U.S. patent application number 13/048674 was filed with the patent office on 2012-03-15 for method for treating tissue with an articulated surgical instrument.
This patent application is currently assigned to CARDICA, INC.. Invention is credited to Bryan D. Knodel, Philipe R. Manoux, Bennie Thompson, Nathan H. White.
Application Number | 20120061446 13/048674 |
Document ID | / |
Family ID | 43805798 |
Filed Date | 2012-03-15 |
United States Patent
Application |
20120061446 |
Kind Code |
A1 |
Knodel; Bryan D. ; et
al. |
March 15, 2012 |
Method for Treating Tissue With an Articulated Surgical
Instrument
Abstract
One example of a surgical method of treating tissue within the
body of a patient may include providing a surgical instrument that
includes a handle; a shaft extending from the handle, an end
effector connected to the shaft, where the shaft includes a lumen
defined therethrough and an articulated region; and at least one
feeder belt extending through the lumen of the shaft into the end
effector, where the feeder belt includes at least one staple
frangibly united therewith; inserting the end effector into the
body of a patient; orienting the end effector relative to tissue to
be treated within the body of the patient and relative to a
remainder of the shaft; actuating the end effector to staple
tissue; and removing the end effector from the body of the
patient.
Inventors: |
Knodel; Bryan D.;
(Flagstaff, AZ) ; Thompson; Bennie; (Cincinnati,
OH) ; Manoux; Philipe R.; (San Francisco, CA)
; White; Nathan H.; (Palo Alto, CA) |
Assignee: |
CARDICA, INC.
Redwood City
CA
|
Family ID: |
43805798 |
Appl. No.: |
13/048674 |
Filed: |
March 15, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
12400760 |
Mar 9, 2009 |
7918376 |
|
|
13048674 |
|
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|
Current U.S.
Class: |
227/175.1 |
Current CPC
Class: |
A61B 2017/2908 20130101;
A61B 2017/2929 20130101; A61B 2017/00473 20130101; A61B 2017/2927
20130101; A61B 17/07207 20130101 |
Class at
Publication: |
227/175.1 |
International
Class: |
A61B 17/068 20060101
A61B017/068 |
Claims
1. A surgical method of treating tissue within the body of a
patient, comprising: providing a surgical instrument including a
handle; a shaft extending from said handle, an end effector
connected to said shaft, wherein said shaft includes a lumen
defined therethrough and an articulated region; and at least one
feeder belt extending through said lumen of said shaft into said
end effector, said feeder belt including at least one staple
frangibly united therewith; inserting said end effector into the
body of a patient; orienting said end effector relative to tissue
to be treated within the body of the patient and relative to a
remainder of said shaft; actuating said end effector to staple
tissue; and removing said end effector from the body of the
patient.
2. The surgical method of claim 1, wherein said orienting is
performed about at least a first axis by bending said articulated
region of said shaft, and is performed about a second axis
different from said first axis by rotating the proximal end of said
shaft.
3. The surgical method of claim 1, wherein said surgical instrument
further comprises at least one actuation cable extending from said
handle to said end effector through said lumen of said shaft,
wherein said actuating is performed by pulling said actuation cable
proximally.
4. The surgical method of claim 1, wherein said surgical instrument
further comprises at least one clamp cable extending from said
handle to said end effector through said lumen of said shaft;
further comprising clamping said end effector by pulling said clamp
cable proximally.
5. The surgical method of claim 1, further comprising repeating
said orienting and said actuating before said removing.
6. The surgical method of claim 5, incorporating by reference all
of the elements of that claim; wherein said repeating includes
advancing at least part of at least one feeder belt from said lumen
of said shaft into said end effector.
7. The surgical method of claim 6, further comprising a slider
movable relative to said handle; and further comprising sliding
said slider to cause said advancing.
8. The surgical method of claim 1, further comprising an
articulation control associated with said handle, wherein said
orienting is performed at least in part by exerting a force on one
side of said articulation control lateral to the longitudinal
centerline of said articulation control.
9. The surgical method of claim 1, wherein a plurality of said
staples are arranged in at least one substantially longitudinal row
on said feeder belt, and wherein said actuation serially deploys a
plurality of said staples in at least one said row.
10. A surgical method of treating tissue within the body of a
patient, comprising: providing a surgical instrument including a
handle; a shaft extending from said handle, an end effector
connected to said shaft, wherein said shaft includes a lumen
defined therethrough and an articulated region; and an articulation
control connected to said handle, said articulation control movable
from side to side; inserting said end effector into the body of a
patient; orienting said end effector relative to tissue to be
treated within the body of the patient and relative to a remainder
of said shaft, wherein said orienting is performed at least in part
by exerting a force on one side of said articulation control;
actuating said end effector to staple tissue; and removing said end
effector from the body of the patient.
11. The surgical method of claim 10, wherein said exerting a force
on one side of said articulation control is performed with one
hand.
12. The surgical method of claim 10, further comprising providing
at least one feeder belt extending through said lumen of said shaft
into said end effector, said feeder belt including at least one
staple frangibly united therewith.
13. The surgical method of claim 10, wherein said articulated
region is spaced apart from said handle, and wherein said
articulation control is movable by rotation about an axis different
from the longitudinal axis of the portion of said shaft between
said handle and said articulated region.
14. The surgical method of claim 13, wherein said articulation
control is additionally rotatable substantially about the
longitudinal axis of the portion of said shaft between said handle
and said articulated region.
15. The surgical method of claim 13, further comprising locking
said articulation control in place after said orienting such that
the orientation of said end effector relative to the portion of
said shaft between said handle and said articulated region is also
locked into place.
16. The surgical method of claim 10, wherein said orienting is
performed with one hand.
17. The surgical method of claim 10, further comprising clamping
said end effector to tissue before said actuating, and unclamping
said end effector from tissue after said actuating.
18. The surgical method of claim 17, wherein said end effector is
biased to a neutral position; further comprising allowing said end
effector to return to said neutral position after said
unclamping.
19. The surgical method of claim 10, wherein said inserting is
through an opening in the body of the patient between 5 millimeters
and 10 millimeters in diameter.
20. The surgical method of claim 10, further comprising repeating
said orienting and said actuating before said removing.
Description
[0001] This application is a divisional of U.S. patent application
Ser. No. 12/400,760, filed on Mar. 9, 2009, which is herein
incorporated by reference in its entirety.
FIELD OF THE INVENTION
[0002] The invention generally relates to an articulated surgical
instrument, and more specifically to an instrument that may be used
to articulate a surgical stapler or endocutter.
BACKGROUND
[0003] Minimally invasive surgery is performed through small
incisions in the body, into which trocar ports may or may not be
placed. One or more surgical instruments are inserted through each
incision in order to perform the surgical procedure. In order to
effectuate one of the objectives of minimally invasive surgery,
which is the minimization of incisions to the body to reduce
healing time and scarring, it is desirable to minimize the number
of incisions made in the body. The number of incisions and their
placement are determined by the particular surgical procedure to be
performed and the configuration of the instruments used to carry
out that procedure.
[0004] One problem encountering during the performance of a
minimally invasive surgical procedure is access to the tissue to be
treated. Depending on the specific anatomy of the patient, it may
be difficult to reach an area to be treated with a specific
surgical instrument. As a result, one or more additional incisions
may need to be made in the patient in order to access that tissue.
Or, the surgeon may need to obtain a different surgical instrument,
adding to the time and expense of the procedure. Additionally,
where more incisions may be made or additional instruments may be
utilized, it can be difficult and/or time-consuming for the surgeon
to find the surgical site again.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] FIG. 1 is a perspective view of a an exemplary surgical
instrument.
[0006] FIG. 2 is a detail perspective view of an exemplary
articulated region on a shaft of the surgical instrument of FIG.
1.
[0007] FIG. 3 is a detail perspective view of a second exemplary
articulated region on a shaft of the surgical instrument of FIG.
1.
[0008] FIG. 4 is a side cutaway view of a handle of the surgical
instrument of FIG. 1.
[0009] FIG. 5 is a detail side cutaway view of the distal end of
the handle of the surgical instrument of FIG. 1.
[0010] FIG. 6 is a top cross-section view of a handle of the
surgical instrument of FIG. 1.
[0011] FIG. 7 is a detail cutaway view of a portion of the proximal
end of the handle of the surgical instrument of FIG. 1.
[0012] FIG. 8 is a top cross-section view of the proximal end of
the handle of the surgical instrument of FIG. 1.
[0013] FIG. 9 is a side cutaway view of the proximal end of the
handle of the surgical instrument of FIG. 1.
[0014] FIG. 10 is a perspective view of an exemplary end effector
of the surgical instrument of FIG. 1.
[0015] FIG. 11 is a perspective view of an exemplary feeder belt
with two rows of staples frangibly connected thereto.
[0016] The use of the same reference symbols in different figures
indicates similar or identical items.
DETAILED DESCRIPTION
[0017] U.S. patent application Ser. No. 11/851,379, filed Sep. 6,
2007; U.S. patent application Ser. No. 11/956,988, filed Dec. 14,
2007; and U.S. patent application Ser. No. 12/263,171, filed Oct.
31, 2008 (the "Endocutter Applications") are hereby incorporated by
reference herein in their entirety. Those documents, and any and
all other documents incorporated by reference in this
specification, are as much as a part of the specification as if the
text were repeated in the application.
[0018] Surgical Instrument
[0019] Referring to FIG. 1, a surgical instrument 1 includes a
handle 2 attached to a shaft 4, which in turn is attached to an end
effector 6. The surgical instrument 1 may be an endocutter, a
linear cutter, a stapler, or any other suitable surgical
instrument. The end effector 6 may be one or more separate
components that are connected to the shaft 4, or may be fabricated
integrally with the distal end of the shaft 4. As discussed in
greater detail below, the end effector 6 may be fixed to the shaft
4, or may be separable from the shaft 4 such that a fresh end
effector 6 may be attached to the shaft 4 after one or more
actuations of the surgical instrument. The end effector 6 and at
least the distal end of the shaft 4 may be sized to pass through an
incision or through a standard trocar port that may be placed in
the patient. Advantageously, the end effector 6 may be sized to
pass through a trocar port, having an opening between 5-10
millimeters in diameter. Alternately, the surgical instrument 1 may
be used in the course of conventional open surgery, where a trocar
port is not used. The end effector 6 may include a staple holder 8
connected to an anvil 10, and may be movable between an open
configuration and a closed configuration. In the closed
configuration, tissue may be clamped between the staple holder 8
and the anvil 10. Alternately, the end effector 6 may omit the
anvil 10. Alternately, the end effector 6 need not include a staple
holder 8 or anvil 10, and the end effector 6 may instead be a
different surgical instrument, such as but not limited to a bipolar
cutter, a biopsy device, a grasper, or a stabilizer.
[0020] The shaft 4 advantageously has a tubular shape with a lumen
defined therein. Optionally, the shaft 4 may include a cutaway,
trough or other feature (not shown) to allow a guidewire (if any)
or other positioning aid that may be used in the surgical procedure
to remain in place during actuation of the surgical instrument 1.
The shaft 4 may be flexible or rigid, in whole or in part. The
shaft 4 may be articulated in at least one location, if desired.
Referring to FIG. 2, as one example, the shaft 4 may be generally
rigid, with the exception of a flexible articulated region 12 that
connects two generally-rigid segments of the shaft 4. A plurality
of slots 14 may be located in the shaft 4 in the articulated region
12. The slots 14 may extend completely through the wall of the
shaft 4 from the outer surface of the shaft to the lumen in the
shaft 4. The slots 14 may be arranged in any suitable manner. As
one example, each slot 14 may extend along greater than 180 degrees
of circumference of the shaft 4, between two vertices 15.
Proceeding proximally along the shaft 4, at least two slots 14 may
be generally arranged in an alternating manner. That is, one slot
14 may open generally in one direction away from the longitudinal
centerline of the shaft 4, and the slot 14 proximal to that may
open generally in the opposite direction away from the longitudinal
centerline of the shaft 4. To accomplish this, the vertices 15 of a
slot opening (for example) laterally to the left may be located
laterally to the right of the vertices of a longitudinally adjacent
slot opening laterally to the right. As a result, where at least
two slots 14 extend along greater than 180 degrees of circumference
of the shaft 4, no line on the surface of the shaft 4 that is
parallel to the longitudinal centerline of the shaft 4 can extend
completely through the articulating region 12 without encountering
a slot 14. Put another way, every line on the surface of the shaft
4 that is parallel to the longitudinal centerline of the shaft 4
crosses at least slot 14. The slots 14 may be oriented and arranged
relative to one another to provide for lateral articulation of the
shaft 4. That is, the slots 14 may be oriented and arranged such
that the portion of the shaft 4 distal to the articulating region
12 is rotatable in a single plane, laterally left and right.
Alternately, the slots 14 may be oriented and arranged such that
the portion of the shaft 4 distal to the articulating region 12 is
rotatable in a single plane in a direction other than laterally
left and right. Alternately, the slots 14 may be oriented and
arranged such that the portion of the shaft 4 distal to the
articulating region 12 is rotatable in more than a single
plane.
[0021] At least one slot 14 may be angled. That is, extending
outward from a vertex 15 of the slot 14, the walls of the slot may
be angled relative to one another rather than parallel. Such an
angle facilitates bending of the articulated region 12.
Advantageously, at least one slot 14 has an angle of substantially
two degrees between its walls. However, the angle may be different,
or the walls may instead be substantially parallel to one another.
The width and angle of each slot 14 may be selected to affect the
total amount of travel of the articulating section. Advantageously,
the articulating section 12 is bendable such that the portion of
the shaft 4 distal to the articulating section 12 is movable
through substantially ninety degrees relative to the portion of the
shaft 4 proximal to the articulating section, where 45 degrees of
such movement is on either side of the longitudinal centerline of
the shaft 4. Alternately, the articulating section 12 may be
configured to allow a different amount of movement, either greater
than or less than ninety degrees. Alternately, the articulating
section 12 may be configured to allow movement in more than one
plane, in either the same or different amounts in either plane.
Alternately, the articulating section 12 may be configured to allow
asymmetrical articulation, wherein the distal end of the shaft 4
distal to the articulating section may be movable through a first
angle on one side of the longitudinal centerline of the shaft 4
that is greater than a second angle on the other side of the
longitudinal centerline of the shaft 4.
[0022] Referring to FIG. 3, another example of an articulating
region 12 is shown. The slots 14 may be configured similarly to
those described above with regard to FIG. 2. However, at least one
of the slots 14 may extend along less than 180 degrees of
circumference of the shaft 4. If all of the slots 14 do so, then
the slots 14 may be arranged such that a line on the surface of the
shaft 4 that is parallel to the longitudinal centerline of the
shaft 4 can extend completely through the articulating region 12
without encountering a slot 14. One or more slots 14 may be
connected to a longitudinal aperture 17 at a vertex 15 thereof,
such that the slot 14 may have a T-shaped appearance if viewed from
above. The presence of the longitudinal aperture 17, and its
length, provide for greater flexibility of the articulated region
12. The longer the longitudinal apertures 17, the more flexible the
articulated region 12.
[0023] The handle 2 may be attached to the proximal end of the
shaft 4, or any other suitable portion of the shaft 4. The shaft 4
may be fabricated integrally with the handle 2. Alternately, the
shaft 4 and the handle 2 may be two separate items that are
connected together in any suitable manner. The handle 2 may include
any mechanism, mechanisms, structure or structures that are
suitably configured to actuate the end effector 6. The handle 2 may
also include a source of stored energy for actuating the end
effector 6. The source of stored energy may be mechanical (such as
a spring), electrical (such as a battery), pneumatic (such as a
cylinder of pressurized gas) or any other suitable source of stored
energy. The source of stored energy, its regulation, and its use in
actuating the end effector 6 may be as described in the U.S. patent
application Ser. No. 11/054,265, filed on Feb. 9, 2005, which is
herein incorporated by reference in its entirety. The handle 2 may
instead, or also, include a connector or connectors suitable for
receiving stored energy from an external source, such as a hose
connected to a hospital utility source of pressurized gas or of
vacuum, or an electrical cord connectable to a power source.
[0024] Referring also to FIGS. 4 and 8, a cable 64 extends through
the lumen of the shaft 4 proximally into the housing 20 of the
handle 2. The cable 64 wraps around an rotary articulator 62 and
then extends distally back out of the housing 20 into the lumen of
the shaft 4. The rotary articulator 62 may be spherical, partially
spherical, spheroidal, cylindrical, or may have any other suitable
shape. The cable 64 may be fixed to the rotary articulator 62, such
as by a cylinder 66, tab, or other wider structure that is fixed to
the cable 64. The cylinder 66 is held by a corresponding detent in
the rotary articulator 62, such as in its proximal end. The
cylinder 66 may be fixed to the rotary articulator 62, such as by
welding, adhesive, crimping, pressure fitting, or any other or
additional structure, mechanism or method. Alternately, the cable
64 may be fixed directly to the rotary articulator 62, such as by
welding, adhesive, crimping, pressure fitting, or any other or
additional structure, mechanism or method. The cable 64 may be
wrapped around the rotary articulator 62 once, or more than once.
Advantageously, the cable 64 is wrapped around the proximal end of
the rotary articulator 62 such that the cable 64 is routed
proximally from the shaft 4 along one side of the rotary
articulator 62, around the proximal end of the rotary articulator
62, then distally along the other side of the rotary articulator 62
to the shaft 4. Referring also to FIG. 6, the cable 64 is routed
through the handle 2 such that it is capable of moving
substantially freely. The clamp controller 32 may include two or
more ramps 112 or apertures that receive the cable 64 and allow the
cable 64 to smoothly enter the lumen of the shaft 4. The clamp
controller 32 may also include a tunnel 114 or opening extending
longitudinally therethrough to allow the actuation cable 110 to
extend therethrough into the lumen of the shaft 4.
[0025] Referring also to FIG. 10, the proximal end of the end
effector 6 may include a bulkhead 90 in which one or more apertures
94 are defined. Advantageously, both ends of the cable 64 extend
through separate apertures 94, where those apertures 94 are
laterally spaced apart from one another. Advantageously, those two
apertures 94 through which the cable 64 extends and the
longitudinal centerline of the shaft 4 are aligned along a straight
line. Distal to the bulkhead 90, the ends of the cable 64 may be
knotted, fixed to structures wider than the diameter of the
aperture 94, or otherwise secured distal to the bulkhead 90. The
cable 64 may be under tension when the ends of the cable 64 are
secured relative to the bulkhead 90. Alternately, one or more of
the apertures 94 may be omitted, and at least one end of the cable
64 is fixed directly to the bulkhead, such as by welding, adhesive,
crimping, pressure fitting, or any other or additional structure,
mechanism or method. Alternately, the bulkhead 90 may be fixed to
the shaft 4, rather than the end effector 6. Alternately, the
bulkhead 90 may be any rigid structure substantially fixed relative
to the distal end of the shaft 4.
[0026] The rotary articulator 62 may be held in a cradle 72 within
the housing of the handle 2. The cradle 72 holds the rotary
articulator 62 in a substantially fixed longitudinal position
within the handle 2. The proximal end of the cradle 72 may be
shaped substantially the same as the proximal surface of the rotary
articulator 62, such that the rotary articulator 62 can rotate
smoothly in the cradle 72. One or more pins 100, lips or tabs may
extend inward from the distal end of the cradle 72 to retain the
rotary articulator 62 within the cradle 72 while still allowing the
rotary articulator 62 to rotate. Alternately, the cradle 72 is not
used, and the housing 20 or other component of the handle 2 holds
the rotary articulator 62 in a substantially fixed longitudinal
position within the handle 2. Referring also to FIG. 9, at least
one axle 68 may extend from the cradle 72 into a corresponding slot
70 defined in the rotary articulator 62. The axle or axles 68
define an axis about which the rotary articulator 62 is rotatable.
Alternately, the axles 68 are not utilized, and the rotary
articulator 62 is otherwise constrained to rotate about one or more
axes.
[0027] Referring also to FIG. 9, an articulation control 60 may be
connected to the rotary articulator 62, and extend through an
opening 74 in the housing 20 as well as an opening 88 in the
proximal end of the cradle 72. The articulation control 60 may be
fixed to the rotary articulator 62, and may be connected to it in
any suitable manner, such as by fasteners, adhesive, welding, or
any other suitable structure, mechanism or method. The articulation
control 60 is configured such that motion of the articulation
control 60 from side to side causes rotation of the rotary
articulator 62 about an axis, such as defined by one or more of the
axles 68. A tube 81 may extend from the articulation control 60
toward the rotary articulator, and a pin 80 may be positioned
partially in the lumen of and extending proximally from that tube
81. The pin 80 may be slidable within the lumen of the tube 81. A
clip 82 is fixed to the pin 80, and extends distally into the tube
81. The clip 82 may includes two legs 84 biased outward relative to
the longitudinal centerline of the tube 81. The legs 84 may be
generally symmetrical and generally thin and planar, or may be
otherwise configured. The legs 84 may be spaced apart from one
another.
[0028] The opening 88 in the proximal end of the cradle 72 may have
a plurality of teeth 86 defined along its upper and/or lower edges.
The clip 82 is configured to slide between adjacent teeth 86 when
the pin 80 moves distally. The pin 80 may be biased distally, or
may be configured to remain placed where the user sets it. When the
pin 80 is moved proximally, the legs 84 are positioned proximal to
the proximal edges of the teeth 86, such that the articulation
control 60 may be rotated left or right in order to rotate the
rotary articulator 62. The clip 82 optionally may be shaped such
that when the pin 80 is moved proximally, the outer edges of the
legs 84 encounter the distal end of the tube 81 and are colleted
down by that contact. Such motion may facilitate free motion of the
rotary articulator 62. When the pin 80 is moved distally, it enters
a space between two teeth 86, thereby preventing rotation of the
rotary articulator 62 and fixing the rotary articulator 62 in
place. The teeth 86 may be angled such that if a leg 84 encounter a
space between teeth 86 while moving distally, the leg 84 is
directed to the left or right into the space between adjacent teeth
86. The spacing between the teeth 86 defines the number of discrete
positions at which the rotary articulator 62 can be selectively
fixed. Alternately, the teeth 86 may be omitted, and any other
suitable mechanism may be used to selectively fix the rotary
articulator 62, either in one of a number of discrete positions, or
along an infinitely variable continuum.
[0029] As the rotary articulator 62 is rotated about the axle or
axles 68, the cable 64 transmits that rotation to the end effector
6, as described in greater detail below. The rotary articulator 62
may provide for articulation about one axis. Optionally, a rototube
50 may provide for rotation about a second axis. Alternately, the
rotary articulator 62 is not used, and the rototube 50 provides
rotation about its axis. Where the rototube 50 is utilized, the
cradle 72 may be fixed to the proximal end of the rototube 50. The
cradle 72 may include one or more lateral protrusions 102 that is
held between two ridges 104 defined in the inner surface of the
housing 20 of the handle 2. The ridges 104 may be generally
parallel to one another, and each in a plane generally
perpendicular to the longitudinal centerline of the rototube 50. In
this way, the cradle 72 is able to rotate about the longitudinal
axis of the rototube 50, along with a remainder of the rototube 50,
while remaining at substantially the same longitudinal position
relative to the handle 2. Referring also to FIG. 6, the distal end
of the rototube necks down to connect to the proximal end of the
shaft 4. The shaft 4 is configured to be held by the handle 2 in
such a manner that the shaft 4 is rotatable relative to the handle.
The aperture 106 at the distal end of the handle 2 supports the
shaft 4, but is not fixed to the shaft 4, such that the shaft 4 is
rotatable within the aperture 106. By rotating the rototube 50
about its longitudinal axis, another axis of rotation is provided
for the end effector 6 in addition to the axis of rotation provided
by the rotary articulator 62. The rototube 50 may be actuated to
rotate about its longitudinal axis in any suitable manner. As one
example, after the rotary articulator 62 is locked in place as
described above, the articulation control 60 may be rotated about
its axis, thereby rotating the rototube 50 about its longitudinal
axis as well. As another example, the articulation control 60 may
be actuated to rotate the rototube 50 prior to locking the rotary
articulator 62 in place. As another example, the articulation
control 60 may be free to both rotate the rototube 50 and the
rotary articulator 62 at the same time.
[0030] Referring to FIGS. 4-5, the handle 2 may include a clamping
trigger 22 for actuating the end effector 6 to move to a clamped
position or state, and an actuating trigger 40 for actuating the
end effector 6 to deploy staples and/or otherwise actuate the end
effector 6. Where the end effector 6 is not configured to clamp
tissue, the clamping trigger 22 may be omitted. The clamping
trigger 22 may be configured in any suitable manner that allows it
to actuate the end effector 6 to a clamped position or state. As
one example, an aperture may be defined through the housing 20 such
that the distal end of the clamping trigger 22 enters the housing
20. A clamping axle 30 may be defined in the housing 20 and extend
inward from the inner surface of the housing 20, and the clamping
trigger 22 may be configured to rotate about that clamping axle 30.
The clamping trigger 22 may have a pivot 26 defined therein, where
that pivot 26 is oriented substantially perpendicular to the
longitudinal centerline of the proximal end of the shaft 4. A
linkage 24 is rotatably connected to the pivot 26 at or near one
end, and the other end of the linkage 24 is positioned in a notch
34 in a clamp controller 32. The clamp controller 32 may be
generally cylindrical, and the notch 34 defined therein may extend
around part or all of the circumference of the clamp controller 32.
The notch 34 may be oriented substantially perpendicular to the
longitudinal centerline of the proximal end of the shaft 4. As the
free end of the clamping trigger 22 is depressed, and the clamping
trigger 22 rotates about the clamping axle 30, the proximal end 28
of the linkage 24 moves proximally, urging the clamp controller 32
proximally to actuate the end effector 6 to clamp, as described in
greater detail below.
[0031] The actuating trigger 40 may be configured in any suitable
manner that allows it to actuate the end effector 6 to deploy
staples and/or otherwise actuate the end effector 6. A trigger axle
42 may be defined in the housing 20 and extend inward from the
inner surface of the housing 20, and the actuating trigger 40 may
be configured to rotate about that trigger axle 42. The trigger 40
is advantageously oriented to be compressed by hand by the user.
The upper surface of the trigger 40 may include one or more teeth
44 defined therein. Alternately, the teeth 44 may be defined in a
different part of the trigger 40. Correspondingly, one or more
teeth 48 may be defined in the lower surface of an actuation
controller 46, and configured to engage the teeth 44 of the trigger
40. As the trigger 40 is depressed, the trigger 40 rotates about
the trigger axle 42, such that the upper surface of the trigger 40
moves proximally. As that upper surface moves proximally, the teeth
44 of the trigger 40 engage the teeth 48 of the actuation
controller 46 and urge the actuation controller proximally to
actuate the end effector 6, as described in greater detail below.
The rototube 50 may include at least one cutout 52 defined therein
to allow the rototube 50 to rotate about its longitudinal axis
without colliding with the upper end of the trigger 40.
[0032] A portion of at least one feeder belt 120 may extend from
the shaft 4 into, or be positioned within, the end effector 6.
Where at least one feeder belt extends from the shaft 4 through the
bulkhead 90 into the end effector 6, each feeder belt may extend
through the feeder belt access apertures 96 in the bulkhead 90. The
feeder belt 120 and its associated hardware may be as set forth in
the Endocutter Applications and in FIG. 11. In the interest of
brevity, the feeder belt 120 will not be described in detail
herein. Each feeder belt 120 may be a long, narrow, thin strip of
material from which one or more staples 122 extend. At least one
staple 122 may be frangibly connected to the feeder belt 120 at one
end, with the other end of the staple being free. One row 124 of
staples 122 may be located along each side of the feeder belt 120.
Each feeder belt 120 may be movable relative to the end effector 6,
as set forth in the Endocutter Applications, such that the end
effector 6 can be actuated multiple times without the need to
exchange cartridges or remove the end effector 6 from the patient
between actuations. The end effector 6 may be configured generally
as set forth in the Endocutter Applications, as one example, or may
be configured differently.
[0033] The end effector 6 optionally may include at least one
engagement feature 92 defined therein, or thereon. The engagement
feature 92 connects to a corresponding feature on the shaft 4, such
that the end effector 6 can be removed from the shaft 4, and a new
end effector 6 connected to the shaft 4. That is, the end effector
6 optionally may be interchangeable on the shaft 4. In this way,
the end effector 6 can be removed for sterilization of a remainder
of the surgical instrument 1, and/or the end effector 6 can be
reloaded during a surgical procedure with a fresh end effector 6 of
the same type, or a different end effector 6 of a different type.
If so, the feeder belt optionally may not extend through the
bulkhead 90, such that the apertures 96 need not be provided in the
bulkhead 90.
[0034] Operation
[0035] The end effector 6 of the surgical instrument 1 is
introduced into the body of the patient, whether through a trocar
port, a small incision for minimally invasive surgery, or a larger
incision for conventional open surgery. At least part of the shaft
4 may follow the end effector 6 into the patient. The end effector
6 is positioned by the user at a surgical site. As one example,
where the end effector 6 is an endocutter such as described in the
Endocutter Applications, a surgical site is located on a blood
vessel which is to be transected. For clarity, this document
describes the exemplary operation of the surgical instrument 1 for
transection of a blood vessel. However, the use of the surgical
instrument 1 is not limited to blood vessel transection; the
surgical instrument 1 may be used to perform any other suitable
procedure at any other surgical site in the body. For example, the
surgical instrument 1 may be used to transect a bile duct, to
remove a diseased appendix, to transect gastrointestinal tissue,
and/or to transect soft tissue or organs. Alternately, the end
effector 6 may be used to treat a surface of the body, such that
the end effector 6 is not inserted into the patient.
[0036] The end effector 6 may be inserted into the body of a
patient through an opening, incision, trocar port or other
aperture, in the open or closed position. The end effector 6 is
then advanced to a site where tissue to be treated is located. An
endoscope, inserted through the same or a different opening,
incision, trocar port, or aperture may be used to guide the end
effector 6 into position, where the end effector 6 is utilized for
a minimally-invasive surgical procedure. Alternately, a camera (not
shown) is attached to the end effector 6 and/or shaft 4 of the
surgical instrument 1; a light source and any other necessary
auxiliary hardware may be attached to the end effector 6 and/or
shaft 4 as well. If so, the surgeon may visualize the surgical site
solely utilizing the surgical instrument 1, thereby reducing the
number of openings that are made in the patient and rendering the
surgical procedure more minimally invasive.
[0037] The surgeon advances the end effector 6 into proximity to
the surgical site. The end effector 6 fortuitously may be properly
oriented relative to the surgical site at this time. If so, the end
effector 6 need not be articulated. If the end effector 6 is not
properly oriented relative to the surgical site, then the end
effector 6 may be articulated. The surgeon first may move the
articulation control 60, such as with his or her thumb. The pin 80
is moved proximally, if it is not already in that position whether
due to its affirmative motion proximally by the surgeon, or due to
a force biasing the pin 80 proximally. As a result, the
articulation control 60, and consequently the rotary articulator
62, is free to rotate left and right about the axle or axles 68.
The cable 64 is under tension, and is fixed to the rotary
articulator 62 as described above. As the surgeon rotates the
articulation control 60 to the left, for example, the cable 64
exerts a force in the proximal direction on the right side of the
bulkhead 90 of the end effector 6, at a point lateral to and spaced
apart from the longitudinal centerline of the end effector 6, such
as at an aperture 94 on the right side of the bulkhead 90. As a
result, this force exerts a torque about the yaw axis, causing the
shaft 4 to bend to the right due to bending in the articulated
region 12. As the only flexible region between the bulkhead 90 of
the end effector 6 and the handle 2, bending is focused in and
substantially restricted to the articulated region 12. Because the
articulated region 12 is flexible, and because springs or other
force transmission members are advantageously not used in
articulating the shaft 4 and/or returning the shaft 4 to a neutral
position, the surgeon need not overcome a substantial force in
order to articulate the end effector 6, and can move the
articulation control 60 one-handed. The surgeon moves the
articulation control 60 left or right until the desired orientation
is reached, and then moves the pin 80 distally. The surgeon may
release the pin 80, if it is biased distally, or may affirmatively
move the pin 80 distally. As the pin 80 moves distally, the legs 84
of the clip 82 move distally, and may move apart from one another
as well. Each leg 84 enters a space between adjacent teeth 86
defined in the opening 88, or between a tooth 86 and a wall
defining the leftmost or rightmost edge of the opening 88. As the
legs 84 enter those spaces, the orientation of the end effector 6
may change slightly; the spaces between teeth 86 define discrete
positions, and the teeth 86 are tapered to a point extending in the
proximal direction to assist the legs 84 in sliding therebetween
and slightly reorienting the end effector 6 as a result. The rotary
articulator 62 is thus locked in place. If the surgeon is unhappy
with the resulting orientation, or changes his or her mind, the pin
80 may be retracted proximally, and the articulation control 60 may
be moved again. The rotary articulator 60 is then locked in place
in the desired position, as set forth above.
[0038] Next, if necessary, the surgeon may rotate the rototube 50
to orient the end effector 6 more precisely. To do so, the surgeon
may rotate the articulation control 60 about its longitudinal axis.
With the rotary articulator 62 locked in place relative to the
cradle 72, and with the cradle 72 being fixed to the rototube 50,
the rotation of the articulation control 60 about its longitudinal
axis causes rotation of the rototube 50. Alternately, the rototube
50 may be actuated by a separate control. As the rototube 50
rotates, the shaft 4 (the proximal end of which is at least
rotationally fixed to the distal end of the rototube 50) rotates as
well, about the longitudinal axis of the part of the shaft 4
located proximal to the articulated section 12 of the shaft 4. The
articulation control 60 may then be locked into position in any
suitable manner, to prevent further movement of the end effector 6.
Alternately, the articulation control 60 need not be locked
further; for example, clamping of the end effector 6 onto tissue at
or in proximity to the surgical site may provide sufficient
restriction of further motion of the end effector 6.
[0039] In this way, the end effector 6 is articulable in two
degrees of freedom, about the roll and yaw axes. Although
articulation of the end effector 6 has been described in a
particular order, the surgeon could reverse the order, such that
the rototube 50 is rotated first, then the articulation left or
right about the yaw axis is performed. To do so, the surgeon may
simply lock the rotary articulator 62 in a random position, rotate
the rototube 50, then unlock the rototube 50 and articulate the end
effector 6 to cause bending of the shaft 4 in the articulated
region 12. Alternately, the surgeon may articulate the end effector
6 about both axes at the same time, if desired, then lock the
rotary articulator 62 in place.
[0040] The end effector 6 is now ready for actuation. The end
effector 6 is in the open position as it is moved into position at
the surgical site. The end effector 6 may be located in the desired
position relative to the surgical site at the end of the
articulation process. Alternately, the shaft 4 may be advanced or
moved after articulation to place the properly-oriented end
effector 6 at the surgical site. Where the end effector 6 is used
to perform transection of a blood vessel, the end effector 6 is in
the open configuration, and placed over the blood vessel to be
transected until the blood vessel is located between the staple
holder 8 and the anvil 10 of the end effector 6. The end effector 6
is then moved to the closed position. To do so, the clamping
trigger 22 may be actuated. As the clamping trigger 22 is moved
toward the housing 20 of the handle 2, the pivot 26 of the trigger
22 moves toward the housing 20 as well, causing the linkage 24 to
rotate about the pivot 26 and move toward the housing, and causing
the proximal end of the linkage 24 to move proximally. As set forth
above, the proximal end of the linkage 24 resides at least
partially within the notch 34 in the clamp controller 32, and the
proximal motion of the proximal end of the linkage 24 urges the
clamp controller 32 proximally. The clamp controller 32 may be
connected to a clamp cable 36, such that proximal motion of the
clamp controller 32 pulls the clamp cable 36 proximally. The clamp
cable 36 may extend into the end effector 6 through an aperture 94
in the bulkhead 90 of the end effector 6. Proximal motion of the
clamp cable 36, and/or tensioning of the clamp cable 36, may move
the end effector 6 from the open position to the closed position,
such as set forth in the Endocutter Applications.
[0041] The end effector 6 then may be actuated. The surgeon may
squeeze the actuating trigger 40, which rotates about the trigger
axle 42. As the trigger 40 rotates, the teeth 44 of the trigger 40
engages the teeth 48 of the actuation controller 46. Thus, as the
upper surface of the trigger 40 moves proximally, the teeth 44 urge
the teeth 48, and thereby the actuation control 46, proximally. The
actuation controller 46 may be connected to an actuation cable 110,
such that proximal motion of the actuation controller 46 pulls the
actuation cable 110 proximally. The actuation cable 110 may extend
into the end effector 6 through an aperture 94 in the bulkhead 90
of the end effector 6. Proximal motion of the actuation cable 110,
and/or tensioning of the clamp cable 36, may actuate the end
effector 6 such as set forth in the Endocutter Applications. For
example, the staple holder 8 may deploy staples into the blood
vessel and against the anvil 10, along two or more lines, and a
knife may cut the blood vessel between two such lines.
[0042] As the actuation controller 46 moves proximally, the slider
54 connected to the actuation controller 46 moves proximally as
well. The slider 54 extends out of the housing 20, such as through
a slot 61 in the upper surface of the housing 20, and provides a
visual indication that the end effector 6 has been actuated. The
actuation of the end effector 6 is thus complete. The clamping
trigger 22 may be moved away from the housing 20, thereby releasing
tension on the clamp cable 36, allowing the end effector 6 to move
back to the open position. Advantageously, the end effector 6 is
biased to the open position, such as by a spring. If the surgical
procedure is complete, the end effector 6 may be withdrawn from the
patient.
[0043] If the surgeon desires to use the end effector 6 at a
different location within the patient, and the surgical instrument
1 includes one or more feeder belts, as described in the Endocutter
Applications, the feeder belt or belts may be advanced, placing a
fresh set of staples in position for deployment within the staple
holder. Such advancement may be accomplished as set forth in the
Endocutter Applications. Optionally, the slider 54 may be used to
reset the surgical instrument 1 and advance the feeder belt or
belts. For example, the slider may engage the driver and move the
driver distally, thereby causing the ratchet pawl fixed to the
driver to engage a corresponding face of the top plate of the
feeder belt and advance the top plate distally, as set forth in the
Endocutter Applications. In this way, the slider 54 also acts to
indicate that the surgical instrument 1 has been reset and is ready
to be fired again. The end effector 6 need not be withdrawn from
the body of the patient during advancement of the feeder belts. The
feeder belts may extend through the lumen of the shaft 4 into the
housing 20 of the handle 2. If so, the feeder belts may enter the
end effector 6 through the feeder belt access apertures 96 in the
bulkhead 90 of the end effector 6. The surgeon may release the end
effector 6 from its selected, articulated position, such as by
moving the pin 80 proximally out of engagement with the teeth 86.
The surgeon may then articulate the end effector 6 differently for
use at a different surgical site, as set forth above.
[0044] While the invention has been described in detail, it will be
apparent to one skilled in the art that various changes and
modifications can be made and equivalents employed, without
departing from the present invention. It is to be understood that
the invention is not limited to the details of construction, the
arrangements of components, and/or the method set forth in the
above description or illustrated in the drawings. Statements in the
abstract of this document, and any summary statements in this
document, are merely exemplary; they are not, and cannot be
interpreted as, limiting the scope of the claims. Further, the
figures are merely exemplary and not limiting. Topical headings and
subheadings are for the convenience of the reader only. They should
not and cannot be construed to have any substantive significance,
meaning or interpretation, and should not and cannot be deemed to
indicate that all of the information relating to any particular
topic is to be found under or limited to any particular heading or
subheading. Therefore, the invention is not to be restricted or
limited except in accordance with the following claims and their
legal equivalents.
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