JP2021506429A - Surgical instruments with synchronous drive system - Google Patents

Abstract

Surgical instruments for treating a patient's tissue are disclosed. The surgical instrument includes a handle, a shaft extending from the handle, and an end effector. The surgical instrument is a first drive system configured to perform a first end effector drive motion with an electric drive system, the first operably linked to the electric drive system. It further comprises a drive system and a second drive system configured to perform a second end effector drive motion, which is operably coupled to the electric drive system. ing. The surgical instrument further comprises a synchronization means for repeatedly generating a first end effector driven motion and a second end effector driven motion in sequence.

Description

The present invention relates to surgical instruments and, in various situations, to surgical staples and cutting instruments designed to staple and cut tissue and staple cartridges for use with them.

The various features of the embodiments described herein, along with their advantages, can be understood by the following description in conjunction with the following accompanying drawings.
FIG. 3 is a perspective view of a surgical staple fastening device according to at least one embodiment. It is sectional drawing of the staple fastener of FIG. 1 along the line 2-2 of FIG. It is a partial perspective view of the drive system of the staple fastener of FIG. It is a top view of the drive system of FIG. It is an elevation view of the drive system of FIG. 3 shown in the 1st operation configuration. It is a side view of the drive system of FIG. 3 shown in the 1st operation configuration of FIG. It is a side view of the drive system of FIG. 3 shown in the 2nd operation configuration. FIG. 3 is a partial perspective view of a surgical staple fastening device according to at least one embodiment. FIG. 3 is a partial perspective view of a surgical staple fastening device according to at least one embodiment. It is a perspective view of the handle housing of the staple fastening device of FIG. It is a perspective view of the battery by at least one Embodiment. It is a perspective view of the handle of the staple fastener of FIG. FIG. 3 is a perspective view of a surgical staple fastening instrument including a display according to at least one embodiment. The status control on the display of FIG. 13 is shown. The speed control on the display of FIG. 13 is shown. The fault threshold control on the display of FIG. 13 is shown. The directional control on the display of FIG. 13 is shown. The display of FIG. 13 and the speed control of FIG. 15 are shown. The display and speed control of FIG. 13 are shown. FIG. 13 shows the display and staple path control of FIG. 13 which is used to alter the staple firing path of a staple fastener. The display of FIG. 13 and the staple path control of FIG. 21 which are used to change the staple firing path of the staple fastener are shown. The display of FIG. 13 and the control for stopping the staple fastener along the staple firing path are shown. A surgical instrument system including an external or offboard display according to at least one embodiment is shown. A display of a surgical staple fastening device according to at least one embodiment is shown. FIG. 24 shows the display of FIG. 24 used to alter the staple firing path when forming a gastric sleeve during a gastric reduction procedure. FIG. 24 shows a joystick used to change the staple firing path on the display. Shows staple fasteners guided along the staple launch path. Shows the patient's stomach. It is sectional drawing of a patient's stomach. FIG. 29 is a cross-sectional view of a target inserted into the stomach of FIG. FIG. 9 is a cross-sectional view of the stomach of a patient thinner than the stomach of FIG. FIG. 31 is a cross-sectional view of a target inserted into the stomach of FIG. It shows various anatomical features that can be referenced during the gastric sleeve procedure. FIG. 3 is a partial elevational view of a surgical staple fastening device comprising a shaft, an end effector, and a arthroplasty joint according to at least one embodiment. FIG. 34 is a partial elevation view of the staple fastening device of FIG. 34 showing an end effector in a joint motion position. FIG. 3 is a bottom sectional view of an end effector of a surgical staple fastening device according to at least one embodiment. FIG. 3 is a partial cross-sectional view of a surgical staple fastening device comprising a tissue driving system according to at least one embodiment. FIG. 37 is a partial cross-sectional view of the staple fastening device of FIG. 37 showing a tissue drive system engaged with a patient's tissue. FIG. 37 is a partial cross-sectional view of the staple fastening device of FIG. 37 showing a tissue drive system pressing patient tissue in a first direction. FIG. 37 is a partial cross-sectional view of the staple fastening device of FIG. 37 showing a tissue drive system pressing patient tissue in a second direction. FIG. 37 is a partial cross-sectional view of the staple fastening device of FIG. 37 showing the tissue drive system being disengaged from the patient's tissue. FIG. 6 is a partial elevational view of a drive system including a synchronization mechanism according to at least one embodiment. The synchronization mechanism of FIG. 42 that activates the end effector drive system is shown. The following shows a drive system configured to drive a plurality of end effector drive systems by reciprocating motion. A plot of two synchronized end effector drives is shown. It is a table which shows the synchronization of four end effector drives. A to G indicate the operating steps of the surgical staple fastening device according to at least one embodiment. It is a table which shows the synchronization of the end effector drive device of the surgical staple fastening instrument by at least one embodiment. A module for operating a surgical staple fastener according to at least one embodiment. FIG. 3 is a partial perspective view of an end effector including a tissue drive system according to at least one embodiment shown in an extended manner. It is a partial perspective view of the tissue drive system of FIG. 50 that is retracted. FIG. 5 is a partial cross-sectional view of the end effector of FIG. 50 showing a tissue drive system in a retracted configuration. FIG. 5 is a partial cross-sectional view of the end effector of FIG. 50 showing a tissue drive system in a descent configuration. FIG. 5 is a partial cross-sectional view of the end effector of FIG. 50 showing an extended tissue drive system. FIG. 5 is a partial cross-sectional view of the end effector of FIG. 50 showing the teeth of a tissue drive system in a protruding configuration. FIG. 5 is a partial cross-sectional view of the end effector of FIG. 50 showing the drive system retracted. FIG. 3 is a partial perspective view of a tissue drive system according to at least one embodiment. FIG. 5 is a partial perspective view of the tissue drive system of FIG. 57 in an extended configuration. The operating process of the tissue drive system of the surgical staple fastening device according to at least one embodiment is shown. The operating process of the tissue drive system of the surgical staple fastening device according to at least one embodiment is shown. The operating process of the tissue drive system of the surgical staple fastening device according to at least one embodiment is shown. The operating process of the tissue drive system of the surgical staple fastening device according to at least one embodiment is shown. The operation process of the tissue drive system of FIG. 59A is further shown. The operation process of the tissue drive system of FIG. 59B is further shown. The operation process of the tissue drive system of FIG. 59C is further shown. The operation process of the tissue drive system of FIG. 59D is further shown. FIG. 3 is a partial perspective view of a surgical staple fastening device including a tissue drive system according to at least one embodiment. FIG. 6 is a partial perspective view of the tissue drive system of FIG. 61 in an extended configuration. FIG. 3 is a partial cross-sectional perspective view of a surgical staple fastening device comprising a tissue driving system according to at least one embodiment. It is a bottom sectional view of the staple fastening device of FIG. 63. FIG. 3 is a partial cross-sectional view of a surgical staple fastening device, including a decompression system, according to at least one embodiment. It is a partial detailed view of the tissue drive system of the staple fastener of FIG. 65. FIG. 6 is a partial cross-sectional view of the staple fastener of FIG. 65 showing tissue being pulled into the end effector of the staple fastener. It is a partial detailed view of the organization drive system of FIG. FIG. 6 is a partial cross-sectional view of the staple fastener of FIG. 65 showing where the tissue is released. FIG. 6 is a partial cross-sectional view of a surgical staple fastening device with a decompression system according to at least one embodiment. It is a partial cross-sectional view of the staple fastener of FIG. 70 which shows the 1st and 2nd drive foot of the staple fastener in the retracted configuration. FIG. 7 is a partial cross-sectional view of the staple fastening device of FIG. 70 showing a first drive foot in an extended position. It is a decompression manifold of the staple fastening device of FIG. 70 that communicates fluidly with the first drive foot. FIG. 3 is a partial perspective view of a surgical staple fastening device according to at least one embodiment. A to D show the operating steps of the surgical staple fastening device according to at least one embodiment. FIG. 3 is a partial cross-sectional perspective view of a surgical staple fastening device according to at least one embodiment. The operation process for manipulating the staple fastener of FIG. 76 is shown. The operation process for manipulating the staple fastener of FIG. 76 is shown. The operation process for manipulating the staple fastener of FIG. 76 is shown. The operation process for manipulating the staple fastener of FIG. 76 is shown. FIG. 5 is a cross-sectional end view of a surgical staple fastening instrument according to at least one embodiment. FIG. 6 is a partial elevational view of a surgical staple fastening device according to at least one embodiment with a tissue drive. The position of the foot of the tissue driving device corresponding to FIG. 79 is shown. FIG. 7 is a partial elevational view of the staple fastening device of FIG. 79 showing where the foot is extended. The position of the foot of the tissue driving device corresponding to FIG. 80 is shown. FIG. 79 is a partial elevational view of the staple fastening device of FIG. 79 showing where the foot is in an extended configuration. The position of the foot of the tissue driving device corresponding to FIG. 81 is shown. FIG. 7 is a partial elevational view of the staple fastening device of FIG. 79 showing where the foot is retracted. The position of the foot of the tissue driving device corresponding to FIG. 82 is shown. FIG. 7 is a partial cross-sectional view of the tissue drive device of the staple fastening device of FIG. 79. The kinematics of the tissue drive of the staple fastener of FIG. 79 is shown. FIG. 84 shows a cam capable of generating kinematics. FIG. 8 is a perspective view of a cam capable of generating the kinematics of FIG. FIG. 3 is a partial perspective view of a surgical staple fastening device including a tissue drive device according to at least one embodiment. The tissue driving device of the surgical staple fastening device according to at least one embodiment is shown. The tissue driving device of FIG. 88 in the extended configuration is shown. The operating steps of a surgical staple fastening device, including a tissue drive device, according to at least one embodiment are shown. The operating steps of a surgical staple fastening device, including a tissue drive device, according to at least one embodiment are shown. The operating steps of a surgical staple fastening device, including a tissue drive device, according to at least one embodiment are shown. The operating steps of a surgical staple fastening device, including a tissue drive device, according to at least one embodiment are shown. A to D show the operation steps of the surgical staple fastening device including the tissue drive device according to at least one embodiment. The tissue driving device of the surgical staple fastening device according to at least one embodiment is shown. The tissue driving device of FIG. 92 in the extended configuration is shown. FIG. 3 is a partial cross-sectional perspective view of a surgical staple fastening device according to at least one embodiment. FIG. 3 is a partial elevational view of a surgical staple fastening device with a tissue cutting member according to at least one embodiment. The tissue cutting member of FIG. 95 that is being moved over the entire tissue cutting stroke is shown. FIG. 3 is a partial perspective view of a surgical staple fastening device according to at least one embodiment. FIG. 3 is a perspective view of two connected staples according to at least one embodiment. It is a partial perspective view of the staple of FIG. 98 which is separated. FIG. 9 is a partial cross-sectional view of the staple firing system of the staple fastening device of FIG. 97, including a staple firing chamber according to at least one embodiment. It shows where the staples are fired by the staple firing system of FIG. It is shown that another staple is loaded into the staple firing chamber of FIG. 100. FIG. 9 is an end view of a bottom cross section of the staple fastening device of FIG. 97. FIG. 3 is a partial cross-sectional perspective view of a surgical staple fastening device according to at least one embodiment. The operation process of the staple fastener of FIG. 104 is shown. The operation process of the staple fastener of FIG. 104 is shown. The operation process of the staple fastener of FIG. 104 is shown. The operation process of the staple fastener of FIG. 104 is shown. FIG. 3 is a partial perspective view of a surgical staple fastening device according to at least one embodiment. FIG. 10 is an exploded perspective view of a staple clip for use with the surgical staple retainer of FIG. 106. It is a top view of the staple clip by at least one embodiment. FIG. 8 is an end view of a staple clip of FIG. 108 placed within a surgical staple fastener. It is a perspective view of the staple clip of FIG. 108. FIG. 3 is an end view of a staple clip according to at least one embodiment placed within a surgical staple fastening instrument. It is a perspective view of the staple clip of FIG. 111. FIG. 3 is an end view of a staple clip according to at least one embodiment placed within a surgical staple fastening instrument. It is a perspective view of the staple clip of FIG. 113. FIG. 3 is a partial plan view of a staple strip in an unfolded configuration according to at least one embodiment. FIG. 11 is an end view of the staple strip of FIG. 115 in an unfolded configuration. FIG. 5 is an end view of the staple strip of FIG. 115 in a folded configuration. It is a perspective view of the staple strip of FIG. 115 which is being deployed. It is a perspective view of the staple cluster by at least one embodiment. FIG. 3 is a partial perspective view of a staple cluster of FIG. 119 loaded into a surgical staple fastener. FIG. 3 is a partial perspective view of a surgical staple clamp with deployable staple clusters, according to at least one embodiment. FIG. 3 is a partial perspective view of a surgical staple fastening device comprising a tissue drive device according to at least one embodiment. FIG. 12 is a partial perspective view of the staple fastening device of FIG. 122 showing the tissue drive device in an extended configuration. The cross-sectional width of the distal head of the staple fastening device of FIG. 122 is shown. It is sectional drawing of the tissue gripping surface of the tissue driving device of FIG. 122. FIG. 3 is a cross-sectional end view of a surgical staple fastening device comprising a tissue drive device according to at least one embodiment, shown in an extended configuration. FIG. 12 is a cross-sectional end view of the staple fastening device of FIG. 126 showing the tissue drive device in a retracted configuration. A firing drive for a surgical stapled device according to at least one embodiment, shown in a non-launch configuration. The tissue driving device of the staple fastener of FIG. 128 shown in the extended configuration is shown. The launch drive device of FIG. 128 shown in the launch configuration is shown. The tissue drive device of FIG. 128A in the retracted configuration is shown. The launch drive device of FIG. 128 shown in the unlaunched configuration is shown. The tissue drive device of FIG. 128A in the retracted configuration is shown. FIG. 3 is a perspective view of a staple loading system for surgical staple fasteners according to at least one embodiment. It is a top view of the staple loading system of FIG. 131. FIG. 13 is a partial elevation view of the staple loading system of FIG. 131. It is a partial cross-sectional view of the staple fastener of FIG. 131 shown in the unfired configuration. FIG. 3 is a partial cross-sectional view of the staple fastening device of FIG. 131, shown in the firing configuration. FIG. 3 is a partial cross-sectional view of the staple fastener of FIG. 131, which has been retracted to the unlaunched configuration. It is a partial cross-sectional view of the staple fastener of FIG. 131 shown in the unfired configuration. The staple pattern that can be generated by the surgical staple fastening instrument according to at least one embodiment is shown. The staple pattern that can be generated by the surgical staple fastening instrument according to at least one embodiment is shown. A surgical staple fastening device according to at least one embodiment is shown. The operating process used by the staple fasteners of FIG. 140 to manufacture and deploy staples is shown. Shows the staple firing line in the patient's stomach. The progress of staple firing according to at least one embodiment is shown. The staple fastening instrument of FIG. 1 used during a surgical procedure is shown. The staple fastening instrument of FIG. 1 used during a surgical procedure is shown. The staple fastening instrument of FIG. 1 used during a surgical procedure is shown. A surgical staple fastening device according to at least one embodiment used during a surgical procedure is shown. FIG. 147 is a partial elevational view of the surgical staple fastening device of FIG. 147. It is a partial perspective view of the staple fastening device of FIG. 147 in the first configuration. It is a partial perspective view of the staple fastening device of FIG. 147 in the second configuration. The potential consequences of gastric sleeve procedures using the surgical stapled instruments disclosed herein are shown. Shows a guide inserted into the patient's stomach. It shows where a guide is used to define a staple firing path in the patient's stomach. It shows where the guide of FIG. 153 is used to form a gastric sleeve during a gastric bypass procedure. It is a partial sectional view of the guide of FIG. 153. FIG. 6 is a partial cross-sectional view of a guide according to at least one embodiment, shown except for some components. It is a schematic diagram of the guide of FIG. 153. FIG. 3 is a perspective view of a surgical staple system with a loadable staple cartridge according to at least one embodiment. Specific operating components of the stapled system of FIG. 158 are shown. FIG. 3 is an end view of a surgical staple fastening device comprising a projector system including two lenses according to at least one embodiment. The staple fastening device of FIG. 160 is shown being used during a surgical procedure. A surgical staple system including a projector according to at least one embodiment is shown. A surgical staple system with a visual system and a projection system according to at least one embodiment is shown. FIG. 163 shows where the projector system of the staple fastening system is used. A projected image on the patient's tissue according to at least one embodiment is shown. The staple firing path projected onto the patient's tissue according to at least one embodiment is shown. A first projector configured to project a first portion of the staple firing path onto the patient's tissue and a second portion of the staple firing path onto the patient's tissue, according to at least one embodiment. Shown shows a surgical staple fastening device comprising a second projector configured as described above. FIG. 6 is a partial elevational view of a surgical staple fastening device comprising a articulated end effector according to at least one embodiment. FIG. 168 is a partial elevational view of the surgical staple fastening device of FIG. 168. FIG. 6 is a partial elevational view of a surgical staple fastening device comprising a articulated end effector and a dampener configured to reduce unintended movement of the end effector, according to at least one embodiment. FIG. 3 is a partial elevational view of a surgical staple fastening device, including an end effector dumper, according to at least one embodiment. FIG. 171 shows where the staple fastening device is used in a surgical procedure. FIG. 171 shows where the staple fastening device is used in a surgical procedure. Shows the staple firing path formed by a surgical staple fastening instrument with a longitudinal end effector. The staple firing path formed by the surgical staple fasteners disclosed herein is shown. Shows the staple firing path formed by a surgical staple fastening instrument with a longitudinal end effector. The staple firing path formed by the surgical staple fasteners disclosed herein is shown. Shows the staple firing path formed by a surgical staple fastening instrument with a longitudinal end effector. The staple firing path formed by the surgical staple fasteners disclosed herein is shown. FIG. 3 is a perspective view of a handle of a surgical instrument according to at least one embodiment. FIG. 3 is a perspective view of the handle of the surgical instrument of FIG. 180 enclosed in a sterilization barrier. FIG. 181 is a partial cross-sectional view of the sterile barrier and touch sensitive display of the handle of FIG. 181. FIG. 8 is a plan view of the touch-sensitive display of FIG. 182 showing a grid of electrodes in which a plurality of pixels are activated. It is a graph which shows the relationship between the position of the active pixel of FIG. 183 and the capacitance detected by the touch sensitive display of FIG. 182.

Throughout the drawings, the corresponding reference numerals indicate the corresponding parts. The illustrations described herein illustrate various embodiments of the invention in one form, and such illustrations should be construed as limiting the scope of the invention in any way. Absent.

The applicant of the present application owns the following US patent applications filed on December 21, 2017, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 850,431, Invention Title "CONTINUOUS USE SELF-PROPELLED STAPLING INSTRUMENT",
-US Patent Application No. 15 / 850,461, Title of Invention "SURGICAL INSTRUMENT COMPRISING SPEED CONTRO",
-US Patent Application No. 15 / 850,433, title of invention "SURGICAL INSTRUMENT COMPRISING A PROJECTOR",
-US Patent Application No. 15 / 850,495, Title of Invention "STAPLE INSTRUMENT COMPRISING A FIRING PATH DISPLAY",
-US Patent Application No. 15 / 850,480, Invention Title "SELF-GUIDING STAPLING INSTRUMENT",
-US Patent Application No. 15 / 850,522, Title of Invention "SURGICAL INSTRUMENT CONFIGURED TO DETERMINE FIRING PHAT",
-US Patent Application No. 15 / 850,542, Title of Invention "SURGICAL INSTRUMENT COMPRISING AN END EFFECTOR DAMPENEER",
-US Patent Application No. 15 / 850,505, Invention Title "STAPLING INSTRUMENT COMPRISING A TISSUE DRIVE",
-US Patent Application No. 15 / 850,534, Title of Invention "SURGICAL INSTRUMENT COMPRISING A TISSUE GRASPING SYSTEM",
-US Patent Application No. 15 / 850,562, Invention Title "SURGICAL INSTRUMENT COMPRISING SEQENCED SYSTEMS",
-US Patent Application No. 15 / 850,587, Title of Invention "STAPLING INSTRUMENT COMPRISING A STAPLE FEEDING SYSTEM",
-US Patent Application No. 15 / 850,508, Title of Invention "SURGICAL STAPLER COMPRISING STORABLE CARTRIDGES HAVING DIFFERENT STAPLE SIZES",
-US Patent Application No. 15 / 850,526, Title of Invention "SURGICAL INSTRUMENT HAVING A DISPLAY COMPRISING IMAGE LAYERS",
-US Patent Application No. 15 / 850,529, Invention Title "SURGICAL INSTRUMENT COMPRISING A DISPLAY",
-US Patent Application No. 15 / 850,500, Invention Name "SURGICAL INSTRUMENT COMPRISING AN ARTICULATABLE DISTAL HEAD",-US Patent Application No. 15 / 850,518, Invention Name "SURGICAL INSTRUMENTA IMPRISING" ..

The applicant of the present application owns the following US patent applications filed on December 19, 2017, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 847,306, title of invention "METHOD FOR DETERMINING THE POSITION OF A ROTATABLE JAW OF A SURGICAL INSTRUMENT ATTACHMENT ASSEMBLY",
-US Patent Application No. 15 / 847,297, Title of Invention "SURGICAL INSTRUMENTS WITH DUAL ARTICULATION DRIVERS",
-US Patent Application No. 15 / 847,325, title of invention "SURGICAL TOOLS CONFIGURED FOR INTERCHANGE ABLE USE WITH DIFFERENT CONTROLLER INTERFACES",
-US Patent Application No. 15 / 847,293, Title of Invention "SURGICAL INSTRUMENT COMPRISING CLOURE AND FIRING LOCKING MEMHANISM",
-US Patent Application No. 15 / 847,315, title of invention "ROBOTIC ATTACHMENT COMPRISING EXTERIOR DRIVE ACTUATOR", and-US Design Patent Application No. 29 / 630,115, title of invention "SURGICAL INSTRUMENT ASSEMBLY".

The applicant of the present application owns the following US patent applications filed on December 15, 2017, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 843,485, Title of Invention "SEALED ADAPTERS FOR USE WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS",
-US Patent Application No. 15 / 843,518, title of invention "END EFFECTORS WITH POSITIVE JAW OPENING FEATURES FOR USE WITH ADAPTERS FOR ELECTROMECANICAL SURGICAL INSTRUMENTS",
-US Patent Application No. 15 / 843,535, Title of Invention "SURGICAL END EFFECTORS WITH CLAMPING ASSEMBLES CONFIGURED TO INCREASE JAW APERTURE RANGES",
-US Patent Application No. 15 / 843,558, title of invention "SURGICAL END EFFECTORS WITH PIVOTAL JAWS CONFIGURED TO TOUCH AT THEIR RESPECTIVE DISTAL ENDS WHEN FULLY CLOSED"
-US Patent Application No. 15 / 843,528, title of invention "SURGICAL END EFFECTORS WITH JAW STIFFENEER ARRANGEMENTS CONFIGURED TO PERMIT MONITORING OF FIRING MEMBER",
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-US Patent Application No. 15 / 843,556, title of invention "DYNAMIC CLAMPING ASSEMBLEES WITH IMPROVED WEAR CHARACTERISTICS FOR USE IN CONMENTION WITH ELECTROMECHANGE CHANGESURGICAL SURGICAL"
-US Patent Application No. 15 / 843,514, title of invention "ADAPTERS WITH FIRING STROKE SENSING ARRANGEMENTS FOR USE IN CONCEPTION WITH ELECTROME CHANGE STATE SURGICAL INSTRUMENTS",
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-US Patent Application No. 15 / 843,689, invention name "SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER", and-US Patent Application No. 15 / 843,704, invention name "METHODS OF OPERATING SURGICAL END" ..

The applicant of the present application owns the following US patent applications filed on June 29, 2017, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 636,829, title of invention "CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT",
-US Patent Application No. 15 / 636,837, title of invention "CLOSED LOOP VELOCITY CONTROLL TECHNIQUES BASED ON SENSED TISSUE PARAMETERS FOR ROBOTIC SURGICAL INSTRUMENT",
-US Patent Application No. 15 / 636,844, title of invention "CLOSED LOOP VELOCITY CONTROL OF CLOSER MEMBER FOR ROBOTIC SURGICAL INSTRUMENT",
-US Patent Application No. 15 / 636,854, title of invention "ROBOTIC SURGICAL INSTRUMENT WITH CLOSED LOOP FEEDBACK TECHNIQUES FOR ADVANCEMENT OF CLOSER MEMBER DURING SYSTEM FOR CONTROLLING ARTICULATION FORCES ".

The applicant of the present application owns the following US patent applications filed on June 28, 2017, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 635,693, title of invention "SURGICAL INSTRUMENT COMPRISING AN OFFSET ARTICULATION JOINT",
-US Patent Application No. 15 / 635,729, Invention Title "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO",
-US Patent Application No. 15 / 635,785, Invention Title "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO",
-US Patent Application No. 15 / 635,808, Invention Title "SURGICAL INSTRUMENT COMPRISING FIRING MEMBER SUPPORTS",
-US Patent Application No. 15 / 635,837, title of invention "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE TO A FRAME",
-US Patent Application No. 15 / 635,941, Title of Invention "SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE BY A CLOSE SYSTEM",
-US Patent Application No. 15 / 636,029, title of invention "SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A HOUSING ARRANGEMENT",
-US Patent Application No. 15 / 635,958, Title of Invention "SURGICAL INSTRUMENT COMPRISING SELECTIVELY ACTUATABLE ROTATABLE COUPLESS",
-US Patent Application No. 15 / 635,981, Title of Invention "SURGICAL STAPLING INSTRUMENTS COMPRISING SHORTENED STAPLE CARTRIDGE NOSES",
-US Patent Application No. 15 / 636,009, title of invention "SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A Closure TUBE PROFILE",
-US Patent Application No. 15 / 635,663, Title of Invention "METHOD FOR ARTICULATING A SURGICAL INSTRUMENT",
-US Patent Application No. 15 / 635,530, title of invention "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITH AXIALLY SHORTENED ARTICULATION JOINT CONFIGURATION"
-US Patent Application No. 15 / 635,549, title of invention "SURGICAL INSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLY MOVABLE FIRING MEMBER THAT IS INITIALLY PARKED INLO
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-US Patent Application No. 15 / 635,578, Title of Invention "SURGICAL END EFFECTORS WITH IMPROVEED JAW APERTURE ARRANGEMENTS",
-US Patent Application No. 15 / 635,594, title of invention "SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVIL WITH A TISSUE LOCATING ARRANGEMENT IN CLOSE PROXIMITY
-US Patent Application No. 15 / 635,612, title of invention "JAW RETAINER ARRANGEMENT FOR RETAINING A PIVOTABLE SURGICAL INSTRUMENT JAW IN PIVOTABLE RETAINING ENGAGEMENT WITE"
-US Patent Application No. 15 / 635,621, Title of Invention "SURGICAL INSTRUMENT WITH POSITIVE JAW OPENING FEATURES",
-US Patent Application No. 15 / 635,631, Title of Invention "SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSE MEMBER",
-US Patent Application No. 15 / 635,521, Invention Title "SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT",
-US Design Patent Application No. 29 / 609,087, Invention Name "STAPLE FORMING ANVIL",
-US Design Patent Application No. 29 / 609,083, title of invention "SURGICAL INSTRUMENT SHAFT",-US Design Patent Application No. 29 / 609,093, title of invention "SURGICAL FASTENEER CARTRIDGE".

The applicant of the present application owns the following US patent applications filed on June 27, 2017, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 634,024, Invention Title "SURGICAL ANVIL MANUFACTURING METHODS",
-US Patent Application No. 15 / 634,035, Invention Title "SURGICAL ANVIL ARRANGEMENTS",
-US Patent Application No. 15 / 634,046, Invention Title "SURGICAL ANVIL ARRANGEMENTS",
-US Patent Application No. 15 / 634,054, Invention Title "SURGICAL ANVIL ARRANGEMENTS",
-US Patent Application No. 15 / 634,068, Invention Title "SURGICAL FIRING MEMBER ARRANGEMENTS",
-US Patent Application No. 15 / 634,076, Invention Title "STAPLE FORMING POCKET ARRANGEMENTS",
-US Patent Application No. 15 / 634,090, Invention Title "STAPLE FORMING POCKET ARRANGEMENTS",
-US Patent Application No. 15 / 634,099, title of invention "SURGICAL END EFFECTORS AND ANVILS",-US Patent Application No. 15 / 634,117, title of invention "ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS".

The applicant of the present application owns the following US patent applications filed on December 21, 2016, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 386,185, Invention Title "SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLES THEREOF",
-US Patent Application No. 15 / 386,230, Title of Invention "ARTICULATABLE SURGICAL STAPLING INSTRUMENTS",
-US Patent Application No. 15 / 386,221, Title of Invention "LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS",
-US Patent Application No. 15 / 386,209, Invention Title "SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF",
-US Patent Application No. 15 / 386,198, Title of Invention "LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE TOOL ASSEMBLES",
-US Patent Application No. 15 / 386,240, Title of Invention "SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR",
-US Patent Application No. 15 / 385,939, title of invention "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN",
-US Patent Application No. 15 / 385,941, Title of the Invention "SURGICAL TOOL ASSEMBLES WITH CLUTCHING ARRANGEMENTS FOR SHIFTING BETWEEEN CLOSURE SYSTEMS WITH CLOSESTRONSATIONSTURE PRODUCT"
-US Patent Application No. 15 / 385,943, Invention Title "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS",
-US Patent Application No. 15 / 385,950, Invention title "SURGICAL TOOL ASSEMBLES WITH CLOSE STROKE REDUCTION FEATURES",
-US Patent Application No. 15 / 385,945, title of invention "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN",
-US Patent Application No. 15 / 385,946, Invention Title "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS",
-US Patent Application No. 15 / 385,951, Title of Invention "SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASING A JAW OPENING DISTANCE",
-US Patent Application No. 15 / 385,953, Invention Title "METHODS OF STAPLING TISSUE",
-US Patent Application No. 15 / 385,954, Invention Title "FIRING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATURES FOR SURGICAL END EFFECTORS",
-US Patent Application No. 15 / 385,955, Invention Title "SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOP ARRANGEMENTS",
-US Patent Application No. 15 / 385,948, title of invention "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS",
-US Patent Application No. 15 / 385,956, Title of Invention "SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES",
-US Patent Application No. 15 / 385,958, title of invention "SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTING FIRING SYSTEM ACTUETION UNLESS ANUNESPENT STAPLE
-US Patent Application No. 15 / 385,947, title of invention "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN",
-US Patent Application No. 15 / 385,896, Title of Invention "METHOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT",
-US Patent Application No. 15 / 385,898, title of invention "STAPLE FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF STAPLES",
-US Patent Application No. 15 / 385,899, Title of Invention "SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CONTROL",
-US Patent Application No. 15 / 385,901, title of invention "STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRISING WINDOWS DEFINED THEREIN",
-US Patent Application No. 15 / 385,902, Title of Invention "SURGICAL INSTRUMENT COMPRISING A CUTTING MEMBER",
-US Patent Application No. 15 / 385,904, Invention title "STAPLE FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND / OR SPENT CARTRIGE LOCKOUT",
-US Patent Application No. 15 / 385,905, Invention Title "FIRING ASSEMBLY COMPRISING A LOCKOUT",
-US Patent Application No. 15 / 385,907, title of invention "SURGICAL INSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUT AND A FIRING ASSEMBLY LOCKOUT",
-US Patent Application No. 15 / 385,908, Invention Title "FIRING ASSEMBLY COMPRISING A FUSE",
-US Patent Application No. 15 / 385,909, Title of Invention "FIRING ASSEMBLY COMPRISING A MULTIPLE FAIRD-STATE FUSE",
-US Patent Application No. 15 / 385,920, Title of Invention "STAPLE FORMING POCKET ARRANGEMENTS",
-US Patent Application No. 15 / 385,913, Invention Title "ANVIL ARRANGEMENTS FOR SURGICAL STAPLE / FASTENERS",
-US Patent Application No. 15 / 385,914, title of invention "METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT"
-US Patent Application No. 15 / 385,893, Invention Title "BILATERALLY ASYMMETRIC STAPLE FORMING POCKET PAIRS",
-US Patent Application No. 15 / 385,929, title of invention "CLOSE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SURGICAL INSTRUMENTS WITH SEPARATE AND DISTINCT CLOSE AND FIRING TYPE"
-US Patent Application No. 15 / 385,911, title of invention "SURGICAL STAPLE / FASTENERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND FIRING SYSTEMS",
-US Patent Application No. 15 / 385,927, title of invention "SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CARTRIDGES",
-US Patent Application No. 15 / 385,917, title of invention "STAPLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAMPING BREADTHS",
-US Patent Application No. 15 / 385,900, title of invention "STAPLE FORMING POCKET ARRANGEMENTS COMPRISING PRIMARY SIDEWALLS AND POCKET SIDEWALLS",
-US Patent Application No. 15 / 385,931, Title of Invention "NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FOR SURGICAL STAPLE / FASTENERS",
-US Patent Application No. 15 / 385,915, Invention Title "FIRING MEMBER PIN ANGLE",
-US Patent Application No. 15 / 385,897, Invention title "STAPLE FORMING POCKET ARRANGEMENTS COMPRISING ZONED FORMING SURFACE GROOVES",
-US Patent Application No. 15 / 385,922, Title of Invention "SURGICAL INSTRUMENT WITH MULTIPLE FAIRURE RESPONSE MODES",
-US Patent Application No. 15 / 385,924, Title of Invention "SURGICAL INSTRUMENT WITH PRIMERY AND SAFETY PROCESSORS",
-US Pat.
-US Patent Application No. 15 / 385,910, Invention Title "ANVIL HAVING A KNIFE SLOT WIDTH",
-US Patent Application No. 15 / 385,906, Invention Title "FIRING MEMBER PIN CONFIGURATIONS",
-US Patent Application No. 15 / 386,188, Invention Title "STEPPED STAPLE CARTRIDGE WITH ASMYMETRICAL STAPLES",
-US Patent Application No. 15 / 386,192, Title of Invention "STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES",
-US Patent Application No. 15 / 386,206, Invention Title "STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES",
-US Patent Application No. 15 / 386,226, Title of Invention "DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLES OF SURGICAL STAPLING INSTRUMENTS",
-US Patent Application No. 15 / 386,222, title of invention "SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITH POSITIVE OPENING FEATURES",
-US Patent Application No. 15 / 386,236, title of invention "CONCEPTION PORTIONS FOR DISPOSABLE LOADING UNITS FOR SURGICAL STAPLING INSTRUMENTS",
-US Patent Application No. 15 / 385,887, title of invention "METHOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICAL INSTRUMENT AND, ALTERNANTIVELY, TO A SURGICAL ROBOT"
-US Patent Application No. 15 / 385,889, title of invention "SHAFT ASSEMBLY COMPRISING A MANUALLY-OPERABLE RETRATION SYSTEM FOR USE WITH A MOTORIZED SURGICAL INSTRUMENT"
-US Patent Application No. 15 / 385,890, Invention Title "SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE SYSTEMS",
-US Patent Application No. 15 / 385,891, title of invention "SHAFT ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO ADATT THE OUTPUT OF A ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEM"
-US Patent Application No. 15 / 385,892, title of invention "SURGICAL SYSTEM COMPRISING A FIRING MEMBER ROTATABLE INTO AN ARTICULATION STATE TO ARTICULATE AN END EFFECTOR OFSTER"
-US Patent Application No. 15 / 385,894, Invention Title "SHAFT ASSEMBLY COMPRISING A LOCKOUT",
-US Patent Application No. 15 / 385,895, Title of Invention "SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULATION LOCKOUTS",
-US Patent Application No. 15 / 385,916, Invention Title "SURGICAL STAPLING SYSTEMS",
-US Patent Application No. 15 / 385,918, Invention Title "SURGICAL STAPLING SYSTEMS",
-US Patent Application No. 15 / 385,919, title of invention "SURGICAL STAPLING SYSTEMS",
-US Patent Application No. 15 / 385,921, title of invention "SURGICAL STAPLE / FASTENEER CARTRIDGE WITH MOVABLE CAMMING MEMBER CONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES",
-US Patent Application No. 15 / 385,923, Invention Title "SURGICAL STAPLING SYSTEMS",
-US Patent Application No. 15 / 385,925, title of invention "JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCEMENT OF A FIRING MEMBER IN A SURGICAL END EFFECTOR UNISTER INTERENCE
-US Patent Application No. 15 / 385,926, title of invention "AXIALLY MOVABLE CLOSE SYSTEM ARRANGEMENTS FOR APPLYING CLOSURE MOTIONS TO JAWS OF SURGICAL INSTRUMENTS",
-US Patent Application No. 15 / 385,928, title of invention "PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN A MOVABLE JAW AND ACTUATOR SHAFT OF A SURGICAL INST"
-US Patent Application No. 15 / 385,930, Title of Invention "SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERATING OPENING FEATURES FOR OPENING AND CLOSEING END EFFECTOR JAWS",
-US Patent Application No. 15 / 385,932, Title of Invention "ARTICULATABLE SURGICAL END EFFECTOR WITH Asymmetric SHAFT ARRANGEMENT",
-US Patent Application No. 15 / 385,933, title of invention "ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLE LINKAGE DISTAL OF AN ARTICULATION LOCK",
-US Patent Application No. 15 / 385,934, title of invention "ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR IN AN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF
-US Patent Application No. 15 / 385,935, title of invention "LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN TERMON, INTERU. The name of "ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES".

The applicant of the present application owns the following US patent applications filed on June 24, 2016, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 191,775, Title of Invention "STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES",
-US Patent Application No. 15 / 191,807, Invention title "STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPED STAPLES",
-US Patent Application No. 15 / 191,834, Title of Invention "STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME",
-US Patent Application No. 15 / 191,788, Invention Name "STAPLE CARTRIGGE COMPRISING OVERDRIVEN STAPLES",-US Patent Application No. 15 / 191,818, Invention Name "STAPLE CARTRIGGE COMPRISING OFFSET LONGITUDINAL".

The applicant of the present application owns the following US patent applications filed on June 24, 2016, the entire contents of which are incorporated herein by reference.
-US Design Patent Application No. 29 / 569,218, Invention Title "SURGICAL FASTENEER",
-US Design Patent Application No. 29 / 569,227, Invention Name "SURGICAL FASTENEER",
-US Design Patent Application No. 29 / 569,259, title of invention "SURGICAL FASTENEER CARTRIDGE",-US Design Patent Application No. 29 / 569,264, title of invention "SURGICAL FASTENEER CARTRIDGE".

The applicant of the present application owns the following patent applications filed on April 1, 2016, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 089,325, Invention Title "METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM", Currently US Patent Application Publication No. 2017/0281171,
-US Patent Application No. 15 / 089,321, Invention Title "MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY", Currently US Patent Application Publication No. 2017/0281163,
-US Patent Application No. 15 / 089,326, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD", now US Patent Application Publication No. 2017/0281172,
-US Patent Application No. 15 / 089,263, Invention Title "SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP PORTION", now US Patent Application Publication No. 2017/0281165,
-US Patent Application No. 15 / 089,262, Invention Title "ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT SYSTEM", now US Patent Application Publication No. 2017/0281161,
-US Patent Application No. 15 / 089,277, Invention Title "SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC DRIVE MEMBER", now US Patent Application Publication No. 2017/0281166,
-US Patent Application No. 15 / 089,296, Title of Invention "INTERCHANGE SURGICAL TOOL ASSEMBLY WITH A SURGICAL END EFFECTOR THAT IS SELECTIVELY ROTATABLE rotatabelle 20 IS8
-US Patent Application No. 15 / 089,258, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION", Currently US Patent Application Publication No. 2017/0281178,
-US Patent Application No. 15 / 089,278, Invention Title "SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVE CUTTING OF TISSUE", now US Patent Application Publication No. 2017/0281162,
-US Patent Application No. 15 / 089,284, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT", Currently US Patent Application Publication No. 2017/0281186,
-US Patent Application No. 15 / 089,295, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSION LOCKOUT", now US Patent Application Publication No. 2017/0281187,
-US Patent Application No. 15 / 089,300, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT", Currently US Patent Application Publication No. 2017/0281179,
-US Patent Application No. 15 / 089,196, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSE LOCKOUT", Currently US Patent Application Publication No. 2017/0281183,
-US Patent Application No. 15 / 089,203, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT", Currently US Patent Application Publication No. 2017/0281184,
-US Patent Application No. 15 / 089,210, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGE LOCKOUT", Currently US Patent Application Publication No. 2017/0281185,
-US Patent Application No. 15 / 089,324, Invention Title "SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM", Currently US Patent Application Publication No. 2017/0281170,
-US Patent Application No. 15 / 089,335, Invention Title "SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS", Currently US Patent Application Publication No. 2017/0281155,
-US Patent Application No. 15 / 089,339, Invention Title "SURGICAL STAPLING INSTRUMENT", Currently US Patent Application Publication No. 2017/0281173,
-US Patent Application No. 15 / 089,253, Invention Title "SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OF STAPLES HAVING DIFFERENT HEIGHTS", now US Patent Application Publication No. 2017/0211
-US Patent Application No. 15 / 089,304, Invention Title "SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET", now US Patent Application Publication No. 2017/0281188,
-US Patent Application No. 15 / 089,331, Invention Title "ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLE / FASTENEERS", Currently US Patent Application Publication No. 2017/0281180,
-US Patent Application No. 15 / 089,336, Invention Title "STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES", Currently US Patent Application Publication No. 2017/0281164,
-US Patent Application No. 15 / 089,312, Invention Title "CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUE SUPPORT", Currently US Patent Application Publication No. 2017/0281189,
-US Patent Application No. 15 / 089,309, Invention Title "CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM", Currently US Patent Application Publication No. 2017/0281169, and-US Patent Application No. 15 / 089,349, The title of the invention, "CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTORL", is currently US Patent Application Publication No. 2017/0281174.

The applicant of the present application also owns the following US patent applications filed on December 30, 2015, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 984,488, Invention Title "MECHANIMSS FOR COMPENSATING FOR BATTERY PACK FAIRURE IN POWERED SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2017/01889018,
-US Patent Application No. 14 / 984,525, title of invention "MEMHANIMSS FOR COMPENSATING FOR DRIVETRAIN FAIRURE IN POWERED SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2017/01889019, and-US Patent Application No. 14/98 No. 552, the title of the invention "SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROL CIRCUITS", currently US Patent Application Publication No. 2017/018902.

The applicant of the present application also owns the following US patent applications filed on February 9, 2016, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 019,220, Title of Invention "SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLATABLE END EFFECTOR", Currently US Patent Application Publication No. 2017/0224333,
-US Patent Application No. 15 / 019,228, Invention Title "SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS", now US Patent Application Publication No. 2017/0224342,
-US Patent Application No. 15 / 019,196, Invention Title "SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT", now US Patent Application Publication No. 2017/0224330,
-US Patent Application No. 15 / 019,206, Invention Title "SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLY ARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY"
-US Patent Application No. 15 / 019,215, Invention Title "SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION ARRANGEMENTS", now US Patent Application Publication No. 2017/02243332,
-US Patent Application No. 15 / 019,227, Invention Title "ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATION LINK ARRANGEMENTS", now US Patent Application Publication No. 2017/0224334,
-US Patent Application No. 15 / 019,235, Invention Title "SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEEN ARTICULATION SYSTEMS", now US Patent Application Publication No. 2017/0224336,
-US Patent Application No. 15 / 019,230, title of invention "ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAM ARRANGEMENTS", now US Patent Application Publication No. 2017/0224335, and-US Patent Application No. 15/019, No. 245, the title of the invention "SURGICAL INSTRUMENTS WITH CLOSE STROKE REDUCTION ARRANGEMENTS", currently US Patent Application Publication No. 2017/0224343.

The applicant of the present application also owns the following US patent applications filed on February 12, 2016, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 15 / 043,254, title of invention "MEMHANIMSS FOR COMPENSATING FOR DRIVETRAIN FAIRURE IN POWERED SURGICAL INSTRUMENTS",
-US Patent Application No. 15 / 043,259, title of invention "MEMHANIMSS FOR COMPENSATING FOR DRIVETRAIN FAIRURE IN POWERED SURGICAL INSTRUMENTS",
-US Patent Application No. 15 / 043,275, title of invention "MECHANIMSS FOR COMPENSATING FOR DRIVETRAIN FAIRURE IN POWERED SURGICAL INSTRUMENTS", and-US Patent Application No. 15/043,289, title of invention "MECHANISMS FOR FAIRURE IN POWERED SURGICAL INSTRUMENTS ".

The applicant of the present application owns the following patent applications filed on June 18, 2015, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 742,925, Invention Title "SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS", Currently US Patent Application Publication No. 2016/0367256,
-US Patent Application No. 14 / 742,941, Invention title "SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSEING FEATURES", now US Patent Application Publication No. 2016/0367248,
-US Patent Application No. 14 / 742,914, Invention Title "MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2016/0367255,
-US Patent Application No. 14 / 742,900, title of invention "ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAM STRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR
-US Patent Application No. 14 / 742,885, Invention Title "DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2016/0367246, and-US Patent Application No. 14 / 742,885, and-US Patent Application No. 14 / 742,885. No., the title of the invention "PUSH / PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLE SURGICAL INSTRUMENTS", currently US Patent Application Publication No. 2016/0367245.

The applicant of the present application owns the following patent applications filed on March 6, 2015, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 640,746, Invention Title "POWERED SURGICAL INSTRUMENT", Current US Patent Application Publication No. 9,808,246,
-US Patent Application No. 14 / 640,795, Invention Title "MULTIPLE LEVEL THESHOLDS TO MODEFIY OPERATION OF POWERED SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2016/02561185,
-US Patent Application No. 14 / 640,832, Title of Invention "ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURE RATES FOR MULTIPLE TISSUE TYPES", now US Patent Application Publication No. 2016/02564
-US Patent Application Nos. 14 / 640,935, Invention Title "OVERLAID MULTI SENSOR RADIO FREENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION", now US Patent Application Publication No. 2016/0256071
-US Patent Application No. 14 / 640,831, Title of Invention "MONITORING SPEED CONTROLL AND PRECISION INCREMENTING OF MOTOR FOR FOR POWERED SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2016/0256153,
-US Patent Application No. 14 / 640,859, Invention Title "TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINE STABILITY, CREEP, AND VISCOELASTIC ELEMENTS OF MEASURES", now published in US Patent No. 14 / 640,859
-US Patent Application No. 14 / 640,817, Invention Title "INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2016/0256186,
-US Patent Application Nos. 14 / 640,844, Title of Invention "CONTROLL TECHNIQUES AND SUB-PROCESSOR CONTROL WITHIN MODULAR SHAFT WITH SELECT CONTROLL PROCESSING Entry, US Patent No. 15/56, US Pat.
-US Patent Application No. 14 / 640,837, Invention Title "SMART SENSORS WITH LOCAL SIGNAL PROCESSING", Currently US Patent Application Publication No. 2016/0256163,
-US Patent Application No. 14 / 640,765, Invention Title "SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A SURGICAL STAPLE / FASTENEER", now US Patent Application Publication No. 2016/0256160
-US Patent Application No. 14 / 640,799, Invention Title "SIGNAL AND POWER COMMUNICATION SYSTEM SYSTEM POSITIONED ON A ROTATABLE SHAFT", now US Patent Application Publication No. 2016/0256162, and-US Patent Application No. 14/640, No. 780, the title of the invention "SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING", currently US Patent Application Publication No. 2016/0256161.

The applicant of the present application owns the following patent applications filed on February 27, 2015, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 633,576, Invention Title "SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSTECTION STATION", Currently US Patent Application Publication No. 2016/0249919,
-US Patent Application No. 14 / 633,546, title of invention "SURGICAL APPARATUS CONFIGURED TO ASSESS WHERE THER A PERFORMANCE PARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACC"
-US Patent Application No. 14 / 633,560, Invention Title "SURGICAL CHARGING SYSTEM THAT CHARGES AND / OR CONDITIONS ONE OR MORE BATTERIES", Currently US Patent Application Publication No. 2016/0249910,
-US Patent Application No. 14 / 633,566, Invention Title "CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A BATTERY", now US Patent Application Publication No. 2016/0249918,
-US Patent Application No. 14 / 633,555, Invention Title "SYSTEM FOR MONITORING WHERTHER A SURGICAL INSTRUMENT NEEDS TO BE SERVICED", now US Patent Application Publication No. 2016/0249916,
-US Patent Application No. 14 / 633,542, Invention Title "REINFORCED BATTERY FOR A SURGICAL INSTRUMENT", Currently US Patent Application Publication No. 2016/0249908,
-US Patent Application No. 14 / 633,548, Invention Title "POWER ADAPTER FOR A SURGICAL INSTRUMENT", Currently US Patent Application Publication No. 2016/0249909,
-US Patent Application No. 14 / 633,526, Invention Title "ADAPTABLE SURGICAL INSTRUMENT HANDLE", Currently US Patent Application Publication No. 2016/0249945,
-US Patent Application No. 14 / 633,541, Invention Title "MODULAR STAPLING ASSEMBLY", now US Patent Application Publication No. 2016/0249927, and-US Patent Application No. 14 / 633,562, Invention Title " SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER ”, currently US Patent Application Publication No. 2016/0249917.

The applicant of the present application owns the following patent applications filed on December 18, 2014, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 574,478, title of invention "SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF4, USA
-US Patent Application No. 14 / 574,483, Invention Title "SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS", Currently US Patent Application Publication No. 2016/0174969,
-US Patent Application No. 14 / 575,139, Invention Title "DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS", now US Pat. No. 9,844,375,
-US Patent Application No. 14 / 575,148, Invention Title "LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLES WITH ARTICULATABLE SURGICAL END EFFECTORS", now US Patent Application Publication No. 2016/017
-US Patent Application No. 14 / 575,130, Title of Invention "SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLE ABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STEP ,
-US Patent Application No. 14 / 575,143, Invention Title "SURGICAL INSTRUMENTS WITH IMPROVEED CLOSE ARRANGEMENTS", Currently US Patent Application Publication No. 2016/0174983,
-US Patent Application No. 14 / 575,117, title of invention "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS", now US Patent Application Publication No. 4975 /
-US Patent Application No. 14 / 575,154, Invention Title "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVEED FIRING BEAM SUPPORT ARRANGEMENTS", now US Patent Application Publication No. 9732016
-US Patent Application No. 14 / 574,493, Invention Title "SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM", now US Patent Application Publication No. 2016/0174970, and-US Patent Application No. 14 / 574,500. , The title of the invention "SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM", currently US Patent Application Publication No. 2016/0174971.

The applicant of the present application owns the following patent applications filed on March 1, 2013, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 13 / 782,295, title of invention "ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCIVE PATHWAYS FOR SIGNAL COMMUNICATION", now US Pat. No. 9,700,309,
-US Patent Application No. 13 / 782,323, Invention Title "ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS", now U.S. Pat. No. 9,782,169,
-US Patent Application No. 13 / 782,338, Invention Title "THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS", Currently US Patent Application Publication No. 2014/0249557,
-US Patent Application No. 13 / 782,499, Invention Title "ELECTROMECANICAL SURGICE WITH SIGNAL RELAY ARRANGEMENT", now US Pat. No. 9,358,003,
-US Patent Application No. 13 / 782,460, Title of Invention "MULTIPLE PROCESSOR MOTOR CONTROL FOR MODEDULAR SURGICAL INSTRUMENTS", now US Pat. No. 9,554,794,
-US Patent Application No. 13 / 782,358, Invention Title "JOYSTICK SWITCH ASSEMBLES FOR SURGICAL INSTRUMENTS", now US Pat. No. 9,326,767,
-US Patent Application No. 13 / 782,481, Invention title "SENSOR STRAIGHTENEED END EFFECTOR DURING REMOVAL THROUGH TROCAR", now US Pat. No. 9,468,438,
-US Patent Application No. 13 / 782,518, Invention Title "CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMEMENT PORTIONS", Currently US Patent Application Publication No. 2014/0246475,
-US Patent Application No. 13 / 782,375, title of invention "ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGRES OF FREEDOM", now US Patent No. 9,398,911, and-US Patent Application No. 13,782,536 No., the title of the invention "SURGICAL INSTRUMENT SOFT STOP", currently US Pat. No. 9,307,986.

The applicant of the present application also owns the following patent applications filed on March 14, 2013, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 13 / 803,097, Invention Title "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE", now US Pat. No. 9,687,230,
-US Patent Application No. 13 / 803,193, Invention Title "CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT", now US Pat. No. 9,332,987,
-US Patent Application No. 13 / 803,053, Invention Title "INTERCHANGE SHAFT ASSEMBLES FOR USE WITH A SURGICAL INSTRUMENT", now US Patent Application Publication No. 2014/0263564,
-US Patent Application No. 13 / 803,086, Invention title "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK", now US Patent Application Publication No. 2014/0263541,
-US Patent Application No. 13 / 803,210, Invention Title "SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS", now US Pat. No. 9,808,244,
-US Patent Application No. 13 / 803,148, Invention Title "MULTI-function MOTOR FOR A SURGICAL INSTRUMENT", Currently US Patent Application Publication No. 2014/0263554,
-US Patent Application No. 13 / 803,066, Invention title "DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODELAR SURGICAL INSTRUMENTS", now US Pat. No. 9,629,623,
-US Patent Application No. 13 / 803,117, Invention Title "ARTICULATION CONTORL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS", now US Pat. No. 9,351,726,
-US Patent Application No. 13 / 803,130, Invention Title "DRIVE TRAIN CONTOROL ARRANGEMENTS FOR MODELAR SURGICAL INSTRUMENTS", Currently US Patent No. 9,351,727, and-US Patent Application No. 13 / 803,159 , The title of the invention "METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT", currently US Patent Application Publication No. 2014/0277017.

The applicant of the present application also owns the following patent application filed on March 7, 2014, the entire contents of which are incorporated herein by reference.
-U.S. Patent Application No. 14 / 200,111, Invention Title "CONTROLL SYSTEMS FOR SURGICAL INSTRUMENTS", now U.S. Pat. No. 9,629,629.

The applicant of the present application also owns the following patent applications filed on March 26, 2014, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 226,106, Invention Title "POWER MANAGEMENT CONTORL SYSTEMS FOR SURGICAL INSTRUMENTS", Currently US Patent Application Publication No. 2015/0272582,
-US Patent Application No. 14 / 226,099, Invention Title "STERILIZATION VERIFICATION CIRCUIT", Currently US Pat. No. 9,826,977,
-US Patent Application No. 14 / 226,094, Invention Title "VERIFICATION OF NUMBER OF BATTERY EXCHANGE COUNT", now US Patent Application Publication No. 2015/0272580,
-US Patent Application No. 14 / 226,117, Invention Title "POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTOROL", now US Patent Application Publication No. 2015/0272574,
-US Patent Application No. 14 / 226,075, Invention Title "MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLES", now US Pat. No. 9,734,929,
-US Patent Application No. 14 / 226,093, Invention Title "FEEDBACK ALGORTITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2015/0272569,
-US Patent Application No. 14 / 226,116, Invention Title "SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION", Currently US Patent Application Publication No. 2015/0272571,
-U.S. Patent Application No. 14 / 226,071, the title of the invention "SURGICAL INSTRUMENT CONTROLL CIRCUIT HAVING A SAFETY PROCESSOR", now U.S. Pat.
-US Patent Application No. 14 / 226,097, Invention Title "SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS", now US Pat. No. 9,820,738,
-US Patent Application No. 14 / 226,126, Invention Title "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS", Currently US Patent Application Publication No. 2015/0272572,
-US Patent Application No. 14 / 226,133, Invention Title "MODULAR SURGICAL INSTRUMENT SYSTEM", Currently US Patent Application Publication No. 2015/0272557,
-US Patent Application No. 14 / 226,081, Invention title "SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT", now US Pat. No. 9,804,618,
-US Patent Application No. 14 / 226,076, Invention Title "POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTESTION", now US Pat. No. 9,733,663,
-US Patent Application No. 14 / 226,111, Invention Title "SURGICAL STAPLING INSTRUMENT SYSTEM", now US Pat. No. 9,750,499, and-US Patent Application No. 14 / 226,125, Invention Title " SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT ”, currently US Patent Application Publication No. 2015/0280384.

The applicant of the present application also owns the following patent applications filed on September 5, 2014, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 479,103, Invention Title "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE", Currently US Patent Application Publication No. 2016/0066912,
-US Patent Application No. 14 / 479,119, Invention Title "ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION", now US Pat. No. 9,724,094,
-US Patent Application No. 14 / 478,908, Invention Title "MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION", now US Pat. No. 9,737,301,
-US Patent Application No. 14 / 478,895, Title of Invention "MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR INTERPRETATION", now US Pat. No. 9,757,128,
-US Patent Application No. 14 / 479,110, Invention Title "POLARITY OF HALL MAGNET TO DETECT MISLOADED CARTRIDGE", Currently US Patent Application Publication No. 2016/0066915,
-US Patent Application No. 14 / 479,098, Invention Title "SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION", Currently US Patent Application Publication No. 2016/0066911,
-US Patent Application No. 14 / 479,115, Invention Title "MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE", now US Pat. No. 9,788,836, and-US Patent Application No. 14 / 479,108, The title of the invention, "LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION", is currently US Patent Application Publication No. 2016/0066913.

The applicant of the present application also owns the following patent applications filed on April 9, 2014, the entire contents of which are incorporated herein by reference.
-US Patent Application No. 14 / 248,590, Invention Title "MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS", now US Pat. No. 9,286,976,
-US Patent Application No. 14 / 248,581, Title of Invention "SURGICAL INSTRUMENT COMPRISING A CLOSEING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT", currently US Patent No. 110, 9
-US Patent Application No. 14 / 248,595, title of invention "SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRUMENT", now U.S. Pat.
-US Patent Application No. 14 / 248,588, Invention Title "POWERED LINEAR SURGICAL STAPLE / FASTENEER", Currently US Patent Application Publication No. 2014/0309666,
-US Patent Application No. 14 / 248,591, Invention Title "TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT", Currently US Patent Application Publication No. 2014/0305911,
-US Patent Application No. 14 / 248,584, Title of Invention "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURFTS WITH SULTS
-US Patent Application No. 14 / 248,587, Invention Name "POWERED SURGICAL STAPLE / FASTENEER", Currently US Patent Application Publication No. 2014/0309665,
-US Patent Application No. 14 / 248,586, Invention Title "DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT", now US Patent Application Publication No. 2014/03059090, and-US Patent Application No. 14 / 248,607. , The title of the invention "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS", currently US Pat. No. 9,814,460.

The applicant of the present application also owns the following patent applications filed on April 16, 2013, the entire contents of which are incorporated herein by reference.
-US Patent Provisional Application No. 61 / 812,365, Title of Invention "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR",
-US Patent Provisional Application No. 61 / 812,376, Invention Title "LINEAR CUTTER WITH POWER",
-US Patent Provisional Application No. 61 / 812,382, Invention Title "LINEAR CUTTER WITH MOTOR AND PISTOL GRIP",
-US Patent Provisional Application No. 61 / 812,385, title of invention "SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTION MOTORS AND MOTOR CONTROL", and-US Patent Provisional Application No. 61 / 812,372, title of invention "SURGICAL" MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR ".

Numerous specific details are described to provide a complete understanding of the overall structure, function, manufacture, and use of embodiments, as described herein and shown in the accompanying drawings. .. Well-known behaviors, components, and elements are not described in detail so as not to obscure the embodiments described herein. The reader is that the embodiments described and illustrated herein are non-limiting examples, and therefore the particular structural and functional details disclosed herein may be representative and exemplary. Will be understood. Modifications and changes to the claims can be made without departing from the scope of the claims.

The terms "comprise" (one of the comprise word forms such as "comprises" and "comprising"), "have" (one of the have word forms such as "has" and "having"), " "Include" (one of the inflection word forms such as "inclusions" and "inclating") and "contain" (one of the content word forms such as "contains" and "contining") are A mutable concatenated verb. As a result, a surgical system, device, or device that "includes", "has", "contains", or "contains" one or more elements has one or more of them. However, it is not limited to having only one or more of them. Similarly, an element of a system, device, or device that "includes", "has", "contains", or "contains" one or more features has one or more of those features, but they It is not limited to having only one or more features.

The terms "proximal" and "distal" are used herein with reference to the clinician operating the handle portion of the surgical instrument. The term "proximal" refers to the part closest to the clinician, and the term "distal" refers to the part located away from the clinician. It will be further appreciated that for convenience and clarity, spatial terms such as "vertical", "horizontal", "top", and "bottom" may be used with respect to the drawings herein. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limited and / or absolute.

Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgery. However, it will be readily appreciated by the reader that the various methods and devices disclosed herein can be used in many surgical procedures and applications, including those associated with, for example, open surgery. By reading "Forms for Carrying Out the Invention" herein, the reader can read that the various instruments disclosed herein are incised or punctured within the tissue, eg, through a natural opening. You will further understand that it can be inserted into the body in any way, such as through a hole. The working or end effector portion of these instruments may be inserted directly into the patient's body or through an access device with a working corridor capable of advancing the end effector and elongated shaft of the surgical instrument. May be good.

Various surgical instruments configured to fasten the patient's tissue are disclosed herein. As described in more detail below, such surgical instruments include end effectors and multiple drive systems configured to perform various end effector functions. Such drive systems, for example, cut anvil drive systems configured to clamp tissue within an end effector, staple launch systems configured to deploy staples within tissue, and / or tissue. It can include a tissue cutting system configured as such. Such drive systems may also include, for example, joint motion drive systems configured to articulate end effectors, tissue drive systems configured to move end effectors relative to tissue, and / or end effectors. A staple loading system configured to reload the staples can be included. As discussed in more detail below, two or more of these drive systems may be operably linked to a common drive system so that they operate synchronously.

The staple fastener 1000 is shown in FIG. The staple fastener 1000 includes a handle 1100, a shaft assembly 1200 extending from the handle 1100, and an end effector 1300 extending from the shaft assembly 1200. The handle 1100 includes a frame 1110 and gripping portions 1120 located on both sides of the frame 1110. The handle 1100 further comprises a plurality of electric motors configured to operate the drive system of the staple fastener 1000. Although three electric motors 1130, 1140, and 1150 are shown, the surgical instrument 1000 can include any suitable number of electric motors. Each electric motor is operably connected to a rotatable output unit. For example, the electric motor 1130 is operably connected to a rotatable output unit 1135, the electric motor 1140 is operably connected to a rotatable output unit 1145, and the electric motor 1150 is operably connected to a rotatable output unit 1155. It is operably connected. The handle 1100 further comprises, for example, batteries 1160 that power the electric motors 1130, 1140, and 1150. With reference to FIG. 11, battery 1160 includes, for example, a lithium 18650 battery, but may include any suitable battery. Primarily with reference to FIG. 12, the battery 1160 is located within the battery compartment 1115 defined within the handle frame 1110 but can be stored in any suitable location. The battery 1160 is also configured to power the control system and / or display of the handle 1110 described in more detail below.

Handles 1100'are shown in FIGS. 8 and 10. The handle 1100'is similar to the handle 1100 in many respects, most of which are not discussed herein for brevity. Handle 1100' includes a battery compartment accessible through door 1115'. Door 1115'makes it possible to replace batteries in the battery compartment. Handle 1100 ″ is shown in FIG. The handle 1100 ″ is similar to the handle 1100 in many respects, most of which are not discussed herein for brevity. The handle 1100 ″ comprises, for example, a plug 1115 ″ configured to power the handle 1100 ″ from a generator and / or a wall outlet. In various examples, the handle 1100 ″ may be powered from an internal source such as the battery 1160 and an external source such as the plug 1115 ″.

Referencing FIG. 1 again, the handle frame 1110 includes a connector 1170. The shaft assembly 1200 comprises an outer housing 1210 that includes a shaft connector 1270 configured to engage the handle connector 1170 to connect the shaft assembly 1200 to the handle 1100. The shaft connector 1270 and handle 1170 include a rotatable bayonet interconnect, but any suitable interconnect can be used. The shaft assembly 1200 further comprises a rotatable input unit 1235, which is configured to be operably connected to a rotatable output unit 1135 when the shaft assembly 1200 is assembled to the handle 1100. There is. Similarly, the shaft assembly 1200 also has a rotatable input unit 1245 configured to be operably coupled to a rotatable output unit 1145 and a rotatable output when the shaft assembly 1200 is assembled to the handle 1100. It comprises a rotatable input unit 1255 configured to be operably connected to the unit 1155.

In addition to the above, the outer shaft housing 1210 further comprises a distal connector 1290. The end effector 1300 comprises a shaft portion 1310 including an end effector connector 1390 configured to engage the distal connector 1290 to connect the end effector 1300 to the shaft assembly 1200. The end effector connector 1390 and the distal shaft connector 1290 include a rotatable interconnect, but any suitable interconnect can be used. The end effector 1300 further comprises a first drive that is configured to be operably coupled to the shaft input 1235 when the end effector 1300 is assembled to the shaft assembly 1200. Similarly, the end effector 1300 can operate on a second drive that is configured to be operably coupled to the shaft input 1245 and on the shaft input 1255 when the end effector 1300 is assembled to the shaft assembly 1200. It comprises a third drive device configured to be connected to.

In various examples, the shaft assembly 1200 and / or the end effector 1300 comprises one or more sensors and / or electrically driven components. Referring to FIG. 2, the staple fastener 1000 comprises at least one electrical circuit extending through a handle 1100, a shaft assembly 1200, and an end effector 1300. This electrical circuit comprises conductors within the handle 1100, shaft assembly 1200, and end effector 1300, when the shaft assembly 1200 is assembled to the handle 1100 and the end effector 1300 is assembled to the shaft assembly 1200. They are arranged so as to be electrically connected to each other. FIG. 2 shows four conductors 1280 in a shaft assembly 1200 that is part of two separate electrical circuits, but any suitable number of conductors and / or circuits may be used. The handle connector 1170 and shaft connector 1270 include electrical contacts that rotate and engage when the shaft assembly 1200 is rotatably assembled to the handle 1100. Similarly, the distal shaft connector 1290 and end effector connector 1390 include electrical contacts that rotate and engage when the end effector 1300 is assembled to the shaft assembly 1200.

Referring again to FIG. 1, the end effector 1300 further comprises a distal head 1320 rotatably connected to a shaft portion 1310 about a joint motion joint 1370. The end effector 1300 also comprises a joint motion drive system configured to articulate the distal head 1320 with respect to the shaft portion 1310. The distal head 1320 comprises an anvil 1360 that can be moved between open and closed positions. In use, the anvil 1360 is movable towards the tissue compression surface 1325 by the anvil drive system to clamp or compress the tissue within the end effector 1300. As discussed below in connection with FIGS. 3-7, the tissue compression surface 1325 is on a tissue drive system configured to engage the patient tissue and move the staple fastener 1000 relative to the patient tissue. It is defined.

Primarily with reference to FIG. 3, the end effector 1300 comprises a rotatable drive shaft 1330, which selectively opens the anvil 1360 to operate the tissue drive system (FIGS. 4-6). It can be used to reposition the distal head 1320 relative to the tissue and close the anvil 1360 before the staple fastener 1000 performs the staple firing stroke (FIG. 7). The drive shaft 1330 is driven by an electric motor, and the drive shaft 1330 is operably engaged with a key 1332 extending from the drive shaft 1330 with the tissue drive system (FIGS. 4-6). And the second position, where the key 1332 is operably engaged with the anvil drive system (FIG. 7), can be translated. When the drive shaft 1330 is in its first position, the key 1332 is located in the key slot 1333 defined in the drive gear 1331 of the tissue drive system. When the drive shaft 1330 is in its second position, the key 1332 is located in the key slot 1363 defined within the drive collar 1361 of the anvil drive system.

With reference to FIGS. 4-6, the tissue drive system comprises a first foot 1380a and a second foot 1380b. The feet 1380a, 1380b can be extended to engage the patient tissue and then retracted relative to the patient tissue by pulling the distal head 1320 of the end effector 1300. The tissue drive system is configured to extend the first foot 1380a while retracting the second foot 1380b, and similarly extend the second foot 1380b while retracting the first foot 1380a. There is. FIG. 4 shows a first foot 1380a in the extended position and a second foot 1380b in the retracted position. As a result of the above, the tissue drive system may be configured to run the end effector 1300 across the tissue to form a staple firing path within the tissue. In various alternative embodiments, the tissue drive system causes the first foot 1380a and the second foot 1380b to extend simultaneously and / or retract the first foot 1380a and the second foot 1380b simultaneously. Can be configured in.

In addition to the above, the tissue drive system transmits the rotation of the drive shaft 1330 to the second gear 1380b and the first gear train configured to transmit the rotation of the drive shaft 1330 to the first gear 1380a. A second gear train configured as described above is provided. The first gear train comprises a spur gear 1381a that operably meshes with the drive gear 1331, a transmission gear 1382a that operably meshes with the spur gear 1381a, and a spur gear 1383a that operably meshes with the transmission gear 1382a. The rotation of 1330 is transmitted to the spur gear 1383a. The first gear train further comprises a shaft gear 1384a that operably meshes with the spur gear 1383a. Mainly referring to FIGS. 5 and 6, the shaft gear 1384a is fixedly mounted on the transmission shaft 1385a so that the rotation of the spur gear 1383a is transmitted to the transmission shaft 1385a. The first gear train further includes a bevel gear 1386a fixedly mounted on the transmission shaft 1385a, a side bevel gear 1387a operably meshed with the bevel gear 1386a, and a pinion gear 1388a fixedly mounted on the side bevel gear 1387a. The pinion gear 1388a is configured to rotate together with the side bevel gear 1387a. Primarily with reference to FIG. 6, the pinion gear 1388a operably meshes with a rack 1389a mounted on the first foot 1380a, which converts rotational input motion into translational motion of the first foot 1380a.

The second gear train is in many respects similar to the first gear train, except that the second gear train does not include a transmission gear between the two spur gears, as described below. .. The second gear train includes a spur gear 1381b that operably meshes with the drive gear 1331 and a spur gear 1383b that operably meshes with the spur gear 1381b, so that the rotation of the shaft 1330 is transmitted to the spur gear 1383b. The second gear train further comprises a shaft gear 1384b that operably meshes with the spur gear 1383b. Mainly referring to FIG. 5, the shaft gear 1384b is fixedly mounted on the transmission shaft 1385b so that the rotation of the spur gear 1383b is transmitted to the transmission shaft 1385b. The second gear train further includes a bevel gear 1386b fixedly mounted on the transmission shaft 1385b, a side bevel gear 1387b operably meshing with the bevel gear 1386b, and a pinion gear 1388b fixedly mounted on the side bevel gear 1387b. The pinion gear 1388b is configured to rotate with the side bevel gear 1387b. The pinion gear 1388b operably meshes with a rack 1389b mounted on the second foot 1380b, which converts the rotational input motion into a translational motion of the second foot 1380b.

Since the transmission gear 1382a is present in the first gear train and the corresponding transmission gear is not present in the second gear train, the first foot 1380a and the second foot 1380b rotate the drive shaft 1330. In response to, they will move in opposite directions. For example, when the drive shaft 1330 is rotated in the first direction, the first foot 1380a is extended and the second foot 1380b is retracted. Similarly, when the drive shaft 1330 is rotated in the second direction, that is, in the opposite direction, the first foot 1380a is retracted and the second foot 1380b is extended. As described above, the first and second feet 1380a, 1380b are configured to grip and pull the end effector 1300 against the tissue as they extend and retract. The movements of the feet 1380a, 1380b may be linear, but other embodiments that result in different movements, such as arched movements, are also disclosed herein.

When the end effector 1300 is properly moved with respect to the tissue by the tissue drive system, the drive shaft 1330 is longitudinally translated to disengage from engagement with the tissue drive system and anvil drive, as shown in FIG. Engage with the system. In various examples, the rotation of the drive shaft 1330 may be stopped before being disengaged from the tissue drive system. In another example, the drive shaft 1330 can continue to rotate as it is disengaged from the tissue drive system and translated to engage the drive collar 1361. In each case, the drive collar 1361 comprises a threaded opening 1362 defined therein, the threaded opening comprising a thread 1365. The anvil 1360 includes a push rod 1364 extending from it, the push rod including an end that is screwably engaged with a thread 1365 in the opening 1366. When the drive collar 1361 is rotated in the first direction by the drive shaft 1330, the drive collar 1361 pushes the anvil 1360 away from the feet 1380a and 1380b to open the anvil 1360. When the anvil 1360 is fully opened, the drive shaft 1330 can be shifted to engage the tissue drive system and move the end effector 1300 relative to the tissue. The drive shaft 1330 can then be re-engaged with the anvil drive system. As shown in FIG. 7, when the drive collar 1361 is rotated in the second, or opposite direction, at such a point, the drive collar 1361 pulls the anvil 1360 towards the feet 1380a and 1380b and the anvil. Close or clamp the 1360. When the anvil 1360 is closed, the staple firing system of the staple fastener 1000 can be activated. At such point, the anvil 1360 may be reopened by the anvil drive system and the cycle described above may be repeated.

Notably, the drive shaft 1330 extends along the longitudinal axis 1339 which is in line with the longitudinal axis 1369 which extends through the push rod 1364 of the anvil drive system. With such a configuration, the drive shaft 1330 can be operably connected to the push rod 1334 via the drive collar 1361. Also noteworthy is that the drive collar 1361 comprises a proximal flange 1367 and a distal flange 1368 extending from it. Flange 1367 and 1368 act as stops that limit the longitudinal movement of the anvil 1360 in the proximal and distal directions, respectively. Therefore, flanges 1367 and 1368 define the limits of the opening and closing strokes of the anvil 1360. The anvil 1360 comprises a tissue clamp surface that extends orthogonally or at least substantially orthogonally to the longitudinal axis 1369 and moves longitudinally with respect to the distal head 1320. The anvil 1360 includes a movable jaw, and the feet 1380a and 1380b of the tissue drive system include another movable jaw located opposite the anvil 1360.

Referring again to FIG. 3, there is a longitudinal gap between the drive gear 1331 of the tissue drive system and the drive collar 1361 of the anvil drive system. As a result, there may be pauses in operation when shifting between the tissue drive system and the anvil drive system. The shorter the gap, the shorter the pause, whereas the longer the gap, the longer the pause. Other embodiments are also envisioned in which there is little or no gap between the drive gear 1331 and the drive collar 1361, and as a result, operational pauses can be eliminated.

Referring to FIG. 1 again, the end effector 1300 includes a plurality of staple cartridges 1400 housed therein. The staple fastener 1000 comprises a cartridge drive system configured to push the staple cartridge 1400 into the end effector 1300. As a result, the cartridge drive system can be used to reload the end effector 1300 without the need to remove the staple fastener 1000 from the surgical site. However, when the supply of the staple cartridge 1400 in the end effector 1300 is exhausted, the staple fastener 1000 will not be equipped with a system for loading the cartridge during operation of the staple fastener 1000. It may have to be removed from the surgical site and reloaded. Such a system is described in more detail below. In any case, the end effector 1300 can be removed from the shaft assembly 1200, and then an unused end effector 1300 can be attached to the shaft assembly 1200 to reload the staple fastener 1000.

With reference to FIG. 1 again, each end effector 1300 is intended for as many uses as the number of staples or staple cartridges housed in the end effector 1300. The shaft assembly 1200 is intended for more applications than the end effector 1300. As a result, the used end effector 1300 can be replaced with another end effector 1300 without the need to replace the shaft assembly 1200. In at least one example, for example, each end effector 1300 is intended for 10 uses and the shaft assembly is intended for 100 uses. The handle 1100 is intended to be used more times than the shaft assembly 1200 and / or the end effector 1300. As a result, the used shaft assembly 1200 can be replaced without the need to replace the handle 1100. In at least one example, for example, the shaft assembly 1200 is intended for 100 uses and the handle 1100 is intended for 500 uses.

As mentioned above, the staple fastener 1000 was configured to reciprocate to open or unclamp the anvil, creating a relative motion between the end effector and the patient's tissue, and then clamping the anvil again. Equipped with a drive system. 42 and 43 show exemplary embodiments of another reciprocating drive system that may be used. The drive system 2800 includes a rotatable drive shaft 2830 and a drive gear 2831 fixedly mounted on the drive shaft 2830. The drive system 2800 further comprises a spur gear 2832 that operably meshes with the drive gear 2831 so that the rotation of the drive shaft 2830 is transmitted to the spur gear 2832. The drive system 2800 includes a bevel gear 2833 that is mounted on and rotates with the bevel gear 2832, a side bevel gear 2834 that operably meshes with the bevel gear 2833, and a spur gear 2835 that operably meshes with a gear mounted on one surface of the bevel gear 2834. Further prepare. The drive system 2800 is fixedly mounted on and rotates with the spur gear 2835, a pinion gear 2836, an output gear 2837 operably meshed with the pinion gear 2836, and fixedly mounted and rotated with the output gear 2837. A cam 2838 and the like are further provided. As a result of the above, the rotation of the drive shaft 2830 will rotate the cam 2838, which is converted into a reciprocating motion of the drive shaft 2830 as described below.

In addition to the above, the drive system 2800 includes a rotatable shifter 2840 that includes a cam arm 2848 and a shifter arm 2849, which shifter is rotatable about a pivot 2841. In use, the cam 2838 is configured to engage the cam arm 2848 of the shifter 2840 and rotate the shifter 2840 between a first position (FIG. 43) and a second position (FIG. 42). There is. As shown in FIG. 42, when the shifter 2840 is rotated to its second position, the cam arm 2848 engages the shoulder 2839 defined on the drive shaft 2830 and presses the drive shaft 2830 upward. .. The spring 2820 is located between the shoulder 2839 and the frame 2819 of the staple fastener, which is compressed when the drive shaft 2830 is moved to its second position, in which potential energy is transferred. accumulate. As shown in FIG. 43, as the cam 2838 continues to rotate, the cam 2838 is disengaged from the cam arm 2848 and the spring 2820 elastically returns the drive shaft 2830 to its first position. This reciprocating motion of the drive shaft 2830 between its first and second positions can be utilized to operate the reciprocating drive system within the end effector of the staple fastener.

FIG. 44 shows another exemplary embodiment of the reciprocating motion drive system. The drive system 2900 includes an electric motor 2930, a first drive system 2940 operably coupled to the electric motor 2930, and a second drive system 2950 operably coupled to the electric motor 2930. The electric motor 2930 includes a rotatable output shaft 2931 and a drive gear 2932 fixedly mounted on the output shaft 2931. The first drive system 2940 includes an input gear 2942 that operably meshes with the drive gear 2932. The input gear 2942 is fixedly mounted on the drive shaft 2943 so that the drive shaft 2943 rotates with the input gear 2942. The first drive system 2940 further comprises a barrel cam 2944 that is slidably mounted on the drive shaft 2943 and rotates with the drive shaft 2943. The barrel cam 2944 comprises an opening 2945 defined therein, which transmits rotation, for example, between the drive shaft 2943 and the barrel cam 2944, yet allowing relative translation between them. It has a non-circular profile configured to. The barrel cam 2944 further comprises a cam slot 2949 defined around it, the cam slot of which interacts with a cam pin 2919 mounted on the frame 2910 so that when the barrel cam 2944 is rotated, the barrel cam 2944 Further translated. The barrel cam 2944 is translated distally when the barrel cam 2944 is rotated in the first direction and proximally when the barrel cam 2944 is rotated in the second direction, that is, in the opposite direction. The first drive system 2940 further comprises a drive shaft 2946 extending from the barrel cam 2944, which drive shaft is configured to drive the first end effector function.

The second drive system 2950 includes an input gear 2952 that operably meshes with the drive gear 2932. The input gear 2952 is fixedly mounted on the drive shaft 2953 so that the drive shaft 2953 rotates with the input gear 2952. The second drive system 2950 further comprises a barrel cam 2954 that is slidably mounted on the drive shaft 2953 and rotates with the drive shaft 2953. The barrel cam 2954 comprises an opening 2955 defined therein, which transmits rotation, for example, between the drive shaft 2953 and the barrel cam 2954, yet allowing relative translation between them. It has a non-circular profile configured to. The barrel cam 2954 further comprises a cam slot 2959 defined around it, the cam slot of which interacts with a cam pin 2919 mounted on the frame 2910 so that when the barrel cam 2954 is rotated, the barrel cam 2944 Further translated. The barrel cam 2954 is translated distally when the barrel cam 2954 is rotated in the first direction and proximally when the barrel cam 2954 is rotated in the second direction, that is, in the opposite direction. The second drive system 2950 further comprises a drive shaft 2965 extending from the barrel cam 2954, which drive shaft is configured to drive the second end effector function.

When the electric motor 2930 of the drive system 2900 is rotated in the first direction, the first drive shaft 2946 is moved forward distally and the second drive shaft 2956 is moved backward proximally. Correspondingly, the first drive shaft 2946 is retracted proximally and the second drive shaft 2965 is moved distally when the electric motor 2930 is operated in the second direction, the opposite direction. .. Other embodiments are also envisioned in which the drive shafts 2946 and 2965 are simultaneously moved distally.

With reference to FIGS. 92 and 93, the staple fastening device 4500 comprises a tissue drive 4590 including a first foot 4580a and a second foot 4580b. The first foot 4580a comprises a rack of teeth 4583a defined on it, the second foot 4580b comprises a rack of teeth 4583b defined on it, and the tissue drive 4500 comprises racks 4583a and 4583b. Further comprises a pinion gear 4593 that meshes with and engages with. The pinion gear 4593 can rotate back and forth about an axis to extend and retract the feet 4580a and 4580b by reciprocating motion, resulting in driving a stapler against the patient's tissue. The tissue drive 4590 further comprises a first actuator 4592 pinned to the pinion gear 4595 in the pivot joint 4591 and a second actuator 4594 pinned to the pinion gear 4595 in the pivot joint 4595. In use, the first actuator 4592 is pushed and / or the first to rotate the pinion gear 4595 in the first direction, extend the second foot 4580b, and retract the first foot 4580a. Actuator 4594 of 2 is pulled. Correspondingly, the first actuator 4592 is pulled and / or in order to rotate the pinion gear 4595 in the second direction, extend the first foot 4580a, and retract the second foot 4580b. The second actuator 4594 is pushed. Notably, the feet 4580a and 4580b are displaced linearly and in opposite directions, respectively. Thus, the feet 4580a and 4580b are configured such that when one of the feet 4580a and 4580b is retracted to pull the tissue, the other foot slides or slides against the tissue when extended. ing.

As mentioned above, the feet 1380a and 1380b of the staple fastener 1000 extend and retract along a linear path. In such an example, the feet 1380a and 1380b can slide over the tissue when extended and then grip and pull the tissue when retracted. The feet 1380a and 1380b may include teeth extending from them, the teeth sliding against the tissue when the feet 1380a and 1380b are moved in one direction and when moving in the opposite direction. It has a contour that facilitates gripping the tissue. In at least one example, the teeth are, for example, substantially triangular, but have a shallow angle on the first side and a steeper angle on the other side. In such an example, a shallow angle allows the first side to slide against the tissue, whereas a steeper angle on the second side is when the feet 1380a and 1380b are retracted. Bites into the tissue or grips the tissue.

As mentioned above, the feet 1380a and 1380b are driven along a linear path by racks 1389a and 1389b defined on them. In some examples, the linear movements of the feet 1380a and 1380b can be precisely guided, and there is little, if any, idleness or deflection from the linear movements. With reference to FIGS. 88 and 89, in various embodiments, the foot of the tissue drive system may include one or more joints that provide at least one additional degree of freedom, whereby the foot is pure. It is possible to deviate from the linear path. The tissue drive system 4200 includes a first foot 4280a and a second foot 4280b movably connected by a link 4282. The link 4282 is connected to the first foot 4280a at the pivot joint 4281a and to the second foot 4280b at the pivot joint 4281b. The feet 4280a and 4280b are moved proximally and distally by an input 4290 that includes a drive shaft 4292 connected to the link 428 at the pivot joint 4283. Pivot joints 4281a, 4281b, and 4283 allow the feet 4280a and 4280b to be lifted or lifted upward as they extend throughout the tissue.

As mentioned above, the staple fastening device disclosed herein, equipped with a tissue drive system, staples and cuts the patient tissue along the stapling path to staple itself throughout the patient's tissue. It is configured to drive or march. In various examples, tissue thickness can vary along the length of the staple firing path. In other words, the tissue can increase and / or decrease its thickness in the anterior-posterior and / or lateral direction. With reference to FIGS. 88 and 89 again, the degrees of freedom provided by the pivot joints 4281a, 4281b, and 4283 allow the feet 4280a and 4280b to tilt in response to such changes in tissue thickness. .. For example, the feet 4280a and 4280b may tilt in the anteroposterior and / or lateral direction. Further, the feet 4280a and 4280b can incline independently of each other. Therefore, the feet 4280a and 4280b can be tilted in the same or different directions. Therefore, an alternative embodiment in which the foot 4280a and the foot 4280b are inclined in the same direction is also envisioned. Such a configuration can have a simpler drive system. In any case, the feet 4280a and 4280b can self-up and down in response to changes in tissue thickness and can have the desired traction on the tissue.

With reference to FIG. 87, the staple fastening device 4100 comprises a distal staple fastening head 4120, which, like the staple fastening device 1000, comprises a tissue drive system 4190 including a foot 4180. The tissue drive system 4190 includes a rocker link 4192 rotatably mounted within the staple fastening head 4120 around a pivot pin 4124. The rocker link 4192 comprises leg 4193 and pivot pin 4124 extends through an opening 4194 defined within leg 4193. Each of the legs 4193 is pivotally connected to the foot 4180 around the pivot pin 4195. In use, the tissue drive system 4190 swings the rocker link 4192 back and forth to extend and retract the foot 4180 along a non-linear or curvilinear path. The foot 4180 is extended and retracted together, but an embodiment in which each is moved in the opposite direction is also envisioned. Further, in addition to the above, the foot 4180 can be tilted about the pivot pin 4195 to adapt to changes in tissue thickness. In various examples, the tissue drive system 4190 can lift the foot 4180 away from the tissue over at least a portion of the tissue drive stroke, for example at the end of the tissue drive stroke.

Here, referring to FIGS. 37-41, the surgical instrument 2700 comprises a distal head 2720, including an anvil 2760, a tissue drive foot 2780, and a tissue drive 2790. The tissue drive 2790 comprises a positioning rod 2791 attached to the drive foot 2780 in the pivot joint 2781. The positioning rod 2791 can be displaced along the longitudinal axis to engage (FIG. 38) and disengage (FIG. 41) the drive foot 2780 with respect to the patient tissue T. Referring to FIG. 37, when the drive foot 2780 is disengaged from the tissue and pulled into the distal head 2720, the distal tip 2785 of the drive foot 2780 is positioned within the distal head 2720 and distal. Does not extend from the tip. Further, when the drive foot 2780 is pulled into the distal head 2720, the drive foot 2780 is prevented from being locked or rotated in place. More specifically, the distal head 2720 comprises a control slot 2724 defined therein, and the foot 2780 comprises two control pins 2784 slidably disposed within the control slot 2724, among which. The control pins are provided to prevent the drive foot 2780 from rotating when the drive foot 2780 is in its retracted position (FIGS. 37 and 41) and when the drive foot 2780 is in the engaging position (FIGS. 38-40). The drive foot 2780 is configured to allow rotation, which will be discussed below.

Referring to FIGS. 38-40, the drive foot 2780 is configured to engage the patient tissue T and drive the distal head 2720 relative to the tissue in order to rearrange the distal head 2720 relative to the tissue. ing. The tissue drive 2790 comprises a first driver 2792 and a second driver 2793 configured to rotate the foot 2780 about a pivot joint 2781. The first driver 2792 comprises a push end located within a first socket 2782 defined on the drive foot 2780, and the second driver 2793 has a second defined on the opposite side of the drive foot 2780. It has a push end located within socket 2783. With reference to FIG. 40, the first driver 2792 is displaceable towards the tissue in order to rotate the drive foot 2780 in the first direction. With reference to FIG. 39, the second driver 2793 is displaceable towards the tissue in order to rotate the drive foot in the second direction, i.e. the opposite direction. In use, the drive foot 2780 can be rotated back and forth by the tissue drive device 2790 to create anterior or posterior relative movement between the distal head 2720 and the tissue.

With reference to FIGS. 78-85, the staple fastening device 3900 has a staple firing system 3950 configured to staple the patient's tissue and a staple firing system that clamps the patient tissue against the tissue compression surface 3925. Anvil 3960 configured to deform staples deployed by 3950 and Foot 3980 configured to generate relative movement between the distal head 3920 and tissue when the anvil 3960 is in the unclamped position. And, including, including a distal head 3920. The staple fastener 3900 further comprises a tissue drive 3990 configured to extend and retract the foot 3980. Primarily with reference to FIGS. 83 and 84, the tissue drive 3990 comprises a rotatable drive shaft 3992 and a worm gear 3939 fixedly mounted to the drive shaft 3992, so that the worm gear 3991 together with the drive shaft 3992 Rotate. The worm gear 3939 meshes and engages with a gear surface 3995 defined on one side of the drive wheel 3994. The drive wheel 3994 is rotatably mounted about a pin 3991 mounted on the distal head 3920. As a result of the above, the drive wheel 3994 rotates in response to the rotation of the drive shaft 3992.

In addition to the above, referring to FIGS. 79-82, the tissue drive 3990 further comprises a coupler bar 3996, which is a cam slot 3999 defined on the second side or surface of the drive wheel 3994 (FIGS. 83 and 83 and). It includes a first end that is slidably arranged within 85). In at least one example, the coupler bar 3996 comprises a pin that gets into the cam slot 3999. The coupler bar 3996 further comprises a second end pivotally mounted on the foot 3980 in the pivot joint 3998. When the drive wheel 3994 is rotated, the side wall of the cam slot 3999 pushes the first end of the coupler bar 3996 through the path or motion shown in FIG. This path is also shown in FIGS. 79A, 80A, 81A, and 82A, which follow the motion of the tissue drive 3990 and foot 3980 shown in FIGS. 79, 80, 81, and 82, respectively. FIG. 79 shows the foot 3980 in the retracted position, and FIG. 79A shows the dots P on the foot movement path FM representing the position of the foot 3980 along the foot movement path FM. FIG. 80 shows the foot 3980 extending, and FIG. 80A shows the dot P advanced along the foot movement path FM. FIG. 81 shows that the foot 3980 is in the fully extended position and the dot P is further advanced along the foot movement path FM. FIG. 82 shows the foot 3980 returning to the retracted position. At such point, the movement of the foot 3980 can be repeated, i.e. reciprocated.

In addition to the above, the coupler bar 3996 comprises a longitudinal slot 3997 defined therein, and the staple head 3920 collaborates to limit or suppress the movement of the coupler bar 3996 into the longitudinal slot 3997. It comprises an extending pin 3927. FIGS. 84 and 85 map three corresponding positions labeled 1, 2, and 3 along the cam slot 3999 and launch motion path FM. The position 1 corresponds to the point P in FIG. 79A, the position 2 corresponds to the point P in FIG. 80A, and the position 3 corresponds to the point P in FIG. 81A. In various examples, the tissue drive 3990 comprises a 4-bar linkage, in which the foot 3980 is lofted when extended. To facilitate this movement, each foot 3980 comprises a slot 3891 defined therein, the sidewalls of those slots sliding against a pin 3921 extending into the slot 3891. The pin 3921 / slot 3891 configuration allows the foot 3980 to translate and rotate during the tissue drive stroke cycle.

FIG. 86 shows an alternative embodiment of cam path 4099 with a shoulder that prevents backward movement of the coupler bar 3996 in slot 3999. For example, cam path 4099 comprises a first shoulder 4091 corresponding to position 1 and FIG. 79A, and once the coupler bar 3996 passes this point, the coupler bar 3996 cannot go back beyond position 1. Cam path 4099 comprises a second shoulder 4092 corresponding to position 2 and FIG. 80A, and once the coupler bar 3996 has passed this point, the coupler bar 3996 cannot go back beyond position 2. The cam path 4099 also comprises a third shoulder 4093 corresponding to position 3 and FIG. 81A, and once the coupler bar 3996 passes this point, the coupler bar 3996 cannot go back beyond position 3.

With reference to FIGS. 50-56, the staple fastening device 3100 comprises a distal head 3120, including an anvil 3160 and a tissue drive foot 3180. With reference to FIG. 50, the drive foot 3180 can be extended to engage the patient's tissue, and then with reference to FIG. 51, the distal head 3120 is moved relative to the patient's tissue. It is possible to retreat. Each drive foot 3180 comprises a rack or array of teeth 3193 configured to engage patient tissue, which rack or array is also movable between extension and retract positions. FIG. 51 shows the teeth 3193 extending from the drive foot 3180 when the drive foot 3180 is retracted from the extension position. More specifically, the teeth 3193 project from the tissue compression surface 3125 defined on the drive foot 3180 when the drive foot 3180 is retracted from their full extension position. On the other hand, referring to FIG. 50, when the drive foot 3180 is extended, the teeth 3193 do not protrude from the tissue compression surface 3125, whereby the drive foot 3180 is extended to the patient tissue while being extended. It is possible to slide against it.

With reference to FIGS. 52-56, the staple fastening device 3100 comprises a tissue drive device 3190 configured to extend and retract the drive foot 3180 and extend and retract the teeth 3193. The tissue drive 3190 comprises an input bar 3191 which extends into and is movable within a cavity 3181 defined within each drive foot 3180. The input bar 3191 is a circuit including an ascending / retracting position (FIGS. 52 and 56), a descending / retracting position (FIG. 53), a descending extension position (FIG. 54), and an ascending / extending position (FIG. 55). The drive foot 3180 is moved through a non-linear path. The input bar 3191 comprises a pin 3192 extending from it, the pin extending into a slot 3182 defined within the drive foot 3180. As discussed in more detail below, the interaction between the pin 3192 and the side wall of slot 3182 transmits the movement of the input bar 3191 to the drive foot 3180. Each of the slots 3182 extends along an axis that is transverse and non-parallel to the longitudinal axis of the distal head 3120, resulting in the desired movement of the drive foot 3180 and the teeth 3193.

As shown in FIG. 52, when the input bar 3191 is in the fully retracted position, the input bar 3191 positions the drive foot 3180 in its ascending / retracting position. In this position, the teeth 3193 project through a window 3183 defined within the drive foot 3180. Referring to FIG. 53, when the input bar 3191 is moved out of its fully retracted position, the pin 3192 interacts with the side wall of slot 3182 to cam drive the drive foot 3180 downward. At such time, the teeth 3193 do not protrude through the window 3183. As the input bar 3191 is moved further away from its fully retracted position, the input bar 3191 begins to extend the drive foot 3180, as shown in FIG. Notably, the teeth 3193 do not project through the window 3183 when the drive foot 3180 is extended. However, as shown in FIG. 55, when the input bar 3191 is retracted, the pin 3192 interacts with the side wall of slot 3182 to raise the drive foot 3180, which causes the teeth 3193 to protrude through the window 3183. Become. As a result, as shown in FIG. 56, the teeth 3193 either engage the patient tissue or grab the patient tissue and pull the tissue against the distal head 3120 until the drive foot 3180 is fully retracted. be able to. At such point, the tissue may be stapled and / or incised. The above process can be repeated to move the staple device 3100 along the entire staple launch path.

Referring to FIGS. 57-59D, the staple fastening device 3200 comprises a distal staple fastening head 3220 including a tissue driving foot 3270, which tissue driven foot is provided by a tissue driving system such as the tissue driving system of the staple fastening device 1000. , Extends outward along the same path and retracts inward. Therefore, the staple fastening head 3220 further comprises a lateral drive foot 3280 that moves with the drive foot 3270, but can also move laterally with respect to the drive foot 3270, as shown in FIGS. 57 and 58. As a result, the lateral drive foot 3280 is extended along one path, laterally extended, as shown in FIGS. 59A and 59B, and then different, as shown in FIGS. 59C and 59D. Can be retreated along the path. In addition, the drive feet 3270 and 3280 can pull the distal head 3220 with respect to the patient tissue in two different directions, which results in relative movement between the distal stapled head 3220 and the patient tissue. Greater control is provided.

Primarily with reference to FIGS. 57 and 58, the drive feet 3270 and 3280 are rotatably connected in pairs. Each pair was pivotally coupled to an actuator plate 3260, a first link 3272 pivotally connected to a drive foot 3270 centered on a pivot 3721, and a lateral drive foot 3280 centered on a pivot 3281. A second link 3282 is provided. Referring to FIG. 58, when a downward force is applied to the actuator plate 3260, the actuator plate 3260 presses a joint 3213 that rotatably connects the first link 3272 and the second link 3382, thereby sideways. The one foot 3280 is displaced outward. Further, the distal head 3220 constrains the lateral movement of the drive foot 3270, and as a result, the drive foot 3270 does not move laterally when the lateral drive foot 3280 extends laterally. However, with reference to FIGS. 60A-60D, an alternative embodiment is envisioned in which the drive foot 3270 can also move laterally. In either case, for example, an urging member such as a torsion spring located in the joint 3213 and / or connected to the joint 3213 laterally drives the drive foot after the pressing force is removed from the actuator plate 3260. Can be set back. Figures 59A-59D show a series of steps that can be repeated by the surgical instrument 3200 to move the staple fastening instrument 3200 along the staple firing path. Figures 60A-60D also show a series of steps that can be repeated by the surgical instrument 3200 to move the staple fastening instrument 3200 along the staple firing path.

With reference to FIGS. 61 and 62, the surgical instrument 3300 includes a distal head 3320 and a drive foot 3380 that can extend laterally. The drive foot 3380 is connected to the distal head 3320 via a flexible connector 3375 and an actuator 3370. When a compressive force is applied to the actuator 3370, the actuator 3370 is displaced and / or compressed, which causes the connector 3375 to extend laterally and the corresponding drive foot 3380 to be pressed laterally. When the compressive force is removed from the actuator 3370, the connector 3375 elastically contracts, pulling the drive foot 3380 inward. The drive foot 3380 may include a tissue gripping mechanism defined on it so that the tissue gripping mechanism presses and / or pulls the patient tissue as the drive foot 3380 is laterally moved. It is composed. As a result, the drive foot 3380 can generate relative movement between the distal head 3320 and the patient tissue.

With reference to FIGS. 91A-91D, the staple fastening device 4400 comprises a distal head 4420 including a tissue cutting drive 4440, a staple launch drive 4450, and a tissue drive including a foot 4480. Each foot 4480 is rotatably attached to the distal head 4420 about a pivot pin 4441 and is rotatable to drive the distal head 4420 with respect to the patient tissue. FIG. 91 shows the foot 4480 in the retracted position. FIG. 91B shows where the foot 4480 is extended. FIG. 91C shows the foot 4480 in the fully extended position. FIG. 91D shows the foot 4480 being retracted. When the foot 4480 is extended, the foot 4480 drives the distal head 4420 with respect to the patient tissue. Notably, the foot 4480 is synchronized so that they extend and retract together, and in such an example, the foot 4480 is in a straight line or at least a substantially straight line. Along the distal head 4420 can be driven. That said, one of the foot 4480 may be extended while the other foot 4480 is retracted. In such an example, the foot 4480 can rotate the distal head 4420 along a curved path.

With reference to FIGS. 76 and 77A-77D, the staple fastener 3800 comprises a distal head 3820, including a staple launch system 3850, an anvil 3860, and a tissue drive system. The tissue drive system comprises a first foot 3880a and a second foot 3880b, and the feet 3880a and 3880b are selectively extended and retracted to allow the staple fastener 3800 to be stapled along the staple launch path FP. It is configured to move. The tissue drive system is configured to move or march the staple fastener 3800 along a linear and / or curved staple firing path. With reference to FIGS. 77A and 77B, the tissue drive system simultaneously extends and retracts the first foot 3880a and the second foot 3880b by equal or at least approximately equal amounts to linearize the distal launch head 3220. It is configured to move along the launch path. With reference to FIGS. 77C and 77D, the tissue drive system is also configured to extend and retract only one of the feet 3880a and 3880b to swivel the distal launch head 3220. For example, referring to FIG. 77C, the tissue drive system extends the first foot 3880a without extending and retracting the second foot 3880b to swivel the distal head 3820 in the first direction. And can be set back. Similarly, referring to FIG. 77D, the tissue drive system extends the second foot 3880a without extending and retracting the first foot 3880a in order to swivel the distal head 3820 in the second direction. It can be moved out and back.

As mentioned above, the tissue drive system is configured to swivel the distal head 3820 of the staple fastener 3800 by operating one of the feet 3880a and 3880b but not the other. Alternatively, the tissue drive system may be configured to swivel the distal head 3820 by extending one of the feet 3880a and 3880b less than the other. The distal head 3820 can be gradually swiveled in such cases. The tissue drive system may also be configured to swivel the distal head 3820 by moving the feet 3880a and 3880b in opposite directions, respectively. In such an example, the distal head 3820 can follow a small or tight radius of curvature within the staple firing path FP.

With reference to FIGS. 63 and 64, the staple fastener 3400 comprises a distal head 3420, including a staple launch system 3450, an anvil 3460, and a tissue drive system. The tissue drive system comprises two drive wheels 3480 and a shaft 3488 rotatably supported by mount 3482, which extends through an opening defined in the center of the drive wheel 3480. .. The drive wheels 3480 are fixedly mounted on the pins 3481, so that the drive wheels 3480 rotate together. Each drive wheel 3480 comprises an array of teeth extending around it, at least one of the drive wheels 3480 meshing and engaging with the drive shaft of the electric motor. The teeth extending around the drive wheel 3480 are also suitably configured to engage and grip the patient tissue. In use, the electric motor is operated to swivel the drive wheel 3480 to create a relative motion between the distal head 3420 and the patient tissue, moving the distal head 3420 along the staple firing path. obtain.

Referring to FIG. 94, the staple fastener 4600 comprises a distal head 4620, including a staple launch system 4650, an anvil 4660, and a tissue drive system. The tissue drive system comprises two drive wheels 4680, each rotatably supported by separate pins extending through its center. As a result, the drive wheel 4680 can be rotated independently. Each drive wheel 4680 includes an array of teeth extending around it, which meshes and engages with the drive shaft of the electric motor. In other words, the tissue drive system comprises two electric motors configured to rotate the drive wheels 4680 separately. Similar to the above, the teeth extending around the drive wheel 4680 are also suitably configured to engage and grip the patient tissue. In use, the electric motor turns the drive wheel 4680 to create a relative motion between the distal head 4620 and the patient's tissue, stapling the distal head 4620, as described in more detail below. It can be operated to move along the launch path.

In addition to the above, the tissue drive system is configured to rotate the drive wheel 4680 at the same speed and in the same direction to move the distal head 4620 along a linear staple firing path. The tissue drive system is also configured to rotate the wheel 4680 in the same direction, but at different velocities, to swivel the distal head 4620 along a curved staple firing path. The distal head 4620 may turn gradually in such cases. The tissue drive system is also configured to swivel the distal head 4620 along a curved staple launch path without swiveling the other drive wheel 4680, which swivels only one of the wheels 4680. There is. In addition, the tissue drive system is further configured to rotate the drive wheels 4680 in opposite directions, turning the distal head 4620 along a curved staple firing path with a small or tight radius of curvature. There is.

The tissue drive system further comprises a lateral drive wheel 4670 positioned laterally relative to the drive wheel 4680. Similar to the above, each lateral drive wheel 4670 is operably connected to a different electric motor. As a result, the tissue drive system of the stapler 4600 comprises four electric motors that can operate simultaneously or at different times. The lateral drive wheel 4670 can operate independently of the drive wheel 4680, but may operate at the same time as one or both of the drive wheels 4680. Further, the lateral drive wheels 4670 can operate independently of each other. Similar to the drive wheel 4680, the tissue drive system swivels the lateral drive wheel 4670 together at the same speed, at different speeds, and / or in different directions to provide the distal head 4620 along the staple firing path. It is configured to move. In addition, the tissue drive system swivels any suitable combination of drive wheels 4670 and 4680 in any suitable direction and at any suitable speed to staple the staple fastener 4600 along the desired staple launch path. It is configured to move.

Referring to FIG. 36, the staple fastener 2600 comprises a distal head 2620, including a staple launch system 2650, an anvil 2660, and a tissue drive system. The tissue drive system comprises two drive wheels 2670 and two drive wheels 2680, which can be rotated independently at the same time or at different time points to move the distal head 2620 along the staple firing path. Each drive wheel 2670 is rotatable about axis 2671 and each drive wheel 2680 is rotatable about axis 2681, but axis 2671 is not parallel to axis 2681. In fact, the axes 2671 and 2681 are orthogonal, but may be oriented in any suitable direction. The tissue drive system comprises four electric motors configured to rotate the drive wheels 2670 and 2680 separately, whereas the tissue drive system is of any suitable number to drive the drive wheels 2670 and 2680. It may have an electric motor. In use, the electric motor swivels the drive wheels 2670 and 2680 to create a relative motion between the distal head 2620 and the patient's tissue, causing the distal head 2620 to move along the staple firing path. , Can be operated.

With reference to FIGS. 75A-75D, the staple fastener 3700 comprises a distal head 3720, including an anvil 3760 and a tissue drive system including a tissue drive foot 3780. The staple fastener 3700 is in many respects similar to the staple fastener 1000, most of which are not discussed herein for brevity. The anvil 3760 is movable relative to the foot 3780 between the closed or clamped positions (FIGS. 75A and 75D) and the open or unclamped positions (FIGS. 75B and 75C). Referring to FIG. 75B, while the anvil 3760 is open, the drive foot 3780 can be extended to engage and grip the tissue. Referring to FIG. 75C, the drive foot 3780 is then retracted to generate relative movement between the distal head 3720 and the patient tissue. With reference to FIG. 75D, the anvil 3760 is movable towards its closed position while the drive foot 3780 is retracted and / or after the drive foot 3780 is retracted. The drive foot 7580 may have any suitable means for gripping and / or gripping the teeth and / or tissue gripping the tissue. In various examples, the drive foot 7580 is configured to apply decompression to the tissue in order to grip and pull it. In at least one such example, the decompression system is turned off, for example, during the operating steps shown in FIGS. 75A and 75B and turned on during the operating steps shown in FIGS. 75C and 75D. In such an example, decompression can retain tissue within the distal head 7520 when the anvil 7560 is closed, but other decompression is turned off during the operating process shown in FIG. 75D. Embodiments are also envisioned.

With reference to FIGS. 65-69, the staple fastener 3500 comprises a distal head 3520 including an anvil 3560 and a tissue drive system, the tissue drive system having a decompression supply line 3570 and two decompression graspers 3580. And two glass staples 3590. The reduced pressure supply line 3570 includes a manifold 3571 configured to supply a reduced pressure difference to the two glasspa extenders 3590 and the two reduced pressure glasspers 3580. Each Graspa Extender 3590 comprises a bellows 3591 communicating with a manifold 3571, which contracts and expands when decompression is transmitted to its inner plenum. When the bellows 3591 contracts, it extends the Graspa 3580 to the position shown in FIG. Each bellows 3591 is in fluid communication with a cavity 3581 defined within the Graspa 3580, which allows the decompression difference to be transmitted to the Graspa hole 3582 defined in the tissue engaging surface 3585 of the Graspa 3580. Become. This decompression difference at Graspahole 3582 allows the patient tissue to be retained against the tissue engaging surface 3585.

As mentioned above, the extension of Graspa 3580 corresponds to the application of a decompression difference to the tissue. When the decompression supply line 3570 ceases to supply the decompression difference to the bellows 3591, the bellows 3591 elastically re-expands and contracts, thereby retracting the Graspa 3580 as shown in FIG. Similarly, the bellows 3591 can also re-expand and retract the Graspa 3580 when the decompression difference is reduced. In any case, the decompression difference in the Graspa Hall 3582 can decrease as the Graspa 3580 is retracted. In some cases, the residual decompression difference at Graspahole 3582 may be sufficient to draw patient tissue into the tissue chamber 3525 of the distal head 3520. In another example, the residual decompression difference at Graspahole 3582 may not be sufficient by itself to draw patient tissue into the tissue chamber 3525. With this in mind, the Graspa 3580 comprises flexible teeth 3586 extending from its tissue engaging surface 3585. Referring to FIG. 66, when the Graspa 3580 is extended, the flexible teeth 3586 slide on the patient tissue without being caught, or at least not significantly caught by the patient tissue. This relative movement is also facilitated by the transverse angle at which the teeth 3586 extend from the tissue engaging surface 3585. Referring to FIG. 68, when the Graspa 3580 is retracted, the teeth 3586 bite into the patient tissue and pull the patient tissue into the tissue chamber 3525. Again, this is facilitated by the angle of the teeth 3586 and can compensate for the loss of decompression difference in Graspahole 3582.

Once the patient tissue is positioned within the tissue chamber 3525, the tissue can be stapled and / or incised. The supply line 3570 does not supply the decompression difference during the stapling and / or cutting operation, because such a decompression difference can extend the Graspa 3580 and move the tissue. Thus, for example, if there is another way to hold the tissue in place, the decompression supply can be turned off during the stapling and / or cutting operation. In any case, the anvil 3560 can then be opened again, the distal head 3520 can be moved relative to the tissue, and a reduced pressure supply can be used to re-extend the tissue graspa 3580, thus the process described above. Can be repeated, as shown in FIG. 69.

Referring to FIGS. 70-73, the staple fastening device 3600 comprises a distal staple fastening head 3620 including a staple firing system 3650, an anvil 3660, a tissue cutting system 3640, and a tissue grasping system utilizing a decompression difference. There is. The staple fastener 3600 is in many respects similar to the staple fastener 3500, most of which are not discussed herein for brevity. Therefore, the tissue gripping system communicates with two separate and distinct decompression supply lines, i.e., a first bellows 3690a that communicates fluidly with the first tissue drive foot 3680a via the foot manifold 3685a. The supply line 3670a also includes a second supply line 3670b that communicates with a second bellows 3690b that communicates fluidly with the second tissue drive foot 3680b via a foot manifold 3685b. The foot manifold 3685a comprises an array of manifold openings 3686, which communicate with the foot opening 3682 defined in the first foot 3680a when decompression is supplied to the first supply line 3670a. In addition, the decompression difference is transmitted to the foot opening 3682. When the foot manifold 3685b comprises an array of manifold openings 3686, these manifold openings communicate with the foot opening 3682 defined in the second foot 3680b and decompression is supplied to the second supply line 3670b. In addition, the decompression difference is transmitted to the foot opening 3682. The staple fastener 3600 selectively decompresses the first supply line 3670a and the second supply line 3670b so that the first drive foot 3680a and the second drive foot 3680b can be selectively extended and retracted. It also has a control system configured to add to. In some examples, the feet 3680a and 3680b are synchronized and extended and retracted together at the same time, whereas in other examples the feet 3680a and 3680b are extended and retracted at different times.

An alternative embodiment of the staple fastener 3600'is shown in FIG. The staple fastener 3600'is similar to the staple fastener 3600 in many respects. That said, the device 3600'has a larger tissue drive foot 3680' with more decompression holes 3682 defined in it compared to the tissue drive foot 3680 of the staple fastening device 3600.

With reference to FIGS. 47A-47G, the staple fastener 3000 holds the staple launch system, the anvil closure system including the anvil 3060, the tissue drive device including at least one drive foot 3080, and the tissue releasably. It comprises a distal head 3020, including a tissue gripper 3070 configured as described above. With reference to FIG. 47A, the anvil 3060 is movable from the clamped position to the non-clamped position in order to unclamp the patient tissue T. Referring to FIG. 47B, the tissue gripper 3070 can engage the patient tissue T to hold the tissue in place while the drive foot 3080 is extended, which is shown in FIGS. 47C and 47D. It is shown. The tissue gripper 3070 may engage with tissue when the anvil 3060 is open and / or after the anvil 3060 is opened. In each case, referring to FIG. 47E, the tissue gripper 3070 is before the drive foot 3080 is retracted to pull the distal head 3020 against the tissue and position the distal head 3020 in a new position along the staple firing path. Is disengaged from the tissue (shown in FIG. 47F). With reference to FIG. 47G, at that point the patient tissue is clamped by the anvil 3060 and the staple launch system is actuated to staple the tissue. At that point, the above cycle can be repeated.

As shown in FIGS. 47D-47F, the drive foot 3080 communicates fluidly with the decompression source 3090. Similar to the above, the drive foot 3080 can utilize the decompression difference from the decompression source 3090 to grip the patient tissue. Further, similarly to the above, the decompression difference from the decompression source 3090 can be used to extend the drive foot 3080. That said, the drive foot 3080 may be extended using any suitable mechanism.

With reference to FIG. 78 again, the staple fastener 3900 further comprises a tissue gripper 3970. The tissue gripper 3970 can be used with the drive foot 3980 in the same or similar manner as the tissue gripper 3070 is used with the drive foot 3080.

45, 46, 48, and 49 show the operating sequence of staple fasteners that can be used with staple fasteners disclosed herein, such as, for example, staple fasteners 4000 and / or staple fasteners 3900 described above. ing. The staple fastener 4000 is, in many respects, similar to the other staple fasteners disclosed herein, most of which are not discussed herein for brevity. The staple fastener 4000 is a tissue drive system configured to move the anvil drive system 4060, the staple launch system 4050, the tissue cutting system 4040, the tissue grasping system 4090, and the staple fastener 4000 with respect to the patient tissue. It is equipped with 4080. FIG. 49 shows the operating steps of the staple fastener 4000 that occur in the presented order. For example, step 4003 follows step 4002, step 4002 follows step 4001, and so on. That said, adjacent operating steps may occur simultaneously, or at least with some overlap, as shown in FIG. 46 and described in more detail below. Should be understood. Further, the operating steps of FIG. 49 can be reconstructed in any suitable order.

With reference to FIG. 49 again, the operating step 4001 includes loading the staple cartridge into the staple fastener 4000 and / or pushing the staple cartridge into place within the staple fastener 4000. The operating step 4002 comprises removing the staples from the staple cartridge, and the operating step 4003 comprises arranging the staples in place within the staple firing drive 4050. The operation step 4004 includes jointly moving the end effector of the staple fastener 4000 as needed. Therefore, operation step 4004 can also occur before and / or during steps 4001, 4002, and / or 4003. The moving step 4005 includes positioning the end effector on the patient tissue, and the moving step 4006 involves operating the anvil drive system 4060 to clamp the anvil on the tissue. The operating step 4005 may also be performed before the operating step 4004.

In addition to the above, operation step 4007 includes forming staples against the anvil, and operation step 4008 includes deploying a knife for tissue cutting system 4040. The operation step 4007 occurs before the operation step 4008, but the steps 4007 and 4008 may occur at the same time or may occur with some overlap. The operating step 4009 includes retracting the knife using the tissue cutting system 4040, which is a continuation of the operating step 4008. The operating step 4010 involves using the tissue gripping system 4090 to grip and hold the patient tissue located within the end effector of the staple fastener 4000. The operating step 4011 involves using the anvil drive system 4060 to unclamp the anvil. In such an example, the staple fastener 4000 is capable of retaining tissue even when the anvil is open as a result of the tissue gripping system. The operating step 4012 involves advancing the foot of the tissue drive system 4080. The operation step 4013 includes activating the tissue gripping system 4090 to release the tissue, and the motion step 4014 retracts the foot of the tissue drive system 4080 and advances the staple fastener 4000 with respect to the tissue. Including.

In addition to the above, FIG. 46 shows that certain operating steps can occur simultaneously or with some overlap. For example, step 4011 to open the anvil and step 4001 to load the staple cartridges in place can occur simultaneously or with at least some overlap. Similarly, steps 4002 and / or 4003, including advancing the staples to a fixed position within the staple launch drive 4050, grip the tissue using, for example, step 4011 opening the anvil, tissue gripping system 4090. Step 4010, step 4012 to extend the foot of the tissue drive system 4080, step 4013 to release the tissue using the gripping system 4090, and / or step 4014 to retract the foot of the tissue drive system 4080 at the same time or somewhat. It can occur with duplication. Further, the step 4001 of reloading another staple cartridge into place in the staple fastener 4000 coincides with or with some overlap with step 4008 of cutting tissue and / or step of retracting the tissue cutting knife 4009. Can occur with it.

In addition to the above, FIG. 45 shows the operating cycles of the anvil drive system 4060 and the tissue drive system 4080 of the staple fastener 4000. The working cycle of FIG. 45 is plotted against time t, where the limit on the horizontal time axis of 0 or zero represents the start of the cycle sequence of staple fastener 4000. With reference to the operating cycle of the anvil drive system 4060, peak 4006 correlates with step 4006 described above, which involves closing, i.e., clamping the anvil onto the tissue. Similarly, the rest 4011 correlates with step 4011 described above, which involves opening the tissue, i.e. unclamping. Referring here to the working cycle of tissue drive system 4080, peak 4012 correlates with step 4012, which involves extending the foot of tissue drive system 4080, peak 4014 retracts the foot of tissue drive system 4080. Correlate with step 4014, which involves driving the stapler 4000 against patient tissue. Comparing the operating cycles of the anvil drive system 4060 and the tissue drive system 4080, it can be recognized that the anvil is open or is being opened when the foot is extended. In addition, it may be recognized that the anvil is open when the foot is retracted and that the anvil is closed at the beginning of the next cycle of staple fastener 4000.

As mentioned above, it may be desirable to perform certain operating steps of the staple device 4000 sequentially and other operating steps simultaneously. However, in some cases, it may not be desirable to perform a particular operating step at that time. As such, the staple fastener 4000 is configured to lock out certain drive systems and prevent them from operating while the other drive systems of the staple fastener 4000 are in operation. Lockouts can include, for example, mechanical lockouts and / or electrical lockouts. All of the staple fastener 4000 drive systems are electric and communicate with the staple fastener 4000 controller, so the drive system can be locked out using the controller. The controller includes, for example, a microprocessor configured to electronically lock out one or more drive systems during the operation of one or more other drive systems. FIG. 48 is a chart showing which operating steps are prevented from being executed during the execution of other operating steps. For example, in the step 4001 in which the staple cartridge is loaded in place, the step 4004 of jointly moving the end effector of the staple fastener 4000, the step 4005 of positioning the staple fastener 4000 with respect to the tissue, and the step of unclamping the anvil. All operating steps other than 4011 are locked out or prevented from occurring. In this example, the staple launch system 4050, the tissue drive system 4080, and the tissue gripping system 4090 are locked out. This is just one example. If doing so is determined to be non-harmful or unacceptably non-harmful to the operation of the staple fastener 4000, other steps may be unlocked during step 4001.

Referring to FIGS. 90A-90D, the staple fastener 4300 comprises a distal head 4320 including a staple launch system 4350, an anvil drive system including an anvil 4360, and a tissue cutting system 4340. The staple fastener 4300 is in many respects similar to the staple fastener 1000 and the staple fastener 4400, most of which are not discussed herein for brevity. The staple fastening device 4300 further includes upper feet 4370a and 4370b, and lower feet 4380a and 4380b. Similar to the foot 4480 of the stapler 4400, the feet 4370a, 4370b, 4380a, and 4380b are in the extension position (FIG. 90A) and the retracted position (FIG. 90A) to move the distal head 4320 relative to the patient tissue T. It is rotatable between 90B and 90D). With reference to FIG. 90A, the feet 4370a and 4380a include a first synchronized pair of feet that move together to grip the patient tissue as they are moved to their extension positions. In such cases, the feet 4370a and 4380a are moved towards each other to exert compressive or pressure on the tissue. Referring to FIG. 90B, when the feet 4370a and 4380a are retracted, the feet 4370a and 4380a pull the tissue to move the distal head 4320 relative to the tissue. With reference to FIG. 90C, when the feet 4370a and 4380a are retracted, the staple firing system 4350 and the tissue cutting system 4340 staple and cut the patient tissue. The staple firing system 4350 and the tissue cutting system 4340 are operated simultaneously, but the staple firing system 4350 may be operated before the tissue cutting system 4340. Therefore, cutting the tissue before stapling can result in unwanted bleeding. However, notably, the foot 4370a and foot 4380a apply clamping pressure to the tissue while the stapling device 4300 staples and cuts the tissue. Referring to FIG. 90D, when the tissue is stapled and incised, the feet 4370a and 4380a move away from the tissue to unclamp the tissue.

As mentioned above, the feet 4370a and 4380a are operably connected together so that they move together as a pair. They rotate together as a pair, they clamp together as a pair, and they unclamp together as a pair. Although various alternative embodiments are envisioned in which only one of the feet 4370a and 4380a moves to clamp and unclamp the tissue, the feet 4370a and 4380a still rotate together in pairs. The synchronized second pair of feet, including the feet 4370b and 4380b, moves in the same manner as the synchronized first pair of feet, including the feet 4370a and 4380a, so the description of their movement is brief. Not repeated to do. Therefore, the movement of the first pair of feet is synchronized with the movement of the second pair of feet. More specifically, the second pair of feet is extended at the same time as the first pair of feet is extended, and the second pair of feet is clamped by the first pair of feet. At the same time, they are clamped to grip the tissue, the second pair of feet are retracted at the same time as the first pair of feet are retracted, and the second pair of feet are clamped by the first pair of feet. The clamp is released at the same time as it is released. In certain examples, the movements of the first pair of feet and the second pair of feet are either unsynchronized or not perfectly synchronized. In at least one such example, the first pair of feet extends and retracts independently of the second pair of feet, causing the distal head 4320 to swivel along a curvilinear staple path. ..

As mentioned above, the staple fastening devices disclosed herein are configured to staple the patient's tissue. They are also configured to cut tissue. Referring to FIGS. 95 and 96, the staple fastener 5000 is distal, including a staple launch system, a tissue cutting system 5040, and an anvil 5060 configured to deform staples deployed by the staple launch system. It is equipped with a head 5020. The tissue cutting system 5040 comprises a knife bar 5042, which includes a knife edge 5045 defined at its distal end 5044. In use, the knife bar 5042 is laterally translatable through the distal head 5020 during the tissue cutting stroke. The tissue cutting stroke of the knife bar 5042 extends between the first non-working position and the second working position shown in FIG. 95. During the tissue cutting stroke, the knife edge 5045 extends between the tissue compression surface 5025 and the tissue compression surface 5065 defined on the anvil 5060. The knife edge 5045 may also extend into the distal head 5020 and / or the anvil 5060 during the tissue cutting stroke to ensure that the entire thickness of the tissue is transected.

In addition to the above, the distal head 5020 defines the longitudinal head axis HA. During the tissue cutting stroke, the knife bar 5042 moves orthogonally to the longitudinal head axis HA. The tissue cutting system 5400 further comprises a cutting actuator 5046 configured to engage the knife bar 5042 and laterally displace the knife bar 5042. The cutting actuator 5046 comprises a distal end 5047 that includes a skewed cam surface so that the skewed cam surface engages a corresponding cam surface 5043 defined on the distal end 5044 of the knife bar 5042. It is configured. The cutting actuator 5046 may also be configured to press the knife bar 5042 in any suitable manner. In other embodiments, the knife bar 5042 can be moved without the cutting actuator 5046.

Referring to FIG. 98, the staple fastener 5100 includes a distal head 5120 including a staple molded anvil 5160. The staple fastener 5100 further comprises a staple supply system 5190, a staple alignment system 5180, and a staple launch system 5150. The staple firing system 5150 includes a staple drive 5151 that is longitudinally movable to eject a set or cluster of staples 5130 from the distal head 5120 during the staple firing stroke. With reference to FIGS. 99 and 100, each staple 5130 includes a base 5131 and staple legs 5132 extending from the base 5131. Referring to FIGS. 100 and 101, the staple drive 5151 bases the staple 5130 to press the staple leg 5132 against a molded pocket 5162 (FIG. 97) defined within the anvil 5160 during the staple firing stroke. It is configured to press 5131. With reference to FIG. 102, at such a point, the staple drive unit 5151 returns to the starting point, i.e., unlaunching point of the staple firing stroke so that another staple firing stroke can be performed.

As mentioned above, the staple fastener 5100 is configured to deploy staples during each staple firing stroke. Referring to FIG. 103, the staple fastener 5100 further comprises a tissue cutting knife 5140 configured to cut tissue during and / or after each staple firing stroke. The staple launch system 5150 is located on the first side of the cutting path CP generated by the knife 5140, the first group or cluster of the three staples 5130, and on the second side of the cutting path CP. It is configured to deploy a second group or cluster of three staples 5130. The staple launch system 5150 simultaneously deploys a first staple group and a second staple group, but an embodiment in which the first group is deployed before the second staple group is also envisioned. Alternative embodiments are also envisioned in which the stapler does not include a tissue cutting system or the stapler tissue cutting system can be deactivated. The staple feeding system 5190 and the staple alignment system 5180 are to reposition another set of staples 5130 in the distal head 5120 after each staple firing stroke is performed so that different staple firing strokes can be performed. Collaborate with. In various examples, the staples 5130 are reloaded during and / or after the tissue cutting stroke.

Primarily with reference to FIGS. 97, 100 and 102, the staple supply system 5190 includes a staple pusher 5191. Each staple pusher 5191 is configured to push the staple 5130 into a staple cavity 5121 defined within the distal head 5120. In addition to the above, the distal head 5120 comprises six staple cavities 5121, each configured to receive staples 5130 from the staple supply system 5190. The staples 5130 are arranged as six stacks or rows aligned with the staple cavities 5121. The staple pusher 5191 presses the base 5131 of the most recent staple 5130 in each staple stack to push the most distal staple 5130 of each staple stack into the staple cavity 5121 during a push stroke. The staple pusher 5191 loads the staple 5130 into the staple cavity 5121 at the same time, i.e. during a common push stroke, but in an alternative embodiment, the staple pusher 5191 loads the staple 5130 into the staple cavity 5121. It may be configured to be loaded sequentially. With reference to FIGS. 98 and 99, the staples 5130 in the staple stack are releasably attached to each other, for example, by at least one adhesive 5135. As shown in FIG. 100, the staples 5130 of each staple stack are adhered to each other at an angle traversing the firing axis FA of the staple firing system drive 5151. The distal head 5120 comprises a cam surface 5122 that aligns and aligns the staples 5130 with the firing axis FA of the staple firing system drive 5151 before the staple firing stroke of the staple firing system 5150 is performed.

The staple drive 5151 and the staple pusher 5191 move parallel to each other, or at least substantially parallel to each other. Referring to FIGS. 97 and 103, due to the design of the staple drive 5151 and the staple pusher 5191 and / or other spatial constraints, the staple fastener 5100 works with the staple pusher 5191 to staple the staple 5130 to the staple drive 5151. It further includes a staple alignment system with a staple pusher 5180 configured to align with. The staple pusher 5191 pushes the staple 5130 in the longitudinal direction, and the staple pusher 5180 pushes the staple 5130 laterally.

Referring to FIGS. 104-105D, the staple fastener 5200 is an anvil including a staple launch system 5250 configured to deploy staples 5230, a tissue cutting system and a molded pocket configured to deform the staples 5230. It comprises a distal head 5220, including 5260. The staple firing system 5250 includes a rotatable actuator 5252 configured to displace the lateral staple drive 5254 along a linear or at least substantially linear lateral path. Each rotatable actuator 5252 engages with a shoulder 5255 defined on the staple drive 5254, as shown in FIG. 105B, to displace the cam 5254 laterally. I have. The staple firing system 5250 further comprises one or more springs 5224 located between the lateral staple drive 5254 and the frame 5222 of the distal head 5220. As shown in FIG. 105C, the spring 5224 is laterally driven by the actuator 5252, which allows the staple drive 5254 to rotate during continuous rotation of the actuator 5252 until the cam 5253 disengages from the shoulder 5255 of the drive 5254. It is compressed when slid in the direction. With reference to FIG. 105D, at such a point, the spring 5224 elastically returns the lateral staple drive 5254 back to their non-actuated position.

Referring to FIGS. 104 and 105A, the staple launch drive 5250 further comprises a longitudinal staple drive 5257 driven along a longitudinal staple launch path by a lateral staple drive 5254. Each lateral staple drive 5254 comprises a drive cavity 5256 defined therein, in which the drive cavity receives a portion of the longitudinal staple drive 5257. More specifically, each longitudinal staple drive unit 5257 includes a cam portion located within the drive cavity 5256, which cam portion has a lateral staple drive portion 5254 as shown in FIG. 105B. When moved laterally, it is driven longitudinally by a cam surface 5258 defined within the drive cavity 5256. As a result of the above, the rotational movement of the rotatable actuator 5252 is converted into the lateral translation of the lateral staple drive unit 5254, and this lateral translation is converted into the longitudinal translation of the longitudinal staple drive unit 5257. The longitudinal movement of the staple drive unit 5257 drives the staple 5230 with respect to the anvil 5260 to deform the staple 5230, as shown in FIG. 105B. The longitudinal staple drive 5257 includes a staple cradle 5251 defined therein, the staple cradle being configured to support the staple 5230 when the staple 5230 is deformed.

Referring to FIG. 105C, in addition to the above, the return lateral motion of the staple drive 5254 pulls the longitudinal staple drive 5257 back into their non-actuated position. More specifically, the drive cavity 5256 reverses the longitudinal staple drive 5257 until the staple drive 5257 is reset to their non-actuated position, i.e. the unlaunched position, as shown in FIG. 105D. It further comprises a cam surface 5258'configured to drive. Notably, the anvil 5260 is moved to the open position when the longitudinal staple drive 5257 is retracted. At such time, as shown in FIG. 105A, the distal head 5220 can be moved relative to the tissue, the staples 5230 can be reloaded into the distal head 5220, and the anvil 5260 can be loaded onto the tissue. It can be re-clamped, where another staple firing stroke of the staple firing drive 5250 can be performed.

As mentioned above, a row of connected staples can be used to supply and resupply the staple launch system of staple fasteners. In other embodiments, the entire staple cartridge can be used to feed and resupply the staple firing system. Referring to FIG. 106, the staple fastening device 5300 includes a shaft 5310, a distal head 5320, and an articulation joint 5370 that rotatably connects the distal head 5320 to the shaft 5310. The staple fastener 5300 further comprises a plurality of staple cartridges 5330'' housed in the shaft 5310 and a cartridge pusher system configured to push the staple cartridge 5330'' into the distal head 5320. There is. When the staple cartridge 5330'' is positioned within the distal head 5320, the staple 5330 (FIG. 107) contained within the staple cartridge 5330'' is separated by a staple firing system, as described in more detail below. Can be deployed. In various examples, the staple cartridge comprises a cartridge body that is split and deployed with the staples, but in other examples the staples are ejected from the cartridge body and the cartridge body is not embedded.

Referring to FIG. 107, in addition to the above, the staple cartridge 5330 ″ includes a cartridge body 5333 including an internally defined opening. The opening has a first side 5334 configured to receive and store a first group of staples 5330 and a second side 5335 configured to receive and store a second group of staples 5330. And, including. A first group of staples 5330 is deployed on the first side of the tissue incision path formed by the tissue cutting knife, and a second group of staples 5330 is deployed on the second side of the tissue incision path. The staples 5330 are further arranged within a cluster of three staples, 5330', which are deployed together, but the staple clusters may contain any suitable number of staples. Five staple clusters 5330'are stored on the first side 5334 of the cartridge body 5333 and five staple clusters 5330' are stored on the second side 5335 of the cartridge body 5333, but any suitable number. Clusters can be used. The staple cluster 5330'is ejected from each side 5334 and 5335 of the cartridge body 5333 and deformed relative to the anvil 5360 during each staple firing stroke of the staple fastening system. In various alternative embodiments, the staple cluster 5330'can be deployed continuously from the first side 5334 and the second side 5335.

In addition to the above, the staples 5330 of each staple cluster 5330'are attached to each other by at least one adhesive, but the staple clusters 5330' themselves are not attached to each other and instead line up in the cartridge body 5333. It is stored in. In at least one alternative embodiment, the staples of adjacent staple clusters are releasably attached to each other. Referring here to FIG. 108, for example, the cartridge body 5333 may be configured to releasably house a plurality of staple clusters 5430', each staple cluster 5430' having three staples. The three staples 5430 of each staple cluster 5430'are attached to each other by at least one adhesive 5435, and the staple clusters 5430'are attached to each other by at least one adhesive 5435. In such an embodiment, the staple clusters 5430'are attached to each other to form a staple strip 5430'', with one or more staple clusters 5430'pulled apart from the other staple clusters 5430' and the distal head 5320. Load the staples into. Although the staple cluster of the above embodiment comprises three staples, the staple cluster may include any suitable number of staples, for example two staples, or more than three staples.

With reference to FIGS. 109 and 110, the staple device 5400 is distal to the patient's tissue with a shaft 5410, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system. It is equipped with a system configured to move the head. The staple fastener 5400 further comprises a staple strip 5430 ″ of FIG. 108 housed within a shaft 5410. The staple strip 5430 ″ may be stored in the cartridge body 5333 as described above, or may be stored in the shaft 5410 without using the cartridge body. The staple strip 5430 ″ may comprise any suitable number of staples and / or staple clusters. In at least one example, the staple strip 5430 ″ contains, for example, 588 staples.

With reference to FIGS. 111 and 112, the staple device 5500 is a shaft 5510, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closure system, and distal to the patient's tissue. It is equipped with a system configured to move the head. The staple fastener 5500 further includes a first staple strip 5530a ″ and a second staple strip 5530b ″ housed in the shaft 5510. The staple strips 5530a ″ and 5530b ″ are composed of staples 5430 arranged within the staple cluster 5430 ′. The staple strips 5530a ″ and 5530b ″ are nested so that the bases of the staples 5430 face in opposite directions.

With reference to FIGS. 113 and 114, the staple device 5600 is distal to the shaft 5610, the distal head, the staple loading system, the staple firing system, the tissue cutting system, the anvil closure system, and the patient's tissue. It is equipped with a system configured to move the head. The staple fastener 5600 further includes a first staple strip 5630a ″ and a second staple strip 5630b ″ housed in the shaft 5610. The staple strips 5630a ″ and 5630b ″ are composed of staples 5430 arranged within the staple cluster 5430 ′. The staple strips 5630a ″ and 5630b ″ are arranged side by side so that the bases of the staples 5430 face in the same direction.

With reference to FIG. 106 again, the staple fastener 5300 comprises a system for pushing the staple cartridge 5330 ″ into the distal head 5320 from the shaft 5310. Notably, this cartridge pushing system pushes the staple cartridge 5330 ″ into the distal head 5320 through the articulation joint 5370. As a result, the size of the staple cartridge 5330 ″ and / or staple 5330 can be limited by the spatial constraints of the articulation joint 5370, especially when the distal head 5320 is articulated. FIGS. 115-118 disclose a staple fastening device 5700 with a flexible staple strip that can supply staples into the distal head through a joint motor joint. The staple fastener 5700 includes a first staple strip 5730'with staples 5730 attached to the first carrier 5760'. More specifically, the staples 5730 are attached to the first carrier 5760'on the tab 5716'. Each staple 5730 comprises a base 5731 and legs 5732 extending from the base, the base 5731 being connected to the first staple strip 5730'by a tab 5716'. The staple fastener 5700 further includes a second staple strip 5730 ″ with staples 5730 attached to the second carrier 5760 ″ on the tab 576 ″. Carriers 5760'and 5760', respectively, have openings 5762 used to feed staple strips 5730'and 5730' into the distal head of the staple fastener 5700, as described in more detail below. It has an array of.

The staple strip 5730'is housed in the shaft of the staple fastener 5700. In its retracted state, the staple strip 5730'is planar, or at least substantially planar. More specifically, with reference to FIGS. 115 and 116, the staple 5730 is attached to the first carrier 5760'so that it is in the same plane as the first carrier 5760'. The staple fastener 5700 further comprises a staple supply system including a drive wheel configured to push the staple strip 5730'into the distal head of the staple fastener 5700. The drive wheel comprises an array of drive pins that extend around it, the drive pins engaging the opening 5762 of the first carrier 5760'and the first carrier 5760' into the distal head. It is configured to drive. The second staple strip 5730 ″ is also housed within the shaft of the staple fastener 5700. In its retracted state, the staple strip 5730 ″ is planar, or at least substantially planar. More specifically, referring to FIGS. 115 and 116, the staple 5730 is attached to the second carrier 5760 ″ so that it is in the same plane as the second carrier 5760 ″. Similar to the above, the drive wheel of the staple supply system engages the opening 5762 of the second carrier 5760'' and drives the second carrier 5760'' into the distal head of the staple fastener 5700. It is configured to do.

With reference to FIGS. 115 and 118, the staple strips 5730'and 5730'' may be driven on opposite sides with the carriers 5760'and 5760'' of the staple strips 5730' and 5730'' engaged by the staple feeding system. As you can see, they are stored in a facing configuration. Referring to FIG. 116, when the staple strips 5730'and 5730'' are fed into the distal head, the staples 5730 have tabs 5716'and 5716'' of staple strips 5730'and 5730'', respectively. Can be bent downwards around. In at least one example, the distal head frame comprises a cam surface configured to bend the staples 5730 downwards. In a particular example, the staple instrument 5700 comprises, for example, one or more actuators configured to bend the staple 5730 downwards around a mandrel located under tabs 5761'and 5761'. When displaced to the lower position, the staples 5730 are removed from the staple strips 5730'and 5730'. In at least one example, the frame of the distal head is such that the staples 5730 are separated from the tabs 5761'and 5716'' as the staple strips 5730'and 5730'' are advanced into the distal head. It comprises one or more configured staples or knife edges. In a particular example, the staple fastener 5700 further comprises one or more shears that are actuated to separate the staples 5730 from the staple strips 5730'and 5730'. In each case, the separated staples are then positioned to be deployed by the staple launch system of the staple fastener 5700.

In addition to the above, the staple appliance 5700 is configured to separate the staple clusters from the staple strips 5730'and 5730'' and then advance the carriers 5760'and 5760' of the staple strips 5730'and 5730'. This allows another cluster of staples to be separated from the staple strips 5730'and 5730''. Referring to FIG. 118, when the staples 5730 are separated from the carriers 5760'and 5760'', the empty or stripped portion of the carriers 5760'and 5760' is again reintroduced into the shaft of the staple fastener 5700. Be supplied. As a result, the action of feeding the new staples 5730 into the staple launch system will also feed the empty carriers 5760'and 5760'' into the shaft again.

Referring to FIG. 119, the staple cluster 5830'includes four staples 5830 that are glued together by at least one adhesive 5835. Each staple 5830 includes a base 5831 and two staple legs 5832 extending from the base 5831. Notably, the leg 5832 is not coplanar with the base 5831. Rather, the base 5831 resides in the base plane and the leg 5832 resides in the leg plane. Embodiments are also envisioned in which the base plane is parallel to, or at least substantially parallel to, the leg plane, but the base plane and the leg plane are not parallel. In each case, two of the staples 5830 of the staple cluster 5830'face inward and two of the staples 5830 face outward. The staple 5830 faces outward when its base plane is closer to the center of the staple cluster 5830'than its leg plane. Correspondingly, the staple 5830 faces inward when its leg plane is closer to the center of the staple cluster 5830'than its base plane.

In addition to the above, the staple cluster 5830'includes two staples 5830 located on the first side of the centerline CL and two staples 5830 located on the second side of the centerline CL. The staples 5830 on the first side of the staple cluster 5830'are connected by a first adhesive connector 5835, and the staples 5830 on the second side of the staple cluster 5830' are connected by a second adhesive connector 5835. There is. Further, the staple 5830 on the first side of the staple cluster 5830'is connected to the staple 5830 on the second side of the staple cluster 5830' by an adhesive connector 5835. As such, the staple cluster can include any suitable number of adhesive connectors. The adhesive connector 5835 holds the staples 5830 together so that they can be released. An alternative embodiment is also envisioned in which the adhesive connector 5835 is broken before the staples 5830 are implanted in the patient tissue, but the adhesive connector 5835 is not broken before the staples 5830 are implanted in the patient tissue. The adhesive connector 5835 is composed of a biocompatible and / or bioabsorbable material, such as a bioabsorbable polymer.

Referring to FIG. 120, the staple fastening device 5900 includes a shaft, a distal head 5920, a staple feeding system, a staple firing system, a tissue cutting system, an anvil closure system, and a distal head to the patient's tissue. It comprises a drive system configured to move the 5290. The distal head 5920 comprises a first staple cavity 5921 and a second staple cavity 5921. Each staple cavity 5921 is configured to house a row of staple clusters 5930'or staple clusters 5930'in it. Each staple cluster 5930'contains four staples 5930, but may include any suitable number of staples. Each staple 5930 comprises a base 5931 and two staple legs 5932 extending from the base. The base 5931 and legs 5932 are coplanar, or at least substantially coplanar. The staples 5930 are releasably connected to each other by at least one adhesive.

In addition to the above, each staple cluster 5930'includes one or more guides 5935. The guide 5935 is defined on the lateral side of the cluster 5930'and is configured to be received within a notch 5925 defined within the staple cavity 5921. More specifically, the guide 5935 is tightly received by the side wall of the notch 5925 such that there is little, if any, relative lateral movement between the cluster 5930'and the distal head 5920. .. For this purpose, the staple cluster 5930'is still aligned with the anvil molding pocket when the staple 5930 is deployed. The guide 5935 is composed of, for example, a biocompatible and / or bioabsorbable material such as a bioabsorbable polymer and can be implanted with the staple 5930.

Referring to FIG. 121, the staple fastener 6000 includes, among other things, a shaft, a distal head 6020 including an anvil 6060, and a staple firing system. In this embodiment, the staple firing system loads the staples 6030 into the distal head 6020 and launches them by pressing them against the anvil 6060. The distal head 6020 comprises a staple cavity 6021 defined therein, the staple cavity being configured to retract and guide the staple when the staple 6030 is pressed towards the anvil 6060.

With reference to FIGS. 122-125, the staple fastener 6100 includes a shaft, a distal head 6120, a staple loading system, a staple launch system, an anvil drive system, a tissue gripping system, and distal to patient tissue. It comprises a tissue drive system configured to move the head 6120. The drive system of the staple fastener 6100 comprises a rotatable foot 6180, which is configured to grip the patient's tissue and pull the distal head 6120 against the tissue, as described above. ing. Also similar to the above, the tissue gripping system is configured to hold the tissue when the foot 6180 is extended and / or during any suitable time during operation of the surgical instrument 6100. There is. Primarily with reference to FIG. 125, the tissue gripping system comprises a tissue holder 6170 configured to engage the patient's tissue. The tissue holder 6170 includes a rectangular body 6172 and a stem 6174 extending from the body 6172. The tissue holder 6170 defines a tissue engaging surface 6175 that is smaller than the cross-sectional thickness 6125 of the distal head 6120 shown in FIG. 124. Due to the smaller area of the tissue engaging surface 6175 compared to the cross-sectional thickness 6125, the tissue holder 6170 exerts greater gripping pressure than the distal head 6120 can apply for a given clamping force. Can be added to. In at least one example, the tissue engaging surface 6175 has an area that is about 25% of the cross-sectional thickness 6125.

With reference to FIGS. 126-137, the staple fastener 6200 provides a shaft, a distal head 6220, a staple firing system 6250, a tissue cutting system, an anvil drive system, and a distal head 6220 to the patient's tissue. It is equipped with an organization drive system that is configured to move. Referring to FIGS. 126 and 127, the tissue drive system comprises a rotatable foot 6280, the rotatable foot being moved to an extension position (FIG. 126) and then retracted (FIG. 127). , Grasp the patient tissue and move the distal head 6220 relative to the tissue. FIG. 128A also shows one of the foot 6280 in its extension position. The foot 6280 may be extended and retracted simultaneously to move the distal head 6220 along a linear path and then retracted, or separately extended and retracted to swivel the distal head 6220. However, FIG. 128A shows only one foot 6280 for illustration purposes. FIG. 128, corresponding to FIG. 128A, shows the anvil 6260 in a fully clamped state such that the anvil 6260 and the foot 6280 work together to grip the patient tissue. Further, FIG. 128 shows that the unmolded staple 6230 is positioned within the staple cavity 6221 defined in the distal head 6220 and the staple firing system 6250 is in an unfired state.

FIG. 129A shows the foot 6280 in the retracted position, similar to FIG. 127. FIG. 129, corresponding to FIG. 129A, shows the anvil 6260 in a fully clamped state and the staple firing system 6250 in a firing state. As shown in FIG. 129, the leg 6232 of the staple 6230 is completely deformed to form a B-shape, but other modified configurations of the staple 6230 may be suitable. Referring here to FIGS. 131 and 133, the staple firing system 6250 includes a firing bar 6255 and a plurality of staples 6230 housed in recesses 6252 defined on the sides of the firing bar 6255. The first row of staples 6230 is stored on the first side of the launch bar 6255 and the second row of staples 6230 is stored on the second, or opposite side, of the launch bar 6255. Each of the recesses 6252 is defined by a proximal staple cradle 6251 positioned therein and configured to press against the base 6231 of the staple 6230. FIG. 134 shows two staples 6230 positioned within a staple cavity 6221 defined in the distal head 6220, with the firing bar 6255 of the staple firing system 6250 in an unfired state.

Referencing FIG. 134 again, the side portion of the staple cavity 6221 comprises a recess 6222 defined therein. The side portion of the staple cavity 6221 also comprises a resistance surface 6223 located in the middle of the recess 6222. Staples housed in the firing bar 6255 as the firing bar 6255 is pressed distally to launch a first group of staples 6230 located in the staple cavity 6221 during the first staple firing stroke. The 6230 is pressed by the resistance surface 6223. Referring to FIG. 136, when the firing bar 6255 is retracted after the first firing stroke, the staple 6230 is caught on the resistance surface 6223, which causes the firing bar 6255 to slide relative to the staple 6230. In such an example, as a result, the staple 6230 aims at the next distal set of recesses 6252 defined within the firing bar 6255, thereby presenting a new set of staples 6230 ejected from the staple cavity 6221. Will be done. Figures 130 and 130A show the surgical instrument 6200 as it is reopened to release the patient tissue so that the distal head 6220 can be repositioned with respect to the patient tissue. With reference to FIG. 137, when the distal head 6220 is properly repositioned, the launch bar 6255 may be advanced distally to perform a second staple launch stroke. This process can be repeated to deploy all of the staples 6230 stored within the launch bar 6255.

The staple fasteners disclosed herein may be configured to deploy staples in a suitable staple pattern. FIG. 138 shows one exemplary staple pattern including staples 6330 and staples 6330'positioned on either side of the tissue cutting line 6340. Each side of the tissue cutting line 6340 includes an inner row of staples 6330 facing away from the cutting line 6340 and an outer row of staples 6340 facing away from the cutting line 6340. FIG. 139 shows another exemplary staple pattern, including staples 6330, staples 6330 ′, and staples 6430 ″. Staples 6430 ″ are arranged in rows on both sides of the tissue cutting line 6340. More specifically, the staples 6430 ″ are arranged in a staple row positioned between the sets of both the inner row of staples 6330 and the outer row of staples 6330 ″.

Referring to FIGS. 140 and 141, the staple fastening device 6500 includes a shaft 6510, a distal head 6520, and an articulation joint 6270 that rotatably connects the distal head 6520 to the shaft 6510. The staple fastener 6500 further comprises a staple supply system 6590 configured to produce and provide a continuous supply of staples 6530 to the distal head 6520. The staple supply system 6590 includes a spool 6592 operably connected to an electric motor. The spool 6592 comprises a metal wire 6594 wound around a central core. The wire 6594 is made of, for example, stainless steel and / or titanium. The wire 6594 is supplied through the passage 6514 defined in the shaft 6510 and the articulation joint 6570. In use, the electric spool 6594 pushes the wire 6594 into the distal head 6520. As described in more detail below, the distal head 6520 further comprises a molded mandrel configured to transform the wire 6594 into staples 6530. The mandrel is driven by an electric motor and / or actuator, but may be operated in any suitable manner. As described in more detail below, the distal head 6520 comprises a knife, or shear member, configured to cut the wire 6594. The shearing member is driven by an electric motor and / or actuator, but may be operated in any suitable manner. Once the staples 6530 have been molded and separated from the wires 6594, the staples 6530 can be deployed and deformed against the anvil 6560 of the staple fastener 6500.

Referring to FIG. 141, the surgical instrument 6500 further comprises a staple molding system 6580 configured to make staples 6530 from wires 6594. The staple molding system 6580 comprises a molding mandrel 6582 located within a molding cavity 6522 defined within the distal head 6520. The staple forming system 6580 further comprises a forming actuator 6584, which is configured to engage the wire 6594 and deform the wire 6594 within the forming cavity 6522. At this point, the molding mandrel 6582 is actuated to cut off the staples 6530 from the wire 6594. After the staple 6530 has been deployed and / or moved out of the molding cavity 6522, another staple 6530 may be molded within the cavity 6522. In certain alternative embodiments, the wire segment is cut from the metal wire 6594 before being formed into staples 6530. In either case, the staples 6530 may, for example, have a substantially U-shaped configuration. Alternatively, the wire segments may be formed into a substantially V-shaped configuration. In addition, the staple fastener 6500 may be configured to make and deploy any suitable fasteners such as tacks and / or clamps.

With reference to FIGS. 158 and 159, the staple fastening device 7300 includes a shaft 7310, a distal head 7320, and an articulation joint 7370 that rotatably connects the distal head 7320 to the shaft 7310. Upon use, the staple fastener 7300 is inserted into patient P through the Trocar TC. The trocar TC has a passage that extends through it, which allows a portion of the distal head 7320 and shaft 7310 to be inserted into the patient. In another example, the distal head 7320 can be inserted into the patient through an open incision without the use of a trocar. In either case, the staple fastener 7300 is configured to deploy staples from a staple cartridge inserted therein. The shaft 7310 comprises a loading port 7312, which communicates with a cartridge passage or channel extending through the shaft 7310, the articulation joint 7370, and the distal head 7320. In use, staple cartridges, such as the staple cartridge 7330', are inserted into the shaft 7310 through the loading port 7312 and then pushed into the distal head 7320. The staple fastener 7300 further comprises a cartridge pusher system configured to push the staple cartridge 7330'into the end effector 7300.

In various examples, in addition to the above, the staple cartridge 7330'inside the staple fastener 7300 so that the staple retainer 7300 can be continuously operated without having to be removed from the patient to be reloaded. Can be supplied to. Each staple cartridge 7330'contains a staple having a first size, such as a first unfired height. In certain examples, it is desirable to generate staple lines where all staples have the same size or unlaunched height. Such an example can occur when the stapled tissue has a substantially uniform thickness. In another example, it is desirable to generate staple lines where the staples have different sizes or unlaunched heights. Such an example can occur when the stapled tissue does not have a uniform thickness. For example, gastric tissue traversed during a gastric reduction procedure usually does not have a consistent thickness. In such an example, the first staple cartridge 7330'can be loaded into a staple fastener 7300 having staples having a first unfired height, and the second staple cartridge 7330'' can be loaded into a second staple. It can be loaded into a staple fastener 7300 with a firing height. The first unlaunched height is higher than the second unlaunched height, but the first unlaunched height may be lower than the second unlaunched height. Similarly, the third staple cartridge 7330'''is loaded into a staple fastener 7300 having staples having a first unfired height and a third unfired height different from the second unfired height. obtain.

In addition to the above, more than one staple cartridge may be loaded into the staple fastener 7300. Staple cartridges can be inserted into the staple fastener 7300 for use in a particular order. For example, a staple cartridge with a shorter unfired height can be fired in front of a staple cartridge with a higher unfired height. Alternatively, the staple cartridge with the higher unfired height may be fired in front of the staple cartridge with the shorter unfired height. In any case, the most distal staple cartridge is used first and the most recent staple cartridge is used last. Such a configuration makes it possible to pre-plan the surgical procedure with little, if any, loss of time when loading the staple fastener 7300 during the surgical procedure. Alternatively, the staple cartridges may be supplied to the staple fastener 7300 one by one. Such a configuration provides the clinician with the opportunity to change the order in which the staple cartridges are ultimately used.

The loading port 7312 comprises an opening accessible from the outside of the shaft 7310, which may be defined within the handle of the staple fastener 7300 or at any other suitable location. In various examples, the staple fastener 7300 may further comprise a door configured to cover the loading port 7312. In at least one example, the door may be sealed to prevent or prevent fluids and / or contaminants from entering the staple fastener 7300 when closed. In such an example, the door and / or housing of the shaft 7310 may include one or more seals.

Primarily with reference to FIG. 159, the staple fastener 7300 comprises a system for stripping clusters of staples, such as the staple 7330, from the most distal staple cartridge. The staple fastener 7300 further comprises a staple firing system 7350, which is configured to deploy the staples 7330 and deform the staples 7330 relative to the anvil 7360 during the staple firing stroke. The staple fastening device 7300 further comprises a tissue drive system 7380 configured to move the distal head 7320 relative to the patient tissue after a staple firing stroke.

With reference to FIGS. 168 and 169, the staple fastening device 7900 includes a shaft 7910, a distal head 7920, and an articulation joint 7970 that rotatably connects the distal head 7920 to the shaft 7910. As described in more detail below, the distal head 7920 is pivotable in any suitable direction. Similar to the above, the staple fastener 7900 is a cartridge configured to feed the staple cartridge 7930'to the distal head 7920 through a shaft 7910, an articulation joint 7970, and a cartridge passage 7914 extending through the distal head 7920. It has a supply system. Again, as above, the staple 7930 is stripped from the most distal staple cartridge 7930'and then fired at the anvil 7960. As described in more detail below, the staple fastening device 7900 further comprises a joint motion drive system 7980 configured to articulate the distal head 7920.

In addition to the above, with reference to FIGS. 168 and 169 again, the distal head 7920 is articulated in several directions with respect to the shaft 7910. The shaft 7910 extends along the longitudinal shaft axis LA and the distal head 7920 extends along the longitudinal head axis HA. The head axis HA is aligned with, or at least substantially aligned with, the shaft axis LA when the distal head 7920 is not articulated. When the distal head 7920 is articulated, the head axis HA traverses the shaft axis LA. With reference to FIG. 168, the distal head 7920 is capable of lateral or lateral joint movement. In at least one such example, the distal head 7920 is articulated within a range that includes, for example, about 15 degrees to the first side of the shaft axis LA and about 15 degrees to the second side of the shaft axis LA. You can exercise. The joint motion drive system 7980 is configured to drive or actively articulate the distal head 7920 over this range of motion. The joint motion drive system 7980 includes a first lateral drive 7982 mounted on the distal head 7920 and a second lateral drive 7984 mounted on the distal head 7920 on the opposite side of the distal head 7920. , Equipped with. During use, the first lateral drive 7982 is pushed and / or the second lateral drive 7984 is pulled in order to joint the distal head 7920 in the first direction. Similarly, in order to joint the distal head 7920 in the second direction, the first lateral drive 7982 is pulled and / or the second lateral drive 7984 is pushed. In at least one example, the first side drive unit 7882 comprises a first guide wire and the second side drive unit 7988 comprises a second guide wire. Such a guide wire is suitable for pulling the distal head 7920.

With reference to FIG. 169, the distal head 7920 is also articulating in the anterior and / or posterior directions. In at least one such example, the distal head 7920 is capable of joint movement within a range that includes, for example, about 25 degrees in the posterior direction and about 25 degrees in the forward direction. In certain embodiments, although not shown, the articulation drive system 7980 is configured to actively articulate the distal head 7920 in the forward and posterior directions (FIG. 169). In an alternative embodiment, the distal head 7920 may be passively articulated in the anterior and posterior directions. In such an embodiment, the staple fastener 7900 does not actively drive the distal head 7920 with respect to the shaft 7910. Instead, the distal head 7920 can float in the anterior-posterior direction. Similarly, the distal head 7920 can be passively jointed laterally with or without the joint drive system 7980. In either case, the distal head 7920 is articulating in both the anterior-posterior and lateral planes and can take a synthetic angle with respect to the longitudinal axis LA of the shaft 7910.

In various embodiments, the surgical instrument 7900 has a lock configured to hold the distal head 7920 in place where it can be released to allow the distal head 7920 to move relative to the shaft 7910. Can be prepared. In various examples, the distal head 7920 may be passively articulated by pushing the distal head 7920 against the patient tissue within the surgical site when the distal head 7920 is unlocked. The distal head 7920 can also be actively articulated when the distal head 7920 is unlocked. In either case, when the distal head 7920 is properly positioned, the distal head 7920 can be locked to its joint motion position. To return the distal head 7920 to its non-articular motion position, the distal head 7920 can be unlocked and then realigned with the shaft axis LA. In at least one example, the staple fastening device 7900 comprises one or more springs configured to urge the distal head 7920 to its non-articular motion position. In any case, the joint motion lock can prevent, or at least suppress, the reverse drive of the distal head 7920 in response to external and / or internal forces and torques.

In addition to the above, the articulation joint 7970 of the staple fastening device 7000 allows the distal head 7920 to be articulated about one or more axes. In various alternative embodiments, the shaft of the staple fastening device is a first articulating joint that allows the distal head to move joints about a first articulating axis, and the distal head is first. It is provided with a second joint movement joint that enables joint movement around the two joint movement axes. The first joint motion axis and the second joint motion axis extend in orthogonal planes, but can extend in any suitable transverse plane. In various examples, the first and second articulated joints are passively articulated. In some examples, the first and second articulated joints are actively articulated. In at least one example, the first articulated joint is actively articulated and the second articulated joint is passively articulated.

Referring to FIG. 170, the stapler 8000 includes a buffer system 8080 configured to control or slow down the joint movement of the distal head 7920. The buffer system 8080 includes a first link 8082, a second link 8084, and a dashpot 8085. The first link 8082 is pinned to the distal head 7920 at the pivot 8081. The first link 8082 is also pinned to the second link 8084 on the pivot 8083. Pivots 8081 and 8083 allow the buffer system 8080 to adapt to various joint motions of the distal head 7920. The dashpot 8085 includes a housing 8087 mounted on a shaft 7910 and a buffer medium 8088 housed in a chamber defined within the housing 8087. The second link 8084 comprises a piston 8086 defined on its proximal end, which piston is located within the housing opening and buffer medium 8088 when the distal head 7920 is articulated. It is configured to move through. The buffer medium 8088 flows through and / or around the piston 8086, thereby allowing relative movement between the piston 8086 and the housing 8097, which slows it down. Correspondingly, the buffer medium 8088 allows the distal head 7920 to move relative to the shaft 7910, but slows it down. Sudden movements of the distal head 7920 can be difficult for clinicians to control and / or predict, and can also cause the distal head 7920 to collide with patient tissue. The buffer medium 8088 may include any suitable medium such as buffer grease.

Referring to FIG. 171, the staple fastening device 8100 includes a buffer system 8180 configured to control or slow down the joint movement of the distal head 7920. The buffer system 8180 includes a link 8182 and a dashpot 8185. The link 8182 is pinned to the distal head 7920 at the pivot 8181. The first link 8082 is flexible, which allows the buffer system 8180 to adapt to the various joint motion motions of the distal head 7920. The dashpot 8185 includes a housing 8187 rotatably mounted on the shaft 7910 and a buffer medium 8188 housed in a chamber defined within the housing 8187. The link 8182 comprises a piston 8186 defined on its proximal end, the piston being located within the housing opening and moving through the buffer medium 8188 when the distal head 7920 is articulated. It is configured as follows. The buffer medium 8188 flows through and / or around the piston 8186, thereby allowing relative movement between the 8186 and the housing 8197, which slows it down. Correspondingly, the buffer medium 8188 allows the distal head 7920 to move relative to the shaft 7910, but slows it down. Sudden movements of the distal head 7920 can be difficult for clinicians to control and / or predict, and can also cause the distal head 7920 to collide with patient tissue. The buffer medium 8188 may include any suitable medium such as buffer grease.

With reference to FIG. 172, the staple fastening device 8100 is insertable into patient P through the trocar TC and is also mobile with respect to target tissue T. The trocar TC can be moved to the patient P to some extent, and the staple fastener 8100 can be moved to the trocar TC to some extent. However, such movement can result in movement of the shaft 7910 over a wide range of angles. To keep the distal head 7920 aligned with the tissue as the distal head 7920 is advanced along the staple line, the distal head 7920 may, for example, be progressively articulated posteriorly. Referring to FIG. 173, the distal head 7920 is progressively articulated anteriorly and / or posteriorly so as to keep the axis of the distal head 7920 orthogonal to, or at least substantially orthogonal to, the target tissue T. obtain. In various examples, the distal head 7920 is actively articulated by the articulation drive system to adjust the angle between the distal head 7920 and the shaft 7910. In a particular example, the distal head 7920 is passively articulated by a joint motion drive system to adjust the angle between the distal head 7920 and the shaft 7910. In such an example, the distal head 7920 can adaptively float to follow the staple firing path.

With reference to FIGS. 34 and 35, the staple fastening device 2500 includes a shaft 2510, a distal head 2520, and an articulation joint 2570 that rotatably connects the distal head 2520 to the shaft 2510. The shaft 2510 extends along the longitudinal shaft axis LA and the distal head 2520 extends along the longitudinal head axis HA. The shaft axis LA and the head axis HA are aligned when the distal head 2520 is not articulated, as shown in FIG. Referring to FIG. 35, the head axis HA traverses the shaft axis LA when the distal head 2520 is in joint motion. The stapler 2500 further comprises a buffer system 2580 configured to control or slow down the joint movement of the distal head 2520. The buffer system 2580 includes a first link 2581, a second link 2582, and a dashpot 2585. The first link 2581 is pinned to the distal head 2520 at pivot 2584. The first link 2581 is also pinned to the second link 2582 at pivot 2583. Pivots 2583 and 2584 allow the buffer system 2580 to adapt to the various joint motion motions of the distal head 2520. Referring to FIG. 34, when the distal head 2520 is not articulated, the first link 2581 is aligned with the second link 2582 along the longitudinal axis. Referring to FIG. 35, the first link 2581 traverses the second link 2582 when the distal head 2520 is articulated.

The dashpot 2585 comprises a housing mounted on the shaft 2510 and a buffer medium 2586 housed in a chamber defined within the housing. The second link 2582 comprises a piston defined on its proximal end, which is positioned within the housing opening and buffers when the distal head 2520 is articulated. It is configured to move through medium 2586. The buffer medium 2586 flows through and / or around the piston, thereby allowing relative movement between the piston and the housing, which slows it down. Correspondingly, the buffer medium 2586 allows the distal head 2520 to move relative to the shaft 2510, but slows it down. The buffer medium 2586 may include any suitable medium such as buffer foam.

The staple fastener 2000 is shown in FIG. 13, which is in many respects similar to the staple fastener 1000 and / or the other staple fasteners disclosed herein, most of which are For brevity, it is not discussed herein. The staple fastener 2000 includes a handle 2100 including a housing 2110, a grip 2120, and a display 2130. The housing 2110 comprises a connector 2170 configured to connect a shaft assembly, such as the shaft assembly 1200, to the handle 2100, for example. The handle 2100 further comprises a replaceable battery pack 2160, which is releasably attached to the housing 2110 and located removably within a cavity 2115 defined within the housing 2110. The battery pack 2160 powers the motor drive system housed in the display 2130 and / or the handle 2100. As described in more detail below, the display 2130 is configured to allow the user to control the movement of the surgical instrument 2000.

In addition to the above, the staple fastener 2000 comprises a staple launch system configured to apply staple lines to the patient's tissue, and the display 2130 comprises a control device for assessing the status of the staple launch system. The display 2130 also has, for example, the speed at which the staple fastener 2000 is applying the staple line, the direction in which the staple line is applied, and / or is being met, exceeded, or is about to be exceeded. A control device for evaluating and / or changing an arbitrary performance threshold is provided. The display 2130 includes a capacitive touch screen, but any suitable screen can be used.

Referring to FIG. 14, display 2130 includes status control 2140. The status control 2140 includes a window 2141 that includes a window header 2142. The status control 2140 further comprises an image window 2145, which is an image window that provides information about the stapled tissue, the staple firing path, and / or any that the clinician can use to operate the staple device 2000. It is configured to display other information. For example, the image window 2145 has a staple path 2143 on which the staple fastener 2100 is currently moving and / or a staple path around a particular anatomical mechanism within the patient tissue T, such as a vessel V. It is configured to display an alternative staple launch path 2143'to guide. The status control 2140 is a digital control and / or display that signals and communicates with the controller of the staple fastener 2000.

Referring to FIG. 17, display 2130 further comprises a directional control 2190 configured to control the direction of the staple firing path. The orientation control 2190 includes a window 2191 that includes a window header 2192 and an image window 2195. The image window 2195 is configured to display the orientation of the distal head of the staple fastener with respect to the original starting orientation. The image window 2195 includes a plurality of orientation lines 2194 that indicate specific azimuths, such as 15 degrees, 30 degrees, and 45 degrees, with respect to the starting orientation lines 2194 demarcated as 0 degrees. The image window 2195 further comprises a needle 2193 indicating the orientation of the distal head of the staple fastener with respect to the starting direction of the staple fastener. The directional control 2190 further comprises an edit window 2198, which, when activated, allows the user to correct the direction of the staple path by manipulating the needle 2193. The directional control 2190 further comprises a save window 2199, which, when activated, allows the user to save the input provided to the controller through the directional control 2190. At such a point, the staple fastener 2000 can move along its new orientation. The status control 2190 is a digital control and / or display that signals and communicates with the controller of the staple fastener 2000.

Referring to FIG. 15, display 2130 further comprises a speed control 2150 configured to control the speed at which the staple fastener 2000 forms a staple path. The speed control 2150 includes a window 2151 that includes a window header 2152 and an image window 2155. The image window 2155 includes an indicator 2153 configured to display the speed of the staple fastener. For example, indicator 2153 can display the number of staple firing strokes performed by the staple fastener 2000 per minute. The image window 2155 further comprises an up arrow control 2156 that can be actuated to increase the speed of the staple firing stroke and a down arrow control 2157 that can be actuated to decrease the speed of the staple firing stroke. Indicator 2153 may be configured to indicate the speed at which the staple fastener 2000 is being propelled across the patient tissue by the tissue drive system. Other metrics regarding the speed of the stapler 2000 may also be used and displayed. The status control 2150 is a digital control and / or display that signals and communicates with the controller of the staple fastener 2000.

Referring to FIG. 16, display 2130 further comprises a fault threshold control 2180 configured to manage the fault threshold of the staple fastener 2000 when it occurs. For example, the force threshold required to perform a staple firing stroke may be used to establish a fault condition that requires input from the user. If the force required to perform the staple firing stroke exceeds the threshold, the controller of the staple fastener 2000 can warn the user via the fault threshold control 2180 and / or stop the staple fastener 2000. be able to. Certain obstacles may be overridden or otherwise managed by the user, allowing the staple fastener 2000 to continue to apply the staple line. Failure threshold control 2180 allows the user to manage these failures. Other failures may not be overridden. In such an example, the fault threshold control 2180 determines how the fault cannot be overridden and / or how the fault is resolved so that the staple fastener 2000 can continue to operate. It is configured to be displayed in. The fault threshold control 2180 includes a window 2181 that includes a window header 2182 and an image window 2185. The fault threshold control 2180 is a digital control and / or display that signals and communicates with the controller of the stapler 2000.

With reference to FIG. 18, the staple fastener 2000 further comprises a visual capture system discussed in more detail below, and the display 2130 is configured to display, among other things, real-time video images from the visual capture system. It also has an image window 2135. The display 2130 further comprises a menu 2131 extending along the left side of the image window 2135, which may be located at any suitable location on the display 2130. Menu 2131 includes a status control 2140, a speed control 2150, a fault threshold control 2180, and the directional control 2190 described above. Menu 2131 also includes configuration controls 2132 that can be used to select and / or reconfigure windows and / or controls on the display 2130. Menu 2131 further includes a stop control 2136 that can immediately stop the progress of the staple fastener 2100 along the staple firing path. Menu 2131 is a digital control and / or display that signals and communicates with the controller of the staple fastener 2100.

In addition to the above, with reference to FIG. 18 again, the display 2130 further comprises a first view window 2133 and a second view window 2134. The view windows 2133 and 2134 are positioned along the right side of the image window 2135, but may be located at any suitable location on the display 2130. View windows 2133 and 2134 provide the user with an alternative view of the staple fastener 2000. For example, the first view window 2133 provides the user with a side view of the staple fastening device 2000 at the surgical site, and the second view window 2134 provides the user with a top view of the staple fastening device 2000 at the surgical site. These additional figures may be sourced by one or more digital cameras on the stapler 2000 and / or from other surgical instruments, such as an endoscope within the surgical site. In such an example, other surgical instruments signal and communicate with the controller of the stapler 2000 to provide these additional images. In a particular example, the controller of the staple fastener 2000 can interpret the data provided to the controller and generate additional images of windows 2133 and 2134 based on the data provided.

As mentioned above, the speed at which the staple firing system and / or tissue drive system of the staple fastener 2000 is operated can be controlled by the speed control 2150 on the display 2130. As mentioned above, in various examples the speed can be controlled manually or by input from the user. In another example, the controller of the staple fastener 2000 can automatically control the speed. In such an example, the controller assesses the characteristics of the stapled tissue, such as thickness and / or density, and adjusts the speed of the staple launch system and / or tissue drive system accordingly. It is configured. For example, if the controller determines that the stapled tissue is thick, that is, close to the tissue thickness threshold, is at the tissue thickness threshold, or exceeds the tissue thickness threshold, the controller is stapled. The speed of 2000 can be reduced. Similarly, if the controller determines that the stapled tissue is dense, i.e. close to the tissue density threshold, at the tissue density threshold, or above the tissue density threshold, the controller will perform a stapler. The speed of 2000 can be reduced. Correspondingly, the controller can increase the speed of the stapler 2000 if the controller determines that the stapled tissue is, for example, thinner, i.e. less dense than usual. In addition to the above, referring to FIG. 19, the speed control 2150 of the staple fastener 2000 is an automatic speed control 2158 in which the staple fastener 2000 controls the speed of the staple fixture 2000, and the user controls the speed of the staple fastener 2000. Includes options for the user to choose between and the manual speed control 2159.

Referring to FIG. 20, the staple fastener 2200 includes a display 2230. The stapler 2200 is in many respects similar to the stapler 2000 and the display 2230 is in many ways similar to the display 2130, most of which are described herein for brevity. Not discussed in the book. The display 2230 includes a menu 2231 and a central image window 2235. The central image window 2235 displays an image of the patient tissue T stapled and the staple launch path 2243 in which the staple fastening device 2200 is moving. The staple launch path 2243 is represented as a series of operations, ie, staple launch 2244. Each projection actuation 2244 indicates the path through which the tissue T is incised and the location with respect to the tissue incision where the staple cluster 2245 is deployed within the tissue T. The projection actuation 2244 closest to the distal head of the staple fastener 2200 is highlighted relative to the other projection actuation 2244 so that the user distinguishes between the next staple firing and the subsequent projection staple firing. be able to. Such highlighting may include, for example, different colors and / or color brightness of the projection actuation 2244. In at least one example, the indicated actuation 2244 of the staple launch path 2243 may be progressively less emphasized as it moves away from the distal head of the staple fastener 2200.

In addition to the above, the display 2230 is further configured to show one or more alternative staple firing paths. For example, display 2230 is configured to display an alternative staple firing path 2243'in the central image window 2235. Similar to the staple launch path 2243, the staple launch path 2243'is represented as a series of operations, i.e., staple launch 2244'. Each projection actuation 2244'indicates the path through which tissue T is cut and where the staple cluster 2245 is deployed within tissue T. Menu 2231 includes a staple line control 2240 that can be activated by the user of the staple fastener 2200 to edit the staple launch path 2243 to create an alternative staple launch path 2243'. Once an alternative staple launch path 2243'is established, it can be stored and the staple fastener 2200 can be operated to follow the alternative staple launch path 2243'. As shown in FIG. 20, the staple line control 2240 includes an actuable edit subcontrol 2241 and an actuable save subcontrol 2242 to modify and store the staple firing path as described above.

As mentioned above, the staple launch path 2243 can be modified to an alternative staple launch path 2243'. The staple launch path 2243 and the alternative staple launch path 2243'are displayed in the image overlaid on the video image from the camera. The staple firing path 2243 and the alternative staple firing path 2243'are displayed on the same image overlay or layer, but may be displayed on different image overlays or layers. In at least one such example, the staple firing path 2243 is displayed within the first image overlay or layer, and the alternative staple firing path 2243 is a second image overlay or layer different from the first image overlay. It is displayed in. The screen of the display 2230 is configured to receive input commands from a central image window 2235 that can drag the staple firing path 2243 and / or the alternative staple firing path 2243'in the image overlay. The screen of display 2230 is configured to respond to the user's finger, so the staple firing path can be modified by the user dragging his or her finger. With reference to FIG. 21, the screen of the display 2230 is further configured to respond, for example, to the stylus 2220.

As mentioned above, the display 2230 may be configured to display the current or intended staple firing path and one or more alternative staple firing paths. The controller of the staple fastener 2200 is configured to generate one or more alternative staple firing paths and display these alternative staple firing paths on the display 2230. In various examples, the controller can determine an alternative staple firing path based on one or more attributes of the stapled tissue T. For example, the controller can identify a blood vessel in tissue T and provide or propose an alternative staple firing path that guides the staple device 2200 around the blood vessel.

Referring to FIG. 22, the display 2230 is configured to modify the staple firing path while the staple fastener 2200 is deploying the staple path and / or after the staple fastener 2200 is stopped. It has a menu that includes controls. Display 2230 provides menu 2231 containing multiple operable controls configured to be used while the staple fastener 2200 is performing its series of staple firing strokes to generate a staple path. I have. Menu 2231 includes, for example, a view control 2232 for changing the video image displayed in the central image window 2235. In at least one such example, the video control can be used to toggle between different video feeds. Menu 2231 further comprises controls for the staple line 2240 described above, which are configured to modify the staple firing path. The staple firing system of the staple fastener 2200 can be initiated by the user activating the staple control 2234 in menu 2231 and stopped by the user activating the stop control 2236 in menu 2231.

In addition to the above, the shaft assembly attached to the handle of the staple fastener 2200 can be rotated relative to the handle. The shaft assembly includes a rotatable slip joint configured to allow the distal head of the shaft assembly to rotate relative to the handle, but any suitable configuration can be used. As a result of this slip joint, the user of the stapler 2200 can selectively orient the display 2230 with respect to the distal head of the stapler 2200. In such an example, the user can maintain, for example, the orientation of the display 2230 with respect to the patient, even as the distal head swivels to follow the staple firing path. Similarly, FIGS. 144-146 show a staple fastener 1000 being inserted into patient P through a trocar TC, and by a rotatable interface between the handle display and shaft assembly of the staple fastener 1000. The handle display can be maintained in a constant orientation by clinician C with respect to itself, even if the shaft assembly is rotating to follow the staple launch path FP.

With reference to FIGS. 147-150, the staple fastener 7000 comprises a handle 7010 including a grip 7020 and a shaft assembly 1200 assembled to the handle 7010. The handle 7010 further comprises a display 7030 rotatably attached to the handle 7010 about a rotary joint 7035. The display 7030 is in many respects similar to the display 2230, most of which are not discussed herein for brevity. Upon use, the display 7030 may be rotated with respect to the handle 7010 to maintain a suitable orientation of the display 7030 with respect to the clinician C and / or any other frame of reference.

FIG. 180 shows the handle 1500 of a surgical instrument 100 used by a clinician during a surgical procedure. The handle 1500 includes a central portion 110 bounded by one or more ergonomic grips 120 to facilitate the handling of the surgical instrument 100 by the clinician. Each ergonomic grip 120 is configured to fit in the clinician's hands for improved control and comfort. The handle 1500 comprises one or more interactive controls 180 configured to provide navigation commands to the end effectors of the surgical instrument 100. In various examples, the one or more interactive controls 180 are configured to provide user commands corresponding to the selection of one or more items. The interactive control 180 is located on the handle 1500 at a position that allows easy operation by the clinician, such as within the reach of the clinician's thumb. In various examples, the control 180 is composed of, for example, various types of switches and / or buttons. In various examples, the interactive control 180 is a toggle switch, an analog stick, a rocker, a D-pad, and / or any other capable of facilitating the communication of user commands to, for example, the controller of the surgical instrument 100. Includes appropriate interactive controls for.

The handle 1500 further comprises a touch-sensitive display 1510. A portion of the touch-sensitive display 1510 displays a menu bar 1512 to the clinician. The options of the menu bar 1512 represent various display modes of the surgical instrument 100, including, but not limited to, view mode, position mode, and / or staple mode. In various display modes, data and / or images related to the status of the surgical procedure and / or surgical instrument 100 are displayed. In view mode, the touch-sensitive display 1510 displays multiple views of the surgical site, including, for example, side and top views. Side views and top views are displayed within separate frames 1514, 1516 of the touch-sensitive display 1510, but they may be displayed in any suitable fashion. As mentioned above, the clinician can focus on a particular view by switching the desired view to the magnifying focus frame 1518 using the interactive control 180. In various embodiments, the clinician can switch views by dragging the desired view towards the central frame 1518, using, for example, an input device 1530 such as a stylus or a clinician's finger. The input device 1530 will be described in more detail below.

To create a sterile environment for the surgical instrument 100, a sterile barrier 190 is hung over the handle 1500, as shown in FIG. 181. As described in more detail below, the sterilization barrier 190 is composed of a transparent elastic material such as plastic. The sterile barrier 190 extends around the handle 1500 and on the proximal portion of the shaft 200. The sterilization barrier 190 comprises one or more preformed areas 192 configured to fit over the interactive control 180. The preformed area 192 assists in aligning the sterile barrier 190 onto the handle 1500 of the surgical instrument 100. The sterile barrier 190 is stretched on the touch-sensitive display 1510 to create a smooth and uniform barrier, or at least a substantially smooth and uniform barrier. A mounting member 194, such as a clip, secures the sterilization barrier 190 in place around the peripheral portion 193 of the touch-sensitive display 1510. The sterile barrier 190 fits loosely around the remaining components of the handle 1500, and the sterile barrier 190 is clamped around the shaft 200 of the surgical instrument 100, but any suitable configuration is used. Good. For example, covering the handle 1500 with a sterile barrier 190 protects various components of the handle 1500 from exposure to body fluids and / or contaminants. Hanging the sterile barrier 190 over the handle 1500 and the proximal portion of the shaft 200 is also a cost effective and rapid means for sterilizing and reusing the handle 1500 of the surgical instrument 100.

FIG. 182 shows the touch-sensitive display assembly 500. The touch-sensitive display assembly 500 includes a sterile barrier 190 and a touch-sensitive display 1510. In a particular example, the touch-sensitive display 1510 functions as a projected capacitive sensor. The touch-sensitive display 1510 includes an insulating layer 1511 made of an insulating material mounted on the upper part of the sensing mechanism 1513. In a particular example, the insulating layer 1511 is attached to the sensing mechanism 1513 by an adhesive, such as an optical adhesive. As mentioned above, the sterile barrier 190 is stretched on the touch-sensitive display 1510 in a uniform or nearly uniform form. The mounting member 194 (FIG. 181) holds the sterilization barrier 190 in its extended position in a manner that forms a gap 1520 between the sterilization barrier 190 and the insulating layer 1511. The gap 1520 spans a distance of a few millimeters between the insulating layer 1511 and the sterile barrier 190, and the gap 1520 is configured to prevent the formation of contact bubbles when the sterile barrier 190 comes into contact with the insulating layer 1511. ing.

The conductive particles 191 are dispersed throughout the sterilization barrier 190, giving the sterilization barrier 190 a specific capacitance. The sensing mechanism 1513 of the touch-sensitive display assembly 500 comprises a plurality of pixels 1515 and, for example, a material such as indium tin oxide configured to form electrodes. As discussed in more detail with respect to FIG. 183, in various examples the electrodes are configured as orthogonal grids, but any suitable configuration can be used. In particular, the sensing mechanism 1513 is configured to detect that the sterile barrier 190 has been attached. More specifically, the sensing mechanism 1513 detects the attachment of the sterile barrier 190 by the specific capacitance of the sterile barrier 190. If the clinician wishes to take advantage of the features of the touch-sensitive display 1510, the input device 1530 is contacted with the sterile barrier 190 at the desired contact point, as described above. The sensing mechanism 1513 is configured to detect the additional capacitance of the input device 1530 and distinguish the capacitance of the input device 1530 from the capacitance of the sterile barrier 190. Further, when the input device 1530 is brought into contact with the sterilization barrier 190, the conductive particles 191 of the sterilization barrier 190 are compressed or brought closer to each other. Such compression creates a denser conductive particle 191 in the region surrounding the contact point of the input device 1530, thus resulting in higher capacitance. The change in charge at the contact point in the sensing mechanism 1513 activates or applies voltage to the pixels 1515 of the sensing mechanism 1513 near the contact point.

The touch-sensitive display 1510 is configured to function in the same manner and / or in a similar manner without the sterile barrier 190. In a particular example, the input device 1530 consists of, for example, a clinician's finger surrounded by latex gloves. Medical latex gloves are usually thin enough so as not to impair the conductivity of the clinician's fingers. If the gloves worn by the clinician are expected to reduce the conductivity of the clinician's fingers, the settings of the touch-sensitive display 1510 may be modified to increase the sensitivity of the sensing mechanism 1513.

FIG. 183 shows the touch-sensitive display 1510 of FIG. 182 when the input device 1530 comes into contact with the sterile barrier 190 of the touch-sensitive display assembly 500. As mentioned above, in various examples, the electrodes are configured as orthogonal grids, but any suitable configuration can be used. In such an example, the electrodes include an x-electrode 1542 and a y-electrode 1544. The touch-sensitive display 1510 includes a plurality of pixels 1515 that are uniformly or nearly uniformly configured throughout the sensing mechanism 1513, although any suitable configuration can be used. FIG. 183 further shows the various groupings of activated pixel clusters 1517 and 1519. During that deactivated state, low levels of capacitance are present across all pixels 1515 (FIG. 182) within the touch-sensitive display 1510. When the input member 1530 (FIG. 182) contacts the sterile barrier 190 and activates the touch-sensitive display 1510, the pixels 1515 associated with the pixel clusters 1517 and 1519 are activated with higher new capacitance. Pixels 1515 within pixel clusters 1517 and 1519 are activated as the input device 1530 remains in contact with the sterile barrier 190. The sensing mechanism 1513 detects the positions of the active pixel clusters 1517 and 1519 by scanning the matrix of the x-electrode 1542 and the y-electrode 1544.

FIG. 184 shows a graphical representation of the relationship between the position of the active pixel cluster within the x-electrode 1542 of the touch-sensitive display 1510 and the capacitance detected by the sensing mechanism 1513. The first capacitance C ₁ indicates a low level or unactivated capacitance that is present throughout the pixels 1515 of the touch sensitive display 1510 prior to application of the sterile barrier 190. For reference, capacitance C ₀ represents the detected capacitance that _{is zero, and capacitance C 1} represents the capacitance above zero. The second capacitance C ₂ indicates a threshold capacitance. It exceeds the threshold capacitance _{C 2,} surgical instrument 100, recognizes that the sterilization barrier 190 is attached to the touch-sensitive display 1510. In the graph representation 1550, when the detected capacitance is above the threshold capacitance _{C 2,} sterility barrier 190 is attached to the touch-sensitive display 1510. The third capacitance C ₃ represents another threshold capacitance. When the sensing mechanism 1513 detects a capacitance greater than a threshold capacitance _{C 3,} surgical instrument 100 recognizes that the input device 1530 is in contact with the sterile barrier 190. The graph display 1550, when the detected capacitance exceeds the threshold capacitance C ₃ 2 times, input device 1530 is in contact with the sterile barrier 190 in two places. When the input device 1530 is removed from the sterile barrier 190, the capacitance detected by the pixels 1515 in the clusters 1517 and 1519 returns to a capacitance less than _{C 3} but greater than or equal to _{C 2.} When the sterile barrier 190 is removed from the touch-sensitive display 1510, the capacitance detected by the pixels 1515 in the clusters 1517 and 1517 returns to a capacitance less than _{C 2} but greater than or equal to _{C 1.}

Returning to FIG. 182, the touch-sensitive display 1510 is an alternative resistance-sensitive display. In at least one such embodiment, the sterilization barrier 190 is composed of a flexible material that allows the sterilization barrier 190 to flex in response to a force F applied by the input device 1530. In such an embodiment, the sensing mechanism 1513 of the touch-sensitive display 1510 is configured to detect the pressure generated from the location and the force F applied by the input device 1530. Various user commands are associated with a particular location on the touch-sensitive display 1510, and the location of the detected pressure corresponds to one of the various user commands.

Referring to FIG. 24, the surgical instrument 2400 includes a display 2430. The staple fastener 2400 is in many respects similar to the staple fasteners 2000 and 2200, and the display 2430 is in many respects similar to the displays 2130 and 2230, most of which are for brevity. In addition, it is not discussed herein. The display 2430 includes a touch screen that includes an image display 2435. The image display 2435 presents an image of the patient tissue T to be stapled. A user of the stapler 2400 can use the stylus 2220, for example, to draw one or more potential staple lines on the tissue T. For example, the user can draw a first staple line 2444 and a second staple line 2444'. The controller of the staple fastener 2400 may then require the user to choose between two different staple lines 2444 and 2444'to be followed. Similarly, the user of the staple fastener 2400 can use the stylus to change the staple line 2444 to an alternative staple line 2444'.

With reference to FIG. 24 again, the image of tissue T can be a substantially two-dimensional image of the top of tissue T. In such an example, the controller is configured to map a two-dimensional staple firing path over tissue T. With reference to FIG. 25, the image of tissue T can be a three-dimensional image overlooking the surface of tissue T. In such an example, the controller is configured to map a three-dimensional staple firing path over the tissue. In either case, the stylus 2220 and / or the patient's finger can be used to establish and / or modify the staple firing path. With reference to FIGS. 26 and 27, the staple fastener 2400 further comprises a joystick 2450 configured to modify the staple firing path 2444 of the staple fastener 2400. The joystick 2450 is attached to the handle of the staple fastener 2400 and is rotatable about an axis. When the joystick 2450 is rotated to the right, i.e. clockwise, the staple launch path 2444 is curved to the right. Similarly, when the joystick 2450 is rotated to the left, i.e. counterclockwise, the staple firing path 2444 is curved to the left. Other configurations of the joystick are also conceivable.

Referring again to FIGS. 26 and 27, the joystick 2450 can be used to modify the staple firing path of the staple fastener 2400 while the staple fastener 2400 is suspended or not firing the staple. The joystick 2450 can also be used by clinicians to steer the staple fastener 2400 in real time while the staple fastener 2400 is firing staples. In various examples, at least a portion of the staple device 2400 is visible on the display 2430 to assist the user in maneuvering the staple device 2400. For example, the shaft 2410 of the staple fastener 2400 is visible in the image display 2435. In various examples, a graphically created depiction of the staple fastener 2400 may be presented within one or more windows of the display 2430. As an example, the shaft 2410 and / or distal head 2420 of the staple fastener 2400 can be depicted, for example, in windows 2133 and 2134.

As mentioned above, with reference to FIG. 23 here, the staple fastener 2100 includes a handle 2110 including a grip 2120 and a display 2130 mounted on the handle 2110. The display 2130 may have any suitable configuration, but the size of the display 2130 may be limited by the spatial constraints of the handles 2110. In various examples, the staple fastening device 2100 may be part of a surgical system 2300 that includes an offboard display 2330 in addition to or instead of an onboard display 2130. The controller of the staple fastener 2100 signals and communicates with the displays 2130 and 2330. Although the controller wirelessly communicates with the off-board display 2330, it may communicate with the display 2330 by wire. In each case, the controller is configured to provide the same information to the displays 2130 and 2330. However, because of their different sizes and / or shapes, the displays 2130 and 2330 may be configured to configure this information in different ways. In another example, one of the displays 2130 and 2330 may display more information than the other. In at least one such example, the offboard display 2330 can display more information than the onboard display 2130, for example because of its larger size.

In addition to the above, the onboard display 2130 includes a touch screen, which may be operated by controls located on the handles 2110. Similarly, the offboard display 2330 also comprises a touch screen, but may be operated by other controls. Similar to the above, the touch screens of the displays 2130 and 2330 can be used to manipulate the staple firing path of the staple fastener 2100. In various examples, the clinician can, for example, touch the touch screen with his or her finger and drag the staple firing path of the staple fastener 2100 to a new position. In another example, a tool such as a stylus may be used to touch the touch screen and manipulate the staple firing path. In addition, both displays 2130 and 2330 are configured to control any other movement of the staple fastener 2100.

When the first overlay or layer is modified on one of the displays 2130 and 2330, the controller of the staple fastener 2100 modifies the first overlay on the other display. Similarly, when the second overlay or layer is modified on one of the displays 2130 and 2330, the stapler 2100 controller modifies the second overlay on the other display. Further, the user of the staple fastener 2100 can modify one overlay or layer on the display without modifying the other overlay or layer on that display or any of the displays.

While the staple firing paths and / or other images projected within the onboard and offboard displays described above are very helpful in generating the desired staple firing path, staple fasteners are provided by the user of the staple fastener. It may include one or more projectors configured to display on patient tissue an image that may help generate the desired staple firing path. With reference to FIGS. 160 and 161 the staple fastening device 7400 includes a shaft 7410, a distal head 7420, and a projector 7490 mounted on the distal head 7420. In at least one example, the projector 7490 is clamped to the distal head 7420. The projector 7490 is configured to project an image I onto the stomach S of patient P. The projector 7490 is sized and configured to be inserted into the patient through the Trocar TC, but may be inserted into the patient through an open incision. The projector 7490 is positioned proximal to the anvil 7460 of the distal head 7420, but distal to the articulation joint that rotatably connects the distal head 7420 to the shaft 7410. There is. As a result, the projector 7490 and the images projected by the projector move with the distal head 7420.

With reference to FIG. 162, the staple fastening device 7500 includes a shaft 7510, a distal head 7520, and an articulation joint 7570 that rotatably connects the distal head 7520 to the shaft 7510. The staple fastener 7500 further comprises a projector 7590 extending in parallel with the shaft 7510. The projector 7590 includes a flexible tube attached to a shaft 7510 and a distal head 7520, and is configured to flex when the distal head 7520 is articulated. As a result, the image I projected by the projector 7590 can track the orientation of the distal head 7520 and be projected distal to the anvil 7560 of the staple fastener 7500. The projector 7590 comprises one lens and is configured to project one image I, but the projector includes more than one lens and / or projects more than one image on the patient tissue. Various alternative embodiments are envisioned that are possible.

With reference to FIG. 160 again, the projector 7490 includes a first lens 7492 and a second lens 7494. The first lens 7492 and the second lens 7494 signal communicate with the controller of the stapler 7400 and are configured to project at least one image onto the patient tissue. In a particular example, the first lens 7492 and the second lens 7494 project the same image. The first lens 7492 and the second lens 7494 are fixedly mounted within the projector 7490 so as to project an image at a common focal point, but these lenses produce an image (s) at different focal points. It can also be projected. In various embodiments, the orientation of the first lens 7492 and / or the orientation of the second lens 7494 can be adjusted to correct the focus. In at least one such embodiment, the projector 7490 has a first electric actuator system for reorienting the first lens 7492 and a second motorized actuator system for reorienting the second lens 7494. It is equipped with an electric actuator system.

In a particular example, in addition to the above, the first lens 7492 of the projector 7490 may be configured to project a first image onto the patient's tissue and the second lens 7494 may be a second, ie. It may be configured to project different images onto the patient's tissue. The controller of the stapler 7400 is configured to supply, modify, and / or modify the image projected by the first lens 7492 and / or the second lens 7494. In various examples, the images projected by the first lens 7492 and the second lens 7494 can present a two-dimensional image on the patient's tissue. In another example, the image projected by the first lens 7492 and the second lens 7494 can present a three-dimensional image on the patient tissue. Projecting a three-dimensional image can be facilitated by the lenses 7492 and 7494 being oriented or configurable in different directions.

Referring to FIG. 165, the stapler 7700 comprises a distal head 7720 located on the first side of the patient tissue T and an anvil 7760 located on the second side of the patient tissue T. Like the other staple fasteners disclosed herein, the staple device 7700 deploys the staple 7730 into the tissue T and incises the tissue T along the incision 7740 during a series of staple firing strokes. It is configured as follows. The stapler 7700 further comprises a projector 7770 configured to project the image I onto the tissue T. Image I of FIG. 165 represents the position of the next firing stroke that includes the two lateral regions to which the staple clusters are applied. Referring to FIG. 166, the image projected by the projector 7770 includes a line designating a staple firing path FP and / or a line designating an alternative staple firing path FP'. These lines can be, for example, solid and / or dashed lines. These lines may be the same color or different colors.

In addition to the above, the controller of the staple fastener 7700 is configured to modify the image projected by the projector 7770 as the staple fastener 7700 moves or marches along the staple firing path. The controller can continuously evaluate and determine where the next firing stroke should occur, and can continuously adapt the image projected by the staple fastener 7700. In various examples, the controller can update the projected image, for example, after each firing stroke. In some examples, the controller can use the projector 7770 to continuously project an image or series of images, while in other examples, the controller uses the projector 7770 to project one image. Alternatively, a series of images can be projected intermittently. In at least one example, the controller can use the projector 7770 to display an image before the staple fastener 7700 clamps the tissue. In such an example, the user of the staple fastener 7700 is given the opportunity to suspend or stop the staple fastener 7700 before the staple fastener 7700 makes another staple firing stroke.

Referring to FIG. 167, the stapler 7800 comprises a distal head 7820 located on the first side of the patient tissue T and an anvil 7860 placed on the second side of the patient tissue T. Like the other staple fasteners disclosed herein, the staple device 7800 deploys the staple 7830 into the tissue T and incises the tissue T along the incision 7840 during a series of staple firing strokes. It is configured as follows. The staple fastener 7800 further comprises a projector 7870 that includes a first lens 7782 and a second lens 7874. The first lens 7782 is _{configured to project the first image I 1} onto the patient tissue T, and the second lens 7874 is configured to project the _{second image I 2 onto the patient tissue T.} Has been done. Image I ₁ depicts the location of the next staple cluster and image I ₂ depicts the cutting path of the staple fastener 7800, but any suitable image may be projected. Images I ₁ and I ₂ can be, for example, solid and / or dashed lines. Image I ₁ may be the _{same color as image I 2} or may be a different color.

As mentioned above, the staple fasteners disclosed herein may include at least one projector for projecting an image onto the patient tissue and at least one camera for observing the patient tissue. With reference to FIGS. 163 and 164, the staple fastening device 7600 includes a shaft, a distal head, and a video system. The video system includes at least one image projector 7690 and a camera system 7670 that includes at least one camera communicating with the controller, such as, for example, a first camera 7672 and a second camera 7674. The first camera 7672 is oriented in the first direction and is focused on the first region F1 of the patient tissue, and the second camera 7674 is oriented in the second direction and is the first of the patient tissue. Focused on two, i.e. different regions F2. In various examples, the controller is configured to present both images simultaneously or at different times so that the user can toggle between the images on the surgical instrument display. In a particular example, the controller is configured to use images from the first and second cameras 7672 and 7674 to generate a composite image and present the composite image on the surgical instrument display.

In addition to the above, the first camera 7672 comprises a digital camera configured to supply a first digital video stream to the controller, and the second camera 7674 to supply a second digital video stream. It is equipped with a digital camera configured in. The camera system 7670 further comprises a first actuator system configured to move the first camera 7672 and / or a second actuator system configured to move the second camera 7674. .. In other embodiments, one or both of the orientations of the cameras 7672 and 7674 are fixed. In any case, the image I projected onto the patient tissue by the projector 7690 can be captured by the first camera 7672 and / or the second camera 7674 and by the user of the surgical instrument 7600 via the surgical instrument display. Visual recognition is possible.

In addition to the above, any of the projectors 7690 and / or the projectors disclosed herein are configured to emit light at any suitable wavelength. In various examples, the projector 7690 emits, for example, visible light, infrared light, and / or ultraviolet light. In particular, visible light is useful for clinicians to see the color of tissue as it reflects off the tissue. Red or pink tissue may indicate angiogenic healthy tissue and dark or black tissue may indicate unhealthy tissue. In addition to the above, the camera system 7670 is configured to capture, for example, visible light, infrared light, and / or ultraviolet light. Infrared light indicates the presence of heat from, for example, large blood vessels. Ultraviolet light indicates, for example, the presence of blood or bleeding. In addition to or instead of the above, the projector may be configured to emit sound waves, ultrasonic waves, and / or ultrasound, and the surgical instrument detects the waves reflected from the patient's tissue and the patient. It may include one or more acoustic sensors configured to generate data that can be used by the controller to generate a three-dimensional profile of the tissue.

Referring to FIG. 142, the staple fastening device described herein is configured to repeatedly fire staples into a patient's tissue, such as the patient's stomach S. Many of the staple fastening devices disclosed herein follow the desired or modified staple launch path FP while firing a staple, such as a staple 6630, into the patient's tissue and then staple. It is self-driving, self-propelled, and / or self-manipulating in that it is sufficiently electrified so that it can propel itself along the path FP. The staples are continuously ejected from the staple fastener as the staple fastener moves along the staple launch path FP. In various examples, the staple firing system of the staple fastener enters a pause between staple firing strokes while the staple fastener is being moved along the staple firing path. However, such pauses are part of the continuous operation of the staple fasteners. As mentioned above, with reference to FIG. 143, many of the staple fasteners described herein are configured to deploy a cluster of staples, such as staple cluster 6630', during each staple firing stroke. There is. Such staple clusters may contain any suitable number of staples, but each of the staple clusters 6630'shown in FIG. 143 contains three staples 6630 and are deployed on either side of the tissue incision 6640. ing. In at least one exemplary embodiment, seven staple clusters 6630'are deployed on each side of the tissue incision 6640, every inch of the staple firing path. In such an embodiment, 42 staples are deployed every inch, but any suitable number can be used. The staple fastener can continue to deploy the staple along the staple launch path without the need to remove the staple fastener from the patient as long as the staple is present within the staple fastener. In at least one example, the staple fastener can be used, for example, in 84-98 firings before reloading is required. Such launches can be deployed, for example, between 504-588 staples.

In addition to the above, many of the staple fasteners disclosed herein can swivel at least partially during staple firing. As a result, such staple fasteners can follow complex and / or non-linear staple firing paths. With reference to FIG. 174, conventional staple fasteners were configured to deploy, for example, a linear staple line portion 8230'consisting of staples 8230. An overlapping region 8235'inside the staple line portion 8230' was formed to swivel the staple line within the tissue. Such a configuration would form a dense staple 8230 within the overlapping region 8235', thereby highly compressing the tissue within the overlapping region 8235'. In addition, the overlapping region 8235'represents a sharp turn in the staple firing path that can form a potential leak path within the staple line. With reference to FIG. 175, the staple fasteners disclosed herein can swivel after each firing stroke, allowing for a more gradual swivel. For example, the staple fasteners can be swiveled after deploying each staple cluster 7930'and can be swiveled in that way without creating overlap between the staple clusters 7930'.

The stapled instruments disclosed herein can be used to perform any suitable surgical procedure. For example, referring to FIG. 179, the staple fastening device disclosed herein is used during a gastric bypass procedure to generate a gastric pocket SP, thereby effectively reducing the size of the patient's gastric S. Can be done. According to the stapler system disclosed herein, these staples can generate a curved staple pathway 7930'that produces a curved gastric pocket SP. Referring to FIG. 178, conventional staple fasteners have produced a staple path that includes a square gastric pocket SP, or a linear portion 8230'forming a gastric pocket SP with right-angled corners. The curved gastric pocket SP produced by the staple fastening device disclosed herein is believed to leak less than the linear gastric pocket SP produced by a conventional staple fastening device.

As described in more detail herein, with reference to FIG. 177, the staple fastening device disclosed herein produces a gastric sleeve SS, thereby effectively sizing the size of the patient's stomach S. Can be used during gastric shrinkage procedures to shrink. According to the stapler system disclosed herein, these staples can generate a curved staple path 7930'that produces a curved gastric sleeve SS. With reference to FIG. 176, conventional staple fasteners have resulted in a straight gastric sleeve SS, or a staple path containing a straight portion 8230' forming a gastric sleeve SS with right angled corners 8235'. .. The curved gastric sleeve SS produced by the staple fastening device disclosed herein is considered to leak less than the linear gastric sleeve SS produced by the conventional staple fastening device. Further details for producing the gastric sleeve SS are shown in FIG. 151, where the staple firing pathway FP is used to cut the gastric sleeve SS from the patient's stomach S.

In addition to the above, gastric bypass and gastric sleeve procedures assist in weight loss and are used to treat severe obesity. Both procedures serve to significantly reduce the size of the stomach in order to limit food intake. The gastric bypass procedure involves forming a small compartment in the stomach to receive food and block the rest of the stomach. In particular, limiting the size of the stomach serves to limit the amount of fat and calories absorbed by the patient's body. Gastric bypass procedures form a direct route from the gastric subdivision to the lower intestine. In such cases, as a result, this direct pathway would eliminate the use of the upper intestine in digestion.

The gastrosleeve procedure involves forming a sleeve-like pathway from the esophagus through the stomach to the upper intestine. Laparoscopic sleeve gastrectomy (LSG) is a type of gastric sleeve procedure that involves a transverse incision and sealing of most of the stomach to form a small gastric reservoir or pocket. Unlike gastric bypass procedures, LSG procedures have been found not to cause reduced absorption of nutrients and / or to rule out the use of any part of the intestine. However, the LSG procedure still works to significantly reduce the size of the patient's stomach. In such LSG procedures, a long, thin, flexible member, a bougie, can be used as a measuring tool. More specifically, a bougie may be used to determine or define the size and shape of the stomach that will become the stomach sleeve upon completion of the LSG procedure. Bougie B is shown in FIGS. 30 and 32. Bougies are manufactured in different sizes to accommodate different stomach sizes. The appropriate size of the bougie is often determined based on the size of the stomach and the size of the expected gastric sleeve. During the first step of the LSG procedure, the surgeon inserts a bougie through the patient's mouth, below the esophagus, and finally through the esophageal sphincter to reach the patient's stomach. When the bougie reaches the patient's stomach, the bougie is placed so that the end of the bougie reaches the pyloric canal, which is the lower region of the stomach connected to the pylorus.

FIG. 28 shows different parts of the gastric anatomy involved during the various steps of the LSG procedure. Specifically, FIG. 28 shows the stomach before the bougie B is inserted into the stomach S during the LSG procedure. As seen in FIG. 28, the net O, which is a bilayer of adipose tissue, is connected to the outer layer of the stomach S. The net O includes two parts, an omentum and a lesser omentum. The omentum serves to store fat deposits, and the lesser omentum connects the stomach S and intestines to the liver. The stomach S contains various shadowed areas based on the tissue thickness of the stomach S. The tissue thickness of the stomach S forms _{the first shadow S 1a} and the second shadow S _1b. The size and location of the shadows S _1a and S _1b vary based on the thickness of the stomach S. As further shown in FIG. 28, the first shadow S _1a appears along the larger curvature GC of the stomach S and the second shadow S _1b appears along the smaller curvature LC of the stomach S. ing. As described in more detail below, the shadows S _1a and S _1b are used to determine or estimate the thickness of the stomach S along the larger curvature GC and the smaller curvature LC, respectively. Once the thickness of the stomach S has been determined or estimated, that thickness is used to determine the appropriate size and placement of the bougie B with respect to the calculated shading line SL, as shown in FIG.

FIG. 33 shows another view of the anatomy of the stomach according to various embodiments. Similar to the anatomy of the stomach shown in FIG. 28, the tissue thickness of the stomach S forms a first shadow S ₁ and a second shadow S _2. Similar to the above description, the first shadow S ₁ occurs along the larger bend GC and the second shadow S ₂ occurs along the smaller bend LC. The first shadow S ₁ and the second shadow S ₂ intersect at a point S _3. In the stomach sleeve procedure, the position and the point S ₃ of the pylorus P _X, used to determine the position of the cutting line C ¹ that is shifted from the pylorus P _X at a distance A. As shown in FIG. 33 and described in more detail below, the sleeve diameter D is determined based on the estimated tissue thickness.

FIG. 152 shows different parts of the stomach involved during the various steps of the LSG procedure. Specifically, FIG. 152 shows the initial steps of the LSG procedure, where the bougie B is inserted into the stomach S. At the beginning of the LSG procedure, the surgeon inserts a bougie B through the patient's mouth, below the esophagus E, and finally through the esophageal sphincter to reach the patient's stomach. When the bougie B reaches the patient's stomach, the bougie B is placed so that the end of the bougie B fits within the pyloric canal PC and stops at the pyloric sphincter PS. Further, as shown in FIG. 152, the bougie B is configured to sit along the square notch AN of the smaller curved portion LC according to the shape and length of the stomach S. As described in more detail below with respect to FIG. 153, it has a magnetic property configured to interact with and guide the staple device 7100 along a predetermined path parallel to the bougie 7210. Bougie 7210 can be used.

Referring to Figure 152 again, bougie when placed in its final position, the distance D ¹ is measured along the antrum PA larger curvature GC. The distance D ¹ is used to determine the position of the pylorus P _x and is also used to determine the position of the cutting line C ¹ . The bougie 7210 illustrated in FIG. 153 generates one or more magnetic fields used to guide the staple fastener 7100 to the bougie 7210. Referring to FIG. 154, then stapling instrument 7100, in order to create a cut line ^{C 1,} to follow the magnetic field along a path adjacent to the bougie 7210. As a result, the cutting line C ^1, through the stomach S of the patient, extending upwardly in accordance with the shape and curvature of both the stomach S and bougie 7210. Cut line ^{C 1} is then to reach His angle AH, advances upward through the stomach S of the patient along a path adjacent to the bougie 7210. Once the cutting line C ¹ is established, the staple fastener 7100 applies staples, such as the staple 7130, to the tissue along both sides of the ^{cutting line C 1.} The rest of the stomach S, which is still in communication with the esophagus, is substantially the size and shape of the bougie 7210. A significant portion of the stomach S, which begins with pyloric antrum PA and ends with His angle AH, is excluded from involvement in the digestive process. The excluded portion of the stomach S is shown in more detail in FIG. 154 and includes a larger curved portion GC of the stomach S.

In some cases, the clinician can estimate the appropriate staple firing path in the patient's stomach by observing specific anatomical markers on the stomach and / or elsewhere within the surgical site. With reference to FIG. 152, staple fasteners disclosed herein, such as the staple fastener 7100, are configured to sense anatomical markers within the patient to determine the appropriate staple firing path. ing. In addition to the above, the staple fasteners disclosed herein include one or more cameras configured to sense or detect one or more anatomical markers, and the detected anatomical markers. A controller configured to calculate the staple firing path based on it may be provided. In at least one example, the stapler is configured to detect a smaller curve in the stomach and calculate a staple firing path within the gastric tissue that is parallel to, or at least substantially parallel to, the smaller curve of the stomach. ing. Other anatomical markers of the patient's stomach that can be detected and used to determine the staple firing pathway include, for example, horn notches, esophageal sphincter, His horn, pyloric sphincter, and / or pyloric antrum.

As mentioned above, smaller curves of the stomach can be used to determine the staple firing path. However, in various cases, the smaller curves are at least partially obscured by fat and / or connective tissue. However, for example, smaller curves, lesser omentums, and any overlap between smaller curves and lesser omentums can be visually distinguished. More specifically, the unobscured gastric tissue has a first color, the lesser omentum has a second color different from the first color, and the overlap between the two is It has a first color and a third color that is different from the second color. These colors are detectable by staple fasteners to determine the appropriate staple firing path. In certain examples, the color of the gastric tissue under the lesser omentum produces a shadow that can be detected by a stapler. Other methods may be used to determine the proper position of the staple firing path.

In addition to the above, the gastric sleeve SS formed during the gastric bypass procedure must have a sufficiently large digestive passage defined therein for the passage of food. As a result, referring here to FIG. 29, the staple firing pathway through the patient's stomach S must be sufficiently spaced from the smaller curve of the stomach to form a sufficient digestive pathway D. The staple fastening device disclosed herein detects a smaller curve of the stomach and calculates a staple launch path _{, for example, a staple launch path SP 1 that is a distance X away from the edge of the stomach S.} , Can be configured. In another example, the staple fastening device disclosed herein detects a lesser omentum LO bounded by a smaller curve of the stomach, eg, a staple launch path SP ₁ is defined or defined from the edge of the stomach S. It may be configured to calculate as being separated by a predetermined distance X.

As mentioned above, it can be difficult to detect the edge of the stomach S. In certain examples, the stapled devices disclosed herein are camera systems configured to observe gastric tissue color and / or gastric tissue color changes to determine the margin of the stomach S. Can be equipped. In various examples, the stapled devices disclosed herein may be configured to detect the margin of the stomach by assessing changes in gastric tissue thickness and / or gastric tissue thickness. The tissue of the patient's stomach is typically thinner around the periphery or edges of the stomach than in the center of the stomach, and the color of the stomach tissue is often a function of its thickness. It recognized. In other words, the tissue around the periphery of the stomach appears to have a shaded or darker color due to its thinner thickness. The shaded area _{S 1} is bounded by the distance _{Z 1} in FIG. 29. The distance Z ₁ also demarcates the transition from the thinner tissue of the stomach S _{to the region T 1 of total tissue thickness.} In various examples, the surgical instruments disclosed herein determine the staple launch path SP _{1 by establishing, for example, the staple launch path SP 1} at a specific distance from the shadow region S _1. Can be configured in. In at least one embodiment, surgical instrument, for example, it is possible to establish the staple firing path SP ₁ apart by a specific distance from the midpoint between the reticulum LO and the edge of the shadow area S _1.

In addition to the above, the staple fastener controller disclosed herein may include an edge detection algorithm. The edge detection algorithm is configured to sense a first light intensity at a first position and a second light intensity at a second position on the gastric tissue. The edge detection algorithm calculates a first light intensity value for a first light intensity and a second light intensity value for a second light intensity, and then sets the first light intensity value as a second light intensity value. It is further configured for comparison. Light intensity values can be on the scale of 1-100, where, for example, lower values represent darker tissue and higher values represent brighter tissue. The first and second positions establish a sample line from which additional samples can be taken to establish the intensity gradient. To achieve this goal, the edge detection algorithm senses a third light intensity at a third position along the sample line, determines a third light intensity value at the third position, and a third. It is further configured to compare the light intensity value with the first light intensity value and the second light intensity value. The first position, the second position, and the third position are sequentially positioned along the sample line, and the algorithm states that the first light intensity value is higher than the second light intensity value. If the algorithm determines that it is large and the second light intensity value is greater than the third light intensity value, then the algorithm then, for example, has a shading gradient between the first and third positions. It can be determined that the third position is closer to the edge of the gastric tissue than the first position. This method can be applied on a very large scale to map the shading and / or color gradient of the entire gastric tissue or at least a portion of the gastric tissue.

As mentioned above, the thickness of gastric tissue can affect the color or shading of gastric tissue. Therefore, a stomach with thicker tissue (FIG. 29) will typically have a different color and / or shading than a stomach with thinner tissue (FIG. 31). Thinner tissue of Figure 31 has a shaded area S ₂ which bounded by the distance Z _2. The distance Z ₂ is also partitioned boundary of the transition to the area T ₂ of the total tissue thickness from thinner tissue of the stomach S _2. In various examples, a surgical instrument is disclosed herein, for example, by establishing apart by a certain distance staple firing path SP ₂ from the shaded area S _2, to determine the staple firing path SP ₂ Can be configured in. In at least one embodiment, surgical instrument, for example, can be from the midpoint between the reticulum LO ₂ and the edge of the shadow area S ₂ apart by a specific distance establishing a staple firing path SP _2.

The staple launch path SP ₁ establishes a first sleeve profile, and the staple launch path SP ₂ establishes a second sleeve profile that is different from the first sleeve profile. The first sleeve profile has a first width X and the second sleeve profile has a second width Y that is different from the width X. Regardless of the sleeve profile produced by the staple fasteners disclosed herein, the tissue drive system of the staple fasteners will propel the staple fasteners along the staple firing path forming the desired gastric sleeve. It is configured in. Such staple fasteners are configured to identify anatomical markers and steer the staple fasteners themselves towards, away from, and / or parallel to one or more anatomical markers. obtain.

In addition to the above, referring to FIG. 153, the staple fastening device 7100 includes a shaft 7110, a distal head 7120, and an articulation joint 7170 that rotatably connects the distal head 7120 to the shaft 7110. .. The staple fastener 7100 makes an incision in the patient's stomach along path C1 and applies three rows of staples 7130 to each side of path C1. As mentioned above, the bougie 7210 is configured to guide the staple fastener 7100 along the staple launch path. More specifically, the bougie 7210 is configured to emit one or more magnetic fields that can be detected by the staple fastener 7100 and then used by the staple fastener 7100 to determine the staple firing path. .. In at least one example, the bougie 7210 emits a strong magnetic field SMF and a weak magnetic field WMF, which, when emitted, are emitted along the length of the bougie 7210. Notably, the weak magnetic field WMFs are alternately arranged in the middle of the strong magnetic field SMFs.

Referring to FIG. 154, the staple fastening device 7100 comprises one or more sensors configured to detect a strong magnetic field SMF and a weak magnetic field WMF, such as a Hall effect sensor. The sensor communicates with the controller of the staple fastener 7100, which uses the data from the sensor to detect the configuration of the strong magnetic field SMF and the weak magnetic field WMF, and sets the staple firing path to the magnetic field SMF and WMF. It can be aligned so that the staple fastening device 7100 follows the bougie 7210 to generate the desired gastric sleeve profile. In at least one example, the strength of the strong magnetic field SMF is, for example, twice that of the weak magnetic field WMF. In another example, the strength of the strong magnetic field SMF is 50% stronger than, for example, the strength of the weak magnetic field WMF.

With reference to FIGS. 155 and 157, the bougie 7210 includes an inner flexible core 7212 and a plurality of conductor windings configured to emit the magnetic fields SMF and WMF described above. The flexible core 7212 is composed of, for example, a non-conductive material, or at least a substantially non-conductive material such as rubber. The flexible core 7212 is solid, but may include a tube. The conductor winding includes a winding circuit 7214 that emits a weak magnetic field WMF and a winding circuit 7216 that emits a strong magnetic field SMF. The winding circuit 7214 has fewer turns than the winding circuit 7216 and produces a weaker magnetic field than the winding circuit 7216 for a given current. Each winding circuit 7214 comprises a conductive wire that is wound around an inner flexible core 7212 and communicates with the controller of the bougie 7210. Each winding circuit 7214 is different from the other winding circuits 7214, and is also different from the winding circuit 7216. Similarly, each winding circuit 7216 is different from the other winding circuits 7216 and is also different from the winding circuit 7214. Each conductive wire comprises an inner conductive core and an insulating jacket that extends around the conductive core. In an alternative embodiment, the conductive wire comprises a conductive core embedded in the flexible core 7212. In each case, the bougie 7210 comprises an outer jacket 7218, the outer jacket of which is configured to seal the contents therein to prevent or prevent fluid from entering the bougie 7210.

In use, in addition to the above, a voltage source is applied to the winding circuits 7214 and 7216. The voltages applied to the winding circuits 7214 and 7216 are the same, or at least substantially the same. Alternatively, a first voltage is applied to the winding circuit 7214 and a second, or different, voltage is applied to the winding circuit 7216. In various alternative embodiments, the winding circuits 7214 are not separate circuits, but rather they are part of one long circuit, with a single current flowing through each of the winding circuits 7214. Similarly, in various alternative embodiments, the winding circuits 7216 are not separate circuits, but rather they are part of one long circuit and a single current passes through each of the winding circuits 7216. Flows. In any case, the winding circuits 7214 and 7216 emit a magnetic field that extends around the entire circumference of the bougie 7210, so that the bougie 7210 is in any suitable mode for performing the surgical procedure described above. Can be oriented or rotated in.

As mentioned above, the bougie 7210 uses electricity to generate a magnetic field. In various alternative embodiments, the bougie may be equipped with a permanent magnet that produces a magnetic field. In at least one example, the bougie comprises a strong permanent magnet that produces a strong magnetic field and a weak permanent magnet that produces a weak magnetic field. In at least one such example, the strong and weak permanent magnets are arranged alternately to produce, for example, the alternating strong and weak magnetic field SMFs shown in FIG. 154. That said, bougie can generate one or more magnetic fields in any suitable manner.

Referring to FIG. 156, the bougie 7310 comprises an inner flexible core 7312 and a plurality of conductor windings configured to emit the magnetic fields SMF and WMF described above. The flexible core 7312 is composed of, for example, a non-conductive material, or at least a substantially non-conductive material such as rubber. The conductor winding includes a winding circuit 7314 configured to emit a weak magnetic field WMF and a winding circuit 7316 configured to emit a strong magnetic field SMF. The winding circuit 7314 has fewer turns than the winding circuit 7316 and will generate a weaker magnetic field than the winding circuit 7316 for a given current. Each winding circuit 7314 comprises a conductive wire that is wound around an inner flexible core 7312 and communicates with the controller of the bougie 7310. The windings of circuit 7314 are more compact, i.e., denser than the windings of circuit 7214. For example, the windings of circuit 7214 extend longitudinally as they wrap around the core 7212, whereas the windings of circuit 7314 do not extend longitudinally, or at least substantially. .. Similarly, the windings of circuit 7316 are more compact, i.e., denser than the windings of circuit 7216. High density or compact windings can produce, for example, a dense or compact magnetic field that is more identifiable to the staple fastener 7100.

While the surgical instrument systems described herein are powered by electric motors, the surgical instrument systems described herein can operate in any suitable manner. In certain embodiments, the motors disclosed herein may include parts of a robotic control system. For example, U.S. Patent Application No. 13 / 118,241, the title of the invention "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS", now U.S. Pat. No. 9,072,535 is some examples of robotic surgical instrument systems. Is disclosed in more detail.

The surgical instrument systems described herein have been described in the context of staple deployment and deformation. However, the embodiments described herein are not limited to this. Various embodiments are envisioned for deploying fasteners other than staples, such as clamps or tacks. In addition, various embodiments are envisioned that utilize any suitable means for sealing the tissue. For example, end effectors according to various embodiments may include electrodes configured to heat and seal the tissue. Further, for example, an end effector according to a particular embodiment can apply vibrational energy to seal the tissue.

Example 1-A surgical stapler for stapling a patient's tissue, a handle, a shaft extending from the handle, an end effector, an anvil with a tissue compression surface and a staple molding pocket. Surgical stapler with an anvil, with an end effector, which is movable towards the tissue compression surface during closing motion. Surgical staplers are an electric drive system with a rotatable drive shaft and an anvil closure system configured to move the anvil through a closing motion, operably coupled to the rotatable drive shaft. Anvil closure system and a propulsion system configured to move end effectors to patient tissue during propulsion motion, operably connected to a rotatable drive shaft, and propulsion motion into closed motion. It is further equipped with a propulsion system that is rampant against it.

Example 2-The end effector further comprises a staple cartridge containing a plurality of staples that are detachably stored inside, and the surgical stapler further comprises a firing system configured to deploy the staples along the firing path. The surgical stapler according to Example 1.

Example 3-The surgical stapler according to Example 1 or 2, wherein the end effector further comprises an end effector axis and the closing motion is along the end effector axis.

Example 4-The surgical stapler according to Example 3, wherein the propulsion motion traverses the end effector axis.

Example 5-The surgical stapler according to Example 1, 2, 3, or 4, wherein the closure motion is linear.

Example 6-The surgical stapler according to Example 1, 2, 3, 4, or 5, wherein the propulsion motion is linear.

Example 7-In Example 1, 2, 3, 4, 5, or 6, the anvil closure system is configured to move the anvil through open motion to move the anvil away from the tissue compression surface. Described surgical stapler.

Example 8-The surgical stapler according to Example 1, 2, 3, 4, 5, 6, or 7, further comprising a synchronization mechanism that repeatedly produces a closing motion and a propulsion motion in sequence. ..

Example 9-The surgical stapler according to Example 8, wherein the synchronization mechanism is configured to cause a pause between the closing motion and the propulsion motion.

Example 10-The anvil closure system is configured to move the anvil through an open motion, moving the anvil away from the tissue compression surface, and the synchronization mechanism is an open motion between the closure motion and the propulsion motion. The surgical stapler according to Example 8 or 9, which is configured to perform.

Example 11-The anvil closure system comprises an anvil drive member, the propulsion system comprises a tissue drive member, and the anvil drive member and the tissue drive member extend into the shaft, Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 surgical stapler.

Example 12-A surgical instrument for treating a patient's tissue, a handle, a shaft extending from the handle, an end effector, an electric drive system, a rotatable drive shaft and a synchronization mechanism. With an electric drive system, and with a surgical instrument. The surgical instrument is a first drive system configured to perform a first end effector drive motion, the first drive system operably coupled to a rotatable drive shaft. A second drive system configured to perform a second end effector drive motion, operably coupled to a rotatable drive shaft, the synchronization mechanism with the first end effector drive motion. It further comprises a second drive system in which a second end effector drive motion is iteratively generated in sequence, and the second end effector drive motion traverses the first end effector drive motion.

Example 13-The surgical instrument according to Example 12, wherein the synchronization mechanism is configured to cause a pause between the first end effector drive motion and the second end effector drive motion.

Example 14-The first drive system is configured to perform additional end effector drive motion, and a synchronization mechanism is added between the first end effector drive motion and the second end effector drive motion. The surgical instrument according to Example 12 or 13, which is configured to perform a robotic end effector driven motion.

Example 15-The surgical instrument according to Example 12, 13, or 14, wherein the end effector comprises a staple cartridge.

Example 16-The end effector comprises an anvil with a tissue compression surface and a stapled pocket that is movable towards the tissue compression surface during a closing motion, Examples 12, 13, 14. The surgical instrument according to 14.

Example 17-1 The first drive system comprises an anvil closure system configured to move the anvil to result in a first end effector drive motion, the second drive system delivering the end effector to the patient tissue. The surgical instrument according to Example 16, comprising a propulsion system configured to move and move to provide a second end effector drive motion.

Example 18-A surgical instrument for treating a patient's tissue, comprising a handle, a shaft extending from the handle, an end effector, and an electric drive system. The surgical instrument is a first drive system configured to perform a first end effector drive motion, a first drive system operably linked to an electric drive system, and a second. A second drive system configured to perform the end effector drive motion of, the second drive system operably linked to the electric drive system, and the first end effector drive motion and the first. Further, a synchronization means for repeatedly generating the end effector drive motions of 2 in order is provided.

Example 19-The surgical instrument according to Example 18, wherein the end effector comprises a staple cartridge.

20-The surgical instrument according to Example 18 or 19, wherein the second end effector drive motion is rampant relative to the first end effector drive motion.

The entire disclosure below is incorporated herein by reference.
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Although various devices have been described herein with specific embodiments, modifications and modifications may be made to those embodiments. Specific features, structures or features may be combined in any suitable manner in one or more embodiments. Thus, a particular mechanism, structure, or feature illustrated or described with respect to an embodiment may be combined, in whole or in part, with the mechanism, structure, or feature of one or more other embodiments indefinitely. You can. Also, although the material is disclosed for a particular component, other materials may be used. Further, according to various embodiments, a single component may be replaced with multiple components to perform a given function (s), and multiple components may be combined into a single component. It may be replaced. The above description and the following claims are intended to include all such modifications and variations.

The devices disclosed herein may be designed to be discarded after a single use, or may be designed to be used multiple times. However, in either case, the device can be readjusted for reuse after at least one use. The readjustment can include, but is not limited to, any combination of a device disassembly step, a subsequent cleaning or replacement step of a particular part of the device, and a subsequent device reassembly step. Specifically, the readjustment facility and / or surgical team may disassemble the device, clean and / or replace certain parts of the device, and then reassemble the device for subsequent use. Can be done. Those skilled in the art will appreciate that readjustment of the device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting readjusted devices, are all within the scope of this application.

The devices disclosed herein can be processed prior to surgery. First, new or used utensils can be obtained and cleaned if necessary. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic bag or TYVEK bag. The vessel and instrument can then be placed in a radiation field that can penetrate the vessel, such as gamma rays, X-rays, and / or high energy electrons. Radiation can kill bacteria on instruments and in containers. After this, the sterilized instrument can be stored in a sterilized container. The sealed container can keep the instrument sterile until it is opened in a medical facility. The device may also be sterilized using any other technique known in the art, including but not limited to β-rays, gamma-rays, ethylene oxide, hydrogen peroxide plasma, and / or water vapor.

Although the present invention has been described as having a representative design, the present invention may be further modified within the spirit and scope of the present disclosure. Accordingly, this application shall include any modification, use, or adaptation of the invention that uses its general principles.

Any patent, publication, or other disclosed document, in whole or in part, which is incorporated herein by reference, is an existing definition, opinion, or other disclosure in which the material to be incorporated is described in this disclosure. It is incorporated herein only to the extent that it is consistent with the content. As such, and to the extent necessary, the disclosures expressly set forth herein shall supersede any contradictory statements incorporated herein by reference. Any content, or portion thereof, which is incorporated herein by reference but is inconsistent with the current definitions, views, or other disclosures set forth herein, is incorporated and current. It shall be incorporated only to the extent that there is no contradiction with the disclosed content of.

[Implementation]
(1) A surgical stapler for stapling a patient's tissue.
With the handle
A shaft extending from the handle and
It ’s an end effector,
Tissue compression surface and
An end effector comprising an anvil with a stapled pocket that is movable towards the tissue compression surface during a closing motion.
An electric drive system with a rotatable drive shaft and
An anvil closure system configured to move the anvil through the closure motion, which is operably coupled to the rotatable drive shaft.
A propulsion system configured to move the end effector relative to the patient tissue during propulsion motion, operably connected to the rotatable drive shaft, the propulsion motion relative to the closing motion. Surgical stapler with a rampant propulsion system.
(2) The end effector further comprises a staple cartridge containing a plurality of staples that are detachably stored inside, and the surgical stapler is a firing system configured to deploy the staples along a firing path. The surgical stapler according to embodiment 1, further comprising.
(3) The surgical stapler according to the first embodiment, wherein the end effector further includes an end effector axis, and the closing motion is along the end effector axis.
(4) The surgical stapler according to the third embodiment, wherein the propulsion motion traverses the end effector axis.
(5) The surgical stapler according to the first embodiment, wherein the closing motion is linear.

(6) The surgical stapler according to the first embodiment, wherein the propulsion motion is linear.
(7) The surgical stapler according to embodiment 1, wherein the anvil closure system is configured to move the anvil through an open motion to move the anvil away from the tissue compression surface.
(8) The surgical stapler according to the first embodiment, wherein the electric drive system further includes a synchronization mechanism that repeatedly generates the closing motion and the propulsion motion in order.
(9) The surgical stapler according to embodiment 8, wherein the synchronization mechanism is configured to cause a pause between the closing motion and the propulsion motion.
(10) The anvil closing system is configured to move the anvil through an open motion to move the anvil away from the tissue compression surface, and the synchronization mechanism comprises the closing motion and the propulsion motion. The surgical stapler according to embodiment 8, which is configured to perform the open motion between and.

(11) The first embodiment, wherein the anvil closing system includes an anvil drive member, the propulsion system includes a tissue drive member, and the anvil drive member and the tissue drive member extend into the shaft. Surgical stapler.
(12) A surgical instrument for treating a patient's tissue.
With the handle
A shaft extending from the handle and
With the end effector,
An electric drive system with a rotatable drive shaft and a synchronization mechanism,
A first drive system configured to perform a first end effector drive motion, the first drive system operably coupled to the rotatable drive shaft.
A second drive system configured to perform a second end effector drive motion, operably coupled to the rotatable drive shaft, the synchronization mechanism of the first end effector. A second drive system, in which the drive motion and the second end effector drive motion are repeatedly generated in sequence, and the second end effector drive motion traverses the first end effector drive motion. Surgical instruments equipped with.
(13) The surgical instrument according to embodiment 12, wherein the synchronization mechanism is configured to cause a pause between the first end effector drive motion and the second end effector drive motion.
(14) The first drive system is configured to perform an additional end effector drive motion, and the synchronization mechanism comprises the first end effector drive motion and the second end effector drive motion. 12. The surgical instrument according to embodiment 12, configured to perform the additional end effector driven motion in between.
(15) The surgical instrument according to embodiment 12, wherein the end effector includes a staple cartridge.

(16) The end effector is
Tissue compression surface and
12. The surgical instrument according to embodiment 12, comprising an anvil comprising a stapled pocket that is movable towards the tissue compression surface during a closing motion.
(17) The first drive system includes an anvil closure system configured to move the anvil to bring about the first end effector drive motion, and the second drive system includes the end effector. 16. The surgical instrument according to embodiment 16, comprising a propulsion system configured to move relative to the patient tissue to result in the second end effector driven motion.
(18) A surgical instrument for treating a patient's tissue.
With the handle
A shaft extending from the handle and
With the end effector,
Electric drive system and
A first drive system configured to perform a first end effector drive motion, the first drive system operably linked to the electric drive system.
A second drive system configured to perform a second end effector drive motion, the second drive system operably linked to the electric drive system.
A surgical instrument comprising a synchronization means for repeatedly generating the first end effector drive motion and the second end effector drive motion in sequence.
(19) The surgical instrument according to embodiment 18, wherein the end effector includes a staple cartridge.
(20) The surgical instrument according to embodiment 18, wherein the second end effector drive motion traverses the first end effector drive motion.

Claims (20)

A surgical stapler for stapling patient tissue
With the handle
A shaft extending from the handle and
It ’s an end effector,
Tissue compression surface and
An end effector comprising an anvil with a stapled pocket that is movable towards the tissue compression surface during a closing motion.
An electric drive system with a rotatable drive shaft and
An anvil closure system configured to move the anvil through the closure motion, which is operably coupled to the rotatable drive shaft.
A propulsion system configured to move the end effector relative to the patient tissue during propulsion motion, operably connected to the rotatable drive shaft, the propulsion motion relative to the closing motion. Surgical stapler with a rampant propulsion system. The end effector further comprises a staple cartridge containing a plurality of staples that are detachably stored therein, and the surgical stapler further comprises a launch system configured to deploy the staples along a launch path. , The surgical stapler according to claim 1. The surgical stapler according to claim 1, wherein the end effector further comprises an end effector axis, and the closing motion is along the end effector axis. The surgical stapler according to claim 3, wherein the propulsion motion traverses the end effector axis. The surgical stapler according to claim 1, wherein the closing motion is linear. The surgical stapler according to claim 1, wherein the propulsion motion is linear. The surgical stapler according to claim 1, wherein the anvil closure system is configured to move the anvil through an open motion to move the anvil away from the tissue compression surface. The surgical stapler according to claim 1, wherein the electric drive system further includes a synchronization mechanism that repeatedly generates the closing motion and the propulsion motion in order. The surgical stapler according to claim 8, wherein the synchronization mechanism is configured to cause a pause between the closing motion and the propulsion motion. The anvil closure system is configured to move the anvil through an open motion to move the anvil away from the tissue compression surface, and the synchronization mechanism is between the closure motion and the propulsion motion. The surgical stapler according to claim 8, which is configured to perform the opening motion. The surgical stapler according to claim 1, wherein the anvil closure system comprises an anvil drive member, the propulsion system comprises a tissue drive member, and the anvil drive member and the tissue drive member extend into the shaft. .. A surgical instrument for treating a patient's tissue
With the handle
A shaft extending from the handle and
With the end effector,
An electric drive system with a rotatable drive shaft and a synchronization mechanism,
A first drive system configured to perform a first end effector drive motion, the first drive system operably coupled to the rotatable drive shaft.
A second drive system configured to perform a second end effector drive motion, operably coupled to the rotatable drive shaft, the synchronization mechanism of the first end effector. A second drive system, in which the drive motion and the second end effector drive motion are repeatedly generated in sequence, and the second end effector drive motion traverses the first end effector drive motion. Surgical instruments equipped with. The surgical instrument according to claim 12, wherein the synchronization mechanism is configured to cause a pause between the first end effector drive motion and the second end effector drive motion. The first drive system is configured to perform an additional end effector drive motion, and the synchronization mechanism is said to be between the first end effector drive motion and the second end effector drive motion. 12. The surgical instrument according to claim 12, which is configured to perform an additional end effector driven motion. The surgical instrument according to claim 12, wherein the end effector includes a staple cartridge. The end effector is
Tissue compression surface and
12. The surgical instrument of claim 12, comprising an anvil comprising a stapled pocket that is movable towards the tissue compression surface during a closing motion. The first drive system comprises an anvil closure system configured to move the anvil to result in the first end effector drive motion, the second drive system moving the end effector to the patient tissue. 16. The surgical instrument of claim 16, comprising a propulsion system configured to move relative to and provide the second end effector drive motion. A surgical instrument for treating a patient's tissue
With the handle
A shaft extending from the handle and
With the end effector,
Electric drive system and
A first drive system configured to perform a first end effector drive motion, the first drive system operably linked to the electric drive system.
A second drive system configured to perform a second end effector drive motion, the second drive system operably linked to the electric drive system.
A surgical instrument comprising a synchronization means for repeatedly generating the first end effector drive motion and the second end effector drive motion in sequence. The surgical instrument of claim 18, wherein the end effector comprises a staple cartridge. The surgical instrument according to claim 18, wherein the second end effector drive motion traverses the first end effector drive motion.

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