US20180116663A1 - Surgical stapler - Google Patents
Surgical stapler Download PDFInfo
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- US20180116663A1 US20180116663A1 US15/827,250 US201715827250A US2018116663A1 US 20180116663 A1 US20180116663 A1 US 20180116663A1 US 201715827250 A US201715827250 A US 201715827250A US 2018116663 A1 US2018116663 A1 US 2018116663A1
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- staples
- cartridge
- anvil
- stapler
- slot
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07221—Stapler heads curved
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
Definitions
- FIG. 2 is an exploded perspective view of the surgical stapler in FIG. 1B ;
- the second and third slots 142 , 144 may be shaped, configured, or positioned so as to house the first staple at an angle ⁇ oblique to the second slot or staple.
- the angle ⁇ between the second slot 142 and the third slot 144 is between about 4 degrees and about 30 degrees.
- the angle ⁇ is between about 10 degrees and about 20 degrees.
- the angle ⁇ is between about 10 degrees and about 15 degrees.
- the angle ⁇ is between about 15 degrees and about 20 degrees.
- the angle ⁇ is about 15 degrees plus or minus a suitable manufacturing tolerance.
- the angle ⁇ is between about 12 degrees and about 18 degrees.
- the anvil 102 has one or more guides 190 (see e.g. FIG. 9 ), configured to guide the cutting mechanism 108 or member 118 , 120 of the cutting mechanism 108 as the cutting mechanism 108 travels down the anvil 102 (see e.g. FIGS. 20A-20C ).
- the guides 190 in the anvil 102 may correspond to or engage guides 192 in the cutting mechanism 108 .
- the guide(s) 190 in the anvil 102 may be one or more recesses 190 that engage corresponding one or more ridges or protrusions 192 in the upper member 118 of the cutting mechanism 108 , as illustrated.
- the curved tissue clamping interface is curved about a longitudinal axis extending between a proximal end and a distal end of the elongated body; and the curved tissue clamping interface has a radius of between 40% and 60% of the envelope diameter.
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- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
Description
- This application is a continuation of application Ser. No. 15/148,744, filed May 6, 2016, and entitled “SURGICAL STAPLER”, which claims priority to U.S. Provisional Application No. 62/159,191, filed May 8, 2015 and entitled “SURGICAL STAPLER,” the entire disclosure of which is hereby incorporated by reference for all proper purposes.
- A surgical stapler is a medical device which is used to place surgical staples in a patient to close wounds ranging from bowel resections to skin incisions and others.
- The staples to be applied to the tissue must be selected based on the thickness of the tissue to be stapled. Generally, larger staples require the use of surgical staplers that are also larger. For example, one 5 mm stapler sold under the trademark JustRight™, has a nominal shaft diameter of about 5 mm, and is currently indicated for applying staples having a nominal leg length of about 2 mm. Put another way, the 5 mm JustRight™ Surgical Stapler is indicated for use in procedures in which the tissue can be clamped between the stapler jaws to about 1 mm or less. JustRight™ is a trademark belonging to the assignee of this application.
- Some currently-available staplers, such as a stapler sold under the trademarks Cardica™ MicroCutter Xchange® 30, do not use staples defined by a leg length; nonetheless, these staplers are similarly limited in that the staplers cannot staple tissue if the tissue cannot be clamped to a certain thickness. Should the surgeon need to staple tissue clamped to, for example, 2 mm, the surgeon would be required to use a stapler that is around 12 mm in diameter.
- Some manufacturers have attempted to provide a relatively small stapler that may staple relatively thick tissue, such as the Cardica™ stapler described above. However, these staplers use what are known as D-shaped staples, as illustrated in
FIGS. 35A-35B , instead of the more common B-form staples, which are illustrated inFIGS. 35C-35D . The D-shaped staples have relatively thick legs, with one of the legs not having a piercing feature, and have not been subject to extensive field use. It is believed by the Inventors that, for a given tissue thickness, the D-shaped staples introduce more trauma to the patient than do the B-form staples. - While the use of a larger stapler for placing larger staples is often acceptable, in certain medical procedures, such as in procedures performed on small or weak patients, such as small children or those with physical or disease trauma, it may be desirable to use a relatively small shaft surgical device to staple tissue that is relatively thick, using a B-form staple.
- Moreover, it is known that, if a surgeon clamps onto too much tissue for a given staple leg length or indicated use, currently-available staplers could still fire the staples and cut the tissue improperly. That is, the currently-available staplers could fire the staples, and thereafter cut the tissue, leaving the site open. It may therefore be desirable to provide a stapler that does not leave the site open or unsealed if the staples are not properly placed.
- It may also be desirable to provide a surgeon the ability to create a wider cuff (that is, a larger tissue margin between the staples and transection line) for a given clamped tissue thickness than is possible using the currently-available surgical devices.
- There therefore remains a need for a relatively small surgical stapler capable of stapling relatively thick tissue using B-form staples and/or providing a relatively wider cuff, with less impact to the patient, as well as other new and innovative features.
- The present disclosure relates generally to surgical instruments, and more specifically to endosurgical staplers and/or methods of placing surgical staples in a patient.
- An exemplary cartridge for a surgical stapler has an elongated body having a first side with a tissue clamping interface and a second side, the elongated body configured to removably house a plurality of B-form staples. At least one of the plurality of B-form staples has a base and a leg. The elongated body has a first slot shaped to receive a translating cutting mechanism, the first slot passing through the first side and the second side. The elongated body has a second slot shaped to house at least a first one of the plurality of staples. The elongated body has a third slot shaped to house at least a second one of the plurality of staples at an angle oblique to the first one of the plurality of staples.
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FIG. 1A is a perspective view of a surgical stapler coupled to an actuator; -
FIG. 1B is a perspective view of the surgical stapler inFIG. 1A ; -
FIG. 2 is an exploded perspective view of the surgical stapler inFIG. 1B ; -
FIG. 3 is a perspective view of a cartridge in the stapler inFIG. 1B ; -
FIG. 4 is a cross-section view of the cartridge inFIG. 3 ; -
FIG. 5 is another cross-section view of the cartridge inFIG. 3 ; -
FIG. 6 is a top view of the cartridge inFIG. 3 ; -
FIG. 7 is a rotated top view of the cartridge inFIG. 3 ; -
FIG. 8 is a perspective view of an anvil in the stapler inFIG. 1B ; -
FIG. 9 is a top view of the anvil inFIG. 8 ; -
FIG. 10 is a bottom view of the anvil inFIG. 8 ; -
FIG. 11 is a back view of the anvil inFIG. 8 ; -
FIG. 12 is a perspective view of features in the anvil inFIG. 8 ; -
FIG. 13 is a perspective view of features in the anvil inFIG. 8 ; -
FIG. 14 is a cross-section view of a cartridge and anvil suitable for the stapler inFIG. 1B ; -
FIG. 15 is a side view of features of the stapler inFIG. 1B ; -
FIG. 16 is a side view of features of the stapler inFIG. 1B ; -
FIG. 17 is a side view of features of the stapler inFIG. 1B ; -
FIG. 18 is a perspective view of a cutting mechanism in the stapler inFIG. 1B ; -
FIG. 19 is a perspective view of a cutting mechanism in the stapler inFIG. 1B ; -
FIG. 20A is a perspective view of the stapler inFIG. 1B ; -
FIG. 20B is a perspective view of the stapler inFIG. 1B ; -
FIG. 20C is a perspective view of the stapler inFIG. 1B ; -
FIG. 21 is a cross-section view of a clamp suitable for a stapler; -
FIG. 22 is a perspective view of a staple pusher in the stapler inFIG. 1B ; -
FIG. 23 is a first side view of the staple pusher inFIG. 22 ; -
FIG. 24 is a second side view of the staple pusher inFIG. 22 ; -
FIG. 25 is a perspective view of a lower anvil positioner in the stapler inFIG. 1B ; -
FIG. 26 is a perspective view of some components of the stapler inFIG. 1B ; -
FIG. 27 is a side section view of some components of a stapler; -
FIG. 28 is a perspective view of an integrated housing; -
FIG. 29 is a cross-section view of a cartridge, staple pushers, and staples; -
FIG. 30 is a detailed view of the components inFIG. 29 ; -
FIG. 31 is a cross-section view of a cartridge, staple pusher, and staples; -
FIG. 32 is a detailed view of the components inFIG. 31 ; -
FIG. 33 is a cross-section view of a clamp and other components; -
FIG. 34 is a cross-section perspective view of the clamp and other components; -
FIG. 35A is a side view of a D-shaped surgical staple prior to placement; -
FIG. 35B is a side view of the D-shaped staple inFIG. 35A in a placed configuration; -
FIG. 35C is a side view of a B-form surgical staple prior to placement; -
FIG. 35D is a side view of the B-form staple inFIG. 35C in a placed configuration; and -
FIG. 36 is a flowchart of an exemplary method. - To meet the previously-described needs, and/or to provide other new and useful features, a surgical stapler and method may be provided, and this paragraph is intended to be a conceptual overview, so as to give the reader a better understanding of the detailed description that follows. In some examples, a surgical stapler having a relatively small size is provided, and configured to place relatively large staples in a patient. This may be achieved by housing the staples at an oblique angle relative to each other or a common datum, such as a longitudinal axis or transection line. That is, instead of housing the staples parallel to each other (and/or perpendicular to a flat tissue clamping interface), as is known in the art, the Inventors provide, in some examples, a system in which the staples may be housed at a non-zero angle relative to each other or a common datum, and directed to staple tissue clamped between a curved jaw/cartridge and a curved anvil. This configuration gives surgeons the previously-unavailable option of placing relatively large staples using a relatively small stapler. Put another way, this configuration gives surgeons the previously-unavailable option of stapling tissue using a device gap of more than 1.0 mm using a 5 mm stapler (nominal).
- For the purpose of this document, the term “nominal” shall refer to a range of dimensions usual in the medical device and/or surgical stapler industry at the time of invention or at the time of manufacture, whichever range is greater. For example, currently-available 5 mm staplers (nominal) are known to vary across manufacturers from 5.0 to 6.0 mm or 5.5 +/−0.5mm. As another example, a cannula having a nominal inner diameter of 5.5 mm is known to have an actual inner diameter of at least 5.59 mm as of the time of this writing, but may be greater as of the time of manufacture. A staple having a nominal leg length of 3.5 mm is known to have an actual leg length that varies by about +/−0.08 mm as of the time of this writing. Further, for the purpose of this document, all absolute terms, such as, for example, flat, parallel, perpendicular, round, etc., as well as all dimensions, shall be understood to include the limitation “within reasonable manufacturing tolerances at the time of the invention or at the time of manufacture, whichever are greater”. For the purpose of this document, the term “proximal” shall refer to that portion or region of an instrument that is positioned closer to an intended user, such as a surgeon, and the term “distal” shall refer to the end or region away from the user or surgeon.
- Turning now to
FIG. 1 , it illustrates anexemplary endosurgical stapler 100 passing through acannula 400 in a manner known in the art and coupled to astapler actuator 800. The interior diameter of thecannula 400 may be a nominal diameter of 5.0 mm or 5.5 mm, which may be up to 6.0 mm with manufacturing tolerances or standards known in the art. Those skilled in the art will understand that thecannula 400 is placed in the patient to provide a port through which the surgeon may access the patient using thestapler 100. Thestapler 100 may have ananvil 102 that is configured to open or close relative to asupport jaw 103. Thesupport jaw 103 may include acartridge housing 104, which houses acartridge 106. In some embodiments, thehousing 104 andcartridge 106 may be a unitary feature referenced as asupport jaw 103. Theanvil 102 andsupport jaw 103 may be coupled to or manipulated at a proximal region by way of ashaft 116 that houses actuators and/or other control mechanisms in a manner substantially as is known in the art. - To operate the
anvil 102, anupper anvil positioner 110 and alower anvil positioner 112 may be provided. Theanvil positioners anvil 102 between an open position, a clamped position, and a closed position in a coordinated manner, and as will be described in further detail in subsequent sections of this document (see e.g.FIGS. 15-17 ). - Continuing with
FIG. 1 , acutting mechanism 108 may be provided and movable relative to the distal portion of thestapler 100, to cut stapled tissue held between theanvil 102 and thesupport jaw 103 in a manner to be described in further detail in subsequent sections. - Those skilled in the art will readily appreciate that the components of the
stapler 100 inFIG. 1 can be manufactured from any number of suitable materials, and, more particularly, that the materials must be selected with a suitable strength so as to withstand the forces required to clamp and staple relatively large bands of tissue using relatively small features. For example, any number of engineering materials, including, but not limited to, high-strength surgical steels, ceramics, and/or polymers may be selected. - In some embodiments, the
surgical stapler 100 may have ahousing 104, a portion thereof having an envelope diameter of about 5.5 millimeters or configured to pass through a 5.5mm cannula 400. - In some embodiments, a 5.5 mm
nominal housing 104 may house or carry a staple having a 3.0 mm nominal leg length in a manner as previously described herein. In some embodiments, the staple has a 4.8 mm nominal leg length. In some embodiments, the staple has a 2.0 mm nominal leg length. In some embodiments, the staple has a 2.5 mm nominal leg length. - Turning now to
FIG. 2 , further details of thestapler 100 inFIG. 1 are illustrated in an exploded perspective view. As can be appreciated, thecartridge 106 may be configured to house one or morestaple pushers 132 such that, upon being actuated by one ormore cams staple pushers 132 may guide one or more staples (not illustrated inFIG. 2 ) out of thecartridge 106 and towards theanvil 102, whereby the staples are formed about tissue clamped between theanvil 102 and thecartridge 106/support jaw 103. - The cam(s) 128, 130 may be actuated in a manner that is known to those skilled in the art. That is, in some embodiments, a standard staple pusher and staple driving concept as is currently available is used. In some embodiments, an extended cam and a reduced-size staple pusher may be provided. An extended cam is a cam that is taller than is historically used in surgical staplers of comparable size. An extended cam is therefore taller, to drive relatively large staple(s), such as staples having a leg length of 3.0 mm or greater, but the staple pusher size is of a reduced size such that the leg length of the staple(s) is greater than the pusher height, as is illustrated in
FIG. 5 . Those skilled in the art will recognize that, where the staple(s) 150 or staple pusher(s) 132 are housed at an oblique angle Θ relative to each other or to a transection line, the cam(s) 128, 130 are at a similarly defined angle. - Returning to
FIG. 2 , thecutting mechanism 108 may have afirst member 118 and asecond member 120 that are movable or expandable relative to each other, and configured to move from a proximal region of thestapler 100 towards a distal region of thestapler 100 to cut tissue clamped by thestapler 100. Thefirst member 118 of thecutting mechanism 108 may be actuated, controlled, and/or retracted using afirst actuator 122, and thesecond member 120 of thecutting mechanism 108 may be actuated, controlled, and/or retracted using asecond actuator 124. - The
upper anvil positioner 110 may be actuated using anupper anvil actuator 126, and thelower anvil positioner 112 may be actuated using a lower anvil actuator (not illustrated). Thelower anvil positioner 112 may have one ormore flanges anvil 102, to, in coordination with theupper anvil positioner 110, open, clamp, or close theanvil 102. - A
spring 113 may be provided so as to maintain theanvil 102 biased towards the closed position even if the surgeon rotates thestapler 100 upside-down. That is, thespring 113 may prevent theanvil 102 from opening prior to intentional actuation, and may do so in a manner substantially as is known in the art. - With reference now to
FIG. 3 , thecartridge 106 has anelongated body 134 having adistal end 136 and aproximal end 138. Thecartridge 106 may be configured to removably house a plurality of staples (not illustrated inFIG. 3 ). Afirst slot 140 may be provided and shaped to receive a cutting mechanism (e.g. cutting mechanism 108 inFIG. 2 ) and/or to connect or receive a clamping or translating mechanism. With brief reference toFIGS. 1B and 21 , a clamping mechanism may include afirst member 118 or anupper flange 506 configured to apply a moving fulcrum force to theanvil 102 as theclamping mechanism 502 travels distally. In some embodiments, theclamping mechanism 502 is acutting mechanism 108 or comprises a cuttingportion 206. Asecond slot 142 shaped to house at least a first one of the plurality of staples, and athird slot 144 shaped to house at least a second one of the plurality of staples may also be provided. - As illustrated in
FIG. 4 , the second andthird slots second slot 142 and thethird slot 144 is between about 4 degrees and about 30 degrees. In some embodiments, the angle Θ is between about 10 degrees and about 20 degrees. In some embodiments, the angle Θ is between about 10 degrees and about 15 degrees. In some embodiments, the angle Θ is between about 15 degrees and about 20 degrees. In some embodiments, the angle Θ is about 15 degrees plus or minus a suitable manufacturing tolerance. In some embodiments, the angle Θ is between about 12 degrees and about 18 degrees. - As illustrated in
FIG. 5 , in some embodiments, thesecond slot 142 is shaped to translatably house at least afirst staple pusher 146, and thethird slot 144 is shaped to translatably house at least asecond staple pusher 148. Thesecond slot 142 and thethird slot 144 may be configured to limit thefirst staple pusher 146 to translation at an angle Θ oblique to a translation of thesecond staple pusher 148. - As is also apparent in
FIG. 5 , in some embodiments, thefirst staple pusher 146 may be configured to support afirst staple 150 and athird staple 154, while thesecond staple pusher 148 may be configured to support asecond staple 152 and afourth staple 156. The first andthird staples fourth staples staple pushers cartridge 106 may be configured to limit translation of thestaple pushers - The
housing 104 orsupport jaw 103 may have an envelope diameter D of 5.6 mm or 5.5 mm, and may house or carry staples having a nominal leg length of 3.0 mm. In some embodiments, thehousing 104 orsupport jaw 103 may house or carry a plurality ofstaples FIG. 5 . Thestaples first staple 150 and asecond staple 152 are carried on opposing sides of a longitudinal axis defined by thehousing 104,cartridge 106, orsupport jaw 103, or, as illustrated inFIG. 5 , by aslot 140 for acutting mechanism 108. The first andsecond staples first staple 150 and the legs of thesecond staple 152 form an angle Θ with each other. The angle Θ may be an acute angle Θ in some embodiments. In some embodiments, the angle Θ may be between about 4 degrees and about 30 degrees. In some embodiments, thestaples first staple 150 is rotated between about 2 degrees and about 15 degrees from a vertical orientation or from theslot 140, and thesecond staple 152 may be rotated in an opposing direction between about 2 degrees and about 15 degrees from the vertical orientation orslot 140. In some embodiments, the angle Θ between thefirst staple 150 and thesecond staple 152 may be up to about 90 degrees. Athird staple 154 may be parallel to thefirst staple 150, and afourth staple 156 may be parallel to thesecond staple 152. The third andfourth staples second staples - It should be understood that the
surgical stapler 100 may carry or house more than four staples. The first and second staples (and third and fourth staples if applicable) 150, 152, 154, 156 may be near a distal or working end of thesurgical stapler 100, while another set of staples may be more proximal to the user. Thestaples - With simultaneous reference now to
FIGS. 5-7 , in some embodiments, one or more of thestaples third slots cupped regions staples cupped region 158 in afirst staple pusher 146 may work in unison with awall 170 andcupped regions 166, 168 in theelongated body 134 of thecartridge 106 to substantially limit afirst staple 150 to translation as thefirst staple 150 is pushed by way of a cam (e.g.cam 128 inFIG. 2 ) and the first staple pusher (e.g.first staple pusher 146 inFIG. 5 ). Put another way, in some embodiments, awall 170 andcupped regions 166, 168 in thecartridge 106 may provide primary support or guidance of the staple(s) 150, 152, 154, 156. - It should be understood that when referencing limiting a
staple staple pushers staple pushers slots slot 140 along which tissue is to be cut, so as to ensure tissue is stapled together on either side of the cut. Thestaple pushers slots cartridge 106 may be configured to place thestaples staggered staples - With continued reference generally to
FIGS. 3-7 , thecartridge 106 and/orstapler 100 may be configured to house orplace staples staples anvil 102 and thesupport jaw 103 are configured to pass through acannula 400 having an inner diameter of 5.6 mm or less or a nominal inner diameter of 5 mm or less. In some embodiments, at least one of thestaples anvil 102 and thesupport jaw 103 are configured to pass through acannula 400 having a nominal inner diameter of 8 mm or less or an inner diameter of 8.6 mm or less. - In some embodiments, the
stapler 100 is configured to pass through acannula 400 having aninner diameter 402, and thestapler 100 is simultaneously configured to carry at least first andsecond staples staples inner diameter 402 of thecannula 400, or at least 53% of an envelope diameter D of thestapler 100 when the stapler is in a closed configuration (see e.g.FIG. 1B ). - In some embodiments, the leg length L is at least 58% of the
inner diameter 402 or the envelope diameter D. In some embodiments, the leg length L is at least 60% of theinner diameter 402 of thecannula 400 or the envelope diameter D. In some embodiments, the leg length L is at least 61% of theinner diameter 402 of thecannula 400 or the envelope diameter D. For example, astaple 150 having a nominal leg length of 4.8 mm and acannula 400 having a nominal inner diameter of 8.0 may have a ratio of 4.72/8.6 after taking into account manufacturing allowances. For example, astaple 150 having a nominal leg length of 4.8 mm and acannula 400 having a nominal inner diameter of 8.0 may have a ratio of 4.88/8.0 at a less-than ideal tolerance stack-up. - In some embodiments, the leg length L is up to 62% of the inner diameter of the
cannula 400 or the envelope diameter D. In some embodiments, the leg length L is up to 66% of theinner diameter 402 of thecannula 400 or the envelope diameter D. For example, astaple 150 having a nominal leg length of 3.5 mm and acannula 400 having a nominal diameter of 5 mm may have a ratio of 3.58/5.0 at a less-than ideal tolerance stack-up. In some embodiments, the leg length L is between 55% and 67% of theinner diameter 402. - In some embodiments, the
stapler 100 is configured to (a) pass through acannula 400 having aninner diameter 402, (b) place at least first andsecond staples staples inner diameter 402 of thecannula 400, and (c) place at least third andfourth staples fourth staples second staples inner diameter 402. In some embodiments, the first leg length is at least 58% of theinner diameter 402. In some embodiments, the first leg length is at least 61% of theinner diameter 402. - In some embodiments, the
stapler 100 is configured to place afirst staple 150 having a first leg length L1 and another staple 156 having a different leg length L2. In some embodiments, thestapler 100 is configured to place staples having a first leg length L1 on a first side of a tissue cut, and staples having a second leg length L2 on a second side of a tissue cut. In some embodiments, thestapler 100 is configured to place a first staple having a first leg length L1 and a second staple having a second leg length L2 on the same side of the tissue cut. - In some embodiments, the
stapler 100 is configured with an outer envelope diameter D (see e.g.FIG. 1B ) sized to pass through a cannula having aninner diameter 402 when thestapler 100 is in a closed configuration (see e.g.FIG. 15 ) wherein thecurved interfaces stapler 100 may be configured to clamp tissue positioned between theanvil 102 and thesupport jaw 103 and compress the tissue to a particular thickness and/or to limit the tissue to a maximum particular thickness, herein referred to as a device gap G, between theanvil 102 and the cartridge 106 (see e.g.FIG. 14 ). Those skilled in the art will understand thatsurgical staplers 100 and the associated staples are generally sized according to the intended thickness of tissue to be stapled. - For the purpose of this document, the device gap G is defined as the maximum space allowed between the
support jaw 103 orcartridge 106 and theanvil 102 at the time the device fires staple(s) 150 into tissue. - In one example, the
stapler 100, if positioned about very thin tissue, may be configured to or allowed to “float” towards contact between theanvil 102 andsupport jaw 103 and then, as staple(s) 150 are fired into the tissue, thestapler 100 may be configured to allow the staple(s) 150 to bias or push theanvil 102 away from thecartridge 106, up to a maximum device gap G. The maximum device gap G may be limited to a distance defined by a translating cutting mechanism 108 (see e.g.FIGS. 14, 20C ). Thecutting mechanism 108 may move distally substantially or nearly simultaneously or in coordination with one or more cam(s) 128, 130, such as when the staple(s) 150 are fired, so as to prevent thestapler 100 from opening beyond the maximum device gap G. - Relatedly, and as another example, the
stapler 100, if positioned about relatively thick tissue, may be configured to compress the tissue down to the maximum device gap G as the translatingcutting mechanism 108 moves distally. For example, if thestapler 100 is configured to clamp tissue at a device gap G of 2.0 mm, and the tissue positioned between thestapler 100 is greater than 2.0 mm, thestapler 100 and/orcutting mechanism 108 may compress the tissue appropriately. Of note, if the tissue positioned between theanvil 102 and thesupport jaw 103 is so thick as to not be compressible to the appropriate device gap G, thecutting mechanism 108 may be configured to jam or stop translating into tissue that is not suitably clamped. - For example, most currently-available 5 mm (nominal) staplers are indicated for stapling tissue that can be clamped to less than 1.0 mm, while the Cardica 5 mm stapler (nominal—the actual size is greater than 5 mm, about 5.8 mm or more) is indicated for stapling tissue that can easily be clamped to 1.5 mm or less, and uses D-form staples. In both cases, if the surgeon wishes to staple tissue having a greater thickness, a larger stapler must be used. Relatedly, currently-available B-form staples having a nominal leg length of 3.5 mm are indicated for stapling tissue that can be clamped to between 1.5 mm and 2.0 mm. Currently-available B-form staples having a nominal leg length of 4.8 mm are indicated for stapling tissue that can be clamped to 2.0 mm.
- In some embodiments, the envelope diameter D is about 5.5 mm or about 5.6 mm, and the device gap G is between about 0.75 mm and about 1.0 mm. In some embodiments, the envelope diameter D is about 5.5 mm or 5.6 mm, and the device gap G is between about 1.0 mm and about 1.5 mm. In some embodiments, the envelope diameter D is about 5.5 mm or 5.6 mm, and the device gap G is greater than about 1.5 mm, and up to about 2.0 mm. In some embodiments, the envelope diameter D is about 8.5 mm or 8.6 mm, and the device gap G is about 2.0 mm or greater.
- In some embodiments, the device gap G is 13% of the envelope diameter D or greater. In some embodiments, the device gap G is 17% of the envelope diameter D or greater. In some embodiments, the device gap G is 20% of the envelope diameter D or greater. In some embodiments, the device gap G is 22% of the envelope diameter D or greater. In some embodiments, the device gap G is 26.8% of the envelope diameter D or greater. In some embodiments, the device gap G is 27.3% of the envelope diameter D or greater. In some embodiments, the device gap G is about 37% of the envelope diameter D or less. In some embodiments, the device gap G is between about 18% and about 37% of the envelope diameter D. In some embodiments, the device gap G is between about 22% and about 37% of the envelope diameter D. In some embodiments, the device gap G is between about 26.8% and about 35.7% of the envelope diameter D. In some embodiments, the device gap G is between 27.3% and about 36.4% of the envelope diameter D.
- In some embodiments, the
stapler 100 is modular, as illustrated inFIG. 2 orFIG. 6 . That is, one or moreinterchangeable cartridge kits 105 may be provided. For example, afirst cartridge kit 105 having acartridge 106, one or morestaple pushers 132, and one or more staples (not illustrated) having a first leg length may be interchangeable with asecond cartridge kit 105 having acartridge 106, one or morestaple pushers 132, and one or more staples (not illustrated) having a second leg length that is different from the first leg length. In some embodiments, the cartridge kit(s) 105 is removable from ahousing 104 orsupport jaw 103. In some embodiments, alignment features are provided in thehousing 104,support jaw 103, and/orcartridge 106 to enable suitable alignment. In some embodiments, thecartridge kit 105 is removable from thesupport jaw 103 without the use of tools. In some embodiments, locking features may be provided in thecartridge kit 105 so as to prevent removal without the use of a tool. In some embodiments, thecartridge kit 105,housing 104,anvil 102,cutting mechanism 108, upper and/orlower anvil positioners shaft 116 are removable as a unit from thestapler actuator 800. - Turning now to
FIGS. 8-11 , and as illustrated inFIG. 1 , thestapler 100 may have ananvil 102. Theanvil 102 may be shaped or configured to be movable relative to thesupport jaw 103, for example, by way of alinkage mechanism 172. Thelinkage mechanism 172 may include one or more recesses orpassages 174 in one of theanvil 102 or the support jaw 103 (or thehousing 104 in the support jaw 103), configured to engage with one or more corresponding protrusions 176 (seeFIG. 2 ) in the other one of theanvil 102 or the support jaw 103 (or thehousing 104 in the support jaw 103). Thelinkage mechanism 172 may be configured to limit theanvil 102 to rotation and translation relative to thesupport jaw 103 orhousing 104. Thelinkage mechanism 172 may be configured to adjust a pivot point of theanvil 102 as theanvil 102 is rotated relative to thesupport jaw 103 orhousing 104.FIGS. 8A and 8B illustrate how thelinkage mechanism 172 may include one or more recesses orpassages 174 in thesupport jaw 103 and one ormore protrusions 176 in theanvil 102. - The
linkage mechanism 172 may work in a coordinated manner with the upper and/orlower anvil positioners anvil 102 to movement between an open position, a clamped position, and a closed position (see e.g.FIGS. 15-17 ). Those skilled in the art will understand that, although thelinkage mechanism 172 is illustrated as having apassage 174 in theanvil 102 and aprotrusion 176 in thesupport jaw 103 orhousing 104, any number oflinkage mechanisms 172 may be employed. - In some embodiments, the
linkage mechanism 172 includes a snap-fit between an elastic region of theanvil 102 and thesupport jaw 103 orhousing 104. For example, theanvil 102 may have a slight protrusion on one or both sides that correspond to pits, passages, or recesses in thesupport jaw 103 orhousing 104. During assembly, theanvil 102 may be caused to flex slightly, so as to snap-fit to thesupport jaw 103 orhousing 104. In some embodiments, the elastic region may be created by a thin wall section in theanvil 102. - In some embodiments, one or more detents (not illustrated) may be provided in the
anvil 102 and/orsupport jaw 103, and the detents may be configured to engage one or more recesses or passages in the other of theanvil 102 and/orsupport jaw 103, so as to enable assembly a tight fit between theanvil 102 andsupport jaw 103. A detent/recess/passage may be configured to allow a user, recycler, and/or manufacturer to disassemble theanvil 102 from thesupport jaw 103. - Continuing with
FIG. 8 , in some embodiments, theanvil 102 orlinkage mechanism 172 may include atissue stop mechanism 178. Thetissue stop mechanism 178 may be a feature in theanvil 102 and/or the support jaw 103 (orcartridge 106 or housing 104) configured to prevent tissue from being positioned beyond the stapling region between theanvil 102 and thesupport jaw 103. That is, thetissue stop mechanism 178 is configured to prevent thestapler 100 from cutting tissue that is not stapled. In some embodiments, thetissue stop mechanism 178 includes asurface 180 in theanvil 102 that is selected and shaped so as to not engage asurface 182 in the cartridge 106 (see e.g.FIGS. 14-15 ) and damage tissue clamped between thesupport jaw 103 and theanvil 102 when the anvil is moved from the open position to the clamped position. - The
anvil 102 may also have aslot 184 shaped and configured to receive or guide acutting mechanism 108 or amember cutting mechanism 108 as thecutting mechanism 108 travels distally to cut tissue clamped between thesupport jaw 103 and theanvil 102. Theslot 184 may extend from theproximal region 186 of theanvil 102 to a position short of thedistal end 188 of theanvil 102. Theslot 184 may be shaped to limit thecutting mechanism 108 ormember cutting mechanism 108 ormember distal end 188 of theanvil 102. - In some embodiments, the
anvil 102 has one or more guides 190 (see e.g.FIG. 9 ), configured to guide thecutting mechanism 108 ormember cutting mechanism 108 as thecutting mechanism 108 travels down the anvil 102 (see e.g.FIGS. 20A-20C ). Theguides 190 in theanvil 102 may correspond to or engageguides 192 in thecutting mechanism 108. In some embodiments, the guide(s) 190 in theanvil 102 may be one ormore recesses 190 that engage corresponding one or more ridges orprotrusions 192 in theupper member 118 of thecutting mechanism 108, as illustrated. - In some embodiments, guides 192 in the
cutting mechanism 108 may be protrusions that do not extend an entire length of thecutting mechanism 108 ormember cutting mechanism 108 ormember anvil 102. - In some embodiments, the guide(s) 192 in the
cutting mechanism 108 may be recesses (not illustrated). In some embodiments, the guide(s) 190 in theanvil 102 may be protrusions (not illustrated) in theanvil 102. In some embodiments theanvil 102 may have afirst guide 190 that is a recess or groove, and asecond guide 190 that is a protrusion or flange (not illustrated). Those skilled in the art will readily envision any number of means of providing a first and/orsecond guide 190 to guide thecutting mechanism 108 as it travels towards the distal region of thestapler 100, all of which means are contemplated herein. - In some embodiments, the
anvil 102 is sized so as to fit through acannula 400 having a nominal inner diameter of 8.0 mm. In some embodiments, theanvil 102 is sized so as to fit through acannula 400 having an inner diameter of 8.6 mm or less. In some embodiments, theanvil 102 is sized so as to fit through acannula 400 having a nominal inner diameter of 5.5 mm. In some embodiments, theanvil 102 is sized so as to fit through acannula 400 having an inner diameter of 5.6 mm or less. - Continuing with
FIGS. 9-13 , theanvil 102 may have first and/or second cam guides 194, 196. The cam guide(s) 194, 196 may be slots in a portion of theanvil 102 configured to guide one ormore cams 128, 130 (seeFIG. 2 ) as the cam(s) 128, 130 move or translate longitudinally into thesupport jaw 103 orhousing 104 to cause motion of the staple pusher(s) 132 and/or the staple(s) 132, 146, 148. The cam guide(s) 194, 196 may assist in maintaining the cam(s) 128, 130 positioned at an angle Θ relative to each other; for example, the second and/orthird slots cartridge 106 and the cam guide(s) 194, 196 may guide the translating cam(s) 128, 130 at an oblique angle Θ relative to each other, so as to effectuate motion of thestaple pushers FIG. 5 illustrated the cartridge 106). Put another way, the cam guides 1974, 196 may effectuate a first travel path on afirst staple pusher 146 and a second travel path on asecond staple pusher 148, the first travel path being at an oblique angle Θ relative to the second travel path. - With brief reference to
FIGS. 11 and 13 , theanvil 102 may have a curvedtissue clamping interface 202, and thecartridge 106 may have a curved tissue clamping interface 204 (see e.g.FIG. 3 ) configured to oppose the curvedtissue clamping interface 202 of theanvil 102 when thestapler 100 is in a clamped or closed configuration (see e.g.FIGS. 15 and 17 ). That is, in some embodiments, theanvil 102 may be curved to provide a curved beam in flexure and utilize the compression strength of the material to react against the staple forming forces from the opposing sides. More specifically, the curved beam may prevent theanvil 102 from undesired deformation; in turn, the curved beam may assist in proper staple formation. Those skilled in the art will understand that the term “curved tissue clamping interface” is intended to reference a generally curved clamping surface that may or may not be interrupted by one or more recesses, protrusions, and/or flat regions. - Together, the curved
tissue clamping interfaces anvil 102 is in the clamped position (illustrated inFIG. 17 ). The curvedtissue clamping interfaces anvil 102 is in the closed position (illustrated inFIG. 15 ). In some embodiments, a portion of one or both of the curvedtissue clamping interfaces - A portion of the curved
tissue clamping interface 204 in thecartridge 106 may have a corresponding or similarly constrained radius of curvature, so as to nest with or clamp tissue with theanvil 102. In some embodiments, a portion of one or both of the curvedtissue clamping interfaces - The curved
tissue clamping interfaces tissue clamping interfaces staples 150. Thestaples 150 and angle Θ may be configured based on currently known standard leg sizes, or as yet to be developed standard sizes, such as, for example, 2.0 mm, 2.5 mm, 3.0 mm, 3.5 mm, 3.8 mm, 4.1 mm, 4.8 mm, or others. - Returning now to
FIG. 12 , theanvil 102 may have one or more formingpockets 198 configured to form and/or fold the staples(s) 150, 152, 154, 156 as the staple(s) 150, 152, 154, 156 are pushed out of thecartridge 106 and through tissue, into theanvil 102. The forming pocket(s) 198 may be configured substantially in a manner as is known in the art. However, the formingpockets 198 may be angled or positioned in a manner suitable for properly forming the staple(s) 150, 152, 154, 156 in embodiments in which the staple(s) 150, 52, 154, 156 andstaple pushers anvil 102 andcartridge 106 have curvedtissue clamping interfaces pockets 198 may interrupt engagement of tissue by the curvedtissue clamping interface 202. - Turning now to
FIG. 14 , in some embodiments, thestapler 100 may provide for a substantially consistent fixed maximum device gap G across a transverse cross-section of tissue and/or a longitudinal cross-section of tissue during staple firing and/or tissue clamping. In some embodiments, the formingpockets 184 in theanvil 102 are shaped and positioned so as to assist in guiding or drivingstaples anvil 102 andcartridge 106 orsupport jaw 103. In some embodiments, thestapler 100 has an envelope diameter D of 5.6 mm or less in a closed configuration, and is configured to allow a maximum device gap G of greater than 1.5 mm, and up to 2.0 mm between the curvedtissue clamping interfaces stapler 100 has an envelope diameter of 8.6 mm or less in a closed configuration, and is configured to allow a maximum device gap G of 2.0 mm or more. - In some embodiments, the
stapler 100 is configured fit through acannula 400 having aninner diameter 402 of 5.6 mm or less in a closed configuration, and to place staples having a nominal leg length L of 3.5 mm in a patient while allowing a maximum device gap G of more than 1.5 mm between the curvedtissue clamping interfaces stapler 100 is configured to fit through acannula 400 having aninner diameter 402 of 8.6 mm or less in a closed configuration, and to place staples having a nominal leg length L of 4.8 mm in a patient and allow a maximum device gap G of at least 2.0 mm between the curvedtissue clamping interfaces - In some embodiments, an angle Θ between a first set of
staples staples stapler 100 configured for a 5.5mm cannula 400 may be comparable to a cuff achieved using a standard stapler configured for a 12mm diameter cannula 400, and may be about 0.7 mm or more. In some embodiments, acurved cartridge 106 and rotated or angled staple(s) create additional space between the knife/cutting mechanism and the inner row of staples, increasing the width of the tissue “cuff” that is created following staple formation and tissue transection. - Continuing with
FIG. 14 , lead-infeatures 185 of the formingpockets 184 may match the rotation angle Θ of the staples within thecartridge 106. See alsoFIG. 10 . That is, the lead-infeatures 185 may be between about 4 degrees and about 30 degrees from each other, or less than or up to about 90 degrees from each other in some embodiments. The lead-infeatures 185 may include any lead-in means, including bevels, chamfers, reliefs, or any other features known in the art and configured to assist in guiding staples into the forming pockets 184. - Turning now to
FIGS. 15-17 , as previously described, theanvil 102 may be movable relative to thesupport jaw 103 between a closed position as illustrated inFIG. 15 , an open position as illustrated inFIG. 16 , and a clamped position as illustrated inFIG. 17 . In the closed position, theanvil 102 andsupport jaw 103 may have a compressed envelope dimension or diameter D. That is, theanvil 102 andsupport jaw 103 together may be configured to pass through a passage having an inner dimension of a particular nominal size. For example, the closed envelope dimension may have a closed envelope diameter D configured to pass through acannula 400 having an inner dimension ordiameter 402 of a particular nominal size, such as 8.6 mm or 5.6 mm in some embodiments. - In some embodiments, the
stapler 100 may be tip-biased. That is, theanvil 102 and/orsupport jaw 103 may be shaped such that a distal end of thestapler 100 will tend to contact first when thestapler 100 is moved towards a closed configuration. A tip-biasedstapler 100 may be configured such that a slight flexure of theanvil 102 and/orsupport jaw 103 allows full compression to a closed configuration wherein theanvil 102 andcartridge 106 make contact along a substantial or majority portion of the clamping interfaces 202, 204. - After passing through or partially through the
cannula 400, theanvil 102 may be actuated to move into an open position, such as the open position illustrated inFIG. 16 . In the open position, theanvil 102 may be rotated, rotated and translated, or moved such that adistal portion 188 of theanvil 102 is positioned further away from thesupport jaw 103 than is theproximal portion 186. With thestapler 100 in the open configuration, a surgeon may place tissue between thesupport jaw 103 and theanvil 102 in preparation for surgical cutting and/or stapling of tissue. - As illustrated in
FIG. 17 , theanvil 102 may be movable to a clamped position. The clamped position may be selected or designed so as to achieve a substantially consistent maximum device gap G (see e.g.FIGS. 10, 14 ) between theanvil 102 and thecartridge 106 orsupport jaw 103, or between the clampinginterfaces anvil 102 andsupport jaw 103 have an envelope dimension or diameter D2 that is greater in the clamped configuration than the compressed envelope dimension or diameter D in the closed configuration. In some embodiments, the clamped configuration results in an envelope dimension or diameter D that is greater than theinner diameter 402 or dimension of thecannula 400 through which thestapler 100 has been passed. - In some embodiments, an
upper anvil positioner 110 and alower anvil positioner 112 may be provided and configured to effectuate motion of theanvil 102 relative to thesupport jaw 103. That is, theupper anvil positioner 110 and/or thelower anvil positioner 112 may be configured to manipulate or move a pivot point of theanvil 102 as theanvil 102 is moved between the closed, open, and/or clamped positions. - Turning now to
FIGS. 18-20C , and as previously described, thestapler 100 may have anexpandable cutting mechanism 108 and/or clamping member configured to move between a collapsed configuration and an expanded configuration.FIG. 18 illustrates thecutting mechanism 108 in a collapsed configuration, andFIG. 19 illustrates the cutting mechanism in an expanded configuration. - In the collapsed configuration (e.g.
FIG. 18 ), thecutting mechanism 108 may have a height H or envelope diameter that is less than a combined height of theanvil 102 and the support jaw 103 (or the rest of thestapler 100 generally) or less than the envelope diameter D. In the expanded configuration (e.g.FIG. 19 ), thecutting mechanism 108 may have or may approach a height H that is greater than a combined height of theanvil 102 and thesupport jaw 103 when theanvil 102 is in the clamped configuration. Put another way, the height H of thecutting mechanism 108 in the collapsed configuration may be less than the envelope diameter D of thestapler 100 when thestapler 100 is in the closed and/or clamped configurations. In some embodiments, the height H of thecutting mechanism 108 in the collapsed configuration may be less than the combined envelope diameter of theanvil 102 and thesupport jaw 103 when thestapler 100 oranvil 102 is in the closed and/or clamped configurations or positions. In some embodiments, the height H of thecutting mechanism 108 in the expanded configuration may be greater than the combined envelope diameter D of theanvil 102 and thesupport jaw 103 when thestapler 100 oranvil 102 is in the closed and/or clamped configuration or position. The height H of thecutting mechanism 108 in the collapsed configuration may be less than theinner diameter 402 of thecannula 400. The height H of thecutting mechanism 108 in the expanded configuration may be greater than theinner diameter 402 of thecannula 400. - The
expandable cutting mechanism 108 may have afirst member 118 and asecond member 120 that are expandable, translatable, or movable relative to each other. In some embodiments, a first one of themembers support jaw 103 orcartridge 106, and a second one of themembers support jaw 103 orcartridge 106. In some embodiments, both of themembers support jaw 103 orcartridge 106. In some embodiments, a first one of themembers members first member member 108 expands to move up theanvil 102 andsupport jaw 103. The slight rotation may be limited by flanges and/or legs in themembers - One of the
members portion 206, and may be configured to travel through or partially through aslot 140 in thecartridge 106 and/or aslot 184 in theanvil 102 so as to cut tissue clamped between theanvil 102 and thesupport jaw 103. The other one of themembers first member second members stapler 100. More specifically, and as illustrated inFIG. 20C , thecutting mechanism 108 may be configured to apply a supportive clamping force on tissue clamped between theanvil 102 and thesupport jaw 103 when thecutting mechanism 108 is in a distal position and/or moving distally, and expanded about theanvil 102 andsupport jaw 103. - In some embodiments, the
upper anvil positioner 110 is configured to rotate relative to thesupport jaw 103 and assist in guiding thecutting mechanism 108. - In some embodiments, the
expandable cutting mechanism 108 is coupled to or comprises afirst actuator 122 coupled to one of themembers first member 118, and a second actuator coupled to the other one of themembers 118, 129, such as thesecond member 120. In some embodiments one or both of theactuators first actuator 122 is configured to apply a retracting force when actuated (e.g. pull thecutting mechanism 108 towards the user or proximal region of the stapler 100), and asecond actuator 124 is configured to apply an extending force when actuated (e.g. push thecutting mechanism 108 away from the user or towards the distal region of the stapler 100). In some embodiments, aflexible actuator member actuator other member actuator first actuator 122 may provide a limited pushing or extending force on thecutting mechanism 108, and a greater retracting force when retraction is required. - In some embodiments, the
cutting mechanism 108 is configured to move between a collapsed configuration wherein the cuttingportion 206 is not in line with a tissue cutting region defined by theanvil 102 and thesupport jaw 103 and an expanded configuration wherein the cuttingportion 206 is in line with the tissue cutting region, the tissue cutting region defined by a device gap G between theanvil 102 and the support jaw 103 (see e.g.FIGS. 19 and 20A-20C ). - One or both of the
actuators expandable cutting mechanism 108 to expand (e.g. thefirst member 118 may move upward and/or thesecond member 120 may move downward) as theexpandable cutting mechanism 108 travels distally, and rigid enough to apply a strong enough force to cause themember actuator first actuator 122 may orient thefirst member 118 relative to thesecond member 120 while thesecond actuator 124 primarily causes thecutting mechanism 108 to move distally. - It should be understood that the first and
second actuators second members second members layers actuator member actuator cutting mechanism 108 ormember cutting mechanism 108 or member(s) 118, 120 distally and flexible enough to move with thecutting mechanism 108 or member(s) 118, 120 as thecutting mechanism 108 expands outside the envelope diameter D. - Continuing with
FIGS. 18-19 , those skilled in the art will understand that thecutting mechanism 108 may be made of any suitable materials known in the art and suitable for cutting tissue clamped between theanvil 102 and thesupport jaw 103 orcartridge 106. For example, thefirst member 118 may be formed of a surgical steel and polished or machined so as to have asharp cutting portion 206. In some embodiments, thefirst member 118 has one ormore legs 208 with a flange portion(s) 210 that are configured to engage one ormore flanges 214 in one ormore legs 212 in thesecond member 120, so as to limit the amount of expansion possible between the first andsecond members legs member other member cartridge 106,slot 140, and/oranvil 102 are configured to maintain a vertical orientation of thecutting mechanism 108. - The
cutting mechanism 108 may have a means for limiting expansion between the first andsecond members cutting mechanism 108 is configured to assist in preventing theanvil 102 from deforming while clamping tissue. In some embodiments, thecutting mechanism 108 is configured to limit a tissue clamping gap between theanvil 102 andsupport jaw 103 to a device gap G that is suitable for clamping, cutting, and/or stapling tissue. For example, in some embodiments, thecutting mechanism 108 is configured to squeeze theanvil 102 towards the support jaw 103 a given amount as thecutting mechanism 108 travels from a proximal position towards a distal position. As illustrated most clearly inFIG. 19 , in some embodiments, a leadingportion 119 of thefirst member 118 and/or a leadingportion 121 of thesecond member 120 may be positioned on thecutting mechanism 108 at a region that is more distal to the user than is the cuttingsurface 206. The leading portion(s) 119, 121 may be configured to apply a compressive force on theanvil 102 andsupport jaw 103 so as to ensure the device gap G is reached prior to a tissue cut, and/or to ensure the maximum device gap G is not exceeded during a tissue cut. - In some embodiments, the
cutting mechanism 108 is configured to jam or not travel into a region where the maximum device gap G is not achieved. For example, if thestapler 100 is configured to achieve a maximum device gap G of 2.0 mm, but a portion of the tissue cannot be compressed to 2.0 mm, thecutting mechanism 108 will not travel into regions of tissue that are too thick. In this event, even if thestapler 100 has inadvertently fired staples into the tissue, and those staples are not properly formed, thecutting mechanism 108 will not cut that portion of the tissue that is not properly stapled. The surgeon may then manually retract thecutting mechanism 108, and pry the improperly formed staples out of the tissue. - As illustrated in
FIG. 19 , those skilled in the art will understand that any part of thefirst member 118 or thesecond member 120 may be made unitary, or any part may be a separate component coupled to other components of thecutting mechanism 108. In some embodiments, thelegs members curved guide portions members - With reference now to
FIG. 21 , in some embodiments, thesurgical stapler 500 may have an anchoredclamp mechanism 502 with a cuttingsurface 206 as previously described herein. The anchoredclamp mechanism 502 may include a modified I-beam having a first orlower flange 504 and a second orupper flange 506 coupled together such that the modified I-beam does not extend all the way through the diameter of the end effectors, as is the case in currently-available designs. Instead, the I-beam may be anchored at thefirst flange 504 within thecartridge 508, for example, in the space created by the angle of the staples. In some embodiments, the I-beam may include afirst flange 504 shaped to slidingly engage a flange or recess in thecartridge 508. The I-beam may include a surface on one or more of theflanges surgical stapler 500. - In some embodiments, the anchored
clamp mechanism 502,cutting mechanism 108, or I-beam may be shaped to slide to trail the cam(s) 128, 130 and act as a moving fulcrum in a manner substantially as previously described with reference to thecutting mechanism 108. In some embodiments, the anchoredclamp mechanism 502,cutting mechanism 108, or I-beam may be shaped to slide or travel distally - As illustrated in
FIG. 21 , thefirst flange 504 may allow the anchored clamp mechanism to slide through a recess or channel cutout in the cartridge, while allowing or limiting the maximum device gap G in a manner substantially as previously described with reference to thecutting mechanism 108. - Turning now to
FIGS. 22-24 , astaple pusher 148 is illustrated in further detail. Thestaple pusher 148 may comprise a firstcupped region 160 and a secondcupped region 164 configured to support two staples substantially as previously described herein. In some embodiments, thecupped regions FIG. 22 , the staple pusher(s) 148 may have a firstcammed surface 216 and/or a secondcammed surface 218 that is/are configured to, in coordination with a translatingcam cartridge 106, convert longitudinal motion of the translatingcam staple pusher 132 to drive staples into tissue clamped between theanvil 102 and thesupport jaw 103. -
FIG. 25 illustrates thelower anvil positioner 112 having, as previously described,flanges anvil 102, although those skilled in the art will understand that asingle flange flanges 112 a 112 b are coupled together by way of abridge 112 c to enable a single actuator (not illustrated) to effectuate a motion of thelower anvil positioner 112 and/or flange(s) 112 a, 112 b. In some embodiments, thelower anvil positioner 112 has abridge 112 d for coupling theflanges -
FIG. 26 illustrates a relationship between thecutting mechanism 108, thespring 113, and theupper anvil positioner 110. - As illustrated in
FIGS. 27-28 , in some embodiments, a cartridge housing is not provided. That is, acartridge 106 andcartridge housing 104 may be integrated in to one piece, an integratedstaple housing 107, to form an outer casing. The integratedstaple housing 107 may have features to properly guide the staple(s) out of thehousing 107 as they are driven by thecam 128, 130 (and staple pusher(s) 132). In embodiments having an integratedstaple housing 107, aninsert 109, may be coupled to, placed in, or snapped into the center of theintegrated housing 107 to complete the medial features of thestaple pocket 111. Additionally, the staple pusher(s) 132 may be modified (trimmed) or suitably sized so as to make space to increase a housing wall thickness for strength. - In some embodiments, an integrated staple housing providing staples guided by the housing walls as illustrated in
FIGS. 5 and/or 29-30 may allow for an increase in wall thickness of thecartridge 508 or housing, and thereby an increased strength of the surgical stapler as compared to staplers in which the pushers may cup the staples. ContrastFIGS. 29-30 withFIGS. 31-32 . - In some embodiments, the stapler herein disclosed may be used in a flexible catheter. In some embodiments, the
stapler 100 disclosed herein is configured to couple to or to be used with an articulating joint. - As illustrated in
FIGS. 20A-20C and/or 33-34 , ananchor clamp mechanism 502 orcutting mechanism 108 may provide a safety lock feature. In some embodiments, themechanism mechanism anvil 102, and will self-jam, preventing the firing procedure from continuing. - Turning now to
FIG. 36 , in some embodiments, amethod 3600 of performing a stapling procedure on a patient is provided. Themethod 3600 may include providing 3602 a surgical stapler in a closed position, inserting 3604 at least a portion of the stapler through a cannula, and moving 3606 the stapler from the closed position to a clamped position. - Providing 3602 a surgical stapler in a closed configuration may include providing a surgical stapler having any of the features previously described herein with reference to
FIGS. 1-35B . In some embodiments, providing 3602 includes providing a stapler comprising: an anvil movably coupled to a support jaw; wherein the support jaw comprises a cartridge having an elongated body having a distal end and a proximal end and configured to removably house a plurality of staples. The elongated body may have a first slot shaped to receive a cutting mechanism, a second slot shaped to house at least a first one of the plurality of staples, and a third slot shaped to house at least a second one of the plurality of staples at an angle oblique to the first one of the plurality of staples. - Causing 3604 at least a portion of the surgical stapler to pass through a cannula may include causing at least a portion of the stapler to pass through a cannula having an inner diameter. The cannula may be substantially as previously described herein with reference to
FIGS. 1-35B . - Causing 3606 the surgical stapler to move from the closed configuration to the clamped configuration may include causing the stapler to move to a clamped configuration wherein the surgical stapler maintains a gap between the anvil and the support jaw, and the surgical stapler is unable to pass through the cannula. Causing 3606 the stapler to move to the clamped configuration may be achieved using a stapler as previously described with reference to
FIGS. 1-35B . - The
method 3600 may include stapling tissue using a staple having a leg length of 3.0 mm or more using a stapler configured to pass through acannula 400 that has an inner diameter of 5.6 mm or less. Themethod 3600 may include using a stapler that has an envelope diameter of 5.6 mm or less when in a closed position to staple tissue clamped to a thickness that is greater than 1.5 mm. - In some embodiments, the
method 3600 further includes longitudinally translating at least one cam to cause at least one of a first staple pusher or a second staple pusher in a direction oblique to the other one of the first staple pusher or the second staple pusher. - In some embodiments, the
method 3600 further includes replacing a first cartridge kit in the surgical stapler with a second cartridge kit. Themethod 3600 may further include using the stapler having the first cartridge kit to place first set of a plurality of staples having a first leg length in a patient, replacing the cartridge kit, and using the stapler having the second cartridge kit to place a second set of a plurality of staples having a second leg length different from the first leg length in a patient. In some embodiments, the same patient receives both sets of staples. - In addition to the description above, various specific examples are disclosed herein.
- A cartridge for a surgical stapler, comprising: an elongated body configured to fit within an envelope diameter and to removably house a plurality of B-form staples, at least one of the plurality of B-form staples having a base length and a leg length, the leg length at least 53% of the envelope diameter; a first slot shaped to receive a translating cutting mechanism; a second slot shaped to house at least a first one of the plurality of staples; and a third slot shaped to house at least a second one of the plurality of staples at an angle oblique to the first one of the plurality of staples.
- The cartridge of example 1, further comprising: a curved tissue clamping interface; and wherein the oblique angle is between about 4 degrees and about 30 degrees.
- The cartridge of example 1 or example 2, wherein: the second slot is shaped to translatably house at least a first staple pusher; the third slot is shaped to translatably house at least a second staple pusher; and the second slot and the third slot are configured to limit the first staple pusher to translation at an angle oblique to translation of the second staple pusher.
- The cartridge of example 1, wherein: the second slot is shaped to translatably house at least a first staple pusher shaped to support at least the first one of the plurality of staples and a third one of the plurality of staples parallel to the first one of the plurality of staples; the third slot is shaped to translatably house at least a second staple pusher oblique to the first staple pusher, the second staple pusher shaped to support at least the second one of the plurality of staples and a fourth one of the plurality of staples parallel to the second one of the plurality of staples.
- The cartridge of example any one of the preceding examples, wherein one of: at least one of the plurality of staples has a leg length of 3.42 mm or greater, and the envelope diameter is 5.6 mm or less; or at least one of the plurality of staples has a nominal leg length of 4.72 mm or greater, and the envelope diameter is 8.6 mm or less.
- The cartridge of example 3 or example 4, wherein: the second slot is shaped to slidably receive a first longitudinally translating cam to effectuate a sliding motion of the first staple pusher; and the third slot is shaped to slidably receive a second longitudinally translating cam to effectuate a sliding motion of the second staple pusher oblique to the sliding motion of the first staple pusher.
- The cartridge of any one of the preceding examples, wherein the cartridge comprises a curved tissue clamping interface; and the cartridge is configured to position at least one of the plurality of staples at an angle normal to the curved tissue clamping interface.
- The cartridge of example 7, wherein: the curved tissue clamping interface is curved about a longitudinal axis extending between a proximal end and a distal end of the elongated body; and the curved tissue clamping interface has a radius of between 40% and 60% of the envelope diameter.
- The cartridge of example 8, wherein: the envelope diameter is 5.6 mm or less; and at least one of at least the first one of the plurality of staples has a leg length of 3.42 mm or greater; or at least the first one of the plurality of staples is configured to form about tissue clamped to a thickness greater than 1.5 mm.
- The cartridge of example 1, wherein one of: at least the first one of the plurality of staples has a leg length of 3.42 mm or greater, and the envelope diameter is 5.6 mm or less; or at least the first one of the plurality of staples has a leg length of 4.72 mm or greater, and the envelope diameter is 8.6 mm or less.
- The cartridge of any one of the preceding examples, wherein:
- at least the first one of the plurality of staples is configured to staple about tissue clamped up to a tissue thickness; and the tissue thickness is at least 20% of the envelope diameter.
- The cartridge of example 11, wherein: the tissue thickness is between about 22% and about 36% of the envelope diameter.
- The cartridge of example 1, further comprising: a recess for coupling to a cartridge support jaw; and wherein one of the cartridge and the support jaw are shaped to fit within an envelope diameter of 5.6 mm or less; or the cartridge and the support jaw are shaped to fit within an envelope diameter of 8.6 mm or less.
- The cartridge of example 1, further comprising: a curved tissue clamping interface.
- The cartridge of any one of the preceding examples, wherein: at least one of the plurality of staples has a leg length that is at least 61% of the envelope diameter.
- A surgical stapler, comprising: an anvil movably coupled to a support jaw between a clamped configuration wherein the anvil and the support jaw are configured to clamp tissue positioned therebetween, and a closed configuration wherein a tissue clamping interface in the anvil abuts a tissue clamping interface in the cartridge; wherein the support jaw comprises a cartridge having an elongated body configured to removably house a plurality of B-form staples, at least one of the plurality of B-form staples having a base length and a leg length, the cartridge further comprising a first slot shaped to receive a translating cutting mechanism, a second slot shaped to house at least a first one of the plurality of staples, and a third slot shaped to house at least a second one of the plurality of staples at an angle oblique to the first one of the plurality of staples; the anvil and the support jaw comprising the cartridge are shaped to fit within an envelope diameter when in the closed configuration; and the leg length of the at least one of the plurality of B-form staples is at least 53% of the envelope diameter.
- The stapler of example 16, wherein: the third slot is shaped to house the second one of the plurality of staples at an angle of between about 4 degrees and about 30 degrees relative to the first one of the plurality of staples.
- The stapler of example 16 or example 17, wherein: the second slot is shaped to translatably house at least a first staple pusher; the third slot is shaped to translatably house at least a second staple pusher; and the second slot and the third slot are configured to limit the first staple pusher to translation at an angle oblique to translation of the second staple pusher.
- The stapler of example 16, wherein: the second slot is shaped to translatably house at least a first staple pusher shaped to support at least the first one of the plurality of staples and a third one of the plurality of staples parallel to the first one of the plurality of staples; the third slot is shaped to translatably house at least a second staple pusher oblique to the first staple pusher, the second staple pusher shaped to support at least the second one of the plurality of staples and a fourth one of the plurality of staples.
- The stapler of any one of examples 16-19, wherein one of: at least one of the plurality of staples has a leg length of 3.42 mm or greater, and the envelope diameter is 5.6 mm or less; or at least one of the plurality of staples has a leg length of 4.72 mm or greater, and the envelope diameter is 8.6 mm or less; or the envelope diameter is 5.6 mm or less, and the stapler is configured to staple and cut tissue resulting in a cuff width of greater than 0.5 mm.
- The stapler of example 19, further comprising: a first longitudinally translating cam; a second longitudinally translating cam positioned oblique to the first longitudinally translating cam; and wherein the second slot is shaped to slidably receive the first longitudinally translating cam to effectuate a sliding motion of the first staple pusher; and the third slot is shaped to slidably receive the second longitudinally translating cam to effectuate a sliding motion of the second staple pusher oblique to the sliding motion of the first staple pusher.
- The stapler of any one of examples 16-21, further comprising: an expandable cutting mechanism configured to move between a collapsed configuration wherein the cutting mechanism is shaped to fit within the envelope diameter and an expanded configuration wherein the cutting mechanism has a dimension that is greater than the envelope diameter.
- The stapler of examples 16-21, further comprising: an expandable cutting mechanism having a first member with a cutting portion and a second member; wherein the cutting mechanism is configured to move between a collapsed configuration wherein the cutting portion does not intersect a longitudinal axis defined by the tissue clamping interface of the cartridge and an expanded configuration wherein the cutting portion intersects the longitudinal axis defined by the tissue clamping interface of the cartridge.
- The stapler of any one of examples 16-23, wherein one of: at least the first one of the plurality of staples has a leg length of 3.42 mm or greater, and the envelope diameter is 5.6 mm or less; or at least the first one of the plurality of staples has a leg length of 4.72 mm or greater, and the envelope diameter is 8.6 mm or less.
- The surgical stapler of example 16 or example 24, wherein: the surgical stapler is configured to staple and cut tissue up to a pre-defined tissue thickness; the tissue thickness is defined as a distance between the anvil and the cartridge during stapling; and the tissue thickness is at least 20% of the envelope diameter when the stapler is in the closed configuration.
- The stapler of any one of examples 16-25, wherein: the anvil has a curved tissue clamping interface; and the cartridge has a curved tissue clamping interface shaped to engage the curved tissue clamping interface of the anvil when the stapler is in the closed configuration.
- The stapler of any one of examples 16-26, wherein: at least one of the plurality of staples has a leg length that is at least 61% of the envelope diameter.
- A method of placing a surgical staple in a patient, comprising: providing a surgical stapler in a closed configuration, the stapler comprising an anvil movably coupled to a support jaw between a clamped configuration wherein the anvil and the support jaw are configured to clamp tissue positioned therebetween, and a closed configuration wherein a tissue clamping interface in the anvil abuts a tissue clamping interface in the cartridge, wherein the support jaw comprises a cartridge configured to removably house a plurality of B-form staples, at least one of the plurality of B-form staples having a base length and a leg length, the cartridge further comprising a first slot shaped to receive a translating cutting mechanism, a second slot shaped to house at least a first one of the plurality of staples, and a third slot shaped to house at least a second one of the plurality of staples at an angle oblique to the first one of the plurality of staples, the anvil and the support jaw comprising the cartridge are shaped to fit within an envelope diameter when in the closed configuration, and the leg length of the at least one of the plurality of B-form staples is at least 53% of the envelope diameter; passing at least a portion of the stapler in the closed configuration through an envelope diameter; positioning tissue between the anvil and the support jaw; moving the anvil to the clamped configuration wherein the anvil and the support jaw clamp the tissue; and causing the stapler to form the plurality of staples about the tissue.
- The method of example 28, further comprising: housing a third one of the plurality of staples parallel to the first one of the plurality of staples; and housing a fourth one of the plurality of staples parallel to the second one of the plurality of staples; and wherein one of the surgical stapler has an envelope diameter of 5.6 mm or less; or the surgical stapler has an envelope diameter of 8.6 mm or less.
- The method of example 28, further comprising: clamping tissue between a curved tissue clamping interface in the support jaw and a curved tissue clamping interface in the anvil.
- A surgical stapler, comprising: an anvil movably coupled to a support jaw between a clamped configuration wherein the anvil and the support jaw are configured to clamp tissue positioned therebetween, and a closed configuration wherein a tissue clamping interface in the anvil abuts a tissue clamping interface in the cartridge, the anvil and the support jaw defining an envelope diameter when the anvil is in the closed configuration; and a translating cutting mechanism having a first member having a cutting portion, and a second member, the cutting mechanism movable between a collapsed configuration wherein the cutting mechanism is shaped to fit within the envelope diameter and an expanded configuration wherein the cutting mechanism does not fit within the envelope diameter; wherein the support jaw comprises a cartridge having a first slot shaped to receive the translating cutting mechanism, a second slot shaped to house at least a first one of the plurality of staples, and a third slot shaped to house at least a second one of the plurality of staples.
- The surgical stapler of example 31, wherein: at least one of the first member or the second member has at least one guide, the at least one guide configured to engage a corresponding guide on the anvil to limit the cutting mechanism to translation relative to the corresponding guide.
- The surgical stapler of example 31 or example 32, wherein one of: the envelope diameter is 5.6 mm or less; or the envelope diameter is 8.6 mm or less.
- The surgical stapler any one of examples 31-33, further comprising: a first actuator coupled to the first member, the first member configured to move the first member distally and onto the anvil; and a second actuator coupled to the second member, the actuator configured to move the second member distally and onto the support jaw.
- The surgical stapler of example 34, wherein: the first actuator comprises a flexible member.
- The surgical stapler of any one of examples 31-35, wherein: the first member comprises at least one leg having a first flange; and the second member comprises at least one leg having a second flange, the first flange and the second flange shaped to limit expansion of the cutting mechanism.
- The surgical stapler of any one of examples 31-36, wherein: the cutting mechanism is configured to compress the anvil and the support jaw towards each other and into the clamped configuration as the cutting mechanism translates towards a distal end of the surgical stapler.
- The surgical stapler of any one of examples 31-37, wherein: the stapler has an envelope diameter of 5.6 mm in the closed configuration, and is configured to staple and cut tissue clamped between the anvil and the support jaw such that the cut tissue has a cuff width of greater than 0.5 mm.
- Each of the various elements disclosed herein may be achieved in a variety of manners. This disclosure should be understood to encompass each such variation, be it a variation of an embodiment of any apparatus embodiment, a method or process embodiment, or even merely a variation of any element of these. Particularly, it should be understood that the words for each element may be expressed by equivalent apparatus terms or method terms—even if only the function or result is the same. Such equivalent, broader, or even more generic terms should be considered to be encompassed in the description of each element or action. Such terms can be substituted where desired to make explicit the implicitly broad coverage to which this invention is entitled.
- As but one example, it should be understood that all action may be expressed as a means for taking that action or as an element which causes that action. Similarly, each physical element disclosed should be understood to encompass a disclosure of the action which that physical element facilitates. Regarding this last aspect, by way of example only, the disclosure of a clamp should be understood to encompass disclosure of the act of clamping—whether explicitly discussed or not—and, conversely, were there only disclosure of the act of clamping, such a disclosure should be understood to encompass disclosure of a “clamping mechanism”. Such changes and alternative terms are to be understood to be explicitly included in the description.
- The previous description of the disclosed embodiments is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other embodiments without departing from the spirit or scope of the invention. Thus, the present invention is not intended to be limited to the embodiments shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.
Claims (13)
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2016
- 2016-05-06 EP EP23156665.4A patent/EP4245227A3/en active Pending
- 2016-05-06 US US15/148,744 patent/US10143474B2/en active Active
- 2016-05-06 WO PCT/US2016/031280 patent/WO2016182933A1/en active Application Filing
- 2016-05-06 EP EP16726693.1A patent/EP3294149B1/en active Active
- 2016-05-06 JP JP2017558446A patent/JP6420501B6/en active Active
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2017
- 2017-11-30 US US15/827,250 patent/US20180116663A1/en not_active Abandoned
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2018
- 2018-03-09 US US15/916,503 patent/US20180193018A1/en not_active Abandoned
- 2018-05-02 US US15/968,819 patent/US20180250006A1/en not_active Abandoned
- 2018-10-11 JP JP2018192517A patent/JP2019018042A/en active Pending
-
2020
- 2020-06-29 US US16/914,587 patent/US11534166B2/en active Active
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2022
- 2022-03-25 JP JP2022050458A patent/JP2022100319A/en active Pending
- 2022-11-23 US US18/058,443 patent/US11903585B2/en active Active
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2024
- 2024-04-05 JP JP2024061741A patent/JP2024074942A/en active Pending
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Also Published As
Publication number | Publication date |
---|---|
EP3294149B1 (en) | 2023-03-08 |
US20200345362A1 (en) | 2020-11-05 |
JP2022100319A (en) | 2022-07-05 |
EP4245227A3 (en) | 2024-01-17 |
US11903585B2 (en) | 2024-02-20 |
JP2019018042A (en) | 2019-02-07 |
US20160345971A1 (en) | 2016-12-01 |
US20180250006A1 (en) | 2018-09-06 |
JP2018515222A (en) | 2018-06-14 |
EP4245227A2 (en) | 2023-09-20 |
WO2016182933A1 (en) | 2016-11-17 |
US10143474B2 (en) | 2018-12-04 |
US11534166B2 (en) | 2022-12-27 |
JP2024074942A (en) | 2024-05-31 |
US20230091108A1 (en) | 2023-03-23 |
JP6420501B6 (en) | 2018-12-19 |
JP6420501B2 (en) | 2018-11-07 |
EP3294149A1 (en) | 2018-03-21 |
US20180193018A1 (en) | 2018-07-12 |
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