each of the two balls is disposed on one of the two longitudinal ends, and each of the two balls can be removably coupled to the cup device.

  In one aspect of the invention, the instrument activates the end effector using a longitudinally moving firing mechanism. This firing mechanism is advantageously supported via a linkage mechanism by a side support plate or a rigid support channel. In the former embodiment, one or more ends of each support plate are elastically or spring-engaged on one side of the articulation mechanism in order to respond better to the firing of the load on the firing mechanism, Therefore, the buckling of the firing mechanism can be prevented better. For example, a pair of support plates is located on the side of the launch mechanism across the articulation mechanism, and each support plate has an end engaged by a spring in a frame groove formed in the articulation mechanism, inside or outside the articulation mechanism. Helps prevent buckling of the launch mechanism.

  In the channel embodiment, the channel floats within the articulation mechanism and has a surface that supports either side of the firing mechanism when the articulation occurs in either direction. Therefore, buckling of the firing mechanism can be prevented. The channel has a floor and two sides. The support channel rests freely in a cavity inside the articulation mechanism. The end of the channel is curved to match the curvature of this cavity. The support channel has various internal surfaces that contact and support the firing mechanism when bent within the articulation mechanism, thereby preventing buckling of the firing mechanism inside or outside the articulation mechanism. .

  Therefore, the present invention does not cause buckling in the articulating mechanism even if the various types of actuated diagnosis or treatment end effectors have a strong firing force or the size of parts in the endoscope specification is reduced. Can be incorporated into any articulated medical device.

  In a further aspect of the invention, the medical device has a handle portion that produces a closing action, a firing action, an unlocking action of the articulating mechanism, and an articulating action. These movements are each transmitted through the shaft. The end effector includes an elongate channel connected to a shaft that receives the staple or staple cartridge, and a pedestal that is pivotally connected to the elongate channel and is responsive to a closing action from the shaft. The firing device includes a distal cutting device that is received longitudinally between the elongate device and the pedestal. The launch device is coupled from the handle to the end effector via a shaft and articulation mechanism. The firing device uses stapling to cut by a firing action. The articulation mechanism moves the end effector relative to the shaft. The articulation mechanism is connected distally to the shaft and after the articulation lock is released (ie, unlocked) and in response to the force acting on the end effector to produce the articulation action. Connect the actuators. In other words, when the connection lock is released, the pressure on the environment of the end effector causes the end effector to be connected to the shaft. To support the firing mechanism, a pair of support plates can be positioned on the side of the firing mechanism across the articulating mechanism. Each support plate may include a spring-engaged end in a frame groove formed in the articulation mechanism, or a rigid channel may surround the firing mechanism across the articulation mechanism. Thus, the improved stapling and cutting instrument includes a firing device that can withstand high firing loads and does not introduce significantly increased firing force when articulated.

  The actuation device may be manufactured in various lengths and / or may be manufactured to a diameter suitable for either laparoscopic or endoscopic or both. A replaceable staple cartridge can be used. The actuation device can also be configured to attach to the distal end of a flexible endoscope.

  A significant advantage of the present invention is that the end effector movement is passive and lockable. In other words, the end actuator can be unlocked and then moved to the desired position and then held in its new position. All of these operations can be performed by one-handed operation. Endoscopic and laparoscopic surgery requires that the surgeon can use both hands separately. Eliminating this need makes surgery extremely difficult or impossible. The handle of the present invention can be actuated to release / lock without using a second hand, allowing the device to be operated with a true one hand.

  A further advantage of the present invention is that the axial movement of the end effector is separate and manual. For example, the user can set the axial movement by rotating the distal end effector about the longitudinal axis of the device prior to insertion. This preset positioning occurs by pulling the end effector away from the shaft and then twisting the distal end effector in the desired direction. This axial movement, combined with off-axis movement (lateral movement), creates a composite angle at the distal end to aid in precise positioning of the end effector (or multiple end effectors). . In another variation, the user provides a rotating device that axially secures the handle to a distal component that includes a shaft, articulation mechanism, and end effector, and is freely coupled in the rotational direction. This allows the distal end effector to be dynamically rotated about the longitudinal axis of the device at any time. The rotation of the distal component occurs by pulling the bell-shaped rotation device away from the end effector, and then the rotation of the rotation device about the longitudinal axis of the shaft in the desired direction. This rotational motion, combined with the off-axis motion of the end effector, creates a composite angle at the distal end of the device to assist in the precise positioning of the end effector (or end effectors).

  Yet another advantage of the present invention is that the stapler / cutter can be configured to attach to the end of a standard flexible endoscope. This control is sent back through the working channel of the endoscope and matches the control handle or control module.

  In view of the objects of the present invention, a method for operating an end effector of a medical device is also provided. The method includes maintaining a passive articulation joint that controls the articulation of the end effector in a stable position using an articulation lock, and actuating the release of the articulation lock to lock the passive articulation joint. Unwinding and articulating the end effector via a passive articulation joint in response to an external force on the end effector.

  In view of the object of the present invention, a method is provided for manipulating an end effector of a medical device, the method comprising: holding a passive articulation joint that is locked by an articulation lock; Actuating to unlock the passive articulation joint and causing the passive articulation joint to actuate in response to an external force acting on the end effector.

  According to another mode of the invention, the end effector is passively moved to the articulated position.

  According to a further mode of the invention, the end effector is passively moved to the articulated position by pressing a part of the end effector against the structure of the environment.

  According to a further mode of the invention, a force is applied to the end effector to connect the end effector to the desired articulation position.

  According to a further mode of the invention, the operation of the articulation lock is removed and the passive articulation joint is locked, thereby preventing the end effector from further articulating.

  Advantageously, all of the above steps are performed with one hand.

  Other features which are considered as characteristic for the invention are set forth in the appended claims.

  Although the present invention has been shown and described in the drawings as a surgical stapling and cutting device and method of using this device, various modifications and structural variations can be made without departing from the spirit of the invention. However, the present invention is not limited to the details shown in the drawings.

  The structure and method of operation of the present invention, together with additional objects and advantages, are best understood from the following description of specific embodiments when read in conjunction with the accompanying drawings.

The advantages of embodiments of the present invention are apparent from the following detailed description of preferred embodiments of the invention. This description should be considered in conjunction with the accompanying drawings.
FIG. 1 is a fragmentary view of a first embodiment of a distal stapling and cutting end actuating body and a portion of a shaft coupled thereto according to the present invention, enlarged and fragmented as viewed from the distal end. FIG. 6 is a perspective view, with the staple cartridge being pulled about half from the end cartridge staple cartridge engagement and having a stapler base separated from the staple articulation and tissue cutting slide. FIG. 2 is an enlarged fragmentary side view of the end effector shown in FIG. 1 with a distal cowling and a proximal splined axially moving portion for clarity. For this purpose, a cartridge removed and a pedestal for the stapler connected to the slide are provided. FIG. 3 is an enlarged fragmentary perspective view of the end effector shown in FIG. 1, with a staple actuating and tissue cutting slide at the distal portion, and a stapler pedestal remote from the slide. Have. 4 is an enlarged fragmentary perspective view of the end effector shown in FIG. 1 with the staple cartridge removed from the lower occlusion / staple cartridge holder and an angle of about 45 ° with respect to the center. Shows the rotated clevis. FIG. 5 is an enlarged front view of the wire frame side of the distal end portion of the end effector shown in FIG. FIG. 6 is an enlarged, fragmentary perspective view of the end actuator splined shaft travel assembly shown in FIG. 1 rotated approximately 90 °; The lateral movement locking pin and the proximal screw of the part actuating body are omitted. FIG. 7 is an enlarged side view of the end working body shown in FIG. 6 as seen from the bottom side, and is a fragmentary side view of the end working body, which engages with the teeth of the laterally moving sprocket. It includes a laterally moving locking pin and a spring, with the proximal screw removed for clarity. FIG. 8 is an enlarged bottom view of the end working body shown in FIG. 7 and is a fragmentary bottom view of the wire frame. Have. FIG. 9 is an enlarged view of the end working body shown in FIG. 8 in a fragmentary view, seen from the bottom, and is a lateral movement of the end working body that engages with the teeth of the laterally moving sprocket. It has a locking pin and the spring is removed for clarity. FIG. 10 is an enlarged fragmentary perspective view of the end effector rotated about the longitudinal axis shown in FIG. 2 and splined on the clevis, screw, and distal side for clarity. The movement of the sleeve shaft and the spring part are excluded. FIG. 11 is an enlarged fragmentary bottom view of the distal portion of the end effector shown in FIG. 1, showing the staple actuation and tissue cutting slide in a proximal position. 12 is an enlarged fragmentary bottom view of the distal portion of the end effector shown in FIG. 11, showing the staple actuation and tissue cutting slide in an intermediate position. FIG. 13 is an enlarged, fragmentary, radial cross-sectional view through the end effector stapling operation and tissue cutting slide shown in FIG. FIG. 14 is an enlarged, fragmentary horizontal longitudinal section through the lower half of the end effector shown in FIG. FIG. 15 is an enlarged, fragmentary, horizontal cross-sectional view through the upper half of the proximal portion of the end effector shown in FIG. 16 is an enlarged, fragmentary, horizontal cross-sectional view through the longitudinal axis of the proximal portion of the end effector shown in FIG. FIG. 17 is an enlarged, fragmentary, horizontal, longitudinal section through the right half of the proximal portion of the end effector shown in FIG. FIG. 18 is a view showing the left side surface of the surgical stapler according to the present invention, and shows the occlusion of the end working body in the open state in the stable position of the working handle. FIG. 19 is a view showing the left side surface of the surgical stapler shown in FIG. 18, and shows a state where the engagement of the end effector in the operating position of the thumb trigger of the operating handle is closed. FIG. 20 is a view showing the surgical stapler of FIG. 18 from the upper side to the left side, in a state where the lateral movement trigger is pressed and freely moves in the lateral direction depending on contact with the environment such as the surface. The distal end effector in the position and the end effector in the stable position of the actuating handle are shown open, showing the occlusion located laterally at an angle of about 45 °. FIG. 21 is a view of the surgical stapler of FIG. 18 from the top to the left, with a lateral movement trigger in a stable position, a distal end actuating body in a laterally captured movement state, and an actuation handle. The end effector is open in the stable position, showing the occlusion located laterally at an angle of about 30 °. FIG. 22 is a fragmentary view of the left side of the end effector of FIG. 18 showing the occlusion located in a stable position and laterally at about 75 °. FIG. 23 is a fragmentary view of the left side of the end effector of the stapler shown in FIG. 18, showing the occlusion in an open state at the stable position and at the rotated first axial position. 24 is a fragmentary view of the left side of the end effector shown in FIG. 23, showing the occlusion in the stable position and in the open position at the normal position rotated counterclockwise with respect to FIG. . FIG. 25 is a perspective view from the distal end of a second embodiment of the surgical stapling device of the present invention, with a removable end effector having a built-in stapling motor and an open stability. And a ball release lever that captures the ball in a stable position and a motor actuation button in a stable motor off position. FIG. 26 is an enlarged perspective view of the removable end effector shown in FIG. 25, showing the occlusion in a stable open position, with the slide removed for clarity. FIG. 27 is a perspective view of the third embodiment of the surgical stapling device of the present invention from the distal end, with removable end actuation having two ball connecting ends and a built-in stapling motor. The body, the stapling occlusion in the right lateral position at about 45 ° in the stable open position, the staple occlusion facing in the reverse direction and the proximal direction, and the ball release lever in the activated ball release position And a motor actuation button in a stable motor off position. FIG. 28 is an enlarged perspective view of the removable end effector shown in FIG. 27 viewed from the right and distal ends, showing the occlusion in a stable open position, with the slide removed for clarity. Yes. FIG. 29 is a top view of the actuating handle shown in the captured and aligned state of the surgical stapling and cutting device shown in FIGS. 25 and 26 and the ball joint of the removable stapling end effector of FIGS. FIG. 6 is a fragmentary, enlarged side cross-section wireframe of the distal end. FIG. 30 is a fragmentary, enlarged side cross-sectional view of the most distal end opposite the actuation shown in FIG. 29, captured in a misaligned, released but clamped state of the actuation handle. Indicates a ball joint. FIG. 31 is a perspective view from the proximal end of the stapling and cutting device of the present invention, excluding the pedestal. 32 is a fragmentary perspective view, as seen from the proximal end of the device of FIG. 31, with the handle removed to show the proximal side of the decoupling device with push rod. FIG. 33 is an enlarged, exploded view of the proximal end portion of the inner tube of the device shown in FIG. FIG. 34 is a fragmentary perspective view, seen from the distal end, with the outer tube removed and the internal part connecting the disengagement device to the articulation joint of the end effector. FIG. 35 is a fragmentary, enlarged, longitudinal section of a portion of FIG. FIG. 36 is a fragmentary, enlarged perspective view of the knife guide assembly shown in FIG. 31 from the proximal side of the knife guide to the distal side of the knife blade, with the outer and inner tubes removed. is there. FIG. 37 is a fragmentary, enlarged, longitudinal section of the portion of FIG. 35 at the proximal end of the pull band. FIG. 38 is a fragmentary, enlarged, longitudinal section of the portion of FIG. 35 at the distal end of the pull band. FIG. 39 is a fragmentary, enlarged side cross-sectional view of the stapler assembly, drum sleeve, articulating joint, and device clevis of the device of FIG. 31 showing the pedestal in an open state. FIG. 40 is a fragmentary, enlarged side cross-sectional view of the stapler assembly, drum sleeve, articulating joint, and device clevis of the device of FIG. 31, showing the pedestal in a closed firing condition. FIG. 41 is a fragmentary, enlarged perspective view of the knife guide subassembly from the proximal side of the knife guide to the knife blade, with the knife guide, clevis, left hammock, drum sleeve, and cartridge holder shown in FIG. Removed. 42 is a fragmentary, enlarged, longitudinal section of the knife-extrusion rod pin joint of the device of FIG. 43 is a fragmentary, enlarged, longitudinal sectional view of the pull band-aluminum tube pin joint of the device shown in FIG. 44 is a fragmentary, enlarged, longitudinal section view of the clevis proximal surface of the device shown in FIG. 31. FIG. 45 is a fragmentary, enlarged, longitudinal cross-sectional view of the plunger pin spring pocket and articulation release pin of the device shown in FIG. 46 is a fragmentary, enlarged, longitudinal sectional view of the plunger pin cam surface and articulating locking sprocket of the device shown in FIG. 47 is a fragmentary, enlarged, longitudinal sectional view of the end effector articulation joint of the device shown in FIG. 31. FIG. 48 is a fragmentary, enlarged, longitudinal cross-sectional view of the distal pull band pin joint of the device shown in FIG. 31. FIG. FIG. 49 is a fragmentary, enlarged, longitudinal cross-sectional view of the pedestal / upper mating pivot slot of the device shown in FIG. FIG. 50 is a fragmentary, enlarged, longitudinal cross-sectional view of the articulating joint through the spring rod of the device shown in FIG. FIG. 51 is a diagram showing a knife guide blade test bed and a device hammock shown in FIG. 31. FIG. 52 is a fragmentary, enlarged, longitudinal section through the articulation release slide of the articulation joint portion of the device shown in FIG. FIG. 53 is an exploded perspective view of the distal part of the device shown in FIG. 31 as viewed from the distal end without a pedestal. FIG. 54 is a perspective view showing the articulating distal portion of the fourth embodiment of the end effector of the present invention with the inner and outer tubes removed. FIG. 55 is a fragmentary, enlarged, exploded perspective view of the articulated portion of the end effector shown in FIG. 54 with the outer tube removed, with the tip facing inward to the viewer. 56 is a fragmentary, enlarged, bottom view of the articulating portion of the end effector shown in FIG. 54 with the outer clevis and closure ring removed. FIG. 57 is a fragmentary, enlarged, cross-sectional view of the articulation portion of the end effector shown in FIG. 54, passing through the lower end of the dogbone guide. FIG. 58 is a fragmentary, longitudinal cross-sectional view through the spring rod of the articulated portion of the end effector shown in FIG. 54 with the inner tube and push rod-blade support removed. FIG. 59 is a fragmentary, enlarged, longitudinal section through the distal end of the dogbone guide of the articulating portion of the end effector shown in FIG. FIG. 60 is a fragmentary, enlarged, longitudinal section through the proximal end of the lower clevis dogbone guide chamber of the articulation portion of the end effector shown in FIG. 54 with the dogbone guide removed. ing. 61 is a fragmentary, enlarged, longitudinal sectional view through the lower middle portion of the dogbone guide of the articulating portion of the end effector shown in FIG. 54. FIG. 62 is a fragmentary horizontal longitudinal section through the central portion of the dogbone guide of the articulated portion of the end effector shown in FIG. 54. FIG. FIG. 63 is a longitudinal cross-sectional view of the articulated portion of the end effector shown in FIG. 54 passing through the inner tube, push rod support, pedestal, and spring rod with almost half of the staple thread removed. FIG. 64 is a longitudinal sectional view through the spring rod of the articulated portion of the end effector shown in FIG. 54, excluding almost half of the spring plate, pedestal, and staple thread. 65 is a longitudinal cross-sectional view of the distal end of the articulating portion of the end effector shown in FIG. 54 with the inner tube, push rod blade support, pedestal, and nearly half of the staple threads removed. 66 is a perspective view showing the lower clevis, lower dogbone clevis, dogbone guide, and three adjacent knife blades of the end effector shown in FIG. 54. FIG. 67 is a fragmentary, wireframe longitudinal cross-sectional view of the end effector of FIG. 68 is a fragmentary, wireframe perspective view of an alternative embodiment of the pull band distal connection of the end effector of FIG. 54. FIG. FIG. 69 is a fragmentary, longitudinal cross-sectional view of the distal connection of FIG. 68. FIG. 70 is a fragmentary perspective view of a part of the distal connection part of FIG. 68 as seen from below.

  Aspects of the invention are disclosed in the following description and drawings relating to specific embodiments of the invention. Alternate embodiments may be devised without departing from the spirit or scope of the invention. Moreover, well-known elements of exemplary embodiments of the invention will not be described in detail or will not be described in order not to obscure the relevant details of the invention.

  Prior to the disclosure and description of the present invention, the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. It should be noted that as used in the specification and claims, the singular article also has multiple meanings unless the context clearly indicates otherwise.

  While the specification concludes with claims that define the features of the invention believed to be novel, it is believed that the invention will be better understood in view of the following description in conjunction with the drawings. . The same reference numerals are used in the drawings. The drawings are not drawn to scale.

  Referring now in detail to the drawings, and more particularly to FIG. 1, a first exemplary embodiment of a stapling and cutting end effector 1 according to the present invention is shown. The main parts of the end effector include the clevis 10, the pedestal 20, the cartridge holder 30 that receives the staple cartridge 100, the adapter sleeve 40, and the lateral movement or articulating device 50. FIG. 1 shows the detachability of the staple cartridge 100 from the cartridge holder 30.

  Connecting the pedestal 20 to the cartridge holder 30 and the staple cartridge 100 is a staple actuation and tissue cutting slide 60. The slide 60 is operatively engaged with the pedestal 20 and the cartridge holder 30 to hold the two parts 20 and 30 in proper alignment, and the staples actuated in the cartridge 100 are each in the pedestal 20. The stapler pedestal is fixed, and the staple is fixed around the tissue disposed between the pedestal 20 and the cartridge 100. The distal-facing surface of the slide 60 has a blade 62 that cuts the tissue disposed within the occlusions 20, 30 as the tissue is stapled together. The proximal movement of this slide is shown diagrammatically in FIGS. The slide 60 can be seen in FIGS. 1 and 3, and the pedestal 20 is off the tip of the slide 60. However, in operation, the slide 60 must be connected to the pedestal 20, as shown in FIG.

  FIG. 2 shows the end effector 1 with the adapter sleeve 40 removed to show various features of movement within the adapter sleeve.

  The first of the two main parts of the lateral movement device 50 is evident in FIGS. Proximal component 52 includes a proximal sprocket 522, an intermediate splined connector 524, and a distal rod 526. In the exemplary embodiment, intermediate splined connector 524 has four distally protruding teeth 5242, as clearly shown in FIG.

  Also shown in FIG. 2 is a pull cable adapter 70. The pull cable adapter 70 has a proximal side connected to the pull cable 110 (broken line) and a distal side connected to the cartridge holder 30. Accordingly, the pulling cable adapter 70 is used to push or pull the cartridge holder 30 with respect to the pedestal 20, so that the pedestal 20 moves from the open position to the closed position in accordance with the movement of the cartridge holder 30, or It rotates in the opposite direction. The proximal end of the pedestal 20 has cam followers 22 on both sides. The proximal end of the cartridge holder 30 defines two cam surfaces 32 on both sides and is aligned to receive each cam follower 22. Accordingly, the movement of the cartridge holder in the distal direction or the proximal direction causes an opening rotation or a closing rotation corresponding to the base 20.

  FIG. 4 is a diagram illustrating a lateral connecting operation of the staplers 20 and 30 with respect to the clevis 10.

  In FIGS. 5-8, the adapter sleeve 40 and all components including the clevis 10 are shown in wireframe, so that the internal features can be seen. The clevis 10 has four lumens, two of which are shown in FIG. 5, and all four lumens are shown in FIGS. Of these lumens, the first lumen 12 is formed to include a shaft (not shown) that controls the distal and proximal movement of the end effector lateral movement locking pin 120. . This pin 120 is first shown in FIGS. The two lateral lumens 14 are shaped to receive a pull wire that moves the pull cable adapter 70 proximally (the movement of the pull cable adapter 70 distally is caused by a spring). The other lumens of the two lumens 14 are extra lumens and can receive any number of additional instruments. The drive cable lumen 16 is the last lumen of the four lumens and is configured to receive a flexible drive cable that rotates a drive screw 34 (see FIG. 1) that controls the movement of the slide 60.

  At the distal end of the drive cable lumen 16, the clevis 20 defines an oval cavity 18 that receives the lateral movement locking pin 120. 6-9 show in particular an exemplary shape of this cavity 18. Since the lateral movement locking pin 120 has an oval circumferential shape, the pin 120 does not rotate from a position aligned with the teeth of the sprocket 522.

  Also, two decentering springs 130 are visible under the tip side of the clevis 10 shown in FIG. These springs 130 are also shown in FIGS. 6 to 9, in particular in FIG. In order to prevent undesired interactions between the springs 130, a separation plate 140 is provided with the springs 130 in between. FIG. 10 shows two springs 130 with a separation plate 140 in between.

  The mechanism below the transparent sleeve 40 is better described in FIGS. The sleeve 40 defines two outer structures and two inner bores. The first outer structure is a proximal cylinder 42. Proximal cylinder 42 defines a spline structure 422 at its proximal end. These spline structures 422 meet and interact with the splined connector 524 in the middle of the proximal portion 52. The proximal cylinder 42 also defines a first bore 44 that is shaped to receive the distal rod 526 of the proximal portion 52. There is a cylindrical radial clearance between the rod 526 and the inner surface of the first bore 44, and a longitudinal clearance between the proximal end of the cable adapter 70 and the proximal inner surface of the first bore 44. is there. This cylindrical clearance can receive a first cylindrical biasing device (e.g., a coil spring) not shown for clarity. The first biasing device is in a position to apply a proximally directed force to the most proximal end of the adapter sleeve 40. In such a configuration, the force applied by the first biasing device pushes the distal spline structure 422 toward and against the proximal spline structure 5242.

  The second outer structure of the sleeve 40 is a distal cylinder 46. This distal cylinder 46 defines a second bore 48 that is shaped to receive a pull cable adapter 70 therein. The pull cable adapter 70 also defines an inner bore 72 that is shaped to receive the distal rod 526 of the proximal portion 52. In order to clarify this structure, the rod 526 is shown extending completely to the inner bore 72 with a broken line in FIG. In operation, the rod 526 extends completely into the inner bore 72. Inner bore 72 is coaxial and has the same inner diameter as first bore 44 in the exemplary embodiment. Accordingly, there is a cylindrical radial clearance between the rod 526 and the inner surface of the inner bore 72 and a vertical gap between the distal surface of the cable adapter 70 and the inner distal surface of the inner bore 72. There is directional clearance. This is because it is shaped to accommodate the second cylindrical bias device (eg, coil spring) and is not shown in the figure for clarity. The second biasing device is provided to provide a biasing force directed distally to the pull cable adapter 70. Such a force keeps the engagements 20, 30 in the open position. Therefore, the fittings 20 and 30 have a stable open position.

  Without providing an intermediate portion, two bias devices (not shown) are connected, thus forming a single spring. However, it is desirable that the two bias devices do not interact. This is because the separation of the spline portion applies an undesirable force to the carriage, and the movement of the carriage holder 30 may loosen the connection of the spline portions. Accordingly, a washer (not shown) is disposed between the two bias devices in the cylindrical cavity 74 defined by the proximal end surface of the pull cable adapter 70 and the distal end surface of the second bore 48. FIG. 7 is a diagram specifically showing the proximal side for holding the washer, which is shaped to receive only the distal rod 526 therethrough. Thus, as the washer fits between the tension cable adapter 70 and the sleeve 40, the two springs are disengaged, providing an independent biasing force.

  The lower view of FIGS. 11 and 12 shows the drive shaft 34 of the slide 60 and the proximal idler bush 36 that holds the drive shaft 34 in place within the cartridge holder 30. In this position of the idler bush 36, the drive shaft 34 is not threaded. However, on the proximal side of the idler bush 36, the drive shaft 34 is provided with a screw that extends to the distal end of the drive shaft 34 (not shown). 11 and 12 do not show a thrust bearing 38 on the opposite end of the drive shaft 34, FIG. 1 clearly shows this bearing 38. 11, 12 and 13 show the bottom of a slide 60 in the form of a drive nut 64. FIG. In the exemplary embodiment, the drive nut 64 is a part that is separated from the blade 62 of the slide 60, but is fixedly connected to the bottom of the blade 62. The drive nut 64 having the shape shown in the figure has a dumbbell-shaped cross section, and somewhat reduces the force applied on the screw. In FIG. 11, the drive nut 64 is in the proximal position with the pedestal 20 in the open position. FIGS. 12 and 13 conversely show the drive nut 64 in an intermediate position with the pedestal 20 in a partially closed position.

  FIG. 13 is particularly useful for showing the shape and structure of a slide 60 comprising a blade 62 and a drive nut 64.

  The horizontal cross section along the generally longitudinal axis of the end effector shown in FIGS. 14 and 15 is particularly useful to show the bore around the distal rod 526. Also, rod 526 extends the entire path to the distal surface of bore 72 of pull cable adapter 70, but is not shown as such for clarity. Around the proximal end of the rod 526 is a first bore 44 in the adapter sleeve 46. Immediately distal to the first bore 44 is a cavity 74 that receives a washer therein, and immediately distal to the cavity 74 is an inner bore 72 of a pull cable adapter 70 that receives a second biasing device. .

  A longitudinal section generally along the longitudinal axis of the end effector shown in FIG. 16 is particularly useful to show the connection between the drive nut 64 and the drive shaft 34. Similarly, for clarity, the rod 526 extending through all paths to the proximal surface of the bore 72 in the pull cable adapter 70 is not shown.

  A longitudinal section generally along the longitudinal axis of the end effector shown in FIG. 17 is particularly useful for viewing the connection between the slide 60 and the pedestal 20 and cartridge holder 30. The two upper wings 66 are arranged in a groove in the pedestal 20, and the two lower wings 68 form an I-shaped upper holding surface formed by the lower wing 68 and the drive nut 64. Yes.

  FIGS. 18-24 are diagrams illustrating all longitudinal dimensions of a stapling device according to the present invention, showing a first exemplary embodiment of a distal end effector 1 and an actuation handle 2. As shown in FIG. 60, the fittings 20 and 30 are stable in the open position.

  A thumb trigger is connected to the proximal end of the pull cable that terminates in the pull cable adapter 70. Therefore, when the thumb trigger 3 is actuated (see FIG. 19), the cartridge holder 30 is pulled in the proximal direction. Depending on the shape of the cam surface 32, the cam follower 22 moves, thereby rotating the pedestal 20 to a substantially stapling position. As described above, it is not the thumb trigger 3 that ensures that the pedestal 20 is oriented in the correct parallel direction relative to the cartridge holder 30, and thus the staple cartridge 100. Rather, it is the slide 60 that ensures the correct parallel orientation.

  20 to 22 are diagrams showing how the end effector 1 is passively connected in the lateral direction. When the index finger trigger 4 is pressed, the lateral movement locking pin 120 moves rearward and comes off the sprocket 522. If no force is applied to the end effector 1, the two decentering springs 130 cause the end effector 1 to remain in the axially aligned direction, as shown in FIGS. 18 and 19. However, when an external force is applied to the end effector 1 (as shown in FIG. 20), the end effector 1 that is free in the lateral direction is centered around the axis of the sprocket 522, for example, FIG. Can be rotated to any position such as approximately 45 degrees to the left as shown in FIG. See, for example, FIG. When the index finger trigger 4 is released, lateral movement is prevented by returning the distal end of the locking pin 120 between the two teeth of the sprocket 522. Thus, as illustrated in FIGS. 21 and 22, the end effector can be locked at a number of laterally connected positions. Note that the staple cartridge 100 is not shown in FIGS. 18-24 for clarity.

  23 and 24 are diagrams showing the axial rotation control of the end effector. Such axial rotation control is provided by two spline structures 422, 5242 of the adapter sleeve 40 and the lateral movement device 50, respectively. In FIG. 23, the spline structure is engaged and the pedestal 20 is at a 90 degree position with respect to the handle. To disengage the spline structure, sufficient force is applied to the end effector 1 to overcome the first biasing device and the spline structures 422, 5242 are separated. The end effector 1 can then rotate clockwise or counterclockwise. FIG. 68 shows, for example, a state in which the pedestal 20 is rotated counterclockwise to a position of about 9 o'clock.

  1-3 can be used to illustrate the operation of the electric stapling function of the stapling device of the present invention. In FIG. 1, slide 60 is in a proximal position. The reversible motor is housed inside the handle. A three-way switch is connected to the motor. For example, the motor is turned off when in the center position. When in the proximal side, the motor is turned on to rotate the drive shaft 34 and the slide 60 moves in the proximal direction. Conversely, when the switch is in the distal position, the motor is turned on and rotates the drive shaft 34 so that the slide 60 moves in the distal direction. Of course, the switch may be a simple two-way switch without an off position.

  25 and 26 are diagrams illustrating a second exemplary embodiment of the stapling and cutting system 200 of the present invention. This system 200 differs from the first embodiment in that the entire electric stapling assembly is included in the end effector 210. Thus, the handle 220 only requires two actuation devices. The first actuating device 222 is a ball joint release lever and the second actuating device is a stapling / cutting motor on / off button 224.

  End effector 210 is coupled to the distal end of actuation shaft 226 of handle 220 at ball joint connector 228. The end effector 210 has a ball joint 212 at the most distal end. The ball joint 212 has two opposing cup shaped clamps 2122, 2124. The inner surfaces of the clamps 2122 and 2124 have a shape corresponding to the outer shape of the ball joint 212. The clamps 2122, 2124 move toward each other or away from each other based on the operation of the lever 222.

  The clamps 2122, 2124 are biased relative to each other in the closed position, and when the ball joint 212 is disposed therein, the two clamps 2122, 2124 hold the ball joint 212 firmly. Actuation of the lever 222 separates the clamps 2122, 2124, thereby allowing the ball joint 212 to rotate freely within the two clamps 2122, 2124. Thus, when lever 222 is actuated, end effector 210 moves “freely” based on pressure on structures in the environment, such as tissue near the stapling / cutting site. The lever 222 is sufficiently depressed to move the ball joint 212 completely out of the clamps 2122, 2124. Thus, if it is desired that the first end effector 210 is clamped at the first site and the second end effector 210 is desired to stop and cut at the second location, the first end The actuating body 210 remains clamped at the first end, the shaft 226 is removed from the main body, the second end actuating body 210 is loaded, and the second end actuating body 210 is moved to the second portion. Can be guided to.

  The second actuation device 224 is necessary when the user desires to stap and cut with the end effector 210. When the end effector 210 is in the desired stapling / cutting position, it pushes the actuator 224 (eg, a button). Preferably, this actuation connects (or shuts off) the circuitry that supplies power to the motor within the end effector 210, thereby moving the slide 60 distally to engage the stapling and cutting. Perform the function.

  FIG. 25 shows a completely free state for directing the end effector 210 to any position with respect to the ball joint 212. In FIG. 25, the end effector 210 is shown at a position of about 45 degrees in the right lateral direction, and the pedestal is shown at a position of about 90 degrees.

  27 and 28 are views showing a modification of the second embodiment of the end effector shown in FIGS. 25 and 26. FIG. In particular, the handle 220 is the same as that shown in FIGS. However, the end effector 310 is different. In particular, the end effector 310 has the same proximal ball joint 312 as the ball joint 212 shown in FIGS. 25 and 26, but a second distal ball joint 314 that is substantially the same shape as the proximal ball joint 312. Also have. Therefore, when the lever 222 is pushed down to release the ball joints 312 and 314, the end working body 310 can be positioned in the main body, and the opposite end can be sandwiched between the clamps 2122 and 2124. In such a direction as shown in FIG. 27, stapling / cutting can be activated when the open occlusion is facing the user.

  Placing the end effectors 210, 310 at the surgical site requires that access to the surgical site is rather small compared to the open engagement of the end effectors 210, 310. The ability to invert the end effector 310 allows access to several sites that were difficult to reach that could not be reached with the single ball joint end effector 210.

  29 and 30 show the actuation shaft of the surgical stapling and cutting device 200, 300 shown in FIGS. 25-28 holding the ball joints 212, 312, 314 of the end effectors 210, 310 of FIGS. 25-28. The clamps 2122, 2124 at the most distal end of 226 are shown. These drawings show that the lever 222 is connected to a push rod 230 having a plunger 232 at its distal end. The plunger 232 has a cup-shaped surface 234 having a shape corresponding to the outer shape of the ball joints 212, 312, 314 at the most distal end. Thus, when the plunger 232 is in contact with the ball joints 212, 312, 314 in the most distal position, the ball is captured and does not move or rotate. Conversely, when the plunger 232 moves proximally as shown in FIG. 30, the balls of the ball joints 212, 312, and 314 freely rotate between the clamps 2122 and 2124.

  The end stapler shown in FIGS. 31-70 is a variety of different alternative and / or additional features to the end stapler shown in FIGS. 1-30.

  In FIGS. 31-70, only the FIGS. 30 and 40 show the tip occlusion or pedestal 1020 for clarity. Furthermore, the pedestal 20 has been described in detail above with reference to FIGS. 1 to 30 and, therefore, repeated description is avoided below.

  The exemplary handle shown in FIG. 31 is available from Ethicon Endo-Surgery, Inc. And can be found in Ethicon's linear cutter, model ECHELON 60 Endopath Stapler. Thus, the description of the handle is considered redundant because the handle's parts and functional descriptions are published in the art. Such description is incorporated herein by reference in its entirety.

  As described above, the distal end of the end stapler of the present invention is configured to house a standard staple cartridge 100. The cartridge 100 is also disclosed in previous publications and need not be repeated here. This publication is therefore incorporated herein by reference in its entirety.

  FIG. 31 is a diagram partially showing an alternative embodiment of the end stapler 1000 of the present invention. The two distal actuation levers on the handle 1200 of the end stapler 1000 are hidden from view in FIG. 31 for clarity.

  The distal end of the handle 1200 includes a bell-shaped actuator 1100. This provides two control angles for the articulated portion of the end stapler 1000. First, the bell actuator 1100 rotates freely about the central axis of the end stapler 1000 on the distal end of the handle 1200. Since the bell actuator 1100 is pivotally fixedly connected to the outer tube 1100, when the bell actuator 1100 rotates clockwise or counterclockwise, the entire distal end of the end stapler 1000 rotates correspondingly. Second, the bell actuator 1100 can move over a predetermined distance in the proximal direction on the distal end of the handle 1200. As described in more detail below, the proximal movement of the bell actuator 1100 causes the corresponding movement of the articulating lock release slides 120, 1120 to articulate the distal end effector 1002 at the transmission device 50, 1050. Let For example, using a biasing device (not shown) located at the distal portion of the bell actuator 1100 (eg, a compression spring) to bias the bell actuator 1100 and the articulating unlock slide 1120 in a distal direction, The articulated lock release slides 120 and 1120 remain in the operating position or the locked position while remaining in the inoperative state. See FIGS. 8 and 9. This bias device is housed inside the bell actuator 1100 but is not shown in FIG. 32 for clarity. The snap ring that fits into the groove 1139 around the inner tube 1130 is also not shown. The biasing device is delimited by the proximal side of the rod pull block 1105 (FIG. 34) and the distal side of the snap ring. In such a configuration, when the bell actuator 1100 is pulled proximally, the actuator 1100 applies a force to the rod pulling block 1105 proximally thereby causing the articulated unlocking slides 120, 1120 to unlock. Move to position. The key hole on the inner surface of the bell actuator 1100 surrounds the rod tension block 1105 so as to be locked in shape, and the rotation of the bell actuator 1100 about the longitudinal axis of the inner tube 1130 causes force to be applied to the rod tension block 1105. And a corresponding rotation is made. A connection that locks in shape or fits in shape is to connect two elements to each other in the element shape itself, and is opposite to a force-locking connection in which the elements are locked together by an external force applied to the element. Thus, the inner tube and the entire distal assembly of device 1000 rotate in a similar manner. In an alternative configuration, the vertical movement of the bell actuator 1100 causes the first operation to place the slides 120, 1120 in the unlocked state and the second operation to place the slides 120, 1120 in the locked state, Works like a standard ballpoint pen.

  Using the bell actuator 1100 of the present invention, the surgeon can handle all functions of the end stapler 1000 with one hand.

  FIG. 32 shows the proximal end of end stapler 1000 without handle 1200. The push rod 1102 disposed coaxially within the bell actuator 1100 is used to move the cutting blade 1060 when the stapler is in the firing direction.

  FIG. 33 illustrates a component at the proximal end of the end stapler 1000 that couples the distal assembly to the bell actuator 1100 for axially fixed and free rotation. . In particular, the inner tube 1130 (located within the outer tube 1110) has a proximal extension 1132 that defines an inner tube connection chamber 1134. The clamshell cannula 1131 has a cannula connection chamber 1333 corresponding to the connection chamber 1134 of the proximal extension 1132 and a length substantially equal to the extension 1132 of the inner tube 1130. The rotating couple 1141 has a distal T-shaped rotating link 1143 having an outer shape corresponding to both the connecting chambers 1133 and 1134, and the link 1143 is disposed between the extension 1132 and the cannula 1131. The link 1143 is free and rotates there. The couple 1141 is secured to the inside of the handle 1200 through a proximal port 1145 on the proximal end of the couple 1141.

  When placed together, the inner tube 1130 is held axially relative to the couple 1141 but rotates independently of the couple 1141. Since the three connecting portions 1130, 1131, and 1141 are sized to fit inside the outer tube 1110, when these components are arranged inside the outer tube 1110, the outer tube 1110 is locked and connected by its shape, and the inner tube 1130. And any separation of the cannula 1131 (as long as the outer tube 1110 sufficiently covers this area). Accordingly, when the bell actuator 1100 rotates about the longitudinal axis of the inner tube 1130, the inner and outer tubes 1110, 1130 can rotate about the same axis of the tubes 1110, 1130, but in a longitudinal direction inside the handle 1200. The fixed couple 1141 is stable in the vertical direction.

  34 shows the proximal end of end stapler 1000 without handle 1200, bell actuator 1100, and outer tube 1110. FIG. As shown, the inner tube 1130 is hollow in shape and receives an extrusion rod 1102 therethrough. This rod will be described in detail below. As shown in these drawings, the clevis 1010 and the drum sleeve 1040 form a joint or joint 1050 of the end stapler 1000 with each other.

  Note that at this point, the lower occlusion / staple cartridge holder 1030 is fixed longitudinally relative to the handle 1200. This fixation is in contrast to the upper pedestal 1020 which is pivotable and moves somewhat longitudinally when sliding through the keyhole-shaped cam surface 32 to close and / or open the engagement ( The cam surface 1032 is described in more detail below / above).

  In order to form a longitudinally fixed connection between the staple cartridge holder 1030 and the handle 1200, the inner tube 1130 must be connected to the staple cartridge holder 1030. However, at the same time, the staple cartridge holder 1030 must be able to be connected to the longitudinal extent of the inner tube 1130. Accordingly, the two parts 1030 and 1130 are fixed in the axial direction but must be connected in the lateral direction.

  To provide such a connection, the present invention includes at least one pull band 1140, as shown, for example, in FIGS. In the exemplary structure, a number of pull bands 1140 are provided next to each other. Three structures or four bands form two structures. The two pull bands 1140 facing each other have substantially the same longitudinal strength, but the force required to bend the pull band 1140 in the lateral direction is reduced. The same is true for three or four pull bands 1140. FIG. 37 shows the proximal end of pull band 1140, which is secured longitudinally to the distal end of inner tube 1130 with a proximal pull band pin 1142. In order to provide a strong connection between the pull band 1140 and the inner tube 1130, for example, a brass proximal guide block 1150 is disposed between the distal end of the inner tube 1130 and the pull band 1140.

  The pull band 1140 extends over the entire length of the articulating joint 1050 as shown in FIG. 35 and is connected to the distal guide block 1160 as shown in FIG. Distal guide block 1160 (also made of brass, for example) has at least one protrusion that fits into at least one groove on the proximal end of staple cartridge holder 1030. The following figures show the means for connecting the distal guide block 1160 to the staple cartridge holder 1030, which ultimately is axially fixedly connected to the handle, but the inner side. The tube 1130 can be connected. As shown in FIG. 38, the distal pull band pin 1144 axially locks the pull band 1140 to the distal guide block 1160.

  The first embodiment relating to the movement of the occlusions 20, 30 has been described above. Here, the staple cartridge 30 moves in the axial direction, and the pedestal 20 is relatively stationary. In the configuration of the end stapler 1000, as shown in FIG.

  In view of the fact that the staple cartridge holder 1030 is fixed in the longitudinal direction with respect to the handle 1200, an assembly for closing the two occlusions 20, 30; 1020, 1030 must be present. Accordingly, closure is accomplished by movement of the upper occlusion / pedestal 1020 as described below.

  A first lever (eg, proximal handle) of the two levers of handle 1200 is operably coupled to outer tube 1110, and when the first lever is compressed / actuated, outer tube 1110. Move distally. The clevis 1010, the articulating joint 1050, and the drum sleeve 1040 are fixedly connected to the outer tube 1110 in the axial direction (and the outer tube 1110 can slide vertically along the inner tube 1130). The operation of the first lever moves the drum sleeve 1040 distally.

  FIG. 39 shows the pedestal 1020 in the open state. As seen here, the gap 1031 is between the distal end of the drum sleeve 1040 and the proximal shelf at the bottom of the staple cartridge holder 1030. In this direction, the drum sleeve 1040, clevis 1010, and outer tube 1110 are located proximally at a distance from the shelf.

  FIG. 40 shows the pedestal 1020 in the closed state. As shown here, there is no gap 1031 between the drum sleeve 1040 and the proximal shelf of the staple cartridge holder 1030. In this direction, drum sleeve 1040, clevis 1010, and outer tube 1110 are in a position where drum sleeve 1040 contacts the shelf.

  Opposite to the axially fixed position of the staple cartridge holder 1030 relative to the handle 1200, and similar to the movement of the drum sleeve 1040, the knife 60, 1060 must move relative to the handle 1200 along the longitudinal axis. Don't be. FIGS. 35, 36, and 38 through 41 illustrate the axially displaceable connection of the knife 1060 to the knife movement structure of the handle 1200.

  Referring to FIG. 35, a push rod 1102 extends from the handle 1200 and is coupled to a second lever (eg, a distal lever) (not shown) of the handle 1200. The distal end of push rod 1102 is connected to the distal end of at least one flexible knife blade 1062 through push pin 1122. The distal end of the knife blade 1062 is connected to the proximal side of the cutting blade 1060, and the cutting blade 1060 moves distally or proximally following the corresponding movement of the push rod 1102. The knife blade 1062 has a flange 1064 extending upwardly proximally, which houses a bore that receives the push rod pin 1122. When pushed distally by this off-axis connection between push rod 1102 and knife blade 1062, a downward force is applied to the distal end of knife blade 1062, thus, for example, as shown in FIGS. 36 and 42. At a position inside the extrusion rod blade support 1070.

  The knife blade 1062 is sufficiently flexible to bend in any direction that the articulating joint 105 bends. Thus, the knife blade 1062 is also sufficiently flexible to bend if not supported. The present invention thus provides an extruded rod-blade support 1070 shown in FIGS. Here, the proximal end of the push rod-blade support 1070 reveals a rectangular blade channel 1072 that slidably supports the rectangular knife blade 1062. Also shown is a curved push rod channel 1074 that slidably supports a curved (eg, cylindrical) outer surface of the push rod 1102. Thus, the extrusion rod-blade support 1070 supports the extrusion rod 1102 at a position where the extrusion rod 1102 is inside the support 1070, and the knife blade 1062 is located at a position where the knife blade 1062 is inside the support 1070. I support it.

  FIG. 36 shows the connection of the support 1070 and its relationship to the proximal guide block 1150.

  As with the pull band 1140, one or more knife blades 1062 can be arranged. In such a configuration, the plurality of blades 1062 have the same longitudinal stiffness, but provide greater flexibility when the articulation joint 1050 is bent.

  What is apparent in FIG. 41 is an articulated lock release slide 1120 that engages articulation 1020, 1030 articulation.

  FIGS. 42 to 50 are longitudinal sectional views of the distal end of the cylindrical portion of the handle 1200 taken along a plane orthogonal to the longitudinal axis of the end stapler 1000.

  FIG. 42 shows a cross section of the connecting junction between the knife blade 1062 and the push rod pin 1122. Extrusion rod pin 1122 passes through two adjacent blades 1062 and the entire extrusion rod 1102, but does not extend outside the outer surface of the extrusion rod. This figure also shows the relationship of inner and outer tubes 1130, 1110 and push rod-blade support 1070. Also evident from this figure is a release push rod 1104 used to unlock the lock release slide 1120. The longitudinal extent of the release pull rod 1104 is first shown in FIG. 35 and also in FIGS. 36, 37, 41, 52 and 53. In particular, FIG. 41 shows how the pull rod 1104 connects the bell actuator 1100 to the articulated unlocking slide 1120 while the outer parts are hidden. As shown in FIG. 37, at the distal end of the pull rod 1104 that passes through the distal end of the articulating unlocking slide 1120 and is wrapped around the distal end, the unlocking pull rod 1104 is articulated with the bell actuator 1100. A vertical fixed connection between the release slides 1120 is performed. Thus, when the bell actuator 1100 moves proximally, the articulation unlocking slide 1120 correspondingly moves proximally, and the distal teeth 1121 of the articulation unlocking slide 1120 and the sprocket 1522. The spokes 1041 are separated. See especially FIGS. 46 and 52. The rolled connection between the pull rod 1104 and the articulated unlocking slide 1120 is only an exemplary embodiment. Locking by other shapes and locking connection by force are also possible.

  FIG. 43 shows the connection of the pin joint by the pull band 1140 and the inner tube 1130. As described above, the proximal pull band pin 1142 passes entirely through the blade 1062, the proximal guide block 1150, and the inner tube 1130, but does not extend to the outer tube 1110.

  FIG. 44 shows the region immediately proximal to the proximal end of the articulating unlock slide 1120. In this exemplary embodiment, pull band 1140 is disposed on two blades 1062. In order to support at least one of the pull band 1140 and the blade 1062, a pair of hammocks 1066 are arranged along the side of the connecting portion of the pull band 1140 and the blade 1062. For example, as shown in FIG. 50, each hammock 1066 is U-shaped (along the longitudinal section), and the proximal arm of each hammock 1066 is bent around the proximal side of the clevis 1010. The distal arm of each hammock 1066 is bent about the catch surface in the drum sleeve 1040.

  Two spring rods 1012 are arranged inside the clevis 1010, and there are spring rod collars 1014 around this. This collar functions to laterally bias the entire assembly distal side of the articulating joint 1050 towards and along the longitudinal axis. The spring rod and collars 1012, 1014 will be described in further detail below.

  FIG. 45 shows the central open region of the articulating unlock slide 1120 that receives the bent portion of the pull rod 1104 (not shown in this view). A cavity 1016 is also shown, which contains a bias spring of a spring rod 1012 (not shown). This cross-sectional area includes portions of two pull bands 1140 disposed on the two knife blades 1062.

  FIG. 46 shows the open region where the spring rod 1012 is actuated relative to the cam surface 1018. The cam surface 1018 is arched so that contact between the spring rod 1012 and the cam surface 1018 always acts in an axial direction perpendicular to the most distal surface of the spring rod 1012. For example, see FIG. In such a configuration, the distal articulation assembly (eg, pedestal 1020, staple cartridge holder 1030, drum sleeve 1040) is against the cam surface 1018 to bias the longitudinal axis of the inner and outer tubes 1130, 1110. The force exerted by the spring rod 1012 is always at the same radius around the connecting axis of the connecting table cartridge holder 1030. One advantage of such a configuration is that in any case there is no lateral force on the spring rod 1012, in which case the most distal end of the spring rod 1012 catches the cam surface 1018 and engages. Can be stopped.

  FIG. 47 shows the area within the end stapler articulating joint 1050 in cross section. Again, two pull bands 1140, two blades 1062, and two hammocks 1066 are part of this area. Upper and lower axle packs 1152 are inserted into orifices 1042 above and below the surface of drum sleeve 1040. The connection of the clevis 1010 to the drum sleeve 1040 at the articulation joint 1050 is symmetric at the top and bottom. The pack 1152 is inserted into the orifice 1042 at the top and bottom of the proximal end of the drum sleeve 1040. In this direction, the assembly is inserted into the distal end of the clevis 1040 to align the screw hole 1011 with the central threaded bore 1153 of the pack 1152. When aligned, the screw 1013 is screwed into the pack 1152 to fix the drum sleeve 1040 to the clevis 1010 in the axial direction, and the drum sleeve 1040 is centered on the axis defined by the longitudinal axes of the two screws 1013. Connect them.

  FIG. 48 shows the region of the distal pull band pin joint. In this region, the distal end of the pull band 1140 is secured with a distal pull band pin 1144 located within the bore of the distal guide block 1160. Distal guide block 1160 is disposed within staple cartridge holder 1030 and secured thereto as described above.

  FIG. 49 shows the region just proximal of the cutting blade 1060 and shows the fixed connection of the two knife blades 1062 in the proximal orifice of the cutting blade 1060. This figure also clearly shows the cam surface 1032 that causes the pedestal 1020 to rotate and move relative to the staple cartridge holder 1030.

  FIG. 50 shows a longitudinal section through the spring rod 1012. In this figure, the entire longitudinal extent of the hammock 1066 can be seen. The distal portion of the hammock 1066 is articulated about a vertical axis near the distal end of the hammock 1066. In FIG. 50, there is a substantial gap between the spring rod 1012 and the hammock 1066. Without the hammock 1066, the thin knife blade 1062 can bend and warp or bend in these gaps. Placing the hammock 1066 between them prevents the knife blade 1062 from being allowed to bend. FIG. 51 is a diagram showing extremely bent extents of the hammock 1066 and the blade 1062 in the test bed made for such a purpose. The upper hammock 1066 is not used for the upper bend with respect to FIG. 51 because it follows the inner surface of the curve in the critical bend region. In contrast, the lower hammock 1066 is used to substantially prevent the knife blade 1062 (two in the exemplary embodiment) from causing unacceptable bending into the test bed gap. Each hammock 1066 is securely held on both sides and is made of a substantially non-elastic material (eg, stainless steel) so as to form a sling or “hammock” that supports a bent knife blade 1062 therebetween. .

  FIG. 52 shows a cross section through the articulated unlocking slide 1120, clearly showing the distal connecting bend of the release pull rod 1104 into the slide 1120. FIG. In such a configuration, the proximal displacement of the unlocking pull rod 1104 causes the slide 1120 to displace proximally, causing the teeth 1121 of the slide 1120 to correspond to the corresponding teeth on the proximal side of the drum sleeve 1040. Release from between 1041. A biasing device (not shown) biases the articulating unlock slide 1120 distally. This biasing device is within the hollow 1123 and presses against the distal end of the hollow 1123 and a block 1124 that is secured to the clevis 1010.

  FIG. 35 shows the connection between the release pull rod 1104 and the handle 1200. The rod pull block 1105 has a longitudinal bore 1107 for receiving the pull rod 1104. The rod pull block 1105 also has a lateral bore 1109 that receives a screw set (not shown) there for securing the pull rod 1104 within the rod pull block 1105. The inner portion of the bell actuator 1100 engages the rod pull block, and when the bell actuator 1100 moves proximally, the rod pull block 1105 (eg, a shape fitting connection such as a key hole) is biased proximally. It has a shape that makes it stand.

  FIG. 53 is an exploded perspective view of the distal portion of the end stapler as viewed from the distal end.

  The clevis 1010 shown in FIGS. 34 to 53 is an integral type. Alternatively, the clevis 1010 can be molded in half. In such a case, except for the pack 1152, instead of forming the clevis parts in half, the screw 1013 can be dispensed with. This is because the outer tube 1110 holds the halves together when attached to the proximal end of the clevis 1010. Such a configuration is described in the embodiment of the end stapler shown in FIG.

  FIG. 54 is a diagram showing some internal components of the fourth embodiment of the end effector. The pedestal 1020 is disposed on the opposite side of the staple cartridge holder 1030 and the closing ring 1040 surrounds the proximal end of the staple cartridge holder 1030. Inner and outer tubes 1130, 1110 have been removed and articulated unlocking slide 1120, push rod 1102, and push rod blade support 1070 can be clearly seen. A screen door 1103 is mounted around the push rod 1102 and inside the inner and outer tubes 1130, 1110 and the bell actuator 1100. Handle 1200 and bell actuator 1100 have been removed for clarity. Since the screen door 1103 only moves the knife / cutting blade 1060 in the distal direction, the movement of the push rod 1102 is limited to only one direction (distal side).

  The bisected clevis is best shown in FIGS. In these drawings, the outer tube 1110 has been removed to show the various internal structures of the end effector shown in FIG. In the exploded view of FIG. 55, the connection of pull band 1140 to staple cartridge holder 1030 is evident. Pins not shown (see also FIG. 59) include a first proximal flange of holder 1030, a first spacer 1170, a distal flange of pull band 1140, a second spacer 1170, and holder 1030. Each of the second opposing proximal flanges. A closure ring 1040 as shown in FIG. 59 holds the pins here to provide a longitudinal connection of these parts.

  Various configurations of the knife / cutting blade 1060 are also apparent in FIG. The tooth 1060 has a proximal groove 1061 that connects the distal end of the knife blade 1062. In the illustrative embodiment, the groove 1061 and the distal end form a keyhole shaped lock. The upper half of the blade 1060 has two opposing guide wings 1063 having outer shapes that fit into corresponding grooves in the bottom surface of the upper pedestal 1020. The lower half of the blade 1060 also has two opposing guide wings 1065. The holder 1030 has a groove in the upper surface for receiving the lower wing 1065 therein. These two pairs of wings 1063, 1065 ensure that the pedestal 1020 and the holder 1030 are in a fixed, parallel position as the blade 1060 moves along it during the cutting and stapling procedure. A flange 1067 extending in the proximal direction is disposed in the lower half of the blade 1060. A leaf spring 1090 is attached to the staple cartridge holder 1030 by rivets 1036. Other features of leaf spring 1090 and blade 1060 are described in more detail below.

  Figures 55 and 56 also show the various parts of the bisected clevis 2010, 2020. As seen in FIGS. 56 and 58, the inner surface of the clevis upper half 2010 defines two cavities 2011, each of which includes a spring rod 1012 and a bias (not shown) for the spring rod 1012. Holds the device. In the exemplary embodiment shown, the clevis upper half 2010 defines the entire cavity 2011 for the spring rod 1012, and the clevis lower half 2020 is the bottom portion of the cavity only to accommodate the biasing device. 2021 is defined. These clevis halves 2010, 2020 define articulation ports 2012, 2022 for receiving articulation bosses 2031, 2041 on each of the two portions 2030, 2040 of the dogbone clevis.

  56 and 57 show the longitudinal connection of the structure within the outer tube 1110. Extrusion rod blade support 1070 is disposed in the lower channel of inner tube 1130. The push rod blade support 1070 also has a distal extension 1071 with a narrow proximal neck 1074 and a relatively wide distal head 1075. A corresponding groove 2023 at the bottom of the lower half 2020 of the clevis allows the distal extension 1071 to be secured vertically to the clevis half 2020 and thus the remaining half of the clevis.

  The outer tube 1110 and the lower half 2020 of the clevis have been removed in FIG. 56 to show the structure of the spring rod 1012 in the spring rod cavity 2011. Again, the spring rod bias device (eg, coil spring) is not shown in cavity 2011 for clarity. With the various parts removed, the articulated extent of the pull band 1140 is clearly shown in FIG. The support surface for the pull band 1140 inside the upper clevis half 2010 can be seen in the section plane of FIG. Upper dogbone clevis 2030 has two opposing support surfaces 2032, each of which forms the same acute angle with respect to the centerline of unconnected pull band 1140. Similarly, the clevis upper half 2010 has two opposing faces 2013, each of which is also acute with respect to the centerline of the non-join pull band 1140.

  55 and 58 show views on the opposite side of the clevis lower half 2020 toward the inside. Joints for the knife blade 1062 are shown with a dogbone 1080 support surface 2042 within the lower dogbone clevis 2040 and a dogbone 1080 support surface 2024 within the lower half 2010 of the clevis. In this direction, the guide surface and support surface for the dogbone guide 1080 can be seen. In FIG. 57, it can be seen that the lower dogbone clevis has a kidney-shaped distal dogbone recess 2043 and the clevis lower half 2010 has a kidney-shaped proximal dogbone recess 2025. These recesses 2025, 2043 and surfaces 2024, 2042 are also shown in FIG. 66 and are described in detail below. A further feature seen in FIGS. 59, 62 and 66 is the inner passage of the dogbone guide 1080 having left and right surfaces 1082, which will be described in more detail below.

  The distal end of the dogbone guide 1080 is shown in the longitudinal section of FIG. The distal dogbone recess 2043 houses the distal end of the dogbone guide 1080 so that the dogbone guide 1080 does not contact the support surface 2042 of the lower dogbone clevis 2040 when unconnected.

  A proximal housing for the distal end of the dogbone guide 1080 is shown in FIG. In order to clarify the structure of the proximal dogbone recess 2025, the dogbone guide 1080 has been removed from these structures.

  Both recesses 2025 and 2043 are shown in the horizontal longitudinal section of FIG. 57, together with the lower extension of the dogbone guide 1080 disposed here. Here, the underside structure of push rod support 1070, cutting blade 1060, and staple thread 102 (which is part of removable staple cartridge 100) is shown. These structures are shown enlarged in FIGS.

  63, 64 and 65 are views showing a knife blade 1060 closing structure. In other words, it is a safety device that prevents the knife blade 1060 from advancing when there is no staple cartridge 100 or when an already fired staple cartridge is in the staple cartridge holder 1030. For ease of understanding, only the portion of staple cartridge 100 shown in this figure is a staple thread 102.

  The knife blade 1060 should be able to move distally only when the staple sled 102 is in the firing ready position, i.e., when the sled 102 is in the position shown in FIG. When the thread 102 is not in this position, it means two things. That is, there is no staple cartridge 100 in the holder 1030, or the sled 102 has already moved distally, in other words, a partial or complete firing has already been made by the loaded staple cartridge 100. is there. Accordingly, the thread 102 is provided with a closing contact surface 104 and the blade 1060 is provided with a correspondingly shaped contact nose 1069. At this point, the lower guide wing 1065 does not ride on the floor 1034 in the cartridge holder 1030 until the blade 1060 has moved past the edge 1035 distally. With such a configuration, when the thread 102 is not at the distal end of the blade 1060 and does not strike the nose 1069, the lower guide wing 1065 tracks the recess 1037 immediately proximal to the edge 1035 and is above the floor 1034. Instead of proceeding to, the edge 1035 is struck to stop the blade 1060 from moving further forward. To assist such contact when the sled 102 is not present, the staple cartridge 1030 has a leaf spring 1090 (attached by a rivet 1036). A leaf spring 1090 that is fixed upward and presses the flange 1067 downward (at least until the flange 1067 is distal to the distal end of the leaf spring 1090) exerts a downward force on the blade 1060. The wing 1065 is pushed down into the recess 1037. Thus, as the blade 1060 advances distally without the presence of the thread 102, the wing 1065 follows the lower curve of the recess 1037 and stops when the distal edge of the wing 1065 strikes the edge 1035. Do not move further distally. FIG. 63 shows, for example, a distal edge 1035 and two raised bosses 1038. This boss extends to the height of the edge 1035 to prevent the wing 1065 from being pushed beyond the edge 1035 when the thread 102 is inside.

  FIG. 66 is a diagram illustrating exemplary movement of the dogbone 1080 within the clevis lower half 2020 and the lower dogbone clevis 2040. In the fully left-turned position of FIG. 66, the distal bottom protrusion of dogbone 1080 is in the rotational position within distal dogbone recess 2043 and the proximal bottom protrusion is proximal dog. It is in the rotational position within the bone recess 2025. Importantly, the left vertical surface of the dogbone 1080 is almost fully supported on the left dogbone support surfaces 2024, 2042. The shape of the recesses 2025, 2043 and the bottom protrusion of the dogbone 1080 is selected so that the dogbone 1080 does not stretch or compress and swings from left to right when the end effector articulation occurs at the end. .

  Three side-by-side knife blades 1062 are illustrated in FIG. 66 within the left arcuate position of the lower halves 2020, 2040 of the clevis. When bent to the left, the knife blade 1062 is pressed against the right inner surface 1082 of the dogbone 1080. Accordingly, the inner side surface 1082 has a shape corresponding to the extent to which the end effector will bend. Because of the limited nature of the features of the present invention, the blade 1062 is only shown schematically in a generally curved direction.

  To better understand some features of the knife blade 1062, an enlarged view of the proximal connection of the push rod 1102 and push rod blade support 1070 is shown in FIG. Although it is possible to imagine a structure having coaxially aligned knife blades 1062 and push rod 1102, for example, an offset connection as shown in FIGS. 41 and 67 is used. As described above, the length of the knife blade 1062 makes it preferable for the knife blade 1062 to be fully pushed down into the blade channel 1072 within the push rod blade support 1070. FIG. 41 shows a first embodiment of an offset connection that biases the blade 1062 to the channel 1072. FIG. 67 shows a second embodiment of this offset connection. In this second embodiment, the blade 1062 is not fixedly connected to the push rod 1102 as in the first embodiment (connected by a lateral push pin 1122). Instead, a chamber 1108 is formed in the push rod 1102 into which the proximal end of the blade 1062 is inserted. By forming the chamber 1108 into a shape that holds the blade 1062 vertically in the axial direction (for example, lateral offset), no fixed connection is required. In this example, the chamber 1108 is generally L-shaped in longitudinal section and provides such a lateral offset, but may be a variety of different shapes.

  The distal connection of the pull band 1140 is particularly well shown in FIG. In such a configuration, the left and right arches bend each of two, three, four, or more adjacent pull bands 1140. Each pull band 1140 has a fixed length, and the pull bands 1140 are stacked on each other along the side, so that the arches in a given direction can move each pull band 1140 in a different direction, even if the difference is slight. Bend. An alternative embodiment of a distal connection to compensate for such bending differences is shown in FIGS. For clarity and simplicity, only a portion of the upper dogbone clevis 2030 is shown schematically in these drawings.

  In this alternative embodiment, the spacer 1170 of the first embodiment is replaced. Here, five pull bands 1140 are arranged side by side. Upper dogbone clevis 2030 defines an inner bore 2033 (eg, a circular bore) into which piston 2050 having an outer shape corresponding to the inner shape of bore 2033 is inserted. The bore 2033 includes a proximal window 2034 through which a pull band 1140 projects into the bore 2033. Window 2034 has approximately the same width (albeit slightly larger) than the full width of pull band 1140.

  Piston 2050 has a transverse bore in which a proximal pull band pin 2060 is threaded. This pin functions as a shaft when threaded with the piston 2050 and the distal pull band bore 1145 of each pull band 1140. See FIG. The interior 2051 of the piston 2050 does not have a shape corresponding to the width of the overlapping pull band 1140. Instead, the inner opening that receives the distal end of the pull band 1140 has a horizontal cross-sectional shape with wings.

  When the end effectors are articulated, the distal end of the pull band 1140 is bent into a curve. Adjacent parallel plates, such as pull band 1140, bend together and the outer plate moves in a different direction than the central or inner plate. This inhomogeneous movement is compensated by a winged opening 2051 and an oval shaped distal pull band bore 1145. When the end effector is connected, the bending force applied to the pull band 1140 rotates the piston 2050 in the bore 2033 of the upper dogbone clevis 2030. The more the end effector is connected, the more the piston 2050 rotates until the complete connection presses the outer pull band 1140 against the inner surface of the winged opening 2051. At this point, the proximal end of each pull band 1140 is aligned, but the distal end shown in FIGS. 68-70 is not aligned. The presence of the oval opening 1145 allows the pull bands 1140 to move slightly relative to each other.

  The foregoing description and drawings illustrate the principles, preferred embodiments, and modes of operation of the present invention. However, the invention should not be construed as limited to the specific embodiments described above. Further variations of the above-described embodiments will be apparent to those skilled in the art.

Accordingly, the above embodiments should be considered as illustrative rather than limiting. Thus, it will be apparent to one skilled in the art that modifications may be made to these embodiments without departing from the scope of the invention as defined by the appended claims.

Claims (20)

A medical device,
A laparoscopic shaft having a proximal end and a distal end and defining a shaft axis;
A surgical end effector at the distal end of the shaft;
A surgical actuator for performing tissue surgery on the end effector when actuated;
A rotation knob at the proximal end of the shaft;
And the rotary knob is
When rotated, rotating the end effector relative to the shaft about the shaft axis; and
A medical device, wherein the surgical actuator is operated when sliding in a proximal direction. The medical device according to claim 1, wherein
The medical device further comprising a pistol-like handle having a distal end coupled to the proximal end of the shaft and provided with the rotation knob. The medical device according to claim 1, wherein
The medical device, wherein the end working body is fixedly coupled to the rotary knob so as to rotate, and the end working body is rotated when the end working body is rotated about the shaft axis. The medical device according to claim 1, wherein
The surgical actuator is the locking device of the end effector;
A medical device, wherein movement of the surgical actuator by proximal movement of the rotary knob unlocks the locking device. The medical device according to claim 4.
The surgical actuator has a non-actuated state and an actuated state;
The locking device has a locked state and an unlocked state;
The surgical actuator comprises:
Changing the locking device from the locked state to the unlocked state in the activated state in which the rotary knob moves proximally;
Changing the locking device from the unlocked state to the locked state when the rotary knob is released after moving proximally;
A medical device characterized by that. The medical device according to claim 2,
The pistol-shaped handle has a stapler closing device;
The end effector is a surgical stapling end effector having a pair of opposing stapling surfaces;
When the stapler closing device operates, at least one of the stapling surfaces is operable to move relative to the other stapling surface, and compressive force is applied to the tissue between the stapling surfaces. And medical devices. The medical device according to claim 1, wherein
Furthermore, the end effector comprises a knife assembly arranged to cut tissue by the end effector. The medical device according to claim 1, wherein
A medical device, wherein the end effector comprises one of an annular surgical staple head and a linear surgical staple head. The medical device according to claim 3,
The rotary knob is
Rotation of the end effector when rotating about the shaft axis, and operation of the surgical actuator when sliding proximally;
A medical device characterized by enabling. The medical device according to claim 3,
A medical device characterized in that when the rotary knob rotates about the shaft axis and slides proximally, rotation of the end effector and operation of the surgical actuator are enabled simultaneously. The medical device according to claim 2,
The end effector is a surgical stapling end effector having a stapling device with staples and a cutting device with a blade;
A stapler closing actuator that closes the stapling device when actuated, and a firing actuator that, when actuated, staples with the stapling device and cuts with the cutting device;
Have
The medical device, wherein the stapler closing actuator and the staple firing actuator are different from the rotary knob. The medical device according to claim 2,
The end effector is a surgical stapling end effector having a stapling apparatus and a bladed cutting device, and the handle is
A stapler closing actuator that closes the stapling device when actuated, and a firing actuator that, when actuated, staples with the stapling device and cuts with the cutting device;
Have
The medical device, wherein the stapler closing actuator and the staple firing actuator are different actuators from the rotary knob. A medical device,
A pistol-shaped handle having a distal portion;
A laparoscopic shaft having a proximal end and a distal end of the distal portion and defining a shaft axis;
A surgical end effector at the distal end of the shaft;
A surgical actuator for performing tissue surgery on the end effector when actuated;
A rotation knob at the distal portion;
And the rotary knob is
When rotated, rotating the end effector relative to the shaft about the shaft axis; and
A medical device that operates the surgical actuator when sliding in a direction toward the handle. The medical device according to claim 13,
The medical device, wherein the end working body is fixedly coupled to the rotary knob so as to rotate, and the end working body is rotated when the end working body is rotated about the shaft axis. The medical device according to claim 13,
The surgical actuator is the locking device of the end effector;
A medical device, wherein movement of the surgical actuator by proximal movement of the rotary knob unlocks the locking device. The medical device according to claim 13,
The pistol-shaped handle has a stapler closing device;
The end effector is a surgical stapling end effector having a pair of opposing stapling surfaces;
When the stapler closing device operates, at least one of the stapling surfaces is operable to move relative to the other stapling surface, and compressive force is applied to the tissue between the stapling surfaces. And medical devices. The medical device according to claim 13,
Furthermore, the end effector comprises a knife assembly arranged to cut tissue by the end effector. The medical device according to claim 13,
A medical device, wherein the end effector comprises one of an annular surgical staple head and a linear surgical staple head. The medical device according to claim 13,
A medical device characterized in that when the rotary knob rotates about the shaft axis and slides proximally, rotation of the end effector and operation of the surgical actuator are enabled simultaneously. The medical device according to claim 13,
The end effector is a surgical stapling end effector having a stapling device with staples and a cutting device with a blade;
A stapler closing actuator that closes the stapling device when actuated, and a firing actuator that, when actuated, staples with the stapling device and cuts with the cutting device;
Have
The medical device, wherein the stapler closing actuator and the staple firing actuator are different from the rotary knob.

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