U.S. patent application number 10/247897 was filed with the patent office on 2004-03-25 for method of performing surgery using surgical device with expandable member.
Invention is credited to Knodel, Bryan D., Knodel, Timothy B..
Application Number | 20040059362 10/247897 |
Document ID | / |
Family ID | 42237444 |
Filed Date | 2004-03-25 |
United States Patent
Application |
20040059362 |
Kind Code |
A1 |
Knodel, Bryan D. ; et
al. |
March 25, 2004 |
Method of performing surgery using surgical device with expandable
member
Abstract
In accordance with the present invention, there is provided a
surgical device for manipulating tissue. The device includes an
elongated shaft having a proximal end and a distal end extending
therefrom. There is also an elongated end effector having a
proximal end attached to the distal end of the shaft, a distal end
extending therefrom. The end effector has first and second opposing
jaws which are movable with respect to each other from an open
position, wherein the jaws are spaced apart, to a closed position
wherein the jaws are in close approximation to one another. At
least one of the jaws has an expandable member disposed thereon for
selectively increasing the size of the jaw in a direction
perpendicular to the longitudinal axis so as to increase the
rigidity of the end effector.
Inventors: |
Knodel, Bryan D.;
(Flagstaff, AZ) ; Knodel, Timothy B.; (Flagstaff,
AZ) |
Correspondence
Address: |
PHILIP S. JOHNSON
JOHNSON & JOHNSON
ONE JOHNSON & JOHNSON PLAZA
NEW BRUNSWICK
NJ
08933-7003
US
|
Family ID: |
42237444 |
Appl. No.: |
10/247897 |
Filed: |
September 20, 2002 |
Current U.S.
Class: |
606/167 |
Current CPC
Class: |
A61B 17/0686 20130101;
A61B 17/07207 20130101; A61B 2017/00353 20130101; A61B 2017/07214
20130101; A61B 17/320016 20130101 |
Class at
Publication: |
606/167 |
International
Class: |
A61B 017/32 |
Claims
What is claimed is:
1. A method of performing a surgical procedure, said method
comprising: a) providing an instrument having a tissue-manipulating
implement to perform work on tissue; b) inserting said instrument
into a body of a surgical patient; c) increasing a cross-sectional
area of said implement to decrease deflection of said implement
under an applied force; d) applying said implement to tissue to
perform work on the tissue; e) disengaging said implement from the
tissue; f) decreasing a cross-sectional area of said implement to
facilitate passage through a small opening; and g) removing said
instrument from the body of the surgical patient.
2. A method according to claim 14 wherein said increasing a
cross-sectional area of said implement comprises moving a device
attached to said implement to increase said cross-sectional
area
3. A method according to claim 14 wherein said decreasing a
cross-sectional area of said implement comprises moving a device
attached to said implement to decrease said cross-sectional area.
Description
[0001] This application is related to the copending U.S. patent
application Ser. No. --/---,--- [Attorney Docket No. END-867],
which is hereby incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention has application in conventional
endoscopic and open surgical instrumentation as well as application
in robotic or power assisted surgery. The present invention
relates, in general, to an expandable member to stiffen a jaw of a
surgical device and, more particularly, to an anvil cap movable to
a position to increase the height of an anvil of an endoscopic
linear cutter.
BACKGROUND OF THE INVENTION
[0003] Medical devices to simultaneously cut and staple tissue in a
surgical patient, often called linear cutters, are commonly used in
endoscopic surgery. In endoscopic surgery, linear cutters are
placed into the patient through a cannula having a small orifice.
Each linear cutter generally has an end-effector in the form of a
cartridge, for holding and ejecting staples, and an anvil, for
forming the ejected staple into the proper shape. After passing
through the cannula, the cartridge and anvil are clamped around
tissue to be cut and stapled to compress the tissue and stem blood
flow. The tissue exerts a reactive force against the cartridge and
the anvil of the device. Examples of linear cutters can be found in
U.S. Pat. No. 6,032,849 and 5,673,840, both of which are hereby
incorporated herein by reference.
[0004] An anvil of a linear cutter has depressions positioned
within it. Each depression receives the legs of a "C" shaped staple
ejected towards it and bends the legs of the staples to form "B"
shaped closures. To keep each pocket positioned in the correct
position and at the correct distance from the cartridge, it is
advantageous to minimize anvil deflection. Force exerted against
the anvil from the tissue causes bending of the anvil and channel
of the end-effector in a plane orthogonal to the tissue surface.
The bending displaces the staple-forming portion of the anvil from
the optimum position to receive an ejected staple, and may result
in malformation of staples. The malformation has a greater
potential for occurring when the cartridge and the anvil of the
device are made longer.
[0005] A technique for creating a stiffer anvil is to increase the
dimension of the anvil in the plane of bending. This dimension is
commonly called the height of the anvil, and increasing the height
of the anvil can also enlarge the cross-sectional area of the
anvil. However, the benefits of endoscopic surgery stem from
creating small incisions on the patient. Small incisions use small
cannulas, and a small cross-sectional area for the anvil is
desirable to fit the jaws of the device through a small cannula.
Longer working jaws are desirable, but jaw length has been limited
by the need to maintain small cross-sectional area and efficacious
staple formation. Deflection needs consideration not only in the
design of endoscopic linear cutters, but also in any endoscopic
device having an attached implement that receives a reactive force
from tissue or the work being performed.
[0006] Because of the benefits of a small incision, there has been
a desire to use an implement that will have a short height to
facilitate entry through a small orifice and that will expand to a
greater height to become more rigid while being used inside the
body. The present invention provides for a surgical device having a
working implement with a movable device that can be raised to
increase the implement rigidity, and that can be lowered to
decrease implement height to facilitate insertion through a
cannula. The present invention further provides for a method of
utilizing the device for performing surgery.
SUMMARY OF THE INVENTION
[0007] In accordance with the present invention, there is provided
a surgical device and method for manipulating tissue. The device
includes an elongated shaft having a proximal end and a distal end
extending therefrom. There is also an elongated end effector having
a proximal end attached to the distal end of the shaft, a distal
end extending therefrom. The end effector has first and second
opposing jaws which are movable with respect to each other from an
open position, wherein the jaws are spaced apart, to a closed
position wherein the jaws are in close approximation to one
another. At least one of the jaws has an expandable member disposed
thereon for selectively increasing the size of the jaw in a
direction perpendicular to the longitudinal axis so as to increase
the rigidity of the end effector.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] The novel features of the invention are set forth with
particularity in the appended claims. The invention itself,
however, both as to organization and methods of operation, together
with further objects and advantages thereof, may best be understood
by reference to the following description, taken in conjunction
with the accompanying drawings in which:
[0009] FIG. 1 is an isometric view of an endoscopic linear cutter
having an expandable member according to an embodiment of the
invention.
[0010] FIG. 2 is an isometric exploded view of the shaft of the
linear cutter of FIG. 1.
[0011] FIG. 3 is a fragmentary side elevation view of a slot within
the tube shown in FIG. 2.
[0012] FIG. 4 is an isometric view of the anvil depicted in FIG.
2.
[0013] FIG. 5 is a side elevation view, partially in section, of
the shaft of the linear cutter of FIG. 1 showing the anvil closed
against the cartridge and the anvil cap lowered into a cavity of
the anvil.
[0014] FIG. 6 is a section view taken along line 6-6 of FIG. 5
depicting the anvil cap lowered into a cavity of the anvil.
[0015] FIG. 7 is a side elevation view, partially in section, of
the shaft of the linear cutter of FIG. 1 showing the anvil closed
against the cartridge and the anvil cap raised from the cavity of
the anvil.
[0016] FIG. 8 is a section view taken along line 8-8 of FIG. 7
depicting the anvil cap raised from the cavity of the anvil.
[0017] FIG. 9 is a side elevation view, partially in section, of
the shaft of the linear cutter of FIG. 1 showing the anvil opened
away from the cartridge and the anvil cap raised from the cavity of
the anvil.
DETAILED DESCRIPTION OF THE INVENTION
[0018] FIG. 1 shows a surgical device 78 for manipulating tissue.
Surgical device 78 has a first and a second jaw, and one of the
jaws is equipped with an expandable member according to an
embodiment of the invention. In the embodiment shown in FIG. 1, the
expandable member is an anvil cap 10. Anvil cap 10 is shown on one
of the jaws, anvil 22, which is closed adjacent to a second jaw, or
cartridge 60. Cartridge 60 contains staples 61 (FIG. 2), which can
be ejected into tissue to be formed into shape to join and retain
the tissue by pockets within anvil 22. Anvil 22 and cartridge 60
are located at a distal end 19 of an elongated shaft 18. Shaft 18
in the embodiment depicted further comprises a tube 64 extending
along a longitudinal axis 27 proximally towards a rotation knob 73
and a handle 76. Handle 76 attaches at a proximal end 23 of shaft
18. Right thumbpad 42 and left thumbpad 44 extend from shaft 18, as
an expander actuator, to be grasped by a physician to expand anvil
22, as will be shown.
[0019] In the embodiment depicted in FIG. 1, surgical device 78 is
an endoscopic linear cutter. An endoscopic cutter suitable for
modification with the addition of anvil cap 10 could be one
described in U.S. Pat. No. 5,597,107 issued to Bryan Knodel et al,
on Jan. 28, 1997, and which is hereby incorporated herein by
reference. Handle 76 can be the handle of the endoscopic linear
cutter described in U.S. Pat. No. 5,597,107, and contains actuators
to move portions of shaft 18. A closure actuator 41 within handle
76 can move tube 64 to drive anvil 22 to positions next to and away
from cartridge 60. A firing actuator 47 within handle 76 can be
used to eject staples 61 into tissue.
[0020] FIG. 2 shows an exploded isometric view of a shaft 18 of
surgical device 78. Anvil cap 10 is a substantially rigid member
used to stiffen anvil 22. Anvil cap 10 is a roughly "U" shaped
device having a horizontal section 14 and two vertical sections 16.
Anvil cap 10 has the inside of the "U" shape open towards anvil 22
and three diagonal cap slots 12 cut into each vertical section 16.
The length of each cap slot 12 extends at a diagonal to
longitudinal axis 27 (FIG. 1) of shaft 18. The distal portion of
each cap slot 12 is closer to the closed section of the "U" than
the proximal portion. A bulge 20 rises on vertical section 16 next
to each cap slot 12, along the narrow material edge of the open
side of the "U."
[0021] Cavity 24 receives anvil cap 10 into anvil 22. A linkage 32
extends through the center of cavity 24. Linkage 32 has three anvil
holes 36 to align with cap slots 12, and also provides a linkage
hole 38 at a proximal end. Linkage actuator 34 attaches at linkage
hole 38 using, for example, a pin, and extends proximally through
shaft 18 to a thumbpad hole 46 at the proximal end of linkage
actuator 34. Linkage 32 can rotate relative to linkage actuator 34
about linkage hole 38 to facilitate rotational motion of anvil
22.
[0022] Channel 48 carries anvil 22 with assembled anvil cap 10,
linkage 32 and linkage actuator 34. Channel 48 also carries a knife
65 and a wedge driver 63. Curvilinear slots 50 retain anvil bosses
52 to locate anvil 22. Anvil bosses 52 are free to translate along
the curve of curvilinear slots 50. Two "Z" shaped channel thumbpad
slots 56 are located near the proximal end of Channel 48, and at
its distal end, channel 48 has a cartridge retention area 58.
[0023] Cartridge 60 assembles to cartridge retention area 58.
Cartridge 60 supplies staples 61 and staple drivers (not shown) to
surgically staple tissue. Firing wedge 62 travels through openings
(not shown) within cartridge 60, forcing staple drivers towards the
tissue surface and forcing staples 61 into tissue.
[0024] Tube 64 encloses the proximal end of channel 48, linkage
actuator 34, and the proximal end of linkage 32. An indentation 66
in tube 64 near the distal end of tube 64 fits into groove 68 on
anvil 22. Tube thumbpad slots 70 are near the proximal end of tube
64 and have a roughly "L" shaped configuration.
[0025] Right thumbpad 42 and left thumbpad 44 are assembled using a
rod 74 and a male thread (not shown) on one thumbpad extending into
a female thread within the opposite thumbpad. Rod 74 may
alternatively be on either right thumbpad 42 or left thumbpad 44.
Rod 74 is depicted on left thumbpad 44 in FIG. 2. Rod 74 of left
thumbpad 44 extends through tube thumbpad slots 70, channel
thumbpad slots 56, and thumbpad hole 46. Both tube thumbpad slots
70 and channel thumbpad slots 56 fit loosely enough to rod 74 to
allow travel of rod 74 along the length of the respective slots.
Knob groove 72 keys tube 64 to an adjustment knob 73 (FIG. 1) so
that rotation of adjustment knob 73 rotates shaft 18.
[0026] FIG. 3 depicts further detail of one of tube thumbpad slots
70. The roughly "L" shaped configuration is inverted, with the
horizontal portions 81 of the "L" nearer the top of tube 64.
Vertical portions 82 extend perpendicular from the proximal parts
of horizontal portions 81. Vertical portions 82 are shown bounded
by distal walls 84 and proximal walls 83.
[0027] Further detail of anvil 22 is depicted in FIG. 4. Two ribs
26 within cavity 24 fit inside the open portion of the inverted "U"
shape of anvil cap 10 to locate anvil cap 10. Anvil slots 30 in
anvil 22 align with cap slots 12 when anvil cap 10 is within cavity
24. Anvil pins 40 (FIG. 2) align with and extend through anvil
slots 30, anvil holes 36, and cap slots 12. Anvil pins 40 may press
through anvil holes 36 in linkage 32. Anvil pins 40 have clearance
to move proximally and distally within anvil slots 30. Anvil pins
40 also have clearance to move along the length of diagonal cap
slot 12.
[0028] FIG. 5 is a side elevation view, partially in section, of
shaft 18. In FIG. 5, the configuration of shaft 18 is that of FIG.
1 with anvil 22 closed and anvil cap 10 within cavity 24. On the
base of cavity 24, six depressions 28 exist to receive bulges 20
when anvil cap 10 is lowered into cavity 24. It can also be seen
that linkage actuator 34, left thumbpad 44, and right thumbpad 42
are moved distally within horizontal portions 81. Linkage actuator
34 will force linkage 32 distally. Linkage 32 moves anvil pins 40
forward, camming against the bottom portion of cap slots 12 to
force anvil cap 10 into cavity 24.
[0029] FIG. 5 further shows that anvil 22 has an anvil face 21
opposing a cartridge face 29 when anvil 22 and cartridge 60 are
approximated. Additionally, anvil cap 10 possesses an anvil cap
back side 55. A dimension 23, or height, of the expandable assembly
of anvil 22 and anvil cap 10, can be measured from anvil face 21 to
anvil cap back side 55 in a direction perpendicular to longitudinal
axis 21.
[0030] Channel 48 carries a channel back side 57 opposite cartridge
face 29. An analogous dimension to dimension 23 could be measured
from channel back side 55 to cartridge face 29.
[0031] FIG. 6 is a cross-sectional view of anvil 22 taken along
line 6-6 of FIG. 5. FIG. 6 depicts anvil cap 10 recessed within
cavity 24 of anvil 22. With anvil cap 10 recessed into anvil 22,
anvil 22 has a first cross-sectional area and a first area moment
of inertia lower than a second cross-sectional area and a second
area moment of inertia that can be attained by expanding anvil cap
10 from cavity 24. The dimension 23, or height, of anvil 22 is
relatively small, and anvil 22 has first stiffness lower than a
second stiffness that can be attained by expanding anvil cap 10
from cavity 24. However, with anvil cap 10 within cavity 24 of
anvil 22, in the position shown in FIG. 6, anvil 22 has a low
profile easily inserted through a small opening of, for example, a
trocar cannula used in endoscopic surgery.
[0032] FIG. 7 is a side elevation view, partially in section, of
shaft 18 with anvil 22 closed to a position adjacent cartridge 60,
and anvil cap 10 moved out of cavity 24. After inserting shaft 18
through an orifice, the physician can raise anvil cap 10 from
cavity 24 by moving either left thumbpad 44 or right thumbpad 42
proximally along horizontal portions 81 of tube thumbpad slots 70
as shown in the figure. Left thumbpad 44 or right thumbpad 42 pulls
linkage actuator 34 proximally, and linkage actuator 34 in turn
moves linkage 32 proximally. Anvil pins 40 exert a force against
cap slots 12 to cam anvil cap 10 away from cavity 24 in a direction
perpendicular to longitudinal axis 27. Anvil cap 10 is restrained
from moving proximally by the proximal wall of cavity 24. After
raising anvil cap 10, the user can move either left thumbpad 44 or
right thumbpad 42 in a direction away from horizontal portions 81
and along vertical portions 82, rotating linkage actuator 34
slightly relative to linkage 32. Distal walls 84 of tube thumbpad
slots 70 restrain left thumbpad 44 and right thumbpad 42 from
moving distally, locking anvil cap 10 in the expanded position away
from cavity 24.
[0033] FIG. 8 is a cross-sectional view of anvil 22 taken along
line 8-8 of FIG. 7. FIG. 8 shows anvil cap 10 expanded from cavity
24 of anvil 22. With anvil cap 10 expanded from anvil 22, anvil 22
has a second cross-sectional area and a second area moment of
inertia higher than the first cross-sectional area and the first
area moment of inertia that exists when anvil cap 10 is lowered
into cavity 24. The dimension 23, or height, of anvil 22 has
increased, and anvil 22 has a second stiffness higher than the
first stiffness that exists when anvil cap 10 is lowered into
cavity 24. The size of anvil 22 has effectively increased in a
direction perpendicular to longitudinal axis 27. Anvil 22, which
had a low profile for easy insertion through a small orifice, now
has a higher, stiffer profile for use within a body.
[0034] FIG. 9 shows a split section view of shaft 18 with anvil 10
moved to an open position away from cartridge 60. Closure actuator
41 (FIG. 1) of handle 76 moves tube 64 proximally to open anvil 22
by moving anvil 22 rotatably away from cartridge 60. Pulling tube
64 proximally causes indentation 66 to force anvil 22 proximally by
pulling on groove 68. Anvil 22 rotates to an open position when
anvil bosses 52 translate along curvilinear slots 50. Tube thumbpad
slots 70 move with tube 64 proximally relative to channel thumbpad
slots 56. Distal walls 84 on tube 64 urge right thumbpad 42 and
left thumbpad 44 proximally through channel thumbpad slots 56.
Right thumbpad 42 and left thumbpad 44 draw linkage actuator 34 and
linkage 32 proximally, so that linkage actuator 34 maintains a
force on anvil cap 10 through anvil pins 40 and cap slots 12. The
force maintains anvil cap 10 in a position raised from cavity 24 of
anvil 22 as anvil 22 is moved from the closed position to an open
position. Linkage 32 also rotates relative to linkage actuator to
allow rotation of anvil 22 as anvil bosses 52 translate along
curvilinear slots 50.
[0035] Opened surgical device 78 may now grasp on tissue requiring
transection and stapling. Firing actuator 47 (FIG. 1) within handle
76 can move wedge driver 63 distally to force firing wedge 62
through cartridge 61 to eject staples 61. Pockets in anvil 22 form
staples 61 to retain tissue to control bleeding. Knife 65 may be
used to transect tissue.
[0036] After transection and stapling, the user can remove surgical
device 78 from the patient's body through a small orifice. To
accomplish removal, the user opens surgical device 78 to unclamp it
from any tissue. The user then reverses the procedure depicted in
FIGS. 5 through 9. Anvil 22 is first closed by moving tube 64
distally. Distal movement of tube 64 causes the proximal walls 83
of tube thumbpad slots 70 to force right thumbpad 42 and left
thumbpad 44 distally through channel thumbpad slots 56. Right
thumbpad 42 and left thumbpad 44 move to the distal sections of
channel thumbpad slots 56, where the vertical portions 82 of
channel thumbpad slots 56 become available for use. Moving either
thumbpad first vertically along vertical portions 82, then
horizontally and distally along horizontal portions 81 after the
thumbpads are in the distal position will return the thumbpads to
the original position depicted in FIG. 3 and lower anvil cap 10
into cavity 24. The closed anvil 22 with retracted anvil cap 10 may
now be withdrawn through a smaller orifice that would be possible
with expanded anvil 22.
[0037] It will be recognized that equivalent structures may be
substituted for the structures illustrated and described herein and
that the described embodiment of the invention is not the only
structure which may be employed to implement the claimed invention.
As one example of an equivalent structure that may be used to
implement the present invention, the endoscopic linear cutter may
be a surgical implement such as a grasper, scissors, or other
endoscopic surgical tools. Anvil cap 10 may be a plate that moves
alongside an end-effector of a surgical tool instead of recessing
into a cavity in the end-effector.
[0038] While preferred embodiments of the present invention have
been shown and described herein, it will be obvious to those
skilled in the art that such embodiments are provided by way of
example only. For example, as would be apparent to those skilled in
the art, the disclosures herein have equal application in robotic
or power assisted surgery. In addition, it should be understood
that every structure described above has a function and such
structure can be referred to as a means for performing that
function. Numerous variations, changes, and substitutions will now
occur to those skilled in the art without departing from the
invention. Accordingly, it is intended that the invention be
limited only by the spirit and scope of the appended claims.
* * * * *