MXPA06004950A - Spring-based firing mechanism for anastomotic ring applier - Google Patents

Abstract

A surgical instrument for applying an anastomotic ring device comprises a handle that is connected to an anastomotic ring deployment mechanism by an elongate shaft. The instrument also comprises an actuation mechanism that is configured to apply an actuating force to the ring deployment mechanism to deploy an anastomotic ring. In one embodiment, the actuation mechanism applies a compressive force to deploy the anastomotic ring by drawing opposing ends of a ring deployment mechanism together. The actuation mechanism may comprise a spring or other resilient member moveable from a first position to a second position in order to actuate the ring deployment mechanism. A mechanism is operable to maintain the spring in the first position, while permitting the spring to move to the second position in response to user input. A mechanism is operable to dislodge the spring.

Description

SPRING BASED SHOT MECHANISM FOR ANASTOMOTIC RING APPLICATOR FIELD OF THE INVENTION In general, the present invention relates to surgery and, more particularly, to a device for performing a surgical procedure in the digestive system.

BACKGROUND OF THE INVENTION The percentage of the world population that suffers from morbid obesity is constantly growing. Severely obese people may be at increased risk of heart disease, stroke, diabetes, lung disease, and accidents. Due to the effects of morbid obesity on the patient's life, methods of treating morbid obesity have been the subject of intense research. A known method for treating morbid obesity includes the use of anastomotic rings. The devices for applying the anastomotic rings are known. Devices of this nature are commonly adapted to insert an anastomotic ring compressed into an anastomotic opening, formed between proximal walls of gastrointestinal tissue. These applicator devices may utilize a ring deployment mechanism comprising an expansion element that is actuated once the compressed ring is placed in the anastomotic opening, causing the anastomotic ring to expand from its cylindrically compressed position to a hollow rivet driven position. Many conventional applicator devices require that a driving force be transmitted from the operating handle to the remote ring deployment mechanism. Although this force is usually relatively small, even a lower force can be prohibitive when it must be transmitted to the end of a large flexible or separate structure. Also, when the elongated arrow of the applicator device includes one or more flexible joints, the control wires generally used to transmit the driving force through the flexible joints could be susceptible to buckling or twisting. In addition, with some applicator devices including flexible joints, the transmission of force through the wires controlling the ring deployment mechanism, could have the undesirable effect of straightening the flexible union of its orientation due to a greater tension in the transmission wires. Consequently, it may be desirable to have an anastomotic ring applicator device that is capable of deploying an anastomotic ring, without requiring the transfer of a large driving force from a proximal portion of the device to a distal portion thereof.

BRIEF DESCRIPTION OF THE INVENTION The embodiments of the invention provide an anastomotic ring applicator device that is capable of deploying an anastomotic ring, without requiring the transmission of a large driving force from the proximal portion of the device to the distal portion thereof. In addition, since only a very small drive force is transmitted distantly, the transmission force may not affect the desired orientation of any flexible joint that the device may comprise. In one embodiment, a surgical instrument comprises a handle attached to a ring deployment mechanism by an elongated arrow. The ring deployment mechanism comprises a proximal portion, a distal portion and a central portion. The device also comprises a drive mechanism, operable to compress the distal portion and the central portion of the ring deployment mechanism toward the proximal portion to deploy an anastomotic ring. This embodiment allows the user to deploy an anastomotic ring using a distantly located drive mechanism that compresses the ring deployment mechanism. In another embodiment, a surgical instrument for applying an anastomotic ring device comprises a handle attached by an elongated arrow to a ring deployment mechanism. The ring deployment mechanism is configured to receive and deploy an anastomotic ring. The instrument also includes a spring, which is movable from a first position to a second position. The spring is operable to drive the ring deployment mechanism as it moves to the second position. This embodiment allows a user to operate a ring deployment mechanism without the need for the user to introduce a large actuating force. In another embodiment, a device comprises a handle that includes movable operational control from a first position to a second position. The device also comprises an elongated arrow joining the handle to a ring deployment mechanism that is configured to receive and deploy an anastomotic ring under a driving force. The device also comprises a drive member that is configured to store the driving force. The actuating member is operable to apply the driving force to the ring deployment mechanism, when the operating control moves from the first position to the second position. This mode allows the user to fire a stored force to drive the ring deployment mechanism, instead of the user introducing a driving force that must be transmitted along the length of the elongated arrow.

BRIEF DESCRIPTION OF THE FIGURES The accompanying drawings that are incorporated and constitute a part of this specification illustrate versions of the invention and, together with the general description of the invention given above and the detailed description of the versions given below, serve to explain the principles of the present invention. Figure 1 is a perspective view of an anastomotic ring applicator device, shown with a ring deployment mechanism in a non-actuated position. Figure 2 is a partial perspective view of the distal portion of an anastomotic ring applicator device, retaining an anastomotic ring in an unactuated position. Figure 3 is a partial perspective view of the distal portion of the device of Figure 2, retaining an anastomotic ring in the actuated position. Figure 4 is a front view of an operated anastomotic ring. Figure 5 is a perspective view of the device of Figure 1, with the ring deployment mechanism in a partially actuated position. Figure 6 is a perspective view of the device of Figure 1, with the ring deployment mechanism in a fully actuated position. Figure 7 is a perspective view of the device of Figure 1, with the ring deployment mechanism returned to the non-driven position and with a spring actuator in the extended position. Figure 8 is a cross-sectional view of the ring deployment mechanism of the device of Figure 1 in the non-actuated position. Figure 9 is a cross-sectional view of the ring deployment mechanism of the device of Figure 1 in the partially actuated position. Figure 10 is a cross-sectional view of the ring deployment mechanism of the device of Figure 1 in the fully actuated position. Figure 11 is a cross-sectional view of the ring deployment mechanism of the device of Figure 1, returned to the non-driven position and with the spring extended by the spring actuator. Figure 12 is a cross-sectional view taken along the plane 12 of the device of Figure 10. Figure 13 is a cross-sectional view taken along the plane 13 of the device of Figure 10.

DETAILED DESCRIPTION OF THE MODALITIES OF THE INVENTION Turning to the drawings, in which similar numbers denote similar components in all the various views, Figure 1 depicts an applicator, 10, which is operable to deploy and actuate an anastomotic ring device (not shown in Figure 1), a generally cylindrical shape to a shape having properties of a hollow rivet, or ring, capable of forming an anastomotic junction at a target anastomosis site, for example in a gastric bariatric bypass of a morbidly obese patient. Figure 2 depicts another applicator, 12. It will be appreciated that the applicators, 10, 12, can be used in a variety of ways including, without limitation, laparoscopically or endoscopically. The applicator 12 is shown in Figure 2 with an anastomotic ring, 14, in a deployment mechanism, 16. In Figure 2, the anastomotic ring 14 is shown in the cylindrical, compressed position. In Figure 3, the deployment mechanism 16 of the applicator 12 has moved the anastomotic ring 14 to the hollow rivet-shaped position, actuated. Figure 4 is a close-up view of the anastomotic ring 14 in the actuated position. The anastomotic ring 14 may comprise a shape memory effect material (SME), such as nitinol by way of example only, which further aids the actuation to a hollow rivet coupling shape. Other suitable anastomotic ring materials 14 will be apparent to those of ordinary skill in the art. An exemplary anastomotic ring 14 is described in detail in the publication of the U.S. patent application. 2003/0032967, Park and others. It will be appreciated that the terms "near" and "distant" are used herein to refer to a clinician holding a handle of the applicator 10. It will also be appreciated that for convenience and clarity, spatial terms such as "right" and "left" , "vertical" and "horizontal", are used here with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting or absolute. In addition, the aspects of the invention have application to surgical procedures performed endoscopically and laparoscopically, as well as an open procedure or other procedures. The use of these similar terms or terms should not be considered to limit the present invention to only one category of surgical procedure. Referring to Figures 1 and 5-7, there is shown a handle, 18, attached to a ring deployment mechanism, 20, by an elongated arrow, 22, having a proximal portion, 24, and a distal portion, The arrow 22 can be rigid, flexible, malleable, or it can have any other property. The applicator, 10, includes a tip, 28, remote from the ring deployment mechanism 20. A first and a second actuating member, 30, 32 are included in the handle 18. As described in detail below, the actuating members 30 , 32, are operable to control the operation of the ring deployment mechanism 20 to deploy the anastomotic ring, 14. As shown in FIG. 8, the ring deployment mechanism 20 comprises a proximal portion, 40, and a distal portion. , 42. The proximal portion 40 comprises proximal fingers, 44, and the distal portion 42 similarly comprises distal fingers, 46. Both fingers, the proximal and the distal, 44 and 46, are in a doubly hinged relationship with a half ring, 48. , of the deployment mechanism 20. The proximal portion 40 is fixedly attached to the arrow 22. The fingers 44, 46, are configured to retain an anastomotic ring 14 by engaging the petals, 51, before and during deployment of the annulus a nastomotic, and to release the petals 51 after deployment of the anastomotic ring. Of course, any other suitable configuration can be used for the ring deployment mechanism 20. The tip 28 is attached to the distal portion 42 of the deployment mechanism 20. As shown in Figs. 8-11, a rib, 52, of the tip 28 is configured to coincide with a recess, 54, of the distal portion 42. However, it will be appreciated that the tip 28 can be attached to the ring deployment mechanism 20 in many alternative ways. In the present example, the applicator 10 also comprises a rod, 55, which passes through the arrow 22 and ends at the tip 28. The rod 55 may be rigid, flexible, or may have other properties. For those of ordinary skill in the art, other suitable configurations of the tip 28 will be apparent. The arrow 22 also comprises bushes, 86, which are disposed within the arrow 22 and around the rod 55. As shown in Fig. 12 (in which the proximal fingers 44 are omitted), and in Figure 14, a distal portion of the arrow 22 comprises longitudinal ends 88, which are separated by longitudinal grooves. The proximal portion 40 of the deployment mechanism 20 has rib members, 90, which extend radially inwardly and are dimensioned and spaced apart to fit between the ends 88. Similarly, the ring means 48 of the deployment mechanism 20 has rib members, 92, which extend radially inwardly and are dimensioned and spaced apart to fit between the limbs 88. In the present example, the fit between the limbs 88 and the rib members 90, 92, is such that rotation of the limb is substantially prevented. deployment mechanism 20 with respect to arrow 22. Continuing with the reference to figure 8, the applicator 10 of the present example includes a driving mechanism that is operable to apply a driving force to the ring deployment mechanism 20. In one embodiment, the driving mechanism comprises an extension spring, 56. A proximal portion of the spring 56 is in communication with the proximal portion of the deployment mechanism 20. In the present example, the proximal portion 40 of the deployment mechanism 20 includes a rib, 62, which is configured to project toward a proximal turn of the spring 56. Similarly, the Distant portion 42 of deployment mechanism 20 includes a rib, 66, which is configured to protrude towards a turn distant from spring 56. However, it will be appreciated that there is a variety of alternative configurations for performing communication or connection between spring 56 and the deployment mechanism 20, and any such alternatives may be used. In addition, it will be appreciated that any suitable alternative to the spring 56 may be used, including without limitation any other type of elastic member or members. In the present example, the extension spring 56 is urged to compress when the proximal and distant fingers, 44, 46, are in the non-driven position. An exemplary non-driven position is as shown in Figures 1 and 8. As the remote portion 42 of the deployment mechanism 20 and the ring means 48 are configured to move longitudinally with respect to the distal end of the arrow 22, while the portion next 40 of the deployment mechanism 20 is rigidly attached to the arrow 22, compression of the spring 56 is operable to cause the distal portion 42 and the ring means 48 to move toward the proximal portion 40. Due to the double-hinged relationship between the both proximal and distant fingers 44, 46, and the ring means 48, compression of the distal portion 42 and the ring means 48 toward the proximal portion 40, can cause the proximal fingers 44 and the distal fingers 46 to articulate outwardly, actuating a proximal portion and a distal portion, respectively, of the anastomotic ring 14. An exemplary intermediate step of said articulation or actuation of the 44, 46, is shown in Figures 5 and 9. An example of complete articulation or actuation of the fingers 44, 46, is shown in Figures 6 and 10. The applicator 10 is operable to maintain the spring 56 in a position extended until the surgeon has properly positioned the applicator 10 at the site of the anastomosis. In the present example, the applicator 10 has a securing member comprising a substantially rigid strut, 70. The distal end of the strut 70 is hingedly or pivotally attached to the distal portion 42 of the deployment mechanism 20. When the deployment mechanism 20 is in the non-driven position, the strut 70 is in an adjustment position, such that the strut 70 is in communication with the distal surface of a half ring rib member 48, to prevent the spring 56 from compressing. The proximal end of the strut 70 is attached to the first actuator 30 by means of a cable 74. The cable 74 passes through openings in the bushes 86 and an opening in the rib member 90 of the proximal portion 40 of the deployment mechanism 20. Of course, any alternative of the cable 74 may be used. The first actuator 30 is operable to slide proximally from a first non-driven position to a second driven position (FIG. 5), causing the cable 74 to move proximally. As the first actuator 30 slides to the second driven position, the cable 74 is configured to pivotally move the strut 70 out of communication with the distal surface of the rib member 92 of the ring means 48, thereby allowing the spring 56 to be compressed, which, as described above, will cause the near and distant fingers 44, 46, be activated. Another strut, 70, is positioned in the proximal portion 40 of the deployment mechanism 20. Similarly to the strut 70 in the distal portion 42, the strut 70 in the proximal portion 40 is pivotal and is configured to engage with the proximal surface of a rib member, 92, of the half ring 48, to prevent the spring 56 from compressing. The two struts 70 attached to the cable 74, which bifurcates to reach each strut 70 and is configured to pivotally move the two struts 70 concomitantly, in the same proximal movement of the cable 74. In another embodiment, struts 70 located on opposite sides. of the central longitudinal axis of the arrow 22. Such pairs of struts 70 can be placed in both the distant and the next portion, 42, 40, of the deployment mechanism 20. Those of ordinary skill in the art will appreciate that, to ensure that the anastomotic ring 14 be deployed properly, it may be beneficial to effect the deployment in two stages. In one embodiment, the ring deployment mechanism 20 comprises a second strut 76. The second strut 76 is shorter than the first strut 70 and is configured to find the distal surface of a rib member 92 of the ring means 48, after the disengagement of the first strut 70 from a rib member 92 at a predetermined point in the joint of the fingers 44, 46, thus preventing the spring 56 from compressing further. The second strut 76 is in communication with the second actuator 32 by means of a cable 80. The cable 80 passes through openings in ferrules 86 and an opening in the rib member 90 of the proximal portion 40 of the deployment mechanism 20. The second actuator 32 is operable to slide from a first non-driven position proximally, to a second driven position (Figure 6), causing the cable 80 to also move proximally. As the second actuator 32 slides to the second driven position, the cable 80 is configured to pivotally move the second strut 76 out of communication with the detent 72, allowing the spring 56 to be fully compressed, causing the fingers 44, 46, they fully articulate and deploy the anastomotic ring 14. Another second strut 76 is positioned in the proximal portion 40 of the deployment mechanism 20. Similar to the second strut 76 in the distal portion 42, the second strut 76 in the proximal portion 40 is pivoting and is configured to engage the proximal surface of a rib member 92 of the ring means 48, to prevent the spring 56 from compressing further. Both second struts 76 attached to the cable 80, which bifurcates to reach each second strut 76 and is configured to pivotally move the two struts 76 concomitantly, in the same proximal movement of the cable 74. In another embodiment, second struts 76 located at opposite sides of the central longitudinal axis of the arrow 22. Such pairs of second struts 76 can be placed in both the distant and the proximal portions, 42, 40, of the deployment mechanism 20. When the first and second pair of struts, 70 , 76, positioned in each portion 40, 42 of the deployment mechanism 20, the pairs may be angularly offset by any appropriate distance.

Referring now to Figures 7 and 11, after deployment of the ring 14, the applicator 10 is operable to return the fingers 44, 46, to the non-actuated position for removal of the applicator 10 from the site of the anastomosis. The applicator 10 comprises a spring actuator, 82. The spring actuator 82 is in communication with the distal return 64 of the spring 56 by means of a connector 84. The spring actuator 82 is operable to move from a position of omission, in that the connector 84 makes little or no force on the spring 56, to an extended position (FIG. 7) in which the connector 84 moves proximally, pulling the distal return 64 of the spring 56 in the proximal direction (FIG. 11). When the spring actuator 82 moves to the extended position, the distal turn 64 will uncouple the rib 66 from the distal portion 42, substantially releasing the deployment mechanism 20 from the compressive effect of the spring 56. In the present example, the elasticity of the material comprising the deployment mechanism 20 will cause the deployment mechanism to extend distally when the spring 56 no longer exerts compressive forces on the deployment mechanism 20. Such a self-extension remote from the deployment mechanism 20 will thus cause the fingers 44, 46, to return to a substantially unactuated position. In this way, the movement of the spring actuator 82 to the extended position is operable to allow the proximal and distant fingers 44, 46 to return to a substantially non-actuated position, thereby allowing the applicator 10 to be withdrawn from the patient in a manner safe.

It will be appreciated that any alternative of struts 70, 76, or actuators, 30, 32 may be used. Such alternatives and variations will be apparent to those of ordinary skill in the art. For example, in another embodiment, the spring actuator 82 is in communication with the rod 55. In this embodiment, the spring actuator 82 is distally operable to be longitudinally advanced. Such a distal advance of the spring actuator 82 will cause the distal advance of the tip 28 against the compressive pulse of the spring 56, ultimately resulting in the return of the fingers 44, 46, to a substantially non-actuated position. The spring actuator 82 may comprise a functionality, such that by a sufficient distal advance of the spring actuator 82, the functionality is configured to retain the spring actuator 82 in place. In other words, the functionality can prevent subsequent proximal movement of the spring actuator 82, so that the spring actuator 82 retains the rod 55 to maintain a force opposing the spring elasticity 56. Such functionality may comprise a protrusion. which is configured to engage with a notch in the proximal end of the handle 18, by sufficient distal advance of the spring actuator 82 and rotation of the spring actuator 82. With the spring actuator 82, the rod 55, and the deployment mechanism of ring 20 thus held in place, the applicator 10 can be withdrawn from the patient safely. In another alternative embodiment, which may be particularly suitable for applicators 10 having a substantially rigid arrow 22, but not limited thereto, the applicator 10 lacks the struts 70, 76, the cables 80 and the first and second actuator 30, 32. In this embodiment, the handle 18, the rod 55, the spring actuator 82, and the spring 56, are operable to effect actuation of the ring deployment mechanism 20. The handle 18 has a cylindrical opening through which a proximal portion of the rod 55 is disposed. The side wall of the cylindrical opening has a notch formed therein. The notch has a configuration similar to a ladder, which extends longitudinally for a distance, then circumferentially a distance, then longitudinally a distance, and so on. The proximal end of the rod 55 is fixedly attached to the spring actuator 82, such that rotation of the spring actuator 82 with respect to the rod 55 is substantially impeded, and are operable to rotate concomitantly. A protrusion extends radially outward from a proximal portion of the rod 55. The protrusion is configured to engage the notch in the cylindrical opening of the handle 18. In this embodiment, the rod 55 is free to rotate with respect to the deployment mechanism of the rod. ring 20. With the ring deployment mechanism 20 in a non-actuated state, the rod 55 is in a first distal position, held longitudinally in place by engagement of the projection with a circumferential portion of the notch. Being thus retained in place, the rod 55 resists the compressive impulse of the spring 56. In this alternative embodiment, after rotation of the spring actuator 82, the projection on the rod 55 reaches a longitudinal portion of the notch, which allows the rod 55 runs proximally to reach a second position, which further allows the spring 56 to compress the deployment mechanism 20 to a partially driven position. The proximal movement of the rod 55 stops when the projection reaches the next circumferential portion of the notch, at which point the user can again rotate the spring actuator 82 to cause the projection to reach the next longitudinal portion which, when traversed by the projection will allow the spring 56 to cause the deployment mechanism 20 to reach a fully actuated position. It will be appreciated that, after full actuation of the deployment mechanism 20, the deployment mechanism 20 can be brought back into the non-actuated position by successive steps of rotation and disengagement (against the spring impulse 56) of the spring actuator 82. It will also be appreciated that the above embodiment may be varied in any suitable manner, including without limitation the number of "steps" or rungs, the configuration of the notch, or notch-outgoing alternatives. For example, each circumferential portion of the notch may have a longitudinal "hump", which will be engaged by the projection to the spring impulse 56, so that the user must exert some distant force on the spring actuator 82 to rotate the actuator of spring 82 and cause the projection to traverse the circumferential portion of the notch. Other variations will be evident for those who have average knowledge in the subject.

Having shown and described various embodiments and concepts of the invention, a person with ordinary skill in the art can make further adaptations of the methods and systems described herein by appropriate modifications, without departing from the scope of the invention. Several of these alternatives, modifications and potential variations have been mentioned, and others will be apparent to the expert in light of the above teachings. Accordingly, it is considered that the invention encompasses all of these alternatives, modifications and variations that may be within the spirit and scope of the appended claims, and is understood to be not limited to the details of the structure and operation shown and described in specification and drawings. Additional advantages may easily appear for those skilled in the art.

Claims (20)

NOVELTY OF THE INVENTION CLAIMS

1. - An operable surgical instrument for implanting an anastomotic ring, the instrument comprising: a handle; a ring deployment mechanism configured to receive and deploy an anastomotic ring; an elongated arrow joining the handle to the ring deployment mechanism; an elastic member in communication with the ring deployment mechanism, the elastic member being movable from a first position to a second position; wherein the elastic member is configured to actuate the ring deployment mechanism moving from the first position to the second position.

2. The instrument according to claim 1, further characterized in that the elastic member comprises a spring.

3. The instrument according to claim 1, further characterized in that the elastic member is urged to compress from the first position to the second position.

4. The instrument according to claim 1, further characterized in that the elastic member is held in the first position by a first securing element, which is in communication with a fixed element of the instrument.

5. The instrument according to claim 4, further characterized in that an actuating member is operable to move the first securing element out of communication with the fixed element.

6. The instrument according to claim 5, further characterized in that the actuator member is connected to the first securing element by a cable.

7. The instrument according to claim 6, further characterized in that it comprises a second securing element that is configured to engage a fixed element of the instrument when the elastic member reaches an intermediate position between the first and second position.

8. The instrument according to claim 7, further characterized in that it comprises a second actuating member operable to move the second securing element out of communication with the fixed element.

9. The instrument according to claim 1, further characterized in that the arrow is substantially flexible.

10. The instrument according to claim 1, further characterized in that it comprises a spring trigger in communication with the elastic member, the spring trigger being movable from a first position to a second position, wherein the movement of the spring trigger from the first position to the second position is operable to substantially release the ring deployment mechanism from the forces exerted by the elastic member.

11. A surgical instrument operable to implant an anastomotic ring device, the instrument comprising: a handle; a ring deployment mechanism comprising a proximal portion, a distal portion and a central portion, the ring deployment mechanism being configured to receive and deploy an anastomotic ring device; an elongated arrow comprising a proximal portion and a distal portion, wherein the handle is attached to the proximal portion of the arrow, wherein the ring deployment mechanism is attached to the distal portion of the arrow; and a compressively driven member positioned in the distal portion of the shaft, the compressively driven member being in communication with the ring deployment mechanism, wherein the compressively driven member is configured to drive the ring deployment mechanism to an actuated position.

12. The instrument according to claim 11, further characterized in that the compressively driven member comprises an extension spring.

13. The instrument according to claim 11, further characterized in that the proximal portion of the ring deployment mechanism is fixedly attached to the arrow.

14. The instrument according to claim 13, further characterized in that the compressively driven member is configured to move the distal portion of the ring deployment mechanism and the central portion of the ring deployment mechanism toward the proximal portion of the ring mechanism. deployment of ring.

15. - The instrument according to claim 14, further characterized in that the distal portion comprises distal fingers in a doubly hinged relationship with the central portion of the ring deployment mechanism, and the proximal portion of the ring deployment mechanism comprises proximal fingers in a doubly hinged relationship with the central portion of the ring deployment mechanism.

16. The instrument according to claim 11, further characterized in that it comprises a trigger member that is configured to move from a first position to a second position, wherein the trigger member is operable to release the ring deployment mechanism of the effect. compressive of the member driven compressively.

17. The instrument according to claim 17, further characterized in that the distal portion of the ring deployment mechanism and the central portion of the ring deployment mechanism are configured to move away from the proximal portion when the trigger member is move to the second position.

18. The instrument according to claim 11, further characterized in that it comprises one or more locking mechanisms, wherein each locking mechanism is configured to withstand the compressive drive of the compressively driven member, when each locking member is in one position. of adjustment.

19. The instrument according to claim 18, further characterized in that it comprises at least one blocker member actuator, each blocker member actuator being operable to move at least one of the locking mechanisms (one or more) of the adjustment position.

20. An operative surgical instrument for implanting an anastomotic ring, the instrument comprising: a handle comprising a movable operative control from a first position to a second position; a ring deployment mechanism configured to receive and deploy an anastomotic ring under a driving force; an elongated arrow joining the handle to the ring deployment mechanism; a drive member configured to store driving force; wherein the driving member is operable to apply the stored driving force to the ring deployment mechanism, in response to movement of the operating control from the first position to the second position.