JP7483609B2 - Stapling instrument with tissue driver - Google Patents

Description

The present invention relates to surgical instruments and to surgical stapling and severing instruments and staple cartridges for use therewith that are designed to staple and sever tissue in a variety of situations.

The various features of the embodiments described herein, together with their advantages, may be understood from the following description taken in conjunction with the accompanying drawings, in which:
FIG. 1 is a perspective view of a surgical stapling instrument in accordance with at least one embodiment; 2 is a cross-sectional view of the stapling instrument of FIG. 1 taken along line 2-2 of FIG. 1; FIG. 2 is a partial perspective view of a drive system of the stapling instrument of FIG. FIG. 4 is a plan view of the drive system of FIG. 3 . FIG. 4 is an elevational view of the drive system of FIG. 3 shown in a first operational configuration. 6 is a side view of the drive system of FIG. 3 shown in the first operational configuration of FIG. 5; FIG. 4 is a side view of the drive system of FIG. 3 shown in a second operational configuration. FIG. 1 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment; FIG. 1 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment; FIG. 9 is a perspective view of a handle housing of the stapling instrument of FIG. 8 ; FIG. 1 is a perspective view of a battery according to at least one embodiment. FIG. 2 is a perspective view of a handle of the stapling instrument of FIG. FIG. 1 is a perspective view of a surgical stapling instrument including a display in accordance with at least one embodiment; 14 shows status controls on the display of FIG. 13. 14 shows the speed control on the display of FIG. 14 shows a fault threshold control on the display of FIG. 13. 14 shows directional controls on the display of FIG. 13. 13 and the speed control of FIG. 15. 14 shows the display and speed control of FIG. 13. 14 illustrates the display and staple path control of FIG. 13 being used to change the staple firing path of a stapling instrument. 13 and the staple path control of FIG. 21 being used to change the staple firing path of a stapling instrument. 14 illustrates the display of FIG. 13 and controls for stopping the stapling instrument along the staple firing path. 1 illustrates a surgical tool system including an external or off-board display in accordance with at least one embodiment. 1 illustrates a display of a surgical stapling instrument in accordance with at least one embodiment. 25 shows the display of FIG. 24 being used to vary the staple firing path when forming a gastric sleeve during a gastric reduction procedure. 25 shows a joystick being used to change the staple firing path on the display of FIG. 24. 1 illustrates a stapling instrument being guided along a staple firing path; 1 shows the patient's stomach. 1 is a cross-sectional view of a patient's stomach. FIG. 30 is a cross-sectional view of a target inserted into the stomach of FIG. 29. 30 is a cross-sectional view of a patient's stomach that is thinner than the stomach of FIG. 29. FIG. 32 is a cross-sectional view of a target inserted into the stomach of FIG. 31. 1 illustrates various anatomical features that may be referenced during a gastric sleeve procedure. FIG. 1 is a partial elevational view of a surgical stapling instrument including a shaft, an end effector, and an articulation joint in accordance with at least one embodiment; FIG. 35 is a partial elevational view of the stapling instrument of FIG. 34 showing the end effector in an articulated position; FIG. 13 is a bottom cross-sectional view of an end effector of a surgical stapling instrument in accordance with at least one embodiment; FIG. 13 is a partial cross-sectional view of a surgical stapling instrument including a tissue driving system in accordance with at least one embodiment; 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 showing the tissue drive system engaged with tissue of a patient; 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 illustrating the tissue drive system urging tissue of a patient in a first direction; 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 illustrating the tissue drive system urging the patient's tissue in a second direction; 38 is a partial cross-sectional view of the stapling instrument of FIG. 37 showing the tissue drive system disengaged from the patient's tissue; FIG. 1 is a partial elevation view of a drive system including a synchronization mechanism according to at least one embodiment. 43 shows the synchronization mechanism of FIG. 42 for actuating the end effector drive system. 1 illustrates a drive system configured to drive multiple end effector drive systems in a reciprocating motion. 1 shows a plot of two synchronized end effector drives. 1 is a table showing the synchronization of four end effector drivers. AG illustrate steps in operation of a surgical stapling instrument in accordance with at least one embodiment. 13 is a table illustrating synchronization of end effector drivers of a surgical stapling instrument in accordance with at least one embodiment; 1 is a module for operating a surgical stapling instrument in accordance with at least one embodiment. FIG. 13 is a partial perspective view of an end effector including a tissue drive system in accordance with at least one embodiment shown extended; FIG. 51 is a partial perspective view of the tissue drive system of FIG. 50 being retracted. FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the tissue drive system in a retracted configuration. FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the tissue drive system in a lowered configuration. FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the tissue drive system extended. FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the teeth of the tissue drive system in a protruding configuration; FIG. 51 is a partial cross-sectional view of the end effector of FIG. 50 showing the drive system being retracted. FIG. 1 illustrates a partial perspective view of a tissue drive system in accordance with at least one embodiment. FIG. 58 is a partial perspective view of the tissue drive system of FIG. 57 in an extended configuration. 13 illustrates an operational step of a tissue drive system of a surgical stapling instrument in accordance with at least one embodiment. 13 illustrates an operational step of a tissue drive system of a surgical stapling instrument in accordance with at least one embodiment. 13 illustrates an operational step of a tissue drive system of a surgical stapling instrument in accordance with at least one embodiment. 13 illustrates an operational step of a tissue drive system of a surgical stapling instrument in accordance with at least one embodiment. 59B further illustrates the operating steps of the tissue drive system of FIG. 59C further illustrates the operating steps of the tissue drive system of FIG. 59B. 59D further illustrates the operating steps of the tissue drive system of FIG. 59D further illustrates the operating steps of the tissue drive system. FIG. 1 is a partial perspective view of a surgical stapling instrument including a tissue driving system in accordance with at least one embodiment; FIG. 62 is a partial perspective view of the tissue drive system of FIG. 61 in an extended configuration. FIG. 13 is a partial cross-sectional perspective view of a surgical stapling instrument including a tissue driving system in accordance with at least one embodiment; FIG. 64 is a bottom cross-sectional view of the stapling instrument of FIG. 63; FIG. 13 is a partial cross-sectional view of a surgical stapling instrument including a reduced pressure system in accordance with at least one embodiment; FIG. 66 is a partial detailed view of the tissue drive system of the stapling instrument of FIG. 65; 66 is a partial cross-sectional view of the stapling instrument of FIG. 65 showing tissue being drawn into an end effector of the stapling instrument; FIG. 67 is a detailed view of a portion of the tissue drive system of FIG. 66. 66 is a partial cross-sectional view of the stapling instrument of FIG. 65 showing tissue being released; FIG. 13 is a partial cross-sectional view of a surgical stapling instrument including a vacuum system in accordance with at least one embodiment; 71 is a partial cross-sectional view of the stapling instrument of FIG. 70 illustrating the first and second drive feet of the stapling instrument in a retracted configuration; 71 is a partial cross-sectional view of the stapling instrument of FIG. 70 showing the first drive foot in an extended position; 71 is a reduced pressure manifold of the stapling instrument of FIG. 70 in fluid communication with the first drive foot. FIG. 1 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment; 1A-D illustrate steps in operation of a surgical stapling instrument in accordance with at least one embodiment. FIG. 1 is a partial cross-sectional perspective view of a surgical stapling instrument in accordance with at least one embodiment; 77 illustrates an operating step for steering the stapling instrument of FIG. 76; 77 illustrates an operating step for steering the stapling instrument of FIG. 76; 77 illustrates an operating step for steering the stapling instrument of FIG. 76; 77 illustrates an operating step for steering the stapling instrument of FIG. 76; FIG. 1 is a cross-sectional end view of a surgical stapling instrument in accordance with at least one embodiment; FIG. 1 is a partial elevational view of a surgical stapling instrument in accordance with at least one embodiment having a tissue driver; 79 shows the position of the tissue driver foot corresponding to FIG. FIG. 80 is a partial elevational view of the stapling instrument of FIG. 79 showing the feet extended; 81 shows the position of the tissue driver foot corresponding to FIG. 80 . 80 is a partial elevational view of the stapling instrument of FIG. 79 showing the feet in an extended configuration; 82 shows the position of the tissue driver foot corresponding to FIG. 81 . FIG. 80 is a partial elevational view of the stapling instrument of FIG. 79 showing the feet retracted; 83 shows the position of the tissue driver foot corresponding to FIG. 82 . 80 is a partial cross-sectional view of the tissue driver of the stapling instrument of FIG. 79; 80 illustrates the kinematics of the tissue driver of the stapling instrument of FIG. 79 . 85 shows a cam capable of generating the kinematics of FIG. 84. FIG. 85 is a perspective view of a cam capable of generating the kinematics of FIG. 84 . FIG. 1 is a partial perspective view of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment; 1 illustrates a tissue driver of a surgical stapling instrument in accordance with at least one embodiment; 89 shows the tissue driver of FIG. 88 in an extended configuration. 11 illustrates a process of operation of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment; 11 illustrates a process of operation of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment; 11 illustrates a process of operation of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment; 11 illustrates a process of operation of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment; 1A-D illustrate steps in operation of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment. 1 illustrates a tissue driver of a surgical stapling instrument in accordance with at least one embodiment. 93 illustrates the tissue driver of FIG. 92 in an extended configuration. FIG. 1 is a partial cross-sectional perspective view of a surgical stapling instrument in accordance with at least one embodiment; FIG. 1 is a partial elevational view of a surgical stapling instrument including a tissue-cutting member in accordance with at least one embodiment; 96 illustrates the tissue cutting member of FIG. 95 being moved through a tissue cutting stroke. FIG. 1 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment; FIG. 13 is a perspective view of two interlocking staples in accordance with at least one embodiment; FIG. 99 is a partial perspective view of the staple of FIG. 98 separated. 98 is a partial cross-sectional view of a staple firing system of the stapling instrument of FIG. 97 including a staple firing chamber in accordance with at least one embodiment; 101 shows staples being fired by the staple firing system of FIG. 100; 102 shows another staple being loaded into the staple firing chamber of FIG. 100 . FIG. 98 is a bottom cross-sectional end view of the stapling instrument of FIG. 97; FIG. 1 is a partial cross-sectional perspective view of a surgical stapling instrument in accordance with at least one embodiment; 105 illustrates a step in the operation of the stapling instrument of FIG. 104; 105 illustrates a step in the operation of the stapling instrument of FIG. 104; 105 illustrates a step in the operation of the stapling instrument of FIG. 104; 105 illustrates a step in the operation of the stapling instrument of FIG. 104; FIG. 1 is a partial perspective view of a surgical stapling instrument in accordance with at least one embodiment; FIG. 107 is an exploded perspective view of a staple clip for use with the surgical stapling instrument of FIG. 106; FIG. 1 is a top view of a staple clip in accordance with at least one embodiment; FIG. 109 is an end view of the staple clip of FIG. 108 positioned within a surgical stapling instrument; FIG. 109 is a perspective view of the staple clip of FIG. 108; FIG. 1 is an end view of a staple clip in accordance with at least one embodiment disposed within a surgical stapling instrument; FIG. 112 is a perspective view of the staple clip of FIG. 111; FIG. 1 is an end view of a staple clip in accordance with at least one embodiment disposed within a surgical stapling instrument; FIG. 114 is a perspective view of the staple clip of FIG. 113; FIG. 2 is a partial top view of a staple strip in an unfolded configuration in accordance with at least one embodiment. FIG. 116 is an end view of the staple strip of FIG. 115 in an unfolded configuration; FIG. 116 is an end view of the staple strip of FIG. 115 in a folded configuration; FIG. 116 is a perspective view of the staple strip of FIG. 115 being deployed; FIG. 13 is a perspective view of a staple cluster in accordance with at least one embodiment; FIG. 120 is a partial perspective view of the staple cluster of FIG. 119 being loaded into a surgical stapling instrument; FIG. 1 is a partial perspective view of a surgical stapling instrument including an deployable staple cluster in accordance with at least one embodiment; FIG. 13 is a partial perspective view of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment; 123 is a partial perspective view of the stapling instrument of FIG. 122 showing the tissue driver in an extended configuration; 123 illustrates the cross-sectional width of the distal head of the stapling instrument of FIG. 122; FIG. 123 is a cross-sectional view of a tissue gripping surface of the tissue driver of FIG. 122; FIG. 13 is a cross-sectional end view of a surgical stapling instrument including a tissue driver in accordance with at least one embodiment shown in an extended configuration; FIG. 127 is a cross-sectional end view of the stapling instrument of FIG. 126 showing the tissue driver in a retracted configuration; 1 illustrates a firing drive of a surgical stapling instrument in accordance with at least one embodiment shown in an unfired configuration; 129 illustrates the tissue driver of the stapling instrument of FIG. 128 shown in an extended configuration; 129 illustrates the firing drive of FIG. 128 shown in a firing configuration. 128B shows the tissue driver of FIG. 128A in a retracted configuration. 129 illustrates the firing drive of FIG. 128 shown in an unfired configuration. 128B shows the tissue driver of FIG. 128A in a retracted configuration. FIG. 1 is a perspective view of a staple loading system of a surgical stapling instrument in accordance with at least one embodiment; FIG. 132 is a plan view of the staple loading system of FIG. 131 . FIG. 132 is a partial elevational view of the staple loading system of FIG. 131 . 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in an unfired configuration; 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in a firing configuration; 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 being retracted to an unfired configuration; 132 is a partial cross-sectional view of the stapling instrument of FIG. 131 shown in an unfired configuration; 1 illustrates a staple pattern that may be generated by a surgical stapling instrument in accordance with at least one embodiment. 1 illustrates a staple pattern that may be generated by a surgical stapling instrument in accordance with at least one embodiment. 1 illustrates a surgical stapling instrument in accordance with at least one embodiment. 141 illustrates the operational steps used by the stapling instrument of FIG. 140 to create and deploy staples. 1 shows staple firing lines within the patient's stomach. 1 illustrates a progression of staple firing in accordance with at least one embodiment. 2 illustrates the stapling instrument of FIG. 1 in use during a surgical procedure; 2 illustrates the stapling instrument of FIG. 1 in use during a surgical procedure; 2 illustrates the stapling instrument of FIG. 1 in use during a surgical procedure; 1 illustrates a surgical stapling instrument in accordance with at least one embodiment being used during a surgical procedure. FIG. 148 is a partial elevational view of the surgical stapling instrument of FIG. 147; FIG. 148 is a partial perspective view of the stapling instrument of FIG. 147 in a first configuration; FIG. 148 is a partial perspective view of the stapling instrument of FIG. 147 in a second configuration; 1 illustrates potential outcomes of a gastric sleeve procedure using the surgical stapling instrument disclosed herein. 1 shows a guide inserted into a patient's stomach. 13 shows a guide being used to define a staple firing path within a patient's stomach. 154 is shown being used to form a gastric sleeve during a gastric bypass procedure. FIG. 154 is a partial cross-sectional view of the guide of FIG. 153; 1 is a partial cross-sectional view of a guide according to at least one embodiment, with some components shown removed; 154 is a schematic diagram of the guide of FIG. 153; FIG. 1 is a perspective view of a surgical stapling system including a loadable staple cartridge in accordance with at least one embodiment; 159 illustrates certain operational components of the stapling system of FIG. 158 . FIG. 13 is an end view of a surgical stapling instrument with a projector system including two lenses in accordance with at least one embodiment; The stapling instrument of FIG. 160 is shown in use during a surgical procedure. 1 illustrates a surgical stapling system including a projector in accordance with at least one embodiment. 1 illustrates a surgical stapling system comprising a vision system and a projection system in accordance with at least one embodiment. 164 shows the projector system of the stapling system of FIG. 163 in use. 1 illustrates a projection image onto tissue of a patient, in accordance with at least one embodiment. 1 illustrates a staple firing path projected onto a patient's tissue in accordance with at least one embodiment. 1 illustrates a surgical stapling instrument comprising a first projector configured to project a first portion of a staple firing path onto a patient's tissue and a second projector configured to project a second portion of the staple firing path onto the patient's tissue, in accordance with at least one embodiment. FIG. 1 is a partial elevational view of a surgical stapling instrument including an articulating end effector in accordance with at least one embodiment; FIG. 169 is a partial elevational view of the surgical stapling instrument of FIG. 168; FIG. 1 is a partial elevational view of a surgical stapling instrument comprising an articulating end effector and a dampener configured to reduce unintended motion of the end effector in accordance with at least one embodiment; FIG. 1 is a partial elevational view of a surgical stapling instrument including an end effector dampener in accordance with at least one embodiment; The stapling instrument of FIG. 171 is shown in use in a surgical procedure. The stapling instrument of FIG. 171 is shown in use in a surgical procedure. 1 illustrates a staple firing path formed by a surgical stapling instrument having a longitudinal end effector. 1 illustrates a staple firing path formed by a surgical stapling instrument as disclosed herein. 1 illustrates a staple firing path formed by a surgical stapling instrument having a longitudinal end effector. 1 illustrates a staple firing path formed by a surgical stapling instrument as disclosed herein. 1 illustrates a staple firing path formed by a surgical stapling instrument having a longitudinal end effector. 1 illustrates a staple firing path formed by a surgical stapling instrument as disclosed herein. FIG. 1 is a perspective view of a handle of a surgical instrument in accordance with at least one embodiment. FIG. 181 is a perspective view of the handle of the surgical instrument of FIG. 180 enclosed in a sterile barrier. FIG. 182 is a partial cross-sectional view of the sterility barrier and touch-sensitive display of the handle of FIG. 181 . FIG. 183 is a plan view of the touch-sensitive display of FIG. 182 showing a grid of electrodes, with a number of pixels being activated. 184 is a graph showing the relationship between the position of the active pixel of FIG. 183 and the capacitance detected by the touch-sensitive display of FIG. 182.

Corresponding reference characters indicate corresponding parts throughout the several views. The examples described herein are illustrative of various embodiments of the present invention in one form only, and such examples should not be construed as limiting the scope of the present invention in any manner.

The applicant of this application owns the following U.S. patent applications, filed on December 21, 2017, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/850,431, entitled "CONTINUOUS USE SELF-PROPELLED STAPLING INSTRUMENT";
- U.S. Patent Application No. 15/850,461, entitled "SURGICAL INSTRUMENT COMPRESSING SPEED CONTROL";
- U.S. Patent Application No. 15/850,433, entitled "SURGICAL INSTRUMENT COMPRESSING A PROJECTOR";
- U.S. Patent Application No. 15/850,495, entitled "STAPLE INSTRUMENT COMPRESSING A FIRING PATH DISPLAY";
- U.S. Patent Application No. 15/850,480, entitled "SELF-GUIDING STAPLING INSTRUMENT";
- U.S. Patent Application No. 15/850,522, entitled "SURGICAL INSTRUMENT CONFIGURED TO DETERMINE FIRING PATH";
- U.S. Patent Application No. 15/850,542, entitled "SURGICAL INSTRUMENT COMPRESSING AND END EFFECTOR DAMPENER";
- U.S. Patent Application No. 15/850,579, entitled "SURGICAL INSTRUMENT COMPRESSING SYNCHRONIZED DRIVE SYSTEMS";
- U.S. Patent Application No. 15/850,534, entitled "SURGICAL INSTRUMENT COMPRESSING A TISSUE GRASPING SYSTEM";
- U.S. Patent Application No. 15/850,562, entitled "SURGICAL INSTRUMENT COMPRESSING SEQUENCED SYSTEMS";
- U.S. Patent Application No. 15/850,587, entitled "STAPLING INSTRUMENT COMPRESSING A STAPLE FEEDING SYSTEM";
- U.S. Patent Application No. 15/850,508, entitled "SURGICAL STAPLER COMPRESSING STORABLE CARTRIDGES HAVING DIFFERENT STAPLE SIZES";
- U.S. Patent Application No. 15/850,526, entitled "SURGICAL INSTRUMENT HAVING A DISPLAY COMPRESSING IMAGE LAYERS";
- U.S. Patent Application No. 15/850,529, entitled "SURGICAL INSTRUMENT COMPRESSING A DISPLAY";
- U.S. Patent Application No. 15/850,500, entitled "SURGICAL INSTRUMENT COMPRESSING AN ARTICULATABLE DISTAL HEAD"; and - U.S. Patent Application No. 15/850,518, entitled "SURGICAL INSTRUMENT COMPRESSING A PIVOTABLE DISTAL HEAD".

The applicant of this application owns the following U.S. patent applications, filed on December 19, 2017, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/847,306, entitled "METHOD FOR DETERMINING THE POSITION OF A ROTATABLE JAW OF A SURGICAL INSTRUMENT ATTACHMENT ASSEMBLY";
- U.S. Patent Application No. 15/847,297, entitled "SURGICAL INSTRUMENTS WITH DUAL ARTICULATION DRIVERS";
- U.S. Patent Application No. 15/847,325, entitled "SURGICAL TOOLS CONFIGURED FOR INTERCHANGEABLE USE WITH DIFFERENT CONTROLLER INTERFACES";
- U.S. Patent Application No. 15/847,293, entitled "SURGICAL INSTRUMENT COMPRESSING CLOSURE AND FIRING LOCKING MECHANISM";
- U.S. Patent Application No. 15/847,315, entitled "ROBOTIC ATTACHMENT COMPRESSING EXTERIOR DRIVE ACTUATOR", and - U.S. Design Patent Application No. 29/630,115, entitled "SURGICAL INSTRUMENT ASSEMBLY".

The applicant of this application owns the following U.S. patent applications, filed on December 15, 2017, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/843,485, entitled "SEALED ADAPTERS FOR USE WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";
- U.S. Patent Application No. 15/843,518, entitled "END EFFECTORS WITH POSITIVE JAW OPENING FEATURES FOR USE WITH ADAPTERS FOR ELECTROMECHANICAL SURGICAL INSTRUMENTS";
- U.S. Patent Application No. 15/843,535, entitled "SURGICAL END EFFECTORS WITH CLAMPING ASSEMBLYS CONFIGURED TO INCREASE JAW APERTURE RANGE";
- U.S. Patent Application No. 15/843,558, entitled "SURGICAL END EFFECTORS WITH PIVOTAL JAWS CONFIGURED TO TOUCH AT THEIR RESPONDENT DISTRICT ENDS WHEN FULLY CLOSED";
- U.S. Patent Application No. 15/843,528, entitled "SURGICAL END EFFECTORS WITH JAW STIFFENER ARRANGEMENTS CONFIGURED TO PERMIT MONITORING OF FIRING MEMBER";
- U.S. Patent Application No. 15/843,567, entitled "ADAPTERS WITH END EFFECTOR POSITION SENSING AND CONTROL ARRANGEMENTS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";
- U.S. Patent Application No. 15/843,556, entitled "DYNAMIC CLAMPING ASSEMBLIES WITH IMPROVED WEAR CHARACTERISTICS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";
- U.S. Patent Application No. 15/843,514, entitled "ADAPTERS WITH FIRING STROKE SENSING ARRANGEMENTS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS";
- U.S. Patent Application No. 15/843,501, entitled "ADAPTERS WITH CONTROL SYSTEMS FOR CONTROLLING MULTIPLE MOTORS OF AN ELECTROMECHANICAL SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/843,508, entitled "HANDHELD ELECTROMECHANICAL SURGICAL INSTRUMENTS WITH IMPROVED MOTOR CONTROL ARRANGEMENTS FOR POSITIONING COMPONENTS OF AN ADAPTER COUPLED THERETO";
- U.S. Patent Application No. 15/843,682, entitled "SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER FIRING RATE OF A SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/843,689, entitled "SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER", and - U.S. Patent Application No. 15/843,704, entitled "METHODS OF OPERATING SURGICAL END EFFECTORS".

The applicant of this application owns the following U.S. patent applications, filed on June 29, 2017, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/636,829, entitled "CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/636,837, entitled "CLOSED LOOP VELOCITY CONTROL TECHNIQUES BASED ON SENSED TISSUE PARAMETERS FOR ROBOTIC SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/636,844, entitled "CLOSED LOOP VELOCITY CONTROL OF CLOSURE MEMBER FOR ROBOTIC SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/636,854, entitled "ROBOTIC SURGICAL INSTRUMENT WITH CLOSED LOOP FEEDBACK TECHNIQUES FOR ADVANCEMENT OF CLOSURE MEMBER DURING FIRING"; and - U.S. Patent Application No. 15/636,858, entitled "SYSTEM FOR CONTROLLING ARTICULATION FORCES".

The applicant of this application owns the following U.S. patent applications, filed on June 28, 2017, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/635,693, entitled "SURGICAL INSTRUMENT COMPRESSING AN OFFSET ARTICULATION JOINT";
- U.S. Patent Application No. 15/635,729, entitled "SURGICAL INSTRUMENT COMPRESSING AN ARTICULATION SYSTEM RATIO";
- U.S. Patent Application No. 15/635,785, entitled "SURGICAL INSTRUMENT COMPRESSING AN ARTICULATION SYSTEM RATIO";
- U.S. Patent Application No. 15/635,808, entitled "SURGICAL INSTRUMENT COMPRESSING FIRING MEMBER SUPPORTS";
- U.S. Patent Application No. 15/635,837, entitled "SURGICAL INSTRUMENT COMPRESSING AN ARTICULATION SYSTEM LOCKABLE TO A FRAME";
- U.S. Patent Application No. 15/635,941, entitled "SURGICAL INSTRUMENT COMPRESSING AN ARTICULATION SYSTEM LOCKABLE BY A CLOSURE SYSTEM";
- U.S. Patent Application No. 15/636,029, entitled "SURGICAL INSTRUMENT COMPRESSING A SHAFT INCLUDING A HOUSING ARRANGEMENT";
- U.S. Patent Application No. 15/635,958, entitled "SURGICAL INSTRUMENT COMPRESSING SELECTIVELY ACTUATABLE ROTATABLE COUPLERS";
- U.S. Patent Application No. 15/635,981, entitled "SURGICAL STAPLING INSTRUMENTS COMPRESSING SHORTENED STAPLE CARTRIDGE NOSES";
- U.S. Patent Application No. 15/636,009, entitled "SURGICAL INSTRUMENT COMPRESSING A SHAFT INCLUDING A CLOSURE TUBE PROFILE";
- U.S. Patent Application No. 15/635,663, entitled "METHOD FOR ARTICULATING A SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/635,530, entitled "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITH AXIALLY SHORTED ARTICULATION JOINT CONFIGURATIONS";
- U.S. Patent Application No. 15/635,549, entitled "SURGICAL INSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLY MOVABLE FIRING MEMBER THAT IS INITIALLY PARKED IN CLOSE PROXIMITY TO THE JAWS PRIOR TO FIRING";
- U.S. Patent Application No. 15/635,559, entitled "SURGICAL INSTRUMENTS WITH JAWS CONSTRAINED TO PIVOT ABOUT AN AXIS UPON CONTACT WITH A CLOSURE MEMBER THAT IS PARKED IN CLOSE PROXIMITY TO THE PIVOT AXIS";
- U.S. Patent Application No. 15/635,578, entitled "SURGICAL END EFFECTORS WITH IMPROVED JAW APERTURE ARRANGEMENTS";
- U.S. Patent Application No. 15/635,594, entitled "SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVIL WITH A TISSUE LOCATING ARRANGEMENT IN CLOSE PROXIMITY TO AN ANVIL PIVOT";
- U.S. Patent Application No. 15/635,612, entitled "JAW RETAINER ARRANGEMENT FOR RETAINING A PIVOTABLE SURGICAL INSTRUMENT JAW IN PIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICAL INSTRUMENT JAW";
- U.S. Patent Application No. 15/635,621, entitled "SURGICAL INSTRUMENT WITH POSITIVE JAW OPENING FEATURES";
- U.S. Patent Application No. 15/635,631, entitled "SURGICAL INSTRUMENT WITH AXIALLY MOVEABLE CLOSURE MEMBER";
- U.S. Patent Application No. 15/635,521, entitled "SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT";
- U.S. Design Patent Application No. 29/609,087, entitled "STAPLE FORMING ANVIL";
- U.S. Design Patent Application Serial No. 29/609,083, entitled "SURGICAL INSTRUMENT SHAFT", and - U.S. Design Patent Application Serial No. 29/609,093, entitled "SURGICAL FASTENER CARTRIDGE".

The applicant of this application owns the following U.S. patent applications, filed on June 27, 2017, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/634,024, entitled "SURGICAL ANVIL MANUFACTURING METHODS";
- U.S. Patent Application No. 15/634,035, entitled "SURGICAL ANVIL ARRANGEMENTS";
- U.S. Patent Application No. 15/634,046, entitled "SURGICAL ANVIL ARRANGEMENTS";
- U.S. Patent Application No. 15/634,054, entitled "SURGICAL ANVIL ARRANGEMENTS";
- U.S. Patent Application No. 15/634,068, entitled "SURGICAL FIRING MEMBER ARRANGEMENTS";
- U.S. Patent Application Serial No. 15/634,076, entitled "STAPLE FORMING POCKET ARRANGEMENTS";
- U.S. Patent Application No. 15/634,090, entitled "STAPLE FORMING POCKET ARRANGEMENTS";
- U.S. Patent Application No. 15/634,099, entitled "SURGICAL END EFFECTORS AND ANVILS", and - U.S. Patent Application No. 15/634,117, entitled "ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS".

The applicant of this application owns the following U.S. patent applications, filed on December 21, 2016, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/386,185, entitled "SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIES THEREOF";
- U.S. Patent Application No. 15/386,230, entitled "ARTICULATABLE SURGICAL STAPLING INSTRUMENTS";
- U.S. Patent Application Serial No. 15/386,221, entitled "LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS";
- U.S. Patent Application No. 15/386,209, entitled "SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF";
- U.S. Patent Application No. 15/386,198, entitled "LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE TOOL ASSEMBLIES";
- U.S. Patent Application No. 15/386,240, entitled "SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR";
- U.S. Patent Application No. 15/385,939, entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN";
- U.S. Patent Application No. 15/385,941, entitled "SURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGEMENTS FOR SHIFTING BETWEEN CLOSURE SYSTEMS WITH CLOSURE STROKE REDUCTION FEATURES AND ARTICULATION AND FIRING SYSTEMS";
- U.S. Patent Application No. 15/385,943, entitled "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS";
- U.S. Patent Application No. 15/385,950, entitled "SURGICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUCTION FEATURES";
- U.S. Patent Application No. 15/385,945, entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN";
- U.S. Patent Application No. 15/385,946, entitled "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS";
- U.S. Patent Application No. 15/385,951, entitled "SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASING A JAW OPENING DISTANCE";
- U.S. Patent Application No. 15/385,953, entitled "METHODS OF STAPLING TISSUE";
- U.S. Patent Application No. 15/385,954, entitled "FIRING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATURES FOR SURGICAL END EFFECTORS";
- U.S. Patent Application No. 15/385,955, entitled "SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOP ARRANGEMENTS";
- U.S. Patent Application No. 15/385,948, entitled "SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS";
- U.S. Patent Application No. 15/385,956, entitled "SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES";
- U.S. Patent Application No. 15/385,958, entitled "SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTING FIRING SYSTEM ACTUATION UNLESS AND UNSPENT STAPLE CARTRIDGE IS PRESENT";
- U.S. Patent Application Serial No. 15/385,947, entitled "STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN";
- U.S. Patent Application Serial No. 15/385,896, entitled "METHOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT";
- U.S. Patent Application No. 15/385,898, entitled "STAPLE FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF STAPLES";
- U.S. Patent Application No. 15/385,899, entitled "SURGICAL INSTRUMENT COMPRESSING IMPROVED JAW CONTROL";
- U.S. Patent Application No. 15/385,901, entitled "STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRESSING WINDOWS DEFINED THEREIN";
- U.S. Patent Application No. 15/385,902, entitled "SURGICAL INSTRUMENT COMPRESSING A CUTTING MEMBER";
- U.S. Patent Application No. 15/385,904, entitled "STAPLE FIRING MEMBER COMPRESSING A MISSING CARTRIDGE AND/OR SPENT CARTRIDGE LOCKOUT";
- U.S. Patent Application No. 15/385,905, entitled "FIRING ASSEMBLY COMPRESSING A LOCKOUT";
- U.S. Patent Application No. 15/385,907, entitled "SURGICAL INSTRUMENT SYSTEM COMPRESSING AND END EFFECTOR LOCKOUT AND A FIRING ASSEMBLY LOCKOUT";
- U.S. Patent Application No. 15/385,908, entitled "FIRING ASSEMBLY COMPRESSING A FUSE";
- U.S. Patent Application No. 15/385,909, entitled "FIRING ASSEMBLY COMPRESSING A MULTIPLE FAILED-STATE FUSE";
- U.S. Patent Application Serial No. 15/385,920, entitled "STAPLE FORMING POCKET ARRANGEMENTS";
- U.S. Patent Application Serial No. 15/385,913, entitled "ANVIL ARRANGEMENTS FOR SURGICAL STAPLE/FASTENERS";
- U.S. Patent Application No. 15/385,914, entitled "METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT";
- U.S. Patent Application No. 15/385,893, entitled "BILATERALLY ASYMMETRIC STAPLE FORMING POCKET PAIRS";
- U.S. Patent Application No. 15/385,929, entitled "CLOSURE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SURGICAL INSTRUMENTS WITH SEPARATED AND DISTINCT CLOSURE AND FIRING SYSTEMS";
- U.S. Patent Application No. 15/385,911, entitled "SURGICAL STAPLE/FASTENERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND FIRING SYSTEMS";
- U.S. Patent Application No. 15/385,927, entitled "SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CARTRIDGES";
- U.S. Patent Application No. 15/385,917, entitled "STAPLE CARTRIDGE COMPRESSING STAPLES WITH DIFFERENT CLAMPING BREADTHS";
- U.S. Patent Application No. 15/385,900, entitled "STAPLE FORMING POCKET ARRANGEMENTS COMPRESSING PRIMARY SIDEWALLS AND POCKET SIDEWALLS";
- U.S. Patent Application No. 15/385,931, entitled "NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FOR SURGICAL STAPLE/FASTENERS";
- U.S. Patent Application No. 15/385,915, entitled "FIRING MEMBER PIN ANGLE";
- U.S. Patent Application No. 15/385,897, entitled "STAPLE FORMING POCKET ARRANGEMENTS COMPRESSING ZONED FORMING SURFACE GROOVES";
- U.S. Patent Application No. 15/385,922, entitled "SURGICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES";
- U.S. Patent Application No. 15/385,924, entitled "SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS";
- U.S. Patent Application No. 15/385,912, entitled "SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXIS AND INCLUDE SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS";
- U.S. Patent Application No. 15/385,910, entitled "ANVIL HAVING A KNIFE SLOT WIDTH";
- U.S. Patent Application No. 15/385,906, entitled "FIRING MEMBER PIN CONFIGURATIONS";
- U.S. Patent Application Serial No. 15/386,188, entitled "STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES";
- U.S. Patent Application No. 15/386,192, entitled "STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES";
- U.S. Patent Application No. 15/386,206, entitled "STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES";
- U.S. Patent Application No. 15/386,226, entitled "DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLIES OF SURGICAL STAPLING INSTRUMENTS";
- U.S. Patent Application No. 15/386,222, entitled "SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITH POSITIVE OPENING FEATURES";
- U.S. Patent Application No. 15/386,236, entitled "CONNECTION PORTIONS FOR DISPOSABLE LOADING UNITS FOR SURGICAL STAPLING INSTRUMENTS";
- U.S. Patent Application No. 15/385,887, entitled "METHOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICAL INSTRUMENT AND, ALTERNATIVELY, TO A SURGICAL ROBOT";
- U.S. Patent Application No. 15/385,889, entitled "SHAFT ASSEMBLY COMPRESSING A MANUALLY-OPERABLE RETRACTION SYSTEM FOR USE WITH A MOTORIZED SURGICAL INSTRUMENT SYSTEM";
- U.S. Patent Application No. 15/385,890, entitled "SHAFT ASSEMBLY COMPRESSING SEPARATORY ACTUAL AND RETRACTABLE SYSTEMS";
- U.S. Patent Application No. 15/385,891, entitled "SHAFT ASSEMBLY COMPRESSING A CLUTCH CONFIGURED TO ADAPT THE OUTPUT OF A ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEMS";
- U.S. Patent Application No. 15/385,892, entitled "SURGICAL SYSTEM COMPRESSING A FIRING MEMBER ROTATABLE INTO AN ARTICULATION STATE TO ARTICULATE AND END EFFECTOR OF THE SURGICAL SYSTEM";
- U.S. Patent Application No. 15/385,894, entitled "SHAFT ASSEMBLY COMPRESSING A LOCKOUT";
- U.S. Patent Application No. 15/385,895, entitled "SHAFT ASSEMBLY COMPRESSING FIRST AND SECOND ARTICULATION LOCKOUTS";
- U.S. Patent Application No. 15/385,916, entitled "SURGICAL STAPLING SYSTEMS";
- U.S. Patent Application No. 15/385,918, entitled "SURGICAL STAPLING SYSTEMS";
- U.S. Patent Application Serial No. 15/385,919, entitled "SURGICAL STAPLING SYSTEMS";
- U.S. Patent Application No. 15/385,921, entitled "SURGICAL STAPLE/FASTENER CARTRIDGE WITH MOVEABLE CAMMING MEMBER CONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES";
- U.S. Patent Application No. 15/385,923, entitled "SURGICAL STAPLING SYSTEMS";
- U.S. Patent Application No. 15/385,925, entitled "JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCEMENT OF A FIRING MEMBER IN A SURGICAL END EFFECTOR UNLESS AN UNFIRED CARTRIDGE IS INSTALLED IN THE END EFFECTOR";
- U.S. Patent Application No. 15/385,926, entitled "AXIALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR APPLYING CLOSURE MOTIONS TO JAWS OF SURGICAL INSTRUMENTS";
- U.S. Patent Application No. 15/385,928, entitled "PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN A MOVABLE JAW AND ACTUATOR SHAFT OF A SURGICAL INSTRUMENT";
- U.S. Patent Application No. 15/385,930, entitled "SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERATED OPENING FEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS";
- U.S. Patent Application No. 15/385,932, entitled "ARTICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFT ARRANGEMENT";
- U.S. Patent Application No. 15/385,933, entitled "ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLE LINKAGE DISTAL OF AN ARTICULATION LOCK";
- U.S. Patent Application No. 15/385,934, entitled "ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR IN AN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM";
- U.S. Patent Application No. 15/385,935, entitled "LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATED CONFIGURATION"; and - U.S. Patent Application No. 15/385,936, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES".

The applicant of this application owns the following U.S. patent applications, filed on June 24, 2016, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 15/191,775, entitled "STAPLE CARTRIDGE COMPRESSING WIRE STAPLES AND STAMPED STAPLES";
- U.S. Patent Application Serial No. 15/191,807, entitled "STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPED STAPLES";
- U.S. Patent Application Serial No. 15/191,834, entitled "STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME";
- U.S. Patent Application No. 15/191,788, entitled "STAPLE CARTRIDGE COMPRESSING OVERDRIVEN STAPLES", and - U.S. Patent Application No. 15/191,818, entitled "STAPLE CARTRIDGE COMPRESSING OFFSET LONGITUDINAL STAPLE ROWS".

The applicant of this application owns the following U.S. patent applications, filed on June 24, 2016, the entire contents of each of which are incorporated herein by reference:
- U.S. Design Patent Application No. 29/569,218, entitled "SURGICAL FASTENER";
- U.S. Design Patent Application No. 29/569,227, entitled "SURGICAL FASTENER";
- U.S. Design Patent Application Serial No. 29/569,259, entitled "SURGICAL FASTENER CARTRIDGE", and - U.S. Design Patent Application Serial No. 29/569,264, entitled "SURGICAL FASTENER CARTRIDGE".

The applicant of this application owns the following patent applications, filed on April 1, 2016, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 15/089,325, entitled "METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM," now U.S. Patent Application Publication No. 2017/0281171;
- U.S. Patent Application Serial No. 15/089,321, entitled "MODULAR SURGICAL STAPLING SYSTEM COMPRESSING A DISPLAY," now U.S. Patent Application Publication No. 2017/0281163;
- U.S. Patent Application Serial No. 15/089,326, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD," now U.S. Patent Application Publication No. 2017/0281172;
- U.S. Patent Application Serial No. 15/089,263, entitled "SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP PORTION," now U.S. Patent Application Publication No. 2017/0281165;
- U.S. Patent Application Serial No. 15/089,262, entitled "ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT SYSTEM," now U.S. Patent Application Publication No. 2017/0281161;
- U.S. Patent Application Serial No. 15/089,277, entitled "SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC DRIVE MEMBER," now U.S. Patent Application Publication No. 2017/0281166;
- U.S. Patent Application Serial No. 15/089,296, entitled "INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SURGICAL END EFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS," now U.S. Patent Application Publication No. 2017/0281168;
- U.S. Patent Application Serial No. 15/089,258, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A SHIFTABLE TRANSMISSION," now U.S. Patent Application Publication No. 2017/0281178;
- U.S. Patent Application Serial No. 15/089,278, entitled "SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVE CUTTING OF TISSUE," now U.S. Patent Application Publication No. 2017/0281162;
- U.S. Patent Application Serial No. 15/089,284, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A CONTOURABLE SHAFT," now U.S. Patent Application Publication No. 2017/0281186;
- U.S. Patent Application Serial No. 15/089,295, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A TISSUE COMPRESSION LOCKOUT," now U.S. Patent Application Publication No. 2017/0281187;
- U.S. Patent Application No. 15/089,300, entitled "SURGICAL STAPLING SYSTEM COMPRESSING AN UNCLAMPING LOCKOUT," now U.S. Patent Application Publication No. 2017/0281179;
- U.S. Patent Application Serial No. 15/089,196, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A JAW CLOSURE LOCKOUT," now U.S. Patent Application Publication No. 2017/0281183;
- U.S. Patent Application Serial No. 15/089,203, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A JAW ATTACHMENT LOCKOUT," now U.S. Patent Application Publication No. 2017/0281184;
- U.S. Patent Application Serial No. 15/089,210, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A SPENT CARTRIDGE LOCKOUT," now U.S. Patent Application Publication No. 2017/0281185;
- U.S. Patent Application Serial No. 15/089,324, entitled "SURGICAL INSTRUMENT COMPRESSING A SHIFTING MECHANISM," now U.S. Patent Application Publication No. 2017/0281170;
- U.S. Patent Application Serial No. 15/089,335, entitled "SURGICAL STAPLING INSTRUMENT COMPRESSING MULTIPLE LOCKOUTS," now U.S. Patent Application Publication No. 2017/0281155;
- U.S. Patent Application Serial No. 15/089,339, entitled "SURGICAL STAPLING INSTRUMENT," now U.S. Patent Application Publication No. 2017/0281173;
- U.S. Patent Application Serial No. 15/089,253, entitled "SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNUAL ROWS OF STAPLES HAVING DIFFERENT HEIGHTS," now U.S. Patent Application Publication No. 2017/0281177;
- U.S. Patent Application Serial No. 15/089,304, entitled "SURGICAL STAPLING SYSTEM COMPRESSING A GROOVED FORMING POCKET," now U.S. Patent Application Publication No. 2017/0281188;
- U.S. Patent Application Serial No. 15/089,331, entitled "ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLE/FASTENERS," now U.S. Patent Application Publication No. 2017/0281180;
- U.S. Patent Application Serial No. 15/089,336, entitled "STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES," now U.S. Patent Application Publication No. 2017/0281164;
- U.S. Patent Application Serial No. 15/089,312, entitled "CIRCULAR STAPLING SYSTEM COMPRESSING AN INCISABLE TISSUE SUPPORT," now U.S. Patent Application Publication No. 2017/0281189;
- U.S. Patent Application No. 15/089,309, entitled "CIRCULAR STAPLING SYSTEM COMPRESSING ROTARY FIRING SYSTEM," now U.S. Patent Application Publication No. 2017/0281169; and - U.S. Patent Application No. 15/089,349, entitled "CIRCULAR STAPLING SYSTEM COMPRESSING LOAD CONTROL," now U.S. Patent Application Publication No. 2017/0281174.

The applicant of the present application also owns the following identified U.S. patent applications, filed on December 30, 2015, the contents of each of which are incorporated herein by reference in their entirety:
- U.S. Patent Application Serial No. 14/984,488, entitled "MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE IN POWERED SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2017/0189018;
No. 14/984,525, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2017/0189019; and No. 14/984,552, entitled "SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROL CIRCUITS," now U.S. Patent Application Publication No. 2017/0189020.

The applicant of the present application also owns the following identified U.S. patent applications, filed on February 9, 2016, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 15/019,220, entitled "SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLATABLE END EFFECTOR," now U.S. Patent Application Publication No. 2017/0224333;
- U.S. Patent Application Serial No. 15/019,228, entitled "SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224342;
- U.S. Patent Application Serial No. 15/019,196, entitled "SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT," now U.S. Patent Application Publication No. 2017/0224330;
- U.S. Patent Application Serial No. 15/019,206, entitled "SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLY ARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY," now U.S. Patent Application Publication No. 2017/0224331;
- U.S. Patent Application Serial No. 15/019,215, entitled "SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224332;
- U.S. Patent Application Serial No. 15/019,227, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATION LINK ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224334;
- U.S. Patent Application Serial No. 15/019,235, entitled "SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEN ARTICULATION SYSTEMS," now U.S. Patent Application Publication No. 2017/0224336;
No. 15/019,230, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAM ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224335; and No. 15/019,245, entitled "SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTION ARRANGEMENTS," now U.S. Patent Application Publication No. 2017/0224343.

The applicant of the present application also owns the following identified U.S. patent applications, filed on February 12, 2016, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application No. 15/043,254, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS";
- U.S. Patent Application Serial No. 15/043,259, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS";
No. 15/043,275, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS" and No. 15/043,289, entitled "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS".

The applicant of this application owns the following patent applications, filed on June 18, 2015, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 14/742,925, entitled "SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS," now U.S. Patent Application Publication No. 2016/0367256;
- U.S. Patent Application Serial No. 14/742,941, entitled "SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES," now U.S. Patent Application Publication No. 2016/0367248;
- U.S. Patent Application Serial No. 14/742,914, entitled "MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2016/0367255;
- U.S. Patent Application Serial No. 14/742,900, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAM STRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT," now U.S. Patent Application Publication No. 2016/0367254;
No. 14/742,885, entitled "DUAL ARTICLES DRIVE SYSTEM ARRANGEMENTS FOR ARTICLES SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2016/0367246; and No. 14/742,876, entitled "PUSH/PULL ARTICLES DRIVE SYSTEMS FOR ARTICLES SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2016/0367245.

The applicant of this application owns the following patent applications, filed on March 6, 2015, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 14/640,746, entitled "POWERED SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 9,808,246;
- U.S. Patent Application Serial No. 14/640,795, entitled "MULTIPLE LEVEL THRESHOLDS TO MODIFIED OPERATION OF POWERED SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2016/02561185;
- U.S. Patent Application Serial No. 14/640,832, entitled "ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURE RATES FOR MULTIPLE TISSUE TYPES," now U.S. Patent Application Publication No. 2016/0256154;
- U.S. Patent Application Serial No. 14/640,935, entitled "OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION," now U.S. Patent Application Publication No. 2016/0256071;
- U.S. Patent Application Serial No. 14/640,831, entitled "MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTOR FOR POWERED SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2016/0256153;
- U.S. Patent Application Serial No. 14/640,859, entitled "TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINE STABILITY, CREEP, AND VISCOELASTIC ELEMENTS OF MEASURES," now U.S. Patent Application Publication No. 2016/0256187;
- U.S. Patent Application Serial No. 14/640,817, entitled "INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2016/0256186;
- U.S. Patent Application Serial No. 14/640,844, entitled "CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITH IN MODULAR SHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE," now U.S. Patent Application Publication No. 2016/0256155;
- U.S. Patent Application Serial No. 14/640,837, entitled "SMART SENSORS WITH LOCAL SIGNAL PROCESSING," now U.S. Patent Application Publication No. 2016/0256163;
- U.S. Patent Application Serial No. 14/640,765, entitled "SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A SURGICAL STAPLE/FASTENER," now U.S. Patent Application Publication No. 2016/0256160;
- U.S. Patent Application No. 14/640,799, entitled "SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON A ROTATABLE SHAFT," now U.S. Patent Application Publication No. 2016/0256162; and - U.S. Patent Application No. 14/640,780, entitled "SURGICAL INSTRUMENT COMPRESSING A LOCKABLE BATTERY HOUSING," now U.S. Patent Application Publication No. 2016/0256161.

The applicant of this application owns the following patent applications, filed on February 27, 2015, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 14/633,576, entitled "SURGICAL INSTRUMENT SYSTEM COMPRESSING AN INSPECTION STATION," now U.S. Patent Application Publication No. 2016/0249919;
- U.S. Patent Application Serial No. 14/633,546, entitled "SURGICAL APPARATUS CONFIGURED TO ASSESS WHERE A PERFORMANCE PARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND," now U.S. Patent Application Publication No. 2016/0249915;
- U.S. Patent Application Serial No. 14/633,560, entitled "SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONE OR MORE BATTERIES," now U.S. Patent Application Publication No. 2016/0249910;
- U.S. Patent Application Serial No. 14/633,566, entitled "CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A BATTERY," now U.S. Patent Application Publication No. 2016/0249918;
- U.S. Patent Application Serial No. 14/633,555, entitled "SYSTEM FOR MONITORING WHERE A SURGICAL INSTRUMENT NEEDS TO BE SERVICED," now U.S. Patent Application Publication No. 2016/0249916;
- U.S. Patent Application Serial No. 14/633,542, entitled "REINFORCED BATTERY FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2016/0249908;
- U.S. Patent Application Serial No. 14/633,548, entitled "POWER ADAPTER FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2016/0249909;
- U.S. Patent Application Serial No. 14/633,526, entitled "ADAPTABLE SURGICAL INSTRUMENT HANDLE," now U.S. Patent Application Publication No. 2016/0249945;
- U.S. Patent Application No. 14/633,541, entitled "MODULAR STAPLING ASSEMBLY," now U.S. Patent Application Publication No. 2016/0249927; and - U.S. Patent Application No. 14/633,562, entitled "SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER," now U.S. Patent Application Publication No. 2016/0249917.

The applicant of this application owns the following patent applications, filed on December 18, 2014, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 14/574,478, entitled "SURGICAL INSTRUMENT SYSTEMS COMPRESSING AN ARTICULATABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER," now U.S. Patent No. 9,844,374;
- U.S. Patent Application Serial No. 14/574,483, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRESSING LOCKABLE SYSTEMS," now U.S. Patent Application Publication No. 2016/0174969;
- U.S. Patent Application Serial No. 14/575,139, entitled "DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS," now U.S. Patent No. 9,844,375;
- U.S. Patent Application Serial No. 14/575,148, entitled "LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLYS WITH ARTICULATABLE SURGICAL END EFFECTORS," now U.S. Patent Application Publication No. 2016/0174976;
- U.S. Patent Application Serial No. 14/575,130, entitled "SURGICAL INSTRUMENT WITH AN ANVIIL THAT IS SELECTIVELY MOVEABLE ABOUT A DISCRETE NON-MOVEABLE AXIS RELATIVE TO A STAPLE CARTRIDGE," now U.S. Patent Application Publication No. 2016/0174972;
- U.S. Patent Application Serial No. 14/575,143, entitled "SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS," now U.S. Patent Application Publication No. 2016/0174983;
- U.S. Patent Application Serial No. 14/575,117, entitled "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVEABLE FIRING BEAM SUPPORT ARRANGEMENTS," now U.S. Patent Application Publication No. 2016/0174975;
- U.S. Patent Application Serial No. 14/575,154, entitled "SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAM SUPPORT ARRANGEMENTS," now U.S. Patent Application Publication No. 2016/0174973;
- U.S. Patent Application No. 14/574,493, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRESSING A FLEXIBLE ARTICULATION SYSTEM," now U.S. Patent Application Publication No. 2016/0174970; and - U.S. Patent Application No. 14/574,500, entitled "SURGICAL INSTRUMENT ASSEMBLY COMPRESSING A LOCKABLE ARTICULATION SYSTEM," now U.S. Patent Application Publication No. 2016/0174971.

The applicant of this application owns the following patent applications, filed on March 1, 2013, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 13/782,295, entitled "ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION," now U.S. Patent No. 9,700,309;
- U.S. Patent Application Serial No. 13/782,323, entitled "ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,782,169;
- U.S. Patent Application Serial No. 13/782,338, entitled "THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2014/0249557;
- U.S. Patent Application Serial No. 13/782,499, entitled "ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT," now U.S. Patent No. 9,358,003;
- U.S. Patent Application Serial No. 13/782,460, entitled "MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,554,794;
- U.S. Patent Application Serial No. 13/782,358, entitled "JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,326,767;
- U.S. Patent Application Serial No. 13/782,481, entitled "SENSOR STRAIIGHTENED END EFFECTOR DURING REMOVEAL THROUGH TROCAR," now U.S. Patent No. 9,468,438;
- U.S. Patent Application Serial No. 13/782,518, entitled "CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVEABLE IMPLEMENT PORTIONS," now U.S. Patent Application Publication No. 2014/0246475;
- U.S. Patent Application No. 13/782,375, entitled "ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM", now U.S. Patent No. 9,398,911; and - U.S. Patent Application No. 13/782,536, entitled "SURGICAL INSTRUMENT SOFT STOP", now U.S. Patent No. 9,307,986.

The applicant of the present application also owns the following patent applications, filed on March 14, 2013, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 13/803,097, entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRESSING A FIRING DRIVE", now U.S. Patent No. 9,687,230;
- U.S. Patent Application Serial No. 13/803,193, entitled "CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT," now U.S. Patent No. 9,332,987;
- U.S. Patent Application No. 13/803,053, entitled "INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0263564;
- U.S. Patent Application No. 13/803,086, entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRESSING AN ARTICULATION LOCK," now U.S. Patent Application Publication No. 2014/0263541;
- U.S. Patent Application Serial No. 13/803,210, entitled "SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,808,244;
- U.S. Patent Application No. 13/803,148, entitled "MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0263554;
- U.S. Patent Application Serial No. 13/803,066, entitled "DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,629,623;
- U.S. Patent Application Serial No. 13/803,117, entitled "ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS," now U.S. Patent No. 9,351,726;
- U.S. Patent Application No. 13/803,130, entitled "DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS," now U.S. Patent No. 9,351,727; and - U.S. Patent Application No. 13/803,159, entitled "METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0277017.

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

The applicant of the present application also owns the following patent applications, filed on March 26, 2014, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 14/226,106, entitled "POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2015/0272582;
- U.S. Patent Application Serial No. 14/226,099, entitled "STERILIZATION VERIFICATION CIRCUIT", now U.S. Patent No. 9,826,977;
- U.S. Patent Application Serial No. 14/226,094, entitled "VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT," now U.S. Patent Application Publication No. 2015/0272580;
- U.S. Patent Application Serial No. 14/226,117, entitled "POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL," now U.S. Patent Application Publication No. 2015/0272574;
- U.S. Patent Application Serial No. 14/226,075, entitled "MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES," now U.S. Patent No. 9,743,929;
- U.S. Patent Application Serial No. 14/226,093, entitled "FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2015/0272569;
- U.S. Patent Application Serial No. 14/226,116, entitled "SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION," now U.S. Patent Application Publication No. 2015/0272571;
- U.S. Patent Application Serial No. 14/226,071, entitled "SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR," now U.S. Patent No. 9,690,362;
- U.S. Patent Application Serial No. 14/226,097, entitled "SURGICAL INSTRUMENT COMPRESSING INTERACTIVE SYSTEMS," now U.S. Patent No. 9,820,738;
- U.S. Patent Application Serial No. 14/226,126, entitled "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS," now U.S. Patent Application Publication No. 2015/0272572;
- U.S. Patent Application Serial No. 14/226,133, entitled "MODULAR SURGICAL INSTRUMENT SYSTEM," now U.S. Patent Application Publication No. 2015/0272557;
- U.S. Patent Application Serial No. 14/226,081, entitled "SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT," now U.S. Patent No. 9,804,618;
- U.S. Patent Application Serial No. 14/226,076, entitled "POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION," now U.S. Patent No. 9,733,663;
- U.S. Patent Application Serial No. 14/226,111, entitled "SURGICAL STAPLING INSTRUMENT SYSTEM," now U.S. Patent No. 9,750,499; and - U.S. Patent Application Serial No. 14/226,125, entitled "SURGICAL INSTRUMENT COMPRESSING A ROTATABLE SHAFT," now U.S. Patent Application Publication No. 2015/0280384.

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

The applicant of the present application also owns the following patent applications, filed on April 9, 2014, the entire contents of each of which are incorporated herein by reference:
- U.S. Patent Application Serial No. 14/248,590, entitled "MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS," now U.S. Patent No. 9,826,976;
- U.S. Patent Application Serial No. 14/248,581, entitled "SURGICAL INSTRUMENT COMPRESSING A CLOSING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT," now U.S. Patent No. 9,649,110;
- U.S. Patent Application Serial No. 14/248,595, entitled "SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRUMENT," now U.S. Patent No. 9,844,368;
- U.S. Patent Application Serial No. 14/248,588, entitled "POWERED LINEAR SURGICAL STAPLE/FASTENER," now U.S. Patent Application Publication No. 2014/0309666;
- U.S. Patent Application Serial No. 14/248,591, entitled "TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0305991;
- U.S. Patent Application Serial No. 14/248,584, entitled "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS," now U.S. Patent No. 9,801,626;
- U.S. Patent Application Serial No. 14/248,587, entitled "POWERED SURGICAL STAPLE/FASTENER," now U.S. Patent Application Publication No. 2014/0309665;
- U.S. Patent Application Serial No. 14/248,586, entitled "DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT," now U.S. Patent Application Publication No. 2014/0305990; and - U.S. Patent Application Serial No. 14/248,607, entitled "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS," now U.S. Patent No. 9,814,460.

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

As described herein and illustrated in the accompanying drawings, numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments. Well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described herein. The reader will understand that the embodiments described and illustrated herein are non-limiting examples, and thus the specific structural and functional details disclosed herein may be representative and exemplary. Variations and modifications may be made thereto without departing from the scope of the claims.

The terms "comprise" (any form of "comprise", such as "comprises" and "comprising"), "have" (any form of "have", such as "has" and "having"), "include" (any form of "include", such as "includes" and "including"), and "contain" (any form of "contain", such as "contains" and "containing") are modifiable linking verbs. As a result, a surgical system, device, or apparatus that "comprises", "has", "includes", or "contains" one or more elements has those one or more elements, but is not limited to having only those one or more elements. Similarly, an element of a system, device, or apparatus that "comprises," "has," "includes," or "contains" one or more features has those one or more features, but is not limited to having only those one or more features.

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

Various exemplary devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided. However, the reader will readily appreciate that the various methods and devices disclosed herein may be used in many surgical procedures and applications, including, for example, those associated with open surgical procedures. By proceeding through the "Description of the Invention" section of this specification, the reader will further appreciate that the various instruments disclosed herein may be inserted into the body in any manner, such as through a natural orifice, through an incision or puncture made in tissue, etc. The working or end effector portions of these instruments may be inserted directly into the patient's body or through an access device having a working channel through which the end effector and elongate shaft of the surgical instrument may be advanced.

Disclosed herein are various surgical instruments configured to fasten tissue of a patient. As described in more detail below, such surgical instruments include an end effector and a plurality of drive systems configured to perform various end effector functions. Such drive systems can include, for example, an anvil drive system configured to clamp tissue within the end effector, a staple firing system configured to deploy staples into the tissue, and/or a tissue cutting system configured to cut the tissue. Such drive systems can also include, for example, an articulation drive system configured to articulate the end effector, a tissue drive system configured to move the end effector relative to the tissue, and/or a staple loading system configured to reload the end effector with staples. As discussed in more detail below, two or more of these drive systems can be operably coupled to a common drive system such that they are operated in a synchronized manner.

A stapling instrument 1000 is shown in FIG. The stapling instrument 1000 comprises a handle 1100, a shaft assembly 1200 extending from the handle 1100, and an end effector 1300 extending from the shaft assembly 1200. The handle 1100 comprises a frame 1110 and a gripping portion 1120 positioned on either side of the frame 1110. The handle 1100 further comprises a plurality of electric motors configured to operate a drive system of the stapling instrument 1000. Although three electric motors 1130, 1140, and 1150 are shown, the surgical instrument 1000 may include any suitable number of electric motors. Each electric motor is operably coupled to a rotatable output. For example, electric motor 1130 is operably coupled to rotatable output 1135, electric motor 1140 is operably coupled to rotatable output 1145, and electric motor 1150 is operably coupled to rotatable output 1155. Handle 1100 further includes a battery 1160 that provides power to electric motors 1130, 1140, and 1150, for example. With reference to FIG. 11, battery 1160 may include any suitable battery, for example, a Lithium 18650 battery. With reference primarily to FIG. 12, battery 1160 is positioned within a battery compartment 1115 defined within handle frame 1110, but may be stored in any suitable location. Battery 1160 is also configured to provide power to a control system and/or display of handle 1110, which will be described in more detail below.

Handle 1100' is shown in FIGS. 8 and 10. Handle 1100' is similar to handle 1100 in many respects, most of which are not discussed herein for the sake of brevity. Handle 1100' includes a battery compartment accessible through door 1115'. Door 1115' allows for replacement of the battery in the battery compartment. Handle 1100'' is shown in FIG. 9. Handle 1100'' is similar to handle 1100 in many respects, most of which are not discussed herein for the sake of brevity. Handle 1100'' includes a plug 1115'' configured to provide power to handle 1100'', for example, from a generator and/or a wall outlet. In various examples, handle 1100'' can be powered from an internal source, such as battery 1160, and an external source, such as plug 1115''.

1, the handle frame 1110 includes a connector 1170. The shaft assembly 1200 includes an outer housing 1210 including a shaft connector 1270 configured to engage with the handle connector 1170 to couple the shaft assembly 1200 to the handle 1100. The shaft connector 1270 and the handle 1170 include a rotatable bayonet interconnect, although any suitable interconnect may be used. The shaft assembly 1200 further includes a rotatable input 1235 configured to be operably coupled to the rotatable output 1135 when the shaft assembly 1200 is assembled to the handle 1100. Similarly, the shaft assembly 1200 also includes a rotatable input 1245 configured to be operably coupled to the rotatable output 1145 and a rotatable input 1255 configured to be operably coupled to the rotatable output 1155 when the shaft assembly 1200 is assembled to the handle 1100.

In addition to the above, the outer shaft housing 1210 further comprises a distal connector 1290. The end effector 1300 comprises a shaft portion 1310 including an end effector connector 1390 configured to engage with the distal connector 1290 to couple the end effector 1300 to the shaft assembly 1200. The end effector connector 1390 and the distal shaft connector 1290 comprise rotatable mutual joints, although any suitable mutual joints may be used. The end effector 1300 further comprises a first drive configured to be operably coupled to the shaft input 1235 when the end effector 1300 is assembled to the shaft assembly 1200. Similarly, the end effector 1300 comprises a second drive configured to be operably coupled to the shaft input 1245 and a third drive configured to be operably coupled to the shaft input 1255 when the end effector 1300 is assembled to the shaft assembly 1200.

In various examples, the shaft assembly 1200 and/or the end effector 1300 include one or more sensors and/or electrically driven components. With reference to FIG. 2, the stapling instrument 1000 includes at least one electrical circuit extending through the handle 1100, the shaft assembly 1200, and the end effector 1300. The electrical circuit includes conductors in the handle 1100, the shaft assembly 1200, and the end effector 1300 that are disposed in electrical communication with one another when the shaft assembly 1200 is assembled to the handle 1100 and the end effector 1300 is assembled to the shaft assembly 1200. Although FIG. 2 shows four conductors 1280 in the shaft assembly 1200 that are part of two separate electrical circuits, any suitable number of conductors and/or circuits may be used. The handle connector 1170 and the shaft connector 1270 include electrical contacts that are rotated into engagement when the shaft assembly 1200 is rotatably assembled to the handle 1100. Similarly, the distal shaft connector 1290 and the end effector connector 1390 include electrical contacts that are rotated into engagement when the end effector 1300 is assembled to the shaft assembly 1200.

1, the end effector 1300 further comprises a distal head 1320 rotatably connected to the shaft portion 1310 about an articulation joint 1370. The end effector 1300 also comprises an articulation drive system configured to articulate the distal head 1320 relative to the shaft portion 1310. The distal head 1320 comprises an anvil 1360 movable between an open position and a closed position. In use, the anvil 1360 is movable by the anvil drive system toward a tissue compression surface 1325 to clamp or compress tissue within the end effector 1300. As discussed below in connection with FIGS. 3-7, the tissue compression surface 1325 is defined on the tissue drive system configured to engage patient tissue and move the stapling instrument 1000 relative to the patient tissue.

3, the end effector 1300 includes a rotatable drive shaft 1330 that can be used to selectively open the anvil 1360, operate the tissue drive system (FIGS. 4-6) to reposition the distal head 1320 relative to the patient tissue, and close the anvil 1360 (FIG. 7) before the stapling instrument 1000 performs a staple firing stroke. The drive shaft 1330 is driven by an electric motor and is further translatable between a first position in which a key 1332 extending from the drive shaft 1330 is operably engaged with the tissue drive system (FIGS. 4-6) and a second position in which the key 1332 is operably engaged with the anvil drive system (FIG. 7). When the drive shaft 1330 is in its first position, the key 1332 is positioned within a key slot 1333 defined in a drive gear 1331 of the tissue drive system. When the drive shaft 1330 is in its second position, the key 1332 is positioned within a key slot 1363 defined in a drive collar 1361 of the anvil drive system.

With reference to Figures 4-6, the tissue drive system includes a first foot 1380a and a second foot 1380b. The feet 1380a, 1380b are extendable to engage patient tissue and then retractable to pull the distal head 1320 of the end effector 1300 against the patient tissue. The tissue drive system is configured to extend the first foot 1380a while retracting the second foot 1380b, and similarly, to extend the second foot 1380b while retracting the first foot 1380a. Figure 4 shows the first foot 1380a in an extended position and the second foot 1380b in a retracted position. As a result of the above, the tissue drive system can be configured to run the end effector 1300 across tissue to form a staple firing path within the tissue. In various alternative embodiments, the tissue drive system can be configured to simultaneously extend the first foot 1380a and the second foot 1380b and/or simultaneously retract the first foot 1380a and the second foot 1380b.

In addition to the above, the tissue drive system includes a first gear train configured to transmit the rotation of the drive shaft 1330 to the first gear 1380a, and a second gear train configured to transmit the rotation of the drive shaft 1330 to the second gear 1380b. The first gear train includes a spur gear 1381a operably meshed with the drive gear 1331, a transmission gear 1382a operably meshed with the spur gear 1381a, and a spur gear 1383a operably meshed with the transmission gear 1382a, such that the rotation of the shaft 1330 is transmitted to the spur gear 1383a. The first gear train further includes a shaft gear 1384a operably meshed with the spur gear 1383a. Referring primarily to Figures 5 and 6, the shaft gear 1384a is fixedly mounted to the transmission shaft 1385a such that the rotation of the spur gear 1383a is transmitted to the transmission shaft 1385a. The first gear train further comprises a bevel gear 1386a fixedly mounted on the transmission shaft 1385a, a side bevel gear 1387a operatively meshing with the bevel gear 1386a, and a pinion gear 1388a fixedly mounted to the side bevel gear 1387a such that the pinion gear 1388a rotates with the side bevel gear 1387a. Referring primarily to FIG. 6, the pinion gear 1388a operatively meshes with a rack 1389a mounted on the first foot 1380a, which converts rotational input motion into translational motion of the first foot 1380a.

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

The presence of the transmission gear 1382a in the first gear train and the absence of a corresponding transmission gear in the second gear train causes the first foot 1380a and the second foot 1380b to move in opposite directions in response to rotation of the drive shaft 1330. For example, when the drive shaft 1330 is rotated in a first direction, the first foot 1380a is extended and the second foot 1380b is retracted. Similarly, when the drive shaft 1330 is rotated in a second, or opposite, direction, the first foot 1380a is retracted and the second foot 1380b is extended. As described above, the first and second feet 1380a, 1380b are configured to grip and pull the end effector 1300 against tissue as they are extended and retracted. The movement of the feet 1380a, 1380b may be linear, although other embodiments that provide different movements, such as arcuate movements, are also disclosed herein.

Once the end effector 1300 has been properly moved relative to the tissue by the tissue drive system, the drive shaft 1330 is translated longitudinally out of engagement with the tissue drive system and into engagement with the anvil drive system, as shown in FIG. 7. In various examples, rotation of the drive shaft 1330 may be stopped prior to disengagement from the tissue drive system. In other examples, the drive shaft 1330 may continue to rotate as it is disengaged from the tissue drive system and translated into engagement with the drive collar 1361. In either case, the drive collar 1361 includes a threaded opening 1362 defined therein, the threaded opening including threads 1365. The anvil 1360 includes a push rod 1364 extending therefrom, the push rod including an end that is threadably engaged with the threads 1365 in the opening 1366. When the drive collar 1361 is rotated in a first direction by the drive shaft 1330, the drive collar 1361 pushes the anvil 1360 away from the feet 1380a and 1380b to open the anvil 1360. Once the anvil 1360 is sufficiently open, the drive shaft 1330 may be shifted to engage the tissue drive system and move the end effector 1300 relative to the tissue. The drive shaft 1330 may then be re-engaged with the anvil drive system. When the drive collar 1361 is rotated in a second or opposite direction at such point, as shown in FIG. 7, the drive collar 1361 pulls the anvil 1360 towards the feet 1380a and 1380b to close or clamp the anvil 1360. Once the anvil 1360 is closed, the staple firing system of the stapling instrument 1000 may be actuated. At such point, the anvil 1360 may be reopened by the anvil drive system and the cycle described above may be repeated.

Notably, the drive shaft 1330 extends along a longitudinal axis 1339 that is collinear with a longitudinal axis 1369 that extends through a push rod 1364 of the anvil drive system. Such a configuration allows the drive shaft 1330 to be operatively coupled to the push rod 1334 via a drive collar 1361. Notably, the drive collar 1361 also includes a proximal flange 1367 and a distal flange 1368 extending therefrom. The flanges 1367 and 1368 act as stops that limit the longitudinal movement of the anvil 1360 in the proximal and distal directions, respectively. Thus, the flanges 1367 and 1368 define the limits of the opening and closing strokes of the anvil 1360. The anvil 1360 includes a tissue clamping surface that extends perpendicular or at least substantially perpendicular to the longitudinal axis 1369 and moves longitudinally relative to the distal head 1320. The anvil 1360 has a movable jaw, and the feet 1380a and 1380b of the tissue drive system have another movable jaw positioned on the opposite side of the anvil 1360.

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

1, the end effector 1300 includes a plurality of staple cartridges 1400 stored therein. The stapling instrument 1000 includes a cartridge drive system configured to drive the staple cartridges 1400 into the end effector 1300. As a result, the cartridge drive system can be used to reload the end effector 1300 without having to remove the stapling instrument 1000 from the surgical site. However, once the supply of staple cartridges 1400 in the end effector 1300 is exhausted, the stapling instrument 1000 may have to be removed from the surgical site and reloaded unless the stapling instrument 1000 includes a system for loading a cartridge during operation of the stapling instrument 1000. Such systems are described in more detail below. In any event, the end effector 1300 can be removed from the shaft assembly 1200 and then an unused end effector 1300 can be attached to the shaft assembly 1200 to reload the stapling instrument 1000.

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

As described above, the stapling instrument 1000 includes a drive system configured to reciprocate to open or unclamp the anvil, create relative motion between the end effector and the patient tissue, and then clamp the anvil again. FIGS. 42 and 43 show an exemplary embodiment of another reciprocating drive system that may be used. The drive system 2800 includes a rotatable drive shaft 2830 and a drive gear 2831 fixedly mounted to the drive shaft 2830. The drive system 2800 further includes a spur gear 2832 that operably meshes with the drive gear 2831, so that rotation of the drive shaft 2830 is transmitted to the spur gear 2832. The drive system 2800 further includes a bevel gear 2833 that is mounted to and rotates with the bevel gear 2832, a side bevel gear 2834 that operably meshes with the bevel gear 2833, and a spur gear 2835 that operably meshes with a gear mounted on one side of the bevel gear 2834. The drive system 2800 further includes a pinion gear 2836 fixedly mounted to and rotating with the spur gear 2835, an output gear 2837 operatively meshing with the pinion gear 2836, and a cam 2838 fixedly mounted to and rotating with the output gear 2837. As a result of the above, rotation of the drive shaft 2830 rotates the cam 2838, which is translated into reciprocating motion of the drive shaft 2830, as described below.

In addition to the above, the drive system 2800 includes a rotatable shifter 2840 including a cam arm 2848 and a shifter arm 2849, which is rotatable about a pivot 2841. In use, the cam 2838 is configured to engage the cam arm 2848 of the shifter 2840 and rotate the shifter 2840 between a first position (FIG. 43) and a second position (FIG. 42). As shown in FIG. 42, when the shifter 2840 is rotated to its second position, the cam arm 2848 engages a shoulder 2839 defined on the drive shaft 2830 and urges the drive shaft 2830 upward. A spring 2820 is positioned between the shoulder 2839 and the frame 2819 of the stapling instrument, which is compressed and stores potential energy therein when the drive shaft 2830 is moved to its second position. As the cam 2838 continues to rotate, as shown in FIG. 43, it disengages from the cam arm 2848 and the spring 2820 resiliently returns the drive shaft 2830 to its first position. This reciprocating motion of the drive shaft 2830 between its first and second positions can be utilized to operate a reciprocating drive system within an end effector of the stapling instrument.

44 illustrates another exemplary embodiment of a reciprocating drive system. The drive system 2900 includes an electric motor 2930, a first drive system 2940 operably coupled to the electric motor 2930, and a second drive system 2950 operably coupled to the electric motor 2930. The electric motor 2930 includes a rotatable output shaft 2931 and a drive gear 2932 fixedly mounted to the output shaft 2931. The first drive system 2940 includes an input gear 2942 that operably meshes with the drive gear 2932. The input gear 2942 is fixedly mounted to a drive shaft 2943 such that the drive shaft 2943 rotates with the input gear 2942. The first drive system 2940 further includes a barrel cam 2944 that is slidably mounted to the drive shaft 2943 and rotates with the drive shaft 2943. The barrel cam 2944 includes an opening 2945 defined therein, e.g., a non-circular profile configured to transmit rotation between the drive shaft 2943 and the barrel cam 2944, yet allow relative translation therebetween. The barrel cam 2944 further includes a cam slot 2949 defined therein that interacts with a cam pin 2919 mounted to the frame 2910 such that as the barrel cam 2944 is rotated, the barrel cam 2944 is further translated. The barrel cam 2944 is translated distally when the barrel cam 2944 is rotated in a first direction and is translated proximally when the barrel cam 2944 is rotated in a second, opposite direction. The first drive system 2940 further includes a drive shaft 2946 extending from the barrel cam 2944, the drive shaft configured to drive a first end effector function.

The second drive system 2950 includes an input gear 2952 that operably meshes with the drive gear 2932. The input gear 2952 is fixedly mounted to the drive shaft 2953 such that the drive shaft 2953 rotates with the input gear 2952. The second drive system 2950 further includes a barrel cam 2954 that is slidably mounted to and rotates with the drive shaft 2953. The barrel cam 2954 includes an opening 2955 defined therein, e.g., with a non-circular profile configured to transmit rotation between the drive shaft 2953 and the barrel cam 2954, yet allow relative translation therebetween. The barrel cam 2954 further includes a cam slot 2959 defined therein that interacts with a cam pin 2919 mounted to the frame 2910 such that rotation of the barrel cam 2954 further translates the barrel cam 2944. The barrel cam 2954 is translated distally when the barrel cam 2954 is rotated in a first direction and is translated proximally when the barrel cam 2954 is rotated in a second, opposite direction. The second drive system 2950 further comprises a drive shaft 2956 extending from the barrel cam 2954, the drive shaft being configured to drive a second end effector function.

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

92 and 93, the stapling instrument 4500 comprises a tissue driver 4590 including a first foot 4580a and a second foot 4580b. The first foot 4580a has a rack of teeth 4583a defined thereon and the second foot 4580b has a rack of teeth 4583b defined thereon, and the tissue driver 4500 further comprises a pinion gear 4593 meshingly engaged with the racks 4583a and 4583b. The pinion gear 4593 is rotatable back and forth about an axis to reciprocally extend and retract the feet 4580a and 4580b, thereby driving the stapling instrument against the patient's tissue. The tissue driver 4590 further comprises a first actuator 4592 pinned to the pinion gear 4593 at pivot joint 4591 and a second actuator 4594 pinned to the pinion gear 4593 at pivot joint 4595. In use, the first actuator 4592 is pushed and/or the second actuator 4594 is pulled to rotate the pinion gear 4593 in a first direction, extending the second foot 4580b and retracting the first foot 4580a. Correspondingly, the first actuator 4592 is pulled and/or the second actuator 4594 is pushed to rotate the pinion gear 4593 in a second direction, extending the first foot 4580a and retracting the second foot 4580b. Notably, the feet 4580a and 4580b are displaced linearly and in opposite directions. Thus, the feet 4580a and 4580b are configured such that when one of the feet 4580a and 4580b is retracted to pull the tissue, the other foot slides or glides against the tissue as it is extended.

As discussed above, the feet 1380a and 1380b of the stapling instrument 1000 are extended and retracted along a linear path. In such an example, the feet 1380a and 1380b can slide over tissue when extended and then grip and pull the tissue when retracted. The feet 1380a and 1380b can have teeth extending therefrom that have a contour that facilitates the feet 1380a and 1380b sliding against tissue when moved in one direction and gripping tissue when moved in the opposite direction. In at least one example, the teeth are substantially triangular, for example, with a shallow angle on a first side and a steeper angle on the other side. In such an example, the shallow angle allows the first side to slide against tissue, while the steeper angle on the second side bites into or grips tissue when the feet 1380a and 1380b are retracted.

As described above, the feet 1380a and 1380b are driven along a linear path by the racks 1389a and 1389b defined thereon. In some instances, the linear motion of the feet 1380a and 1380b may be closely guided, with little, if any, free movement or deviation from the linear motion. Now referring to FIGS. 88 and 89, in various embodiments, the feet of the tissue drive system may include one or more joints that provide at least one additional degree of freedom, allowing the feet to deviate from a purely linear path. The tissue drive system 4200 includes a first foot 4280a and a second foot 4280b that are movably connected by a link 4282. The link 4282 is coupled to the first foot 4280a at a pivot joint 4281a and to the second foot 4280b at a pivot joint 4281b. The feet 4280a and 4280b are moved proximally and distally by an input 4290 that includes a drive shaft 4292 connected to a link 4282 at a pivot joint 4283. The pivot joints 4281a, 4281b, and 4283 allow the feet 4280a and 4280b to be lifted or floated upward as they extend across tissue.

As discussed above, the stapling instruments disclosed herein with tissue drive systems are configured to drive or march themselves across the patient's tissue as they staple and cut the patient's tissue along the staple firing path. In various examples, the thickness of the tissue may vary along the length of the staple firing path. In other words, the tissue may increase and/or decrease in thickness in the anterior-posterior and/or lateral directions. Referring again to FIGS. 88 and 89, the degrees of freedom provided by pivot joints 4281a, 4281b, and 4283 allow feet 4280a and 4280b to tilt in response to such changes in tissue thickness. For example, feet 4280a and 4280b may tilt in the anterior-posterior and/or lateral directions. Additionally, feet 4280a and 4280b may tilt independently of one another. Thus, feet 4280a and 4280b may tilt in the same or different directions. Therefore, alternative embodiments are also envisioned in which the feet 4280a and 4280b are inclined in the same direction. Such a configuration may have a simpler drive system. In any case, the feet 4280a and 4280b may be able to raise and lower themselves in response to changes in tissue thickness and have the desired traction on the tissue.

87, the stapling instrument 4100 includes a distal stapling head 4120 which, like the stapling instrument 1000, includes a tissue drive system 4190 including a foot 4180. The tissue drive system 4190 includes a rocker link 4192 rotatably mounted within the stapling head 4120 about a pivot pin 4124. The rocker link 4192 includes legs 4193 which extend through openings 4194 defined within the legs 4193. Each of the legs 4193 is pivotally connected to the foot 4180 about a pivot pin 4195. In use, the tissue drive system 4190 causes the rocker link 4192 to rock back and forth to extend and retract the foot 4180 along a non-linear or curved path. Although the feet 4180 are extended and retracted together, embodiments in which each is moved in opposite directions are also envisioned. Further to the above, the foot 4180 may tilt about the pivot pin 4195 to accommodate changes in tissue thickness. In various examples, the tissue drive system 4190 may lift the foot 4180 away from the tissue during at least a portion of the tissue driving stroke, such as at the end of the tissue driving stroke.

37-41, the surgical instrument 2700 comprises a distal head 2720 including an anvil 2760, a tissue driver foot 2780, and a tissue driver 2790. The tissue driver 2790 comprises a positioning rod 2791 attached to the drive foot 2780 at a pivot joint 2781. The positioning rod 2791 is displaceable along a longitudinal axis to engage (FIG. 38) and disengage (FIG. 41) the drive foot 2780 from the patient tissue T. Referring to FIG. 37, when the drive foot 2780 is disengaged from the tissue and retracted into the distal head 2720, the distal tip 2785 of the drive foot 2780 is positioned within the distal head 2720 and does not extend beyond the distal tip. Furthermore, when the drive foot 2780 is retracted into the distal head 2720, the drive foot 2780 is locked in place or prevented from being rotated. More specifically, the distal head 2720 includes a control slot 2724 defined therein, and the foot 2780 includes two control pins 2784 slidably disposed within the control slot 2724, the control pins being configured to prevent the drive foot 2780 from rotating when the drive foot 2780 is in its retracted position (FIGS. 37 and 41) and to allow the drive foot 2780 to rotate when the drive foot 2780 is in its engaged position (FIGS. 38-40), as discussed below.

38-40, the drive foot 2780 is configured to engage and drive the distal head 2720 relative to the patient tissue T to reposition the distal head 2720 relative to the tissue. The tissue driver 2790 includes a first driver 2792 and a second driver 2793 configured to rotate the foot 2780 about a pivot joint 2781. The first driver 2792 includes a push end disposed within a first socket 2782 defined in the drive foot 2780, and the second driver 2793 includes a push end disposed within a second socket 2783 defined on the opposite side of the drive foot 2780. With reference to FIG. 40, the first driver 2792 is displaceable toward the tissue to rotate the drive foot 2780 in a first direction. With reference to FIG. 39, the second driver 2793 is displaceable toward the tissue to rotate the drive foot in a second or opposite direction. In use, the drive foot 2780 can be rotated back and forth by the tissue driver 2790 to create relative motion between the distal head 2720 and the tissue in a forward or rearward direction.

78-85, the stapling instrument 3900 includes a distal head 3920 including a staple firing system 3950 configured to staple tissue of a patient, an anvil 3960 configured to clamp the patient tissue against a tissue compression surface 3925 and deform a staple deployed by the staple firing system 3950, and a foot 3980 configured to generate relative motion between the distal head 3920 and the tissue when the anvil 3960 is in an unclamped position. The stapling instrument 3900 further includes a tissue driver 3990 configured to extend and retract the foot 3980. Referring primarily to FIGS. 83 and 84, the tissue driver 3990 includes a rotatable drive shaft 3992 and a worm gear 3993 fixedly mounted to the drive shaft 3992 such that the worm gear 3993 rotates with the drive shaft 3992. The worm gear 3993 is meshingly engaged with a gear surface 3995 defined on one side of the drive wheel 3994. The drive wheel 3994 is rotatably mounted about a pin 3991 mounted on the distal head 3920. As a result of the above, the drive wheel 3994 rotates in response to rotation of the drive shaft 3992.

79-82, in addition to the above, the tissue driver 3990 further comprises a coupler bar 3996 having a first end slidably disposed within a cam slot 3999 (FIGS. 83 and 85) defined in a second side or face of the drive wheel 3994. In at least one example, the coupler bar 3996 comprises a pin that rides within the cam slot 3999. The coupler bar 3996 further comprises a second end pivotally mounted to the foot 3980 at a pivot joint 3998. As the drive wheel 3994 is rotated, the sidewall of the cam slot 3999 pushes the first end of the coupler bar 3996 through the path or motion shown in FIG. 84. This path is also shown in FIGS. 79A, 80A, 81A, and 82A, which follow the motion of the tissue driver 3990 and the foot 3980 shown in FIGS. 79, 80, 81, and 82, respectively. FIG. 79 shows the foot 3980 in a retracted position, and FIG. 79A shows a dot P on the foot motion path FM representing the position of the foot 3980 along the foot motion path FM. FIG. 80 shows the foot 3980 extended, and FIG. 80A shows the dot P advanced along the foot motion path FM. FIG. 81 shows the foot 3980 in a fully extended position with the dot P advanced further along the foot motion path FM. FIG. 82 shows the foot 3980 returned to the retracted position. At such point, the motion of the foot 3980 may be repeated, i.e., shuttled.

In addition to the above, the coupler bar 3996 includes a longitudinal slot 3997 defined therein, and the staple head 3920 includes a pin 3927 extending into the longitudinal slot 3997 that cooperates to limit or inhibit the motion of the coupler bar 3996. FIGS. 84 and 85 map three corresponding positions, labeled 1, 2, and 3, along the cam slot 3999 and the firing motion path FM. Position 1 corresponds to point P in FIG. 79A, position 2 corresponds to point P in FIG. 80A, and position 3 corresponds to point P in FIG. 81A. In various examples, the tissue driver 3990 includes a four-bar linkage in which the feet 3980 are lofted when extended. To facilitate this motion, each foot 3980 includes a slot 3981 defined therein, the sidewalls of which slide against a pin 3921 extending into the slot 3981. The pin 3921/slot 3981 configuration allows the foot 3980 to translate and rotate during the tissue drive stroke cycle.

86 shows an alternative embodiment of the cam path 4099 with a shoulder that prevents backward movement of the coupler bar 3996 in the slot 3999. For example, the cam path 4099 has a first shoulder 4091 corresponding to position 1 and FIG. 79A, where the coupler bar 3996 passes this point and is unable to back up beyond position 1. The cam path 4099 has a second shoulder 4092 corresponding to position 2 and FIG. 80A, where the coupler bar 3996 passes this point and is unable to back up beyond position 2. The cam path 4099 also has a third shoulder 4093 corresponding to position 3 and FIG. 81A, where the coupler bar 3996 passes this point and is unable to back up beyond position 3.

50-56, the stapling instrument 3100 includes a distal head 3120 including an anvil 3160 and a tissue drive foot 3180. With reference to FIG. 50, the drive foot 3180 is extendable to engage the patient's tissue, and then with reference to FIG. 51, the drive foot 3180 is retractable to move the distal head 3120 relative to the patient's tissue. Each drive foot 3180 includes a rack or array of teeth 3193 configured to engage the patient's tissue, which are also movable between an extended position and a retracted position. FIG. 51 shows the teeth 3193 extending from the drive foot 3180 when the drive foot 3180 is retracted from the extended position. More specifically, the teeth 3193 protrude from a tissue compression surface 3125 defined on the drive foot 3180 when the drive foot 3180 is retracted from their fully extended position. On the other hand, referring to FIG. 50, when the drive foot 3180 is extended, the teeth 3193 do not protrude from the tissue compression surface 3125, thereby allowing the drive foot 3180 to slide against the patient tissue while extended.

52-56, the stapling instrument 3100 includes a tissue driver 3190 configured to extend and retract the drive foot 3180 and extend and retract the teeth 3193. The tissue driver 3190 includes an input bar 3191 that extends into and is movable within a cavity 3181 defined in each drive foot 3180. The input bar 3191 moves the drive foot 3180 through a circuitous, non-linear path that includes an elevated retracted position (FIGS. 52 and 56), a lowered retracted position (FIG. 53), a lowered extended position (FIG. 54), and an elevated extended position (FIG. 55). The input bar 3191 includes a pin 3192 extending therefrom that extends into a slot 3182 defined in the drive foot 3180. As discussed in more detail below, interaction between the pin 3192 and the sidewalls of the slots 3182 transmits motion of the input bar 3191 to the drive foot 3180. Each of the slots 3182 extends along an axis that is transverse and non-parallel to the longitudinal axis of the distal head 3120, resulting in the desired motion of the drive foot 3180 and teeth 3193.

As shown in FIG. 52, when the input bar 3191 is in its fully retracted position, it positions the drive foot 3180 in its raised retracted position. In this position, the teeth 3193 protrude through a window 3183 defined in the drive foot 3180. Referring to FIG. 53, as the input bar 3191 is moved out of its fully retracted position, the pin 3192 interacts with the sidewall of the slot 3182, camming the drive foot 3180 downward. At such time, the teeth 3193 no longer protrude through the window 3183. As the input bar 3191 is moved further away from its fully retracted position, the input bar 3191 begins to extend the drive foot 3180, as shown in FIG. 54. Notably, the teeth 3193 do not protrude through the window 3183 when the drive foot 3180 is extended. However, as shown in FIG. 55, when the input bar 3191 is retracted, the pin 3192 interacts with the sidewall of the slot 3182 to raise the drive foot 3180, causing the teeth 3193 to protrude through the window 3183. As a result, as shown in FIG. 56, the teeth 3193 can engage or grasp the patient tissue and pull the tissue against the distal head 3120 until the drive foot 3180 is fully retracted. At such point, the tissue can be stapled and/or transected. The above process can be repeated to move the stapling instrument 3100 along the entire staple firing path.

57-59D, the stapling instrument 3200 includes a distal stapling head 3220 including a tissue drive foot 3270 that is extended outward and retracted inward along the same path by a tissue drive system, such as the tissue drive system of the stapling instrument 1000. Thus, the stapling head 3220 further includes a lateral drive foot 3280 that moves with the drive foot 3270, but can also move laterally relative to the drive foot 3270, as shown in FIGS. 57 and 58. As a result, the lateral drive foot 3280 can be extended and extended laterally along one path, as shown in FIGS. 59A and 59B, and then retracted along a different path, as shown in FIGS. 59C and 59D. Additionally, the drive feet 3270 and 3280 can pull the distal head 3220 against the patient tissue in two different directions, thereby providing greater control over the relative movement between the distal stapling head 3220 and the patient tissue.

57 and 58, the drive feet 3270 and 3280 are rotatably coupled in pairs. Each pair includes an actuator plate 3260, a first link 3272 pivotally coupled to the drive foot 3270 about a pivot 3271, and a second link 3282 pivotally coupled to the lateral drive foot 3280 about a pivot 3281. Referring to FIG. 58, when a downward force is applied to the actuator plate 3260, the actuator plate 3260 presses against the joint 3213 that rotatably connects the first link 3272 and the second link 3282, thereby displacing the lateral foot 3280 outward. Additionally, the distal head 3220 constrains the lateral movement of the drive foot 3270, and as a result, the drive foot 3270 does not move laterally when the lateral drive foot 3280 extends laterally. However, with reference to FIGS. 60A-60D, alternative embodiments are envisioned in which the drive foot 3270 may also move laterally. In either case, a biasing member, such as, for example, a torsion spring disposed within and/or coupled to the joint 3213, may cause the drive foot to retract laterally after the biasing force is removed from the actuator plate 3260. FIGS. 59A-59D show a series of steps that may be repeated by the surgical instrument 3200 to move the stapling instrument 3200 along the staple firing path. FIGS. 60A-60D also show a series of steps that may be repeated by the surgical instrument 3200 to move the stapling instrument 3200 along the staple firing path.

61 and 62, the surgical instrument 3300 includes a distal head 3320 and a laterally extendable drive foot 3380. The drive foot 3380 is coupled to the distal head 3320 via a flexible connector 3375 and an actuator 3370. When a compressive force is applied to the actuator 3370, the actuator 3370 is displaced and/or compressed, which causes the connector 3375 to extend laterally and press the corresponding drive foot 3380 laterally. When the compressive force is removed from the actuator 3370, the connector 3375 resiliently contracts, pulling the drive foot 3380 inward. The drive foot 3380 can include a tissue gripping mechanism defined thereon that is configured to push and/or pull patient tissue as the drive foot 3380 is moved laterally. As a result, the drive foot 3380 can create relative motion between the distal head 3320 and the patient tissue.

91A-91D, the stapling instrument 4400 includes a distal head 4420 including a tissue cutting driver 4440, a staple firing driver 4450, and a tissue driver including a foot 4480. Each foot 4480 is rotatably mounted to the distal head 4420 about a pivot pin 4481 and is rotatable to drive the distal head 4420 against the patient tissue. FIG. 91 shows the foot 4480 in a retracted position. FIG. 91B shows the foot 4480 extended. FIG. 91C shows the foot 4480 in a fully extended position. FIG. 91D shows the foot 4480 retracted. When the foot 4480 is extended, the foot 4480 drives the distal head 4420 against the patient tissue. Notably, the feet 4480 may be synchronized such that they are extended and retracted together, and in such examples, the feet 4480 may drive the distal head 4420 along a straight or at least substantially straight line. That said, one of the feet 4480 may be extended while the other foot 4480 is retracted. In such examples, the feet 4480 may rotate the distal head 4420 along a curved path.

76 and 77A-77D, the stapling instrument 3800 includes a distal head 3820 including a staple firing system 3850, an anvil 3860, and a tissue drive system. The tissue drive system includes a first foot 3880a and a second foot 3880b and is configured to selectively extend and retract the feet 3880a and 3880b to move the stapling instrument 3800 along a staple firing path FP. The tissue drive system is configured to move or march the stapling instrument 3800 along a linear and/or curved staple firing path. With reference to FIGS. 77A and 77B, the tissue drive system is configured to simultaneously extend and retract the first foot 3880a and the second foot 3880b by equal or at least approximately equal amounts to move the distal firing head 3220 along a linear firing path. 77C and 77D, the tissue drive system is also configured to extend and retract only one of the feet 3880a and 3880b to pivot the distal firing head 3220. For example, referring to FIG. 77C, the tissue drive system may extend and retract the first foot 3880a without extending and retracting the second foot 3880b to pivot the distal head 3820 in a first direction. Similarly, referring to FIG. 77D, the tissue drive system may extend and retract the second foot 3880a without extending and retracting the first foot 3880a to pivot the distal head 3820 in a second direction.

As described above, the tissue drive system is configured to pivot the distal head 3820 of the stapling instrument 3800 by actuating one of the feet 3880a and 3880b but not the other. Alternatively, the tissue drive system may be configured to pivot the distal head 3820 by extending one of the feet 3880a and 3880b less than the other. The distal head 3820 may be pivoted gradually in such a case. The tissue drive system may also be configured to pivot the distal head 3820 by moving the feet 3880a and 3880b in opposite directions. In such an example, the distal head 3820 may follow a small or tight radius of curvature in the staple firing path FP.

63 and 64, the stapling instrument 3400 includes a distal head 3420 including a staple firing system 3450, an anvil 3460, and a tissue drive system. The tissue drive system includes two drive wheels 3480 and a shaft 3481 rotatably supported by a mount 3482, the shaft extending through an opening defined in the center of the drive wheels 3480. The drive wheels 3480 are fixedly mounted to the pins 3481 so that the drive wheels 3480 rotate together. Each drive wheel 3480 includes an array of teeth extending therearound, at least one of the drive wheels 3480 being meshingly engaged with the drive shaft of an electric motor. The teeth extending around the periphery of the drive wheels 3480 are also preferably configured to engage and grasp patient tissue. In use, the electric motor can be operated to pivot the drive wheel 3480 to create relative motion between the distal head 3420 and patient tissue to move the distal head 3420 along a staple firing path.

94, the stapling instrument 4600 includes a distal head 4620 including a staple firing system 4650, an anvil 4660, and a tissue drive system. The tissue drive system includes two drive wheels 4680 each rotatably supported by a separate pin extending through its center. As a result, the drive wheels 4680 can be rotated independently. Each drive wheel 4680 includes an array of teeth extending therearound that are meshingly engaged with a drive shaft of an electric motor. Stated differently, the tissue drive system includes two electric motors configured to separately rotate the drive wheels 4680. As above, the teeth extending around the drive wheels 4680 are also suitably configured to engage and grip patient tissue. In use, the electric motor can be operated to pivot the drive wheels 4680 to create relative motion between the distal head 4620 and the patient tissue and move the distal head 4620 along a staple firing path, as described in more detail below.

In addition to the above, the tissue drive system is configured to rotate the drive wheels 4680 at the same speed and in the same direction to move the distal head 4620 along a linear staple firing path. The tissue drive system is also configured to rotate the wheels 4680 in the same direction, but at different speeds, to pivot the distal head 4620 along a curved staple firing path. The distal head 4620 may pivot gradually in such a case. The tissue drive system is also configured to pivot the distal head 4620 along a curved staple firing path by pivoting only one of the wheels 4680 and not the other drive wheel 4680. Furthermore, the tissue drive system is further configured to rotate the drive wheels 4680 in opposite directions to pivot the distal head 4620 along a curved staple firing path having a small or tight radius of curvature.

The tissue drive system further comprises a lateral drive wheel 4670 positioned laterally relative to the drive wheel 4680. As above, each lateral drive wheel 4670 is operably coupled to a different electric motor. As a result, the tissue drive system of the stapling instrument 4600 comprises four electric motors that can operate simultaneously or at different times. The lateral drive wheels 4670 can operate independently of the drive wheels 4680, but may be operated simultaneously with one or both of the drive wheels 4680. Additionally, the lateral drive wheels 4670 can operate independently relative to each other. As with the drive wheels 4680, the tissue drive system is configured to pivot the lateral drive wheels 4670 together at the same speed, at different speeds, and/or in different directions to move the distal head 4620 along the staple firing path. Further, the tissue drive system is configured to pivot any suitable combination of the drive wheels 4670 and 4680 in any suitable direction and at any suitable speed to move the stapling instrument 4600 along a desired staple firing path.

36, the stapling instrument 2600 includes a distal head 2620 including a staple firing system 2650, an anvil 2660, and a tissue drive system. The tissue drive system includes two drive wheels 2670 and two drive wheels 2680 that can be rotated independently, simultaneously or at different times, to move the distal head 2620 along a staple firing path. Each drive wheel 2670 is rotatable about an axis 2671, and each drive wheel 2680 is rotatable about an axis 2681, but the axes 2671 are not parallel to the axis 2681. In practice, the axes 2671 and 2681 are orthogonal, but may be oriented in any suitable direction. Although the tissue drive system includes four electric motors configured to separately rotate the drive wheels 2670 and 2680, the tissue drive system may have any suitable number of electric motors to drive the drive wheels 2670 and 2680. In use, the electric motor can be operated to pivot the drive wheels 2670 and 2680 to create relative motion between the distal head 2620 and patient tissue to move the distal head 2620 along a staple firing path.

75A-75D, the stapling instrument 3700 comprises a distal head 3720 including an anvil 3760 and a tissue drive system including a tissue drive foot 3780. The stapling instrument 3700 is similar to the stapling instrument 1000 in many respects, most of which are not discussed herein for the sake of brevity. The anvil 3760 is movable relative to the foot 3780 between a closed or clamped position (FIGS. 75A and 75D) and an open or unclamped position (FIGS. 75B and 75C). With reference to FIG. 75B, while the anvil 3760 is open, the drive foot 3780 can be extended to engage and grasp tissue. With reference to FIG. 75C, the drive foot 3780 is then retracted to generate relative motion between the distal head 3720 and the patient tissue. 75D, the anvil 3760 can be moved toward its closed position while and/or after the drive foot 3780 is retracted. The drive foot 7580 can have teeth for gripping tissue and/or any suitable means for gripping and pulling tissue. In various examples, the drive foot 7580 is configured to apply reduced pressure to tissue to grip and pull the tissue. In at least one such example, the reduced pressure system is turned off during the steps of operation shown in, for example, FIGS. 75A and 75B and turned on during the steps of operation shown in FIGS. 75C and 75D. In such examples, the reduced pressure can hold the tissue within the distal head 7520 when the anvil 7560 is closed, although other embodiments are envisioned in which the reduced pressure is turned off during the steps of operation shown in FIG. 75D.

65-69, a stapling instrument 3500 includes a distal head 3520 including an anvil 3560 and a tissue drive system including a vacuum supply line 3570, two vacuum graspers 3580, and two grasper extenders 3590. The vacuum supply line 3570 includes a manifold 3571 configured to supply a vacuum differential to the two grasper extenders 3590 and the two vacuum graspers 3580. Each grasper extender 3590 includes a bellows 3591 in communication with the manifold 3571 that contracts and expands when vacuum is delivered to its inner plenum. When the bellows 3591 contracts, it extends the grasper 3580 to the position shown in FIG. Each bellows 3591 is in fluid communication with a cavity 3581 defined in the grasper 3580, thereby allowing a reduced pressure differential to be transmitted to a grasper hole 3582 defined in the tissue engaging surface 3585 of the grasper 3580. This reduced pressure differential across the grasper hole 3582 allows patient tissue to be held against the tissue engaging surface 3585.

As described above, the extension of the grasper 3580 corresponds to a reduced pressure differential being applied to the tissue. When the reduced pressure supply line 3570 no longer supplies the reduced pressure differential to the bellows 3591, the bellows 3591 resiliently re-expands and contracts, retracting the grasper 3580 accordingly, as shown in FIG. 67. Similarly, the bellows 3591 may also re-expand and retract the grasper 3580 when the reduced pressure differential is reduced. In either case, the reduced pressure differential at the grasper hole 3582 may decrease as the grasper 3580 is retracted. In some cases, the residual reduced pressure differential at the grasper hole 3582 may be sufficient to draw the patient tissue into the tissue chamber 3525 of the distal head 3520. In other instances, the residual reduced pressure differential at the grasper hole 3582 may not be sufficient by itself to draw the patient tissue into the tissue chamber 3525. With this in mind, the grasper 3580 includes soft teeth 3586 extending from its tissue engaging surface 3585. Referring to FIG. 66, when the grasper 3580 is extended, the soft teeth 3586 slide over the patient tissue without catching, or at least without significantly catching, on the patient tissue. This relative motion is also facilitated by the transverse angle at which the teeth 3586 extend from the tissue engaging surface 3585. Referring to FIG. 68, when the grasper 3580 is retracted, the teeth 3586 bite into the patient tissue, drawing it into the tissue chamber 3525. Again, this is facilitated by the angle of the teeth 3586, and can compensate for loss of vacuum pressure differential at the grasper hole 3582.

Once the patient tissue is positioned within the tissue chamber 3525, the tissue may be stapled and/or cut. The supply line 3570 does not supply a vacuum differential during the stapling and/or cutting operation, as doing so would cause the grasper 3580 to be extended and the tissue to be moved. Thus, for example, the vacuum supply may be turned off during the stapling and/or cutting operation if there is another way to hold the tissue in place. In any case, the anvil 3560 may then be reopened, the distal head 3520 may be moved relative to the tissue, and the vacuum supply may be used to re-extend the tissue grasper 3580, and the above process may then be repeated, as shown in FIG.

70-73, the stapling instrument 3600 includes a distal stapling head 3620 including a staple firing system 3650, an anvil 3660, a tissue cutting system 3640, and a tissue gripping system utilizing a vacuum differential. The stapling instrument 3600 is similar to the stapling instrument 3500 in many respects, most of which are not discussed herein for the sake of brevity. Thus, the tissue gripping system includes two separate and distinct vacuum supply lines, a first supply line 3670a in communication with a first bellows 3690a in fluid communication with a first tissue drive foot 3680a via a foot manifold 3685a, and a second supply line 3670b in communication with a second bellows 3690b in fluid communication with a second tissue drive foot 3680b via a foot manifold 3685b. The foot manifold 3685a comprises an array of manifold openings 3686 which communicate with the foot openings 3682 defined in the first foot 3680a for transmitting a reduced pressure differential to the foot openings 3682 when a reduced pressure is applied to the first supply line 3670a. The foot manifold 3685b comprises an array of manifold openings 3686 which communicate with the foot openings 3682 defined in the second foot 3680b for transmitting a reduced pressure differential to the foot openings 3682 when a reduced pressure is applied to the second supply line 3670b. The stapling instrument 3600 further comprises a control system configured to selectively apply reduced pressure to the first and second supply lines 3670a, 3670b such that the first and second drive feet 3680a, 3680b may be selectively extended and retracted. In some instances, feet 3680a and 3680b are synchronized and extended and retracted together at the same time, while in other instances, feet 3680a and 3680b are extended and retracted at different times.

An alternative embodiment of the stapling instrument 3600' is shown in FIG. 74. The stapling instrument 3600' is similar in many respects to the stapling instrument 3600. That said, the instrument 3600' includes a larger tissue drive foot 3680' having more vacuum holes 3682 defined therein as compared to the tissue drive foot 3680 of the stapling instrument 3600.

47A-47G, the stapling instrument 3000 includes a distal head 3020 including a staple firing system, an anvil closure system including an anvil 3060, a tissue driver including at least one drive foot 3080, and a tissue gripper 3070 configured to releasably hold tissue. With reference to FIG. 47A, the anvil 3060 is movable from a clamping position to an unclamping position to unclamp the patient tissue T. With reference to FIG. 47B, the tissue gripper 3070 is engageable with the patient tissue T to hold the tissue in place while the drive foot 3080 is extended, as shown in FIGS. 47C and 47D. The tissue gripper 3070 may be engaged with the tissue when the anvil 3060 is open and/or after the anvil 3060 is open. In either case, referring to FIG. 47E, the tissue gripper 3070 is disengaged from the tissue (shown in FIG. 47F) before the drive foot 3080 is retracted to pull the distal head 3020 against the tissue and position the distal head 3020 at a new location along the staple firing path. Referring to FIG. 47G, at that point, the patient tissue is clamped by the anvil 3060 and the staple firing system is operated to staple the tissue. At that point, the cycle described above can be repeated.

As shown in FIGS. 47D-47F, the drive foot 3080 is in fluid communication with the reduced pressure source 3090. As above, the drive foot 3080 can utilize a reduced pressure differential from the reduced pressure source 3090 to grasp the patient tissue. Also as above, the reduced pressure differential from the reduced pressure source 3090 can be used to extend the drive foot 3080. That said, the drive foot 3080 can be extended using any suitable mechanism.

78, the stapling instrument 3900 further includes a tissue gripper 3970. The tissue gripper 3970 can be used with the drive foot 3980 in the same or similar manner as the tissue gripper 3070 is used with the drive foot 3080.

45, 46, 48, and 49 show a sequence of operation of a stapling instrument that may be used with the stapling instruments disclosed herein, such as, for example, stapling instrument 4000 and/or stapling instrument 3900 described above. The stapling instrument 4000 is similar to other stapling instruments disclosed herein in many respects, most of which are not discussed herein for the sake of brevity. The stapling instrument 4000 includes an anvil drive system 4060, a staple firing system 4050, a tissue cutting system 4040, a tissue gripping system 4090, and a tissue drive system 4080 configured to move the stapling instrument 4000 relative to patient tissue. FIG. 49 shows the steps of operation of the stapling instrument 4000 occurring in the order presented. For example, step 4003 follows step 4002, which follows step 4001, and so on. That being said, it should be understood that adjacent operational steps may occur simultaneously or with at least some overlap, as shown in FIG. 46 and described in more detail below. Additionally, the operational steps of FIG. 49 may be rearranged in any suitable order.

49, action step 4001 includes loading a staple cartridge into the stapling instrument 4000 and/or driving the staple cartridge into a fixed position within the stapling instrument 4000. Action step 4002 includes removing staples from the staple cartridge, and action step 4003 includes placing staples into a fixed position within the staple firing drive 4050. Action step 4004 includes articulating the end effector of the stapling instrument 4000 as necessary. Thus, action step 4004 may also occur before and/or during steps 4001, 4002, and/or 4003. Action step 4005 includes positioning the end effector on the patient tissue, and action step 4006 includes operating the anvil drive system 4060 to clamp the anvil on the tissue. Action step 4005 may also occur before action step 4004.

Further to the above, action step 4007 includes forming a staple against the anvil, and action step 4008 includes deploying a knife of the tissue cutting system 4040. Action step 4007 occurs before action step 4008, but steps 4007 and 4008 may occur simultaneously or with some overlap. Action step 4009 includes retracting the knife using the tissue cutting system 4040, which follows action step 4008. Action step 4010 includes using the tissue gripping system 4090 to grip and hold patient tissue positioned within the end effector of the stapling instrument 4000. Action step 4011 includes unclamping the anvil using the anvil drive system 4060. In such an example, the stapling instrument 4000 can hold tissue even though the anvil is open as a result of the tissue gripping system. Action step 4012 includes advancing the foot of the tissue drive system 4080. The operation step 4013 includes actuating the tissue gripping system 4090 to release the grip on the tissue, and the operation step 4014 includes retracting the foot of the tissue drive system 4080 and advancing the stapling instrument 4000 against the tissue.

46 further illustrates that certain operational steps may occur simultaneously or with some overlap. For example, step 4011 of opening the anvil and step 4001 of loading the staple cartridge into position may occur simultaneously or with at least some overlap. Similarly, steps 4002 and/or 4003, which include advancing the staples into position within the staple firing drive 4050, may occur simultaneously or with some overlap with, for example, step 4011 of opening the anvil, step 4010 of gripping tissue with the tissue gripping system 4090, step 4012 of extending the foot of the tissue drive system 4080, step 4013 of releasing tissue with the gripping system 4090, and/or step 4014 of retracting the foot of the tissue drive system 4080. Additionally, step 4001 of reloading another staple cartridge into place within the stapling instrument 4000 may occur simultaneously or with some overlap with step 4008 of cutting tissue and/or step 4009 of retracting the tissue-cutting knife.

In addition to the above, FIG. 45 illustrates an operational cycle of the anvil drive system 4060 and tissue drive system 4080 of the stapling instrument 4000. The operational cycle of FIG. 45 is plotted against time t, with the limit 0 or zero on the horizontal time axis representing the start of the cycle sequence of the stapling instrument 4000. Referring to the operational cycle of the anvil drive system 4060, peak 4006 correlates with step 4006 described above, which includes closing or clamping the anvil onto the tissue. Similarly, pause 4011 correlates with step 4011 described above, which includes opening or unclamping the tissue. Referring now to the operational cycle of the tissue drive system 4080, peak 4012 correlates with step 4012, which includes extending the foot of the tissue drive system 4080, and peak 4014 correlates with step 4014, which includes retracting the foot of the tissue drive system 4080 and driving the stapling instrument 4000 against the patient tissue. Comparing the operating cycles of the anvil drive system 4060 and the tissue drive system 4080, it can be seen that the anvil is open or opening when the foot is extended. It can also be seen that the anvil is opening when the foot is retracted, and that the anvil is closing at the start of the next cycle of the stapling instrument 4000.

As discussed above, it may be desirable to perform certain operational steps of the stapling instrument 4000 sequentially and other operational steps simultaneously. However, in some cases, it may not be desirable to perform certain operational steps at the time. Therefore, the stapling instrument 4000 is configured to lock out certain drive systems to prevent them from operating while other drive systems of the stapling instrument 4000 are being operated. The lockout may include, for example, a mechanical lockout and/or an electrical lockout. All of the drive systems of the stapling instrument 4000 are motorized and in communication with the controller of the stapling instrument 4000, such that the drive systems may be locked out using the controller. The controller may include, for example, a microprocessor configured to electronically lock out one or more drive systems during the operation of one or more other drive systems. FIG. 48 is a chart showing which operational steps are prevented from being performed during the execution of other operational steps. For example, during step 4001 in which the staple cartridge is loaded into place, all of the operational steps other than step 4004 of articulating the end effector of the stapling instrument 4000, step 4005 of positioning the stapling instrument 4000 relative to the tissue, and step 4011 of unclamping the anvil are locked out or prevented from occurring. In this example, the staple firing system 4050, the tissue driving system 4080, and the tissue gripping system 4090 are locked out. This is by way of example only. Other steps may be unlocked during step 4001 if it is determined that doing so would not be detrimental or unacceptably detrimental to the operation of the stapling instrument 4000.

90A-90D, the stapling instrument 4300 includes a distal head 4320 including a staple firing system 4350, an anvil drive system including an anvil 4360, and a tissue cutting system 4340. The stapling instrument 4300 is similar to the stapling instrument 1000 and the stapling instrument 4400 in many respects, most of which are not discussed herein for the sake of brevity. The stapling instrument 4300 further includes upper feet 4370a and 4370b and lower feet 4380a and 4380b. Similar to the foot 4480 of the stapling instrument 4400, the feet 4370a, 4370b, 4380a, and 4380b are rotatable between an extended position (FIG. 90A) and a retracted position (FIGS. 90B-90D) to move the distal head 4320 relative to the patient tissue T. 90A, the feet 4370a and 4380a comprise a first synchronized pair of feet that move together to grip patient tissue as they are moved to their extended positions. In such a case, the feet 4370a and 4380a are moved towards each other to apply a compressive force or pressure to the tissue. With reference to FIG. 90B, as the feet 4370a and 4380a are retracted, the feet 4370a and 4380a pull the tissue to move the distal head 4320 relative to the tissue. With reference to FIG. 90C, as the feet 4370a and 4380a are retracted, the staple firing system 4350 and the tissue cutting system 4340 staple and cut the patient tissue. The staple firing system 4350 and the tissue cutting system 4340 are operated simultaneously, although the staple firing system 4350 may be operated before the tissue cutting system 4340. Thus, cutting the tissue before stapling can result in unwanted bleeding. Notably, however, feet 4370a and 4380a apply clamping pressure to the tissue while stapling instrument 4300 staples and cuts the tissue. Referring to FIG. 90D, once the tissue has been stapled and cut, feet 4370a and 4380a move away from the tissue to unclamp the tissue.

As described above, the feet 4370a and 4380a are operably coupled together such that they move together as a pair. They rotate together as a pair, they clamp together as a pair, and they unclamp together as a pair. Various alternative embodiments are envisioned in which only one of the feet 4370a and 4380a moves to clamp and unclamp tissue, but the feet 4370a and 4380a still rotate together as a pair. The synchronized second pair of feet, including feet 4370b and 4380b, moves in the same manner as the synchronized first pair of feet, including feet 4370a and 4380a, and therefore a description of their movement will not be repeated for brevity. Thus, the movement of the first pair of feet is synchronized with the movement of the second pair of feet. More specifically, the second pair of feet is extended at the same time as the first pair of feet is extended, the second pair of feet is clamped to grasp tissue at the same time as the first pair of feet is clamped, the second pair of feet is retracted at the same time as the first pair of feet is retracted, and the second pair of feet is unclamped at the same time as the first pair of feet is unclamped. In certain examples, the movements of the first and second pairs of feet are not synchronized or are not fully synchronized. In at least one such example, the first pair of feet is extended and retracted independently of the second pair of feet to pivot the distal head 4320 along a curved staple path.

As discussed above, the stapling instruments disclosed herein are configured to staple tissue of a patient. They are also configured to cut tissue. With reference to FIGS. 95 and 96, the stapling instrument 5000 includes a distal head 5020 including a staple firing system, a tissue cutting system 5040, and an anvil 5060 configured to deform staples deployed by the staple firing system. The tissue cutting system 5040 includes a knife bar 5042 including a knife edge 5045 defined at a distal end 5044 thereof. In use, the knife bar 5042 is translatable laterally through the distal head 5020 during a tissue cutting stroke. The tissue cutting stroke of the knife bar 5042 extends between a first inactivated position shown in FIG. 95 and a second activated position. During the tissue cutting stroke, the knife edge 5045 extends between the tissue compression surface 5025 and a tissue compression surface 5065 defined on the anvil 5060. The knife edge 5045 may also extend into the distal head 5020 and/or the anvil 5060 during the tissue cutting stroke to ensure that the full thickness of the tissue is transected.

Further to the above, the distal head 5020 defines a longitudinal head axis HA. During a tissue cutting stroke, the knife bar 5042 moves perpendicular to the longitudinal head axis HA. The tissue cutting system 5400 further includes a cutting actuator 5046 configured to engage and laterally displace the knife bar 5042. The cutting actuator 5046 includes a distal end 5047 including an angled cam surface configured to engage a corresponding cam surface 5043 defined on the distal end 5044 of the knife bar 5042. The cutting actuator 5046 may also be configured to bias the knife bar 5042 in any suitable manner. In other embodiments, the knife bar 5042 may be moved without the cutting actuator 5046.

98, the stapling instrument 5100 includes a distal head 5120 including a staple forming anvil 5160. The stapling instrument 5100 further includes a staple feed system 5190, a staple alignment system 5180, and a staple firing system 5150. The staple firing system 5150 includes a staple driver 5151 that is longitudinally movable to eject a set or cluster of staples 5130 from the distal head 5120 during a staple firing stroke. With reference to FIGS. 99 and 100, each staple 5130 includes a base 5131 and a staple leg 5132 extending from the base 5131. 100 and 101, the staple driver 5151 is configured to press the base 5131 of the staple 5130 during the staple firing stroke to press the staple legs 5132 against the forming pockets 5162 (FIG. 97) defined in the anvil 5160. With reference to FIG. 102, at such time, the staple driver 5151 returns to the start or unfired point of the staple firing stroke so that another staple firing stroke can be performed.

As discussed above, the stapling instrument 5100 is configured to deploy staples during each staple firing stroke. With reference to FIG. 103, the stapling instrument 5100 further comprises a tissue cutting knife 5140 configured to cut tissue during and/or after each staple firing stroke. The staple firing system 5150 is configured to deploy a first group or cluster of three staples 5130 positioned on a first side of the cut path CP created by the knife 5140 and a second group or cluster of three staples 5130 positioned on a second side of the cut path CP. The staple firing system 5150 deploys the first and second staple groups simultaneously, although embodiments are also envisioned in which the first group is deployed before the second staple group. Alternative embodiments are also envisioned in which the stapling instrument does not include a tissue cutting system or in which the tissue cutting system of the stapling instrument may be deactivated. The staple feeding system 5190 and the staple alignment system 5180 cooperate to reposition another set of staples 5130 within the distal head 5120 after each staple firing stroke is performed so that another staple firing stroke can be performed. In various examples, the staples 5130 are reloaded during and/or after the tissue cutting stroke.

97, 100 and 102, the staple feeding system 5190 includes staple pushers 5191. Each staple pusher 5191 is configured to push a staple 5130 into a staple cavity 5121 defined in a distal head 5120. In addition to the above, the distal head 5120 includes six staple cavities 5121 each configured to receive a staple 5130 from the staple feeding system 5190. The staples 5130 are arranged in six stacks or rows that are aligned with the staple cavities 5121. The staple pusher 5191 presses against the base 5131 of the proximal-most staple 5130 in each staple stack to push the distal-most staple 5130 of each staple stack into the staple cavity 5121 during a push stroke. The staple pushers 5191 simultaneously, i.e., during a common push stroke, load the staples 5130 into the staple cavities 5121, although in alternative embodiments, the staple pushers 5191 may be configured to sequentially load the staples 5130 into the staple cavities 5121. With reference to FIGS. 98 and 99, the staples 5130 in the staple stacks are releasably attached to one another, for example, by at least one adhesive 5135. As shown in FIG. 100, the staples 5130 in each staple stack are adhered to one another at a transverse angle relative to the firing axis FA of the staple firing system driver 5151. The distal head 5120 includes a cam surface 5122 that orients and aligns the staples 5130 with the firing axis FA of the staple firing system driver 5151 before the staple firing stroke of the staple firing system 5150 is performed.

The staple driver 5151 and the staple pusher 5191 move parallel or at least substantially parallel to one another. With reference to FIGS. 97 and 103, depending on the design of the staple driver 5151 and the staple pusher 5191 and/or other space constraints, the stapling instrument 5100 further includes a staple alignment system including a staple pusher 5180 configured to cooperate with the staple pusher 5191 to align the staple 5130 with the staple driver 5151. The staple pusher 5191 pushes the staple 5130 longitudinally and the staple pusher 5180 pushes the staple 5130 laterally.

104-105D, the stapling instrument 5200 includes a distal head 5220 including a staple firing system 5250 configured to deploy the staples 5230, a tissue cutting system, and an anvil 5260 including shaped pockets configured to deform the staples 5230. The staple firing system 5250 includes rotatable actuators 5252 configured to displace the lateral staple drivers 5254 along a linear or at least substantially linear lateral path. Each rotatable actuator 5252 includes a cam 5253 configured to engage a shoulder 5255 defined on the staple driver 5254 and displace the driver 5254 laterally, as shown in FIG. 105B. The staple firing system 5250 further includes one or more springs 5224 positioned intermediate the lateral staple drivers 5254 and the frame 5222 of the distal head 5220. As shown in FIG. 105C, the springs 5224 are compressed as the staple drivers 5254 are slid laterally by the rotatable actuator 5252 during continued rotation of the actuator 5252 until the cams 5253 disengage from the shoulders 5255 of the drivers 5254. With reference to FIG. 105D, at such time, the springs 5224 resiliently return the lateral staple drivers 5254 to their unactuated positions again.

104 and 105A, the staple firing drive 5250 further includes a longitudinal staple drive 5257 that is driven along a longitudinal staple firing path by the lateral staple drive 5254. Each lateral staple drive 5254 includes a drive cavity 5256 defined therein that receives a portion of the longitudinal staple drive 5257 therein. More specifically, each longitudinal staple drive 5257 includes a cam portion positioned within the drive cavity 5256 that is driven longitudinally by a cam surface 5258 defined within the drive cavity 5256 when the lateral staple drive 5254 is moved laterally, as shown in FIG. 105B. As a result of the above, rotational motion of the rotatable actuator 5252 is translated into lateral translation of the lateral staple driver 5254, which is translated into longitudinal translation of the longitudinal staple driver 5257. The longitudinal motion of the staple driver 5257 drives the staples 5230 against the anvil 5260 to deform the staples 5230, as shown in FIG. 105B. The longitudinal staple driver 5257 includes a staple cradle 5251 defined therein that is configured to support the staples 5230 as they are being deformed.

105C, further to the above, the return lateral motion of the staple driver 5254 retracts the longitudinal staple drivers 5257 back to their inactivated position. More specifically, the drive cavity 5256 further comprises a cam surface 5258' configured to drive the longitudinal staple drivers 5257 in the opposite direction until the staple drivers 5257 are reset to their inactivated or unfired position, as shown in FIG. 105D. Notably, the anvil 5260 is moved to the open position when the longitudinal staple driver 5257 is retracted. At such time, as shown in FIG. 105A, the distal head 5220 can be moved relative to the tissue, the staples 5230 can be reloaded into the distal head 5220, and the anvil 5260 can be re-clamped on the tissue, whereupon another staple firing stroke of the staple firing driver 5250 can be performed.

As discussed above, the rows of connected staples may be used to feed and re-feed the staple firing system of the stapling instrument. In other instances, the entire staple cartridge may be used to feed and re-feed the staple firing system. Referring to FIG. 106, the stapling instrument 5300 includes a shaft 5310, a distal head 5320, and an articulation joint 5370 rotatably connecting the distal head 5320 to the shaft 5310. The stapling instrument 5300 further includes a plurality of staple cartridges 5330″ stored in the shaft 5310 and a cartridge pusher system configured to push the staple cartridges 5330″ into the distal head 5320. Once the staple cartridges 5330″ are positioned within the distal head 5320, the staples 5330 ( FIG. 107 ) contained within the staple cartridges 5330″ may be separated and deployed by the staple firing system, as described in more detail below. In various examples, the staple cartridge includes a cartridge body that is split and deployed with the staples, while in other examples, the staples are ejected from the cartridge body and the cartridge body is not embedded.

107, further to the above, the staple cartridge 5330'' comprises a cartridge body 5333 including an opening defined therein. The opening includes a first side 5334 configured to receive and store a first group of staples 5330 and a second side 5335 configured to receive and store a second group of staples 5330. The first group of staples 5330 are deployed on a first side of a tissue incision path formed by the tissue cutting knife and the second group of staples 5330 are deployed on a second side of the tissue incision path. The staples 5330 are further arranged in clusters 5330' of three staples deployed together, although the staple clusters may include any suitable number of staples. Five staple clusters 5330' are stored on a first side 5334 of the cartridge body 5333 and five staple clusters 5330' are stored on a second side 5335 of the cartridge body 5333, although any suitable number of clusters may be used. A staple cluster 5330' is ejected from each side 5334 and 5335 of the cartridge body 5333 and deformed against the anvil 5360 during each staple firing stroke of the stapling system. In various alternative embodiments, the staple clusters 5330' may be deployed sequentially from the first side 5334 and the second side 5335.

Further to the above, the staples 5330 of each staple cluster 5330' are attached to one another by at least one adhesive, but the staple clusters 5330' themselves are not attached to one another, but instead are stored side-by-side within the cartridge body 5333. In at least one alternative embodiment, the staples of adjacent staple clusters are releasably attached to one another. Referring now to FIG. 108, for example, the cartridge body 5333 can be configured to releasably store therein a plurality of staple clusters 5430', each staple cluster 5430' comprising three staples. The three staples 5430 of each staple cluster 5430' are attached to one another by at least one adhesive 5435, and the staple clusters 5430' are attached to one another by at least one adhesive 5435. In such embodiments, the staple clusters 5430' are attached to one another to form a staple strip 5430'' and one or more staple clusters 5430' are pulled away from the other staple clusters 5430' to load the staples into the distal head 5320. Although the staple clusters in the above embodiment comprise three staples, the staple clusters may include any suitable number of staples, such as, for example, two staples or more than three staples.

109 and 110, the stapling instrument 5400 includes a shaft 5410, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closing system, and a system configured to move the distal head relative to the tissue of a patient. The stapling instrument 5400 further includes a staple strip 5430" of FIG. 108 stored within the shaft 5410. The staple strip 5430" may be stored within a cartridge body 5333 as described above, or may be stored within the shaft 5410 without a cartridge body. The staple strip 5430" may include any suitable number of staples and/or staple clusters. In at least one example, the staple strip 5430" includes, for example, 588 staples.

111 and 112, the stapling instrument 5500 includes a shaft 5510, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closing system, and a system configured to move the distal head relative to the tissue of the patient. The stapling instrument 5500 further includes a first staple strip 5530a'' and a second staple strip 5530b'' stored within the shaft 5510. The staple strips 5530a'' and 5530b'' are comprised of staples 5430 arranged in a staple cluster 5430'. The staple strips 5530a'' and 5530b'' are nested such that the bases of the staples 5430 face in opposite directions.

113 and 114, the stapling instrument 5600 includes a shaft 5610, a distal head, a staple loading system, a staple firing system, a tissue cutting system, an anvil closing system, and a system configured to move the distal head relative to the tissue of the patient. The stapling instrument 5600 further includes a first staple strip 5630a'' and a second staple strip 5630b'' stored within the shaft 5610. The staple strips 5630a'' and 5630b'' are comprised of staples 5430 arranged in a staple cluster 5430'. The staple strips 5630a'' and 5630b'' are arranged side by side such that the bases of the staples 5430 face in the same direction.

106, the stapling instrument 5300 includes a system for forcing the staple cartridge 5330'' from the shaft 5310 into the distal head 5320. Notably, the cartridge forcing system forces the staple cartridge 5330'' into the distal head 5320 through the articulation joint 5370. As a result, the size of the staple cartridge 5330'' and/or the staples 5330 may be limited by the spatial constraints of the articulation joint 5370, particularly when the distal head 5320 is articulated. FIGS. 115-118 disclose a stapling instrument 5700 with a flexible staple strip that can feed staples through the articulation joint into the distal head. The stapling instrument 5700 includes a first staple strip 5730' with staples 5730 attached to a first carrier 5760'. More specifically, the staples 5730 are attached to a first carrier 5760' at tabs 5761'. Each staple 5730 includes a base 5731 and a leg 5732 extending from the base, the base 5731 being connected to the first staple strip 5730' by a tab 5761'. The stapling instrument 5700 further includes a second staple strip 5730'' including staples 5730 attached to a second carrier 5760'' at tabs 5761''. The carriers 5760' and 5760'' each include an array of openings 5762 that are used to feed the staple strips 5730' and 5730'' into the distal head of the stapling instrument 5700, as described in more detail below.

The staple strip 5730' is stored within the shaft of the stapling instrument 5700. In its stored state, the staple strip 5730' is planar or at least substantially planar. More specifically, with reference to FIGS. 115 and 116, the staple 5730 is attached to the first carrier 5760' such that it is in the same plane as the first carrier 5760'. The stapling instrument 5700 further comprises a staple feed system including a drive wheel configured to drive the staple strip 5730' into the distal head of the stapling instrument 5700. The drive wheel comprises an array of drive pins extending therearound that are configured to engage openings 5762 in the first carrier 5760' and drive the first carrier 5760' into the distal head. The second staple strip 5730'' is also stored within the shaft of the stapling instrument 5700. In its stored state, the staple strip 5730" is planar or at least substantially planar. More specifically, with reference to FIGS. 115 and 116, the staple 5730 is attached to the second carrier 5760" such that the staple 5730 is in the same plane as the second carrier 5760". As above, the drive wheel of the staple feeding system is configured to engage the opening 5762 of the second carrier 5760" and drive the second carrier 5760" into the distal head of the stapling instrument 5700.

115 and 118, the staple strips 5730' and 5730" are stored in an opposed configuration such that the carriers 5760' and 5760" of the staple strips 5730' and 5730" can be engaged and driven on opposite sides by a staple feed system. With reference to FIG. 116, as the staple strips 5730' and 5730" are fed into the distal head, the staples 5730 are bent downwardly around the tabs 5761' and 5761" of the staple strips 5730' and 5730", respectively. In at least one example, the frame of the distal head comprises a cam surface configured to bend the staples 5730 downwardly. In certain examples, the stapling instrument 5700 comprises one or more actuators configured to bend the staples 5730 downwardly, for example, around a mandrel positioned under the tabs 5761' and 5761". When displaced to the lower position, the staples 5730 are detached from the staple strips 5730' and 5730". In at least one example, the frame of the distal head includes one or more shearing surfaces or knife edges configured to separate the staples 5730 from the tabs 5761' and 5761" as the staple strips 5730' and 5730" are advanced into the distal head. In certain examples, the stapling instrument 5700 further includes one or more shears that are actuated to separate the staples 5730 from the staple strips 5730' and 5730". In either case, the separated staples are then positioned to be deployed by a staple firing system of the stapling instrument 5700.

In addition to the above, the stapling instrument 5700 is configured to separate a cluster of staples from the staple strips 5730' and 5730" and then advance the carriers 5760' and 5760" of the staple strips 5730' and 5730" so that another cluster of staples can be separated from the staple strips 5730' and 5730". Referring to FIG. 118, when the staples 5730 are separated from the carriers 5760' and 5760", the empty or peeled portions of the carriers 5760' and 5760" are fed back into the shaft of the stapling instrument 5700. As a result, the act of feeding new staples 5730 into the staple firing system also feeds the empty carriers 5760' and 5760" back into the shaft.

119, the staple cluster 5830' includes four staples 5830 adhered together by at least one adhesive 5835. Each staple 5830 includes a base 5831 and two staple legs 5832 extending from the base 5831. Notably, the legs 5832 are not coplanar with the base 5831. Rather, the base 5831 lies in a base plane and the legs 5832 lies in a leg plane. The base plane is parallel or at least substantially parallel to the leg plane, although embodiments in which the base and leg planes are not parallel are also envisioned. In either case, two of the staples 5830 of the staple cluster 5830' face inward and two of the staples 5830 face outward. A staple 5830 faces outward when its base plane is closer to the center of the staple cluster 5830' than its leg plane. Correspondingly, a staple 5830 faces inward when its leg plane is closer to the center of the staple cluster 5830' than its base plane.

Further to the above, the staple cluster 5830' comprises two staples 5830 located on a first side of the centerline CL and two staples 5830 located on a second side of the centerline CL. The staples 5830 on the first side of the staple cluster 5830' are connected by a first adhesive connector 5835 and the staples 5830 on the second side of the staple cluster 5830' are connected by a second adhesive connector 5835. Further, the staples 5830 on the first side of the staple cluster 5830' are connected to the staples 5830 on the second side of the staple cluster 5830' by the adhesive connector 5835. Thus, the staple cluster can include any suitable number of adhesive connectors. The adhesive connectors 5835 releasably hold the staples 5830 together. The adhesive connector 5835 is broken before the staple 5830 is implanted in the patient tissue, although alternative embodiments are envisioned in which the adhesive connector 5835 is not broken before the staple 5830 is implanted in the patient tissue. The adhesive connector 5835 is comprised of a biocompatible and/or bioabsorbable material, such as a bioabsorbable polymer.

120, the stapling instrument 5900 includes a shaft, a distal head 5920, a staple feed system, a staple firing system, a tissue cutting system, an anvil closure system, and a drive system configured to move the distal head 5290 relative to the patient's tissue. The distal head 5920 includes a first staple cavity 5921 and a second staple cavity 5921. Each staple cavity 5921 is configured to store a staple cluster 5930' or a row of staple clusters 5930' therein. Each staple cluster 5930' includes four staples 5930, but may include any suitable number of staples. Each staple 5930 includes a base 5931 and two staple legs 5932 extending from the base. The base 5931 and the legs 5932 are coplanar or at least substantially coplanar. The staples 5930 are releasably connected to one another by at least one adhesive.

In addition to the above, each staple cluster 5930' includes one or more guides 5935. The guides 5935 are configured to be received within notches 5925 defined on the lateral sides of the cluster 5930' and within the staple cavities 5921. More specifically, the guides 5935 are closely received by the side walls of the notches 5925 such that there is little, if any, relative lateral movement between the cluster 5930' and the distal head 5920. To this end, the staple cluster 5930' remains aligned with the forming pockets of the anvil when the staples 5930 are deployed. The guides 5935 are comprised of a biocompatible and/or bioabsorbable material, such as, for example, a bioabsorbable polymer, and are implantable with the staples 5930.

121, the stapling instrument 6000 includes, among other things, a shaft, a distal head 6020 including an anvil 6060, and a staple firing system. In this embodiment, the staple firing system loads the staples 6030 into the distal head 6020 and fires them by pressing them against the anvil 6060. The distal head 6020 includes a staple cavity 6021 defined therein that is configured to store and guide the staples 6030 as they are pressed against the anvil 6060.

122-125, the stapling instrument 6100 includes a shaft, a distal head 6120, a staple loading system, a staple firing system, an anvil drive system, a tissue gripping system, and a tissue drive system configured to move the distal head 6120 relative to a patient's tissue. The drive system of the stapling instrument 6100 includes a rotatable foot 6180 configured to grip the patient's tissue and pull the distal head 6120 relative to the tissue, as described above. Also as described above, the tissue gripping system is configured to hold the tissue when the foot 6180 is extended and/or during any suitable time during operation of the surgical instrument 6100. Referring primarily to FIG. 125, the tissue gripping system includes a tissue holder 6170 configured to engage the patient's tissue. The tissue holder 6170 includes a rectangular body 6172 and a stem 6174 extending from the body 6172. The tissue holder 6170 defines a tissue engaging surface 6175 that is smaller than the cross-sectional thickness 6125 of the distal head 6120 shown in FIG. 124. The smaller area of the tissue engaging surface 6175 compared to the cross-sectional thickness 6125 allows the tissue holder 6170 to apply a greater gripping pressure to the patient tissue than the distal head 6120 can apply for a given clamping force. In at least one example, the tissue engaging surface 6175 has an area that is about 25% of the cross-sectional thickness 6125.

126-137, the stapling instrument 6200 includes a shaft, a distal head 6220, a staple firing system 6250, a tissue cutting system, an anvil drive system, and a tissue drive system configured to move the distal head 6220 relative to the patient's tissue. With reference to FIGS. 126 and 127, the tissue drive system includes a rotatable foot 6280 that is moved to an extended position (FIG. 126) and then retracted (FIG. 127) to grasp the patient tissue and move the distal head 6220 relative to the tissue. FIG. 128A also shows one of the feet 6280 in its extended position. The feet 6280 can be simultaneously extended and then retracted to move the distal head 6220 along a linear path, or extended and retracted separately to pivot the distal head 6220, although only one foot 6280 is shown in FIG. 128A for illustrative purposes. FIG. 128, which corresponds to FIG. 128A, illustrates the anvil 6260 in a fully clamped state such that the anvil 6260 and foot 6280 cooperate to grasp patient tissue. Additionally, FIG. 128 illustrates an unformed staple 6230 positioned within a staple cavity 6221 defined in the distal head 6220, and the staple firing system 6250 in an unfired state.

FIG. 129A illustrates the foot 6280 in a retracted position, similar to FIG. 127. FIG. 129, which corresponds to FIG. 129A, illustrates the anvil 6260 in a fully clamped state and the staple firing system 6250 in a fired state. As shown in FIG. 129, the legs 6232 of the staples 6230 are fully deformed into a B-shaped configuration, although other deformed configurations of the staples 6230 may be suitable. Now referring to FIGS. 131 and 133, the staple firing system 6250 includes a firing bar 6255 and a plurality of staples 6230 stored within recesses 6252 defined in a side of the firing bar 6255. A first row of staples 6230 is stored on a first side of the firing bar 6255 and a second row of staples 6230 is stored on a second or opposite side of the firing bar 6255. Each of the recesses 6252 is defined by a proximal staple cradle 6251 positioned therein and configured to compress the base 6231 of the staple 6230. FIG. 134 illustrates two staples 6230 positioned within the staple cavities 6221 defined in the distal head 6220 and the firing bar 6255 of the staple firing system 6250 in an unfired state.

134, the side of the staple cavity 6221 includes a recess 6222 defined therein. The side of the staple cavity 6221 also includes a resistance surface 6223 positioned intermediate the recess 6222. When the firing bar 6255 is pushed distally to fire a first group of staples 6230 positioned within the staple cavity 6221 during a first staple firing stroke, the staples 6230 stored within the firing bar 6255 are pushed by the resistance surface 6223. Referring to FIG. 136, when the firing bar 6255 is retracted after the first firing stroke, the staples 6230 catch on the resistance surface 6223, thereby causing the firing bar 6255 to slide relative to the staples 6230. In such an instance, the staples 6230 will then be aimed at the next distal set of recesses 6252 defined in the firing bar 6255, thereby presenting a new set of staples 6230 that are ejected from the staple cavities 6221. FIGS. 130 and 130A show the surgical instrument 6200 as it is reopened to release the patient tissue so that the distal head 6220 can be repositioned against the patient tissue. With reference to FIG. 137, once the distal head 6220 is properly repositioned, the firing bar 6255 can be advanced distally to perform a second staple firing stroke. This process can be repeated to deploy all of the staples 6230 stored within the firing bar 6255.

The stapling instruments disclosed herein may be configured to deploy staples in any suitable staple pattern. FIG. 138 illustrates one exemplary staple pattern including staples 6330 and staples 6330' positioned on either side of a tissue cut line 6340. Each side of the tissue cut line 6340 includes an inner row of staples 6330 facing away from the cut line 6340 and an outer row of staples 6340 facing toward the cut line 6340. FIG. 139 illustrates another exemplary staple pattern including staples 6330, 6330', and 6430'', with the staples 6430'' arranged in rows on either side of the tissue cut line 6340. More specifically, the staples 6430'' are arranged in a staple row positioned intermediate both the inner row of staples 6330 and the outer row of staples 6330'.

140 and 141, the stapling instrument 6500 comprises a shaft 6510, a distal head 6520, and an articulation joint 6270 rotatably connecting the distal head 6520 to the shaft 6510. The stapling instrument 6500 further comprises a staple feed system 6590 configured to produce and provide a continuous supply of staples 6530 to the distal head 6520. The staple feed system 6590 comprises a spool 6592 operably coupled to an electric motor. The spool 6592 comprises a metal wire 6594 wound around a central core. The wire 6594 is comprised of, for example, stainless steel and/or titanium. The wire 6594 is fed through a passageway 6514 defined in the shaft 6510 and the articulation joint 6570. In use, the motorized spool 6594 pushes the wire 6594 into the distal head 6520. As described in more detail below, the distal head 6520 further comprises a forming mandrel configured to transform the wire 6594 into the staples 6530. The mandrel may be driven by an electric motor and/or actuator, but may be actuated in any suitable manner. As described in more detail below, the distal head 6520 comprises a knife or shearing member configured to cut the wire 6594. The shearing member may be driven by an electric motor and/or actuator, but may be actuated in any suitable manner. Once the staples 6530 have been formed and separated from the wire 6594, the staples 6530 may be deployed and transformed against the anvil 6560 of the stapling instrument 6500.

141, the surgical instrument 6500 further includes a staple forming system 6580 configured to create a staple 6530 from the wire 6594. The staple forming system 6580 includes a forming mandrel 6582 positioned within a forming cavity 6522 defined within the distal head 6520. The staple forming system 6580 further includes a forming actuator 6584 configured to engage the wire 6594 and deform the wire 6594 within the forming cavity 6522. At this point, the forming mandrel 6582 is actuated to cut the staple 6530 from the wire 6594. After the staple 6530 is deployed and/or moved out of the forming cavity 6522, another staple 6530 can be formed within the cavity 6522. In certain alternative embodiments, the wire segments are cut from the metal wire 6594 prior to being formed into the staple 6530. In either case, the staple 6530 may include, for example, a substantially U-shaped configuration. Alternatively, the wire segments may be formed into a substantially V-shaped configuration. Additionally, the stapling instrument 6500 may be configured to produce and deploy any suitable fastener, such as, for example, a tack and/or a clamp.

158 and 159, the stapling instrument 7300 includes a shaft 7310, a distal head 7320, and an articulation joint 7370 that rotatably connects the distal head 7320 to the shaft 7310. In use, the stapling instrument 7300 is inserted into a patient P through a trocar TC. The trocar TC includes a passage extending therethrough that allows the distal head 7320 and a portion of the shaft 7310 to be inserted into the patient. In other examples, the distal head 7320 may be inserted into the patient through an open incision without a trocar. In either case, the stapling instrument 7300 is configured to deploy staples from a staple cartridge inserted therein. The shaft 7310 includes a loading port 7312 that is in communication with a cartridge passage or channel that extends through the shaft 7310, the articulation joint 7370, and the distal head 7320. In use, a staple cartridge, such as staple cartridge 7330', is inserted into the shaft 7310 through the loading port 7312 and then pushed into the distal head 7320. The stapling instrument 7300 further includes a cartridge pusher system configured to push the staple cartridge 7330' into the end effector 7300.

In various examples, further to the above, staple cartridges 7330' may be provided within the stapling instrument 7300 such that the stapling instrument 7300 may be operated continuously without having to be removed from the patient to be reloaded. Each staple cartridge 7330' has staples stored therein having a first size, such as a first unfired height. In certain examples, it is desirable to create a staple line in which the staples all have the same size or unfired height. Such examples may occur when the tissue being stapled has a substantially uniform thickness. In other examples, it is desirable to create a staple line in which the staples have different sizes or unfired heights. Such examples may occur when the tissue being stapled does not have a uniform thickness. For example, gastric tissue that is transected during a gastric reduction procedure does not typically have a consistent thickness. In such an example, a first staple cartridge 7330' can be loaded into the stapling instrument 7300 having staples with a first unfired height and a second staple cartridge 7330'' can be loaded into the stapling instrument 7300 having a second unfired height. The first unfired height can be higher than the second unfired height, but the first unfired height can be lower than the second unfired height. Similarly, a third staple cartridge 7330'' can be loaded into the stapling instrument 7300 having staples with a third unfired height that is different than the first unfired height and the second unfired height.

In addition to the above, more than one staple cartridge may be loaded into the stapling instrument 7300. The staple cartridges may be inserted into the stapling instrument 7300 to be used in a particular order. For example, a staple cartridge having a shorter unfired height may be fired before a staple cartridge having a higher unfired height. Alternatively, a staple cartridge having a higher unfired height may be fired before a staple cartridge having a shorter unfired height. In either case, the most distal staple cartridge is used first and the most proximal staple cartridge is used last. Such a configuration allows for pre-planning of the surgical procedure with little, if any, lost time in loading the stapling instrument 7300 during the surgical procedure. Alternatively, the staple cartridges may be delivered to the stapling instrument 7300 one at a time. Such a configuration provides the clinician with the opportunity to vary the order in which the staple cartridges are ultimately used.

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

Referring primarily to FIG. 159, the stapling instrument 7300 includes a system for stripping a cluster of staples, such as staples 7330, from a distal-most staple cartridge. The stapling instrument 7300 further includes a staple firing system 7350 configured to deploy the staples 7330 and deform the staples 7330 against the anvil 7360 during a staple firing stroke. The stapling instrument 7300 further includes a tissue drive system 7380 configured to move the distal head 7320 against the patient tissue after the staple firing stroke.

168 and 169, the stapling instrument 7900 includes a shaft 7910, a distal head 7920, and an articulation joint 7970 rotatably connecting the distal head 7920 to the shaft 7910. As described in more detail below, the distal head 7920 is pivotable in any suitable direction. As above, the stapling instrument 7900 includes a cartridge feed system configured to feed a staple cartridge 7930' to the distal head 7920 through a cartridge passage 7914 extending through the shaft 7910, the articulation joint 7970, and the distal head 7920. Also as above, the staples 7930 are stripped from the distal-most staple cartridge 7930' and then fired against the anvil 7960. As described in more detail below, the stapling instrument 7900 further includes an articulation drive system 7980 configured to articulate the distal head 7920.

In addition to the above, and referring again to FIGS. 168 and 169, the distal head 7920 is articulatable in several directions relative to the shaft 7910. The shaft 7910 extends along a longitudinal shaft axis LA, and the distal head 7920 extends along a longitudinal head axis HA. The head axis HA is aligned, or at least substantially aligned, with the shaft axis LA when the distal head 7920 is not articulated. When the distal head 7920 is articulated, the head axis HA is transverse to the shaft axis LA. Referring to FIG. 168, the distal head 7920 is articulatable laterally or laterally. In at least one such example, the distal head 7920 is articulatable within a range including, for example, about 15 degrees to a first side of the shaft axis LA and about 15 degrees to a second side of the shaft axis LA. The articulation drive system 7980 is configured to drive or actively articulate the distal head 7920 throughout this range of motion. The articulation drive system 7980 comprises a first lateral drive 7982 mounted to the distal head 7920 and a second lateral drive 7984 mounted to the distal head 7920 on an opposite side of the distal head 7920. In use, to articulate the distal head 7920 in a first direction, the first lateral drive 7982 is pushed and/or the second lateral drive 7984 is pulled. Similarly, to articulate the distal head 7920 in a second direction, the first lateral drive 7982 is pulled and/or the second lateral drive 7984 is pushed. In at least one example, the first lateral drive 7982 comprises a first guidewire and the second lateral drive 7984 comprises a second guidewire. Such guidewires are suitable for pulling the distal head 7920.

169, the distal head 7920 is also articulatable in a forward and/or rearward direction. In at least one such example, the distal head 7920 is articulatable within a range including, for example, about 25 degrees in the rearward direction and about 25 degrees in the forward direction. In certain embodiments, not shown, the articulation drive system 7980 is configured to actively articulate the distal head 7920 in the forward and rearward (FIG. 169) directions. In alternative embodiments, the distal head 7920 may be passively articulated in the forward and rearward directions. In such embodiments, the stapling instrument 7900 does not actively drive the distal head 7920 relative to the shaft 7910. Instead, the distal head 7920 may float in the anterior-posterior direction. Similarly, the distal head 7920 may be passively articulated in a lateral direction with or without the articulation drive system 7980. In either case, the distal head 7920 can articulate in both the anterior-posterior and lateral planes and can form a compound angle with respect to the longitudinal axis LA of the shaft 7910.

In various embodiments, the surgical instrument 7900 can include a lock configured to hold the distal head 7920 in place that can be released to allow the distal head 7920 to move relative to the shaft 7910. In various examples, the distal head 7920 can be passively articulated by pushing the distal head 7920 against patient tissue within the surgical site when the distal head 7920 is unlocked. The distal head 7920 can also be actively articulated when the distal head 7920 is unlocked. In either case, once the distal head 7920 is properly positioned, the distal head 7920 can be locked in its articulated position. To return the distal head 7920 to its non-articulated position, the distal head 7920 can be unlocked and then realigned with the shaft axis LA. In at least one example, the stapling instrument 7900 includes one or more springs configured to bias the distal head 7920 toward its non-articulated position. In any case, the articulation lock can prevent or at least inhibit back-driving of the distal head 7920 in response to external and/or internal forces and torques.

In addition to the above, the articulation joint 7970 of the stapling instrument 7000 allows the distal head 7920 to be articulated about one or more axes. In various alternative embodiments, the shaft of the stapling instrument includes a first articulation joint that allows the distal head to be articulated about a first articulation axis and a second articulation joint that allows the distal head to be articulated about a second articulation axis. The first articulation axis and the second articulation axis extend in orthogonal planes, but may extend in any suitable transverse plane. In various examples, the first and second articulation joints are passively articulated. In some examples, the first and second articulation joints are actively articulated. In at least one example, the first articulation joint is actively articulated and the second articulation joint is passively articulated.

170, the stapling instrument 8000 includes a dampening system 8080 configured to control or slow down the articulation of the distal head 7920. The dampening system 8080 includes a first link 8082, a second link 8084, and a dashpot 8085. The first link 8082 is pinned to the distal head 7920 at a pivot 8081. The first link 8082 is also pinned to the second link 8084 at a pivot 8083. The pivots 8081 and 8083 allow the dampening system 8080 to accommodate various articulation motions of the distal head 7920. The dashpot 8085 includes a housing 8087 attached to the shaft 7910 and a dampening medium 8088 contained in a chamber defined within the housing 8087. The second link 8084 includes a piston 8086 defined on its proximal end, the piston being positioned within the housing opening and configured to move through the dampening medium 8088 when the distal head 7920 is articulated. The dampening medium 8088 flows through and/or around the piston 8086, thereby allowing but slowing relative movement between the piston 8086 and the housing 8097. Correspondingly, the dampening medium 8088 allows but slows movement of the distal head 7920 relative to the shaft 7910. Sudden movement of the distal head 7920 can be difficult for a clinician to control and/or predict and may result in the distal head 7920 impacting patient tissue. The dampening medium 8088 may include any suitable medium, such as, for example, a dampening grease.

171, the stapling instrument 8100 includes a dampening system 8180 configured to control or slow down the articulation of the distal head 7920. The dampening system 8180 includes a link 8182 and a dashpot 8185. The link 8182 is pinned to the distal head 7920 at a pivot 8181. The first link 8082 is flexible, thereby allowing the dampening system 8180 to accommodate various articulation motions of the distal head 7920. The dashpot 8185 includes a housing 8187 rotatably mounted to the shaft 7910 and a dampening medium 8188 housed in a chamber defined within the housing 8187. The link 8182 includes a piston 8186 defined on a proximal end thereof, the piston being positioned within the housing opening and configured to move through the dampening medium 8188 when the distal head 7920 is articulated. The buffering medium 8188 flows through and/or around the piston 8186, thereby allowing but slowing relative movement between 8186 and the housing 8197. Correspondingly, the buffering medium 8188 allows but slows movement of the distal head 7920 relative to the shaft 7910. Sudden movement of the distal head 7920 can be difficult for a clinician to control and/or predict and may result in the distal head 7920 impacting patient tissue. The buffering medium 8188 may include any suitable medium, such as, for example, a buffering grease.

172, the stapling instrument 8100 can be inserted into the patient P through a trocar TC and moved relative to the target tissue T. The trocar TC can be moved relative to the patient P to a certain extent, and the stapling instrument 8100 can be moved relative to the trocar TC to a certain extent. However, such movement can cause the shaft 7910 to move through a wide range of angles. To keep the distal head 7920 aligned with the tissue as it is advanced along the staple line, the distal head 7920 can be articulated, for example, rearwardly in an incremental manner. With reference to FIG. 173, the distal head 7920 can be articulated forward and/or rearward in an incremental manner to keep the axis of the distal head 7920 perpendicular, or at least substantially perpendicular, to the target tissue T. In various examples, the distal head 7920 is actively articulated by an articulation drive system to adjust the angle between the distal head 7920 and the shaft 7910. In certain instances, the distal head 7920 is passively articulated by an articulation drive system to adjust the angle between the distal head 7920 and the shaft 7910. In such instances, the distal head 7920 can adaptively float to follow the staple firing path.

34 and 35, the stapling instrument 2500 includes a shaft 2510, a distal head 2520, and an articulation joint 2570 rotatably connecting the distal head 2520 to the shaft 2510. The shaft 2510 extends along a longitudinal shaft axis LA, and the distal head 2520 extends along a longitudinal head axis HA. The shaft axis LA and the head axis HA are aligned when the distal head 2520 is not articulated, as shown in FIG. 34. With reference to FIG. 35, the head axis HA is transverse to the shaft axis LA when the distal head 2520 is articulated. The stapling instrument 2500 further includes a dampening system 2580 configured to control or slow the articulation of the distal head 2520. The dampening system 2580 includes a first link 2581, a second link 2582, and a dashpot 2585. The first link 2581 is pinned to the distal head 2520 at a pivot 2584. The first link 2581 is also pinned to the second link 2582 at a pivot 2583. The pivots 2583 and 2584 allow the dampening system 2580 to accommodate various articulation motions of the distal head 2520. With reference to FIG. 34, when the distal head 2520 is not articulated, the first link 2581 is aligned with the second link 2582 along the longitudinal axis. With reference to FIG. 35, when the distal head 2520 is articulated, the first link 2581 traverses relative to the second link 2582.

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

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

In addition to the above, the stapling instrument 2000 includes a staple firing system configured to apply a staple line to the patient's tissue, and the display 2130 includes controls for evaluating the status of the staple firing system. The display 2130 also includes controls for evaluating and/or changing, for example, the speed at which the stapling instrument 2000 is applying the staple line, the direction in which the staple line is being applied, and/or any performance thresholds that have been met, exceeded, or are about to be exceeded. The display 2130 includes a capacitive touch screen, although any suitable screen may be used.

14, the display 2130 includes a status control 2140. The status control 2140 includes a window 2141 that includes a window header 2142. The status control 2140 further includes an image window 2145 that is configured to display information about the tissue being stapled, the staple firing path, and/or any other information that the clinician may use to operate the stapling instrument 2000. For example, the image window 2145 is configured to display the staple firing path 2143 along which the stapling instrument 2100 is currently moving, and/or an alternative staple firing path 2143' that guides the staple path around a particular anatomical feature in the patient tissue T, such as a blood vessel V. The status control 2140 is a digital control and/or display that is in signal communication with the controller of the stapling instrument 2000.

17, the display 2130 further comprises a direction control 2190 configured to control the direction of the staple firing path. The direction control 2190 comprises a window 2191 including a window header 2192 and an image window 2195. The image window 2195 is configured to display the orientation of the distal head of the stapling instrument relative to an original starting orientation. The image window 2195 includes a plurality of orientation lines 2194 indicating specific direction angles, such as 15 degrees, 30 degrees, and 45 degrees, relative to a starting orientation line 2194 bounded as 0 degrees. The image window 2195 further comprises a needle 2193 representing the orientation of the distal head of the stapling instrument relative to the starting direction of the stapling instrument. The direction control 2190 further comprises an edit window 2198 which, when activated, allows the user to modify the direction of the staple path by manipulating the needle 2193. The orientation control 2190 further includes a save window 2199 which, when activated, allows the user to save the input provided to the controller through the orientation control 2190. At such time, the stapling instrument 2000 can move along its new orientation. The status control 2190 is a digital control and/or display in signal communication with the controller of the stapling instrument 2000.

15, the display 2130 further comprises a speed control 2150 configured to control the speed at which the stapling instrument 2000 forms a staple path. The speed control 2150 comprises a window 2151 including a window header 2152 and an image window 2155. The image window 2155 comprises an indicator 2153 configured to display the speed of the stapling instrument. For example, the indicator 2153 can display the number of staple firing strokes performed by the stapling instrument 2000 per minute. The image window 2155 further comprises an up arrow control 2156 operable to increase the speed of the staple firing strokes and a down arrow control 2157 operable to decrease the speed of the staple firing strokes. The indicator 2153 can be configured to display the speed at which the stapling instrument 2000 is being propelled through the patient tissue by the tissue drive system. Other metrics related to the speed of the stapling instrument 2000 can also be used and displayed. The status control 2150 is a digital control and/or display that is in signal communication with the controller of the stapling instrument 2000.

16, the display 2130 further includes a fault threshold control 2180 configured to manage fault thresholds of the stapling instrument 2000 when they occur. For example, a threshold of the force required to perform a staple firing stroke may be used to establish a fault condition requiring input from a user. If the force required to perform a staple firing stroke exceeds the threshold, the controller of the stapling instrument 2000 may alert the user via the fault threshold control 2180 and/or stop the stapling instrument 2000. Certain faults may be overridden or otherwise managed by the user to allow the stapling instrument 2000 to continue applying the staple line. The fault threshold control 2180 allows the user to manage these faults. Other faults may not be overridden. In such an example, the fault threshold control 2180 is configured to indicate to the user that the fault may not be overridden and/or how to resolve the fault to allow operation of the stapling instrument 2000 to continue. The failure threshold control 2180 includes a window 2181 that includes a window header 2182 and an image window 2185. The failure threshold control 2180 is a digital control and/or display and is in signal communication with the controller of the stapling instrument 2000.

18, the stapling instrument 2000 further comprises a visual capture system, discussed in more detail below, and the display 2130 further comprises an image window 2135 configured to display, among other things, a real-time video image from the visual capture system. The display 2130 further comprises a menu 2131 extending along the left side of the image window 2135, although the menu 2131 may be located in any suitable location on the display 2130. The menu 2131 includes a status control 2140, a speed control 2150, a fault threshold control 2180, and a direction control 2190 as described above. The menu 2131 also includes a settings control 2132 that may be used to select and/or reconfigure windows and/or controls on the display 2130. The menu 2131 further includes a stop control 2136 that may immediately stop the progression of the stapling instrument 2100 along the staple firing path. The menu 2131 is a digital control and/or display that is in signal communication with the controller of the stapling instrument 2100.

In addition to the above, and referring again to FIG. 18, the display 2130 further includes a first view window 2133 and a second view window 2134. The view windows 2133 and 2134 are positioned along the right side of the image window 2135, but may be located in any suitable location on the display 2130. The view windows 2133 and 2134 provide the user with alternative views of the stapling instrument 2000. For example, the first view window 2133 provides the user with a side view of the stapling instrument 2000 at the surgical site, and the second view window 2134 provides the user with a top view of the stapling instrument 2000 at the surgical site. These additional views may be provided by one or more digital cameras on the stapling instrument 2000 and/or from other surgical instruments, such as, for example, an endoscope within the surgical site. In such an example, the other surgical instruments are in signal communication with the controller of the stapling instrument 2000 to provide these additional images. In certain examples, the controller of the stapling instrument 2000 can interpret the data provided to the controller and generate additional images in windows 2133 and 2134 based on the data provided to the controller.

As discussed above, the speed at which the staple firing system and/or tissue drive system of the stapling instrument 2000 are operated may be controlled by a speed control 2150 on the display 2130. As discussed above, in various examples, the speed may be controlled manually or by input from a user. In other examples, the controller of the stapling instrument 2000 may automatically control the speed. In such examples, the controller may be configured to evaluate characteristics of the tissue being stapled, such as, for example, thickness and/or density, and adjust the speed of the staple firing system and/or tissue drive system accordingly. For example, if the controller determines that the tissue being stapled is thick, i.e., near, at, or above a tissue thickness threshold, the controller may slow down the speed of the stapling instrument 2000. Similarly, if the controller determines that the tissue being stapled is dense, i.e., near, at, or above a tissue density threshold, the controller may slow down the speed of the stapling instrument 2000. Correspondingly, the controller may increase the speed of the stapling instrument 2000 if the controller determines that the tissue being stapled is, for example, thin or less dense than normal. In addition to the above, and with reference to FIG. 19, the speed control 2150 of the stapling instrument 2000 includes an option for the user to select between an automatic speed control 2158, in which the stapling instrument 2000 controls the speed of the stapling instrument 2000, and a manual speed control 2159, in which the user controls the speed of the stapling instrument 2000.

20, the stapling instrument 2200 includes a display 2230. The stapling instrument 2200 is similar in many respects to the stapling instrument 2000, and the display 2230 is similar in many respects to the display 2130, most of which are not discussed herein for the sake of brevity. The display 2230 includes a menu 2231 and a central image window 2235. The central image window 2235 displays an image of the patient tissue T being stapled, and a staple firing path 2243 along which the stapling instrument 2200 is traveling. The staple firing path 2243 is displayed as a series of actuations, or staple firings 2244. Each projected actuation 2244 indicates the path along which the tissue T is incised, and the location relative to the tissue incision where a staple cluster 2245 is deployed within the tissue T. The projected actuations 2244 closest to the distal head of the stapling instrument 2200 are highlighted relative to the other projected actuations 2244 so that a user can distinguish between the next staple firing and subsequent projected staple firings. Such highlighting may include, for example, different colors and/or color intensities of the projected actuations 2244. In at least one example, the displayed actuations 2244 of the staple firing path 2243 may be progressively less highlighted as they move away from the distal head of the stapling instrument 2200.

In addition to the above, the display 2230 is further configured to display one or more alternative staple firing paths. For example, the display 2230 is configured to display the alternative staple firing path 2243' in the central image window 2235. Similar to the staple firing path 2243, the staple firing path 2243' is displayed as a series of actuations, i.e., staple firings 2244'. Each projected actuation 2244' indicates the path along which the tissue T is cut and the location where the staple cluster 2245 is deployed within the tissue T. The menu 2231 includes a staple line control 2240 that can be operated by a user of the stapling instrument 2200 to edit the staple firing path 2243 to create an alternative staple firing path 2243'. Once the alternative staple firing path 2243' has been established, it can be saved and the stapling instrument 2200 can be operated to follow the alternative staple firing path 2243'. As shown in FIG. 20, the staple line control 2240 includes an operable edit subcontrol 2241 and an operable save subcontrol 2242 for modifying and saving the staple firing path as described above.

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

As described above, the display 2230 can be configured to display a current or intended staple firing path and one or more alternative staple firing paths. The controller of the stapling instrument 2200 is configured to generate one or more alternative staple firing paths and display these alternative staple firing paths on the display 2230. In various examples, the controller can determine the alternative staple firing path based on one or more attributes of the tissue T being stapled. For example, the controller can identify a blood vessel within the tissue T and provide or suggest an alternative staple firing path that directs the stapling instrument 2200 around the blood vessel.

22, the display 2230 includes a menu including a plurality of controls configured to modify a staple firing path while the stapling instrument 2200 is deploying a staple path and/or after the stapling instrument 2200 is stopped. The display 2230 includes a menu 2231 including a plurality of actuatable controls configured to be used while the stapling instrument 2200 is performing its series of staple firing strokes to generate a staple path. The menu 2231 includes, for example, a view control 2232 for changing the video image displayed in the central image window 2235. In at least one such example, the video control can be used to toggle between different video feeds. The menu 2231 further includes the staple line 2240 control described above, configured to modify the staple firing path. The staple firing system of the stapling instrument 2200 can be started by a user activating a staple control 2234 in the menu 2231 and stopped by a user activating a stop control 2236 in the menu 2231.

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

147-150, the stapling instrument 7000 includes a handle 7010 including a grip 7020 and a shaft assembly 1200 assembled to the handle 7010. The handle 7010 further includes a display 7030 rotatably mounted to the handle 7010 about a rotary joint 7035. The display 7030 is similar to the display 2230 in many respects, most of which are not discussed herein for the sake of brevity. In use, the display 7030 can be rotated relative to the handle 7010 to maintain a preferred orientation of the display 7030 relative to the clinician C and/or any other frame of reference.

FIG. 180 illustrates a handle 1500 of a surgical instrument 100 used by a clinician during a surgical procedure. The handle 1500 includes a central portion 110 bounded by one or more ergonomic grips 120 to facilitate handling of the surgical instrument 100 by the clinician. Each ergonomic grip 120 is configured to fit within the clinician's hand for improved control and comfort. The handle 1500 includes one or more interactive controls 180 configured to provide navigational commands to an end effector of the surgical instrument 100. In various examples, the one or more interactive controls 180 are configured to provide user commands corresponding to the selection of one or more items. The interactive controls 180 are positioned on the handle 1500 in a location that allows for easy manipulation by the clinician, such as within reach of the clinician's thumb. In various examples, the controls 180 are comprised of, for example, various types of switches and/or buttons. In various examples, the interactive controls 180 include toggle switches, analog sticks, rockers, D-pads, and/or any other suitable interactive controls capable of facilitating communication of user commands to a controller of the surgical instrument 100, for example.

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

To create a sterile environment for the surgical instrument 100, a sterile barrier 190 is draped over the handle 1500, as shown in FIG. 181. As described in more detail below, the sterile barrier 190 is constructed of a transparent, resilient material, such as, for example, plastic. The sterile barrier 190 extends around the handle 1500 and over the proximal portion of the shaft 200. The sterile barrier 190 includes one or more preformed regions 192 configured to fit over the interactive control 180. The preformed regions 192 aid in aligning the sterile barrier 190 over the handle 1500 of the surgical instrument 100. The sterile barrier 190 is stretched over the touch-sensitive display 1510 to create a smooth, uniform barrier, or at least a substantially smooth, uniform barrier. Attachment members 194, such as, for example, clips, secure the sterile barrier 190 in place around the periphery 193 of the touch-sensitive display 1510. The sterility barrier 190 fits loosely around the remaining components of the handle 1500, and the sterility barrier 190 is tightened around the shaft 200 of the surgical instrument 100, although any suitable configuration may be used. For example, by covering the handle 1500 with the sterility barrier 190, the various components of the handle 1500 are protected from exposure to bodily fluids and/or contaminants. Laying the sterility barrier 190 over the handle 1500 and the proximal portion of the shaft 200 also provides a cost-effective and rapid means for sterilizing and reusing the handle 1500 of the surgical instrument 100.

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

Conductive particles 191 are dispersed throughout the sterile barrier 190, giving it a particular capacitance. The sensing mechanism 1513 of the touch-sensitive display assembly 500 comprises a plurality of pixels 1515 and a material, such as, for example, indium tin oxide, configured to form electrodes. As discussed in more detail with respect to FIG. 183, in various examples, the electrodes are configured as an orthogonal grid, although any suitable configuration may be used. In particular, the sensing mechanism 1513 is configured to detect that the sterile barrier 190 has been attached. More specifically, the sensing mechanism 1513 detects the attachment of the sterile barrier 190 by the particular capacitance of the sterile barrier 190. When the clinician desires to utilize the functionality of the touch-sensitive display 1510, the input device 1530 is contacted with the sterile barrier 190 at a desired contact point, as described above. The sensing mechanism 1513 is configured to detect the additional capacitance of the input device 1530 and distinguish the capacitance of the input device 1530 from the capacitance of the sterile barrier 190. Furthermore, when the input device 1530 is contacted with the sterile barrier 190, the conductive particles 191 of the sterile barrier 190 are compressed or brought closer together. Such compression creates a higher density of conductive particles 191 in the area surrounding the contact point of the input device 1530, thus resulting in a higher capacitance. The change in charge at the contact point in the sensing mechanism 1513 causes the pixels 1515 of the sensing mechanism 1513 to be activated or energized near the contact point.

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

FIG. 183 illustrates the touch-sensitive display 1510 of FIG. 182 when an input device 1530 contacts the sterility barrier 190 of the touch-sensitive display assembly 500. As discussed above, in various examples, the electrodes are arranged as an orthogonal grid, although any suitable configuration may be used. In such examples, the electrodes include x-electrodes 1542 and y-electrodes 1544. The touch-sensitive display 1510 includes a plurality of pixels 1515 arranged uniformly or nearly uniformly across the sensing mechanism 1513, although any suitable configuration may be used. FIG. 183 further illustrates various groupings of activated pixel clusters 1517 and 1519. During its inactivated state, a low level of capacitance exists across all of the pixels 1515 (FIG. 182) in the touch-sensitive display 1510. When an input member 1530 (FIG. 182) contacts the sterility barrier 190 and activates the touch-sensitive display 1510, the pixels 1515 associated with pixel clusters 1517 and 1519 are activated with a new, higher capacitance. Pixels 1515 within pixel clusters 1517 and 1519 are activated as the input device 1530 continues to contact the sterility barrier 190. A sensing mechanism 1513 detects the location of the active pixel clusters 1517, 1519 by scanning a matrix of x-electrodes 1542 and y-electrodes 1544.

FIG. 184 shows a graphical representation 1550 of the relationship between the location of an active pixel cluster within the x-electrodes 1542 of the touch-sensitive display 1510 and the capacitance detected by the sensing mechanism 1513. A first capacitance _C1 represents a low level or non-activated capacitance present across the pixels 1515 of the touch-sensitive display 1510 prior to application of the sterility barrier 190. For reference, capacitance _C0 represents a detected capacitance that is zero, and capacitance _C1 represents a capacitance above zero. A second capacitance _C2 represents a threshold capacitance. Upon exceeding the threshold capacitance _C2 , the surgical instrument 100 recognizes that the sterility barrier 190 is attached to the touch-sensitive display 1510. In the graphical representation 1550, when the detected capacitance is above the threshold capacitance _C2 , the sterility barrier 190 is attached to the touch-sensitive display 1510. A third capacitance _C3 represents another threshold capacitance. When the sensing mechanism 1513 detects a capacitance that exceeds the threshold capacitance _C3 , the surgical instrument 100 recognizes that the input device 1530 is in contact with the sterile barrier 190. In the graphical representation 1550, when the detected capacitance exceeds the threshold capacitance _C3 by two, the input device 1530 is in contact with the sterile barrier 190 in two locations. When the input device 1530 is removed from the sterile barrier 190, the capacitance detected by the pixels 1515 in clusters 1517 and 1519 returns to a capacitance that is less than _C3 but greater than or equal to _C2 . When the sterile barrier 190 is removed from the touch-sensitive display 1510, the capacitance detected by the pixels 1515 in clusters 1517 and 1519 returns to a capacitance that is less than _C2 but greater than or equal to _C1 .

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

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

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

26 and 27, while the stapling instrument 2400 is paused or not firing staples, the joystick 2450 can be used to modify the staple firing path of the stapling instrument 2400. The joystick 2450 can also be used by the clinician to steer the stapling instrument 2400 in real time while the stapling instrument 2400 is firing staples. In various examples, at least a portion of the stapling instrument 2400 is visible on the display 2430 to assist the user in steering the stapling instrument 2400. For example, the shaft 2410 of the stapling instrument 2400 is visible in the video display 2435. In various examples, a graphically generated representation of the stapling instrument 2400 can be presented in one or more windows of the display 2430. By way of example, the shaft 2410 and/or the distal head 2420 of the stapling instrument 2400 may be depicted, for example, in windows 2133 and 2134.

As discussed above, and referring now to FIG. 23, the stapling instrument 2100 includes a handle 2110 including a grip 2120 and a display 2130 mounted to the handle 2110. The display 2130 may include any suitable configuration, although the size of the display 2130 may be limited by the spatial constraints of the handle 2110. In various examples, the stapling instrument 2100 may be part of a surgical system 2300 that includes an off-board display 2330 in addition to or instead of the on-board display 2130. A controller of the stapling instrument 2100 is in signal communication with the displays 2130 and 2330. The controller is in wireless communication with the off-board display 2330, but may also be in wired communication with the display 2330. In either case, the controller is configured to provide the same information to the displays 2130 and 2330. However, the displays 2130 and 2330 may be configured to organize this information in different ways due to their different sizes and/or shapes. In other examples, one of displays 2130 and 2330 may display more information than the other. In at least one such example, off-board display 2330 may display more information than on-board display 2130, for example, because of its larger size.

In addition to the above, the on-board display 2130 includes a touch screen, but may be operated by controls located on the handle 2110. Similarly, the off-board display 2330 also includes a touch screen, but may be operated by other controls. As above, the touch screens of the displays 2130 and 2330 may be used to manipulate the staple firing path of the stapling instrument 2100. In various examples, the clinician may touch the touch screen with, for example, their finger, and drag the staple firing path of the stapling instrument 2100 to a new position. In other examples, a tool, such as, for example, a stylus, may be used to touch the touch screen and manipulate the staple firing path. Additionally, both displays 2130 and 2330 are configured to control any other operation of the stapling instrument 2100.

When a first overlay or layer is modified on one of the displays 2130 and 2330, the controller of the stapling instrument 2100 modifies the first overlay on the other display. Similarly, when a second overlay or layer is modified on one of the displays 2130 and 2330, the controller of the stapling instrument 2100 modifies the second overlay on the other display. Furthermore, a user of the stapling instrument 2100 can modify one overlay or layer on a display without modifying another overlay or layer on that display or any display.

While the staple firing path and/or other images projected in the on-board and off-board displays described above are very helpful in generating a desired staple firing path, the stapling instrument may include one or more projectors configured to display images on the patient tissue that may assist a user of the stapling instrument in generating a desired staple firing path. With reference to FIGS. 160 and 161, a stapling instrument 7400 includes a shaft 7410, a distal head 7420, and a projector 7490 mounted to the distal head 7420. In at least one example, the projector 7490 is clamped to the distal head 7420. The projector 7490 is configured to project an image I onto the stomach S of the patient P. The projector 7490 is sized and configured to be inserted into the patient through a trocar TC, but may also be inserted into the patient through an open incision. The projector 7490 is positioned proximally relative to the anvil 7460 of the distal head 7420, but distally relative to the articulation joint that rotatably connects the distal head 7420 to the shaft 7410. As a result, the projector 7490 and the image it projects move with the distal head 7420.

162, the stapling instrument 7500 comprises a shaft 7510, a distal head 7520, and an articulation joint 7570 rotatably connecting the distal head 7520 to the shaft 7510. The stapling instrument 7500 further comprises a projector 7590 extending parallel to the shaft 7510. The projector 7590 comprises a flexible tube attached to the shaft 7510 and the distal head 7520 and configured to bend when the distal head 7520 is articulated. As a result, the image I projected by the projector 7590 tracks the orientation of the distal head 7520 and can be projected distally relative to the anvil 7560 of the stapling instrument 7500. Although the projector 7590 has one lens and is configured to project one image I, various alternative embodiments are envisioned in which the projector includes more than one lens and/or is capable of projecting more than one image onto the patient tissue.

160, the projector 7490 includes a first lens 7492 and a second lens 7494. The first lens 7492 and the second lens 7494 are in signal communication with a controller of the stapling instrument 7400 and are configured to project at least one image onto the patient tissue. In certain examples, the first lens 7492 and the second lens 7494 project the same image. The first lens 7492 and the second lens 7494 are fixedly mounted within the projector 7490 to project an image at a common focal point, although the lenses can also project the image(s) at different focal points. In various embodiments, the orientation of the first lens 7492 and/or the orientation of the second lens 7494 can be adjusted to modify the focal point. In at least one such embodiment, the projector 7490 includes a first motorized actuator system for changing the orientation of the first lens 7492 and a second motorized actuator system for changing the orientation of the second lens 7494.

In certain examples, further to the above, the first lens 7492 of the projector 7490 may be configured to project a first image onto the patient tissue and the second lens 7494 may be configured to project a second, or different, image onto the patient tissue. The controller of the stapling instrument 7400 is configured to provide, modify, and/or correct the images projected by the first lens 7492 and/or the second lens 7494. In various examples, the images projected by the first lens 7492 and the second lens 7494 can present a two-dimensional image onto the patient tissue. In other examples, the images projected by the first lens 7492 and the second lens 7494 can present a three-dimensional image onto the patient tissue. Projecting a three-dimensional image may be facilitated by the lenses 7492 and 7494 being oriented or oriented in different directions.

165, the stapling instrument 7700 includes a distal head 7720 disposed on a first side of the patient tissue T and an anvil 7760 disposed on a second side of the patient tissue T. As with other stapling instruments disclosed herein, the stapling instrument 7700 is configured to deploy staples 7730 into the tissue T and incise the tissue T along an incision 7740 during a series of staple firing strokes. The stapling instrument 7700 further includes a projector 7770 configured to project an image I onto the tissue T. Image I of FIG. 165 represents the location of the next firing stroke including two lateral regions where the staple clusters will be applied. With reference to FIG. 166, the image projected by the projector 7770 includes lines designating a staple firing path FP and/or lines designating an alternative staple firing path FP'. The lines may be, for example, solid and/or dashed lines. The lines may be the same color or different colors.

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

167 , the stapling instrument 7800 includes a distal head 7820 disposed on a first side of the patient tissue T and an anvil 7860 disposed on a second side of the patient tissue T. Similar to other stapling instruments disclosed herein, the stapling instrument 7800 is configured to deploy staples 7830 into the tissue T and incise the tissue T along an incision 7840 during a series of staple firing strokes. The stapling instrument 7800 further includes a projector 7870 including a first lens 7872 and a second lens 7874. The first lens 7872 is configured to project a first image I ₁ onto the patient tissue T and the second lens 7874 is configured to project a second image I ₂ onto the patient tissue T. The image I ₁ depicts the location of the next staple cluster and the image I ₂ depicts the cutting path of the stapling instrument 7800, although any suitable image may be projected. Images _I1 and _I2 may for example be solid and/or dashed lines. Image _I1 may be of the same color as image _I2 or of a different color.

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

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

Additionally, the projector 7690 and/or any of the projectors disclosed herein may be configured to emit light at any suitable wavelength. In various examples, the projector 7690 may emit, for example, visible, infrared, and/or ultraviolet light. Visible light, among other things, may be useful for a clinician to see the color of tissue as it reflects off the tissue. Red or pink tissue may indicate vascularized healthy tissue, while dark or black tissue may indicate unhealthy tissue. Additionally, the camera system 7670 may be configured to capture, for example, visible, infrared, and/or ultraviolet light. Infrared light may indicate the presence of heat, for example, from large blood vessels. Ultraviolet light may indicate the presence of blood or bleeding, for example. Additionally or alternatively, the projector may be configured to emit sonic, subsonic, and/or ultrasonic waves, and the surgical instrument may include one or more acoustic sensors configured to detect waves reflecting off the patient tissue and generate data that may be used by the controller to generate a three-dimensional profile of the patient tissue.

142, the stapling instruments described herein are configured to repeatedly fire staples into a patient's tissue, such as, for example, the patient's stomach S. Many of the stapling instruments disclosed herein are self-driven, self-propelled, and/or self-steered in that they are sufficiently motorized to follow and propel themselves along a desired or modified staple firing path FP during firing of a staple, such as, for example, staple 6630, into the patient's tissue. Staples are continuously ejected from the stapling instrument as it moves along the staple firing path FP. In various examples, the staple firing system of the stapling instrument enters a pause between staple firing strokes while the stapling instrument is moved along the staple firing path. However, such a pause is part of the continuous motion of the stapling instrument. As mentioned above, and with reference to FIG. 143, many of the stapling instruments described herein are configured to deploy a cluster of staples, such as, for example, staple cluster 6630', during each staple firing stroke. While such staple clusters may include any suitable number of staples, each of the staple clusters 6630' shown in FIG. 143 includes three staples 6630 and is deployed on either side of the tissue incision 6640. In at least one exemplary embodiment, seven staple clusters 6630' are deployed on each side of the tissue incision 6640 for every inch of the staple firing path. In such an embodiment, 42 staples are deployed per inch, although any suitable number may be used. The stapling instrument can continue to deploy staples along the staple firing path without the need to remove the stapling instrument from the patient as long as there are staples within the stapling instrument. In at least one example, the stapling instrument can be used for, for example, 84-98 firings before needing to be reloaded. Such firings may deploy between, for example, 504-588 staples.

In addition to the above, many of the stapling instruments disclosed herein may pivot at least partially during staple firing. As a result, such stapling instruments may follow complex and/or non-linear staple firing paths. With reference to FIG. 174, conventional stapling instruments have been configured to deploy a linear staple line portion 8230' comprised of staples 8230, for example. To pivot the staple line in tissue, an overlap region 8235' in the staple line portion 8230' was formed. Such a configuration resulted in the formation of a high density of staples 8230 in the overlap region 8235', thereby causing a high degree of compression of the tissue in the overlap region 8235'. Furthermore, the overlap region 8235' represents a sharp turn in the staple firing path that may form a potential leak path in the staple line. With reference to FIG. 175, the stapling instruments disclosed herein may pivot after each firing stroke, allowing for a more gradual pivot. For example, the stapling instrument can pivot after deploying each staple cluster 7930' and can do so without causing overlap between the staple clusters 7930'.

The stapling instruments disclosed herein may be used to perform any suitable surgical procedure. For example, with reference to FIG. 179, the stapling instruments disclosed herein may be used during a gastric bypass procedure to create a stomach pocket SP, thereby effectively reducing the size of the patient's stomach S. In accordance with the stapling instrument system disclosed herein, these stapling instruments may create a curved staple path 7930' that creates a curved stomach pocket SP. With reference to FIG. 178, conventional stapling instruments have produced staple paths that include straight portions 8230' that create a square stomach pocket SP, or a stomach pocket SP with right-angled corners. The curved stomach pocket SP created by the stapling instruments disclosed herein is believed to have less leakage than the straight stomach pocket SP created by conventional stapling instruments.

177, as described in more detail herein, the stapling instruments disclosed herein may be used during a gastric reduction procedure to create a gastric sleeve SS, thereby effectively reducing the size of the patient's stomach S. In accordance with the stapling instrument system disclosed herein, these stapling instruments may create a curved staple path 7930' that creates a curved gastric sleeve SS. Referring to FIG. 176, conventional stapling instruments create a straight gastric sleeve SS, or a staple path that includes a straight portion 8230' that creates a gastric sleeve SS with a right angle corner 8235'. The curved gastric sleeve SS created by the stapling instruments disclosed herein is believed to have less leakage than the straight gastric sleeve SS created by conventional stapling instruments. Further details for creating the gastric sleeve SS are shown in FIG. 151, where a staple firing path FP is used to sever the gastric sleeve SS from the patient's stomach S.

In addition to the above, gastric bypass and gastric sleeve procedures aid in weight loss and are used to treat severe obesity. Both procedures work to significantly reduce the size of the stomach to restrict food intake. Gastric bypass involves creating a small section within the stomach to receive food and block the rest of the stomach. Among other things, restricting the size of the stomach serves to limit the amount of fat and calories absorbed into the patient's body. Gastric bypass creates a direct pathway from a small section of the stomach to the lower intestine. In such cases, this direct pathway results in eliminating the use of the upper intestine in digestion.

The gastric sleeve procedure involves creating a sleeve-like pathway from the esophagus through the stomach to the upper intestine. Laparoscopic sleeve gastrectomy (LSG) is a type of gastric sleeve procedure that involves transecting and sealing a large portion of the stomach to create a small gastric reservoir or pocket. Unlike gastric bypass procedures, it has been found that the LSG procedure does not cause a decrease in nutrient absorption and/or preclude the use of any portion of the intestine. However, the LSG procedure still functions to significantly reduce the size of the patient's stomach. In such LSG procedures, a long, thin, flexible member, or bougie, may be used as a measurement tool. More specifically, the bougie may be used to determine or define the size and shape of the stomach that will become the gastric sleeve upon completion of the LSG procedure. A bougie B is shown in FIGS. 30 and 32. Bougies are manufactured in a variety of sizes to accommodate different stomach sizes. The appropriate size of the bougie is often determined based on the size of the stomach and the expected size of the gastric sleeve. During the first step of the LSG procedure, the surgeon inserts the bougie through the patient's mouth, down the esophagus, through the esophageal sphincter, and finally into the patient's stomach. Once the bougie reaches the patient's stomach, it is positioned so that the end of the bougie reaches the pyloric canal, which is the lower region of the stomach that connects to the pylorus.

FIG. 28 illustrates various portions of the stomach anatomy that are involved during various steps of the LSG procedure. Specifically, FIG. 28 illustrates the stomach before the bougie B is inserted into the stomach S during the LSG procedure. As seen in FIG. 28, the omentum O, a double layer of fatty tissue, is connected to the outer layer of the stomach S. The omentum O includes two portions, the greater omentum and the lesser omentum. The greater omentum serves to store fatty deposits, and the lesser omentum connects the stomach S and the intestines to the liver. The stomach S includes various shadowed regions based on the tissue thickness of the stomach S. The tissue thickness of the stomach S forms a first shadow S _1a and a second shadow S _1b . The size and location of the shadows S _1a and S _1b vary based on the thickness of the stomach S. As further shown in FIG. 28, the first shadow S _1a appears along the greater curvature GC of the stomach S, and the second shadow S _1b appears along the lesser curvature LC of the stomach S. As will be explained in more detail below, the shadows _S1a and _S1b are used to determine or estimate the thickness of the stomach S along the greater curvature GC and the lesser curvature LC, respectively. Once the thickness of the stomach S is determined or estimated, it is used to determine the appropriate size and placement of the bougie B relative to the calculated shadow line SL, as shown in FIG.

FIG. 33 shows another view of the stomach anatomy according to various embodiments. Similar to the stomach anatomy shown in FIG. 28, the tissue thickness of the stomach S forms a first shadow S ₁ and a second shadow S _2. As described above, the first shadow S ₁ occurs along the greater curvature GC and the second shadow S ₂ occurs along the lesser curvature LC. The first shadow S ₁ and the second shadow S ₂ intersect at a point S _3. During the gastric sleeve procedure, the location of the pylorus P _X and point S ₃ are used to determine the location of the cutting line C ¹ offset from the pylorus P _X by a distance A. As shown in FIG. 33 and described in more detail below, the diameter D of the sleeve is determined based on the estimated tissue thickness.

152 illustrates the various portions of the stomach involved during the various steps of the LSG procedure. Specifically, FIG. 152 illustrates the initial steps of the LSG procedure, in which the bougie B is inserted into the stomach S. At the start of the LSG procedure, the surgeon inserts the bougie B through the patient's mouth, down the esophagus E, through the esophageal sphincter, and finally into the patient's stomach. Once the bougie B reaches the patient's stomach, the bougie B is positioned so that the end of the bougie B fits within the pyloric canal PC and stops at the pyloric sphincter PS. As further shown in FIG. 152, the bougie B is configured to seat along the angular notch AN of the lesser curvature LC and conform to the shape and length of the stomach S. As will be described in more detail below with respect to FIG. 153, a bougie 7210 with magnetic properties configured to interact with and guide the stapling instrument 7100 along a predetermined path parallel to the bougie 7210 may be used.

Referring again to FIG. 152, once the bougie is placed in its final position, a distance ^D1 is measured along the antrum PA of the greater curvature GC. Distance ^D1 is used to determine the location of the pylorus _Px and is used to determine the location of the cut line ^C1 . The bougie 7210 illustrated in FIG. 153 generates one or more magnetic fields that are used to guide the stapling instrument 7100 to the bougie 7210. Referring to FIG. 154, the stapling instrument 7100 then follows the magnetic field along a path adjacent to the bougie 7210 to create the cut line ^C1 . As a result, the cut line ^C1 extends upward through the patient's stomach S, following the shape and curvature of both the stomach S and the bougie 7210. The cut line ^C1 then proceeds upward through the patient's stomach S along a path adjacent to the bougie 7210 until it reaches the angle of His AH. Once the cut line ^C1 is established, the stapling instrument 7100 applies staples, such as staples 7130, to the tissue along either side of the cut line ^C1 . The remaining portion of the stomach S, which remains in communication with the esophagus, is substantially the size and shape of the bougie 7210. A substantial portion of the stomach S beginning at the antrum PA and ending at the angle of His AH is excluded from participating in the digestive process. The excluded portion of the stomach S is shown in more detail in FIG. 154 and includes the greater curvature GC of the stomach S.

In some cases, a clinician can estimate a proper staple firing path in a patient's stomach by observing certain anatomical markers on the stomach and/or elsewhere in the surgical site. With reference to FIG. 152, a stapling instrument disclosed herein, such as, for example, stapling instrument 7100, is configured to sense anatomical markers in a patient to determine a proper staple firing path. In addition to the above, a stapling instrument disclosed herein may include one or more cameras configured to sense or detect one or more anatomical markers and a controller configured to calculate a staple firing path based on the detected anatomical markers. In at least one example, the stapling instrument is configured to detect a lesser curve of the stomach and calculate a staple firing path in the stomach tissue that is parallel or at least substantially parallel to the lesser curve. Other anatomical markers of a patient's stomach that can be detected and used to determine a staple firing path include, for example, the angular notch, the esophageal sphincter, the angle of His, the pyloric sphincter, and/or the pyloric antrum.

As discussed above, the lesser curve of the stomach may be used to determine the staple firing path. However, in various cases, the lesser curve is at least partially obscured by fat and/or connective tissue. Nonetheless, for example, the lesser curve, the lesser omentum, and any overlap between the lesser curve and the lesser omentum may be visually distinguishable. More specifically, the unobscured gastric tissue has a first color, the lesser omentum has a second color different from the first color, and the overlap between the two has a third color different from the first and second colors. These colors are detectable by the stapling instrument to determine the proper staple firing path. In certain instances, the color of the gastric tissue below the lesser omentum creates a shadow that is detectable by the stapling instrument. Other methods may be used to determine the proper location of the staple firing path.

In addition to the above, the gastric sleeve SS formed during the gastric bypass procedure must have a sufficiently large digestive passage defined therein to allow food to pass therethrough. As a result, referring now to FIG. 29 , the staple firing path through the patient's stomach S must be spaced sufficiently away from the lesser curve of the stomach to form a sufficient digestive passage D. The stapling instruments disclosed herein may be configured to detect the lesser curve of the stomach and calculate a staple firing path, such as, for example, staple firing path _SP1 , that is a distance X away from the edge of the stomach S. In another example, the stapling instruments disclosed herein may be configured to detect the lesser omentum LO, which is bounded by the lesser curve of the stomach, and calculate a staple firing path, such as, for example, staple firing path _SP1 , as a predetermined or pre-determined distance X away from the edge of the stomach S.

As mentioned above, detecting the edge of the stomach S can be difficult. In certain examples, the stapling instruments disclosed herein can include a camera system configured to view stomach tissue color and/or changes in stomach tissue color to determine the edge of the stomach S. In various examples, the stapling instruments disclosed herein can be configured to detect the edge of the stomach by evaluating stomach tissue thickness and/or changes in stomach tissue thickness. It has been recognized that the tissue of a patient's stomach is typically thinner around the periphery or edge of the stomach than in the center of the stomach, and that the color of the stomach tissue is often a function of its thickness. Stated differently, the tissue around the periphery of the stomach appears to have a shaded or darker color because of its thinner thickness. This shaded region _S1 is bounded in FIG. 29 by distance _Z1 . Distance _Z1 also bounds the transition from the thinner tissue of the stomach S to the region _T1 of full tissue thickness. In various examples, the surgical instruments disclosed herein can be configured to determine the staple firing path _SP1 , for example, by establishing the staple firing path _SP1 a particular distance away from the shaded area _S1 . In at least one example, the surgical instrument can establish the staple firing path _SP1 a particular distance away from the midpoint between the lesser omentum LO and an edge of the shaded area _S1 , for example.

In addition to the above, the controller of the stapling instrument disclosed herein may include an edge detection algorithm. The edge detection algorithm is configured to sense a first light intensity at a first location on the stomach tissue and a second light intensity at a second location. The edge detection algorithm is further configured to calculate a first light intensity value for the first light intensity and a second light intensity value for the second light intensity, and then compare the first light intensity value to the second light intensity value. The light intensity value may be on a scale of 1 to 100, where, for example, lower values represent darker tissue and higher values represent lighter tissue. The first and second locations establish a sample line from which additional samples may be taken to establish an intensity gradient. To this end, the edge detection algorithm is further configured to sense a third light intensity at a third location along the sample line, determine a third light intensity value at the third location, and compare the third light intensity value to the first and second light intensity values. The first location, the second location, and the third location are located sequentially along the sample line, and if the algorithm determines that the first light intensity value is greater than the second light intensity value and the second light intensity value is greater than the third light intensity value, the algorithm may then determine, for example, that a shading gradient exists between the first location and the third location, and that the third location is closer to the edge of the stomach tissue than the first location. This method may be applied on a very large scale to map the shading gradient and/or color gradient of the entire stomach tissue or at least a portion of the stomach tissue.

As discussed above, the thickness of the stomach tissue may affect the color or shading of the stomach tissue. Thus, a stomach having thicker tissue (FIG. 29) will typically have a different color and/or shading than a stomach having thinner tissue (FIG. 31). The thinner tissue of FIG. 31 has a shaded region _S2 bounded by a distance _Z2 . Distance _Z2 also bounds the transition from the thinner tissue of the stomach _S2 to the region _T2 of full tissue thickness. In various examples, the surgical instruments disclosed herein may be configured to determine the staple firing path _SP2 , for example, by establishing the staple firing path _SP2 a particular distance away from the shaded region _S2 . In at least one example, the surgical instrument may establish the staple firing path _SP2 a particular distance away from the midpoint between the lesser omentum _LO2 and the edge of the shaded region _S2 .

Staple firing path _SP1 establishes a first sleeve profile and staple firing path _SP2 establishes a second sleeve profile that is different from the first sleeve profile. The first sleeve profile comprises a first width X and the second sleeve profile comprises a second width Y that is different from width X. Regardless of the sleeve profile produced by the stapling instruments disclosed herein, the tissue drive system of the stapling instruments is configured to propel the stapling instruments along a staple firing path that forms a desired gastric sleeve. Such stapling instruments can be configured to identify anatomical markers and steer themselves toward, away from, and/or parallel to one or more anatomical markers.

153, in addition to the above, the stapling instrument 7100 includes a shaft 7110, a distal head 7120, and an articulation joint 7170 rotatably connecting the distal head 7120 to the shaft 7110. The stapling instrument 7100 incises the patient's stomach along a path C1 and applies three rows of staples 7130 on each side of the path C1. As described above, the bougie 7210 is configured to guide the stapling instrument 7100 along a staple firing path. More specifically, the bougie 7210 is configured to emit one or more magnetic fields that can be detected by the stapling instrument 7100 and then used by the stapling instrument 7100 to determine the staple firing path. In at least one example, the bougie 7210 emits a strong magnetic field SMF and a weak magnetic field WMF that, when emitted, are emitted along the length of the bougie 7210. Notably, the weak magnetic field WMFs are alternately placed between the strong magnetic field SMFs.

154, the stapling instrument 7100 includes one or more sensors, such as, for example, Hall effect sensors, configured to detect the strong magnetic field SMF and the weak magnetic field WMF. The sensors are in communication with a controller of the stapling instrument 7100, which can use data from the sensors to detect the configuration of the strong magnetic field SMF and the weak magnetic field WMF and align the staple firing path with the magnetic fields SMF and WMF such that the stapling instrument 7100 follows the bougie 7210 to generate a desired gastric sleeve profile. In at least one example, the strength of the strong magnetic field SMF is, for example, twice as strong as the weak magnetic field WMF. In another example, the strength of the strong magnetic field SMF is, for example, 50% stronger than the strength of the weak magnetic field WMF.

155 and 157, the bougie 7210 comprises an inner flexible core 7212 and a number of conductor windings configured to emit the above-mentioned magnetic fields SMF and WMF. The flexible core 7212 is composed of a non-conductive material, or at least a substantially non-conductive material, such as rubber, for example. The flexible core 7212 is solid, but may also comprise a tube. The conductor windings include a winding circuit 7214 that emits a weak magnetic field WMF and a winding circuit 7216 that emits a strong magnetic field SMF. The winding circuit 7214 has fewer turns than the winding circuit 7216 and generates a weaker magnetic field than the winding circuit 7216 for a given current. Each winding circuit 7214 comprises a conductive wire wound around the inner flexible core 7212 and in communication with the controller of the bougie 7210. Each winding circuit 7214 is distinct from the other winding circuits 7214 and also from the winding circuits 7216. Similarly, each winding circuit 7216 is distinct from the other winding circuits 7216 and also from the winding circuits 7214. Each conductive wire comprises an inner conductive core and an insulating jacket extending around the conductive core. In an alternative embodiment, the conductive wire comprises a conductive core embedded in a flexible core 7212. In either case, the bougie 7210 comprises an outer jacket 7218 configured to seal the contents therein and prevent or inhibit the ingress of fluids into the bougie 7210.

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

As discussed above, the bougie 7210 utilizes electricity to generate a magnetic field. In various alternative embodiments, the bougie may include permanent magnets that generate the magnetic field. In at least one example, the bougie includes strong permanent magnets that generate a strong magnetic field and weak permanent magnets that generate a weak magnetic field. In at least one such example, the strong and weak permanent magnets are arranged in an alternating fashion to generate alternating strong magnetic fields SMF and weak magnetic fields WMF as shown, for example, in FIG. 154. That said, the bougie may generate one or more magnetic fields in any suitable manner.

156, the bougie 7310 comprises an inner flexible core 7312 and a number of conductor windings configured to emit the above-mentioned magnetic fields SMF and WMF. The flexible core 7312 is composed of a non-conductive material, or at least a substantially non-conductive material, such as rubber, for example. The conductor windings include a winding circuit 7314 configured to emit a weak magnetic field WMF and a winding circuit 7316 configured to emit a strong magnetic field SMF. The winding circuit 7314 has fewer turns than the winding circuit 7316 and will generate a weaker magnetic field for a given current than the winding circuit 7316. Each winding circuit 7314 comprises a conductive wire wound around the inner flexible core 7312 and in communication with the controller of the bougie 7310. The windings of the circuit 7314 are more compact, i.e., denser, than the windings of the circuit 7214. For example, the windings of circuit 7214 extend longitudinally as they wrap around core 7212, whereas the windings of circuit 7314 do not extend longitudinally, or at least do not extend substantially so. Similarly, the windings of circuit 7316 are more compact, i.e., denser, than the windings of circuit 7216. The denser or more compact windings may generate a denser or more compact magnetic field that may be more discernible to, for example, stapling instrument 7100.

Although the surgical tool systems described herein are powered by electric motors, the surgical tool systems described herein may be powered in any suitable manner. In certain instances, the motors disclosed herein may comprise part of a robotic control system. For example, U.S. Patent Application Serial No. 13/118,241, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS," now U.S. Patent No. 9,072,535, discloses in more detail some examples of robotic surgical tool systems.

The surgical instrument systems described herein have been described in connection with the deployment and deformation of staples. However, the embodiments described herein are not so limited. Various embodiments are contemplated that deploy fasteners other than staples, such as, for example, clamps or tacks. Additionally, various embodiments are contemplated that utilize any suitable means for sealing tissue. For example, end effectors according to various embodiments may include electrodes configured to heat and seal tissue. Additionally, for example, end effectors according to certain embodiments may apply vibrational energy to seal tissue.

Example 1 - A surgical stapler for stapling tissue of a patient, the surgical stapler comprising: a handle; a shaft extending from the handle; and an end effector comprising an anvil having a tissue compressing surface and a staple forming pocket, the anvil being movable toward the tissue compressing surface during a closing motion. The surgical stapler further comprises an anvil closing system configured to move the anvil through a closing motion; and a propulsion system comprising a first foot configured to engage and move the end effector relative to the patient tissue during a first propulsion stroke, and a second foot configured to engage and move the end effector relative to the patient tissue during a second propulsion stroke.

Example 2 - A surgical stapler as described in Example 1, wherein the propulsion system is configured to repeatedly sequentially produce a first propulsion stroke and a second propulsion stroke, thereby enabling the propulsion system to walk the end effector against patient tissue.

Example 3 - A surgical stapler as described in Example 1 or 2, wherein the propulsion system is configured to complete a first propulsion stroke before initiating a second propulsion stroke.

Example 4 - The surgical stapler of Examples 1, 2, or 3, wherein the propulsion system is configured to at least partially complete a first propulsion stroke before initiating a second propulsion stroke.

Example 5 - The surgical stapler of Examples 1, 2, 3, or 4, wherein the propulsion system includes means for synchronizing the first propulsion stroke with the second propulsion stroke.

Example 6 - A surgical stapler as described in Examples 1, 2, 3, 4, or 5, wherein the end effector further comprises a staple cartridge having a plurality of staples.

Example 7 - The surgical stapler of Example 6, further comprising a staple firing system configured to deploy the staples during the staple firing stroke.

Example 8 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the propulsion system includes a synchronization means for performing a closing motion after both the first propulsion stroke and the second propulsion stroke have been performed.

Example 9 - The surgical stapler of Example 8, wherein the synchronizing means performs the staple firing stroke after the closing stroke is performed.

Example 10 - A surgical stapler as described in Example 8 or 9, in which the synchronization means includes a mechanism.

Example 11 - A surgical stapler as described in Examples 8, 9, or 10, wherein the synchronization means comprises a controller including a microprocessor.

Example 12 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11, wherein the propulsion system is configured to perform the first propulsion stroke and the second propulsion stroke simultaneously.

Example 13 - The surgical stapler of any one of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12, wherein the propulsion system is configured to perform a first propulsion stroke to steer the end effector in a first direction and a second propulsion stroke to steer the end effector in a second direction.

Example 14 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, or 13, further comprising a vacuum system in communication with at least one of the first foot and the second foot, the vacuum system configured to hold patient tissue within the end effector utilizing the vacuum system.

Example 15 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14, wherein the first foot comprises a first rotatable element and the second foot comprises a second rotatable element.

Example 16 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the first foot comprises a first set of teeth configured to grip patient tissue and the second foot comprises a second set of teeth configured to grip patient tissue.

Example 17 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 16, wherein the first foot comprises a first translatable element and the second foot comprises a second translatable element.

Example 18 - The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, or 17, wherein the first foot comprises a first base and a first extendable portion extendable relative to the first base, and the second foot comprises a second base and a second extendable portion extendable relative to the second base.

Example 19 - A surgical stapler for stapling tissue of a patient, the surgical stapler comprising: a handle; a shaft extending from the handle; and an end effector comprising a tissue compression surface and an anvil having staple forming pockets, the anvil being movable toward the tissue compression surface during a closing motion. The surgical stapler further comprises an anvil closing system configured to move the anvil through the closing motion, and a tissue advancing system comprising a foot configured to engage and pull the patient tissue against the end effector during the tissue advancing stroke.

Example 20 - A surgical stapler for stapling tissue of a patient, comprising: a handle; a shaft extending from the handle; a plurality of staple cartridges; and an end effector, the end effector comprising a tissue compression surface and an anvil having staple forming pockets, the anvil being movable toward the tissue compression surface during a closing motion. The surgical stapler further comprises an anvil closing system configured to move the anvil through the closing motion, a staple firing system configured to deploy the staple cartridge along a path, and a means for gripping the patient tissue and causing relative motion between the end effector and the patient tissue to reposition the end effector along the path.

The entire disclosures of the following are incorporated herein by reference:
- U.S. Patent No. 5,403,312, entitled "ELECTROSURGICAL HEMOSTATIC DEVICE," issued April 4, 1995;
No. 7,000,818, entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS," issued on February 21, 2006;
- U.S. Patent No. 7,422,139, entitled "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK", issued on September 9, 2008;
- U.S. Patent No. 7,464,849, entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIIL ALIGNMENT COMPONENTS," issued December 16, 2008;
- U.S. Patent No. 7,670,334, entitled "SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR", issued March 2, 2010;
No. 7,753,245, entitled "SURGICAL STAPLING INSTRUMENTS," issued on July 13, 2010;
No. 8,393,514, entitled "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE," issued on March 12, 2013;
- U.S. Patent Application Serial No. 11/343,803, entitled "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES," now U.S. Patent No. 7,845,537;
- U.S. Patent Application No. 12/031,573, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES," filed February 14, 2008;
- U.S. Patent Application Serial No. 12/031,873, entitled "END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT," filed February 15, 2008, now U.S. Patent No. 7,980,443;
- U.S. Patent Application Serial No. 12/235,782, entitled "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT", now U.S. Patent No. 8,210,411;
- U.S. Patent Application Serial No. 12/249,117, entitled "POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM," now U.S. Patent No. 8,608,045;
- U.S. Patent Application Serial No. 12/647,100, entitled "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY," filed December 24, 2009, now U.S. Patent No. 8,220,688;
- U.S. Patent Application Serial No. 12/893,461, entitled "STAPLE CARTRIDGE," filed September 29, 2012, now U.S. Patent No. 8,733,613;
- U.S. Patent Application Serial No. 13/036,647, entitled "SURGICAL STAPLING INSTRUMENT," filed February 28, 2011, now U.S. Patent No. 8,561,870;
- U.S. Patent Application Serial No. 13/118,241, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS," now U.S. Patent No. 9,072,535;
- U.S. Patent Application No. 13/524,049, entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRESSING A FIRING DRIVE," filed June 15, 2012, now U.S. Patent No. 9,101,358;
- U.S. Patent Application No. 13/800,025, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," filed March 13, 2013, now U.S. Patent No. 9,345,481;
- U.S. Patent Application No. 13/800,067, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," filed March 13, 2013, now U.S. Patent Application Publication No. 2014/0263552;
U.S. Patent Application Publication No. 2007/0175955, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM," filed Jan. 31, 2006; and
- U.S. Patent Application Publication No. 2010/0264194, entitled "SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR," filed on April 22, 2010, now U.S. Patent No. 8,308,040.

Although various devices have been described herein with specific embodiments, modifications and variations may be made to those embodiments. Particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, a particular feature, structure, or characteristic illustrated or described with respect to one embodiment may be combined, in whole or in part, with the feature, structure, or characteristic of one or more other embodiments, without limitation. Also, although materials are disclosed with respect to particular components, other materials may be used. Moreover, in accordance with various embodiments, a single component may be replaced with multiple components, and multiple components may be replaced with a single component, to perform a given function(s). It is intended that the foregoing description and the following claims encompass all such modifications and variations.

The devices disclosed herein may be designed to be disposed of after a single use, or may be designed to be used multiple times. In either case, however, the device may be reconditioned for reuse after at least one use. Reconditioning may include, but is not limited to, any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular parts of the device, and then reassembly of the device. Specifically, a reconditioning facility and/or surgical team may disassemble the device, clean and/or replace particular parts of the device, and then reassemble the device for subsequent use. One of ordinary skill in the art will appreciate that reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned devices, are all within the scope of the present application.

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

While the invention has been described as having an exemplary design, the invention may be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles.

Any patent, publication, or other disclosure that is incorporated herein by reference in its entirety or in part is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, views, or other disclosures set forth in this disclosure. As such, and to the extent necessary, the disclosures expressly set forth herein shall take precedence over any conflicting statements incorporated herein by reference. Any content, or portions thereof, that is incorporated herein by reference but that conflicts with current definitions, views, or other disclosures set forth herein shall be incorporated only to the extent that there is no conflict between the incorporated content and the current disclosures.

[Embodiment]
(1) A surgical stapler for stapling tissue of a patient, comprising:
A handle and
a shaft extending from the handle;
An end effector,
a tissue compression surface;
an end effector comprising an anvil with staple forming pockets, the anvil movable toward the tissue compressing surface during a closing motion;
an anvil closing system configured to move the anvil through the closing motion;
1. A propulsion system comprising:
a first foot configured to engage the patient tissue and move the end effector relative to the patient tissue during a first propulsion stroke;
a second foot configured to engage and move the end effector relative to the patient tissue during a second drive stroke.
2. The surgical stapler of claim 1, wherein the propulsion system is configured to repeatedly sequence the first and second propulsion strokes, thereby enabling the propulsion system to walk the end effector relative to the patient tissue.
3. The surgical stapler of claim 1, wherein the drive system is configured to complete the first drive stroke before beginning the second drive stroke.
4. The surgical stapler of claim 1, wherein the drive system is configured to at least partially complete the first drive stroke before beginning the second drive stroke.
5. The surgical stapler of claim 1, wherein the drive system includes means for synchronizing the first drive stroke with the second drive stroke.

(6) The surgical stapler of claim 1, wherein the end effector further comprises a staple cartridge comprising a plurality of staples.
(7) The surgical stapler of claim 6, further comprising a staple firing system configured to deploy the staples during a staple firing stroke.
8. The surgical stapler of claim 7, wherein the drive system includes a synchronization means for executing the closing motion after both the first drive stroke and the second drive stroke have been executed.
9. The surgical stapler of claim 8, wherein the synchronizing means executes the staple firing stroke after the closing stroke is executed.
(10) The surgical stapler of claim 9, wherein the synchronizing means includes a mechanism.

11. The surgical stapler of claim 9, wherein the synchronization means comprises a controller including a microprocessor.
12. The surgical stapler of claim 1, wherein the drive system is configured to perform the first drive stroke and the second drive stroke simultaneously.
13. The surgical stapler of claim 1, wherein the drive system is configured to perform the first drive stroke to steer the end effector in a first direction and to perform the second drive stroke to steer the end effector in a second direction.
14. The surgical stapler of claim 1, further comprising a vacuum system in communication with at least one of the first foot and the second foot, the vacuum system configured to hold the patient tissue within the end effector utilizing the vacuum system.
15. The surgical stapler of claim 1, wherein the first foot comprises a first rotatable element and the second foot comprises a second rotatable element.

16. The surgical stapler of claim 1, wherein the first foot comprises a first set of teeth configured to grasp the patient tissue and the second foot comprises a second set of teeth configured to grasp the patient tissue.
17. The surgical stapler of claim 1, wherein the first foot comprises a first translatable element and the second foot comprises a second translatable element.
18. The surgical stapler of claim 1, wherein the first foot comprises a first base and a first extendable portion extendable relative to the first base, and the second foot comprises a second base and a second extendable portion extendable relative to the second base.
(19) A surgical stapler for stapling tissue of a patient, comprising:
A handle and
a shaft extending from the handle;
An end effector,
a tissue compression surface;
an end effector comprising an anvil with staple forming pockets, the anvil movable toward the tissue compressing surface during a closing motion;
an anvil closing system configured to move the anvil through the closing motion;
1. A surgical stapler comprising: a tissue advancing system comprising: a foot configured to engage and pull the patient tissue against the end effector during a tissue advancing stroke.
(20) A surgical stapler for stapling tissue of a patient, comprising:
A handle and
a shaft extending from the handle;
a plurality of staple cartridges;
An end effector,
a tissue compression surface;
an end effector comprising an anvil with staple forming pockets, the anvil movable toward the tissue compressing surface during a closing motion;
an anvil closing system configured to move the anvil through the closing motion;
a staple firing system configured to deploy the staple cartridge along a path;
means for grasping the patient tissue and causing relative motion between the end effector and the patient tissue to reposition the end effector along the path.

Claims (16)

1. A surgical stapler for stapling tissue of a patient, comprising:
A handle and
a shaft extending from the handle;
An end effector,
a tissue compression surface;
an anvil having staple forming pockets, the anvil being movable toward the tissue compression surface during a closing motion to clamp tissue of the patient against the tissue compression surface;
an anvil closing system configured to move the anvil through the closing motion;
a tissue drive system;
the tissue compression surface is defined on the tissue drive system;
The tissue drive system comprises:
a first foot extendable to engage tissue of the patient during a first propulsion stroke and retractable to move the end effector relative to the tissue of the patient;
a second foot extendable to engage tissue of the patient during a second drive stroke and retractable to move the end effector relative to the patient's tissue. The surgical stapler of claim 1, wherein the tissue drive system is configured to repeatedly sequence the first and second drive strokes, thereby enabling the tissue drive system to walk the end effector against the patient's tissue. The surgical stapler of claim 1, wherein the tissue drive system is configured to complete the first drive stroke before beginning the second drive stroke. The surgical stapler of claim 1, wherein the tissue drive system is configured to at least partially complete the first drive stroke before initiating the second drive stroke. The surgical stapler of claim 1, wherein the tissue drive system includes means for synchronizing the first and second drive strokes. The surgical stapler of claim 1, wherein the end effector further comprises a staple cartridge having a plurality of staples. 8. The surgical stapler of claim 6, further comprising a staple firing system configured to deploy the staples during a staple firing stroke. 8. The surgical stapler of claim 7, wherein the tissue drive system includes a synchronization means for executing the closing motion after both the first and second drive strokes have been performed. The surgical stapler of claim 8, wherein the synchronizing means executes the staple firing stroke after the closing motion is performed. The surgical stapler of claim 1, wherein the tissue drive system is configured to perform the first and second drive strokes simultaneously. The surgical stapler of claim 1, wherein the tissue drive system is configured to perform the first drive stroke to steer the end effector in a first direction and to perform the second drive stroke to steer the end effector in a second direction. The surgical stapler of claim 1, further comprising a vacuum system in communication with at least one of the first foot and the second foot, the vacuum system configured to hold tissue of the patient within the end effector utilizing the vacuum system. The surgical stapler of claim 1, wherein the first foot comprises a first rotatable element and the second foot comprises a second rotatable element. 2. The surgical stapler of claim 1, wherein the first foot comprises a first set of teeth configured to grip the patient's tissue and the second foot comprises a second set of teeth configured to grip the patient's tissue. The surgical stapler of claim 1, wherein the first foot comprises a first translatable element and the second foot comprises a second translatable element. The surgical stapler of claim 1, wherein the first foot comprises a first base and a first extendable portion extendable relative to the first base, and the second foot comprises a second base and a second extendable portion extendable relative to the second base.

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