JP7087122B2 - Surgical instrument with gradual rotary drive system - Google Patents

Description

The present invention relates to surgical instruments and, in various embodiments, to surgical staple fastening and cutting instruments, as well as staple cartridges used with them.

Staple fasteners can include a pair of collaborative elongated jaw members, each jaw member being inserted into the patient and adapted to be positioned against the tissue to be stapled and / or incised. can. In various embodiments, one of the jaw members can support a staple cartridge containing at least two rows of laterally spaced staples, and the other jaw member is a staple in the staple cartridge. Anvils with staple-forming pockets aligned with rows can be supported. In general, staple fasteners further include a push bar and knife blade that are slidable with respect to the jaw member, via a cam surface on the push bar and / or a cam surface on the wedge thread that is pushed by the push bar. Staples can be continuously ejected from the staple cartridge. In at least one embodiment, the staples are pushed against the anvil and held by a cartridge to form a laterally spaced row of deformed staples within the tissue gripped between the jaw members, with the staples. The cam surface can be formed to actuate multiple associated staple drivers. In at least one embodiment, the knife blade follows the cam surface and is capable of cutting tissue along the lines between the staple rows.

The above discussion is intended only to explain various aspects of the art in the field of the invention at the time and should not be regarded as denying the claims.

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.
Longitudinal cross-sectional view of the end effector of a surgical instrument system shown in an open or unclamped configuration, which includes staple cartridges, staples detachably housed in staple cartridges, and staples. Includes anvils configured to transform. FIG. 1 is a longitudinal sectional view of the end effector of FIG. 1, shown in a closed or clamped configuration, showing a launching member in a pre-launch position prior to firing the staples. FIG. 1 is a longitudinal sectional view of the end effector of FIG. 1, showing the launching member of the end effector in a partially fired position. FIG. 1 is a longitudinal sectional view of the end effector of FIG. 1, showing a launching member in a retracted position. It is sectional drawing in the longitudinal direction of the end effector of FIG. 1, and shows the end effector of the structure which opened again. FIG. 3 is a perspective view of a surgical staple system comprising an end effector according to at least one embodiment. FIG. 6 is a partial cross-sectional perspective view of the end effector of FIG. FIG. 6 is a partial cross-sectional elevation view of the end effector of FIG. 6, showing an end effector in an open, unfired configuration. Another partial cross-sectional elevation view of the end effector of FIG. 6 shows an end effector closure system in an open configuration and an end effector launch system in an unlaunched configuration. FIG. 6 is a partially cross-sectional elevation view of the end effector of FIG. 6, showing a closed system in a partially closed configuration and a launch system in a non-launch configuration. FIG. 6 is a partial cross-sectional elevation view of the end effector of FIG. 6, showing a closed system in a completely closed configuration and a launch system in a partially fired configuration. FIG. 6 is a partial cross-sectional elevation view of the end effector of FIG. 6, showing a closed system in a completely closed configuration and a launch system in a fully fired configuration. FIG. 6 is a partial cross-sectional elevation view of the end effector of FIG. 6, showing a closed system in a completely closed configuration and a launch system in a completely retracted configuration. FIG. 6 is a partial cross-sectional elevation view of the end effector of FIG. 6, showing a closed system on its way back to an open configuration and a launch system in a fully retracted configuration. FIG. 3 is a partial cross-sectional elevation view of an end effector comprising a staple firing system configured to compensate for the non-flat gap between the anvil and the end effector staple cartridge according to at least one embodiment. Longitudinal cross-sectional view of the end effector of a surgical instrument system shown in an open or unclamped configuration, which includes staple cartridges, staples detachably housed in staple cartridges, and staples. Includes anvils configured to transform. Longitudinal section of a portion of the end effector of FIG. 16 showing a portion of the anvil in cross section, with the closure nut in the open position in the initial position and the launch nut in the pre-launch position at the start. ing. Another longitudinal sectional view of the end effector of FIG. 17 shows an overall view of the anvil portion. Another longitudinal cross-section of a portion of the end effector of FIG. 17, with a portion of the anvil shown in section, with the closure nut in the "middle" fully closed position and the launch nut in the neutral launch range. It is in the pre-launch position located at the distal end of. Another longitudinal sectional view of a portion of the end effector of FIG. 19 shows an overall view of the anvil portion. Another longitudinal sectional view of a portion of the end effector of FIG. 19, the firing nut is at the end position after the staples have been launched from the staple cartridge, and a portion of the anvil is shown in cross section. Another longitudinal sectional view of a portion of the end effector of FIG. 21 shows an overall view of the anvil portion. FIG. 3 is a partial cross-sectional top view of a portion of a surgical instrument shaft assembly in a configuration in which actuator members are engaged. FIG. 23 is another partial cross-sectional elevation view of the shaft assembly of FIG. Another partial cross-sectional top view of the shaft assembly of FIGS. 23 and 24, showing a state in which the locking system is in a "pre-locking configuration". FIG. 25 is a partial cross-sectional elevation view of the shaft assembly of FIG. Another partial cross-sectional top view of the shaft assembly of FIGS. 23-26, wherein the actuator member is in a non-engaged configuration and the locking system is in a locked configuration. FIG. 27 is a partial cross-sectional elevation view of the shaft assembly of FIG.

Throughout the drawings, the corresponding reference numerals indicate the corresponding members. 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. do not have.

The applicant of the present application owns the following patent applications filed on the same day as the present application, each of which is incorporated herein by reference in its entirety:
-US Patent Application No. ________, Title of the Invention "STAPLING END EFFETURED TO COMPENSATE FOR AN UNEVEN GAP BETWEEEN A FIRST JAW AND A SECOND No. 1/475
-US Patent Application No. ________, title of invention "SURGICAL INSTRUMENT WITH SELECTIVELY DISENGAGEABLE THREADED DRIVE SYSTEMS", agent reference number END7554USNP / 140479.

The applicant of this application owns the following patent applications filed on March 6, 2015, each of which is incorporated herein by reference in its entirety:
-US Patent Application No. 14 / 640,746, Invention Title "POWERED SURGICAL INSTRUMENT",
-US Pat.
-US Pat.
-US Patent Application No. 14 / 640,935, title of invention "OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE SYSTEMSION",
-US Patent Application No. 14 / 640,831, Title of the Invention "MONITORING SPEED CONTROLL AND PRECISION INCREMENTING OF MOTOR FOR FOR POWERED SURGICAL INSTRUMENTS",
-US Patent Application No. 14 / 640,859, title of invention "TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINE STABILITY, CREEP, AND VISCOELASTIC ELEMENTS OF MEASURES",
-US Patent Application No. 14 / 640,817, Title of Invention "INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS",
-US Patent Application No. 14 / 640,844, title of invention "CONTROL TECHNIQUES AND SUB-PROCESSOR COUNTAINED WITHIN MODELAR SHAFT WITH SELECT CONTROLL PROCESSING FROM HANDLE",
-US Patent Application No. 14 / 640,837, Invention Title "SMART SENSORS WITH LOCAL SIGNAL PROCESSING",
-US Patent Application No. 14 / 640,765, title of invention "SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A SURGICAL STAPLER",
-US Patent Application No. 14 / 640,799, title of invention "SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON A ROTATABLE SHAFT", and-US Patent Application No. 14 / 640,780, title of invention "SURGICAL INSTRUME" BATTERY HOUSING ".

The applicant of this application owns the following patent applications filed on February 27, 2015, each of which is incorporated herein by reference in its entirety:
-US Patent Application No. 14 / 633,576, Title of Invention "SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSTECTION STATION",
-US Pat.
-US Patent Application No. 14 / 633,576, Invention Title "SURGICAL CHARGING SYSTEM THAT CHARGES AND / OR CONDITIONS ONE OR MORE BATTERIES",
-US Patent Application No. 14 / 633,566, Invention Title "CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A BATTERY",
-US Patent Application No. 14 / 633,555, Invention Title "SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TO BE SERVICED",
-US Patent Application No. 14 / 633,542, title of invention "REINFORCED BATTERY FOR A SURGICAL INSTRUMENT",
-US Patent Application No. 14 / 633,548, Title of Invention "POWER ADAPTER FOR A SURGICAL INSTRUMENT",
-US Patent Application No. 14 / 633,526, Invention Title "ADAPTABLE SURGICAL INSTRUMENT HANDLE",
-US Patent Application No. 14 / 633,541, Invention Name "MODULAR STAPLING ASSEMBLY", and-US Patent Application No. 14 / 633,562, Invention Name "SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER"".

The applicant of the present application owns the following patent applications filed on 18 December 2014, each of which is incorporated herein by reference in its entirety:
-US Pat.
-US Patent Application No. 14 / 574,483, Invention Title "SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS",
-US Patent Application No. 14 / 575,139, Title of Invention "DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS",
-US Patent Application No. 14 / 575,148, Title of Invention "LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLEES WITH ARTICULATABLE SURGICAL END EFFECTORS",
-US Pat.
-US Patent Application No. 14 / 575,143, Invention Title "SURGICAL INSTRUMENTS WITH IMPROVEED CLOSE ARRANGEMENTS",
-US Patent Application No. 14 / 575,117, title of invention "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS",
-US Patent Application No. 14 / 575,154, title of invention "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAM SUPPORT ARRANGEMENTS",
-US Patent Application No. 14 / 574,493, title of invention "SURGICAL INSTRUMENT ASSIMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM", and-US Patent Application No. 14 / 574,500, title of invention "SURGICAL SYSTEM ".

The applicant of the present application owns the following patent applications filed on March 1, 2013, each of which is incorporated herein by reference in its entirety:
-US Pat.
-US Patent Application No. 13 / 782,323, Invention Title "Rotary Powered Articulation Joints For Surgical Instruments", now US Patent Application Publication No. 2014/0246472,
-US Patent Application No. 13 / 782,338, Invention Title "Thumbwheel Switch Arrangements For Surgical Instruments", now US Patent Application Publication No. 2014/0249557,
-US Patent Application No. 13 / 782,499, Invention Title "Electromechanical Device with Signal Relay Arrangement", now US Patent Application Publication No. 2014/0246474,
-US Patent Application No. 13 / 782,460, Invention Title "Multiple Procedure Motor Control for Modular Surgical Instruments", now US Patent Application Publication No. 2014/0246478,
-US Patent Application No. 13 / 782,358, Invention Title "Joystic Switch Associates For Surgical Instruments", now US Patent Application Publication No. 2014/0246477,
-US Patent Application No. 13 / 782,481, Invention Title "Sensor Straightened End Effector During Removal Through Trocar", now US Patent Application Publication No. 2014/0246479,
-US Patent Application No. 13 / 782,518, Invention Title "Control Methods for Surgical Instruments with Removable Implement Parts", now US Patent Application Publication No. 2014/0246475,
-US Patent Application No. 13 / 782,375, title of invention "Rotary Powered Surgical Instruments With Multiple Degrees of Freedom", now US Patent Application Publication No. 2014/0246473, and
-US Patent Application No. 13 / 782,536, title of invention "Surgical Instrument Soft Stop", now US Patent Application Publication No. 2014/0246476.

The applicant of the present application also owns the following patent applications filed on March 14, 2013, each of which is incorporated herein by reference in its entirety:
-US Patent Application No. 13 / 803,097, Invention Title "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE", now US Patent Application Publication No. 2014/0263542,
-US Patent Application No. 13 / 803,193, Invention Title "CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT", now US Patent Application Publication No. 2014/0263537,
-US Pat.
-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 POSTIONING SYSTEM FOR SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2014/0263538,
-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 MODEDULAR SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2014/0263565,
-US Patent Application No. 13 / 803,117, Invention Title "ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2014/0263553,
-US Pat.
-US Patent Application No. 13 / 803,159, Invention Title "METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT", now 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:
-US Patent Application No. 14 / 200,111, Invention Title "CONTROLL SYSTEMS FOR SURGICAL INSTRUMENTS", now US Patent Application Publication No. 2014/0263539.

The applicant of the present application also owns the following patent applications filed on March 26, 2014, each of which is incorporated herein by reference in its entirety:
-US Patent Application No. 14 / 226,106, Title of Invention "POWER MANAGEMENT CONTROLL SYSTEMS FOR SURGICAL INSTRUMENTS",
U.S. Patent Application No. 14 / 226,099, Invention Title "STERILIZETION VERIFICATION CIRCUIT",
-US Patent Application No. 14 / 226,094, Invention Title "VERIFICATION OF NUMBER OF BATTERY EXCHANGE COUNT",
-US Patent Application No. 14 / 226,117, Invention Title "POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROLL",
-US Patent Application No. 14 / 226,075, Invention Title "MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHANBLE SHAFT ASSEMBLES",
-US Patent Application No. 14 / 226,093, title of invention "FEEDBACK ALGORTITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS",
-US Patent Application No. 14 / 226,116, Invention Title "SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION",
-US Patent Application No. 14 / 226,071, Title of the Invention "SURGICAL INSTRUMENT CONTROLL CIRCUIT HAVING A SAFETY PROCESSOR",
-US Patent Application No. 14 / 226,097, Invention Title "SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS",
-US Patent Application No. 14 / 226,126, Title of Invention "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS",
-US Patent Application No. 14 / 226,133, Title of Invention "MODULAR SURGICAL INSTRUMENT SYSTEM",
-US Patent Application No. 14 / 226,081, Title of the Invention "SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT",
-US Patent Application No. 14 / 226,076, Invention Title "POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROECTION",
-US Patent Application No. 14 / 226,111, the title of the invention "SURGICAL STAPLING INSTRUMENT SYSTEM", and
-US Patent Application No. 14 / 226,125, title of invention "SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT".

The applicant of this application also owns the following patent applications filed on September 5, 2014, each of which is incorporated herein by reference in its entirety:
-US Patent Application No. 14 / 479,103, Title of Invention "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE",
-US Patent Application No. 14 / 479,119, Title of Invention "ADJUNCT WITH INTERGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION",
-US Patent Application No. 14 / 478,908, Invention Title "MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION",
-US Patent Application No. 14 / 478,895, title of invention "MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR INTERPRETION",
-US Patent Application No. 14 / 479,110, Title of Invention "USE OF POLARITY OF HALL MAGNET DETICTION TO DETECT MISLOADED CARTRIDGE",
-US Patent Application No. 14 / 479,098, Title of Invention "SMART CARTRIDGE WAKE UP OPERATION AND DATA RETIONION",
-US Pat.

The applicant of this application also owns the following patent applications filed on April 9, 2014, each of which is incorporated herein by reference in its entirety:
-US Pat.
-US Patent Application No. 14 / 248,581, Invention Title "SURGICAL INSTRUMENT COMPRISING A CLOSEING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT", currently US Patent Application No. 3059/09
-US Patent Application No. 14 / 248,595, Invention Title "SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRUMENT", currently published in US Patent No. 14/248, 595
-US Patent Application No. 14 / 248,588, Invention Title "POWERED LINEAR SURGICAL STAPLER", 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. 2014/03059191,
-US patent application No. 14 / 248,584, title of invention "MODULAR MOTOR DRIVERN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHOFTS WITH SURFTS U.S.A.
-US Patent Application No. 14 / 248,587, Invention Title "POWERED SURGICAL STAPLER", 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 Pat.

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

Many specific details are provided to provide a complete understanding of the overall structure, function, manufacture, and use of embodiments described herein and shown in the accompanying drawings. Well-known behaviors, components, and elements are not described in detail to avoid obscuring the embodiments described herein. It is understood by the reader that the embodiments described and illustrated herein are non-limiting examples, and therefore the particular structural and functional details disclosed herein are exemplary and exemplary. It will be understood that it is possible. Modifications and changes to them can be made without departing from the claims.

The terms "comprise" (any form of complement such as "comprises" and "comprising"), "have" (any form of have such as "has" and "having"), "include ( "include" (any form of include such as "includes" and "including") "and" contain "(any form of contain such as" contains "and" containing ") are open concatenations. It is a verb. As a result, a surgical system, device, or device that "equipped", "has", "contains", or "contains" one or more elements is one or more of them. It has elements, but is not limited to having only one or more of them. Similarly, a system, device, or device element that "includes", "has", "contains", or "contains" one or more features is one or more of them. However, it is not limited to having only one or more of these characteristics.

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. For convenience and clarity, it is further understood that spatial terms such as "vertical", "horizontal", "top", and "bottom" can be used with respect to the drawings herein. Let's go. 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 surgical procedures. However, it is 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 surgical procedures. Will be done. By reading "forms for carrying out the invention" herein, the reader may read that the various instruments disclosed herein are incisions or punctures formed in the tissue, eg, through a natural opening. You will further recognize that it can be inserted into the body in any way, such as through a hole. The actuated or end-effector portion of these instruments can be inserted directly into the patient's body, or through an access device with a passage of action that allows the end-effector and elongated shaft of the surgical instrument to be advanced. ..

Surgical staple fastening systems can include a shaft and an end effector extending from the shaft. The end effector includes a first jaw and a second jaw. The first jaw comprises a staple cartridge. The staple cartridge is insertable into the first jaw and removable from the first jaw, but the staple cartridge is not removable from the first jaw, or at least not easily replaceable, etc. The embodiment of is also recalled. The second jaw comprises an anvil configured to deform the staple ejected from the staple cartridge. The second jaw is pivotable about the closed axis with respect to the first jaw, while the first jaw is pivotable with respect to the second jaw. Embodiments are also recalled. The surgical staple system further comprises a joint that is configured to allow the end effector to rotate, i.e., jointly move with respect to the shaft. The end effector is rotatable about a joint motion axis that extends through the joint. Other embodiments that do not include joints are also recalled.

The staple cartridge includes a cartridge body. The cartridge body includes a proximal end, a distal end, and a deck extending between the proximal and distal ends. In use, the staple cartridge is located on the first side of the tissue to be stapled and the anvil is located on the second side of the tissue. The anvil is moved towards the staple cartridge to compress and clamp the tissue against the deck. Subsequently, staples detachably stored in the cartridge body can be subsequently deployed within the tissue. The cartridge body includes a staple cavity defined therein, and the staples are detachably stored in the staple cavity. The staple cavities are arranged in six longitudinal rows. The three rows of staple cavities are located on the first side of the longitudinal slot and the three rows of staple cavities are located on the second side of the longitudinal slot. Staple cavities and other arrangements of staples are also possible.

The staples are supported by a staple driver inside the cartridge body. The driver can move between the first, i.e., unlaunched position and the second, i.e., the firing position, which ejects the staples from the staple cavity. The driver includes an elastic member that is held within the cartridge body by a retainer that extends around the bottom of the cartridge body and is configured to grip the cartridge body and hold the retainer against the cartridge body. .. The driver can be moved between its unfired position and its fired position by a thread. The thread is mobile between the proximal position adjacent to the proximal end and the distal position adjacent to the distal end. The thread slides under the driver and has multiple ramps configured to lift the driver, on which the staples are supported and towards the anvil.

In addition to the above, the thread is moved distally by the launcher. The launcher is configured to contact the thread and push the thread towards the distal end. Longitudinal slots defined within the cartridge body are configured to accommodate launching members. The anvil also includes a slot configured to receive the launching member. The firing member further comprises a first cam that engages the first jaw and a second cam that engages the second jaw. As the launcher is advanced distally, the first and second cams can control the distance between the deck of the staple cartridge and the anvil, i.e. the tissue gap. The launcher also comprises a knife configured to incise the tissue trapped between the staple cartridge and the anvil. It is desirable that the knife be positioned at least partially proximal to the slope so that the staples are ejected forward of the knife.

1-5 are longitudinal cross-sectional views of the end effector of the surgical instrument system. These figures show the end effector in the open position before being placed on the tissue (Fig. 1), the end effector in the closed position ready for firing (Fig. 2), and the firing motion for deploying staples within the tissue. The end effector inside (FIG. 3), the end effector after the launch operation is completed (FIG. 4), and the end effector in the reopened position to release the end effector from the tissue (FIG. 5) are shown. This surgical instrument system is disclosed in US Pat. No. 5,667,517, the title of the invention "ENDOSCOPIC SURGICAL SYSTEM WITH SENSING MEANS" (Michael Dawson Houven, issued September 16, 1997). And are similar in many respects. The entire disclosure of US Pat. No. 5,667,517 is incorporated herein by reference.

The end effectors of FIGS. 1 to 5 include a shaft housing 60 and an end effector housing 70. The end effector housing 70 is connected to the shaft housing 60 by any suitable method, such as press fitting or ultrasonic welding. The rotatable shaft 61 extends through the shaft housing 60 and is operably coupled to an electric motor, which can rotate the shaft 61, for example. The threaded rod 71 extends substantially over the length of the end effector and is connected to the rotatable shaft 61. The threaded rod 71 has a larger diameter portion 72 adjacent to the shaft 61 and a smaller diameter portion 73 of the rest of the threaded rod 71. The end effector further includes a staple or staple cartridge portion 74 and an anvil portion 75. The staple cartridge portion 74 and the anvil portion 75 are pivotally connected to each other by an anvil pivot swivel pin 76. Screwed onto the larger diameter portion 72 of the threaded rod 71 is the closure nut 77, from which the closure pin 78 extends, which is the pivot of the end effector. It moves in the closure slot 79 arranged in the freely mounted anvil portion 75. When the shaft 61 rotates, the threaded rod 71 also rotates, and when it rotates in the first direction, the closure nut 77 lowers the threaded rod 71, moves the closure pin 78 in the closure slot 79, and staples the end effector. The anvil portion 75 is closed with respect to the portion 74.

In addition to the above, the tissue treated or manipulated by the end effector is placed between the anvil portion 75 of the end effector and the staple cartridge portion 74 when the anvil portion 75 is in the open position. When the tissue is suitably positioned between the anvil portion 75 and the staple cartridge portion 74, a force is applied to the shaft 61 to rotate the shaft 61 and the threaded rod 71 and close the anvil portion 75. As will be appreciated, the magnitude of torque required to pivotally swivel the anvil portion 75 around the pivot swivel pin 76 can be detected and, as a result, between the anvil portion 75 and the staple cartridge portion 74. The thickness of the tissue can be determined. The surgical instrument system may further include a microprocessor or controller, which processes this information and is positioned between the anvil portion 75 of the end effector and the staple cartridge portion 74 when the anvil portion 75 is closed. The surgeon can be informed if the amount of tissue present is appropriate or if the amount of tissue located between the anvil portion 75 and the staple cartridge portion 74 is too much or too little. The microprocessor can also be configured to inform the surgeon if the end effector should be re-operated. When the electric motor that rotates the shaft 61 is driven by a constant voltage, for example, the force required to close the end effector can be measured by monitoring the motor current. In various examples, the power delivered to the end effector can be controlled by varying the motor voltage and / or current, eg, varying the load to achieve a constant motor speed. In certain examples, pulse width modulation and / or frequency modulation can be utilized to control the electric motor.

The staple cartridge portion 74 includes a removable staple cartridge 80. The staple cartridge 80 may include any suitable number of staple rows and may include, for example, four rows of staples 81 or six rows of staples 81. Staple rows are parallel to each other and adjacent rows are offset from each other. The staple cartridge 80 is arranged in the staple cartridge portion 74 so as to face the anvil portion 75 and snap into the staple cartridge portion 74 of the end effector as shown. As shown in FIGS. 1-5, a smaller diameter portion 73 of the threaded rod 71 extends through the staple cartridge 80. The staple cartridge 80 may include an opening defined in its bottom, whereby the staple cartridge 80 can be positioned above the threaded rod 71 and can be seated within the staple cartridge portion 74. Other embodiments are also conceivable, such that the threaded rod 71, or at least a portion of the threaded rod 71, is part of the staple cartridge 80. In one such embodiment, the threaded rod 71 may be operably coupled to the drive shaft 61 when the staple cartridge 80 is contained within the staple cartridge portion 74. Some embodiments are also conceived such that the staple cartridge 80 cannot be easily replaced within the end effector. In at least one such embodiment, the end effector may be interchangeable as a whole.

A knife member 82 and a drive wedge member 83 are mounted on the threaded rod 71, and these are connected to each other. The interconnected knife member 82 and wedge member 83 are screwably engaged with the smaller diameter portion 73 of the threaded rod 71, and as the threaded rod 71 rotates in the first direction, the distal direction ( That is, it advances in the same direction as the threaded rod 71 rotates and approaches the anvil portion 75). As it travels along the threaded rod 71, the wedge member 83 advances ahead of the knife member 82, i.e., is positioned distal to the knife member 82. When the wedge member 83 lowers the threaded rod 71, the wedge member 83 drives the staple 81 and pulls it out of the cartridge 80 via the staple driver 84. The staple driver 84 may include individual staple drivers, or one or more staple drivers 84 may be connected to each other. The staple 81 passes through the tissue and is pressed against the anvil portion 75 to form the staple 81 within the tissue. The knife member 82 following the drive wedge 83 cuts the tissue between the two adjacent rows of staples 81. The drive wedge 83 may consist of two parts, i.e., one wedge piece on one side of the knife member 82 for driving the staple 81 on the first side of the knife member 82, and a knife. It has a similar wedge piece on the opposite side of the knife member 82 for driving the staple 81 on the second side (opposite side) of the member 82.

It is also conceivable that the staples 81 have the same unformed height, but the staples 81 may have different unformed heights. It is also conceivable that the staples 81 have the same deformed height, but the staples 81 may have different deformed heights. US Patent Application Publication No. 2007/0131732, title of invention "SURGICAL STAPLING INSTRUMENTS INCLUDING A CARTRIDGE HAVING MULTIPLE STAPLE SIZES", currently US Patent No. 7,398,908 (November 3, 2006) , Incorporated herein by reference. The entire disclosure of US Pat. No. 7,635,074, title of the invention "STAPLE DRIVE ASSEMBLY" (issued December 22, 2009) is incorporated herein by reference in its entirety. US Patent Application No. 14 / 527,398, invention title "STAPLE CARTRIDGES COMPRISING DRIVER ARRANGEMENTS" (filed October 29, 2014), and US Patent Application No. 14 / 527,384, invention title "CARTRIDGE ASSEMBLES". The entire disclosure of "FOR SURGICAL STAPLERS" (filed October 29, 2014) is incorporated herein by reference.

As shown in FIG. 2, when the anvil portion 75 is closed, the closure nut 77 advances the stop member 85, which causes the firing nut 86 on which the knife 82 and wedge 83 are located to advance and the threaded rod. Engage with the thread of the smaller diameter portion 73 of 71, advance along the rod 71 and drive the staple 81 to cut the tissue. At the same time that the closure nut 77 switches the stop member 85 from the backward configuration (FIG. 6) to the forward configuration (FIG. 7), the closure nut 77 derails (or disengages) from the thread of the threaded portion 72. .. The firing nut 86 is urged using a suitable method so that it does not engage the thread of the threaded portion 73 until the stop member 85 is activated or pushed forward as described above. When the firing nut 86 moves to the most advanced position, drives and forms all the staples 81 and cuts the tissue, the firing nut 86 engages with the suitable contact 87, which immediately causes an electric motor. Is inverted to rotate the rod in the second direction (ie, in the opposite direction) and retract the firing nut 86. Now referring to FIG. 9, when in the fully retracted position, the firing nut 86 moves the stop member 85 backwards, whereby the closure nut 77 reengages with the thread of the threaded portion 72. At the same time that the stop member 85 is pushed into the backward configuration (FIG. 9), the firing nut 86 is derailed (or disengaged) from the thread of the threaded portion 73. When the threaded rod 71 is continuously rotated in the second direction, the closure nut 77 retracts and the anvil portion 75 of the end effector opens as shown in FIG.

Another configuration of the above embodiment is to place the contact in the handle portion of the instrument, or in the proximal housing attached to the robotic surgical stapler, and use a follower nut on the rotating shaft 61. , Monitor the position of the closure nut 77 and / or the firing nut 86. The entire disclosure of US Patent Application Nos. 13 / 118,241 (named "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS" (now US Patent Publication No. 2012/02987719) is incorporated herein by reference in its entirety. During surgery, various information may be transmitted to and / or from the microprocessor of the surgical instrument system, for example, pushing the firing nut 86 onto the staples of the threaded portion 73 and / or closing. The movement of the stop member 85, such as pushing the nut 77 into the staples of the threaded portion 72, can be detected. The most advanced position of the wedge 83 and / or the knife member 82 can be detected. In addition, the presence of the staple cartridge 80 in the staple cartridge portion 74 and / or the presence of the staple 81 in the cartridge 80 can also be detected. All this information is returned to the controller. , Can be stored and operated in the controller, which allows the surgeon using the instrument to receive information about the condition of the surgical instrument system.

The surgical instrument system disclosed herein can be used with auxiliary materials such as buttress materials. Auxiliary materials may include layers of one or more materials detachably attached to staple cartridges and / or anvils. The entire disclosure of US Patent Application Publication No. 2010/0012704, title of the invention "SURGICAL STAPLING APPARATUS" (published January 21, 2010) (currently US Patent No. 8,413,871), by reference herein. Incorporated into the book.

The surgical instrument system shown in FIGS. 1-5 and described above is useful for its intended purpose. However, there are several aspects of this surgical instrument system that can be improved. For example, the closure nut 77 and the firing nut 86 move forward continuously. In other words, the closure nut 77 completely completes the closing stroke at the threaded portion 72 of the rod 71 before the firing nut 86 initiates the firing stroke at the threaded portion 73 of the rod 71. As a result, the tissue clamping system must be fully clamped before the staple firing system can be operated. Further, the closure nut 77 cannot be retracted until the firing nut 86 is completely retracted. As a result, the tissue clamping system cannot unclamp immediately after the staple 81 has been fired. Rather, the tissue clamp system is stuck in the clamp configuration until the launch system is completely reset. In addition to the above, a very precise allowance for adjusting the closure nut 77 to disengage from the thread of the threaded portion 72 at the same time that the closure nut 77 switches the stop member 85 to the forward configuration. Degree may be needed. Similarly, there is a very precise tolerance for adjusting the firing nut 86 to disengage from the thread of the threaded portion 73 at the same time that the firing nut 86 switches the stop member 85 to the backward configuration. May be needed.

6-14 show the surgical instrument system 150. The surgical instrument system 150 includes a shaft 160 and an end effector 170 extending from the shaft 160. The shaft 160 extends from a housing 152 configured to be attached to a robotic surgery system (eg, a DAVINIC robotic surgery system manufactured by Intuitive Surgical, Inc.). The entire disclosure of US Patent Application No. 13 / 118,241, title of the invention "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS" (currently US Patent Publication No. 2012/02987719) is incorporated herein by reference. Is done. Alternatively, the shaft 160 may extend, for example, from the handle of a surgical instrument configured to be gripped and operated by a surgeon. US Pat. No. 7,143,923, Invention title "Surgical stopping instrument having a firing locked out for an unclosed unvil" (issued December 5, 2006), US Pat. No. 7,044,352, "Surgical standard". having a single lockout mechanism for presentation of field "(issued May 16, 2006), US Patent No. 7,000, 818," Surgical stopping invention spartment year 2nd season ), US Pat. No. 6,988,649, "Surgical stopping invention having a spent cartridge lockout" (issued January 24, 2006), and US Pat. No. 6,978,921, "Surgical starting instrument". -Beam fielding mechanism "(issued December 27, 2005) is incorporated herein by reference. The shaft 160 includes at least one joint joint (eg, joint joint 190, etc.), which is configured to allow the end effector 170 to move jointly around at least one axis of rotation. Other embodiments in which the shaft 160 does not include a joint are also conceivable.

Primarily with reference to FIG. 6, the end effector 170 includes a staple cartridge portion 174 and an anvil portion 175. The staple cartridge 180 is positioned in the staple cartridge portion 174. The staple cartridge 180 is removable from the staple cartridge portion 174, which allows it to be easily replaced with another staple cartridge. However, other embodiments are also conceivable in which the staple cartridge 180 cannot be easily replaced. The anvil portion 175 is rotatable with respect to the staple cartridge portion 174 about a pivot swivel pin 176 extending from the anvil portion 175. Another embodiment is conceivable in which the staple cartridge portion 174 is rotatable relative to the anvil portion 175. As described in more detail below, the anvil 175 is rotatable between the open position (FIGS. 6-9) and the closed position (FIGS. 10-13) by a closed drive. Further, as described in more detail below, the staples (eg, staples 81, etc.) are detachably stored in the staple cartridge 180 and can be ejected from the staple cartridge 180 by a firing drive and deformed with respect to the anvil 175.

Primarily with reference to FIGS. 7-9, the shaft 160 includes a rotatable input shaft 161. As described in more detail below, the input shaft 161 is utilized to operate the closed drive and the launch drive. The input shaft 161 is rotatably mounted within the shaft 160 by one or more bearings and includes a threaded portion 172. The closed drive includes a closure nut 177, which includes a threaded opening 162 defined therein. The closure nut 177 further includes closure pins 178 extending from both sides thereof, which are slidably positioned within closure slots 179 defined on both sides of the anvil portion 175.

The threaded opening 162 of the closure nut 177 is screwably engaged with the threaded portion 172 of the input shaft 161 so that when the input shaft 161 rotates in the first direction, as shown in FIG. As the closure nut 177 moves distally towards the end of the end effector 170 and the input shaft 161 rotates in the second direction (opposite direction), the closure nut 177 moves proximally towards the housing 152. .. The interaction between the closure pin 178 of the closure nut 177 and the side wall of the closure slot 179 prevents the closure nut 177 from rotating with the input shaft 161 so that the rotational movement of the input shaft 161 is the closure nut. It is converted into a longitudinal translational motion of 177.

During use, the closure nut 177 advances distally by the input shaft 161 to move the anvil portion 175 between the open position (FIGS. 6-9) and the closed position (FIGS. 11-13). In such an example, the closure pin 178 engages the lower sidewall of the closure slot 179 and cam drives the anvil 175 towards the staple cartridge 180, as shown in FIG. Similarly, with reference to FIG. 14, the closure nut 177 advances proximally by the input shaft 161 to move the anvil portion 175 between the closed and open positions. In such an example, the closure pin 178 engages the upper sidewall of the closure slot 179 and cam drives the anvil 175 away from the staple cartridge 180.

The input shaft 161 further includes a distal gear 165 fixedly mounted at its distal end. When the input shaft 161 rotates in the first direction, the distal gear 165 rotates in the first direction, and when the input shaft 161 rotates in the second direction, the distal gear 165 rotates in the second direction. do. The launch drive of the end effector 170 includes a rotatable launch shaft 171 which is rotatably mounted on the staple cartridge portion 174 by one or more bearings (eg, bearing 163). The launch shaft 171 includes a proximal gear 185 and a threaded portion 173. The proximal gear 185 of the launch shaft 171 meshes with and engages with the distal gear 165 of the input shaft 161 so that the input shaft 161 drives the launch shaft 171 when the input shaft 161 rotates. Can be done. The proximal gear 185 is slidably mounted on the launch shaft 171. More specifically, the launch shaft 171 includes a spline portion 168, and the proximal gear 185 is slidably connected to the spline shaft portion 168 and includes a spline opening 169 extending through it. As a result, the proximal gear 185 can rotate the launch shaft 171 around the longitudinal axis and, in addition, can slide longitudinally along the longitudinal axis, as described in more detail below. ..

The firing drive also includes a firing nut 186, which includes a threaded opening 189 defined therein, which is screwably engageable with the threaded portion 173 of the shaft 171. The firing nut 186 further includes a wedge 183 defined on it, which is configured to slide under the staple driver 84 and lift the staple 81 towards the anvil portion 175, thereby with the staple cartridge 180. Staple fastening is performed on the tissue located between the anvil portion 175 and the anvil portion 175. The firing nut 186 also includes a cutting member 182 defined above itself, configured to cut the stapled tissue. When the firing nut 186 is screwably engaged with the shaft 171 and the input shaft 161 rotates in the first direction, the firing nut 186 moves distally towards the end of the end effector 170 and the staple 81. Is discharged from the staple cartridge 180, and the tissue is cut. When the firing nut 186 is screwably engaged with the threaded portion 173 of the shaft 171 and the input shaft 161 rotates in the second direction, the firing nut 186 moves proximally towards the housing 152. The wedge 183 and the cutting member 182 are retracted to their respective unlaunched positions.

As can be seen from the above, the surgical instrument system 150 includes a system for switching between the clamp operation mode and the staple firing operation mode, which is the surgical instrument system of FIGS. 1-5. It is an improvement over the relatedly disclosed switching system. With reference to FIGS. 7-9 again, the closure nut 177 can be moved from the proximal position to the distal position during the clamp stroke, thereby moving the anvil portion 175 from the open position to the closed position. When the closure nut 177 is in the proximal position, the closure nut 177 is screwably engaged with a thread 172 defined on the input shaft 171. The closure system may include an urging member (eg, spring 164, etc.), which urges the thread 162 of the closure nut 177 to engage with the thread 172 of the input shaft 171. It is configured to maintain that engagement. The spring 164 is positioned between the closure nut 177 and the shoulder 166 defined on the shaft 171.

As a result of the above, the first rotation of the input shaft 161 in the first direction can immediately move the closure nut 177 distally to initiate closure of the anvil portion 175. Further, if the input shaft 161 is erroneously driven in the second direction while the closure nut 177 is in the proximal position, the closure nut 177 will move to the proximal side and be disengaged from the thread 172. Can be idle. However, the spring 164 can keep the thread 162 of the closure nut 177 close to the thread 172 of the input shaft 161 so that when the input shaft 161 rotates in the first direction, the thread 162 Can capture the thread 172 and the closure nut 177 can be pulled distally to close the anvil portion 175.

In particular, in addition to the above, the rotation of the input shaft 161 used to initiate the clamp stroke of the closure nut 177 is transmitted to the launch shaft 171 via the meshed gears 165 and 185. The rotation of the launch shaft 171 does not drive the launch nut 186 in the distal direction. This is because the firing nut 186 is not screwably engaged with the thread 173 of the firing shaft 171 at this point in the operation of the surgical instrument system 150. Rather, the launch nut 185 is in the idle position and the launch shaft 171 rotates within the threaded opening 169 defined within the launch nut 185. As described in more detail below, the firing nut 185 is pushed into the thread 173 by the closure nut 177 during the portion after the clamp stroke.

Here, primarily with reference to FIG. 9, the closure nut 177 further includes a switch arm 184 extending distally. When the closure nut 177 is in the proximal position, the switch arm 184 is not in contact with the slidable proximal gear 185, as shown in FIG. During the distal movement of the closure nut 177, the switch arm 184 contacts the proximal gear 185, as shown in FIG. As can be seen from FIG. 10, when the switch arm 184 first contacts the proximal gear 185, the anvil portion 175 has not yet reached its fully closed position. Therefore, prior to the completion of the clamp stroke, the closure nut 177 engages with the proximal gear 185. As the closure nut 177 moves further distal to complete the clamp stroke, the closure nut 177 moves the proximal gear 185 distally along the spline portion 168 of the firing shaft 171. This distal movement of the proximal gear 185 causes the push spring 181 to move distally, which is positioned between the proximal gear 185 and the firing nut 186. Further, the distal movement of the push spring 181 causes the firing nut 186 to move distally and engage the thread 173. The thread 189 of the firing nut 186 includes the most distal thread 188, which can initiate a thread engagement between the firing nut 186 and the firing shaft 171.

Comparing FIGS. 10 and 11, it will be appreciated that the spring 181 can be compressed when used to push the firing nut 186 distally as described above. In such an example, the pushing force between the proximal gear 185 and the firing nut 186 can increase as the proximal gear 185 moves distally towards the firing nut 186. In at least one example, the movement of the proximal gear 185 may be linearly proportional to the force applied by the spring 181 to the firing nut 186. The force applied to the firing nut 186 by the spring 181 may be increased until the thread 189 of the firing nut 186 captures the thread 173, so that the firing nut 186 is pushed distally by the firing shaft 171. .. When the firing nut 186 is screwably engaged with the thread 173, the firing nut 186 can be pulled away from the spring 181 as shown in FIG.

As a result of the above, the clamp operation mode can start the firing operation mode before the clamp operation mode is completed. In at least one example, it may be desirable to start the staple firing mode towards the end of the clamping mode, which allows the staple 81 to stay at least until the anvil portion 175 is positioned favorably. , Not fired. Further, the surgical instrument system 150 may include a sensor system, for example, an electric motor that detects that or is about to start a staple firing mode of operation and drives an input shaft 161. It is configured to pause. Such sensor systems can be configured to detect, for example, the positions of closure nuts 177, firing nuts 186, proximal gears 185, and / or springs 181. In at least one such example, whether the surgeon may proceed with staple firing into the tissue by suspending the electric motor, or whether the anvil portion 175 should be reopened and the end effector 170 relocated. Can be evaluated. In at least one example, the surgeon can be provided with two switches to operate selectively, for example, the first button is for restarting the electric motor to advance the firing stroke, the second button is. The electric motor is reversed and the anvil portion 175 is reopened. The first button can be, for example, green and the second button can be, for example, red. The first button may contain, for example, a "forward" sign, while the second button may contain other marks, such as "back". Such switches can be optionally located on the remote control console and / or the handle of the surgical instrument.

After initiating the launch mode by pushing the launch nut 186 into the thread 173 of the launch shaft 171 with the advance of the closure nut 177, the closure nut 177 derails the closure nut 177 from the thread 172 as described above. And continue to move over the clamp stroke along the thread 172 of the input shaft 161 until it is operably disengaged from the input shaft 161. At such a point, the anvil portion 175 is in a completely closed position. Further, at such time, the closure nut 177 is idle and subsequent rotation of the input shaft 161 to operate the staple firing system does not advance the closure nut 177.

As described above, the firing nut 186 advances distally to eject the staple 81 from the staple cartridge 180. The firing nut 186 can advance to the distal end of the end effector 170 to complete the firing stroke, as shown in FIG. The thread 173 of the launch shaft 171 can be configured such that when the launch nut 186 reaches the end of the launch stroke, the launch nut 186 remains screwably engaged with the launch shaft 171. In one such example, the firing nut 186, wedge 183, and / or cutting member 182 is a switch 87 positioned at the distal end of the end effector 170 when the firing nut 186 reaches the end of the firing stroke. Can change the state of. The switch 87 communicates with the controller of the surgical instrument system 150, which reverses the direction of the electric motor and rotates the input shaft 161 in the second direction when the state of the switch 87 is reversed. be able to. When the input shaft 161 is rotating in the second direction, the firing nut 186 retracts towards its unlaunched position. In addition to, or in lieu of, the surgical instrument 150 can include a switch that allows the surgeon to act to stop and / or reverse the direction of the electric motor.

In addition to the above, here with reference to FIG. 12, when the electric motor operates in the second direction, the launch nut 186 returns to its unlaunched position and retracts to reset the launch system. As the firing nut 186 retracts, here with reference to FIG. 13, the firing nut 186 contacts the spring 181 and pushes the spring 181 proximally. The firing nut 186 contacts the spring 181 before the firing nut 186 derails (or disengages) from the thread 173. As the firing nut 186 pushes the spring 181 proximally, the spring 181 pushes the proximal gear 185 and the closure nut 177 proximally, whereby the closure nut 177 becomes an input shaft, as shown in FIG. Re-engages with thread 172 of 161 so that it can be screwed. The threaded opening 162 of the closure nut 177 includes a thread 167 on the proximal side, which captures the thread 172 and initiates a thread engagement between the closure nut 177 and the input shaft 161. When the closure nut 177 is screwably reengaged with the thread 172, continued rotation of the input shaft 161 in the second direction moves the closure nut 177 proximally to cam drive the anvil portion 175. And return it to its open position, thus resetting the clamp system. At the same time, the firing nut 186 can be derailed (or disengaged) from the thread 173 of the firing shaft 171 by continued rotation of the input shaft 161 in the second direction. The launch system is reset when the launch nut 186 is operably disengaged from the launch shaft 171.

During use, the anvil portion 175 can be rotated away from its fully clamped position to release the tissue trapped between the anvil portion 175 and the staple cartridge 180. In addition, the anvil portion 175 can move between open and closed positions to clamp and release tissue as needed, and / or insert the end effector 170 into the patient's body, eg, through a trocar. As possible, the anvil portion 175 can be positioned relative to the staple cartridge 180. With the pause function described above, the surgical instrument system 150 opens and closes the anvil portion 175 without firing the staples in the staple cartridge 180 and / or cutting the tissue. It is possible to operate with.

In addition to the aspects of the surgical instrument system of FIGS. 1-5 above, the closure nut 77 engages the anvil portion 75 at its proximal end, so that the closure nut 77 completes the distal end of the anvil portion 75. It may not be possible to push it to the closed position. Further, the firing nut 86 does not include a cam engaging member capable of pulling the distal end of the anvil portion 75 to a fully closed position. Thus, the tissue gap between the anvil portion 75 and the distal end of the staple cartridge 80 can be larger than the tissue gap between the anvil portion 75 and the proximal end of the staple cartridge 80, thereby being distant. It may not be possible to form the position-side staples at the proper, or at least suitable, formation height. Improvements to this arrangement are further discussed below.

The end effector 270 of the surgical instrument system 250 is shown in FIG. The end effector 270 includes a staple cartridge portion 274 and an anvil portion 275. The end effector 270 further includes a staple cartridge 280 positioned within the staple cartridge portion 274. Similar to the above, the staple cartridge 280 is easily removable from the staple cartridge portion 274 and is easily replaceable with another staple cartridge. Other embodiments are also conceived in which the staple cartridge 280 is not easily removable from the staple cartridge portion 274. The anvil portion 275 is rotatable relative to the staple cartridge 280 between the open and closed positions and compresses the tissue T between them. Other embodiments are also conceivable in which the staple cartridge portion 274 is rotatable relative to the anvil portion 275. In either case, the end effector 270 can be moved between the open and closed configurations in any preferred manner. In at least one example, the end effector 270 is moved from an open configuration to a closed configuration by cams 256 and 257 extending from the firing nut 286. More specifically, the cam 257 is configured to enter a longitudinal cam slot 258 defined within the anvil portion 275, and the cam 256 engages the staple cartridge portion 274 and / or the staple cartridge 280. As the firing nut 286 advances distally, they work together to position the anvil portion 275 with respect to the staple cartridge 280. In another embodiment, the firing nut 286 does not include a cam for moving the end effector 270 between the open and closed configurations. In at least one such example, the end effector comprises a closed system that separates from the staple firing system of the end effector and is distinct from the staple firing system. The examples provided herein are compatible with both embodiments.

The staple cartridge 280 includes a deck 291 configured to mount and support the tissue, and a plurality of staple cavities 253 defined within the deck 291. The staple 81 is detachably stored in, for example, the staple cavity 253. Each staple 81 has the same configuration. For example, each staple 81 may have, for example, a U-shaped configuration or a V-shaped configuration. The staple having a U-shaped structure includes a base portion and two legs extending in parallel directions extending from the base portion. The staple having a V-shaped structure includes a base portion and two legs extending from the base portion in non-parallel directions. Each staple 81 housed in the staple cartridge 280 is defined with the same unformed height. The unformed height of the staple 81 is the total height of the staple measured from the surface including the bottom surface of the base portion to the surface including the tip of the leg portion. The staple 81 may have an unformed height of, for example, 2.0 mm, 2.5 mm, 3.0 mm, 3.5 mm, or 4.0 mm. The staple cartridge 280 further has a plurality of staple drivers 284a-284g located within the staple cavity 253, which support the staple 81 within the staple cavity 253. The firing nut 286 includes a wedge surface 283 defined on it, which slides underneath the staple drivers 284a-284g and has the staple drivers 284a-284g and the staples 81 supported on it. It is configured to be continuously lifted towards the anvil portion 275. Each staple driver 284a-284g includes an inclined surface 281 defined on its bottom surface, which engages the wedge surface 283 as the firing nut 286 advances distally. The anvil portion 275 includes a plurality of staple forming pockets 251 defined therein, which are configured to deform the staple 81 as it is ejected from the staple cavity 253.

In addition to the above, the anvil portion 275 further includes a tissue compression surface 292 defined therein, which compresses the tissue against the cartridge deck 291 as the anvil portion 275 moves to the fully closed position. It is configured as follows. When the anvil portion 275 is in the fully closed position, it may be desirable for the anvil compression surface 292 to be parallel to the cartridge deck 291. At such a position, the gap between the anvil compressed surface 292 and the cartridge deck 291, i.e. the tissue gap, is constant along the longitudinal length of the end effector 270. In other words, when the anvil portion 275 is parallel to the staple cartridge 280, the tissue gap above the most proximal staple cavity (ie, tissue gap 255a) is the tissue above the most distal staple cavity. It is the same as the gap (that is, the tissue gap 255 g). However, such parallel positions of the anvil portion 275 may not always be achievable in some examples. In certain examples, the tissue T located between the anvil compressed surface 292 and the cartridge deck 291 may be thick and when the anvil portion 275 reaches its final or fully clamped position. The anvil portion 275 may not reach the parallel position. Further, in some examples, for example, when the end effector 270 is clamped onto thick tissue, the distal end 259 of the anvil portion 275 may be deflected or bent upwards. In either case, as shown in FIG. 15, the distal end 259 of the anvil portion 275 can be positioned further away from the cartridge deck 291 than the proximal end 258. In such an example, as a result, the tissue gap above the most distal staple cavity (ie, tissue gap 255 g) is larger than the tissue gap above the most proximal staple cavity (ie, tissue gap 255a). Become.

The firing nut 286 includes a cut surface (eg, knife 282, etc.), which, as described above, is tissue as the firing nut 286 advances distally to drive the staple 81 towards the anvil portion 275. It is configured to cut the tissue located between the compression surface 292 and the cartridge deck 291.

In addition to the above, each staple 81 is formed within the forming gap. The formation gap of the staple 81 is formed in the support surface of the staple driver supporting the staple 81 (for example, the support surface 244 of the staple drivers 284a to 284 g) and the anvil portion 254 when the staple driver reaches the fully fired position. A gap between the defined corresponding forming pocket 251. The staple driver reaches the fully fired position as the ridge or tip of the wedge 283 passes under the bottom surface of the staple driver. The tip of the wedge 283 is defined by a tip height 243. As the firing nut 286 advances distally, the ridge of the wedge 283 continuously passes under the staple drivers 284a-284g, continuously ejecting and deforming the staple 81. During the first portion of the firing nut 286 progression, the wedge 283 lifts the driver 284a towards the anvil portion 275. As the wedge 283 moves the driver 284a to the fully fired position, the wedge 283 begins to lift the driver 284b towards the anvil portion 275. As the wedge 283 moves the driver 284b to the fully fired position, the wedge 283 begins to lift the driver 284c towards the anvil portion 275, and so on. In another embodiment, the wedge 283 begins to lift the driver 284b only when the driver 284a reaches the fully fired position, and similarly, only when the driver 284b reaches the fully fired position does it begin to lift the driver 284c, and thereafter. Is the same.

As described above, the formation gap of the staple 81 is between the support surface 244 of the driver supporting the staple 81 and the formation pocket 251 positioned facing the staple 81 when the driver reaches the fully fired position. Delimited between. With reference to FIG. 15, the formation gap distance 254a is defined between the support surface 244 of the staple driver 284a and the formation pocket 251 positioned facing the staple driver 284a. Similarly, the forming clearance distance 254g is defined between the support surface 244 of the staple driver 284g and the forming pocket 251 positioned facing the staple driver 284g. However, it should be noted that the formation gap distances 254a and 254g shown in FIG. 15 do not represent the fully fired positions of the staple drivers 284a and 284g. In fact, the staple drivers 284a and 284g are shown in the unlaunched position in FIG. Therefore, it will be appreciated that when the staple drivers 284a and 284g are lifted towards the anvil portion 275, the distances 254a and 254g are shortened.

As mentioned above, the orientation of the anvil portion 275 can affect the tissue gap between the staple cartridge 280 and the anvil portion 275. The orientation of the anvil portion 275 can also affect the forming gap with respect to the staple 81 in the end effector 270. When the distal end 259 of the anvil portion 275 is positioned further away from the staple cartridge 280 than the proximal end 258, the forming gap with respect to the staple 81 at the distal end of the end effector 270, as shown in FIG. Without any compensating means, it can be larger than the forming gap for the staple 81 at the proximal end of the end effector 270. If such compensation measures are not taken, the distal staple 81 is formed at a different height than the proximal staple 81. In at least one such example, the staple 81 comprises the highest preformed staple at the distal end of the end effector 270 and the lowest preformed staple at the proximal end of the end effector 270. Can be formed within. In some examples, such a preformed height range of staples 81 may be suitable, especially if the gradient between the staple heights formed is small. In another example, the proximal staple 81 may be deformed at a suitable height, while the distal staple 81 may not be deformed at a suitable height.

The end effector 270 is configured to compensate, for example, if the anvil portion 275 is not parallel to the staple cartridge 280. In other words, the end effector 270 has little difference (if any) in the stapling 81 formation gap when the anvil portion 275 is not closed parallel to the deck 291 of the staple cartridge 280. It is composed. To achieve this result, the support surface 244 of the staple drivers 284a-284g can be lifted to different heights in a way that corresponds to the orientation of the anvil portion 275. For example, the support surface 244 of the staple driver 284a is lifted to a first height with respect to the cartridge deck 291 and the support surface 244 of the staple driver 284b is at a second height (first height) with respect to the cartridge deck 291. Can be lifted to (greater than halfbeak). Similarly, the support surface 244 of the staple driver 284c is lifted to a third height (greater than the second height) with respect to the cartridge deck 291. The arrangement of the first height, the second height, and the third height is consistent with the angled anvil portion 275. This arrangement is further lifted to, for example, a support surface 244 of the staple driver 248d lifted to a fourth height (greater than the third height) and a fifth height (greater than the fourth height). The support surface 244 of the staple driver 248e lifted and the support surface 244 of the staple driver 248f lifted to a sixth height (greater than the fifth height) and a seventh height (more than the sixth height). Includes a support surface 244 of 248 g of staple driver lifted to (large). When the staple drivers 284a-284g are in their respective fully fired positions, the support surface 244 extends above the cartridge deck 291. However, another embodiment is conceivable in which part of the support surface 244 or the entire support surface 244 does not have to extend above the deck 291.

As mentioned above, the staple drivers 284a-284g are lifted to different heights. The first lift height of the support surface 244 is equal to the sum of the tip height 243 of the wedge 283 and the driver height 241a of the staple driver 284a. Similarly, the second lift height of the support surface 244 is equal to the sum of the tip height 243 of the wedge 283 and the driver height 241b of the staple driver 284b. The tip height 243 of the wedge 283 is the same for the first lift height and the second lift height, but the driver height 241a is lower than the driver height 241b, resulting in a first lift height. Is lower than the second lift height. Similarly, the third lift height of the support surface 244 is equal to the sum of the tip height 243 of the wedge 283 and the driver height 241c of the staple driver 284c, which driver height 241c is the driver of the staple driver 284b. Higher than the height 241b. Along these lines, the driver height 241d of the staple driver 284d is higher than the driver height 241c of the staple driver 284c, and the driver height 241e of the staple driver 284e is higher than the driver height 241d of the staple driver 284d. The driver height 241f of the staple driver 284f is higher than the driver height 241e of the staple driver 284e, and the driver height 241g of the staple driver 284g is higher than the driver height 241f of the staple driver 284f.

Each of the staple support surfaces 244 contains a trough or groove defined on the upper surface of the drivers 284a-284g. Each trough is configured to receive the base of the staple 81. The trough is configured to tightly receive the base of the staple 81, whereby there is little (if any) relative lateral movement between the staple base and the support surface 244. In addition to the above, the formation distance of the staple 81 is measured from the bottom surface of the trough to the top surface of the corresponding formation pocket 251 defined within the anvil portion 275. Each trough has a substantially U-shaped (rounded) bottom surface configuration. However, any suitable configuration, such as a V-shaped or tilted bottom surface, can be used. In either case, each trough may include a cradle for supporting the staples 81.

As mentioned above, the staple support surfaces 244 of the staple drivers 284a-284 g are lifted to different heights, thereby eliminating the difference in forming gap for the staple 81 between the staple support surface 244 and the anvil forming pocket 251. , Or at least alleviate. In certain embodiments, it is desirable that all staples in the staple cartridge 280 be formed at the same, or at least substantially the same, preformed height. In another embodiment, all staples in the first longitudinal row are formed to the first formed height and all staples in the second longitudinal row are defined as the first formed height. It is desirable to be formed at a different second preformed height. The examples provided above can be adapted to such embodiments. For example, a first set of staple drivers with a first driver height range can be used to deploy a first longitudinal staple row of staple drivers with a second driver height range. A second set can be used to deploy a second longitudinal staple row, the second driver height range being different from the first driver height range. In at least one such example, the second driver height range can be higher than the first driver height range. In certain embodiments, the first set of staple drivers is not connected to the second set of staple drivers. However, embodiments are also conceivable in which a driver in a first set of staple drivers is connected to a driver in a second set of staple drivers. In at least one example, two or more drivers in the same longitudinal row can be connected to each other.

In addition to the above, embodiments are also conceivable that include three or more longitudinal staple rows formed at different preformed heights utilizing different forming gaps. In at least one embodiment, the gaps formed by the staples in the first row are at least partially determined by the first wedge 283 and the gaps formed by the staples in the second row are at least partially determined by the second wedge 283. The gap between the formation of the staples in the third row is determined at least partially by the third wedge 283. In one such embodiment, the tip height 243 of the first wedge 283 is different from the tip height 243 of the second wedge 283. Similarly, the tip height 243 of the third wedge 283 is different from the tip height 243 of the first wedge 283 and the second wedge 283.

In various examples, the staples in the first longitudinal staple row may have a first undeformed height and the staples in the second longitudinal staple row may have a first undeformed height. Can have a different second undeformed height. Similarly, the staples in the third longitudinal staple row may have a third undeformed height that is different from the second undeformed height.

As shown in FIG. 15, the staple cartridge 280 has two staple drivers 284a located in a single longitudinal row and two staple drivers 284b located distal to the staple driver 284a. , Two staple drivers 284c located distal to the staple driver 284b, two staple drivers 284d located distal to the staple driver 284c, and distal to the staple driver 284d. Two staple drivers 284e located in, two staple drivers 284f located distal to the staple driver 284e, and two staple drivers 284g located distal to the staple driver 284f. ,including. Other embodiments are also conceivable in which the staple cartridge 280 does not include a staple driver having the same driver height in the same longitudinal row. In at least one such embodiment, each staple driver in one longitudinal row has a different driver height. Various other embodiments are also conceivable, comprising any suitable arrangement of staple drivers in any suitable pattern.

The driver heights of the drivers 284a-284g have a linear gradient. The driver 284g is higher than the driver 284f by the height X, the driver 284f is higher than the driver 284e by the height X, the driver 284e is higher than the driver 284d by the height X, and so on. In various other embodiments, the driver heights of the drivers 284a-284g may have any other suitable gradient, such as a geometric gradient.

As mentioned above, the drivers 284a-284g are shown in FIG. 15 at their respective unfired or unlifted positions. Further, as shown in FIG. 15, the drivers 284a to 284g are supported in their respective unlaunched positions in the staple cartridge 280, whereby the tip of the staple 81 is flush with the cartridge deck 291 or at least. It is positioned on almost the same plane. In such an example, when the staple drivers 284a-284g are in their respective unlaunched positions, the tip of the staple 81 may be positioned coplanar with the cartridge deck 291 and slightly below the cartridge deck 291. Well and / or may be positioned slightly above the cartridge deck 291. In another embodiment, when the staple drivers 284a-284g are in their respective unlaunched positions, a significant portion of the staple 81 may extend above the cartridge deck 291. In at least one such embodiment, the auxiliary material can be positioned on the cartridge deck 291 and the tip of the staple 81 can be embedded in the auxiliary material and then the staple 81 can be lifted with a staple driver 284a-284g. can. Various auxiliary materials include, for example, tissue thickness compensators, buttress materials, and / or any suitable layer. The entire disclosure of US Pat. No. 8,393,514, title of the invention "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENEER CARTRIDGE" (issued March 12, 2013) is incorporated herein by reference in its entirety.

In certain other embodiments, although not shown in the figure, some staples 81 extend above the cartridge deck 291 when the staple drivers 284a-284g are in their respective unlaunched positions, simultaneously one. The staple 81 of the portion does not have to extend above the cartridge deck 291. In at least one such embodiment, when the staple drivers 284a-284g are in their respective unlaunched positions, the proximal staple 81 is positioned below the cartridge deck 291 and at the same time the distal staple 81 is a cartridge. Positioned above deck 291. When the staple drivers 284a-284g are in their respective unlaunched positions, the staple drivers 284a-284g are farthest from the first (unlaunched) position of the most proximal side staple 81 in one longitudinal staple row. It can be positioned and arranged so that there is a height gradient between it and the initial (unlaunched) position of the position side staple 81. Although this gradient is a linear gradient, another embodiment in which this gradient comprises, for example, a geometric gradient is conceivable.

In addition to the above, when the staple drivers 284a-284g are in their respective unfired or unlifted positions, the staple drivers 284a-284g are placed in the staple cartridge 280 so that their drive bottoms are aligned with each other. Other embodiments, such as those stored, are also conceivable. In such an example, the staple 81 is supported at different distances with respect to the cartridge deck 291. Since the forming gap is set by the final position of the staple drivers 284a to 284g, the initial position of such a staple driver 284a to 284g does not affect the forming gap of the staple 81 described above.

In addition to the above, the cartridge deck 291 of the staple cartridge 280 comprises a flat, or at least substantially flat, surface. However, another embodiment in which the cartridge deck 291 is not flat is also conceivable. In at least one embodiment, the distal end of the cartridge deck 291 is higher than the proximal end of the cartridge deck 291. In at least one such embodiment, the cartridge deck 291 is linearly tilted between the proximal and distal ends. In another embodiment, the cartridge deck 291 is geometrically tilted between the proximal and distal ends. In various embodiments, the cartridge deck 291 includes longitudinal steps with different heights. For example, the cartridge deck 291 has, for example, a first longitudinal step aligned with the longitudinal row of the first staple cavity and a second longitudinal step aligned with the longitudinal row of the second staple cavity. And a third longitudinal step aligned with the longitudinal row of the third staple cavity. The transition between adjacent longitudinal steps may be, for example, a vertical wall, or an inclined or angled wall.

As mentioned above, the staples 81 in the staple cartridge 280 have the same or at least substantially the same unformed height. Also, as mentioned above, the unformed height of the staples in the first row can be different from the unformed height of the staples in the second row. In certain embodiments, the staples within one longitudinal row may have different unformed heights. In at least one such embodiment, the most proximal staple in the row can have a first unformed height and the most distal staple in the row has a second unformed height. May have. In one such embodiment, the staples between the most proximal and most distal staples can increase in height continuously. The height of the staples can increase between the proximal and distal ends of the end effector according to the gradient. In at least one example, this gradient is, for example, a linear gradient. In certain examples, this gradient is, for example, a geometric gradient.

Embodiments that include staples with different unformed heights in one staple row can be used with staple drivers with different driver heights. In at least one embodiment, for example, the most proximal staple in a row can be the lowest staple in that row and can be driven by the lowest staple driver. Further, in one such embodiment, for example, the most distal staple can be the highest staple in the row and can be driven by the tallest staple driver. In at least one embodiment, the lowest staple in a row is combined with the lowest staple driver, the highest staple in a row is combined with the highest staple driver, and so on. In certain other embodiments, the lowest staples in a row are not combined with the lowest staple driver, and the highest staples are not combined with the highest staple driver. For example, the lowest staples may be driven by the highest staple driver and the highest staples may be driven by the lowest staple driver. Finally, the staples and staple drivers can be combined in any suitable way to properly fasten the tissue.

As described above, the staples 81 in the staple cartridge 280 have the same or at least substantially the same configuration (eg, V-shaped configuration). Another embodiment is conceivable in which the staples in one staple row have different configurations. In at least one embodiment, each of the staples in a row of staples may have a V-shaped configuration, but the angle of the staple legs forming the V-shaped configuration is at least one (if not all). It may be different for the staples of the part. For example, the most proximal staple in a staple row may have a narrow V-shape, and the most distal staple in the staple row may have a wide V-shape. .. In at least one such example, the angle of the staple legs can increase from the proximal side to the distal side. In another example, the angle of the staple legs can decrease from the proximal side to the distal side. In either case, the angle of the staple legs can affect the formed height of the staples and can be selectively used to secure the tissue in the desired way.

As an unformed structure of another staple, for example, a W-shaped staple can be mentioned. The W-shaped staples may include V-shaped staples in which a portion of the staple base portion extends upward in order to substantially form a W-shaped configuration. W-shaped staples are sometimes also referred to as M-shaped or gull-wing staples. The entire disclosure of US Pat. No. 5,725,554, the title of the invention "SURGICAL STAPLE AND STAPLER" (issued March 10, 1998) is incorporated herein by reference in its entirety. In at least one embodiment, the longitudinal staple row may include, for example, a V-shaped staple at the proximal end of the staple row and a W-shaped staple at the distal end of the staple row. W-shaped staples can be formed differently from V-shaped staples and may be more suitable, for example, to staple the tissue within the larger forming gaps.

16-20 show the surgical instrument system 350. The surgical instrument system 350 includes a shaft assembly 360 and an end effector 370 extending from the shaft assembly 360. In this embodiment, like any other, the shaft assembly 360 is configured to be attached to a robotic surgery system (eg, a DAVINICI robotic surgery system manufactured by Intuitive Surgical, Inc.). Extend from the type of housing. Alternatively, the shaft assembly 360 may extend, for example, from the handle of a surgical instrument configured to be gripped and operated by a surgeon. Such handheld surgical instruments may employ one or more electric motors to generate closure and launch movements, or the closure and launch movements are supported on a handle or housing. It can be manually generated by manipulating one or more triggers or actuation arrangements. All such variations can be effectively incorporated into the surgical instrument system 350 and may be included in the claims attached herein. Further details of such handles, housings, and shaft assemblies are found in the various disclosures incorporated herein by reference. Similar to the arrangement described above, the shaft assembly 360 may also include at least one joint (eg, joint 364, etc.), which is configured to allow the end effector 370 to move around at least one axis of rotation. To. Other embodiments in which the shaft assembly 360 does not include a joint are also conceivable.

Primarily with reference to FIG. 16, the end effector 370 includes a staple cartridge portion 374 and an anvil portion 375. The staple cartridge 380 is positioned within the staple cartridge portion 374. The staple cartridge 380 is removable from the staple cartridge portion 374, which allows it to be easily replaced with another staple cartridge. However, other embodiments are also conceivable in which the staple cartridge 380 cannot be easily replaced. The anvil portion 375 is movable with respect to the staple cartridge portion 374 about an anvil trunnion or an Axis swivel pin 376 extending from the anvil portion 375. See FIGS. 18, 20, and 22. For example, the anvil trunnion 376 extends laterally from each side of the anvil portion 375 and is movably housed in a corresponding opening or slot (not shown) formed within the staple cartridge portion 374. Another embodiment is conceivable in which the staple cartridge portion 374 is "rotatable," "movable," or "pivotable" with respect to the anvil portion 375. As described in more detail below, the anvil portion 375 can be moved between the open position (FIGS. 16-18) and the fully closed position (FIGS. 19-22) by a closed drive. Also, as described in more detail below, the staples (eg, staples 381) are detachably stored in the staple cartridge 380 and can be ejected from the staple cartridge 380 by a firing drive and deformed relative to the anvil portion 375. ..

Primarily with reference to FIGS. 16-18, the shaft assembly 360 includes a rotatable input shaft 361. As described in more detail below, the input shaft 361 is utilized to operate the closed drive and the launch drive. The input shaft 361 is rotatably mounted within the "foundation" or "spine" portion 390 of the shaft assembly 360 by one or more bearings 391 and includes a threaded portion 372. See FIG. The closed drive includes a closure nut 377, which includes a threaded opening 362 defined therein. Closure nuts 377 further include closure pins 378 extending from both sides thereof, which are slidably positioned within closure slots 379 defined on both sides of the anvil portion 375.

The threaded opening 362 of the closure nut 377 is screwably engaged with the threaded portion 372 of the input shaft 361, which causes the input shaft 361 to rotate in the first direction, as shown in FIGS. 16-18. Then, the closure nut 377 moves distally toward the end of the end effector 370 in the distal direction "DD", and when the input shaft 361 rotates in the second direction (opposite direction), the closure nut 377 is housing. Moves to the proximal side in the proximal direction "PD" toward. The interaction between the closure pin 378 of the closure nut 377 and the side wall of the closure slot 379 prevents the closure nut 377 from rotating with the input shaft 361 so that the rotational movement of the input shaft 361 is the closure nut. It is converted into a longitudinal translational motion of 377.

During use, the closure nut 377 is moved distally by the input shaft 361 to move the anvil portion 375 between the open position (FIGS. 16-18) and the fully closed position (FIGS. 19-22). In such an example, the closure pin 378 engages the lower sidewall of each closure slot 379 and cam drives the anvil portion 375 towards the staple cartridge 380. Primarily with reference to FIGS. 19 and 20, it can be observed that the closure slot 379 has a slightly arcuate shape, at least in the illustrated embodiment. In other words, for example, each of the closure slots 379 has a proximal slot portion 392 and a distal slot portion 394, respectively. The point or location where the proximal slot portion 392 transitions to the distal slot portion 394 is referred to herein and is referred to as the apex 395. See FIGS. 20 and 22. When the closure nut 377 is in the most proximal position (eg, "initial position" -FIGS. 16-18), the anvil portion 375 is held in the open position. When the closure nut 377 is in its initial position, the closure pin 378 is at the proximal end of the proximal slot portion 392 of each closure slot 379. The mechanical advantage achieved between the closure pin 378 and the closure slot 379, and the engagement of the anvil trunnion 376 with the cartridge portion 374, serves to hold the anvil portion 375 in the open orientation. If the surgeon wants to close the anvil portion 375, the input shaft 361 is rotated in the first direction to drive the closure nut 377 distally. As the closure pin 378 advances distally through the proximal slot portion 392, the anvil portion 375 begins to close the cam engagement. When the closure pin 378 reaches the top 395, the anvil portion 375 holds a "fully closed" or "fully clamped" position. By continuing to rotate the input shaft 361, the closure nut 377 continues to advance distally. As the closure nut 377 continues to move distally, the closure pin 378 continues to advance distally within the distal slot portion 394, during which time cam engagement or closure with respect to the anvil portion 375 is maintained. It is securely held in the closed position. If the surgeon wants to return the anvil portion 375 to the open position, the input shaft 361 is rotated in the opposite (second) direction, which causes the closure nut 377 to move proximally to the most proximal position (initial position). Drive to return. The closure nut 377 is securely engaged with the input shaft 361, in other words, the closure nut 377 is screwably engaged with the thread 372 of the input shaft 361 throughout the closing and firing process. , A positive closing force on the anvil portion 375 is maintained. Thus, such an arrangement can suppress anvil movement or chatter that can occur in conventional arrangements where the closure nut is loosely bearing on a portion of the input shaft during the firing process.

The input shaft 361 further includes a distal gear 365 fixedly mounted at its distal end. When the input shaft 361 rotates in the first direction, the distal gear 365 rotates in the first direction, and when the input shaft 361 rotates in the second direction, the distal gear 365 rotates in the second direction. do. The launch drive of the end effector 370 includes a rotatable launch shaft 371 which is rotatably mounted on the staple cartridge portion 374 by one or more bearings (eg, bearing 363). The launch shaft 371 includes a proximal gear 385, a proximal threaded portion 396, and a distal threaded portion 397. In the illustrated embodiment, the proximal threaded portion 396 has a first thread "lead", which is the second thread of the distal threaded portion 397, as described in more detail below. It's different from the lead. The proximal gear 385 of the launch shaft 371 meshes with and engages with the distal gear 365 of the input shaft 361 so that the input shaft 361 drives the launch shaft 371 when the input shaft 361 rotates. Can be done. The proximal gear 385 is key-coupled to the launch shaft 371, whereby the rotation of the proximal gear 385 yields rotation of the launch shaft 371.

The launch drive further includes a launch nut 386, which includes a shaft opening 389 and a drive member 398. In the illustrated embodiment, the drive member 398 is received within the opening 399 of the launch nut 386, which is driven by a biasing member or spring (not shown) at the threaded portion of the launch shaft 371. Can be urged at the same time. The firing nut 386 further includes a wedge 383 defined above it, which is configured to slide under the staple driver and lift the staple 381 towards the anvil portion 375, thereby the staple cartridge 380 and the anvil. Staple fastening is performed on the tissue located between the parts and 375. The firing nut 386 also includes a cutting member 382 defined on it configured to cut the stapled tissue. When the firing nut 386 is screwably engaged with the distal threaded portion 397 of the firing shaft 371 and the input shaft 361 rotates in the first direction, the firing nut 386 is directed towards the end of the end effector 370. Moving distally, the staple 381 is ejected from the staple cartridge 380 to cut the tissue. When the firing nut 386 is screwably engaged with the distal threaded portion 397 of the firing shaft 371 and the input shaft 361 rotates in the second direction, the firing nut 386 moves proximally. As the launch nut 386 screwably reengages with the proximal threaded portion 396 of the launch shaft 371, the leads of the proximal threaded portion 396 become smaller or narrower as they approach the starting position. The advance of the firing nut 386 to the proximal side is slowed down.

As can be seen from the above, the surgical instrument system 350 employs a rotary drive closure system and a launch system that is an improvement over the closure and launch systems disclosed in connection with the surgical instrument system of FIGS. 1-5. is doing. As further clarified by reading "Modes for Carrying Out the Invention" herein, the closure and launch system of the surgical system 350 should prevent unwanted "chattering" of the anvil portion during launch. It acts to ensure that the anvil portion 375 is held in the closed position throughout the firing cycle or stroke.

With reference to FIGS. 16-18 again, the closure nut 377 can be moved from the proximal “start” position to the distal “end” position during the clamp stroke, which allows the anvil portion 375 to be fully displaced from the open position. Move to the closed position. When the closure nut 377 is in the proximal position, the closure nut 377 is screwably engaged with a thread 372 defined on the input shaft 361. See FIG. As a result of the above, the first rotation of the input shaft 361 in the first direction can immediately move the closure nut 377 distally to initiate closure of the anvil portion 375. As the closure nut 377 moves distally, the closure pin 378 moves to the proximal portion 392 of the closure slot 379 until it reaches the top 395, where the anvil portion 375 is completely closed or clamped. The continued rotation of the input shaft 361 required to advance the firing nut 386 distally causes the closure nut 377 to continue to advance distally on the input shaft 361. The interaction of closure pins 378 within the distal slot segment 394 of the anvil portion 375 holds the anvil portion 375 in a fully closed position 375 during the completion of the firing stroke.

In particular, in addition to the above, the rotation of the input shaft 361 used to initiate the clamp stroke of the closure nut 377 is transmitted to the firing shaft 371 via the meshed gears 365 and 385. When the launch shaft 371 first rotates, the launch nut 386 screw-engages with the proximal threaded portion 396 of the launch shaft 371, which is narrower or smaller than the thread lead of the distal threaded portion 397. Has a thread lead. As a result, when the launch nut 386 is screw engaged with the proximal threaded portion 397, the launch nut 386 slowly moves through the "neutral launch range" designated as "NFR" in FIG. When the firing nut 386 is in the neutral firing range NFR, the firing nut 386 does not advance distal enough to initiate tissue cutting and staple firing. However, in various arrangements, the firing nut 386 may be configured to slidably engage a portion of the anvil portion 375, which also ensures that the anvil portion 375 is held in the closed position. Further, as the firing nut 386 advances distally through the end effector 370, the spacing of the anvil portion 375 to the staple cartridge 380 can also be maintained. For example, the launch nut 386 can incorporate a shaped steel-like shape as described in the various disclosures incorporated herein by reference, which slidably engage the anvil portion 375. It is configured to fit. However, because the closure nut 377 maintains a positive closing force with respect to the anvil portion 375, in at least some embodiments, the firing nut 386 is configured to reliably engage the anvil portion 375. Thus, the firing nut 386 does not apply any closing or clamping motion to the anvil portion.

Here, primarily with reference to FIGS. 19 and 20, firing nut 386 is driven to the distal end of the proximal thread 396 by continuing to rotate the input shaft 361 and firing shaft 371. Once the drive member 398 of the launch nut 386 engages the distal thread, continued rotation of the launch shaft 377 causes the launch nut 386 to advance distally through the end effector 370. As a result of the above, the clamp operation mode is completed before the actual staple firing mode starts. In addition, the anvil portion 375 is reliably maintained in a closed position throughout the firing process. Further, the surgical instrument system 350 may include a sensor system, for example, an electric motor that detects that or is about to start a staple firing mode of operation and drives an input shaft 361. It is configured to pause. Such sensor systems can be configured to detect, for example, the positions of closure nuts 377, firing nuts 386, and / or proximal gears 385. In at least one such example, whether the surgeon may proceed with staple firing into the tissue by suspending the electric motor or other drive actuator array, or reopening the anvil portion 375 to end effector. It will be possible to evaluate whether the 370 should be rearranged. In at least one example, the surgeon can be provided with two switches to operate selectively, for example, the first button is for restarting the electric motor to advance the firing stroke, the second button is. The electric motor is reversed to reopen the anvil portion 375. The first button can be, for example, green and the second button can be, for example, red. The first button may contain, for example, a "forward" sign, while the second button may contain other marks, such as "back". Such switches can be optionally located on the remote control console and / or the handle of the surgical instrument.

As described above, the firing nut 386 advances distally to eject the staple 81 from the staple cartridge 380. The firing nut 386 can advance to the distal end of the end effector 370 to complete the firing stroke, as shown in FIGS. 21 and 22. The distal threaded portion 397 of the launch shaft 371 allows the drive member 398 of the launch nut 386 to be screwed into the distal thread 397 of the launch shaft 371 when the launch nut 386 reaches the end of the launch stroke. It can be configured to remain engaged. In at least one such example, the firing nut 386, drive member 398, wedge 383, and / or cutting member 382 are located at the distal end of the end effector 370 when the firing nut 386 reaches the end of the firing stroke. The state of the positioned switch can be changed. The switch communicates with the controller of the surgical instrument system 350, which reverses the direction of the electric motor and rotates the input shaft 361 in the second direction when the state of the switch is reversed. Can be done. When the input shaft 361 is rotating in the second direction, the firing nut 386 retracts towards its unfired position. In addition to, or in lieu of, the surgical instrument 350 may include a switch that allows the surgeon to act to stop and / or reverse the direction of the electric motor.

During use, the anvil portion 375 can be moved away from its fully clamped position to release the tissue trapped between the anvil portion 375 and the staple cartridge 380. In addition, the anvil portion 375 can move between open and closed positions as needed to clamp and release tissue and / or insert the end effector 370 into the patient's body, eg, through a trocar. As such, the anvil portion 375 can be positioned relative to the staple cartridge 380. Due to the pause function described above, in the surgical instrument system 350, in the first range of motion to open and close the anvil portion 375 without firing the staples in the staple cartridge 380 and / or without cutting the tissue. It becomes possible to operate.

A portion of another shaft assembly 460 that can be employed with the various end effectors disclosed above is shown in FIGS. 23-28. As can be seen in these figures, the shaft assembly 460 includes a threaded rotary input shaft 461. The threaded rotary input shaft 461 is configured to receive rotary input motion from a motor, which motor is mounted on the shaft assembly 460 or part of a robot system attached to the shaft assembly 460. Is on the handle or housing. In another embodiment, the rotary input shaft 461 can be manually actuated using a manual trigger (s) supported on a handle with the shaft assembly 460 protruding. The shaft assembly 460 includes a hollow outer shaft 510 with a rotary input shaft 461 extending in. The base member 512 is supported in the outer shaft 510 as shown. The base member 512 may be attached to the handle or housing and the surgical staple portion of the end effector and effectively functions as a "spine" or mechanical "foundation" through at least a portion of the shaft assembly 460. The base member 512 also functions as a guide for slidably supporting the actuator member 469 within the outer shaft 510. For example, as can be seen in FIGS. 23-28, the base member 512 includes an axially extending guide trough 514 for receiving the lower portion 522 of the guide 520 attached to the actuator member 469. When viewed from the edge, the guide 520 looks almost "T-shaped". As shown, one side of the base member 512 includes a side guide slot 516 for receiving the side arm portion 524 of the guide 520.

As shown in FIGS. 23-28, the actuator member 469 includes a closure nut assembly 477, which is configured to impart open and close movements to the anvil portion by the method described herein. There is. Closure nut assembly 477 includes a "clamshell" arrangement that includes a first closure nut segment 530 and a second closure nut segment 550, which are attached to a pivot swivel rod or pivot swivel member 560 attached to a guide 520. , Supports clamshell design. With such an arrangement, the closure nut segments 530 and 550 can pivotally swivel from the engaged configuration (FIGS. 23-26) to the non-engaged configuration (FIGS. 27 and 28). The first closure nut segment 530 includes a first screw engagement member 532 and the second closure nut segment 550 includes a second screw engagement member 552. When the closure nut assembly 477 is in an engaging configuration, the first screw engaging member 532 and the second screw engaging member 552 engage the input shaft 461, thereby rotating the input shaft 461. Axial motion of the closure nut assembly 477 occurs. One, and preferably two, laterally extending pivot swivel pins are attached to the structure extending from the guide 520 and / or the pivot swivel member 560, which correspond in the manner described above. It will be understood that it will be accepted by the anvil slot. Therefore, the axial movement of the closure nut assembly 477 opens and closes the anvil portion by the method described above.

With reference to FIGS. 23 and 24, the selective movement of the first and second closure nut segments 530 and 550 between the engaged and non-engaged configurations is controlled by a solenoid or switch member 570. In the illustrated arrangement, for example, the solenoid 570 includes a solenoid body portion 572 attached to a first closure nut segment 530. The solenoid rod 574 is movably supported within the body portion 572 and the first closure nut segment 530 and is movably received within the second closure nut segment 550. As can be seen in FIGS. 23-28, the solenoid rod 574 has a head 576, which is movably received within the U-shaped slot 556 within the second closure nut portion 550.

Still referring to FIGS. 23 and 24, the pair of base contact 518s is located within the base member 512 and opens into the guide trough 514 to facilitate sliding electrical contact with the solenoid contact 578. The base contact 518 is electrically connected to the controller by a wire 519, which extends through the base member 512 back to a possible part such as a handle, housing, or other part for a robotic system. do. For example, the controller can work with a trigger or other switch mechanism, which controls the current supply to the base contact 518 and ultimately extends between the solenoid 570 and the solenoid contact 578. It can be used to control the current supply to the solenoid 570 through the lead wire 579. As can be seen in FIG. 23, in at least one arrangement, the range of axial movement of the closure nut assembly 477 can be defined, for example, by the length "L" of the base contact 518. In one arrangement, the solenoid 570 is urged to the engaging position in the non-energized state and the solenoid rod 572 is maintained in the retracted state as shown in FIGS. 23-26. When the solenoid 570 is energized, the solenoid rod 572 is moved outward towards the second closure segment 550, which causes the closure nut assembly 477 to pivotally swivel into a non-engaged configuration (FIGS. 27 and 28). .. In another arrangement, when the solenoid is in the non-energized state, the solenoid is urged to the non-engaged configuration, and then when the solenoid is energized, it moves to the engaged configuration. In yet other arrangements, the solenoid needs to be reliably actuated between the engaged and non-engaged configurations (ie, the solenoid is employed within the solenoid to urge any of the above configurations. There is no urging member to be used).

When the closure nut assembly 477 is in the non-engaged configuration, the rotation of the input shaft 461 is not transmitted to the closure nut assembly 477. Therefore, in one arrangement, the closure nut 477 may be configured in an engaging position for closing the anvil portion. When the anvil portion moves to the closed position (which can be detected by sensors in the anvil portion and / or surgical staple portion), the controller can de-energize the motor and solenoid, which allows the closure nut assembly. Move the 477 to a non-engaged configuration. At that point, the controller activates the motor again to rotate the input shaft 461 to initiate the firing operation as described above, without operating or axially moving the closure nut assembly 477. Can be done.

The surgical instrument system shown in FIGS. 23-28 also employs a locking system 580 to securely lock the closure nut assembly in place when in the most distal non-engagement orientation ( For example, to prevent further axial movement). As can be seen in these figures, the locking system 580 includes a movable lock link 582, which is a distal link 583 pivotally pinned to the proximal link 586 by an upright central lock pin 587. Includes. The proximal end 588 of the proximal link 586 is pivotally pinned to the base member 512 by the proximal pin 589. The distal end 584 of the distal link 583 is pivotally pinned to the guide 520 by a pin 585. Thus, the lock link 582 moves between the folded configuration (FIG. 23), the aligned "pre-lock" configuration (FIGS. 25 and 26), and the locked configuration (FIGS. 27 and 28).

As can be seen in FIGS. 23-28, the locking system 580 also includes a locking arm 590, which is attached to or protrudes from the closure nut assembly 477, and in the illustrated embodiment, the first closure nut. It protrudes from segment 530. The lock arm 590 includes a lock pin hole 592, which is configured to hold and accept a portion of the lock pin 587 in it. As can be seen in FIGS. 24, 26 and 28, the lower end of the lock pin hole 592 includes a chamfered or tapered portion 594, which facilitates entry of the lock pin 587 into it.

One method of using the closure nut assembly 477 is described here. If the doctor wants to close the anvil portion, the input shaft 461 is rotated in the first direction. This rotational motion can be applied to the input shaft 461 by an electric motor, robotic system, or manually operable closure system, which closure system responds to ratchet engagement such as closure triggers or other forms of operation. It is configured to generate rotational motion. When in that position, the solenoid is urged to the engaging position (by a spring or other urging arrangement) and remains unenergized. The rotation of the input shaft 461 causes the closure nut assembly 477 to move distally. As mentioned above, the distal movement of the closure nut assembly 477 causes closure of the anvil portion. This is due to the cam engagement interaction between the closure pin and the anvil slot provided in the anvil mounting portion. If the doctor wants to reopen the anvil section (to relocate the end effector to the desired target tissue, or for some other reason), the doctor simply rotates the input shaft with respect to the motor or other actuating mechanism. Reverse the direction (second direction). In either case, when the closure nut assembly 477 advances distally and the anvil portion reaches the "completely closed" position (FIG. 25), the application of rotational motion to the input shaft 461 is stopped. This can be achieved manually by the doctor, or if sensors are used to detect the position of the closure nut assembly 477 and / or the position of the anvil portion, the control system "automatically" motors. The application of force to the can be stopped. As can be seen in FIG. 25, when in its fully closed position, the movable lock link is configured in the pre-lock position and the end of the lock pin 587 is aligned with the lock hole 592 of the lock arm 590. When in this position, if the doctor wants to open the anvil portion, the motor is simply re-energized to rotate the input shaft 461 in the second direction. However, if the physician does not want to reopen the anvil portion and wishes to initiate the launch phase, the physician energizes the solenoid to move the closure nut segment into a non-engaged configuration (FIGS. 27 and 28). As can be seen in these figures, as the first closure nut segment 530 pivotally swivels in the direction of the closure link 580, the end of the closure pin 587 enters the hole 592 of the lock arm 590 and disengages the closure nut assembly 477. It holds firmly in place and prevents the closure nut assembly 477 from moving axially during the firing procedure. When in that position, as can be seen in the figure, the links 586 and 584 are in a "bent" configuration, in contact with a portion of the base member and / or the inner wall of the outer shaft 510, thereby relative to the closure nut assembly 477. Further lock resistance may be added. In another arrangement, when the switch system confirms that the closure nut assembly 477 and / or the anvil portion has reached a fully closed position, the control system can "automatically" energize the solenoid 570. In such cases, the closure nut assembly 477 automatically moves to the disengaged locked position. When the firing nut completes the firing stroke and returns to the starting position, a switch is used to detect its state / position and cause the control system to de-energize the solenoid, thereby returning it to the engaged position. Can be momentum. Other solenoid arrangements do not have to include an urging member that urges the solenoid to return to its starting position, but instead requires a second signal to return it to its starting position. In such cases, the control system may send a second signal to the solenoid to reengage the closure nut assembly with the input shaft. The control system can then automatically energize the motor and rotate the input shaft in the second direction to return the closure nut assembly to its initial position and thus the anvil portion to the open position.

Although the surgical instrument system described herein is operated by an electric motor, the surgical instrument system described herein can be operated in any suitable manner. In various examples, the surgical instrument system described herein can be operated, for example, by a manually operated trigger.

The surgical instrument system described herein has been described in connection with the deployment and modification of staples, but the embodiments described herein are not limited thereto. Various embodiments are also conceivable, such as deploying fasteners other than staples, such as clamps or tacks. In addition, various embodiments are conceived 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. Also, for example, the end effector according to a particular embodiment can apply vibration energy to seal the tissue.

While the surgical instrument system described herein is operated by one or more electric motors, the surgical instrument system described herein may operate in any suitable manner. can. In various examples, the surgical instrument system described herein can be operated, for example, by a manually operated trigger.

Embodiment 1-A surgical instrument comprising a rotary input shaft and means for selectively applying rotary input motion to the rotary input shaft. The surgical instrument further comprises a surgical end effector, which is a second jaw that can be selectively moved between an open position and a closed position with respect to the first jaw and the first jaw. It has a jaw. The launch shaft is operably linked to the rotary input shaft, which causes the launch shaft to rotate in response to the rotation of the rotary input shaft. The launching member is in one of the first and second jaws due to the selective axial movement between the start and end positions in response to the rotation of the launch shaft. It is supported to be movable. The closing member is screw-engaged with the rotary input shaft, whereby the closing member moves the second jaw to the closed position by rotating the rotary input shaft in the first direction. The closing member remains screw-engaged with the rotary input shaft while continued rotation of the rotary input shaft in the first direction drives the launcher from the start position to the end position, with the second jaw. Hold in the closed position.

Example 2-The first jaw comprises a surgical staple cartridge, the second jaw comprises an anvil, and the launching member has a tissue cut surface and an anvil by driving the surgical staple from the surgical staple cartridge. The surgical instrument of Example 1, comprising a wedge for forming a contact with the device.

Example 3-The surgical instrument of Example 1 or 2, wherein the input shaft and the launch shaft are not coaxially aligned.

Example 4-The launch shaft comprises a proximal thread set having a first lead and a distal thread set having a second lead different from the first lead. One, two or three surgical instruments.

Example 5-Surgical instrument of Example 4, wherein the second lead is larger than the first lead.

Example 6-The surgical instrument of Example 2, 3, 4 or 5, wherein the launching member is configured to engage the anvil as the launching member moves between the start and end positions. ..

Example 7-The launching member should be spaced from each other at a desired distance between the first jaw and the second jaw as the launching member moves between the start and end positions. The surgical instruments of Examples 1, 2, 3, 4, 5 or 6 that are configured.

Example 8-The surgical instrument of Example 1, 2, 3, 4, 5, 6 or 7, wherein the means for selectively adding is an electric motor.

Example 9-Surgical instruments of Example 1, 2, 3, 4, 5, 6 or 7, wherein the means for selectively adding is a robotic system.

Example 10-A surgical instrument comprising an elongated shaft assembly with an input shaft. The surgical instrument further comprises a surgical end effector, which comprises a staple cartridge portion and an anvil supported for selective movement with respect to the staple cartridge portion. The launch shaft is operably supported by a staple cartridge portion. The launch shaft is operably linked to the input shaft so that the launch shaft is actuated when actuation motion is applied to the input shaft. The launch member is movably supported within the staple cartridge portion for selective axial movement between the start and end positions in response to the actuation of the launch shaft. The closing member is operably linked to the input shaft and is configured to move axially from the initial position to the end position. The clamped position is located between the initial position and the end position and corresponds to the position where the closing member holds the anvil in the fully closed position. After achieving the clamped position of the closing member, further actuation of the input shaft moves the launching member from the start position to the end position while holding the anvil in the fully closed position and the closing member is clamped. Move from the position to the end position.

Example 11-The surgical instrument of Example 10 in which the closure member comprises at least one Axis swivel pin received in a corresponding pin slot within the attachment portion of the anvil portion. Each pin slot comprises a proximal slot portion corresponding to the initial position of the closure member. The distal slot portion is joined to the proximal slot portion at the apex corresponding to the clamped position, whereby the distal slot portion is not axially aligned with the proximal slot portion. ..

Example 12-The surgical instrument of Example 10 or 11, wherein the launch shaft is rotatably actuated by applying actuation motion to the input shaft and the launch member is screwably engaged with the launch shaft.

Example 13-The surgical instrument of Example 10, 11 or 12, where the input shaft and the launch shaft are not coaxially aligned.

Example 14-Embodiment, wherein the launch shaft comprises a proximal thread set with a first lead and a distal thread set with a second lead that is different from the first lead. 10, 11, 12 or 13 surgical instruments.

Example 15-The surgical instrument of Example 14, where the second lead is larger than the first lead.

Example 16-The surgical instrument of Example 10, 11, 12, 13, 14 or 15 in which the closing member is screwably engaged with the input shaft.

Example 17-Surgical instruments of Example 10, 11, 12, 13, 14, 15 or 16 further comprising means for applying working motion to the input shaft.

Example 18-Surgical instrument of Example 17, wherein the means for addition comprises an electric motor.

Example 19-Surgical instrument of Example 17, wherein the means for addition comprises a robotic system.

Example 20-A surgical instrument system comprising a housing and a motor operably supported by the housing and configured to generate rotational motion. The rotary input shaft is configured to receive rotary motion from the motor. The surgical instrument system further comprises a surgical end effector, which comprises a staple cartridge portion and an anvil supported for selective movement with respect to the staple cartridge portion. The launch shaft is operably supported by a staple cartridge portion. The launch shaft is operably linked to the input shaft, which causes the launch shaft to operate when a rotational motion is applied to the rotary input shaft. The surgical end effector further comprises a firing nut with a tissue cut surface and wedges. The firing nut comprises a proximal threaded segment with a first threaded lead and a distal threaded segment with a second threaded lead that is larger than the first threaded lead. It is screw-engaged with the threaded part of. The surgical instrument system is further equipped with a closure nut, which is screw-engaged with the rotary input shaft, which causes the closure nut to open the anvil by rotating the rotary input shaft in the first direction. Move from to the closed position. The closure nut, while continued rotation of the rotary input shaft in the first direction drives the firing nut from thread engagement with the proximal threaded segment to thread engagement with the distal threaded segment. It remains screw engaged with the rotary input shaft and holds the anvil in the closed position.

Example 21-A surgical instrument comprising a surgical end effector and a threaded rotary input shaft. The actuator member is operably engaged with the surgical end effector and selectively screw-engaged with the threaded rotary input shaft, whereby the actuator member is in an engaged configuration when the actuator member is in an engaging configuration. Screw-engaged with a threaded rotary input shaft, which causes the actuator member to move axially due to the rotation of the threaded rotary input shaft, imparting actuating motion to the surgical end effector, and the actuator member is disengaged. When at, the rotation of the threaded rotary input shaft is not imparted to the actuator member. Surgical instruments are a means for selectively moving the actuator between the engaged and non-engaged configurations and to prevent axial movement of the actuator member when the actuator member is in the non-engaged configuration. Further equipped with a locking system.

Example 22-The surgical end effector comprises a first jaw and a second jaw that can be selectively moved between an open position and a closed position with respect to the first jaw. The surgical instrument of Example 21. The actuator member comprises a closing member that is operably engaged with a second jaw portion, whereby the closing member is seconded by rotation of the threaded rotary input shaft when the closing member is in the engaging configuration. The jaw of 2 is moved from the open position to the closed position, and when the threaded rotary input shaft rotates in the second direction, the closing member moves the second jaw from the closed position to the open position.

Example 23-Surgical instrument of Example 22, wherein the first jaw comprises a surgical staple cartridge and the second jaw comprises an anvil.

Example 24-Examples 21 and 22 or comprising a first actuator segment in which the actuator member is supported for axial movement with respect to a threaded rotary input shaft and comprises a first threaded engagement portion. 23 surgical instruments. The second actuator segment is supported for axial movement with respect to the threaded rotary input shaft and comprises a second threaded engagement portion. The first and second actuator segments have an engagement configuration in which the first and second screw engagement portions cooperate to screwably engage the threaded rotary input shaft, and the first and second threads. It is selectively movable with respect to each other by means for selectively moving between a non-engagement configuration in which the engaging portion does not screwably engage the threaded rotary input shaft.

Example 25-The surgical instrument of Example 24, wherein both the first actuator segment and the second actuator segment are pivotally coupled and the means for selectively moving is provided with a solenoid.

Example 26-The lock system engages with a lock pin that is movably supported with respect to the actuator member and that protrudes from the first actuator segment and that the first actuator segment is in a non-engaged configuration. The surgical instrument of Example 24 or 25, comprising a locking member configured to engage in a stationary manner.

Example 27-The surgical instrument of Example 21, 22, 23, 24, 25 or 26, wherein the surgical instrument further comprises means for selectively applying rotational input motion to the threaded rotary input shaft.

Example 28-Surgical instrument of Example 27, wherein the means for selectively adding is an electric motor.

Example 29-Surgical instruments of Example 21, 22, 23, 24, 25, 26, 27 or 28, wherein the means for selectively adding is a robotic system.

20-Examples 22, 23, 24 further comprising a launch shaft operably linked to a threaded rotary input shaft, whereby the launch shaft rotates in response to rotation of the threaded rotary input shaft. , 25, 26, 27, 28, 29 surgical instruments. The launching member is in one of the first and second jaws due to the selective axial movement between the start and end positions in response to the rotation of the launch shaft. It is supported to be movable.

Example 31-The first jaw comprises a surgical staple cartridge, the second jaw comprises an anvil, and the launching member has a tissue cut surface and an anvil that drives the surgical staple from the surgical staple cartridge. A surgical instrument of Example 30, comprising a wedge for forming a contact with the staple.

Example 32-A surgical instrument comprising a rotary input shaft and a surgical end effector. The surgical end effector comprises a first jaw and a second jaw that can be selectively moved between an open position and a closed position with respect to the first jaw. The surgical instrument further comprises a closing member that operably engages with the second jaw and selectively operably engages with the rotary input shaft, whereby the closure member engages with the rotary input shaft. When in the combined configuration, the rotation of the rotary input shaft causes the closing member to impart actuating motion to the second jaw, and when the closing member is in the non-engaging configuration, the rotation of the input shaft imparts to the closing member. Not done. Surgical instruments provide a switch for selectively moving the closing member between the engaged and disengaged configurations and prevent axial movement of the closing member when the closing member is in the non-engaging configuration. Equipped with a lock system for.

Example 33-The surgical instrument of Example 32, wherein the first jaw comprises a surgical staple cartridge and the second jaw comprises an anvil.

Example 34-Surgery of Example 32 or 33, wherein the closing member is supported to move axially with respect to a rotary input shaft and comprises a first closure nut segment comprising a first screw engagement portion. Equipment. The second closure nut segment is supported for axial movement with respect to the rotary input shaft and comprises a second screw engagement portion. The first and second closure nut segments have an engagement configuration in which the first and second screw engagement portions cooperate to screwably engage the rotary input shaft, and the first and second screw engagements. It is selectively movable with respect to each other by a switch between a non-engaging configuration in which the mating portion does not screwably engage the rotary input shaft.

Example 35-The surgical instrument of Example 34, wherein both the first closure nut segment and the second closure nut segment are pivotally coupled and the switch comprises a solenoid.

Example 36-The locking system engages with the locking pin supported against the closing member and when the first closing member projects from a portion of the first closing member and the first closing member is in a disengaged configuration. The surgical instrument of Example 32, 33, 34 or 35, comprising a locking member configured to engage in a stationary manner.

Example 37-The surgical instrument of Example 36, in which the lock pin is movably supported with respect to the closing member.

Example 38-The surgical instrument of Example 37, wherein the lock pin is supported on a link movably connected to the closing member.

Example 39-The launch shaft is operably linked to the rotary input shaft, whereby the launch shaft rotates in response to the rotation of the rotary input shaft, in response to the rotation of the launch shaft and the launch shaft. With a launching member movably supported in one of the first and second jaws for selective axial movement between the start and end positions. The surgical instrument of Example 32, 33, 34, 35, 36, 37 or 38 further comprising.

Example 40-A surgical instrument system comprising a surgical end effector and a threaded rotary input shaft. The surgical instrument is a clamshell actuator member that is supported in an operable engagement with the surgical end effector, with a first closed configuration in which the actuator member is screw engaged with a rotary input shaft. Further comprises a clamshell actuator member in which the actuator member is selectively movable between a threaded rotary input shaft and a second open configuration in which the actuator member is not screw engaged.

Example 41-A staple cartridge for use with a surgical stapler, including anvil, the proximal end, the distal end, the deck, the longitudinal slots defined within the deck, and the longitudinal rows of staple cavities. The cartridge body is provided. The staple cartridge is a staple driver that is removable and stowed in the longitudinal row of the staple cavity and is movable between the unlaunched and fired positions to drive the staples towards the anvil. It comprises a longitudinal row and a launch system that is movable towards the distal end to continuously move the staple driver between unlaunched and launched positions. The longitudinal row of staple drivers is the first staple driver, configured to drive the first lower drive surface configured to be driven by the launch system and the first staple towards the anvil. With a first staple driver and a second staple driver having a first support surface and a first driver distance defined between the first lower drive surface and the first support surface. There is a second lower drive surface configured to be driven by the launch system and a second support surface configured to drive the second staple towards the anvil. The driver distance is defined between the second lower drive surface and the second support surface, and the second driver distance comprises a second staple driver that is different from the first driver distance.

Example 42-The staple cartridge of Example 41, wherein the first staple driver is located proximal to the second staple driver and the first driver distance is shorter than the second driver distance.

Example 43-The first support surface comprises a first pedestal configured to receive a portion of the first staple therein, and the second support surface has a second support surface therein. The staple cartridge of Example 41 or 42, comprising a second cradle configured to receive a portion of the staple.

Example 44-The staple cartridge of Example 41, 42, or 43, wherein the first staple driver is not connected to the second staple driver.

Example 45-The staple cartridge of Example 41, 42, or 43, wherein the first staple driver is connected to the second staple driver.

Example 46-The longitudinal row of the staple driver comprises a third staple driver located distal to the second staple driver so that the third staple driver is driven by the launch system. It has a configured third lower drive surface and a third support surface configured to drive the third staple towards the anvil, with a third driver distance between the third lower drive surface and the third. The staple cartridge of Example 41, 42, 43, 44, or 45, defined between the support surface of 3 and having a second driver distance shorter than the third driver distance.

Example 47-The first driver height, the second driver height, and the third driver height increase in height with a linear gradient, Examples 41, 42, 43, 44, 45, or 46. Staple cartridge.

Examples 48-The first driver height, the second driver height, and the third driver height increase in height according to the geometric gradient, Examples 41, 42, 43, 44, 45, Or 46 staple cartridges.

Example 49-A first longitudinal row of staple drivers is configured to drive a first group of staples, the first staple and the second staple being part of the first group of staples. The staple cartridge further comprises a second longitudinal row of staple drivers configured to drive a second group of staples, the first group of staples being defined by a first undeformed height. , A second group of staples is defined by a second undeformed height, where the first undeformed height is different from the second undeformed height, Examples 41, 42, 43, 44. , 45, 46, 47, or 48 staple cartridges.

Example 50-The deck comprises a first step aligned with a first group of staples and a second step aligned with a second group of staples, the first step being the first. The staple cartridge of Example 49, defined by the height of, the second step is defined by the second height, and the first height is different from the second height.

Example 51-A staple cartridge of Example 41, 42, 43, 44, 45, 46, 47, 48, or 49, wherein the deck is flat.

Example 52-Staple is positioned under the deck when the staple driver is in the unlaunched position, Example 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 or 51. Staple cartridge.

Example 53-A staple cartridge of Example 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, or 52, further comprising a piece of auxiliary material positioned on the deck.

Example 54-A staple cartridge of Example 53, wherein the auxiliary material comprises a tissue thickness compensator.

Example 55-When the staple driver is in the unfired position, the first staple is positioned below the deck, the second staple is partially positioned above the deck, and the staple driver is above the deck. A second staple, further comprising a positioned auxiliary material, is partially embedded within the auxiliary material when the staple cartridge is in the unfired position, Examples 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 or 51 staple cartridges.

Example 56-A staple cartridge of Example 55, wherein the auxiliary material comprises a tissue thickness compensator.

Example 57-Staple driven by a longitudinal row of staple drivers is housed in the cartridge body so that the staples are at the same distance to the deck when the staple driver is in the unfired position. Positioned staple cartridges of Examples 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 or 51.

Example 58-Staple driven by a longitudinal row of staple drivers is housed in the cartridge body so that the staples are at the same distance to the deck when the staple driver is in the unfired position. Staple cartridges of Examples 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 or 51 that are not positioned.

Example 59-A staple cartridge for use with a surgical stapler, including anvil, the proximal end, the distal end, the deck, the longitudinal slots defined within the deck, and the longitudinal rows of staple cavities. A cartridge body is provided. The staple cartridge is a staple that is removable and stored in the longitudinal row of the staple cavity and is a staple driver that is movable between the unlaunched and fired positions to drive the staples towards the anvil. Drive the staples at different distances to the deck with the longitudinal row and the launch system that can move towards the distal end to continuously move the staple driver between the unlaunched and fired positions. Further provided with means for this.

Example 60-An end effector for use with a surgical system, comprising a fastener cartridge comprising a distal end, a deck, and a longitudinal row of fastener cavities. The end effector has a fastener that is detachably stored in the longitudinal row of the fastener cavity, a forming jaw, and an unfired and fired position for driving the fastener toward the forming jaw. A longitudinal row of fastener drivers that can be moved between and a firing system that can move towards the distal end to continuously move the fastener driver between unlaunched and fired positions. , Are further provided. The longitudinal row of fastener drivers is a first fastener driver that drives a first lower drive surface configured to be driven by a launch system and a first fastener towards an anvil. A first fastener driver, and a first fastener driver, comprising a first support surface configured such that a first driver distance is defined between the first lower drive surface and the first support surface. A second lower drive surface configured to be driven by the launch system and a second support surface configured to drive the second fastener towards the anvil, which is the fastener driver of 2. A second driver distance is defined between the second lower drive surface and the second support surface, and the second driver distance is different from the first driver distance. Equipped with a fastener driver.

All disclosures below are incorporated herein by reference:
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US Patent Application Publication No. 2010/0264194 filed on April 22, 2010, title of invention "SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR", currently US Patent No. 8,308,040.

Although various embodiments of the device have been described herein in connection with the particular disclosed embodiments, many modifications and modifications can be made to those embodiments. 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 a plurality of components, or a plurality of components may be replaced with a single component in order to perform a given function. .. The above description and the following claims are intended to include all such amendments and changes.

The devices disclosed herein can be designed to be discarded after a single use, or can 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 any combination of a device disassembly step, a subsequent cleaning or replacement step of a particular part, and a subsequent reassembly step. In particular, the device is disassembled and any number of specific parts or parts of the device device can be selectively replaced or removed in any combination. After cleaning and / or replacing certain parts, the device can be reassembled for later use by the surgical team at a readjustment facility or shortly before a surgical procedure. 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 the present invention.

As a mere example, the embodiments described herein may be processed prior to surgery. First, new or used utensils may be obtained and cleaned as needed. 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, or high energy electron beams. 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 can also be sterilized using any other technique known in the art, including but not limited to beta or gamma rays, ethylene oxide, hydrogen peroxide plasma, 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 patents, publications or other disclosures, in whole or in part, incorporated herein by reference, have existing definitions, statements, or other disclosures that are incorporated herein by reference. It is incorporated herein only to the extent that it is consistent with the disclosure of. As such, and to the extent necessary, the disclosures expressly set forth herein shall supersede any contradictory statements incorporated herein by reference. Any document that is incorporated herein by reference, but is inconsistent with existing definitions, statements, or other disclosed documents described herein, or parts thereof, is an reference document and an existing disclosure. It shall be incorporated only to the extent that there is no contradiction with the content.

[Implementation mode]
(1) It is a surgical instrument and
With the rotary input shaft,
A means for selectively applying a rotary input motion to the rotary input shaft,
It ’s a surgical end effector.
First jaw,
A second jaw that can be selectively moved between an open position and a closed position with respect to the first jaw.
A launch shaft that is operably linked to the rotary input shaft, whereby the launch shaft rotates in response to the rotation of the rotary input shaft.
Move into one of the first and second jaws for selective axial movement between the start and end positions in response to rotation of the launch shaft. A capable launching member as well as a closing member that is screw-engaged with the rotary input shaft, whereby the rotation of the rotary input shaft in a first direction causes the closing member to be the first. The jaw of 2 is moved to the closed position, while the closing member is driven while the subsequent rotation of the rotation input shaft in the first direction drives the launching member from the start position to the end position. A closing member, which remains screw-engaged with the rotary input shaft and holds the second jaw in the closed position.
A surgical end effector, and a surgical instrument.
(2) The first jaw is provided with a surgical staple cartridge, the second jaw is provided with an anvil, and the launching member is provided.
Tissue cut surface and
The surgical instrument according to embodiment 1, comprising a wedge for driving the surgical staples from the surgical staple cartridge to form contact with the anvil.
(3) The surgical instrument according to the first embodiment, wherein the input shaft and the launch shaft are not coaxially aligned.
(4) The launch shaft comprises a proximal thread set having a first lead and a distal thread set having a second lead different from the first lead. The surgical instrument according to aspect 1.
(5) The surgical instrument according to embodiment 4, wherein the second lead is larger than the first lead.

(6) The surgical instrument according to embodiment 2, wherein the launch member is configured to engage the anvil as the launch member moves between the start position and the end position. ..
(7) The launching member is spaced from each other at a desired distance between the first jaw and the second jaw when the launching member moves between the start position and the end position. The surgical instrument according to embodiment 1, which is configured to open.
(8) The surgical instrument according to embodiment 1, wherein the means for selectively adding is provided with an electric motor.
(9) The surgical instrument according to embodiment 1, wherein the means for selectively adding is provided with a robot system.
(10) Surgical instrument
An elongated shaft assembly with an input shaft and
It ’s a surgical end effector.
Staple cartridge part,
Anvil, supported for selective movement with respect to the staple cartridge portion,
A launch shaft operably supported by the staple cartridge portion, which is operably linked to the input shaft, whereby the launch shaft is actuated when actuation motion is applied to the input shaft. The launch shaft,
A launch member movably supported within the staple cartridge portion for selective axial movement between the start and end positions in response to the actuation of the launch shaft, and the input shaft. With a surgical end effector, which is operably linked to and is configured to move axially from the initial position to the end position.
The clamped position is located between the initial position and the end position, the clamped position corresponds to the position where the closing member holds the anvil in the fully closed position, and the closing member is said. After achieving the clamped position, the input shaft is further actuated to move the launching member from the starting position to the ending position while holding the anvil in the fully closed position and the closing member. A surgical instrument that moves from the clamped position to the end position.

(11) The closure member comprises at least one pivot swivel pin received in a corresponding pin slot within the mounting portion of the anvil portion, each of which is a pin slot.
The proximal slot portion corresponding to the initial position of the closing member and
The distal slot portion is joined to the proximal slot portion at the apex corresponding to the clamped position, whereby the distal slot portion is axially aligned with the proximal slot portion. 10. The surgical instrument according to embodiment 10, comprising a distal slot portion that is not aligned with.
(12) The surgery according to embodiment 10, wherein the launch shaft rotatably operates by applying the actuating motion to the input shaft, and the launch member is screwably engaged with the launch shaft. Equipment.
(13) The surgical instrument according to embodiment 10, wherein the input shaft and the launch shaft are not coaxially aligned.
(14) The launch shaft comprises a proximal thread set having a first lead and a distal thread set having a second lead different from the first lead. The surgical instrument according to aspect 12.
(15) The surgical instrument according to embodiment 14, wherein the second lead is larger than the first lead.

(16) The surgical instrument according to embodiment 10, wherein the closing member is screwably engaged with the input shaft.
(17) The surgical instrument according to embodiment 10, further comprising means for applying the actuating motion to the input shaft.
(18) The surgical instrument according to embodiment 17, wherein the means for adding is provided with an electric motor.
(19) The surgical instrument according to embodiment 17, wherein the means for adding is provided with a robot system.
(20) A surgical instrument system
With the housing
A motor that is operably supported by the housing and configured to generate rotational motion.
A rotary input shaft configured to receive the rotational motion from the motor,
It ’s a surgical end effector.
Staple cartridge part,
Anvil, supported for selective movement with respect to the staple cartridge portion,
A launch shaft operably supported by the staple cartridge portion, which is operably linked to the input shaft, whereby the launch shaft is operably linked to the rotary input shaft when the rotational motion is applied. Working on the launch shaft,
A firing nut with a tissue cut surface and wedges.
Proximal threaded segment with first threaded lead,
It comprises a distal threaded segment with a second threaded lead that is larger than the first threaded lead, and a firing nut that is screw engaged with the threaded portion of the firing shaft. With surgical end effectors,
A closure nut that is screw engaged with the rotation input shaft, whereby the rotation of the rotation input shaft in the first direction causes the closure nut to move the anvil from an open position to a closed position. The closure nut is threaded from the screw engagement of the firing nut with the proximal threaded segment to the distal threaded segment by the continued rotation of the rotary input shaft in the first direction. A surgical instrument system comprising a closure nut, which remains screw-engaged with the rotary input shaft and holds the anvil in the closed position while driven into the joint.

Claims (8)

It ’s a surgical instrument,
An elongated shaft assembly with an input shaft and
It ’s a surgical end effector.
Staple cartridge part,
Anvil, supported for selective movement with respect to the staple cartridge portion,
A launch shaft operably supported by the staple cartridge portion, which is operably linked to the input shaft, whereby the launch shaft is actuated when actuation motion is applied to the input shaft. The launch shaft,
With the launching member movably supported within the staple cartridge portion and the input shaft for selective axial movement between the start and end positions in response to the actuation of the firing shaft. A surgical end effector, comprising a closure member, which is operably linked and configured to move axially from an initial position to an end position.
The clamped position is an intermediate position intermediate between the initial position and the end position , and the clamped position corresponds to a position where the closing member holds the anvil in a completely closed position, and the closing position. After the member has achieved the clamped position, the input shaft is further actuated to move the launching member from the starting position to the ending position while holding the anvil in the fully closed position. The closing member is moved from the clamped position , the intermediate position , to the end position.
The closure member comprises at least one Axis swivel pin received in a corresponding pin slot within the mounting portion of the anvil, each of which is a pin slot.
The proximal slot portion corresponding to the initial position of the closing member and
The distal slot portion corresponding to the termination position of the closing member, which is joined to the proximal slot portion at the apex corresponding to the intermediate position, which is the clamped position, thereby said. The distal slot portion comprises a distal slot portion that is not axially aligned with the proximal slot portion.
A surgical instrument in which the at least one pivot swivel pin moves from the proximal slot portion within the pin slot through the apex to the distal slot portion . The first aspect of the present invention, wherein the launching member is slidably engaged with the anvil, and the launching member moves from the start position to the end position while the launching member is engaged with the anvil . Surgical instruments. The surgical instrument according to claim 1, wherein the launch shaft rotatably operates by applying the actuating motion to the input shaft, and the launch member is screwably engaged with the launch shaft. The surgical instrument according to claim 1, wherein the input shaft and the launch shaft are not coaxially aligned. The surgical instrument of claim 1, wherein the closing member is screwably engaged with the input shaft. The surgical instrument according to claim 1, further comprising means for applying the actuating motion to the input shaft. The surgical instrument according to claim 6 , wherein the means for adding is provided with an electric motor. The surgical instrument according to claim 6 , wherein the means for adding is provided with a robot system.

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