JP7090528B2 - Surgical stapling and cutting device and how to use this device - Google Patents

Description

The present invention further relates to the field of medical devices, in particular to the field of surgical stapler instruments capable of cutting tissue between these staple lines while applying staple lines to the tissue, further to improve the stapler device. And to improve the process of forming various components of these stapler appliances, including articulated shafts. The device can be used, in particular, to perform tissue striping and amputation during endoscopic or laparoscopic surgical procedures.

Endoscopic surgical instruments are often preferred over traditional open surgical devices. This is because smaller incisions tend to reduce postoperative recovery time and complications. As a result, significant development has been made in the working range of endoscopic surgical instruments suitable for accurately placing the distal end agonist at the desired surgical site through the cannula of the mantle needle. These distal end agonists engage tissue in a variety of ways to provide diagnostic or therapeutic effects (eg, end cutters, grippers, cutters, staplers, clip appliers, access devices, drugs). / Gene therapy delivery device, energy device using ultrasonic waves, RF, laser, etc.).

Positioning of the end actuator is forced by the mantle needle. In general, these endoscopic surgical instruments have a long shaft between the end agonist and the surgeon-operated handle. This long shaft allows insertion to the desired depth and rotation about the long axis of the shaft, which allows some positioning of the end agonist. By wisely arranging the mantle needle and using the gripper, for example via another mantle needle, this positioning amount is often sufficient. For example, Knodel et al. Surgical stapling and cutting instruments, such as US Pat. Nos. 5, 465, 895, are examples of endoscopic surgical instruments that successfully position end agonists by insertion and rotation.
US Pat. No. 5,465,895

Manufactured by United States Surgical Corporation, Green et al. US Pat. , Equipped with an end actuator that rotates in steps along a single surface. See FIGS. 31 and 32. However, the United States Surgical Corporation stapler is limited by a predetermined angle that can be achieved and a limitation of left-right rotation (-45 ° to + 45 °) and requires two hands to operate.
US Pat. No. 6,644,532 US Pat. No. 6,250,532

It is desirable to further adjust the positioning of the end agonists of the endoscopic surgical instrument, not limited to insertion and rotation, but depending on the characteristics of the operation. In particular, it is often desired to direct the end agonist to an axis that crosses the long axis of the shaft of this instrument. The lateral diameter movement of the end actuator with respect to the shaft of this instrument has traditionally been referred to as "joint". This articulated positioning allows the surgeon to more easily engage the tissue in some cases. Also, advantageously, articulated positioning allows the endoscope to be placed behind the end agonist without being blocked by the instrument shaft.

The non-connected stapling and cutting instruments described above are highly practical and can be successfully utilized in many surgical procedures, but have the ability to connect end agonists to enhance this movement and thereby in use. It is hoped that the surgeon will be given greater flexibility. Articulated surgical instruments typically travel longitudinally through the articulated joint within the instrument shaft, firing staples from the cartridge and cutting the tissue between the innermost staple lines. I'm using the launch bar. One common problem with these surgical instruments is the control of the launch bar through the articulated joint. The end actuating body is arranged at a space in the articulated joint in the vertical direction so that the shaft and the edge of the end actuating body do not collide with each other during the articulation. This gap is filled with support material or is structured so that the launch bar joint clasps do not come off when a single or multiple launch bars are under vertical firing load. Must-have. What is needed is a tide path structure that guides and supports a single or multiple launch bars through the articulated joint, or a support structure that bends or bends when the end agonists are articulated.

Schulze et al. US Pat. No. 5,673,840, granted to, discloses a flexible articulated joint made of an elastomeric or plastic material. It bends with a flexible joint or "flex neck". The launch bar is supported and guided through a hollow tube inside the flex neck. The flex neck is part of the mating closure mechanism and moves longitudinally with respect to the end agonist, shaft, and firing bar as the mating closes on the tissue. The firing bar then moves vertically through the flexneck as the staples are fired and the tissue is cut.

Oberlin et al. US Pat. No. 5,797,537 (owned by Richard-Allan Medical Industries, Inc.), granted to, discloses an articulated joint that rotates around a pin rather than bending around a flex joint. There is. In this instrument, the launch bar is supported between a pair of space-spaced support plates. One end of this plate is connected to the shaft and the other end is connected to the end actuator. At least one of these connections is a slidable connection. The support plate extends through an articulated joint near the flexible drive member on the articulated surface, the support plate has its tip bent through a gap in this articulated surface, and the flexible launch bar has its tip aligned. Bends with respect to the support plate when articulated in one direction from position. U. S. Milliman et al. From Surgical. US Pat. No. 6,330,965, granted in, teaches the use of a support plate that is fixedly attached to the shaft and slidably attached to the end agonist.
US Pat. No. 5,797,537 US Pat. No. 6,330,965

These known support plates guide the launch bar through the articulated joints, but it is believed that they may enhance performance. For example, it is often desired that the launch bar accelerate rapidly during launch to ensure sufficient momentum to effectively cut the tissue. The tightly attached support plate tends to force movement in response, causing the launch bar to pop out of the articulated joint. As a further example, it is desirable that the instruments operate in the same manner regardless of whether they are articulated or not. Higher friction during articulation is not desirable and can confuse the surgeon if the amount of change in firing force needs to be used.

As a result, there is a significant need for improved articulated mechanisms for surgical instrument mechanisms that enhance support for the launch bar via articulated joints.

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

In view of the above and other purposes, the present invention provides a medical device end agonist coupling assembly comprising a passive articulating joint that connects an end agonist to a control handle.

In view of an object of the present invention, in a medical device having an end agonist connected to a control handle, an agonist coupling assembly comprising a passive articulating joint connecting the end agonist to the control handle is provided. There is.

In view of the object of the present invention, there is also provided a medical device comprising a control handle and a surgical end agonist connected to the control handle via a passive articulated connection.

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

In view of the object of the present invention, the passive articulated joint also comprises a control handle having a first portion of the passive articulated joint and a surgical end actuator having a second portion of the passive articulated joint. A medical device is provided in which the first and second portions of the device connect an end agonist to a control handle.

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

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

In view of the object of the present invention, there is also a control handle having articulated joint actuators in non-working and working states, a surgical end working body, and a passive connecting the surgical end working body to the control handle. Medical devices equipped with articulated joints are provided. This articulated joint actuator holds the passive articulated joint when in the non-actuated state, thereby placing the end actuator in a substantially fixed articulated position and when in the actuated state, the passive articulated joint. It is released to a freely articulated state, and the end actuator is freely articulated with respect to the control handle according to the external force acting on the end actuator.

In view of the object of the present invention, there is also a control having a stapler stapling device, a surgical stapler end actuator having at least one of the stapled cutting devices, and a stapler closing actuator that closes the stapler ring device when actuated. A handle, a staple firing actuator that stops the staples when activated, and at least one of the cutting of the tissue with a cutting device, an articulated joint actuator that has an inactive state and an active state, and a handle that controls the end actuator. A medical device is provided with a passively articulated joint that connects to a predetermined articulated position when the articulated joint is activated and the articulated joint actuator is not activated. When locked to, it is freely connected according to the force applied to the end actuator.

According to one aspect of the invention, the surgical instrument has a handle portion that releases the lock and allows firing while being articulated and articulated with the end agonist. This release and launch mechanism is transmitted to the articulating mechanism via the shaft. The articulation mechanism corresponds to the force exerted by the user on the end actuating body and allows the end actuating body to be articulated out of the line of the vertical axis of the shaft. The launch mechanism corresponds to the launch motion and is coupled to the articulating mechanism for movement via the end actuator. The launch support device allows the launch mechanism to support and hold the launch mechanism in place once the concatenation occurs.

According to another feature of the present invention, the control handle comprises an articulated joint actuator having a non-actuated state and an actuated state, and the end actuating body has an articulated lock having a locked articulated state and a non-locking articulated state. The articulated joint actuator changes the articulated lock from the locked articulated state to the non-locked articulated state when the non-operating state changes to the operating state, and when the articulated state changes to the non-operating state, the articulated joint actuator changes the articulated lock. Change the lock from the unlocked articulated state to the locked articulated state.

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

According to an additional feature of the invention, at least one first flexible beam connecting the control handle to the staple firing actuator via a passive articulated joint and an end agonist through the passive articulated joint to the control handle. At least a second flexible beam connected in the longitudinal direction is provided. The first and second flexible beams bend in response to the connection of the passive connection joint.

According to a further feature of the present invention, the control handle has a first vertical axis, the end actuator has a second vertical axis, and the control handle, the end actuator, and the passive chain joint. At least one of them has an alignment device. In an exemplary embodiment, the alignment device biases the end actuator to substantially align the first and second vertical axes when the articulated joint actuator is activated. The alignment device may be a center biased device. In such an embodiment, the central bias device is a spring-loaded plunger set located on opposite sides of the first vertical axis, which individually presses the end agonists to form a first vertical axis. The second vertical axis is aligned with.

Another advantage of the present invention is that the movable distal end agonist is centrally biased. This means that the distal end is first free from a stable position and then passively moves to a new position by pressing the end agonist against environmental structures such as surrounding tissue. A central bias device, preferably at least one bias spring, particularly two that are opposed and thus exert a bias force in the central direction when the actuator that frees the end agonist from a stable position is released. With the bias spring pressed, the distal end actuator returns to its central position. Alternatively, the central bias device is a spring-loaded plunger set located on either side of the end agonist in the clevis, even if it individually presses the end agonist towards the center position. good.

According to a further feature of the invention, the articulated joint actuator has a pull lock with teeth facing the distal side, and the passive articulated joint is this when the articulated joint actuator is inactive. It has gears with proximally oriented teeth that interact with distally oriented teeth. In addition, this articulated joint actuator disengages the teeth facing the distal side from the teeth facing the proximal side when the articulated joint actuator is in the inactive state, and the end actuating body. Release the articulated lock.

According to a further feature of the invention, the actuation of distal movement is triggered by pull-to-release and release-relock triggers. This trigger, which controls passive movement, is usually locked. This lock is released by being pulled at the trigger. When the distal end agonist is in the desired position, the user releases this trigger to lock the distal end agonist to a new position.

Devices according to the invention are surgical staplers and cutters, or, in particular, other endoscopic devices that can be used to staple parts of tissue together and cut tissue at the desired time. In one embodiment of the end agonist, a means of performing both a stapling function and a cutting function is totally retained within the distal end agonist of the device.

Again, another advantage of the invention is that the handle is electronically controlled, universal and electric. The handle features a microprocessor programmed for a number of product configurations. For example, in the case of a stapler, the handle is programmed for a 30 mm, 45 mm, or 60 mm staple cartridge. The distal shaft of the stapler has a proximal end that plugs into the universal handle. This distal shaft comprises an electrical contact array, which contacts the matching array on the handle side at the connection position. This contact is unique for each of the various distal shafts, with the handle "recognizing" the shaft and running the appropriate program for that shaft. The handle is programmed to include secure lockout, stapler delivery speed, stroke distance, and other logic. Such modularity allows one handle with a plurality of end agonists to be manufactured to fit the shaft.

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

The work done by any of these means is a single or combination of screw drives, gear drives, wedges, toggles, cams, belts, pulleys, cables, bearings, or extrusion rods. It can be converted to the desired movement. In particular, screw drives are used to convert the movement of an electric motor into linear movement. In one embodiment, a screw drive motor is provided on the steering wheel. A flexible rotating cable is connected from the motor to the threaded shaft. Therefore, when the motor rotates in either direction, the rotation of the flexible cable is transmitted to the threaded drive shaft, and the stapling actuator and cutting slide are located on the drive shaft, thus moving the distal side of the slide. Performs both functions. In a second embodiment, the entire motor is provided within the end working body and has a shaft connected to the slide drive shaft either directly or via a transmission gear. In this case, what is needed in the handle is an on / off and drive shaft direction actuator, the former for switching the motor on and off, and the latter for determining the direction in which the motor spins. It is a thing.

The device has a screw drive driven carriage that performs many functions, including closing stapler mates, advancing cutting blades, and firing staples. Carriage is not the only way to perform these tasks. Secondary or many sources of work provide the work necessary to perform any of these functions.

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

The entire actuating device can be inserted and operated by a multi-axis "ball" joint or "universal" joint that performs any movement or restriction desired by the operator.

In addition, the entire actuating device is completely free from the handle and can be re-grasped from another angle, allowing for better positional flexibility.

According to a further feature of the invention, the passive articulated joint is a ball joint having a ball, a cup device, and a ball-cup locking device that engages and disengages the ball and cup device from each other. The ball-cup locking device is in the locked state when the control handle is in the inactive state and is in the unlocked state when the control handle is in the active state. The end actuator has one of the ball and the cup device, and the control handle has the other of the ball and the cup device. The ball is detachably attached to the cup device.

According to a further feature of the present invention, the end actuating body has two ends in the vertical direction, the ball being two balls. Each of the two balls is placed on one of the two vertical ends, and each of the two balls can be detachably connected to the cup device.

In one aspect of the invention, the instrument activates the end agonist using a firing mechanism that moves in the vertical direction. This launch mechanism is favorably supported via the articulation mechanism by a side support plate or a rigid support channel. In the former embodiment, one or more ends of each support plate are elastically or spring-engaged to one side of the articulating mechanism in order to better respond to the launch of the load on the launch mechanism. Therefore, buckling of the firing mechanism can be better prevented. For example, support plate pairs are located on the sides of the launch mechanism across the articulation mechanism, and each support plate has a spring-engaged end in the frame groove formed in the articulation mechanism, either inside or outside the articulation mechanism. Helps prevent buckling of the launch mechanism.

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

Therefore, the present invention does not cause buckling in the articulated mechanism of various types of actuated diagnostic or therapeutic end activators, whether with strong firing force or with endoscopically reduced component dimensions. Can be incorporated into articulated medical devices.

In a further aspect of the invention, the medical device has a handle portion that causes a closing action, a firing action, an unlocking action of the connecting mechanism, and a connecting action. Each of these movements is transmitted by taking the shaft. The end actuator comprises an elongated channel articulated to a shaft that receives the staple or staple cartridge and a pedestal that is rotatably coupled to the elongated channel and responds to a closing operation from the shaft. The launching device comprises a distal cutting device that is vertically received between the elongated device and the pedestal. The launch device is connected from the handle to the end agonist via a shaft and articulation mechanism. The launching device utilizes a stapling to perform a disconnect by launching motion. The articulating mechanism moves the end actuator with respect to the shaft. The articulating mechanism is connected to the shaft on the distal side, and after the articulation lock is released (ie, unlocked), and in response to the force acting on the end actuator to cause the articulation motion, the end. The part actuating body is connected. In other words, when the articulation lock is released, the pressure on the environment of the end actuator causes the end actuator to articulate to the shaft. To support the launch mechanism, a pair of support plates can be located on the sides of the launch mechanism across the articulation mechanism. Each support plate may include a spring-engaged end in a frame groove formed within the articulation mechanism, or a rigid channel may surround the firing mechanism over the articulation mechanism. This allows the improved stapling and cutting equipment to include a launching device that can withstand high firing loads without introducing significantly increased firing force during articulation.

Activating devices may be manufactured in various lengths and / or in diameters suitable for either or both for laparoscopes and endoscopes. Replaceable staple cartridges can be used. The actuating device can also be configured to be attached to the distal end of a flexible endoscope.

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

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

Yet another advantage of the present invention is that the stapler / cutter can be configured to be mounted on the edge of a standard flexible endoscope. This control is sent back through the working channel of the endoscope to match the control handle or control module.

In view of the object of the present invention, there is also provided a method of manipulating an end agonist of a medical device. This method involves the step of maintaining a passive articulated joint that controls the articulated operation of the end actuator in a stable position using the articulated lock, and the release of the articulated lock to activate the locking of the passive articulated joint. It is provided with a step of unraveling and connecting the end actuating body via a passive articulating joint according to an external force applied to the end actuating body.

In view of the object of the present invention, there is provided a method of manipulating an end agonist of a medical device, which comprises holding a passive articulated joint locked by an articulated lock and an articulated lock. It is provided with a step of operating to release the lock of the passive articulated joint and causing the passive articulated joint to perform an articulated operation in response to an external force acting on the end actuator.

According to another mode of the invention, the end actuator passively moves to the articulated position.

According to a further mode of the invention, the end agonist passively moves to the articulated position by pressing a portion of the end agonist against the structure of the environment.

According to a further mode of the present invention, a force is applied to the end actuated body in order to articulate the end actuated body to a desired articulated position.

According to a further mode of the present invention, the actuation of the articulated lock is removed to lock the passive articulated joint, thereby preventing the end actuator from further articulating.

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

Other features considered to be features of the present invention are described in the claims.

The present invention has shown and described as a surgical staple and cutting device and as a method of using the device, but various modifications and structural modifications are claimed without departing from the spirit of the present invention. It is not limited to the details shown in the figure because it can be performed within the range of and evenly.

The configuration and method of operation of the present invention, along with additional objectives and advantages, are best understood from the description of the specific examples below when read with the accompanying drawings.

The advantages of the embodiments of the invention are evident from the following detailed description of the preferred embodiments of the invention. This description should be considered with the accompanying drawings.
FIG. 1 shows, when viewed from the distal end, a first embodiment of a distal stapler and a cut end actuator according to the present invention and a part of a shaft connected thereto, in an enlarged and fragmentary manner. It is a perspective view, in which the staple cartridge is pulled out about half from the staple cartridge mating of the end actuator and has a stapler pedestal separated from the staple articulation and tissue cutting slides. FIG. 2 is an enlarged, fragmentary side view of the end agonist shown in FIG. 1, with a distal cowling and a proximal splined axially moving portion for clarity. Equipped with the cartridge removed for this purpose and the pedestal of the stapler connected to the slide. FIG. 3 is an enlarged perspective view of the end-operated body shown in FIG. 1, which has a stapler actuation and tissue cutting slide in the distal portion and a stapler pedestal away from the slide. Prepare. FIG. 4 is an enlarged perspective view of the end actuator shown in FIG. 1, which is an angle of about 45 ° with respect to the center of the staple cartridge removed from the lower mating / staple cartridge holder. Shows the rotated clevis. FIG. 5 is an enlarged and fragmentary view of the wireframe side front view of the distal portion of the end actuator shown in FIG. FIG. 6 is a magnified and fragmented wireframe side perspective view of the splined axial movement assembly of the end actuator shown in FIG. 1 rotated about 90 °, with the ends for clarity. The lateral movement locking pin and proximal screw of the part actuator are excluded. FIG. 7 is a side view of the wire frame side in which the end working body shown in FIG. 6 is viewed from the bottom side and is enlarged and fragmentarily shown, and is an end working body that engages with the teeth of a laterally moving sprocket. It has a lateral movement locking pin and a spring, and the proximal screw is excluded for clarity. FIG. 8 is an enlarged view of the wire-frame side bottom surface showing the end actuating body shown in FIG. 7, in which an end actuating body lateral movement locking pin that engages with the teeth of the laterally moving sprocket is provided. Prepare. FIG. 9 is an enlarged, fragmentary, bottom-viewed vertical cross-sectional view of the end-operated body shown in FIG. 8, which is a lateral movement of the end-operated body that engages with the teeth of a laterally moving sprocket. It has a locking pin and the spring is removed for clarity. FIG. 10 is an enlarged perspective view of the end actuator rotated about the vertical axis shown in FIG. 2, which is splined on the clevis, screw, and distal side for clarity. The movement of the sleeve shaft and the spring part are excluded. FIG. 11 is an enlarged bottom view of the distal portion of the end actuator shown in FIG. 1, showing a staple actuation and tissue cutting slide in the proximal position. FIG. 12 is an enlarged bottom view of the distal portion of the end actuator shown in FIG. 11 showing fragmentary bottom views showing staple actuation and tissue cutting slides at intermediate positions. FIG. 13 is an enlarged, fragmentary, radial cross-sectional view through the stapling actuation and tissue cutting slides of the end agonist shown in FIG. FIG. 14 is an enlarged, fragmented horizontal longitudinal sectional view passing through the lower half of the end actuator shown in FIG. FIG. 15 is an enlarged, fragmented horizontal longitudinal sectional view through the upper half of the proximal portion of the end agonist shown in FIG. FIG. 16 is an enlarged, fragmented horizontal longitudinal sectional view passing through the vertical axis of the proximal portion of the end agonist shown in FIG. FIG. 17 is an enlarged, fragmented horizontal longitudinal sectional view passing through the right half of the proximal portion of the end agonist shown in FIG. FIG. 18 is a view showing the left side surface of the surgical stapler according to the present invention, showing the open state of the end actuating body at the stable position of the actuating handle. FIG. 19 is a view showing the left side surface of the surgical stapler shown in FIG. 18, showing a state in which the engagement of the end actuating body at the actuating position of the thumb trigger of the actuating handle is closed. FIG. 20 is a view showing the left side of the surgical stapler of FIG. 18 from above, and is a state in which the stapler moves freely in the lateral direction depending on contact with the environment such as the surface while the lateral motion trigger is pressed. The distal end actuator in the position of and the end actuator in the stable position of the actuation handle are in the open state and show a laterally positioned engagement at an angle of about 45 °. 21 is a view from above to the left side of the surgical stapler of FIG. 18, with a lateral movement trigger in a stable position, a distal end agonist in a laterally captured moving state, and an actuating handle. In the stable position, the end actuator is in the open state and shows a laterally positioned engagement at an angle of about 30 °. FIG. 22 is a fragmentary view of the left side of the end actuator of FIG. 18 showing a joint that is laterally located at a stable position and at about 75 °. FIG. 23 is a fragmentary view of the left side of the stapler end actuator shown in FIG. 18, showing the open state in the stable position and in the rotated first axial position. FIG. 24 is a diagram showing the left side of the end actuating body shown in FIG. 23 in a fragmentary manner, showing the open state in a stable position and in a normal position rotated counterclockwise with respect to FIG. 23. .. FIG. 25 is a perspective view of a second embodiment of the surgical stapling device of the invention from the distal end, with a removable end agonist with a built-in stapling motor and open stability. The position, the ball release lever that is catching the ball in the stapling engagement and the stable position at the right lateral position of about 45 °, and the motor operation button in the stable motor off position are shown. FIG. 26 is an enlarged perspective view of the removable end actuator shown in FIG. 25, showing the mating in a stable open position, with slides removed for clarity. FIG. 27 is a perspective view of a third embodiment of the surgical stapling device of the invention from the distal end, with removable end actuation with two ball connecting ends and a built-in stapling motor. The body, the stapling latch in the stable open position, about 45 ° to the right lateral position, the staple latch facing the proximal side in the opposite direction, and the ball release lever in the activated ball release position. And the motor operation button in the stable motor off position. FIG. 28 is an enlarged perspective view of the removable end agonist shown in FIG. 27 as seen from the right and distal ends, showing a squint in a stable open position, excluding slides for clarity. There is. FIG. 29 shows the surgical stapling and cutting device shown in FIGS. 25 and 26, and the ball joint of the removable stapling end actuator of FIGS. 25 and 26 in a captured and aligned manner, the most of the actuating handle. FIG. 3 is a view of a fragmentary, enlarged side cross-section wireframe at the distal end. FIG. 30 is a fragmentary, enlarged side profile of the farthest distal end of the opposite side of the actuation shown in FIG. 29, unaligned, in an open state, but captured between clamps on the actuation handle. Indicates a ball joint. FIG. 31 is a perspective view seen from the proximal end of the stapling and cutting device of the present invention, excluding the pedestal. FIG. 32 is a fragmentary perspective view from the proximal end of the device of FIG. 31 with the handle removed to show the proximal side of the disengagement device with the extruded rod. FIG. 33 is an enlarged and disassembled view of the proximal end portion of the inner tube of the device shown in FIG. 31. FIG. 34 is a fragmentary perspective view of the internal component connecting the disengagement device to the articulated joint of the end agonist with the outer tube removed, as viewed from the distal end. FIG. 35 is a fragmentary, enlarged, vertical cross-sectional view of a portion of FIG. 34. FIG. 36 is a fragmentary, enlarged perspective view of the knife guide assembly shown in FIG. 31 from the proximal side of the knife guide to the distal side of the knife blade with the outer and inner tubes removed. be. FIG. 37 is a fragmentary, enlarged, vertical cross-sectional view of a portion of the portion of FIG. 35 at the proximal end of the pull band. FIG. 38 is a fragmentary, enlarged, longitudinal section of a portion of the portion of FIG. 35 at the distal end of the pull band. FIG. 39 is a fragmentary, enlarged side sectional view of the stapler assembly, drum sleeve, articulated joint, and device clevis of the device of FIG. 31, showing an open pedestal. FIG. 40 is a fragmentary, enlarged side sectional view of the stapler assembly, drum sleeve, articulated joint, and clevis of the device of the device of FIG. 31, showing a closed, fired pedestal. FIG. 41 is a fragmentary, enlarged perspective view of the knife guide subassembly from the proximal side of the knife guide to the knife blade, with the knife guide, clevis, left hammock, drum sleeve, and cartridge holder. I'm removing it. 42 is a fragmentary, enlarged, vertical cross-section of the knife-extruded rod pin joint of the device of FIG. 31. FIG. 43 is a fragmentary, enlarged, longitudinal sectional view of the pullband-aluminum tube pin joint of the device shown in FIG. 31. FIG. 44 is a fragmentary, enlarged, vertical cross-sectional view of the proximal clevis surface of the device shown in FIG. 31. FIG. 45 is a fragmentary, enlarged, vertical cross-sectional view of the plunger pin spring pocket and the disengagement pin of the device shown in FIG. 31. FIG. 46 is a fragmentary, enlarged, longitudinal sectional view of the plunger pin cam surface and articulated locking sprocket of the device shown in FIG. 31. FIG. 47 is a fragmentary, enlarged, vertical cross-sectional view of the end actuator articulated joint of the device shown in FIG. 31. FIG. 48 is a fragmentary, enlarged, longitudinal cross-section of the distal pullband pin joint of the device shown in FIG. 31. FIG. 49 is a fragmentary, enlarged, vertical cross-section of the pedestal / upper mating pivot slot of the device shown in FIG. FIG. 50 is a fragmentary, enlarged, vertical cross-sectional view of the articulated joint portion of the device shown in FIG. 31 through the spring rod. FIG. 51 is a diagram showing a test bed for a knife guide blade and a hammock of a device shown in FIG. 31. FIG. 52 is a fragmentary, enlarged, vertical cross-sectional view through the articulated unlock slide of the articulated joint portion of the device shown in FIG. 31. FIG. 53 is an exploded perspective view of the distal component of the device shown in FIG. 31 as viewed from the distal end without a pedestal. FIG. 54 is a perspective view showing the articulated distal portion of a fourth embodiment of the end agonist of the invention with the inner and outer tubes removed. FIG. 55 is a fragmentary, enlarged, exploded perspective view of the articulated portion of the end actuator shown in FIG. 54 with the outer tube removed, with the tip facing inward with respect to the viewer. FIG. 56 is a fragmentary, enlarged, bottom view of the articulated portion of the end agonist shown in FIG. 54, with the outer clevis and closure ring removed. FIG. 57 is a fragmentary, enlarged, cross-sectional view of the articulated portion of the end agonist shown in FIG. 54, passing through the lower end of the dogbone guide. FIG. 58 is a fragmentary, longitudinal cross-sectional view of the articulated portion of the end actuator shown in FIG. 54 through the spring rod, with the inner tube and extruded rod-blade support removed. FIG. 59 is a fragmentary, enlarged, longitudinal cross-sectional view of the articulated portion of the end agonist shown in FIG. 54 through the distal end of the dogbone guide. FIG. 60 is a fragmentary, enlarged, longitudinal cross-sectional view of the articulated portion of the end agonist shown in FIG. 54 through the proximal end of the dogbone guide chamber of the lower clevis, with the dogbone guide removed. ing. FIG. 61 is a fragmentary, enlarged, vertical cross-sectional view of the articulated portion of the end agonist shown in FIG. 54, passing through the lower intermediate portion of the dogbone guide. FIG. 62 is a fragmentary horizontal vertical cross-sectional view of the articulated portion of the end actuator shown in FIG. 54 through the central portion of the dogbone guide. FIG. 63 is a vertical cross-sectional view of the articulated portion of the end actuator shown in FIG. 54 through a spring rod with the inner tube, extrusion rod blade support, pedestal, and approximately half of the staple thread removed. FIG. 64 is a vertical cross-sectional view through the spring rod of the articulated portion of the end actuator shown in FIG. 54, excluding approximately half of the spring plate, pedestal, and staple thread. FIG. 65 is a vertical cross-sectional view of the distal end of the articulated portion of the end actuator shown in FIG. 54 with approximately half of the inner tube, extruded rod blade support, pedestal, and staple thread removed. FIG. 66 is a perspective view showing a lower clevis, a lower dogbone clevis, a dogbone guide, and three adjacent knife blades of the end actuator shown in FIG. 54. FIG. 67 is a fragmentary, vertical cross-sectional view of the wireframe of the end actuator of FIG. 54. FIG. 68 is a fragmentary, wireframe perspective view of an alternative embodiment of the distal connection of the pull band of the end actuator of FIG. 54. FIG. 69 is a fragmentary, longitudinal cross-sectional view of the distal connection of FIG. 68. FIG. 70 is a fragmentary perspective view of a part of the distal connection portion of FIG. 68 as viewed from below.

Aspects of the invention are disclosed in the following description and drawings relating to specific embodiments of the invention. Alternative embodiments can be devised without departing from the spirit or scope of the invention. Moreover, well-known elements of the exemplary embodiments of the invention will not be described in detail or will be omitted so as not to interfere with the relevant details of the invention.

Prior to disclosing and describing the present invention, the terms used herein are for the purpose of describing specific embodiments only and are not intended to be limiting. It should be noted that the singular article, as used in the specification and claims, also has multiple meanings, unless it is clear from the context.

The present specification is bound to the extent of the claims that prescribe the features of the invention that are considered novel, but the invention is believed to be better understood by considering the following description in conjunction with the drawings. .. The same reference numerals are used in the drawings. The drawings are not shown on scale.

A first exemplary embodiment of the stapling and cutting end actuator 1 according to the present invention is shown with reference to the drawings in detail, particularly FIG. Key components of the end actuator include a clevis 10, a pedestal 20, a cartridge holder 30 that receives the staple cartridge 100, an adapter sleeve 40, and a laterally moving or articulating device 50. FIG. 1 shows the detachability of the staple cartridge 100 from the cartridge holder 30.

It is the staple operation and tissue cutting slide 60 that connects the pedestal 20 to the cartridge holder 30 and the staple cartridge 100. The slide 60 is operably engaged with the pedestal 20 and the cartridge holder 30, and the two parts 20 and 30 are correctly aligned and held, and the staples operated in the cartridge 100 are each in the pedestal 20. It hits the stapler pedestal and secures the staples around the tissue placed between the pedestal 20 and the cartridge 100. The distally facing surface of the slide 60 has a blade 62 that cuts the tissue placed within the fittings 20, 30 as the tissues are stapled to each other. The proximal movement of this slide is shown graphically in FIGS. 1-3. The slide 60 can be seen in FIGS. 1 and 3, and the pedestal 20 is detached from the tip of the slide 60. However, during operation, the slide 60 must be connected to the pedestal 20, as shown in FIG. 2, especially FIG.

FIG. 2 is a diagram showing an end actuator 1 with the adapter sleeve 40 removed to show various features of movement within the adapter sleeve.

The first component of the two main components of the lateral movement device 50 is apparent in FIGS. 1-3. The proximal component 52 comprises a proximal sprocket 522, an intermediate splined connector 524, and a distal rod 526. In an exemplary embodiment, the intermediate splined connector 524 has four distally protruding teeth 5242, as clearly shown in FIG.

Further, FIG. 2 shows a pulling cable adapter 70. The proximal side of the pull cable adapter 70 is connected to the pull cable 110 (broken line), and the distal side is connected to the cartridge holder 30. Therefore, the pulling cable adapter 70 is used to push or pull the cartridge holder 30 against the pedestal 20, whereby the pedestal 20 moves from the open position to the closed position or from the open position to the closed position according to the movement of the cartridge holder 30. It rotates in the opposite direction. The proximal end of the pedestal 20 has cam followers 22 on both sides. The proximal end of the cartridge holder 30 defines two cam surfaces 32 on both sides and is aligned to receive each cam follower 22. Therefore, the movement of the cartridge holder in the distal direction or the proximal direction causes an open rotation or a closed rotation corresponding to the pedestal 20.

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

In FIGS. 5-8, all parts, including the adapter sleeve 40 and the clevis 10, are shown in wireframe, which reveals internal features. The clevis 10 comprises four lumens, two of which are shown in FIG. 5 and all four lumens are shown in FIGS. 6 and 7. Of these lumens, the first lumen 12 is formed to include a shaft (not shown) that controls the distal and proximal movement of the end agonist lateral movement locking pin 120. .. The pin 120 is first shown in FIGS. 8 and 9. The two lateral lumens 14 are shaped to receive a pull wire that moves the pull cable adapter 70 to the proximal side (the move of the pull cable adapter 70 to the distal side is caused by a spring). The other lumens of the two lumens 14 are extra lumens and can receive any number of additional instruments. The drive cable lumen 16 is the last lumen of the four lumens and is configured to receive a flexible drive cable that rotates the drive screw 34 (see FIG. 1) that controls the movement of the slide 60.

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

Further, two decentering springs 130 can be seen below the tip end side of the clevis 10 shown in FIG. These springs 130 are also shown in FIGS. 6-9, especially FIG. Separation plates 140 are provided with the springs 130 interposed therebetween to prevent unwanted interactions between the springs 130. FIG. 10 is a diagram showing two springs 130 having a separation plate 140 in between.

The mechanism underneath the transparent sleeve 40 is better described in FIGS. 7-10. The sleeve 40 defines two outer structures and two inner bores. The first outer structure is the proximal cylinder 42. The proximal cylinder 42 defines a spline structure 422 at its proximal end. These spline structures 422 align and interact with a splined connector 524 in the middle of the proximal portion 52. The proximal cylinder 42 also defines a first bore 44, which is shaped to receive the distal rod 526 of the proximal portion 52. There is a cylindrical radial clearance between the rod 526 and the inner surface of the first bore 44, and a longitudinal clearance between the proximal end of the cable adapter 70 and the proximal inner surface of the first bore 44. be. This tubular clearance can receive a first tubular bias device (eg, a coil spring) not shown for clarity. The first bias device is in a position to apply a proximally oriented force to the most proximal end of the adapter sleeve 40. In such a configuration, the force exerted by the first bias device presses the distal spline structure 422 towards and against the proximal spline structure 5242.

The second outer structure of the sleeve 40 is the distal cylinder 46. The distal cylinder 46 defines a second bore 48 shaped to receive the pull cable adapter 70 there. The pull cable adapter 70 also defines an inner bore 72 shaped to receive the distal rod 526 of the proximal portion 52. To clarify this structure, the rod 526 is shown in FIG. 9 as a dashed line extending completely to the inner bore 72. During operation, the rod 526 extends completely into the inner bore 72. The inner bore 72 is coaxial and, in an exemplary embodiment, has the same inner diameter as the first bore 44. Therefore, there is a cylindrical radial clearance between the rod 526 and the inner surface of the inner bore 72, and vertical between the distal surface of the cable adapter 70 and the inner distal surface of the inner bore 72. There is directional clearance. This is because it is shaped to accommodate a second tubular bias device (eg, a coil spring) and is not shown in the figure for clarity. The second bias device is provided to apply a bias force toward the distal side to the pull cable adapter 70. Such a force keeps the joints 20 and 30 in the open position. Therefore, the courts 20 and 30 have a stable open position.

Two bias devices (not shown) are connected without an intermediate section, thus forming a single spring. However, it is desirable that the two bias devices do not interact. This is because the separation of the spline portion may exert an undesired force on the carriage and the movement of the carriage holder 30 may loosen the connection of the spline portion. Therefore, a washer (not shown) is located between the two bias devices in the tubular cavity 74 defined by the proximal end surface of the pull cable adapter 70 and the distal end surface of the second bore 48. FIG. 7 is a diagram particularly showing the proximal side portion for holding the washer, which is shaped to receive the distal rod 526 passing through it. Thus, as the washer fits between the pull cable adapter 70 and the sleeve 40, the two springs disengage and provide independent bias forces.

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

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

A horizontal cross section along approximately the longitudinal axis of the end agonists shown in FIGS. 14 and 15 is particularly useful for showing the bore around the distal rod 526. Also, the rod 526 extends the entire path to the distal surface of the bore 72 of the pull cable adapter 70, but is not shown as such for clarity. Around the proximal end of the rod 526 is a first bore 44 in the adapter sleeve 46. Immediately distal to the first bore 44 is the cavity 74 that receives the washer in it, and just distal to the cavity 74 is the inner bore 72 of the pull cable adapter 70 that receives the second bias device. ..

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

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

18 to 24 are views showing all the vertical dimensions of the stapling device according to the present invention, showing a first exemplary embodiment of the distal end actuating body 1 and actuating handle 2. As shown in FIG. 60, the courts 20 and 30 are stable in the open position.

A thumb trigger is connected to the proximal end of the pull cable terminated by the pull cable adapter 70. Therefore, when the thumb trigger 3 is activated (see FIG. 19), the cartridge holder 30 is pulled in the proximal direction. The shape of the cam surface 32 causes the cam follower 22 to move, thereby rotating the pedestal 20 to approximately the stapling position. As mentioned above, it is not the thumb trigger 3 that ensures that the pedestal 20 is oriented in the correct parallel direction with respect to the cartridge holder 30, and thus the staple cartridge 100. Rather, it is the slide 60 that ensures the correct parallel direction.

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

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

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

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

The end actuating body 210 is connected to the distal end of the actuating shaft 226 of the handle 220 at the ball joint connector 228. The end actuator 210 has a ball joint 212 at the most distal end. The ball joint 212 has two opposing cup-shaped clamps 2122 and 2124. The inner surface of the clamps 2122 and 2124 has a shape corresponding to the outer shape of the ball joint 212. The clamps 2122 and 2124 move toward or away from each other based on the actuation of the lever 222.

The clamps 2122 and 2124 are biased against each other in the closed position and when the ball joint 212 is located therein, the two clamps 2122 and 2124 firmly grip the ball joint 212. The actuation of the lever 222 separates the clamps 2122 and 2124, which allows the ball joint 212 to rotate freely within the two clamps 2122 and 2124. Thus, when the lever 222 is actuated, the end actuating body 210 moves "freely" based on the pressure on the structure in the environment, such as the tissue near the stapling / cutting site. The lever 222 is fully pushed down to move the ball joint 212 completely out of the clamps 2122 and 2124. Therefore, if it is desired that the first end actuating body 210 be clamped at the first site and the second end actuating body 210 perch and cut at the second site, the first end portion. While the actuator 210 remains clamped at the first end, the shaft 226 is removed from the body and a load is applied to the second end agonist 210 to bring the second end agonist 210 to the second portion. Can be guided to.

A second actuating device 224 is needed when the user desires to perform stapling and cutting with the end actuating body 210. The end actuator 210 pushes the actuator 224 (eg, a button) when it is in the desired position for stapling / cutting. Preferably, this actuation connects (or cuts off) a circuit that powers the motor inside the end actuating body 210, thereby moving the slide 60 distally and disconnecting from the stub ring. Perform the function.

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

27 and 28 are diagrams showing a modification of the second embodiment of the end actuating body shown in FIGS. 25 and 26. In particular, the handle 220 is the same as that shown in FIGS. 25 and 26. However, the end actuator 310 is different. In particular, the end agonist 310 has the same proximal ball joint 312 as the ball joints 212 shown in FIGS. 25 and 26, but a second distal ball joint 314 having almost the same shape as the proximal ball joint 312. Also has. Therefore, when the lever 222 is pushed down to release the ball joints 312 and 314, the end actuating body 310 can be positioned in the main body, and the opposite end can be clamped by the clamps 2122 and 2124. In such a direction shown in FIG. 27, the stapling / cutting can be activated when the open mating faces the user.

Placing the end agonists 210, 310 at the surgical site requires less access to the surgical site than the open mating of the end agonists 210, 310. The ability to invert the end agonist 310 allows access to some areas that were difficult to reach with the single ball joint end agonist 210.

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

The end staplers shown in FIGS. 31 to 70 are the end staplers shown in FIGS. 1 to 30 with various different alternatives and / or additional features.

In FIGS. 31-70, for clarity, the tip shaving or pedestal 1020 is shown only in FIGS. 30 and 40. Further, the pedestal 20 is detailed above with reference to FIGS. 1-30, and therefore, repeated description will be avoided below.

The exemplary handle shown in FIG. 31 is from Ethicon Endo-Surgery, Inc. Manufactured by Ethicon, it can be found in the Ethicon 60 Endopath Stapler, a linear cutter. Therefore, the description of this handle is considered redundant as the parts and functional description of this handle are published in this art. Such description is incorporated herein as an overall reference.

As described above, the distal end of the end stapler of the present invention is configured to house the standard staple cartridge 100. The cartridge 100 is also disclosed in the preceding publication and does not need to be reiterated here. This publication is therefore incorporated herein as an overall citation.

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

The distal end of the handle 1200 comprises a bell-shaped actuator 1100. This provides two control angles for the articulated portion of the end stapler 1000. First, the bell actuator 1100 freely rotates about the central axis of the end stapler 1000 on the distal end of the handle 1200. Since the bell actuator 1100 is rotatably and fixedly connected to the outer tube 1100, when the bell actuator 1100 rotates clockwise or counterclockwise, the entire distal end of the end stapler 1000 rotates correspondingly. Second, the bell actuator 1100 can move proximally beyond a predetermined distance on the distal end of the handle 1200. As described in more detail below, with the proximal movement of the bell actuator 1100, the corresponding movements of the articulated lock release slides 120, 1120 articulate the distal end agonist 1002 in the transmission devices 50, 1050. Let me. For example, a bias device (eg, a compression spring) (not shown) located in the distal portion of the bell actuator 1100 is used to bias the bell actuator 1100 and the articulated unlock slide 1120 in the distal direction to force the bell actuator 1100. The articulated unlock slides 120 and 1120 remain in the operating or locked position while in the non-operating state. See FIGS. 8 and 9. This bias device is housed inside the bell actuator 1100, but is not shown in FIG. 32 for clarity. A snap ring that fits into the groove 1139 around the inner tube 1130 is also not shown. The bias device is separated by the proximal side of the rod pull block 1105 (FIG. 34) and the distal side of the snap ring. In such a structure, when the bell actuator 1100 is pulled to the proximal side, the actuator 1100 applies a force to the rod pulling block 1105 to the proximal side, whereby the articulated lock release slides 120 and 1120 are released from the lock. Move to position. The key hole on the inner surface of the bell actuator 1100 surrounds the rod pulling block 1105 so as to be locked by the shape, and the rotation of the bell actuator 1100 about the vertical axis of the inner tube 1130 forces the rod pulling block 1105. Is applied and the corresponding rotation is made. A connection that locks by shape or fits by shape connects two elements to each other by the element shape itself, which is the opposite of a force locking connection that locks the elements to each other by an external force on the element. Thus, the inner tube and the entire distal assembly of device 1000 rotate in the same manner. In an alternative configuration, the vertical movement of the bell actuator 1100 is by a first actuation that positions the slides 120 and 1120 in the unlocked state and a second actuation that positions the slides 120 and 1120 in the locked state. Works like a standard ballpoint pen.

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

FIG. 32 is a diagram showing the proximal end of the end stapler 1000 without the handle 1200. Extruded rods 1102 coaxially arranged within the bell actuator 1100 are used to move the cutting blade 1060 when the stapler is in the firing direction.

FIG. 33 is a diagram showing a component at the proximal end of the end stapler 1000, which connects the distal assembly to the bell actuator 1100 so as to rotate axially fixedly and freely. .. In particular, the inner tube 1130 (located inside the outer tube 1110) has a proximal extension 1132 that defines the inner tube connecting chamber 1134. The clamshell cannula 1131 has a length approximately equal to the extension 1132 of the inner tube 1130 and a cannula connecting chamber 1333 corresponding to the connecting chamber 1134 of the proximal extension 1132. The rotary couple 1141 has a distal T-shaped rotary link 1143 with an outer shape corresponding to both the coupling chambers 1133 and 1134, with the link 1143 located between the extension 1132 and the stalk 1131. When so, link 1143 is free and rotates there. The couple 1141 is secured inside the handle 1200 through the proximal port 1145 on the proximal end of the couple 1141.

When placed together, the inner tube 1130 is held axially with respect to the couple 1141 but rotates independently of the couple 1141. Since the three connecting portions 1130, 1131, 1141 are sized to fit inside the outer tube 1110, when these parts are arranged inside the outer tube 1110, the outer tube 1110 becomes a locking connection by shape, and the inner tube 1130. And prevent any separation of the cannula 1131 (as long as the outer tube 1110 fully covers this area). Therefore, when the bell actuator 1100 rotates about the vertical axis of the inner tube 1130, the inner and outer tubes 1110 and 1130 can rotate about the coaxial of the tubes 1110 and 1130, but vertically inside the handle 1200. It is stable in the vertical direction for the fixed couple 1141.

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

Note that at this point, the lower mating / staple cartridge holder 1030 is fixed vertically to the handle 1200. This fixation is in contrast to the upper pedestal 1020, which is rotatable and moves somewhat longitudinally as it slides through the keyhole-shaped cam surface 32 to close and / or open the mating. The cam surface 1032 will be described in more detail below / above).

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

To provide such a connection, the invention comprises at least one pull band 1140, for example as shown in FIGS. 35-38. In the exemplary structure, a large number of pull bands 1140 are provided next to each other. Three or four bands form two structures. The two opposing pull bands 1140 have about the same strength in the vertical direction, but the force required to bend the pull bands 1140 in the horizontal direction is reduced. The same can be said for 3 or 4 pull bands 1140. FIG. 37 shows the proximal end of the pull band 1140, which is longitudinally fastened to the distal end of the inner tube 1130 with a proximal pull band pin 1142. For a strong connection between the pull band 1140 and the inner tube 1130, for example, a brass proximal guide block 1150 is placed between the distal end of the inner tube 1130 and the pull band 1140.

The pull band 1140 spans the entire length of the articulated joint 1050, as shown in FIG. 35, and is connected to the distal guide block 1160, as shown in FIG. 38. The distal guide block 1160 (also made of, for example, brass) has at least one protrusion that fits into at least one groove above the proximal end of the staple cartridge holder 1030. Subsequent drawings show the means of connecting the distal guide block 1160 to the staple cartridge holder 1030, and finally the staple cartridge holder 1030 is axially fixedly connected to the handle but inside. It can be connected to the tube 1130. As shown in FIG. 38, the distal pullband pin 1144 axially locks the pullband 1140 to the distal guide block 1160.

The first embodiment relating to the movements of the connectors 20 and 30 is described above. Here, the staple cartridge 30 moves in the axial direction, and the pedestal 20 is relatively stationary. In the configuration of the end stapler 1000 as shown in FIG. 31 and the following, the stapler 1000 moves in the opposite direction in terms of operation.

Given that the staple cartridge holder 1030 is fixed vertically to the handle 1200, there must be an assembly that closes the two matings 20, 30; 1020, 1030. Therefore, the closure is performed by the movement of the upper mating / pedestal 1020, as described below.

The first of the two levers of the handle 1200 (eg, the proximal handle) is operably connected to the outer tube 1110 and when the first lever is compressed / actuated, the outer tube 1110. To the distal side. Because the clevis 1010, the articulated joint 1050, and the drum sleeve 1040 are axially fixedly connected to the outer tube 1110 (and because the outer tube 1110 is vertically slidable along the inner tube 1130). , The operation of the first lever moves the drum sleeve 1040 to the distal side.

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

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

The knives 60, 1060 must move relative to the handle 1200 along the vertical axis, as opposed to the axially fixed position of the staple cartridge holder 1030 with respect to the handle 1200, and similar to the movement of the drum sleeve 1040. It doesn't become. 35, 36, and 38-41 show an axially displaceable connection of the knife 1060 to the knife moving structure of the handle 1200.

Referring to FIG. 35, the extrusion rod 1102 extends from the handle 1200 and is connected to a second lever (eg, distal lever) of the handle 1200. The distal end of the extrusion rod 1102 is connected to the distal end of at least one flexible knife blade 1062 through the extrusion pin 1122. The distal end of the knife blade 1062 is connected to the proximal side of the cutting blade 1060, which moves to the distal or proximal side following the corresponding movement of the extrusion rod 1102. The knife blade 1062 has a flange 1064 extending upwardly on the proximal side, which houses the bore that receives the extruded rod pin 1122. When pushed distally by this off-axis connection between the extrusion rod 1102 and the knife blade 1062, a downward force is applied to the distal end of the knife blade 1062, thus, for example, as shown in FIGS. 36 and 42. In addition, it stays in the inner position of the extrusion rod blade support 1070.

The knife blade 1062 is flexible enough to bend in any direction the articulated joint 105 bends. Therefore, the knife blade 1062 is also flexible enough to bend if not supported. The invention therefore provides the extrusion rod-blade support 1070 shown in FIGS. 36 and 42. Here, the proximal end of the extrusion rod-blade support 1070 reveals a rectangular blade channel 1072 that slidably supports the rectangular knife blade 1062. Also shown is a curved extruded rod channel 1074 that slidably supports the curved (eg, cylindrical) outer surface of the extruded rod 1102. Thus, the extrusion rod-blade support 1070 supports the extrusion rod 1102 at a position where the extrusion rod 1102 is inside the support 1070, and the knife blade 1062 at a position where the knife blade 1062 is inside the support 1070. I support it.

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

Similar to the pull band 1140, one or more knife blades 1062 can be lined up. In such a configuration, the plurality of blades 1062 have the same longitudinal stiffness but provide greater flexibility if the articulated joint 1050 has a bend.

What is obvious in FIG. 41 is the articulation lock release slide 1120 that locks the articulation of the couplings 1020 and 1030.

42 to 50 are views showing a vertical cross section of the handle 1200 on the distal side of the tubular portion along a plane orthogonal to the vertical axis of the end stapler 1000.

FIG. 42 shows a cross section of a connecting junction between the knife blade 1062 and the extrusion rod pin 1122. The extruded rod pin 1122 passes through the two adjacent blades 1062 and the extruded rod 1102 in its entirety, but does not extend out of the outer surface of the extruded rod. This drawing also shows the relationship between the inner and outer tubes 1130, 1110 and the extrusion rod-blade support 1070. Also clear from this figure is the release extrusion rod 1104 used to unlock the unlock slide 1120. The longitudinal extract of the release pull rod 1104 is first shown in FIG. 35 and also in FIGS. 36, 37, 41, 52 and 53. In particular, FIG. 41 shows how the pull rod 1104 connects the bell actuator 1100 to the articulated unlock slide 1120, although the outer components are hidden. As shown in FIG. 37, at the distal end of the pull rod 1104 that passes through the distal end of the articulated unlock slide 1120 and is wound around the distal end, the disengaged pull rod 1104 is articulated with the bell actuator 1100. A vertical fixed connection is made between the release slides 1120. Thus, when the bell actuator 1100 moves proximally, the articulated unlock slide 1120 moves correspondingly in the proximal direction, and the distal teeth 1121 and sprocket 1522 of the articulated unlock slide 1120. Sprocket 1041 is separated. In particular, see FIGS. 46 and 52. The wound connection between the pull rod 1104 and the articulated unlock slide 1120 is only an exemplary embodiment. Locking by other shapes and locking by force are also possible.

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

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

Two spring rods 1012 are arranged inside the clevis 1010, and each spring rod collar 1014 is around this. This collar functions to laterally bias the entire distal side of the assembly of the articulated joint 1050 toward and along the vertical axis. The spring rods and collars 1012 and 1014 will be described in more detail below.

FIG. 45 shows a central open region of the articulated unlock slide 1120 that receives a bend in the pull rod 1104 (not shown in this figure). Cavity 1016 is also shown, which contains a bias spring of a spring rod 1012 (not shown). This cross-sectional area includes portions of two pull bands 1140 placed on top of the two knife blades 1062.

FIG. 46 shows an open region in which the spring rod 1012 operates with respect to the cam surface 1018. The cam surface 1018 is arched and the contact between the spring rod 1012 and the cam surface 1018 always acts axially perpendicular to the most distal surface of the spring rod 1012. See, for example, FIG. In such a configuration, with respect to the cam surface 1018 to bias the distal articulated assembly (eg, pedestal 1020, staple cartridge holder 1030, drum sleeve 1040) with respect to the vertical axis of the inner and outer tubes 1130 and 1110. The force applied by the spring rod 1012 is always at the same radius about the articulated axis of the articulated table cartridge holder 1030. One of the advantages of such a configuration is that no lateral force is applied to the spring rod 1012 under any circumstances, in which case the most distal end of the spring rod 1012 engages with the cam surface 1018. Can be stopped.

FIG. 47 shows a cross section of a region within the end stapler articulated joint 1050. Again, two pull bands 1140, two blades 1062, and a portion of two hammocks 1066 are included in this area. Upper and lower shaft packs 1152 are inserted into orifices 1042 above and below the surface of the drum sleeve 1040. The connection of the clevis 1010 to the drum sleeve 1040 at the articulated joint 1050 is symmetrical at the top and bottom. Pack 1152 is inserted into orifice 1042 at the top and bottom of the proximal end of drum sleeve 1040. In this direction, the assembly is inserted at the distal end of the clevis 1040 and aligns the screw hole 1011 with the central threaded bore 1153 of the pack 1152. When aligned, the screw 1013 is screwed into the pack 1152 to axially secure the drum sleeve 1040 to the clevis 1010 and center the drum sleeve 1040 about the axis defined by the vertical axis of the two screws 1013. Connect.

FIG. 48 shows the area of the distal pullband pin joint. In this region, the distal end of the pull band 1140 is secured by a distal pull band pin 1144 located within the bore of the distal guide block 1160. The distal guide block 1160 is located within the staple cartridge holder 1030 and is secured therein as described above.

FIG. 49 shows the region immediately proximal to the cutting blade 1060 and shows the fixed connection of the two knife blades 1062 in the proximal orifice of the cutting blade 1060. This figure also clearly shows the cam surface 1032 that rotates the pedestal 1020 and moves it with respect to the staple cartridge holder 1030.

FIG. 50 shows a vertical cross section through the spring rod 1012. In this figure, the entire vertical extent of the hammock 1066 can be seen. The distal portion of the hammock 1066 is connected about a vertical axis near the distal end of the hammock 1066. In FIG. 50, there is a substantial gap between the spring rod 1012 and the hammock 1066. Without the hammock 1066, the thin knife blade 1062 could bend and warp or bend within these gaps. Placing the hammock 1066 between them prevents the knife blade 1062 from being bent unacceptably. FIG. 51 shows the extremely bent extents of the hammock 1066 and the blade 1062 in a testbed made for this purpose. The upper hammock 1066 is not used for the upper bend with respect to FIG. 51 because it follows the inner surface of the curve in the critical bend region. In contrast, a lower hammock 1066 is used to substantially prevent the knife blades 1062 (two in the exemplary embodiment) from causing an unacceptable bend into the gap in the testbed. Each hammock 1066 is firmly held on both sides and is made of substantially inelastic material (eg, stainless steel), thus forming a sling or "hammock" in between to support the bent knife blade 1062. ..

FIG. 52 is a view showing a cross section through the articulated unlock slide 1120, which clearly shows the distal articulated bend of the unlock pull rod 1104 into slide 1120. In such a configuration, the displacement of the unlocked pull rod 1104 to the proximal side causes the slide 1120 to be correspondingly displaced to the proximal side and the teeth 1121 of the slide 1120 to be the corresponding teeth of the drum sleeve 1040 on the proximal side. Release from 1041. A bias device (not shown) biases the articulated unlock slide 1120 distally. This bias device resides in hollow 1123 and presses against the distal end of hollow 1123 and the block 1124 anchored to the clevis 1010.

FIG. 35 shows the connection between the release pull rod 1104 and the handle 1200. The rod pull block 1105 has a vertical bore 1107 for receiving the pull rod 1104. The rod pull block 1105 also has a lateral bore 1109, which receives a screw set (not shown) in order to secure the pull rod 1104 within the rod pull block 1105. The inner portion of the bell actuator 1100 engages with the rod pull block, and when the bell actuator 1100 moves to the proximal side, the rod pull block 1105 (for example, a shape fitting connection such as a key hole) is biased to the proximal side. It is shaped like a position.

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

The clevis 1010 shown in FIGS. 34 to 53 is an integrated type. Alternatively, the clevis 1010 can be molded in halves. In such cases, with the exception of pack 1152, instead, each portion of the bisected clevis can be formed, thereby eliminating the need for screw 1013. This is because the outer tubes 1110 hold the halves of each other when attached to the proximal end of the clevis 1010. Such a configuration is described in the embodiment of the end stapler of FIG. 54 and below.

FIG. 54 is a diagram showing some internal parts of the fourth embodiment of the end actuator. The pedestal 1020 is located on the opposite side of the staple cartridge holder 1030 and the closing ring 1040 surrounds the proximal end of the staple cartridge holder 1030. The inner and outer tubes 1130 and 1110 have been removed so that the articulated unlock slide 1120, extrusion rod 1102, and extrusion rod blade support 1070 can be clearly seen. Screen doors 1103 are mounted around the extrusion rod 1102 and inside the inner and outer tubes 1130, 1110, and the bell actuator 1100. The handle 1200 and bell actuator 1100 have been removed for clarity. Since the screen door 1103 only moves the knife / cutting blade 1060 in the distal direction, the movement of the extrusion rod 1102 is restricted to only one direction (distal side).

The bisected clevis is best shown in FIGS. 55 and 56. In these drawings, the outer tube 1110 is excluded to show the various internal structures of the end agonists shown in FIG. In the exploded view of FIG. 55, the connection of the pull band 1140 to the staple cartridge holder 1030 is clear. Pins not shown (see also FIG. 59) are the first proximal flange of the holder 1030, the first spacer 1170, the distal flange of the pull band 1140, the second spacer 1170, and the holder 1030. It passes through the second facing proximal side flange of the above, respectively. The closure ring 1040, as shown in FIG. 59, holds the pins here to provide a vertical connection of these components.

The various structures of the knife / cutting blade 1060 are also apparent in FIG. 55. The tooth 1060 has a proximal gutter 1061 connecting the distal ends of the knife blade 1062. In an exemplary embodiment, the groove 1061 and the distal end form a keyhole-shaped locking. The upper half of the blade 1060 has two opposing guide wings 1063 having an outer shape that fits into the corresponding groove in the bottom surface of the upper pedestal 1020. The lower half of the blade 1060 also has two opposing guide wings 1065. The holder 1030 has a groove in the upper surface to receive the lower wing 1065 there. These two pairs of wings 1063, 1065 ensure that the pedestal 1020 and holder 1030 are in a fixed parallel position as the blade 1060 moves along it during the cutting and stapling procedure. A flange 1067 extending proximally is arranged on the lower half of the blade 1060. A leaf spring 1090 is attached to the staple cartridge holder 1030 by a rivet 1036. Other features of the leaf spring 1090 and the blade 1060 are described in more detail below.

FIGS. 55 and 56 also show various parts of the bisected Clevis 2010, 2020. As seen in FIGS. 56 and 58, the inner surface of the upper half 2010 of the clevis defines two cavities 2011, which are the spring rod 1012 and the bias not shown for this spring rod 1012, respectively. Stores the device. In the exemplary embodiment shown, the upper half 2010 of the clevis defines the entire cavity 2011 for the spring rod 1012, and the lower half 2020 of the clevis is the bottom portion of the cavity solely for accommodating the bias device. 2021 is specified. These clevis halves 2010, 2020 define connecting ports 2012, 2022 for receiving the connecting bosses 2031, 2041 on each of the two parts 2030, 2040 of the dogbone clevis.

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

The outer tube 1110 and the lower half 2020 of the clevis are removed in FIG. 56 to show the structure of the spring rod 1012 in the spring rod cavity 2011. Again, spring rod bias devices (eg coil springs) are not shown in the cavity 2011 for clarity. With various components removed, the articulated extents of pullband 1140 are clearly shown in FIG. The support surface for the pull band 1140 inside the upper half 2010 of the clevis can be seen in the cut plane of FIG. The upper dogbone clevis 2030 has two opposing support surfaces 2032, each of which forms the same acute angle with respect to the center line of the non-connected pull band 1140. Similarly, the upper half 2010 of the clevis has two opposing faces 2013, each of which also forms an acute angle with respect to the center line of the unconnected pull band 1140.

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

The distal end of the dogbone guide 1080 is shown in the vertical section of FIG. 59. The distal dogbone recess 2043 houses the distal end of the dogbone guide 1080 so that the dogbone guide 1080 does not contact the support surface 2042 of the lower dogbone clevis 2040 when not articulated.

The proximal housing for the distal end of the dogbone guide 1080 is shown in FIG. To further clarify the structure of the proximal dogbone recess 2025, the dogbone guide 1080 has been removed from these structures.

Both recesses 2025, 2043, together with the lower extension of the dogbone guide 1080 disposed herein, are shown in the horizontal, longitudinal section of FIG. 57. It shows the underside structure of the extrusion rod blade support 1070, the cutting blade 1060, and the staple thread 102 (which is part of the removable staple cartridge 100). These structures are shown enlarged in FIGS. 61 and 62.

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

The knife blade 1060 should only be able to move distally when the staple thread 102 is in the ready to fire position, i.e., when the thread 102 is in the position shown in FIG. 65. When thread 102 is not in this position, it means two things. That is, there is no staple cartridge 100 in the holder 1030, or the thread 102 has already moved distally, in other words, the loaded staple cartridge 100 has already made a partial or complete launch. be. Therefore, the thread 102 is provided with a closed contact surface 104, and the blade 1060 is provided with a contact nose 1069 having a corresponding shape. At this point, the lower guide wing 1065 does not ride on the floor 1034 in the cartridge holder 1030 until the blade 1060 moves distally past the edge 1035. With such a configuration, if the thread 102 is not at the distal end of the blade 1060 and does not hit the nose 1069, the lower guide wing 1065 will track the recess 1037 just proximal to the edge 1035 and above the floor 1034. Instead of hitting the edge 1035, the blade 1060 is stopped from moving further forward. To assist in such contact in the absence of the thread 102, the staple cartridge 1030 has a leaf spring 1090 (attached by a rivet 1036). A downward force is exerted on the blade 1060 by the leaf spring 1090 (at least until the flange 1067 is distal to the distal end of the leaf spring 1090), which is fixed upward and presses the flange 1067 downward. , Pushes the wing 1065 down into the recess 1037. Thus, if the blade 1060 advances distally in the absence of the thread 102, the wing 1065 will follow the lower curve of the recess 1037 and will stop when the distal edge of the wing 1065 hits the edge 1035. Do not move further to the distal side. FIG. 63 shows, for example, the distal edge 1035 and two rising bosses 1038. The boss extends to the height of the edge 1035 to prevent the wing 1065 from being pushed beyond the edge 1035 when the thread 102 is inward.

FIG. 66 is a diagram illustrating exemplary movement of the dogbone 1080 in the lower half 2020 of the clevis and the lower dogbone clevis 2040. In the completely left-sided position of FIG. 66, the distal bottom protrusion of the dogbone 1080 is in a rotational position within the distal dogbone recess 2043 and the proximal bottom protrusion is the proximal dog. It is in the rotational position in the bone recess 2025. Importantly, the left vertical plane of the dogbone 1080 is almost completely supported on the left dogbone support planes 2024, 2042. The shape of the recesses 2025, 2043, and the bottom protrusion of the dogbone 1080 are selected to sway from left to right when there is no extension or compression of the dogbone 1080 and end-to-end articulations occur. ..

Three side-by-side knife blades 1062 are illustrated in FIG. 66 within the arched position on the left side of the lower halves 2020, 2040 of the clevis. When bent to the left, the knife blade 1062 is pressed against the right inner surface 1082 of the dogbone 1080. Therefore, the inner side surface 1082 is shaped according to the extent in which the end actuator will bend. Due to the limitations of the image, the blade 1062 is only shown schematically in a substantially curved direction.

To better understand some features of the knife blade 1062, an enlarged view of the proximal side connection of the extrusion rod 1102 and the extrusion rod blade support 1070 is shown in FIG. It is possible to imagine a structure having a coaxially aligned knife blade 1062 and an extrusion rod 1102, for example the offset connection shown in FIGS. 41, 67 is used. As mentioned above, the length of the knife blade 1062 preferably ensures that the knife blade 1062 is completely pushed down into the blade channel 1072 within the extrusion rod blade support 1070. FIG. 41 shows a first embodiment of offset coupling that biases the blade 1062 to the channel 1072. FIG. 67 shows a second embodiment of this offset connection. In this second embodiment, the blade 1062 is not fixedly connected to the extrusion rod 1102 as in the first embodiment (connected by the lateral extrusion pin 1122). Instead, a chamber 1108 is formed in the extrusion rod 1102 into which the proximal end of the blade 1062 is inserted. By forming the chamber 1108 in a shape that holds the blade 1062 vertically (for example, lateral offset), fixed connection is not required. In this embodiment, chamber 1108 is approximately L-shaped in vertical cross-section, providing such a lateral offset, but may have a variety of different shapes.

The distal connection of pull band 1140 is particularly well shown in FIG. In such a configuration, the left and right arches bend each of two, three, four, or more adjacent pull bands 1140. Since each pullband 1140 has a fixed length and the pullbands 1140 are stacked on top of each other along the sides, arches in a given direction will cause each pullband 1140 to be oriented differently, albeit with a small difference. bend. Examples of alternative distal connections to compensate for such bend differences are shown in FIGS. 68-70. For clarity and simplicity, only a portion of the upper dogbone clevis 2030 is shown in these drawings in schematic form.

This alternative embodiment replaces the spacer 1170 of the first embodiment. Here, five pull bands 1140 are arranged side by side on the side. The upper dogbone clevis 2030 defines an inner bore 2033 (eg, a circular bore) into which a piston 2050 having an outer shape corresponding to the inner shape of the bore 2033 is inserted. The bore 2033 comprises a proximal window 2034 through which the pull band 1140 projects into the bore 2033. The window 2034 has approximately the same width (although slightly larger) as the full width of the pull band 1140.

The piston 2050 has a lateral bore into which the proximal pullband pin 2060 is screwed. This pin acts as a shaft when screwed into the piston 2050 and the distal pullband bore 1145 of each pullband 1140. See FIG. 70. The internal 2051 of the piston 2050 does not have a shape corresponding to the width of the overlapping pull bands 1140. Instead, the medial opening that receives the distal end of the pull band 1140 has a horizontal cross-sectional shape with wings.

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

The above description and drawings show the principles, preferred embodiments, and operating modes of the invention. However, the invention should not be limited to the particular examples described above. Further modifications of the above embodiments will be obvious to those of skill in the art.

Therefore, the above examples should be considered as illustrations, not limitations. Therefore, it is self-evident that those skilled in the art can make modifications of these examples without departing from the scope of the invention as defined by the claims.

Claims (6)

It ’s a surgical device,
Instrument shafts (1110, 1130) with proximal and distal ends, and
A control handle (1200) connected to the proximal end of the instrument shaft (1110, 1130).
It is connected to the distal end of the instrument shaft (1110, 1130) at a joint (1050), and is configured to be connected to the instrument shaft (1110, 1130) at the joint (1050) about a connection axis. Surgical end actuators (1020, 1030) and
Is equipped with
When the control handle (1200) is displaced from the starting position, the surgical end does not cause lateral movement of the surgical end actuator (1020, 1030) with respect to the instrument shaft (1110, 1130). It has an actuator (1100, 1104) configured to release the locking mechanism (120, 1120) of the unit actuating body (1020, 1030).
The locking mechanism (120, 1120) was configured to hold the joint (1050) in a fixed position when the actuator (1100, 1104) was released, and the actuator (1100, 1104) was released. Thereby , a surgical device comprising returning the actuator (1100, 1104) to the starting position. In the surgical device of claim 1, the actuator (1100, 1104) is positioned, selectively connected to the locking mechanism (120, 1120), and when connected, the joint (1100) at the fixed position. A surgical device characterized by holding 1050). In the surgical device of claim 2, the displacement of the actuator (1100, 1104) separates the actuator (1100, 1104) from the locking mechanism and releases the joint (1050) from the fixed position. A surgical device characterized by being. In the surgical device according to claim 1, the surgical end actuating body (1020, 1030) is
A surgical stapling end agonist (1020, 1030) having a pair of opposed stapling surfaces (1020, 1030).
Knife assembly (1060, 1062) and
A surgical device characterized by having. The surgical device according to claim 1 , wherein the surgical end working body (1020, 1030) comprises a surgical stapling end working body (1020, 1030). It ’s a surgical device,
Instrument shafts (1110, 1130) with proximal and distal ends, and
A control handle (1200) connected to the proximal end of the instrument shaft (1110, 1130).
It is connected to the distal end of the instrument shaft (1110, 1130) at a joint (1050), and is configured to be connected to the instrument shaft (1110, 1130) at the joint (1050) about a connection axis. Surgical end actuators (1020, 1030) and
Is equipped with
The control handle (1200) with actuators (1100, 1104) of the surgical end actuator (1020, 1030) with respect to the instrument shaft (1110, 1130) when displaced proximally from the starting position. It is configured to release the locking mechanism (120, 1120) of the surgical end actuator (1020, 1030) without causing lateral displacement.
The locking mechanism (120, 1120) was configured to hold the joint (1050) in a fixed position when the actuator (1100, 1104) was released, and the actuator (1100, 1104) was released. A surgical device comprising such an actuator (1100 , 1104) to return distally towards the starting position.

Images