U.S. patent application number 12/896364 was filed with the patent office on 2011-02-17 for endoscopic stitching devices.
Invention is credited to Ramiro Cabrera, Brian J. Creston, David N. Fowler, Dmitri Menn, Paul D. Richard, Gene Stellon, Thomas Wingardner.
Application Number | 20110040308 12/896364 |
Document ID | / |
Family ID | 43589030 |
Filed Date | 2011-02-17 |
United States Patent
Application |
20110040308 |
Kind Code |
A1 |
Cabrera; Ramiro ; et
al. |
February 17, 2011 |
Endoscopic Stitching Devices
Abstract
The present disclosure relates to devices, systems and methods
for endoscopic suturing or stitching through an access tube or the
like. An endoscopic stitching device is provided and includes a
handle assembly; an elongate shaft supported by and extending from
the handle assembly; and an end effector supported on a distal end
of the elongate shaft. The end effector includes a neck assembly
configured and adapted for articulation in one direction between a
substantially linear configuration and an off-axis configuration,
and a pair of juxtaposed jaws pivotally associated with one
another. Each jaw defines a suture needle receiving recess formed
in a tissue contacting surface thereof.
Inventors: |
Cabrera; Ramiro; (Cheshire,
CT) ; Wingardner; Thomas; (North Haven, CT) ;
Fowler; David N.; (Cheshire, CT) ; Creston; Brian
J.; (West Haven, CT) ; Menn; Dmitri;
(Marblehead, MA) ; Richard; Paul D.; (Shelton,
CT) ; Stellon; Gene; (Burlington, CT) |
Correspondence
Address: |
Mark Farber, Esq.;Tyco Healthcare Group LP
60 Middletown Avenue
North Haven
CT
06473
US
|
Family ID: |
43589030 |
Appl. No.: |
12/896364 |
Filed: |
October 1, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12482049 |
Jun 10, 2009 |
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12896364 |
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61061136 |
Jun 13, 2008 |
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61304825 |
Feb 16, 2010 |
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61249063 |
Oct 6, 2009 |
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Current U.S.
Class: |
606/144 |
Current CPC
Class: |
A61B 2017/2905 20130101;
A61B 17/00234 20130101; A61B 2017/00367 20130101; A61B 2017/2912
20130101; A61B 2017/2929 20130101; A61B 17/06166 20130101; A61B
2017/003 20130101; A61B 2017/06176 20130101; A61B 17/0491 20130101;
A61B 1/0055 20130101; A61B 34/71 20160201; A61B 17/0469 20130101;
A61B 1/0008 20130101; A61B 2017/06047 20130101; A61B 2017/0608
20130101; A61B 17/062 20130101; A61B 17/0625 20130101; A61B
2017/0609 20130101 |
Class at
Publication: |
606/144 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Claims
1. An endoscopic stitching device, comprising: a handle assembly;
an elongate shaft supported by and extending from the handle
assembly; and an end effector supported on a distal end of the
elongate shaft, the end effector including a neck assembly
configured and adapted for articulation in one direction between a
substantially linear configuration and an off-axis configuration,
and a pair of juxtaposed jaws pivotally associated with one
another, wherein each jaw defines a suture needle receiving recess
formed in a tissue contacting surface thereof, wherein the neck
assembly includes: a plurality of links in pivotable contact with
one another, wherein each link includes: a knuckle formed on a
first side thereof; and a clevis formed on a second side thereof,
wherein the knuckle of a first link is operatively connected to a
clevis of an adjacent link; and at least one stiffener plate
extending through at least a pair of the plurality of operatively
connected links.
2. The endoscopic stitching device according to claim 1, wherein
the jaws are rotatably supported on the end effector for selective
rotation about a longitudinal axis thereof when the end effector is
in the substantially linear configuration and in the articulated
configuration.
3. The endoscopic stitching device according to claim 1, wherein
the knuckles and clevises are configured to enable uni-directional
articulation of the neck assembly.
4. The endoscopic stitching device according to claim 1, wherein
the knuckles and clevises are configured to at least partially
overlap one another when the neck assembly is in one of the
substantially linear configuration and the off-axis
configuration.
5. The endoscopic stitching device according to claim 1, wherein
only one end of the at least one stiffener plate is securely
attached to the neck assembly.
6. An endoscopic stitching device, comprising: a handle assembly;
an elongate shaft supported by and extending from the handle
assembly; an end effector supported on a distal end of the elongate
shaft, the end effector including a neck assembly configured and
adapted for articulation in one direction between a substantially
linear configuration and an off-axis configuration, and a pair of
juxtaposed jaws pivotally associated with one another; and a
stiffener plate disposed in the neck assembly and axially extending
therein, wherein the stiffener plate inhibits canting of the end
effector in a direction orthogonal to a direction of articulation
of the end effector.
7. The endoscopic stitching device according to claim 6, wherein
the stiffener plate defines a plane that is substantially
orthogonal to a direction of articulation of the end effector.
8. The endoscopic stitching device according to claim 7, wherein
the stiffener plate is substantially flat and is bendable in a
single.
9. The endoscopic stitching device according to claim 7, wherein
the stiffener plate is translatably disposed in the neck
assembly.
10. The endoscopic stitching device according to claim 9, wherein
the end effector is articulatable in a direction out of a plane
defined by the stiffener plate.
11. The endoscopic stitching device according to claim 10, wherein
the stiffener plate restricts planar articulation of the end
effector with respect to a plane defined by the stiffener
plate.
12. The endoscopic stitching device according to claim 9, wherein
one end of the stiffener plate includes an anchor portion secured
to the neck assembly.
13. The endoscopic stitching device according to claim 12, wherein
the anchor portion is bifurcated and includes at least a pair of
spaced apart tines.
14. The endoscopic stitching device according to claim 7, wherein
the neck assembly further includes a plurality of links in
pivotable contact with one another, wherein each link defines a
stiffener plate receiving slot for receiving the stiffener plate
therethrough.
15. The endoscopic stitching device according to claim 14, wherein
the stiffener plate extends through the receiving slot of at least
one of the links.
16. The endoscopic stitching device according to claim 14, wherein
the stiffener plate extends through the receiving slot of all of
the links.
17. The endoscopic stitching device according to claim 7, wherein
the stiffener plate is made of resilient material.
18. An endoscopic stitching device, comprising: a handle assembly;
an elongate shaft supported by and extending from the handle
assembly; an end effector supported on a distal end of the elongate
shaft, the end effector including a neck assembly configured and
adapted for articulation in one direction between a substantially
linear configuration and an off-axis configuration, and a pair of
juxtaposed jaws pivotally associated with one another, and a pair
of spaced apart stiffener plates disposed in the neck assembly and
axially extending therein, wherein each of the pair of stiffener
plates defines a plane.
19. The endoscopic stitching device according to claim 18, wherein
the pair of stiffener plates are substantially parallel with one
another.
20. The endoscopic stitching device according to claim 19, wherein
the plane defined by each of the pair of stiffener plates is
substantially orthogonal to a direction of articulation.
21. The endoscopic stitching device according to claim 20, wherein
the pair of stiffener plates are substantially flat and being
bendable in a single direction.
22. The endoscopic stitching device according to claim 20, wherein
the pair of stiffener plates are translatably disposed in the neck
assembly.
23. The endoscopic stitching device according to claim 22, wherein
the end effector is articulatable in a direction out of the plane
defined by the pair of stiffener plates.
24. The endoscopic stitching device according to claim 23, wherein
the pair of stiffener plates restrict planar articulation of the
end effector with respect to the plane defined by the pair of
stiffener plates.
25. The endoscopic stitching device according to claim 20, wherein
one end of each of the pair of stiffener plates includes an anchor
portion secured to the neck assembly.
26. The endoscopic stitching device according to claim 18, wherein
the neck assembly further includes a plurality of links in
pivotable contact with one another, wherein each link defines a
pair of stiffener plate receiving slots for receiving the stiffener
plates therethrough.
27. The endoscopic stitching device according to claim 26, wherein
the pair of stiffener plates extend through a slot of at least one
of the links.
28. The endoscopic stitching device according to claim 26, wherein
the pair of stiffener plates extend through the slots of all of the
links.
29. The endoscopic stitching device according to claim 18, wherein
the stiffener plate is made of resilient material.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] The present application claims the benefit of and priority
to each of U.S. Provisional Application Ser. No. 61/304,825, filed
on Feb. 16, 2010, and U.S. Provisional Application Ser. No.
61/249,063, filed on Oct. 6, 2009, the entire content of each of
which is incorporated herein by reference.
[0002] The present application is also a Continuation-in-Part
Application claiming the benefit of and priority to U.S. patent
application Ser. No. 12/482,049, filed Jun. 10, 2009, which claims
the benefit of and priority to U.S. Provisional Application Ser.
No. 61/061,136, filed Jun. 13, 2008, the entire content of each of
which is incorporated herein by reference.
BACKGROUND
[0003] 1. Technical Field
[0004] The present disclosure relates to devices, systems and
methods for endoscopic suturing or stitching and, more
particularly, to devices, systems and methods for endoscopic
suturing and/or stitching through an access tube or the like.
[0005] 2. Background
[0006] As medical and hospital costs continue to increase, surgeons
are constantly striving to develop advanced surgical techniques.
Advances in the surgical field are often related to the development
of operative techniques which involve less invasive surgical
procedures and reduce overall patient trauma. In this manner, the
length of hospital stays can be significantly reduced, and,
therefore, the hospital and medical costs can be reduced as
well.
[0007] One of the truly great advances in recent years to reduce
the invasiveness of surgical procedures is endoscopic surgery.
Generally, endoscopic surgery involves incising through body walls
for example, viewing and/or operating on the ovaries, uterus, gall
bladder, bowels, kidneys, appendix, etc. There are many common
endoscopic surgical procedures, including arthroscopy, laparoscopy
(pelviscopy), gastroentroscopy and laryngobronchoscopy, just to
name a few. Typically, trocars are utilized for creating the
incisions through which the endoscopic surgery is performed. Trocar
tubes or cannula devices are extended into and left in place in the
abdominal wall to provide access for endoscopic surgical tools. A
camera or endoscope is inserted through a relatively large diameter
trocar tube which is generally located at the naval incision, and
permits the visual inspection and magnification of the body cavity.
The surgeon can then perform diagnostic and therapeutic procedures
at the surgical site with the aid of specialized instrumentation,
such as, forceps, cutters, applicators, and the like which are
designed to fit through additional cannulas. Thus, instead of a
large incision (typically 12 inches or larger) that cuts through
major muscles, patients undergoing endoscopic surgery receive more
cosmetically appealing incisions, between 5 and 10 millimeters in
size. Recovery is, therefore, much quicker and patients require
less anesthesia than traditional surgery. In addition, because the
surgical field is greatly magnified, surgeons are better able to
dissect blood vessels and control blood loss. Heat and water loss
are greatly reduced as a result of the smaller incisions.
[0008] In many surgical procedures, including those involved in
endoscopic surgery, it is often necessary to suture bodily organs
or tissue. The latter is especially challenging during endoscopic
surgery because of the small openings through which the suturing of
bodily organs or tissues must be accomplished.
[0009] In the past, suturing of bodily organs or tissue through
endoscopic surgery was achieved through the use of a sharp metal
suture needle which had attached at one of its ends a length of
suture material. The surgeon would cause the suture needle to
penetrate and pass through bodily tissue, pulling the suture
material through the bodily tissue. Once the suture material was
pulled through the bodily tissue, the surgeon proceeded to tie a
knot in the suture material. The knotting of the suture material
allowed the surgeon to adjust the tension on the suture material to
accommodate the particular tissue being sutured and control
approximation, occlusion, attachment or other conditions of the
tissue. The ability to control tension is extremely important to
the surgeon regardless of the type of surgical procedure being
performed.
[0010] However, during endoscopic surgery, knotting of the suture
material is time consuming and burdensome due to the difficult
maneuvers and manipulation which are required through the small
endoscopic openings.
[0011] Many attempts have been made to provide devices to overcome
the disadvantages of conventional suturing. Such prior art devices
have essentially been staples, clips, clamps or other fasteners.
However, none of these above listed devices overcome the
disadvantages associated with suturing bodily tissue during
endoscopic surgery.
[0012] Accordingly, there is a need for improvements in suturing
devices which overcome the shortcomings and drawbacks of prior art
apparatus.
SUMMARY
[0013] An endoscopic stitching device consistent with the present
invention comprises a handle assembly; an elongate shaft supported
by and extending from the handle assembly; and an end effector
supported on a distal end of the elongate shaft, the end effector
including a neck assembly configured and adapted for articulation
in one direction between a substantially linear configuration and
an off-axis configuration, and a pair of juxtaposed jaws pivotally
associated with one another, wherein each jaw defines a suture
needle receiving recess formed in a tissue contacting surface
thereof
[0014] In one embodiment, the jaws that are rotatably supported on
the end effector for selective rotation about a longitudinal axis
thereof when the end effector is in the substantially linear
configuration and in the articulated configuration. In another
embodiment, the handle assembly supports a rotation assembly
configured to transmit an actuation from the handle assembly
through the elongate shaft to effectuate rotation of the jaws. The
rotation assembly may include a knob rotatably supported on a
housing of the handle assembly and operatively connected to a
center drive rod assembly, wherein the center drive rod assembly
includes a distal end extending through the elongate shaft and
connected to the jaws. In some embodiments, at least a portion of
the center drive rod assembly is flexible. In an embodiment, the
endoscopic stitching device includes a center drive rod assembly
translatably supported therein, the center drive rod assembly
including a proximal end operatively connected to at least one
handle of the handle assembly and a distal end extending through
the elongate shaft and operatively connected to the jaws, wherein
axial translation of the center drive rod assembly results in
opening and closing of the jaws. In an embodiment, the axial
rotation of the center drive rod assembly results in rotation of
the jaws about a longitudinal axis thereof In one embodiment, the
endoscopic stitching device includes a rotation assembly supported
on a housing of the handle assembly and operatively connected to
the center drive rod assembly, wherein actuation of the rotation
assembly results in concomitant rotation of the center drive rod
assembly and the jaws. In an embodiment, at least a portion of a
length of the center drive rod assembly is flexible, wherein the
flexible portion of the center drive rod assembly will flex upon an
articulation of the end effector and enable rotation of the jaws
when the end effector is in an articulated condition.
[0015] In an embodiment, the end effector further includes a pair
of axially translatable needle engaging blades slidably supported,
one each, in a respective jaw, each blade having a first position
wherein a portion of the blade engages a suture needle when a
suture needle is present in suture needle receiving recess formed
in the tissue contacting surface of the jaw, and a second position
wherein the blade does not engage the suture needle. In accordance
with an embodiment, a proximal end of each blade is rotatably
supported on a respective barrel of a concentric barrel pair,
wherein the blades rotate about the barrels upon a rotation of the
jaws.
[0016] In some embodiments, a suture needle is loadable into the
suture needle receiving recess defined in the jaw when the
respective blade is in the second position. In one embodiment, the
device includes a loading/unloading assembly supported on the
handle assembly and connected to each blade, wherein the
loading/unloading assembly is movable between a first position in
which the blades are in the first position and a second position in
which the blades are in the second position. The loading/unloading
assembly may be actuatable in a first direction to move a first
blade to the first position and a second blade to the second
position, and a second direction to move the first blade in the
second direction and the second blade in the first direction.
[0017] An endoscopic stitching device of the present invention may
also include an articulation assembly supported on the handle
assembly and actuatable to articulate the end effector, wherein
actuation of the articulation assembly results in articulation of
the end effector between the linear configuration and the off-axis
configuration. In one embodiment, the articulation assembly
includes an articulation cam supported on a housing of the handle
assembly and includes first and second cam disks having opposing
respective first and second camming channels defined therein, a
first pin operably associated with the first camming channel and a
first slider configured to longitudinally translate with respect to
the housing, and a second pin operably associated with the second
camming channel and a second slider configured to longitudinally
translate with respect to the housing, the first and second slider
secured with respective proximal ends of first and second
articulation cables, the distal ends being secured at a location
distal of the neck assembly, and wherein the articulation cables
are disposed on opposed sides of a center drive rod assembly. The
first and second camming channels may be configured to provide
equidistant linear motion directly proportional to the angular
rotation of the first and second cam disks. The first and second
camming channels may have a shape substantially similar to a
logarithmic spiral. In some embodiments, each articulation cable
remains substantially taut upon translation thereof. In an
embodiment, the first and second cam disks are monolithically
formed. A torsion spring may operably couple the first and second
cam disks. In some embodiments, the articulation assembly includes
an articulation knob supported on a housing of the handle assembly,
an articulation sleeve operatively connected to the articulation
knob and including a pair of oppositely pitched outer helical
threads, an articulation collar threadably connected to each
helical thread and configured to permit axial translation and
prevent rotation thereof, and an articulation cable secured to each
articulation collar, wherein each articulation cable includes a
first end secured to the respective articulation collar and a
second end secured at a location distal of the neck assembly, and
wherein the articulation cables are disposed on opposed sides of a
center drive rod assembly.
[0018] In an embodiment, each articulation cable is operably
associated with a seal having first and second lumens extending
therethrough, and wherein at least one lumen is configured to
receive at least one articulation cable in substantial sealing
relationship therewith. At least one of the first and second lumens
of the seal may have an arched section. In an embodiment, at least
one of the first and second lumens of the seal is repositionable
through a plurality of positions including a first position and a
second position in response to longitudinal translation of at least
one articulation cable therethrough. In an embodiment, at least one
lumen of the seal is biased towards at least one of the first or
second positions.
[0019] In some embodiments, rotation of the articulation knob
results in rotation of the articulation sleeve and concomitant
axial translation of the articulation collars, wherein axial
translation of the articulation collars results in articulation of
the end effector. In an embodiment, rotation of the articulation
sleeve in a first direction results in relative axial separation of
the articulation collars to articulate the end effector in a first
direction, and rotation of the articulation sleeve in a second
direction results in relative axial separation of the articulation
collars to articulate the end effector in a second direction.
[0020] In one embodiment, the neck assembly includes a plurality of
links in pivotable contact with one another, wherein each link
includes a knuckle formed on a first side thereof and a clevis
formed on a second side thereof, wherein the knuckle of a first
link is operatively connected to a clevis of an adjacent link. In
one embodiment, the neck assembly further includes at least one
stiffener plate translatably disposed in the plurality of
operatively connected links. In one embodiment, one end of the at
least one stiffener plate is securely attached to the neck
assembly. The knuckles and clevises may be configured to enable
uni-directional articulation of the neck assembly. The knuckles and
clevises may be configured to at least partially overlap one
another when the neck assembly is in either the substantially
linear configuration or the off-axis configuration. An endoscopic
stitching device according to the present invention may include a
handle assembly that has a pair of handles and a center drive rod
connected at a first end to the handles and at a second end to the
pair of jaws, wherein actuation of the handles results in axial
translation of the center drive rod and concomitant opening and
closing of the jaws.
[0021] An endoscopic stitching device consistent with an embodiment
of the invention includes a handle assembly including a housing; an
elongate shaft supported by and extending from the housing; an end
effector supported on a distal end of the elongate shaft, the end
effector including a neck assembly configured and adapted for
articulation in one direction between a substantially linear
configuration and an off-axis configuration, and a pair of
juxtaposed jaws pivotally associated with one another, wherein each
jaw defines a suture needle receiving recess formed in a tissue
contacting surface thereof, and wherein the jaws are rotatably
supported on the end effector for selective rotation about a
longitudinal axis thereof when the end effector is in the
substantially linear configuration and in the articulated
configuration; an articulation assembly supported on the housing
and actuatable to articulate the end effector, wherein actuation of
the articulation assembly results in articulation of the end
effector between the linear configuration and the off-axis
configuration; and a rotation assembly supported on the housing,
the rotation assembly being configured to transmit an actuation
from the handle assembly through the elongate shaft to effectuate
rotation of the jaws.
[0022] In an embodiment, the articulation assembly includes an
articulation cam supported on a housing of the handle assembly and
includes first and second cam disks having opposing respective
first and second camming channels defined therein, a first pin
operably associated with the first camming channel and a first
slider configured to longitudinally translate with respect to the
housing, and a second pin operably associated with the second
camming channel and a second slider configured to longitudinally
translate with respect to the housing, the first and second slider
secured with respective proximal ends of first and second
articulation cables, the distal ends being secured at a location
distal of the neck assembly, and wherein the articulation cables
are disposed on opposed sides of a center drive rod assembly. The
first and second camming channels may be configured to provide
equidistant linear motion directly proportional to the angular
rotation of the first and second cam disks. The first and second
camming channels may have a shape substantially similar to a
logarithmic spiral. In some embodiments, each articulation cable
remains substantially taut upon translation thereof. In an
embodiment, the first and second cam disks are monolithically
formed. A torsion spring may operably couple the first and second
cam disks.
[0023] In an embodiment, the rotation assembly includes a knob
rotatably supported on the housing and operatively connected to a
center drive rod assembly, wherein the center drive rod assembly
includes a distal end extending through the elongate shaft and
connected to the jaws. The rotation assembly may include a beveled
gear assembly operatively associated with the knob. The beveled
gear assembly may be configured to translate the center drive rod
assembly for opening and closing the jaws. The beveled gear
assembly may be configured to translate rotational energy to the
center drive rod assembly in accordance with at least one of the
following ratios 1:1, more than 1:1, or less than 1:1. In an
embodiment, the beveled gear assembly includes a sun gear disposed
in mechanical cooperation with the knob and operatively associated
with first and second beveled gears, the first and second beveled
gears being operatively associated with each other. The beveled
gear assembly may further include a first beveled gear mount
disposed in mechanical cooperation with the first beveled gear and
the knob. The second beveled gear may be disposed in mechanical
cooperation with the center drive rod assembly. In an embodiment,
at least a portion of the center drive rod assembly extending
through the neck assembly is flexible.
[0024] In one embodiment, the endoscopic stitching device includes
a center drive rod assembly at least translatably supported in the
housing, the elongate shaft and the end effector, and at least
rotatably supported in the elongate shaft and the end effector, the
center drive rod assembly including a proximal end operatively
connected to at least one handle of the handle assembly and a
distal end extending through the elongate shaft and operatively
connected to the jaws, wherein axial translation of the center
drive rod assembly results in opening and closing of the jaws.
[0025] In one embodiment, axial rotation of at least a distal
portion of the center drive rod assembly results in rotation of the
jaws about a longitudinal axis thereof. In an embodiment, the end
effector further includes a pair of axially translatable needle
engaging blades slidably supported, one each, in a respective jaw,
each blade having a first position wherein a portion of the blade
engages a suture needle when a suture needle is present in suture
needle receiving recess formed in the tissue contacting surface of
the jaw, and a second position wherein the blade does not engage
the suture needle. A proximal end of each blade may be rotatably
supported on a respective barrel of a concentric barrel pair,
wherein the blades rotated about the barrels upon a rotation of the
jaws. A suture needle may be loadable into the suture needle
receiving recess defined in the jaw when the respective blade is in
the second position.
[0026] An endoscopic stitching device consistent with invention may
have a loading/unloading assembly supported on the handle assembly
and connected to each blade, wherein the loading/unloading assembly
is movable between a first position in which the blades are in the
first position and a second position in which the blades are in the
second position. The loading/unloading assembly may be actuatable
in a first direction to move a first blade to the first position
and a second blade to the second position, and a second direction
to move the first blade in the second direction and the second
blade in the first direction.
[0027] In an embodiment, the articulation assembly includes an
articulation knob supported on the housing of the handle assembly,
an articulation sleeve operatively connected to the articulation
knob and including a pair of oppositely pitched outer helical
threads, an articulation collar threadably connected to each
helical thread and configured to permit axial translation and
prevent rotation thereof, and an articulation cable secured to each
articulation collar, wherein each articulation cable includes a
first end secured to the respective articulation collar and a
second end secured at a location distal of the neck assembly, and
wherein the articulation cables are disposed on opposed sides of a
center drive rod assembly.
[0028] In an embodiment, each articulation cable is operably
associated with a seal having first and second lumens extending
therethrough, and wherein at least one lumen is configured to
receive at least one articulation cable in substantial sealing
relationship therewith. At least one of the first and second lumens
of the seal may have an arched section. At least one of the first
and second lumens of the seal may be repositionable through a
plurality of positions including a first position and a second
position in response to longitudinal translation of at least one
articulation cable therethrough. In an embodiment, at least one
lumen of the seal is biased towards at least one of the first or
second positions.
[0029] In an embodiment, rotation of the articulation knob results
in rotation of the articulation sleeve and concomitant axial
translation of the articulation collars, wherein axial translation
of the articulation collars results in articulation of the end
effector. In one embodiment, rotation of the articulation sleeve in
a first direction results in relative axial separation of the
articulation collars to articulate the end effector in a first
direction, and rotation of the articulation sleeve in a second
direction results in relative axial separation of the articulation
collars to articulate the end effector in a second direction.
[0030] An endoscopic stitching device of the invention may have a
neck assembly that includes a plurality of links in pivotable
contact with one another, wherein each link includes a knuckle
formed on a first side thereof and a clevis formed on a second side
thereof, wherein the knuckle of a first link is operatively
connected to a clevis of an adjacent link. The neck assembly may
further include at least one stiffener plate translatably disposed
in the plurality of operatively connected links. One end of the at
least one stiffener plate may be securely attached to the neck
assembly. The knuckles and clevises may be configured to enable
uni-directional articulation of the neck assembly. The knuckles and
clevises may be configured to at least partially overlap one
another when the neck assembly is in either the substantially
linear configuration or the off-axis configuration.
[0031] In an embodiment, the handle assembly includes a pair of
handles supported on the housing; and a center drive rod connected
at a first end to the handles and at a second end to the pair of
jaws, wherein actuation of the handles results in axial translation
of the center drive rod and concomitant opening and closing of the
jaws.
[0032] An endoscopic stitching device consistent with an embodiment
of the invention includes a handle assembly; an elongate shaft
supported by and extending from the handle assembly; an end
effector supported on a distal end of the elongate shaft, the end
effector including a neck assembly configured and adapted for
articulation in one direction between a substantially linear
configuration and an off-axis configuration, and a pair of
juxtaposed jaws pivotally associated with one another; and a
stiffener plate disposed in the neck assembly and axially extending
therein, wherein the stiffener plate defines a plane.
[0033] In an embodiment, the plane defined by the stiffener plate
is substantially orthogonal to a direction of articulation. The
stiffener plate may be substantially flat, wherein the
substantially flat stiffener plate is bendable in one direction.
The stiffener plate may be translatably disposed in the neck
assembly. The end effector may be articulatable in a direction out
of the plane defined by the stiffener plate. In an embodiment, the
stiffener plate restricts planar articulation of the end effector
with respect to the plane defined by the stiffener plate. In one
embodiment one end of the stiffener plate includes an anchor
portion secured to the neck assembly, wherein the anchor portion
may be bifurcated, the bifurcated anchor portion including at least
a pair of spaced apart tines. In an embodiment, a free end of the
stiffener plate is axially tapered with respect to the width
thereof. In some embodiments, the free end of the stiffener plate
may be axially tapered with respect to the thickness thereof In one
embodiment, the neck assembly includes a plurality of links in
pivotable contact with one another, wherein each link defines a
stiffener plate receiving slot for receiving the stiffener plate
therethrough. The stiffener plate may extend through the slot of at
least one of the links. The stiffener plate, however, may also
extend through the slot of all of the links. The stiffener plate
may be made of resilient material.
[0034] An endoscopic stitching device consistent with an embodiment
of the invention includes a handle assembly; an elongate shaft
supported by and extending from the handle assembly; an end
effector supported on a distal end of the elongate shaft, the end
effector including a neck assembly configured and adapted for
articulation in one direction between a substantially linear
configuration and an off-axis configuration, and a pair of
juxtaposed jaws pivotally associated with one another; and a pair
of stiffener plates disposed in the neck assembly and axially
extending therein, wherein each of the pair of stiffener plates
defines a plane.
[0035] In one embodiment, the pair of stiffener plates is
substantially parallel with one another. The plane defined by each
of the pair of stiffener plates may be substantially orthogonal to
a direction of articulation. In an embodiment, the pair of
stiffener plates is substantially flat, wherein the pair of
substantially flat stiffener plates is bendable in one direction.
In an embodiment, the pair of stiffener plates is translatably
disposed in the neck assembly, wherein the end effector is
articulatable in a direction out of the plane defined by the pair
of stiffener plates. In one embodiment, the pair of stiffener
plates restricts planar articulation of the end effector with
respect to the planes defined by the pair of stiffener plates. One
end of each of the pair of stiffener plates may include an anchor
portion secured to the neck assembly. The anchor portion may be
bifurcated, each of the bifurcated anchor portion including at
least a pair of spaced apart tines. In an embodiment, a free end of
the respective stiffener plate is axially tapered with respect to
the width thereof In another embodiment, a free end of the
respective stiffener plate is axially tapered with respect to the
thickness thereof. In one embodiment, the neck assembly includes a
plurality of links in pivotable contact with one another, wherein
each link defines a pair of stiffener plate receiving slots for
receiving the stiffener plates therethrough. The pair of stiffener
plates may extend through the slot of at least one of the links.
The pair of stiffener plates may also extend through the slot of
all of the links. The stiffener plate may be made of resilient
material.
DETAILED DESCRIPTION OF THE DRAWINGS
[0036] The foregoing objects, features and advantages of the
disclosure will become more apparent from a reading of the
following description in connection with the accompanying drawings,
in which:
[0037] FIG. 1 is a perspective view of a flexible stitching device
according to an embodiment of the present disclosure;
[0038] FIG. 2 is a top, plan view of the flexible stitching device
of FIG. 1;
[0039] FIG. 3 is a side, elevational view of the flexible stitching
device of FIGS. 1 and 2;
[0040] FIG. 4 is a perspective view of an end effector of the
flexible stitching device of FIGS. 1-3;
[0041] FIG. 5 is a perspective view of a neck assembly of the
flexible stitching device of FIGS. 1-3;
[0042] FIG. 6 is a perspective view of the neck assembly of FIG. 5,
as viewed along line 6-6 of FIG. 5;
[0043] FIG. 7 is a top, right-side, perspective view of a handle
assembly of the flexible stitching device, illustrated with a
housing half-section removed therefrom;
[0044] FIG. 8 is a top, left-side, perspective view of a handle
assembly of the flexible stitching device, illustrated with a
housing half-section removed therefrom;
[0045] FIG. 9 is a perspective view, with parts separated, of the
flexible stitching device;
[0046] FIG. 10 is a perspective view, with parts separated, of an
needle load assembly and an end effector articulation assembly of
the flexible stitching device;
[0047] FIG. 11 is a perspective view of a suture needle assembly of
the present disclosure;
[0048] FIG. 12 is a perspective view, with parts separated, of a
needle retention assembly of the flexible stitching device;
[0049] FIG. 13 is a perspective view, with parts assembled, of the
needle retention assembly of FIG. 12;
[0050] FIG. 14 is a longitudinal, cross-sectional view of the
needle retention assembly of FIGS. 12 and 13, as taken through
14-14 of FIG. 13;
[0051] FIG. 15 is a longitudinal, cross-sectional view of the
flexible stitching device of the present disclosure, as taken
through 15-15 of FIG. 3;
[0052] FIG. 16 is a longitudinal, cross-sectional view of the
flexible stitching device of the present disclosure, as taken
through 16-16 of FIG. 15;
[0053] FIG. 17 is an enlarged view of the indicated area of detail
of FIG. 15;
[0054] FIG. 18 is an enlarged view of the indicated area of detail
of FIG. 16;
[0055] FIG. 19 is an enlarged view of the indicated area of detail
of FIG. 15;
[0056] FIG. 20 is an enlarged view of the indicated area of detail
of FIG. 16;
[0057] FIG. 21 is a cross-sectional view of the handle assembly, as
taken through 21-21 of FIG. 20;
[0058] FIG. 22 is a cross-sectional view of a jaw of the end
effector assembly, as taken through 22-22 of FIG. 17;
[0059] FIG. 23 is a cross-sectional view of the handle assembly, of
the flexible stitching device, illustrating an initial actuation of
the handles thereof;
[0060] FIG. 24 is a cross-sectional view of the end effector
assembly, of the flexible stitching device, during the initial
actuation of the handle assembly;
[0061] FIG. 25 is an enlarged view of the indicated area of detail
of FIG. 24;
[0062] FIG. 26 is a cross-sectional view of the jaw of the end
effector illustrating the needle of the suture needle assembly
disposed therein;
[0063] FIG. 27 is a cross-sectional view illustrating the movement
of the needle load assembly during the initial actuation of the
handle assembly;
[0064] FIG. 28 is a cross-sectional view of the needle load
assembly of FIG. 27 as taken through 28-28 of FIG. 27;
[0065] FIG. 29 is a perspective view of a housing half-section of
the flexible stitching device;
[0066] FIG. 30 is an enlarged view of the indicated area of detail
of FIG. 29;
[0067] FIG. 31 is a cross-sectional view of the handle assembly, of
the flexible stitching device, illustrating a release of handles
thereof and an actuation of a needle retention assembly;
[0068] FIG. 32 is a plan view further illustrating the actuation of
the needle retention assembly;
[0069] FIG. 33 is a longitudinal, cross-sectional view of the end
effector assembly, illustrating the loading of a suture needle
assembly therein;
[0070] FIG. 34 is a cross-sectional view of the end effector
assembly as taken through 34-34 of FIG. 33;
[0071] FIG. 35 is a cross-sectional view of the end effector
assembly as taken through 35-35 of FIG. 33;
[0072] FIG. 36 is a cross-sectional view of the handle assembly, of
the flexible stitching device, illustrating a further actuation of
the needle retention assembly;
[0073] FIG. 37 is a longitudinal, cross-sectional view of the end
effector assembly, illustrating the positioning of the needle of
the suture needle assembly in an opposite jaw thereof;
[0074] FIG. 38 is a cross-sectional view of the handle assembly as
taken through 38-38 of FIG. 8;
[0075] FIG. 39 is a cross-sectional view of the handle assembly as
taken through 39-39 of FIG. 8;
[0076] FIG. 40 is a longitudinal cross-sectional view of the handle
assembly, illustrating an actuation of the articulation
assembly;
[0077] FIG. 41 is a perspective view, with parts separated, of the
neck assembly of the flexible stitching device;
[0078] FIG. 42 is a perspective view of a link of the neck assembly
of FIG. 41;
[0079] FIG. 43 is a cross-sectional view of the end effector,
illustrating an articulation thereof;
[0080] FIG. 44 is a perspective view of the end effector of FIG.
43;
[0081] FIG. 45 is a cross-sectional view of the handle assembly as
taken through 45-45 of FIG. 7, illustrating an operation of a
rotation assembly of the flexible stitching device;
[0082] FIG. 46 is a cross-sectional view of the handle assembly as
taken through 46-46 of FIG. 7, illustrating a further operation of
a rotation assembly of the flexible stitching device;
[0083] FIG. 47 is a perspective view illustrating the connection of
a distal center rod and a proximal center rod, including a coupling
sleeve;
[0084] FIG. 48 is a perspective view illustrating the connection of
the distal center rod and the proximal center rod, with the
coupling sleeve removed therefrom;
[0085] FIG. 49 is a perspective view, with parts separated, of the
connection of a distal link of the neck portion of the end effector
assembly to a distal support member of the end effector
assembly;
[0086] FIG. 50 is an enlarged view of the indicated area of detail
of FIG. 49;
[0087] FIG. 51 is a longitudinal cross-sectional view illustrating
the connection of the distal link of the neck assembly the distal
support member;
[0088] FIG. 52 is an enlarged view of the indicated area of detail
of FIG. 51;
[0089] FIG. 53 is a perspective view of the end effector assembly,
illustrating a rotation thereof;
[0090] FIG. 54 is a front, perspective view of an end effector
rotation assembly according to another embodiment of the present
disclosure;
[0091] FIG. 55 is a rear, perspective view of the end effector
rotation assembly of FIG. 54;
[0092] FIG. 56 is a perspective view, with parts separated, of the
end effector rotation assembly of FIGS. 54 and 55;
[0093] FIG. 57 is a rear, perspective view of the end effector
rotation assembly of FIGS. 54-56, illustrating an operation
thereof;
[0094] FIG. 58 is a front, perspective view of an end effector
rotation assembly according to still another embodiment of the
present disclosure;
[0095] FIG. 59 is a cross-sectional view of the end effector
rotation assembly of FIG. 58, as taken through 59-59 of FIG.
58;
[0096] FIG. 60 is a perspective view, with parts separated, of the
end effector rotation assembly of FIGS. 58 and 59;
[0097] FIG. 61 is a cross-sectional view of the end effector
rotation assembly of FIGS. 58-60, as taken through 61-61 of FIG.
58;
[0098] FIG. 62 is the cross-sectional view of FIG. 59, illustrating
an operation of the end effector rotation assembly of FIGS.
58-61;
[0099] FIG. 63 is a longitudinal, cross-sectional view of another
embodiment of the distal end of a flexible stitching device of the
present disclosure, including an arched seal therein;
[0100] FIG. 64 is an enlarged view of the indicated area of detail
of FIG. 63, with the arched seal being illustrated in a first
position;
[0101] FIG. 65 is a perspective view of the arched seal of FIG.
63;
[0102] FIG. 66 is a perspective, longitudinal, cross-sectional view
of the arched seal of FIGS. 63-65, as taken through 66-66 of FIG.
65;
[0103] FIG. 67 is a transverse, cross-sectional view of the arched
seal of FIGS. 63-66, as taken through 67-67 of FIG. 64;
[0104] FIG. 68 is a longitudinal, cross-sectional view of the
arched seal of FIGS. 63-67, with the arched seal being illustrated
in a second position;
[0105] FIG. 69 is a transverse, cross-sectional view of the arched
seal of FIGS. 63-68, as taken through 69-69 of FIG. 68;
[0106] FIG. 70 is a longitudinal, cross-sectional view of an end
effector rotation assembly according to another embodiment of the
present disclosure;
[0107] FIG. 71 is a perspective view of a gear assembly of the end
effector rotation assembly of FIG. 70;
[0108] FIG. 72 is a cross-sectional view of the end effector
rotation assembly of FIGS. 70 and 71, as taken through 72-72 of
FIG. 70;
[0109] FIG. 73 is a perspective view of another embodiment of a
handle assembly of the flexible stitching device, including another
embodiment of an articulation assembly therein;
[0110] FIG. 74 is an enlarged perspective view of the handle
assembly of FIG. 73 with the housing removed to illustrate the
articulation assembly;
[0111] FIG. 75 is a perspective view, with parts separated, of the
articulation assembly of FIGS. 73-74;
[0112] FIG. 76 is a side elevational view of an articulation cam of
the articulation assembly of FIGS. 73-75, with the articulation cam
being illustrated in a first position;
[0113] FIG. 77 is a side elevational view of the articulation cam
of FIG. 76 with the articulation cam being illustrated in a second
position;
[0114] FIG. 78 is a side elevational view of the articulation cam
of FIGS. 76-77 with the articulation cam being illustrated in a
third position;
[0115] FIG. 79 is a perspective view of another embodiment of an
articulation cam in accordance with the present disclosure;
[0116] FIG. 80 is a top plan schematic view of another embodiment
of an articulation assembly in accordance with the present
disclosure;
[0117] FIG. 81 is a top plan schematic view of another embodiment
of an articulation assembly in accordance with the present
disclosure;
[0118] FIG. 82 is a side elevational schematic view of another
embodiment of an articulation assembly in accordance with the
present disclosure;
[0119] FIG. 83 is a perspective, longitudinal, cross-sectional view
of another embodiment of the neck assembly in accordance with the
present disclosure, incorporating therein two stiffener plates;
[0120] FIG. 84A is a distal end view of a stem of the neck assembly
of FIG. 83, configured to receive the two stiffener plates;
[0121] FIG. 84B is a perspective view of the stem of FIG. 84A,
illustrated with a portion cut away therefrom;
[0122] FIG. 85A is a proximal end view of a link of the neck
assembly of FIG. 83, configured to receive the two stiffener
plates;
[0123] FIG. 85B is a perspective view of the link of FIG. 85A,
illustrated with a portion cut away therefrom;
[0124] FIG. 86 is a cross-sectional view of another embodiment of a
link of a neck assembly in accordance with the present disclosure,
incorporating therein two stiffener plates;
[0125] FIG. 87 is a longitudinal, cross-sectional view of the neck
assembly of FIG. 83 as taken through 87-87 of FIG. 83;
[0126] FIG. 88 is another longitudinal, cross-sectional view of the
neck assembly of FIG. 83; and
[0127] FIG. 89 is a perspective view of a drive assembly according
to another embodiment of the present disclosure.
DETAILED DESCRIPTION OF EMBODIMENTS
[0128] The present disclosure relates to devices, systems and
methods for endoscopic, laparoscopic, endoluminal, and/or
transluminal suturing. In one embodiment, for example, such a
device comprises a handle, handle assembly or other suitable
actuating mechanism (e.g., robot, etc.) connected to a proximal end
of a flexible, elongated body portion. A neck assembly operatively
supported on a distal end of the flexible, elongated body portion
allows an end effector, operatively supported at a distal end of
the neck assembly, to articulate in response to actuation of
articulation cables. The end effector includes a suture needle and
a pair of jaws. In operation, the suture needle is passed back and
forth through tissue from one jaw to the other. The device is
adapted to be placed in a lumen of a flexible endoscope and then
inserted into a natural orifice of a patient and transited
endoluminally through the anatomy of the natural lumen to a
treatment site within or outside the natural lumen.
[0129] In the drawings and in the description which follow, the
term "proximal", as is traditional, will refer to the end of the
device which is closest to the operator, while the term "distal"
will refer to the end of the device which is furthest from the
operator.
[0130] Referring now in specific detail to the drawings, in which
like reference numbers identify similar or identical elements,
FIGS. 1-3 illustrate a flexible stitching device, shown generally
at 100. Stitching device 100 is adapted to be particularly useful
in endoscopic or laparoscopic procedures wherein an endoscopic
portion of the stitching device, i.e., end effector, is insertable
into an operative site, via a cannula assembly or the like (not
shown).
[0131] As seen in FIGS. 1-3, stitching device 100 includes an end
effector 200 of supportable on or extends from a handle assembly
300 and/or a distal end of an elongate tubular body portion 308
extending distally from handle assembly 300.
[0132] As seen in FIGS. 1-6, 9, 41 and 42, end effector 200
includes a neck assembly 210 supported on a distal end of shaft 308
extending from handle assembly 300, and a tool or jaw assembly 220
supported on a distal end of neck assembly 210. Neck assembly 210
includes a plurality of links 212 each including a proximal knuckle
212a and a distal clevis 212b formed therewith. As seen in FIGS. 41
and 42, each knuckle 212a operatively engages a clevis 212b of an
adjacent link 212. Each link 212 defines a central lumen 212c (see
FIG. 42) formed therein and two pair of opposed lumen 212d.sub.1,
212d.sub.2 and 212e.sub.1, 212e.sub.2, respectively, formed on
either side of central lumen 212c. A pair of articulation cables
340, 342, slidably extend through respective lumens 212e.sub.1,
212e.sub.2, of links 212.
[0133] Links 212 are configured to enable end effector 200 to move
between a substantially linear configuration and a substantially
angled, off-axis or articulated configuration. Links 212 are also
configured so as to permit end effector 200 to be articulated in
solely a single direction. For example, as seen in FIGS. 5 and 6,
when end effector 200 is in a linear condition, the knuckles and
clevises on a first side of central lumen 212c are fully seated
within one another, and the knuckles and clevises on a second side
of central lumen 212c are not fully seated within one another,
thereby permitting end effector 200 to be articulated in the
direction of the not fully seated side of central lumen 212c.
Moreover, the knuckles and corresponding clevises are dimensioned
such that when end effector 200 is in the substantially linear
configuration, the knuckles and the corresponding clevises on the
not fully seated side of central lumen 212c are at least aligned
with one another or at least partially overlap one another. In this
manner, the possibility of tissue, vessels or other body structures
getting caught or pinched therebetween is reduced.
[0134] Operation of neck assembly 210 to articulate end effector
200 thereabout, will be discussed in greater detail below.
[0135] As seen in FIGS. 1-4, 9, 49 and 50, jaw assembly 220 of end
effector 200 includes a jaw support member 222, and a pair of jaws
230, 232 mounted for pivotable movement on jaw support member 222.
Jaw support member 222 defines a lumen 224 in a proximal end
thereof and a pair of spaced apart arms 226 in a distal end
thereof. As seen in FIG. 49, lumen 224 is configured and
dimensioned to receive a stem 212f extending from a distal-most
link 212 of neck assembly 210.
[0136] As seen in FIGS. 49-52, jaw support member 222 defines an
annular groove 224a formed in a surface of lumen 224 thereof and
stem 212f defines an annular race 212f.sub.1 formed in an outer
surface thereof. An annular groove 224a formed in a surface of
lumen 224 of jaw support member 222 and annular race 212f.sub.1
formed in the outer surface of stem 212f are in registration with
one another when stem 212f is connected to jaw support member 222.
A ring 213 is disposed within annular groove 224a formed in a
surface of lumen 224 of jaw support member 222 and annular race
212f.sub.1 formed in the outer surface of stem 212f to thereby
maintain stem 212f connected to jaw support member 222 and permit
rotation of jaw support member 222 relative to stem 212f.
[0137] As seen in FIGS. 4, 17 and 18, each jaw 230, 232 includes a
needle receiving recess 230a, 232a, respectively, configured to
surround and hold at least a portion of a needle 104 of a suture
needle assembly 102 disposed therein substantially perpendicular to
tissue engaging surfaces thereof. As seen in FIG. 11, needle 104
includes a groove 104a formed near each end thereof. A suture 106
may be secured to surgical needle 104 at a location between grooves
104a.
[0138] Suture 106 of suture needle assembly 104 may comprise a
one-way or barbed suture, wherein the suture includes an elongated
body having a plurality of barbs extending therefrom. The barbs are
oriented in such a way that the barbs cause the suture to resist
movement in an opposite direction relative to the direction in
which the barb faces.
[0139] Suitable sutures for use with suture needle assembly 104
include, and are not limited to, those sutures described and
disclosed in U.S. Pat. No. 3,123,077; U.S. Pat. No. 5,931,855; and
U.S. Patent Publication No. 2004/0060409, filed on Sep. 30, 2002,
the entire content of each of which being incorporated herein by
reference.
[0140] Jaws 230, 232 are pivotably mounted on support member 222 by
means of a jaw pivot pin 234 which extends through holes 226a
formed in arms 226 of support member 222 and respective pivot holes
230b, 232b formed in jaws 230, 232. To move jaws 230, 232 between
an open position and a closed position there is provided an axially
or longitudinally movable center drive rod assembly 236 having a
camming pin 238 mounted at a distal end of a center drive rod
distal portion 236a. Camming pin 238 rides in and engages angled
camming slots 230c, 232c formed in respective jaws 230, 232 such
that axial or longitudinal movement of center rod assembly 236
causes jaws 230, 232 to be cammed between open and closed
positions.
[0141] Jaw assembly 220 includes a drive assembly 240 slidably and
rotatably disposed within lumen 224 of support member 222. As seen
in FIGS. 9 and 12-14, drive assembly 240 includes an inner drive
assembly 242 and an outer drive assembly 244. Inner drive assembly
242 includes an inner barrel or collar 242a defining a lumen 242b
therethrough. Lumen 242b is configured to slidably and rotatably
receive center drive rod distal portion 236a of center drive rod
assembly 236 therein. Inner drive assembly 242 further includes a
cuff 250a slidably and/or rotatably supported on inner barrel 242a,
and a first blade 250b extending from cuff 250a. Blade 250b extends
from cuff 250a in a direction substantially parallel to a central
longitudinal axis of lumen 242b of inner barrel 242a.
[0142] As seen in FIGS. 9 and 12-14, outer drive assembly 244
includes an outer barrel or collar 244a defining a lumen 244b
therethrough and an annular recess 244c formed in a surface of
lumen 244b. Lumen 244b is configured to slidably and rotatably
receive inner barrel 242a therein, such that inner barrel 242a is
nested within lumen 244b of outer barrel 244a. Outer drive assembly
244 further includes a cuff 252a slidably and/or rotatably
supported in annular recess 244c, and a second blade 252b extending
from ring 244d. Blade 252b extends from cuff 252a in a direction
substantially parallel to a central longitudinal axis of lumen 244b
of outer barrel 244a.
[0143] Jaw assembly 220 further includes a clevis 246 disposed
between arms 226 of support member 222. Clevis 246 includes a pair
of spaced apart arms 246b extending from a base 246a. Each arm 246b
defines a lumen 246c therethrough. Clevis 246 defines a central
aperture 246d formed in base 246a. Arms 246b are spaced apart an
amount sufficient and central aperture 246d of base 246b is
dimensioned so as to slidably and rotatably receive distal portion
236a of center rod assembly 236 therethrough.
[0144] Jaw assembly 220, as discussed above, further includes a
pair of needle engaging members or blades 250b, 252b which are
slidably supported within a respective lumen 246c of arms 246b of
clevis 246. Each blade 250b, 252b includes a distal end slidably
extending into blade receiving channels 230d, 232d (see FIG. 17) of
respective jaws 230, 232. Each blade 250b, 252b is resilient so as
to flex or bend as jaws 230, 232 are opened and closed and still
translate relative thereto when jaws 230, 232 are in either the
open or closed condition.
[0145] In operation, as inner drive assembly 242 and outer drive
assembly 244 are translated, in an axial direction, relative to one
another, blades 250b, 252b are also translated with respect to one
another.
[0146] Turning now to FIGS. 1-3 and 7-10, a detailed discussion of
handle assembly 300 is provided. Handle assembly 300 includes a
housing 302 having an upper housing half 304 and a lower housing
half 306. Handle assembly 300 further includes a pair of handles
310 pivotably secured to housing 302 and extending outwardly
therefrom.
[0147] Housing halves 304, 306 of flexible stitching device may be
joined together by snap-fit engagement or by suitable fasteners
(e.g., screws) or the like. Housing 302 defines a window 304a, 306a
respectively formed in housing halves 304, 306. Windows 304a, 306a
of housing halves 304, 306 are dimensioned to receive and provide
access to an articulation assembly 330.
[0148] As seen in FIG. 9, handles 310 are secured to housing 302 at
handle pivot posts. Handle assembly 300 includes a link member 312
having a first end pivotably connected to each handle 310 at a
pivot point 310a formed in a respective handle 310 and a second end
pivotally connected to one another and pivotally connected to a
proximal portion 236b of center drive rod assembly 236 via a drive
pin 316. Each end of drive pin 316 is slidably received in a
respective elongate channel 304b, 306b of housing halves 304, 306.
In use, as will be described in greater detail below, as handles
310 are squeezed, link members 312 push center drive rod assembly
236 proximally via drive pin 316.
[0149] As mentioned above, handle assembly 300 includes a center
drive rod assembly 236 translatably supported in housing 302.
Handle assembly 300 includes a biasing member 318, in the form of a
return spring, supported on proximal portion 236b of center drive
rod assembly 236 and held in place between a surface 306c formed in
lower housing half 306 and a retaining clip 318a connected to
proximal portion 236b of center drive rod assembly 236.
[0150] As seen in FIGS. 9, 47 and 48, a distal end proximal portion
236b of center drive rod assembly 236 is rotatably connected to a
proximal end of an intermediate portion 236c of center drive rod
assembly 236. In this manner, intermediate portion 236c of center
drive rod assembly 236 is free to rotate relative to proximal
portion 236b of center drive rod assembly 236. A sleeve 237 may be
provided to maintain intermediate portion 236c of center drive rod
assembly 236 and proximal portion 236b of center drive rod assembly
236 connected to one another. Intermediate portion 236c of center
drive rod assembly 236 is connected to distal portion 236a of
center drive rod assembly 236. In operation, as proximal portion
236b of center drive rod assembly 236 is translated upon the
actuation of handles 310, said translation is transmitted to
intermediate portion 236c and distal portion 236a of center drive
rod assembly 236. As described above, as distal portion 236a of
center drive rod assembly 236 is translated camming pin 238,
mounted to distal portion 236a of center drive rod assembly 236,
rides in and engages angled camming slots 230c, 232c formed in
respective jaws 230, 232 to cause jaws 230, 232 to be cammed
between open and closed positions.
[0151] Handle assembly 300 further includes an articulation
assembly 330 rotatably supported in housing 302. Articulation
assembly 330 includes a threaded articulation sleeve 332 rotatably
supported and axially fixed on center drive rod 314, at a location
distal of biasing member 318. Threaded articulation sleeve 332
defines a distal thread and a proximal thread 332a, 332b,
respectively.
[0152] As seen in FIGS. 9, 10, 19 and 20, articulation assembly 330
further includes a distal articulation collar 334a and a proximal
articulation collar 334b operatively connected to a respective
thread 332a, 332b of articulation sleeve 332. Each collar 334a,
334b defines a pair of radially extending tabs 334a.sub.1,
334b.sub.1, respectively, that are in slidably engagement in
elongate slots 304d, 306d (see FIG. 20) of upper and lower housing
halves 304, 306, respectively. Threads 332a, 332b of articulation
sleeve 332 and respective threads of distal and proximal
articulation collars 334a, 334b are configured such that rotation
of articulation sleeve 332 results in either approximation of
distal and proximal articulation collars 334a, 334b relative to one
another when articulation sleeve 332 is rotated in a first
direction or separation of distal and proximal articulation collars
334a, 334b relative to one another when articulation sleeve 332 is
rotated in a second direction. It is contemplated that the pitch of
the threads between articulation sleeve 332 and articulation
collars 334a, 334b may be selected as necessary to achieve the
intended purpose of approximating or separating the collars 334a,
334b relative to one another.
[0153] Articulation assembly 330 further includes an articulation
disk 336 rotatably disposed in housing 302 and keyed or otherwise
secured to articulation sleeve 332. In this manner, as articulation
disk 336 is rotated, concomitant rotation is transmitted to
articulation sleeve 332 and to distal and proximal articulation
collars 334a, 334b. Articulation disk 336 is keyed or otherwise
connected to an articulation knob 338 rotatably supported in
housing 302 and accessible through windows 304a, 306a of upper and
lower housing halves 304, 306. In operation, as articulation knob
338 is rotated, said rotation is transmitted to articulation disk
336.
[0154] Articulation assembly 330 further includes a pair of
articulation cables 340, 342 extending through and secured to end
effector 200 and handle assembly 300. A first articulation cable
340 includes a first end secured to proximal articulation collar
334b and a second end extending through distal articulation collar
334a, through a respective slot in articulation disk 336, through
respective lumen 212e.sub.1 of links 212, and secured to
distal-most link 212 or stem 212f of neck portion 210 (see FIG.
18). A second articulation cable 342 includes a first end secured
to distal articulation collar 334a and a second end extending
through a respective slot in articulation disk 336, through
respective lumen 212e.sub.2 of links 212, and secured to
distal-most link 212 or stem 212f of neck portion 210 (see FIG.
18).
[0155] In operation, as will be described in greater detail below,
as articulation knob 338 is rotated, rotation is transmitted to
articulation disk 336 and on to articulation sleeve 332. As
articulation sleeve 332 is rotated, distal and proximal
articulation collars 334a, 334b are approximated and/or separated
relative to one another, and thus cause retraction of either first
or second articulation cable 340, 342, depending on the direction
of rotation of articulation knob 338.
[0156] Articulation assembly 330 further includes a biasing member
346 supported on intermediate portion 236c of center drive rod
assembly 236.
[0157] As seen in FIGS. 1-3 and 7-14, handle assembly 300 further
includes a needle loading/retaining assembly 350 supported thereon.
Needle loading/retaining assembly 350 includes a lever 352
pivotably supported in housing 302 and having a pair of arms 354a,
354b extending therefrom. Needle loading/retaining assembly 350
further includes a first blade control rod 356a and a second blade
control rod 356b. Each blade control rod 356a, 356b includes a
proximal end connected to lever 352 at opposed sides of a pivot
axis. In this manner, as lever 352 is actuated or pivoted in a
first direction, first blade control rod 356a is moved in a first
direction and second blade control rod 356b is moved in a second
direction, opposite to the first direction, and vice-versa. A
distal end of each blade control rod 356a, 356b is connected to a
respective inner drive assembly 242 and outer drive assembly 244,
in particular, to respective inner barrel 242a and outer barrel
244a of drive assembly 240.
[0158] As seen in FIGS. 12-14, needle loading/retaining assembly
350 further includes resilient bendable rods 358a, 358b
interconnecting the distal end of each blade control rod 356a, 356b
to respective inner barrel 242a and outer barrel 244a of drive
assembly 240. As seen in FIGS. 13 and 14, a rod 359a, 359b may
interconnect respective distal ends of blade control rods 356a,
356b and inner and outer barrels 242a, 244a.
[0159] As seen in FIGS. 9, 10, 20-22 and 26-30, needle
loading/retaining assembly 350 further includes a pair of needle
loading/unloading buttons 360, 362 supported on housing 302. Needle
loading/unloading buttons 360, 362 are slidable between a
distal-most position and a proximal-most position. When needle
loading/unloading buttons 360, 362 are in the distal-most position,
blades 250b, 252b are in a distal-most position such that a
respective notch 250c, 252c formed therein, as seen in FIG. 22, is
aligned with or in registration with respective needle receiving
openings 230a, 232a of respective jaws 230, 232. With blades 250b,
252b in a distal-most position, needle 104 of suture needle
assembly 102 may be placed into a selected needle receiving opening
230a, 232a of a selected jaw 230, 232. When needle
loading/unloading buttons 360, 362 are in the proximal-most
position blades 250b, 252b are in a proximal-most position such
that the respective notch 250c, 252c formed therein is out of
aligned with or registration with respective needle receiving
openings 230a, 232a of respective jaws 230, 232. With blades 250b,
252b in the proximal-most position, needle 104 of suture needle
assembly 102, placed into the selected needle receiving opening
230a, 232a of a selected jaw 230, 232, is held in place due to the
blade 250b, 252b engaging a groove 104a of needle 104.
[0160] As seen in FIGS. 9, 20 and 21, each button 360, 362 is
supported on a respective biased stem 360a, 362a by a respective
biasing member 360b, 362b. As seen in FIGS. 21 and 27-30, stems
360a, 360b are slidably disposed within respective slots 304e, 306e
of upper and lower housing halves 304, 306. Each slot 304e, 306e
includes an enlarged proximal end 304f, 306f configured to receive
a portion of a respective stem 360a, 362a therein as buttons 360,
362 are moved to a proximal position. In order to move buttons 360,
362 in a distal direction, once stems 360a, 362a have seated in
enlarged proximal ends 304f, 306f of slots 304e, 306e of upper and
lower housing halves 304, 306, the user must depress buttons 360,
362 to move stems 360a, 362a out of enlarged proximal ends 304f,
306f of slots 304e, 306e and thus allow for buttons 360, 362 to
move distally.
[0161] As seen in FIGS. 9, 10, 20 and 27, needle loading/retaining
assembly 350 is supported on a frame or bracket 368. Bracket 368 is
movable distally and proximally with lever 352 and is configured to
permit passage of center drive rod assembly 236 therethrough. As
seen in FIG. 27, biasing member 346 is interposed between bracket
368 and articulation sleeve 332. In use, as buttons 360, 362 are
moved in a proximal direction, bracket 368 is moved in a proximal
direction to compress biasing member 346. In this manner, when
buttons 360, 362 are depressed to disengage stems 360a, 362a from
enlarged proximal ends 304f, 306f of slots 304e, 306e, biasing
member 346 is permitted to expand the thus return buttons 360, 362
to a distal position.
[0162] As seen in FIGS. 1-3, 7-10, 45 and 46, handle assembly 300
further includes a tip rotation assembly 370 supported on housing
302 for rotating end effector 200 about the longitudinal axis
thereof. Tip rotation assembly 370 includes a rotation knob 372
supported on housing 302. Rotation knob 372 defines an annular
array of internal gear teeth 372a. Tip rotation assembly 370
includes a gear system 374 supported on a frame 376 in housing 302.
Gear system 374 includes at least a first gear 374a operatively
engaged with gear teeth 372a of rotation knob 372, at least a
second gear 374b keyed to or otherwise connected to intermediate
portion 236c of center drive rod assembly 236, and at least a third
gear 374c interconnecting the first gear 374a and the second gear
374b such that the direction of rotation of rotation knob 372
results in concomitant rotation of the intermediate portion 236c
and the distal portion 236a of center drive rod assembly 236 and,
in turn, end effector 200. As intermediate portion 236c and distal
portion 236a of center drive rod assembly 236 is rotated, said
rotation is transmitted to camming pin 238 of jaws 230, 232 and
thus rotation is transmitted to end effector 200. Since blades
250b, 252b are rotatably supported on respective barrels 242a,
244a, blades 250b, 252b also rotate with end effector 200.
[0163] Turning now to FIGS. 15-53, a detailed discussion of the
operation of flexible endoscopic stitching device 100 is provided.
As seen in FIGS. 15-22, stitching device 100 is shown in a needle
load/unload configuration. When stitching device 100 is in the
needle load/unload configuration, as seen in FIGS. 16 and 20,
needle loading/retaining assembly 350 is in a distal position such
that blades 250b, 252b are in a distal-most position and, as seen
in FIG. 22, respective notches 250c, 252c formed therein, are
aligned with or in registration with respective needle receiving
openings 230a, 232a of respective jaws 230, 232. With notches 250c,
252c of blades 250b, 252b aligned with or in registration with
respective needle receiving openings 230a, 232a of respective jaws
230, 232, as seen in FIGS. 24-26, needle 104 of suture needle
assembly 102 may be positioned or loaded into a selected one needle
receiving opening 230a, 232a of respective jaws 230, 232.
[0164] As seen in FIGS. 23-26, once needle 104 is loaded into
either needle receiving opening 230a, 232a of respective jaws 230,
232, handles 310 are actuated (e.g., squeezed) to move link members
312 and, in turn, axially displace center drive rod assembly 236 in
a proximal direction (as indicated by arrow "A" of FIGS. 23 and
24). As seen in FIGS. 24 and 25, as center drive rod assembly 236
is moved in a proximal direction, camming pin 238 is moved in a
proximal direction to approximate jaws 230, 232.
[0165] As seen in FIG. 27, once needle 104 is loaded into either
needle receiving opening 230a, 232a of respective jaws 230, 232,
needle loading/retaining assembly 350 is moved in a proximal
direction to thereby retract blades 250b, 252b and cause each blade
250b, 252b to engage a respective groove 104a of needle 104.
[0166] As seen in FIGS. 31-35, with needle 104 engaged by both
blades 250b, 252b, as seen in FIGS. 31 and 32, lever 352 is
actuated or rotated so that only one blade 250b, 252b, e.g., blade
252b, is maintained in engagement with needle 104, as seen in FIG.
35, and the other blade 250b is disengaged from needle 104, as seen
in FIG. 34. With only one blade, e.g., blade 252b, engaged with
needle 104, as seen in FIGS. 33-35, handles 310 may be released, as
seen in FIG. 31, thereby moving center drive rod assembly 236 and
camming pin 238 in a distal direction to open jaws 230, 232.
[0167] With jaws 230, 232 open, end effector 200 may be positioned
at the surgical site as needed, and handles 310 reactuated to
approximate jaws 230, 232. For example, with jaws 230, 232 in an
open position and needle 104 loaded therein, jaws 230, 232 may be
positioned about or over a target tissue and handles 310 actuated
to approximate jaws 230, 232. As jaws 230, 232 are approximated,
the exposed end of needle 104 is penetrated through the target
tissue and enters into the opposed jaw 230, 232. With needle 104 in
the opposed jaw 230, 232, as seen in FIG. 36, lever 352 is once
again actuated or rotated so that blades 250b, 252b are reversed.
In so doing, blade 252b is disengaged from needle 104 and blade
250b is engaged with needle 104.
[0168] As seen in FIG. 37, with needle 104 engaged by blade 250b,
handles 310 may be released to thereby open jaws 230, 232 and draw
needle 104 through the target tissue. In so doing, suture 106 is
also drawn through the tissue. The process is repeated numerous
times passing the needle 104 between jaws 230, 232 and drawing
suture through the target tissue thereby suturing the target tissue
as needed and or desired.
[0169] During a surgical procedure, if desired or necessary, as
seen in FIGS. 38-44, a user may actuate articulation knob 338 of
articulation assembly 330 to effectuate articulation or off-axis
movement of end effector 200. In particular, as articulation knob
338 is rotated, rotation is transmitted to articulation disk 336
and on to articulation sleeve 332. As articulation sleeve 332 is
rotated, distal and proximal articulation collars 334a, 334b are
moved from an approximated condition to a more separated condition
relative to one another, thus causing retraction of first
articulation cable 340 and extension of second articulation cable
342.
[0170] As seen in FIGS. 43 and 44, as first articulation cable 340
is retracted and second articulation cable 342 is extended, end
effector 200 is articulated at neck portion 210. As end effector
200 is articulated, intermediate portion 236c of center drive rod
assembly 236 is flexed. In this manner, end effector 200 is still
capable of rotation about its axis and jaws 230, 232 are still
capable of opening and closing.
[0171] As seen in FIG. 44, while in an articulated condition, links
212 remain at least partially over-lapped in order to inhibit entry
of tissue of the like therebetween. In this manner, when end
effector 200 is returned to un-articulated or linear condition,
tissue will not be caught or pinched between links 212 of neck
portion 210.
[0172] During a surgical procedure, if desired or necessary, as
seen in FIGS. 45-53, a user may actuate rotation knob 372 of tip
rotation assembly 370 to effectuate rotation of end effector 200
along a longitudinal axis thereof. In particular, as rotation knob
372 is rotated intermediate portion 236c and distal portion 236a of
center drive rod assembly 236 is rotated. As intermediate portion
236c and distal portion 236a of center drive rod assembly 236 is
rotated, said rotation is transmitted to camming pin 238 of jaws
230, 232 and thus rotation is transmitted to end effector 200.
[0173] Turning now to FIGS. 54-57, a tip rotation assembly
according to another embodiment of the present disclosure, for use
with stitching device 100, is generally designated as 470. Tip
rotation assembly 470 includes a rotation knob 472 supported on
housing 302. Knob 472 defines an arcuate slot 472a formed in a rear
surface thereof and which arcuate slot 472a extends radially
outward from a central rotational axis of knob 472 and extends
approximately 180.degree. about the central rotational axis. Tip
rotation assembly 470 includes a collar 474 keyed to or otherwise
secured to center drive rod assembly 236. Tip rotation assembly 470
further includes a wishbone link 476 having a first end 476a
pivotally connected to collar 474 and a second end 476b pivotally
supporting a piston 478. First end 476a of link 476 is curved about
an axis transverse to a pivot axis thereof, so as to define a
pocket 476c configured to selectively receive center drive rod
assembly 236 therein. A pin 479 extends though piston 478 and
connects piston 478 to arcuate slot 472a.
[0174] Rotation assembly 470 includes a home position in which pin
479 is located at a first end of arcuate slot 472a, where the
arcuate slot 472a is furthest from the center drive rod assembly
236.
[0175] In operation, in order to rotate end effector 200 about the
longitudinal axis thereof, rotation knob 472 is rotated from the
home position. As rotation knob 472 is rotated, pin 479 slidably
translates through arcuate slot 472a, approximating pin 479 toward
center drive rod assembly 236. As pin 479 is approximated toward
center drive rod assembly 236, wishbone link 476 is provided with
sufficient clearance in order for wishbone link 476 to encircle
center drive rod assembly 236. In this way, rotation of knob 472
results in a transmission of a rotational force to center drive rod
assembly 236 via piston 478, wishbone link 476 and collar 474.
[0176] Turning now to FIGS. 58-62, a tip rotation assembly
according to another embodiment of the present disclosure, for use
with stitching device 100, is generally designated as 570. Tip
rotation assembly 570 includes a rotation knob 572 supported on
housing 502. Knob 572 defines an inner helical thread 572a formed
in an inner surface thereof. Tip rotation assembly 570 includes a
nut disposed within housing 502. Nut 574 includes a pair of opposed
stems 574a extending radially therefrom and through respective
longitudinally extending slots 502a formed in housing 502. Stems
574a of nut 574 are sufficiently long to engage helical thread 574a
of rotation knob 574. Nut 574 defines an inner helical thread
574b.
[0177] Tip rotation assembly 570 further includes a lead screw 576
keyed to or otherwise connected to center drive rod assembly 236.
Lead screw 576 includes an outer thread or the like 576a which is
configured to operatively engage inner helical thread 574b of nut
574. Lead screw 576 is further axially fixed and rotatably
supported in braces 502b formed in housing 502.
[0178] In operation, as seen in FIG. 62, as rotation knob 572 is
rotated, stems 574a of nut 574 are engaged by the inner helical
thread 572a of rotation knob 572 and cause nut 574 to move axially
through housing 502 and elongate slots 502a of housing 502. As nut
574 moves axially though slots 502a of housing 502, inner thread
574a thereof engages thread 576a of lead screw 576 causing lead
screw 576 to rotate since lead screw 576 is axially fixed in braces
502b of housing 502. As lead screw 576 rotates, lead screw 576
transmits said rotation to center drive rod assembly 236.
[0179] Referring now to FIGS. 63-69, it is contemplated that each
articulation cable 340, 342 may be operably associated with an
arched seal 10 disposed in mechanical cooperation with center drive
rod assembly 236. Arched seal 10 includes a plurality of cable
lumens 12a-12d (see FIG. 65) disposed around a center drive rod
lumen 14, all extending therethrough. Center drive rod lumen 14 is
configured to receive center drive rod assembly 236 therethrough.
Each cable lumen 12a-12d is configured to receive one or more
articulation cables 340, 342 in substantial sealing relationship
therewith. Each cable lumen 12a-12d may have a respective arched
section 16 that includes a venturi portion 16a configured to engage
a surface of one or more articulation cables 340, 342 so that
arched seal 10 may move with articulation cables 340, 342.
[0180] Venturi portion 16a of each arched section 16 enables each
cable lumen 12a-12d to be repositionable through a plurality of
positions including a first position corresponding to a linear
orientation of neck assembly 210 (e.g., FIG. 66) and a second
position corresponding to an articulated orientation of neck
assembly 210 (e.g., FIG. 68) in response to longitudinal
translation of one or more articulation cables 340, 342
therethrough. In this manner, the sealing relationship between
arched seal 10 and articulation cables 340, 342 is maintained at
all times when neck assembly 210 is in either the linear or the
articulated orientation.
[0181] Turning now to FIGS. 70-72, a tip rotation assembly
according to another embodiment of the present disclosure, for use
with stitching device 100, is generally designated as 670. Tip
rotation assembly 670 includes a rotation knob 672 supported on
housing 302 (see FIG. 70) and a beveled gear assembly 680
operatively associated with rotation knob 672. Beveled gear
assembly 680 includes a sun gear 682 disposed in mechanical
cooperation with knob 672, a first beveled gear 684 that is
operatively associated with sun gear 682, and a second beveled gear
686 operatively associated with first beveled gear 684. First
beveled gear 684 may be generally orthogonally disposed relative to
sun gear 682 and second beveled gear 686. Second beveled gear 686
is disposed in mechanical cooperation with center drive rod
assembly 236 for facilitating the transfer of rotational energy
from tip rotation assembly 670 to center drive rod assembly 236 for
opening and closing jaws 230, 232.
[0182] Tip rotation assembly 670 further includes a first beveled
gear mount 685 disposed in mechanical cooperation with first
beveled gear 684 and knob 672. First beveled gear mount 685
rotatably supports first beveled gear 684 relative to knob 672 and,
in particular, interconnecting sun gear 682 and second beveled gear
606.
[0183] Sun gear 682 and second beveled gear 686 may be configured
and dimensioned to rotate about the longitudinal axis of the
stitching device 100 in offset relationship relative to each other.
First beveled gear mount 685 is configured to orient first beveled
gear 684 such that first beveled gear 684 rotates about an axis
transverse to the longitudinal axis of the stitching device 100.
Second beveled gear 686 may be keyed to or flat surfaces for
engaging center drive rod assembly 236 while still allowing axial
movement of center drive rod assembly 236 relative to second
beveled gear 686. Sun gear 682, first beveled gear 684, and second
beveled gear 686 may be configured and dimensioned to collectively
allow only minimal (e.g., five degrees) rotational backlash. In
addition, beveled gear assembly 680 of tip rotation assembly 670
may be configured and dimensioned to translate rotational energy to
the center drive rod assembly 236 in accordance with one or more of
the following ratios: 1:1, more than 1:1, or less than 1:1.
[0184] In operation, as rotation knob 672 is rotated (may be
clockwise or counterclockwise) about the longitudinal axis of the
stitching device 100, sun gear 682 (keyed to rotation knob 672) of
beveled gear assembly 680 concentrically rotates therewith. Sun
gear 682 engages with a first gear portion 684a of first beveled
gear 684, causing first beveled gear 684 to be rotated about an
axis transverse to the longitudinal axis of the stitching device
100. Rotation of the first beveled gear 684 causes second gear
portion 684b of first beveled gear 684 to engage second beveled
gear 686 and to rotate second beveled gear 686 about the
longitudinal axis of the stitching device 100. Rotation of the
second beveled gear 686 causes the center drive rod assembly 236 to
rotate and thus cause jaws 230, 232 to rotate.
[0185] Referring now to FIGS. 73-78, a handle assembly 1300
including another embodiment of an articulation assembly 1000 is
shown. Articulation assembly 1000 includes an articulation cam
1010, a first pin 1020, a second pin 1030, a first slider 1040, a
second slider 1050, and first and second articulation cables 340,
342. Articulation cam 1010 includes first and second articulation
arms 1012, 1014, and first and second cam disks 1016, 1018 for
positioning articulation cam 1010 through a plurality of positions
corresponding to a linear and/or angular orientation of neck
assembly 210 including a first position (FIG. 76), a second
position (FIG. 77), and a third position (FIG. 78).
[0186] Articulation cam 1010 is supported in a housing 1302 of
handle assembly 1300. First and second cam disks 1016, 1018 define
opposing respective first and second camming channels 1016a, 1018a
therein. First and second camming channels 1016a, 1018a may have a
shape substantially similar to a logarithmic spiral that may be
configured to provide equidistant linear motion directly
proportional to the angular rotation of first and second cam disks
1016, 1018. As such, each articulation cable 340, 342 may remain
substantially taut upon translation thereof relative to housing
1302.
[0187] Referring again to FIGS. 73-78, first pin 1020 is operably
associated with first camming channel 1016a of first cam disk 1016
and with first slider 1040. First slider 1040 is configured to
longitudinally translate in a channel defined in housing 1302.
Second pin 1030 is operably associated with second camming channel
1018a of second cam disk 1018 and with second slider 1050. Second
slider 1050 is configured to longitudinally translate in a channel
defined in housing 1302. First and second sliders 1040, 1050 are
secured to respective proximal ends of first and second
articulation cables 340, 342. Distal ends of first and second
articulation cables 340, 342 are secured at a location distal of
the neck assembly 210, as described above. Articulation cables 340,
342 are disposed on opposed sides of center drive rod assembly
236.
[0188] In operation, to articulate neck assembly 210, articulation
cam 1010 is rotated via first and/or second articulation arms 1012,
1014. As seen in FIGS. 73-78, as articulation cam 1010, is rotated,
first and second pins 1020, 1030 translate through respective first
and second camming channels 1016a, 1018a of first and second cam
disks 1016, 1018, and cause respective first and second sliders
1040, 1050 to longitudinally translate. As first and second sliders
1040, 1050 longitudinally translate, either first or second
articulation cables 340, 342 retract, depending on the direction of
the rotation of the articulation cam 1010, thereby causing neck
assembly 210 to articulate. In this manner, one articulation cable
340, 342 is retracted, while the other articulation cable 340, 342
extends precisely the same length as the other shortens. The
retraction and extension of the articulation cables 340, 342 are
proportional with the curvature of first and second camming
channels 1016a, 1018a of first and second cam disks 1016, 1018.
[0189] In other words, upon articulation of neck assembly 210, the
articulation cable 340, 342 translating in a distal direction must
travel a greater distance as compared to articulation cable 340,
342 translating in a proximal direction. As such, in order to
compensate for any slack in the tension of articulation cables 340,
342, first and second camming channels 1016a, 1018a have been
shaped to cause greater proximal translation of articulation cable
340 or 342 the greater the degree of rotation of first and/or
second actuation arms 1012,1014.
[0190] First and second cam disks 1016, 1018 may be monolithically
formed. As illustrated in another embodiment of an articulation cam
designated generally as 2010 and shown in FIG. 79, first and second
cam disks 2016, 2018 may be separate and distinct such that each
may rotate in opposed rotational directions via first and second
articulation arms 2012, 2014. A torsion spring 2015 may operably
couple first and second cam disks 2016, 2018 such that distal and
proximal ends of torsion spring 2015 are disposed in mechanical
cooperation with respective first and second cam disks 2016, 2018.
Torsion spring 2015 may be supported on a shaft axially disposed
between first and second cam disks 2016, 2018 to facilitate about
10 to 15 degree rotation of each cam disk 2016, 2018 in relation to
each other. Torsion spring 2015 may be preloaded such that it
generates force sufficient for maintaining articulation cables 340,
342 in tension for precision operation of the stitching device 100,
yet configured to limit rotation of first and second cam disks
2016, 2018 relative to each other during articulation of the neck
assembly 210.
[0191] As illustrated in other embodiments of articulation
assemblies 3000, 4000, 5000 shown in FIGS. 80-82, articulation
cables 340, 342 may be attached directly to first or second pins
1020, 1030 that are disposed in mechanical cooperation with
respective first and second cam disks 1016, 1018, 2016, 2018 for
providing longitudinal translation. As illustrated in the
embodiments shown in FIGS. 80-81, articulation cables 340, 342 may
be redirected by one or more rollers "R" mounted at various
positions on housing 302, 1302. As such, first and second cam disks
1016, 1018, 2016, 2018 may be positioned in longitudinal alignment
with the longitudinal axis of the stitching device, transverse
thereto, or any other variation thereof since rollers "R" may
redirect the articulation cables 340, 342 in any direction,
depending on placement thereof.
[0192] Turning now to FIGS. 83-88, an alternate embodiment of a
neck assembly is generally designated as 1210. Neck assembly 1210
is similar to neck assembly 210 and thus will only be discussed
herein to the extent necessary to identify differences in
construction and operation thereof.
[0193] As seen in FIGS. 83-88, each link 212 defines a pair of
opposed stiffener plate receiving slots 216a, 216b. Slots 216a,
216b are formed on either side of central lumen 212c and are
interposed between central lumen 212c and a respective articulation
cable lumen 212e.sub.1, 212e.sub.2. As shown in FIGS. 83 and 88,
neck assembly 1210 includes a pair of stiffener plates 218a, 218b
translatably disposed in the plate receiving slots 216a, 216b,
respectively. As seen in FIG. 87, a distal-end of each stiffener
plate 218a, 218b includes an anchor portion 219 to securely attach
respective distal-end of stiffener plate 218a, 218b to stem 212f of
neck assembly 1210, while allowing the proximal-end of each
stiffener plate 218, 218b to translate freely through plate
receiving slots 216a, 216b.
[0194] In an embodiment, as seen in FIG. 87, anchor portion 219 of
each stiffener plate 218a, 218b may be bifurcated and include a
pair of spaced apart tines that snap-fit into packets formed at the
ends of plate receiving slots 216a, 216b. Each stiffener plate
218a, 218b may have an elongated, flattered (e.g., ribbon-like)
profile. Each stiffener plate 218a, 218b thus defines a plane,
wherein the stiffener plates 218a, 218b are supported in neck
assembly 1210 such that the respective planes of stiffener plates
218a, 218b are substantially parallel with one another. In the
present embodiment, the planes of stiffener plates 218a, 218b are
oriented substantially orthogonal to a direction of articulation of
end effector 200. Stiffener plates 218a, 218b may be constructed
from any durable resilient material, such as, for example,
stainless steel, titanium, etc.
[0195] Links 212 are configured to enable end effector 200 to move
between a substantially linear configuration and a substantially
angled, off-axis or articulated configuration. Since stiffener
plates 218a, 218b are oriented such that the planes thereof are
substantially orthogonal to a direction of articulation of end
effector 200, movement or articulation of end effector 200 is
restricted solely in two dimensions (i.e., a single plane). As
illustrated in FIG. 87, stiffener plate 218a (and stiffener plate
218b, not shown) restrict(s) movement or canting of end effector
200 in the direction of arrows "A."
[0196] Turning now to FIG. 89, an alternate embodiment of a drive
assembly is generally designated as 2240. Drive assembly 2240 is
similar to drive assembly 240 and thus will only be discussed
herein to the extent necessary to identify differences in
construction and operation thereof. As seen in FIG. 89, drive
assembly 2240 includes an inner drive member 2242 and an outer
drive member 2244. Inner drive member 2242 includes a partially
circular collar 2242a and a first blade 2250b extending therefrom.
First blade 2250b and the partially circular collar 2242a are
constructed or stamped as one unitary member from one piece of
sheet metal. Similarly, outer drive member 2244 includes a
partially circular collar 2244a and a second blade 2252b extending
therefrom. Second blade 2252b and the partially circular collar
2244a are also constructed or stamped as one unitary member from
one piece of sheet metal. The partially circular collar 2242a of
inner drive member 2242 is nested within the partially circular
collar 2244a of outer drive member 2244 and defines a lumen 2242b
through which center drive rod distal portion 236a of center drive
rod assembly 236 is received. Inner and outer drive members 2242,
2244 provide a snap feature that snaps around inner and outer
bushings (not shown), thereby allowing rotation of inner and outer
drive members 2242, 2244 around the inner and outer bushings,
respectively. Such design reduces the number of parts that are
required to hold blades 2250b, 2252b in place, thereby simplifying
manufacturability and reducing cost of manufacturing.
[0197] While the disclosure has been particularly shown and
described with reference to particular embodiments, it will be
understood by those skilled in the art that various modifications
in form and detail may be made therein without departing from the
scope and spirit of the invention. Accordingly, modifications such
as those suggested above, but not limited thereto, are to be
considered within the scope of the invention.
* * * * *