MXPA06005567A - Surgical stapler having a plastic closure plate - Google Patents

Abstract

A surgical instrument for applying a plurality of surgical fasteners to body tissue. The surgical instrument includes a frame having a proximal end and a distal end, with a handle at the proximal end and a support structure at the distal end. The support structure is adapted to support cartridge containing the plurality of surgical fasteners. The instrument further includes a closure member for supporting at least a portion of the cartridge for movement from a proximal end of the support structure to a distal end of the support structure, wherein at least a portion of the closure memberis made from plastic.

Description

SURGICAL ENRAYER THAT HAS A PLASTIC CLOSURE PLATE CROSS REFERENCE WITH RELATED APPLICATION This application is a partial continuation of patent application Serial No. 11 / 014,910, filed on November 20, 2004, which claims priority of the provisional patent application of E.U.A. Serial No. 60 / 352,912, filed on December 30, 2003, which is incorporated herein by reference.

FIELD OF THE INVENTION The present invention relates to a surgical stapling and cutting instrument adapted for use in the diagnosis and therapy of pathologies treated by stapled resection. In particular, the present invention relates to a surgical stapling and cutting instrument having a curvature particularly adapted to conform to the anatomy of a man's pelvis.

BACKGROUND OF THE INVENTION The stapling and surgical cutting instruments are commonly used in the diagnosis and treatment of pathologies treated by stapled resection. The surgical stapling instruments provide a mechanism to extend the transluminal use of mechanical suture devices introduced through the anal canal, mouth, stomach and service access. Although stapling and surgical cutting instruments are used more commonly with rectal pathologies, stapling and surgical cutting instruments can be used in a variety of settings. Over time, stapling and surgical cutting instruments have been developed. These instruments generally include a support frame, an anvil attached to the support frame and a cartridge module carrying a plurality of staples or fasteners. The instruments also include an actuator within the cartridge module which pushes all the staples or fasteners simultaneously towards the anvil to form the staples in a generally B-shape or join multi-part polymer fasteners, suturing the tissue. In addition, these instruments include approach mechanisms for moving the cartridge module from a spaced position relative to the anvil to accept tissue therebetween to a closed position where the tissue is clamped between the anvil and the cartridge module. Finally, the instruments include a firing means for moving the staple driver forward and forming the staples against the anvil.

BRIEF DESCRIPTION OF THE INVENTION In accordance with the present invention, a surgical method for applying a plurality of surgical fasteners to body tissue is provided. The surgical instrument includes a frame having a proximal end and a distal end, with a handle at the proximal end and a support structure at the distal end. The support structure is adapted to support a cartridge containing the plurality of surgical fasteners. The instrument further includes a closure element for supporting at least a portion of the cartridge for movement from a proximal end of the support structure to a distal end of the support structure, wherein at least a portion of the closure element is made of plastic.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a perspective view of the linear surgical stapler according to the present invention; Figure 2 is a perspective view of the linear surgical stapler with the cartridge module removed; Figure 3 is a perspective view of the linear surgical stapler with the cartridge housing moved to an intermediate position; Figure 4 is a perspective view of the linear surgical stapler with the cartridge housing moved to a closed position; Figure 5 is a perspective view of the linear surgical stapler with the firing trigger in a firing position; Figure 6 is a schematic view of the cartridge module; Figure 7 is an anterior perspective view of the cartridge module with the retainer secured thereto; Figure 8 is an anterior perspective view of the cartridge module with the retainer removed; Figure 9 is a rear perspective view of the cartridge module showing the groove of the cartridge housing in substantial detail; Figures 10, 11 and 12 show the assembly of the retainer; Figure 13 is a partial cross-sectional view of the linear surgical stapler in a non-actuated orientation; Fig. 14 is a schematic view of the pin drive mechanism; Figure 15 is a partial cross-sectional view of the linear surgical stapler with the closure actuator slightly retracted; Figure 16 is a partial cross-sectional view of the linear surgical stapler with the closure activator almost fully retracted; Figure 17 is a partial cross-sectional view of the linear surgical stapler with the closure actuator fully retracted; Fig. 18 is a partial cross-sectional view of the linear surgical stapler with the firing trigger and closure actuator fully retracted; Figure 19 is a partial cross-sectional view of the linear surgical stapler after the surgeon presses the release button; Figure 20 is a partial cross-sectional view of the linear surgical stapler after release of the closing and firing triggers without returning to an intermediate stopping position; Figures 21-29 show the insertion of a cartridge module and the removal of the retainer; Figures 30-38 show the various steps involved in driving the linear surgical stapler of the present; and Figures 39 and 40 are detailed front views of the cartridge housing.

DETAILED DESCRIPTION OF THE INVENTION The detailed embodiments of the present invention are described herein. However, it should be understood that the described modalities are merely examples of the invention, which can be modalized in various ways. Therefore, the details described herein will not be construed as limiting, but simply as the basis for showing a person skilled in the art how to make and / or use the invention. With reference to figure 1, in combination with the figures 2 to 5, a stapling and surgical cutting instrument is shown, in particular, a linear surgical stapler 20 which is designed to staple and cut tissue. The linear surgical stapler 20 has a handle 21 at a first proximal end and an end effector 80 at an opposite distal end. The end effector 80 is curved according to a preferred embodiment of the present invention. Structural plates on the right and left sides (often called "handle plates") 34, 35, respectively, connect the handle 21 with the end effector 80 of the instrument (the handle plate on the left side is not shown in Figure 1) ). The handle 21 has a right-side reinforcement 22 coupled to a left-side reinforcement (the left-side reinforcement is not shown in Figure 1). The handle 21 also has a body portion 23 for holding and maneuvering the linear surgical stapler 20 (see Figures 2 to 5). The linear surgical stapler 20 according to the present invention is particularly adapted for insertion into a man's pelvis. In particular, the male pelvis includes portions which are relatively small and, therefore, difficult to access during lower anterior resection (LAR), which requires the instrument to reach the pelvis in the vicinity of the dentate line. The surgical stapler 20 of the present is specifically configured and dimensioned to access the male pelvis during lower anterior resection. In particular, the end effector 80 of the linear surgical stapler 20 is adapted to fit and operate within an oval cover of 9.20 centimeters by 7.62 centimeters. Considering this and in accordance with a preferred embodiment of the present invention, the linear surgical stapler 20 has a distal end with a tissue end effector 80 having a curvature with a diameter of 19.8 centimeters or less, and preferably, 10.16 centimeters or least in order to fit into a minimum covering of the male pelvis. In particular, the end effector 80 has a curvature with a diameter between about 2.54 centimeters and about 10.16 centimeters, and preferably between about 5.08 centimeters and about 10.16 centimeters. According to a more preferred embodiment, the end effector 80 has a curvature with a diameter of approximately 7.62 centimeters. Although the end effector 80 of the present invention is described below as adapted for use in conjunction with a replaceable cartridge module 120 having various components, the concepts underlying the present invention can be applied to a variety of end effector constructions and cartridge module without departing from the spirit of the present invention.

The end effector 80 is a surgical fastening assembly which includes a cartridge module 120 (see figures 6 to 9) and a C-shaped support structure 81. The term C-shaped is used throughout the specification to describe the concave nature of the support structure 81 and the cartridge module 120. The C-shaped construction facilitates improved functionality and the use of the term "C" in the present specification should be interpreted as including a variety of concave shapes. which also improve the functionality of the stapling and surgical cutting instruments. The distal end 30 of a closure element 28 is arranged to receive the cartridge module 120. The end effector 80 also includes a safety lock mechanism 180 (best appreciated in FIG. 31) to prevent triggering of a module. pre-fired cartridge 120. The cartridge module 120 contains a cartridge housing 121 coupled to an anvil 122. The cartridge module 120 also includes a detent pin 125, a knife 126, a removable retainer 160, a surface that makes contact with the cartridge 120. the fabric 127 which deploys a plurality of slots containing staples 128 in a staggered formation in one or more rows (i.e., staple lines) on either side of the knife 126. The staples (not shown) are fired from the housing of cartridge 121 against the staple forming surface 129 of the anvil 122 facing the surface contacting the tissue 127 of the cartridge housing 121.

As will be apparent from the following description, the linear surgical stapler 20 of the present is designed as a multiple shot device with a replaceable cartridge module 120. However, it should be understood that many of the underlying concepts of the present invention they can also be applied in a single shot device without departing from the spirit of the present invention. The support structure 81 of the end effector 80 is respectively attached to the right and left hand handle plates 34, 35, through a stop rivet 82 and posts 83 which extend from the support structure 81 towards holes of reception in the handle plates 34, 35. According to a preferred embodiment of the present invention, the support structure 81 is formed through a one-piece construction. More specifically, the support structure 81 is formed by extrusion, for example, of aluminum, with subsequent machining to create the support structure 81 described in accordance with the present invention. By constructing the support structure 81 in this manner, multiple parts are not required and the associated manufacturing and assembly cost is substantially reduced. In addition, it is believed that the unitary structure of the support structure 81 improves the overall stability of the linear surgical stapler 20 herein. In addition, the unitary extruded structure of the support structure 81 provides a reduction in weight, a simpler sterilization because the cobalt irradiation will effectively penetrate the extruded aluminum and less trauma to the tissue based on the smooth outer surface achieved at through extrusion. The handle 21 of the linear surgical stapler 20 includes a handle 24 which holds the surgeon with the palm of the hand (see Figures 2 to 5). The handle 24 is composed of a reinforcement handle on the right side (see figure 1) and a reinforcement handle on the left side (the reinforcement handle on the left side is not shown in figure 1). Extending in pivot from the underside of the handle 21, there is a locking actuator 26 and a trigger trigger 27. The linear surgical stapler 20 illustrated in FIG. 1 is shown with the trigger and lock triggers 26, 27 in their non-actuated positions and with a cartridge module 120 inserted and the retainer 160 removed. In consecuense, the cartridge housing 121 is spaced apart from the anvil 122 for tissue placement between the cartridge housing 121 and the anvil 122. The handle 21 of the linear surgical stapler 20 contains a tissue retention pin driving mechanism 100. Tissue retention pin drive mechanism 100 includes a saddle slider 101 positioned on the upper surface of the handle 21. Manual movement of the slider 101 results in distal movement of the push rod 102. The push rod 102 it is coupled to the retaining pin 105 of the cartridge module 120. The distal movement or proximal retraction of the driving rod 102 results in the corresponding movement of the retaining pin 125. The driving mechanism of the retaining pin 100 is also releasably engaged to the closure actuator 26 within the handle 21 in such a way that the actuation of the activator of closure 26 will result in automatic distal movement of retaining pin 125 if it has not been manually moved to its closest position. Referring briefly to FIGS. 2 to 5, what happens when the cartridge module 120 is loaded and the closing and firing activators 26, 27 are consecutively tightened toward the handle 24 to drive the end effector 80 of the stapler is illustrated. linear surgical 20. The linear surgical stapler 20 is loaded with the cartridge module 120, as shown in Fig. 2, and the retainer 160 is removed. The linear surgical stapler 20 is now ready to receive tissues as shown in the figure 1. When the lock actuator 26 is partially depressed to rest in its first stop position shown in Figure 3, the cartridge housing 121 moves from its fully open position 1a to an intermediate position between the open and closed positions as it is discussed below in more detail. Simultaneously, the tissue retention pin driving mechanism 100 moves the retention pin 125 forwardly from the cartridge housing 121 through an opening in the anvil 122. In this position, the tissue that has been placed between the housing of cartridge 121 and anvil 122 can be properly positioned and tissue retention between cartridge housing 121 and anvil 122 is ensured. Therefore, when closure actuator 26 has been driven into its intermediate position, the cartridge housing 121 and anvil 122 are positioned correspondingly in their tissue retention positions. When the lock actuator 26 is fully depressed so that it is adjacent the front end of the handle 24, as illustrated in FIG. 4, the tissue contacting surface 127 of the cartridge housing 121 and the staple forming surface 129 of the anvil 122 they are adjacent to each other, and consequently the appropriately placed and retained tissue is completely secured. Additionally, the trigger 27 has rotated counterclockwise toward the handle 24 to allow the surgeon to hold the trigger 27 to trigger the staples. Accordingly, the firing trigger 27 is now in position for the surgeon to tighten to staple and cut the tissue. When the firing trigger 27 has been fully depressed to fire the staples, as shown in Fig. 5, the firing trigger 27 rests in close proximity to the firing activator 26. Referring now to Figs. 6 to 9, presents a more detailed description of the cartridge module 120. The present cartridge module 120 provides a cutting and sealing mechanism for use within the linear surgical stapler 20 wherein the stapling and cutting functions operate in the same direction during the actuation of the cartridge. device. Although the present cartridge module 120 is particularly adapted for use in conjunction with linear surgical stapling devices, the concepts of the present cartridge module 120 can be applied to other surgical devices without deviating from the essence of the present invention. In particular, the present cartridge module 120 stipulates that the blade 126 be used in conjunction with a corresponding washer 123 during the cutting procedure. The present cartridge module 120 ensures that multiple perforations of the linear surgical stapler 20 do not compromise cutting performance. This is achieved by incorporating the anvil 122, in particular, the cutting washer 123, with the cartridge module 120. By combining the washer 123 and blade 126 with the cartridge module 120, a new washer 123 and blade 126 are provided each time the cartridge module 120 is replaced, resulting in better cutting performance. Better performance is achieved by positioning the anvil 122 and the cartridge housing 121 in a parallel manner so as to move in relation to each other with the oriented surfaces of the anvil 122 and the cartridge housing 121 held in a parallel orientation. This offers a uniform distribution of pressure through the tissue, preventing tissue oppression so that it could bulge the tissue and force portions of the tissue out of the desired space defined between the anvil 122 and the cartridge housing 121. More specifically, the module cartridge 120 includes a cartridge housing 121 that contains a plurality of staples (not shown) placed in slots containing staples 128. Immediately behind the staples is disposed an actuator 131 which is arranged to push the staples out of the slots of staples 128. A knife holder 130 is disposed immediately proximal to the actuator 131 in the cartridge housing 121. The knife holder 130 contains a slot 172 and shoulder 173 for interaction with a knife retractor hook 45 (see FIG. 37), whose function is will discuss below in more detail. The knife holder 130 is attached to a blade 126 which extends distally from the knife holder 130 through a slot 120 in the actuator 131 and through a slot 199 in the cartridge housing 121. Although the knife is described as being inside the housing In accordance with a preferred embodiment of the present invention, other configurations may be employed without departing from the essence of the present invention.; for example, it is contemplated that the cartridge module could be constructed without a blade if required by specific applications. The knife holder 130 has a detent post 138 that extends through the slot 137 in the cartridge housing 121. The knife holder arrest post 138 is arranged to contact the stop protrusion 139 of the cartridge slot 137. during the longitudinal displacement of the blade 126 and the blade holder 130. Similarly, the actuator 131 has a stop post 140 which is arranged to make contact with proximal and distal stopping protrusions 141, 142 respectively of the cartridge slot 137 .The blade 126 and slots 199, 200 are positioned such that there is at least one row of staples on either side of the blade 126. In accordance with a preferred embodiment of the present In this case, two rows of staple slots 128 (and two rows of staples) are provided on each side of the slot 199 of the cartridge housing 121. The cartridge housing 121 contains two generally circular openings 143, 144 at either end of the cartridge. blade groove 199. The general circular opening 143 in the cartridge housing base 121 is shaped and is dimensioned for the passage of a guide pin 124 through the cartridge housing 121. The generally circular hole 144 in the upper phase of the cartridge housing 121 has the shape and is dimensioned for the passage of a retaining pin 125 through the cartridge housing 121. The staple grooves 128 are arranged such that the staples extend laterally passing through the generally circular holes 143. , 144. In accordance with a preferred embodiment of the present invention, the anvil 122 includes a plastic washer 123 and a forming surface a metal staple 129. The anvil 122 is arranged to maintain the staple forming surface 129 in a configuration of engagement with the staples. The latch pin 125 is connected to a coupler 133 by a circumferential groove 135 in the latch pin 125 and a slit 134 in the coupler 133 (best seen in Fig. 14). The coupler 133 is disposed within an arm 145 of the cartridge housing 121 and is held within the arm 145 by an end cap 146. The guide pin 124 and the retaining pin 125 include corresponding grooves 147a, 147b (which look better in Figures 8, 9, 36, 39 and 40) within which the ends 126a, 126b of the blade 126 are disposed. The proximal end 148 of the guide pin 124 is connected to the proximal end 149 of the anvil 122. The distal end 150 of the guide pin 124 extends from the cartridge housing 121 and extends through a slot 151 of the anvil 122. A cutting washer 123 slides over the anvil 122 by a slit 152 in the anvil 122 which fits under a tongue. 153 in the washer 123. The opposite end 154 of the cutting washer 123 slides under the anvil arm 155 and is locked to the anvil arm 155 by a pin 156. In this position, the cutting surface 157 of the groove 123 extends upward through a slot 151 in the anvil 122. The assembly of the cutting washer 123 to the anvil 122 catches the guide pin 124 in aperture formed by the anvil groove 151 and the cutting surface 157, thereby connecting operatively the anvil 122 to the cartridge housing 121. The retainer 160 is attached to the cartridge module 120 as shown in Figure 7 to maintain the components of the cartridge module 120 in a desired orientation until insertion into the end effector 80. Returning to Figures 6 to 12 in combination with Figures 25 to 29, the retainer 160 will be described in greater detail. The detent 160 has a groove 161 which is disposed about a protrusion 159 of the cartridge housing 121. The retainer 160 contains an elastic inner spring arm 162 which is arranged for alternating movement within the retainer 160. The retainer 160 includes containment grooves 163 that extend partially around the guide pin 124. The spring arm 162 includes containment grooves 164 that extend partially around the guide pin 124, but which are configured to face away from the containment grooves 163. The retainer 160 it is positioned on the cartridge module 120 in such a way that the containment grooves 163, 164 surround the guide pin 124 and trap the retainer 160 on the cartridge module 120. The spring arm 162 includes a decoupling flange 165 extending down from the retainer 160 below the anvil arm 155. As such, the retainer 160 is not easily removed from the cartridge module 120 until the cartridge module 120 is properly seated within the end effector 80. When the cartridge module 120 is properly seated within the end effector, the decoupling tab 165 coupling the end effector 80 for releasing the retainer 160. Referring again to Figure 1 in combination with Figure 2 and Figure 13, a more detailed description of the components of the linear surgical stapler 20 is provided. The linear surgical stapler 20 includes an elongated closure element 28, with a generally U-shaped cross section extending from the handle 21 within the surgical fastening assembly of the end effector 80. In accordance with a preferred embodiment of the present invention, the element 28 is a molded plastic element configured for movement and functionality in accordance with the present and invention. By manufacturing the closure element 28 in plastic, manufacturing costs are reduced and the weight of the linear surgical stapler 20 is also reduced. Additionally, the linear surgical stapler 20 is easy to sterilize with cobalt irradiation since the plastic is more Easy to penetrate than stainless steel. Suitable types of plastic include the class of plastics called thermoplastics that include, without restriction, polyamide, polyphenylene sulfide, polyethylene terephthalate, polyacetal, polyester, polysulfone, polyethersulfone, liquid crystal polymers, acrylonitrile butadiene styrene (ABS), polycarbonates, nylon , polyurethane, polyphthalamide, polyether ketone that may or may not be molded with additives such as fibers or glass beads, aramid or carbon to increase its strength. The molded components can be produced in tightly controlled narrow tolerance ways. This would produce the curved shape and intricate characteristics for the element 28. Additionally, there is no longer the need to join multiple plates together. The one-piece molding eliminates the need for fasteners such as rivets to keep the closure subsystem attached. The other holes for the locking pin and for the guide rivets can now be aligned precisely as they are molded in the same tool one at a time. Additionally, plastic weighs much less than stainless steel so the overall weight of the device decreases. In terms of sterilization, a plastic component is much easier to be penetrated by cobalt irradiation than several laminated steel plates. Finally, the use of a one-piece molded closure element allows the elimination of fasteners, stainless steel closure plates, plastic separators, making the assembly much easier. The distal portion of the closure element 28 passes through the walls 84 of the support structure 81. The distal end is arranged to receive and retain the cartridge housing 121 of the cartridge module 120. The central portion of the closure element 28 it is positioned between the right and left hand plates 34, 35 respectively. The right and left hand lock links 36, 37 respectively are hingedly attached to the proximal right and left ends of the closure element 28 by a first integral lock link pin 38. At the opposite end of the lock links 36, 37, the closure links 36, 37 are hingedly attached to a second integral lock link pin 39. The second integral lock link pin 39 connects the lock links 36, 37 to a slotted lock arm link 40. The slotted locking arm link 40 is hingedly mounted to the handle plates 34, 35 of the linear surgical stapler 20 on a locking actuator pivot pin 41. The locking actuator 26 descends from the slotted closure arm link 40 for pivotal rotation about the locking actuator pivot pin 41 towards and away from the handle 24. A closing spring 42 housed within the handle 24 of the handle 21 s and securing the slotted locking arm link 40 to provide a desired resistance when the surgeon tightens the locking actuator 26 toward the handle 24, and to deflect the closure actuator 26 to the open position. Referring to Figures 13 and 14, the components of the latching mechanism of the latching pin 100 will now be described. The handle 21 contains a saddle-shaped slide 101 mounted on the upper part of the handle for linear movement. The slider 101 is connected to a post 103 extending outwardly from a driving rod actuator 104 through the slots 105 (see FIG. 2) in the handle 21. The driving rod actuator 104 is restricted for longitudinal movement as far as possible. length of the long axis of the linear surgical stapler 20 through the slots 105. The driving rod actuator 104 is connected to the push rod 102 by a circumferential groove 107 in the driving rod 102 which fits into the slot 108 of the driving rod actuator. 104. The distal end of the push rod 102 contains a circumferential groove 109 which interconnects with a groove 132 at the proximal end of the coupler 133 of the cartridge module 120 (better shown in Figure 22). The distal end of the coupler 133 contains a groove 134 for interconnection with a circumferential groove 135 in the retaining pin 125.

The closure element 28 contains posts 29 that extend laterally on both sides of the closure element 28 within the handle 21. These posts 29 are slidably connected with an L-shaped slot 110 of a yoke 111. The yoke 111 is pivots the handle 21 by means of a pivot pin 112 in the fork 111. The fork 111 contains cam pins 113 positioned to push the cam surfaces 114 into the driving rod actuator 104. Referring to FIG. 13 and FIG. 37, the components of the shot transmission assembly will now be described. The trigger transmission assembly has an elongated firing bar 43 extending from the handle 21 in the surgical fastening assembly of the end effector 80. The firing bar 43 is positioned within the U-shaped cross section of the element. 6. The distal end of the firing bar 43 extends into the cartridge housing 121 and is positioned just proximally of the knife holder 130 and the actuator 131. The distal end of the firing bar 43 is fixed to a retractor of blade 44 having a blade retraction hook 45. The firing bar 43 has a rectangular receiving groove 46 in that portion of the firing bar 43 which is housed within the handle 21 (see Figure 13). The first integral locking link pin 38 extends through a receiving slot 46. The trigger bar 43 also has a proximal end section 47. The lower side of the proximal end selection 47 of the trigger bar 43 has a sliding surface 48. The proximal end section 47 also has a terminal side engaging surface 49 extending from the sliding surface 48. The trigger activator 27 is pivotally mounted to the handle plates 34, 35 by a pivot pin of the firing trigger 50 separating from the pivot pin of the locking actuator 41 so that each of the pivot pins pivots about mutually independent axes. The trigger activator 27 includes an arcuate firing trigger link 51 extending from the firing trigger 27 on the firing pin pivot pin 50 to an apex 52 resting on the sliding surface 48 of the end section proximal 47 of the firing bar 43. Within the handle 21, the firing trigger 27 is fixed to the first and second spring arms of firing trigger 53, 54, respectively. The spring arms of the firing trigger 53, 54 support a torsion spring (not shown) in the right half of the trigger activator 27. Finally, a firing bar return spring 55 is secured to the underside of the firing bar. shot 43 in that portion of the firing bar 43 within the handle 21 to deflect the firing bar 43 to its non-actuated position. When the lock actuator 26 is pressed towards the handle 24, the slotted locking arm link 40 and the latch links 36 and 37, move distally within the receiving slot 46 of the firing bar 43. The distal movement causes the closure element 28 to move correspondingly distally. Likewise, the firing bar 43 moves concurrently distally with the closing element 28 since the first integral closing link pin 38, to which the closing links 36, 37 are attached, extends to through the receiving slot 46 in the firing bar 43. The mechanism that defines a. Intermediate closing stopping position and releasing the locking actuator 26 from an activated position to its original non-driven position will now be described in relation to FIG. 1 in combination with FIGS. 13-20. The upper side of the slotted locking arm link 40 has a clamping slide surface 56 that deploys an intermediate stop 57 and a lock stop 58. A release pawl 59 slides on the slide surface of clamp 56 and can engage Intermediate and closing detentions 57, 58. The release pawl 59 has a laterally extending ratchet heel 60 (best seen in Figure 1) at its distal end. The release pawl 59 is located within the handle 21, and is integrally secured to a release button 61 located on the outside of the handle 21. The release button 61 has a thumb support 62, and the release button 61 is fixed in pivot to the handle 21 by a release pin 63. The release button 61 is biased away from the handle and, therefore, the release pawl 59 is biased down towards the clamping slide surface 56 by a spring of release 64 which is mounted to the handle 21 by a spring retaining pin 65 and is mounted to the release button 61 by means of a button spring post 66. The slotted closure arm link 40 has an arcuate recess 67 located between the intermediate and closing stops 57, 58. Seated within the arcuate recess 67 for rotary movement are the left oscillating connection 68 integrally connected to the oscillating connection of the right side (the oscillating connection on the right side is not shown). Each oscillating connection 68 has an arm of the oscillating connection 69 which engages with the heel of the ratchet 60. The ratchet heel 60 has a concave proximal surface 70 to provide space between the arm of the oscillating connection 69 and the ratchet bead 60. With reference to Figure 31 (view cut into the cartridge and support structure), the components of the locking mechanism of the fired device 180 will now be described. It will be appreciated from the following description that once the device has triggered the locking mechanism 180 prevents movement of the cartridge housing 121 to its second closed position but allows the relative reapproximation movement of the cartridge housing 121 and the anvil 122, whereupon the reapproximation provides an indicator that the instrument is not working badly The allowed reapproximation will constitute about 1/4 to about 2/3 of the total distance between the housing of the cartridge 121 and the anvil 122 when it is in the first separated position, and more preferably, 1/4, 1/3 or 1 / 2 of the total distance between the cartridge housing and the anvil when the first separated position is.

The locking mechanism 180 contains a locking lever 181 which is pivotally mounted to the distal end 30 of the locking element 28 by a pin 182. The locking lever 181 is spring-biased downward toward the base of the support structure 81. by means of a spring (not shown). The locking lever 181 contains a proximal and distal end 184, 185, respectively. The proximal end 184 has a cam surface 186 and a locking groove 187. The support structure 81 of the end effector 80 contains a flange 85 which is positioned to interact with the locking groove 187 when the locking mechanism 180 engages. . The support structure 81 contains a base surface 86 between the walls 84. The base surface 86 is positioned to interact with a cam surface 186 when the lock lever 181 is not engaged. The loading operation of the cartridge module 120, the closing mechanism, the retaining pin mechanism, the firing transmission assembly, the intermediate and closing detents 57, 58, the release mechanism and the locking mechanism 180 are will describe now. Referring to Figures 7 to 12 and Figures 21 to 28, the loading of the cartridge module 120 into the tissue end effector 20 is described. The cartridge module 120 is formed and sized for selective insertion and removal of the end effector. of tissue 80 of the linear surgical stapler 20. Prior to insertion of the cartridge module 120 into the end effector 80 of the linear surgical stapler 20, as seen in FIG. 7, the retainer 170 can not be easily removed from the stapler module. cartridge 120 as the slit 161 is placed around the protrusion 159 at the upper end of the retainer 160 preventing disconnection. In addition, the containment grooves 163, 164 of the retainer are placed around the guide pin 124 in the bottom of the retainer 160 preventing disconnection as shown in Figure 25. The attached retainer 160 provides support to the structure of the cartridge module 120 and an extended surface area for fastening, both characteristics making loading easier. The retainer 160 also prevents the staples from being pulled out of the cartridge housing 121 during casual handling and prevents the blade 126 from being accidentally exposed during casual handling. The movement of the blade 126 and the movement of the staple is further resisted before loading and during loading by a series of detentions. Referring to Figure 9, the stopping post 138 on the knife holder 130 is prevented from moving proximally and distally by the stopping protrusion 139 in the cartridge receiving groove 137. The accordion 131 is prevented from moving distally due to the casual handling and during cartridge loading of the cartridge 120 in the linear surgical stapler 20 by interaction of the stopping post 140 and the stopping protrusion 141 in the groove of the cartridge housing 137. The cartridge module 120 is loaded into the effector of tissue 80 so that the cartridge housing 121 slides at the distal end 30 of the closure element 28 as seen in Figures 21 to 24. The walls 31a and 31b in the closure element 28 slide into the slots. 170a, 170b of the cartridge housing 121 during loading. Simultaneously, the tabs 174 (see FIG. 8) slide in the slot 88 of the C-shaped support structure 81. The loading of the cartridge module 120 is completed when the detents 171 fit in the stop slot 32 of the end. distal of the closure element 30, as shown in Figures 21 to 24. In the position shown in Figure 24, the cartridge module 120 is fully loaded and the proximal slot 132 of the coupler 133 has engaged the distal circumferential groove. 109 of the push rod 102 so that the holding pin 125 in the cartridge module 120 it is connected to the advancing mechanism of the retaining pin 100. The slot 172 of the knife holder 131 engages the blade retraction hook 45 during loading so that the hook 45 has engaged the retraction flange 173 on the knife holder 130 at the end of the engagement. loading the cartridge module 120. Upon completion of loading the cartridge module 120 a post 188 placed in an accliplier 130 contacts the distal end 185 of the lock lever 181 (see FIG. 31). This contact pivots the locking lever 181 around the locking lever pin 182 to a position such that the camming surface 186 is aligned horizontally with the base surface 186 of the U-shaped support structure 81.

The detent 160 can now be removed from the end effector 80. Specifically, the termination of the charge of the cartridge module 120 causes the decoupling flange 165 to contact the support structure 81 (see FIG. 23), resulting in a movement upward of the spring arm 162 when the cartridge module 120 is fully loaded as in Figure 24. This upward movement displaces the containment grooves 164 upwardly so that the guide pin 124 is no longer contained (see figures 25 and 26). ). Referring now to Figs. 27 to 29, a removal force applied to the thumb pad 166 results in the latch 160 being pivoted upwardly around a protrusion 159 until the slit 161 is capable of rapidly removing the pin. protrusion 159. The removal of retainer 160 allows the loaded linear surgical stapler 20 to be used. In Fig. 15, closure actuator 26 has been partially tightened from its open, non-driven position illustrated in Figs. 1 and 13. When the locking actuator 26 is partially depressed, pivots about the pivot pin of locking actuator 41 in a counterclockwise direction toward handle 24. As it pivots, the closing arm link slot 40 and closing plate closure links 36, 37 move forward, consequently by moving closure element 28 and firing bar 43 distally. As the slotted locking arm link 40 moves forward, the pawl heel 60 of the release pawl 59 slides on the cam sliding surface 56. The pawl 60 engages the distal ends of the pawl arms. the oscillating connection 69 of the oscillating connections 68, and as a consequence, pivots the oscillating connections 68 in a direction in the direction of the hands. As the slotted arm closing link 40 continues to move forward in response to the pivotal movement of the locking actuator 26 toward the handle 24, the ratchet heel 60 of the release pawl 59 will finally lock the intermediate stop 57. Once is placed in the intermediate stop 57, the closing spring 42 is unable to return the closure actuator 26 to its original inactivated position. The lock actuator 26 is now in a partially closed intermediate position, to properly position and retain the tissue between the cartridge housing 121 and the anvil 122, as shown in FIG. 15. In addition, as the element of closure 28 and firing bar 43 move distally, the apex 52 of the arched firing trigger link 51 slides on the sliding surface 48 of the proximal end section 47 of firing bar 43. During the firing stroke closing from the open position to the intermediate position, the mechanism of the retention pin 100 is activated. The forward movement of the closure element 28 moves the integral poles 29 distally. The posts 29 contact the L-shaped groove 100 of the fork 111. Therefore, the distal movement of the posts 29 cammed the L-shaped groove 110 causing the fork to pivot about the pins 112. The rotation leads to the support posts 113 in the fork 111 in contact with the cam surfaces 114 in the driving rod actuator 104. The additional rotational movement of the fork 111 causes the support posts 113 to move the actuator of drive rod 104 distally through the cam contact on surfaces 114. The driving rod actuator 104 contacts the driving rod 102, moving the driving rod 102 distally. The driving rod 102, in turn, moves the coupler 133 and the retention pin 125 distally. The termination of the closing stroke towards the intermediate stopping position 57 results in the movement of the retaining pin 125 distally through the hole 144 of the cartridge housing 121., through the hole 159 running through the washer 123 and the anvil 122 and into the hole (not shown) in the support structure 81. The fabric, which is placed between the contact surface 127 of the cartridge housing 121 and the anvil 122 is now retained between the retaining pin 125 and the guide pin 124. This same result can be obtained before closing with manual distal movement of the saddle type slide 101. The sliding movement will result in a forward movement of the driving rod 102, the coupler 133 and the retaining pin 125 until the retaining pin 125 is fully placed through the anvil 122, the washer 123 and the hole 89 in the support structure 81. The activation of the travel of the closing after the retaining pin 125 moves manually forward, it could still result in the rotation of the fork 111 as described above but without any further movement of the locking pin drive mechanism 100. The closing stroke from the open position to the intermediate stopping position 57 moves the locking lever 181 distally as it joins the closure element 28 through the pin 182 as shown in Fig. 31 (open) and Fig. 32 ( Intermediate position). The distal movement of the locking lever 181 causes the cam surface 186 to contact the locking flange 85 of the support 81, resulting in the lever. lock 181 rotate clockwise and contact slidably with base surface 86 of support structure 81. In this position, distal end 185 of lock lever 181 rotates away from post 188 in the actuator 131. Now with specific reference to FIG. 16, when the lock actuator 126 is pressed towards the handle 24 of the intermediate stop position 57, the oscillating connection arms 69 of the oscillating connection 68 are decoupled from the bead ratchet 60. Accordingly, as the oscillating connection 68 continues to rotate in a clockwise direction, the ratchet bead 60 moves the oscillating connecting arms 69 and with continuous movement of the locking actuator 26 fall into the lock stop 58. As the release pawl 59 moves the swing arm 69 rotates the release button 61 clockwise to around the pivot 63. As the release pawl 60 falls into the stop 58, it produces an audible clicking sound which notifies the surgeon that the closing position has been achieved. Further, as the firing bar 43 continues to move forward, the tip 52 of the link of the arched firing trigger 51 makes contact with the lateral engagement surface 49 of the proximal end section 47 of the firearm 43. Accordingly, the trigger 27 moves in a position where it can continue to move the firing bar 43 distally to drive staples after the tissue is fully secured. When the tip 52 of the arcuate firing trigger 51 moves in engagement with the mating surface 49 of the proximal end section 47, the firing trigger 27 begins to pivot in a counter-clockwise direction. clockwise to the handle 24 in response to the action of a torsion spring on the right hand side of the trigger 27 (the torsion spring is not shown). The trigger activator 27 performs pivotal movement independently of the pivoting movement of the locking actuator 26, but its pivot rotation is blocked until the firing bar 43 moves distally to allow engagement of the firing activator link 51 with the surface of terminal coupling of the firing bar 43. Specifically with respect to Figure 17when the lock actuator 47 is fully tightened and is adjacent to the handle 24, the ratchet bead 60 at the distal end of the release ratchet load 59 at the lock stop 58. In the lock stop position 58, the fabric is fully clamped between the cartridge housing 121 and the anvil 122, and the closing spring 42 is unable to return the locking actuator 26 to its original position. Therefore, the lock actuator 26 is retained in the position shown in Figure 4. Concurrently with the counterclockwise movement of the lock actuator 26, the trigger 27 continues to rotate in the opposite direction clockwise by the action of the return spring of the torsion trigger bar 55 until the firing trigger 27 is in a relatively vertical orientation with respect to the handle 21 of the linear surgical stapler 20. In the fully position When attached, the tip 52 of the arcuate firing trigger link 51 fully engages the engagement surface of the proximal end section 47 of the firing bar 43 and, therefore, firing trigger 27 is in a position where it can further moving the firing bar 43 distally to drive the staples in the tissue. In the fully closed position, the staple cavities 128 of the cartridge housing 121 are aligned with the staple forming surface 129 of the anvil 122 as shown in FIG. 33. The retaining pin 125 is aligned with the upper part of the anvil 122 and the cartridge housing 121 and the guide pin 124 align with the lower part of the cartridge housing 121 with the lower part of the anvil 122.

As illustrated in Fig. 18 and Fig. 34, the firing trigger 27 can be tightened to pivot it towards the handle 24 until it is positioned adjacent to the locking actuator 26. During the pivoting of the firing trigger 27, the firing bar 43 moves distally, making contact with the knife holder 130. The resulting distal movement of the knife holder 130 results in contact with the knife 126 and the actuator 131. The distal movement of the actuator 131 results in the advancement of the staples ( not shown) distally on the staple forming surfaces 129 of the anvil 122 resulting in the formation of the staples in a generally B-shape. The knife 126 advances distally in the grooves 147 of the guide pin 124 and the retaining pin 125 together with the formation of the staple. These slots 147 guide the blade 126 in the cutting surface 157 of the cutting washer 123 resulting in the transection of any retained tissue. Release of manual pressure to the trigger 27 results in the return spring of the firing bar 55 retracting the firing bar 43 and returning the firing trigger 27 to the position shown in Figure 17. This movement results in the retraction by the retraction hook 45 of the retraction flange 173 in the knife holder 130 and the knife 126. The resulting proximal movement retracts the knife 126 in the cartridge housing 121 as shown in Figure 35. The stopping post 138 in the knife holder 130 retracts in engagement with the stop 139 in the cartridge housing 121 to maintain the knife holder 130 and the knife 126 in this retracted position. The actuator 131 is retained in its most distal (fired) position by engaging the stop post 140 on the actuator 131 by engaging the stop 142 of the cartridge slot 137. There may be interference on the blade 126, when the user cuts off on another surgical instrument by mistake, in such a way that the force of the return spring of the firing bar 55 is insufficient to retract the firing bar 43 and thereby retract the blade 126 in the cartridge housing 121, the user can manually retract the cutting system by pulling the trigger trigger 27 in a clockwise direction. Movement in the clockwise direction causes the link of the arched trigger 51 to turn clockwise until it hits with a retraction tab of the shot bar 71 at the proximal end 47 of the firing bar 43. The contact between the firing link of the trigger arched spacer 51 with clockwise movement and the retraction tab of the shot bar 71 causes the firing bar 43 to retract proximally and return to the position shown in figure 17. This in turn causes the the retraction hook 45 retracts the retraction flange 173 on the knife holder 130 and the knife 126. In this way, this safety feature allows the user to retract the cutting mechanism to a safe position and return the triggering system to a position that it may allow the linear surgical stapler 20 to be opened, as will be described below.

With reference to Figure 19, when the surgeon presses the release button 61, the release pawl 59 pivots about a release trunnion 63 in a clockwise direction to disengage the pawl heel 60. of the closing stopping position 58. As it uncouples, the ratchet bead 60 moves on the oscillating connecting arms 69 to bypass the intermediate stopping position 57 on the clamp link 40. In this way, the locking actuators and firing 26, 27 can return to their original positions, not actuated in response to the displacement created from the closing spring 42 and the return spring of the firing bar 55. When the ratchet bead 60 moves on the arms of oscillating connection of the oscillating connections 68, the oscillating connecting arms 69 rotate in the counterclockwise direction according to the closing and trip activators. ro 26, 27 turn in a clockwise direction to return to their original positions, not triggered. Therefore, the surgeon can release the closing and firing activators 26, 27 so that they can return to the positions in Figure 20 without unnecessary return to the intermediate stopping position 57. The release of the linear surgical stapler 20 to the open position shown in the figure in figure 20 causes the closure element 28 and the attached locking lever 181 are retracted to the fully open position as shown in Figure 36. In this position the post 188 of the actuator 131 is no longer positioned to maintain the distal end of the locking lever 185. The actuator 131, as described above, is stopped in place in the forward position by the post 140 and the cartridge stop 142. Therefore, when the lock lever 181, whose proximal end 184 slides along the surface of the support arm 86, retracts completely free to rotate counterclockwise and the fall blocking groove 187 below the flange 85 in the C-shaped support structure 81. The locking lever 181 will remain in this position when the cartridge module 120 is removed as shown in Figure 37. Any future attempts to close the linear surgical stapler 20 that has been fired will result in engaging the locking groove 187 in the flange 85 as shown in Figure 38, providing feedback to the user of a pre-triggering device. This same feature will couple if the detent 160 has been removed prior to loading and the cartridge module 120 has been loaded erroneously without the cartridge module 120 being in the correct position. In this case the actuator post 188 may not be in the correct position to move the lock lever 181 in the position that will be cammed on the surface 86 as described above. Similarly, a cartridge module 120 that has already been fired may also not release the locking mechanism 180. It is important to note that there is a permitted stroke travel in the locking mechanism 180 prior to engagement of the locking groove 187 which it engages in flange 85. This path indicates to the user that the device has not jammed due to a malfunction which may be the reaction if the locking mechanism 180 is not traversed. Therefore, the user knows that the device is not stuck but is incorrectly loaded when the locking mechanism is engaged. After releasing the device back to the open position shown in FIGS. 1 and 2, the latch pin mechanism 100 must be manually retracted by pushing the seat 101 proximally. The retraction causes the latch pin 125 it retracts back into the housing of the cartridge 121. Upon completion of the manual retraction, the fired cartridge module 120 can be discharged and replaced by a new cartridge module 120. The device described above is not only applicable for curved staplers. The invention has the same applicability in a non-curved stapler as those described in the patent of US Pat. No. 5,605,272 issued to Witt et al. on February 25, 1997, the patent of E.U.A. 5,275,322 issued to Brinkerhoff et al., The patent of E.U.A. 5,706,998 issued to 5,706,998, all of which are incorporated herein by reference. Although the preferred embodiments of the present invention have been presented and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes and substitutions will be apparent to those skilled in the art without departing from the invention. For example, as is apparent to those skilled in the art, what is described herein may have an equal application in robotic-assisted surgery. Furthermore, it should be understood that each structure described above has a function, and that reference to said structure can be made as a means to perform said function. Accordingly, it should be understood that the invention is limited only by the spirit and scope of the appended claims.

Claims (18)

NOVELTY OF THE INVENTION CLAIMS

1. - A surgical instrument for applying a plurality of surgical fasteners to a body tissue, said instrument having an open position, and a closed position for applying said fasteners, the surgical instrument comprises: a) a frame having a handle at a proximal end of the same, and a support structure at a distal end thereof, said support structure is adapted to support said plurality of surgical fasteners; b) a closure element for supporting at least a portion of said plurality of surgical fasteners to move from said open position to said closed position, wherein at least a portion of said closure element comprises plastic.

2.- The surgical instrument in accordance with the claim 1, further characterized in that it also includes a firing mechanism for deploying said surgical fasteners.

3. The surgical instrument according to claim 1, further characterized in that said support structure has a substantially C-shaped.

4. The surgical instrument according to claim 3, further characterized in that said support structure has a radius of curvature of at least approximately 19,812 centimeters.

5. - The surgical instrument according to claim 3, further characterized in that said support structure has a curvature of between approximately 2.54 centimeters in diameter and approximately 10.16 centimeters in diameter.

6.- The surgical instrument in accordance with the claim 3, further characterized because said supporting structure has an adapted curvature to fit within an oval cover of 9,194 centimeters by 7.62 centimeters.

7. The surgical instrument according to claim 1, further characterized in that said device is adapted to deploy at least one row of surgical fasteners.

8. The surgical device in accordance with claim 1, further characterized in that it also includes a blade for cutting an eyelid.

9.- The surgical instrument in accordance with the claim 1, further characterized in that said closure element is formed at least partially with a thermoplastic polymer selected from the group comprising: polyamide, polyphenylene sulfide, polyethylene terephthalate, polyacetal, polyester, polysulfone, polyethersulfone, polyetherimide, liquid crystal polymers, acrylonitrile butadiene styrene, polycarbonates, nylon, polyurethane, polyphthalamide, polyether cetron.

10. - The surgical instrument according to claim 1, further characterized in that said surgical fasteners comprise staples.

11. A surgical instrument for applying a plurality of surgical fasteners in a body tissue, the surgical instrument comprises: a) a frame having a handle at a proximal end thereof, and a support structure in a distal eximere thereof; said support structure is adapted to support said plurality of surgical fasteners; b) a closure element for supporting at least a portion of said plurality of surgical fasteners to move from said open position to said closed position, wherein said closure is made substantially entirely of plastic.

12. The surgical instrument according to claim 11, further characterized in that it also includes a trigger mechanism for deploying said surgical fasteners.

13. The surgical instrument according to claim 11, further characterized in that said support structure has a substantially C-shape.

14. The surgical instrument according to claim 11, further characterized in that said closure element is formed by at least partially with a thermoplastic polymer selected from the group comprising: polyamide, polyphenylene sulfide, polyethylene terephthalate, polyacetal, polyester, polysulfone, polyethersulfone, polyetherimide, liquid crystal polymers, acrylonitrile butadiene styrene, polycarbonates, nylon, polyurethane, polyphthalamide, polyether ketone.

15. The surgical instrument according to claim 11, further characterized in that said surgical fasteners comprise staples.

16. A surgical instrument for applying a plurality of surgical fasteners on a body cord, the surgical instrument comprising: a) a frame having a handle at a proximal end thereof, and a support structure at a distal end thereof, said spherical support structure adapted to support said plurality of surgical fasteners; b) a closure element for supporting at least a portion of said plurality of surgical fasteners to move from said open position to said closed position, wherein said closure element is formed entirely from a single piece of molded plastic.

17. The surgical instrument according to claim 11, further characterized in that it also includes a trigger mechanism for the deployment of said surgical fasteners.

18. The surgical device according to claim 11, further characterized in that said closing element is formed at least partially of an ion-plastics polymer selected from the group comprising: polyamide, polyphenylene sulfide, polyethylene terephthalate, polyacetal, polyester, polysulfone, polyethersulphone, polyetherimide, liquid crystal polymers, acrylonitrile butadiene styrene, polycarbonates, nylon, polyurethane, polyphthalamide, polyolefin.