U.S. patent application number 14/624887 was filed with the patent office on 2015-06-11 for variable compression surgical fastener cartridge.
The applicant listed for this patent is Covidien LP. Invention is credited to JOHN BEARDSLEY, FRANK VIOLA.
Application Number | 20150157318 14/624887 |
Document ID | / |
Family ID | 40873785 |
Filed Date | 2015-06-11 |
United States Patent
Application |
20150157318 |
Kind Code |
A1 |
BEARDSLEY; JOHN ; et
al. |
June 11, 2015 |
VARIABLE COMPRESSION SURGICAL FASTENER CARTRIDGE
Abstract
A non-reloadable surgical fastener cartridge is provided. The
non-reloadable surgical fastener cartridge includes a cartridge
body that includes a tissue contacting surface that includes a
plurality of fastener retention slots. A plurality of surgical
fasteners is disposed in the plurality of fastener retention slots.
Each surgical fastener includes first and second legs of different
lengths. A plurality of pushers is operably associated with the
plurality of surgical fasteners. One or more of the pushers is
configured such that, upon formation of a corresponding surgical
fastener, a first area defined by the first leg is smaller than a
second area defined by the second leg. The non-reloadable surgical
fastener cartridge also includes an actuation mechanism operably
associated with the plurality of pushers.
Inventors: |
BEARDSLEY; JOHN; (HAMDEN,
CT) ; VIOLA; FRANK; (SANDY HOOK, CT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Family ID: |
40873785 |
Appl. No.: |
14/624887 |
Filed: |
February 18, 2015 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
12427794 |
Apr 22, 2009 |
8967446 |
|
|
14624887 |
|
|
|
|
61051923 |
May 9, 2008 |
|
|
|
Current U.S.
Class: |
227/176.1 ;
606/219 |
Current CPC
Class: |
A61B 17/1155 20130101;
A61B 2017/07242 20130101; A61B 17/072 20130101; A61B 2017/0023
20130101; A61B 2017/07271 20130101; A61B 17/07207 20130101; A61B
17/064 20130101; A61B 17/105 20130101; A61B 2017/07278 20130101;
A61B 2017/07228 20130101; A61B 2017/07214 20130101; A61B 17/068
20130101; A61B 2017/0688 20130101; A61B 17/0644 20130101 |
International
Class: |
A61B 17/068 20060101
A61B017/068; A61B 17/072 20060101 A61B017/072; A61B 17/064 20060101
A61B017/064 |
Claims
1. (canceled)
2. A surgical fastener cartridge comprising: a cartridge body
including a tissue contacting surface, the tissue contacting
surface including a fastener retention slot; a surgical fastener
disposed in the fastener retention slot, the surgical fastener
having a first leg and a second leg; a pusher operably associated
with the surgical fastener, the pusher configured for urging the
surgical fastener through the fastener retention slot, the pusher
having a first sidewall, a second sidewall, and a top surface, the
first sidewall having a height larger than a height of the second
sidewall such that, upon formation of the surgical fastener, a
first area defined by the first leg is less than a second area
defined by the second leg, the top surface of the pusher defining
an acute angle with respect to the tissue contacting surface; and
an actuation mechanism operably associated with the pusher.
3. The surgical fastener cartridge of claim 2, wherein the pusher
is configured to urge the surgical fastener towards a depression in
an anvil.
4. The surgical fastener cartridge of claim 2, wherein the first
leg has a first length and the second leg has a second length, the
first length different from the second length.
5. The surgical fastener of claim 4, wherein the first length is
less than the second length.
6. The surgical fastener cartridge of claim 2, wherein the tissue
contacting surface includes a slot configured to accommodate
longitudinal movement of a cutting element.
7. The surgical fastener cartridge of claim 6, wherein the fastener
retention slot is angled forming inner and outer ends with respect
to the slot.
8. The surgical fastener cartridge of claim 2, wherein the formed
surgical fastener includes a first loop defining the first area and
a second loop defining the second area.
9. The surgical fastener cartridge of claim 2, wherein the first
and second legs of the surgical fastener are connected by a
backspan that defines an angle with respect to the tissue
contacting surface.
10. A surgical fastener applying apparatus comprising: a handle
assembly; an elongated shaft extending distally from the handle
assembly; and an operative tool attachable to the shaft, the
operative tool including: an anvil pivotably coupled to a
cartridge, the anvil and the cartridge configured to move between
an approximated relationship and a spaced apart relationship, the
cartridge includes a cartridge body with a tissue contacting
surface, the tissue contacting surface including a fastener
retention slot; a surgical fastener disposed in the fastener
retention slot, the surgical fastener having a first leg and a
second leg; a pusher operably associated with the surgical
fastener, the pusher configured for ejecting the surgical fastener
towards a depression in the anvil, the pusher having a first
sidewall, a second sidewall, and a top surface, the first sidewall
having a height larger than a height of the second sidewall such
that, upon formation of the surgical fastener, a first area defined
by the first leg is smaller than a second area defined by the
second leg, the top surface of the pusher being sloped; and an
actuation mechanism operably associated with the pusher.
11. The surgical fastener applying apparatus of claim 10, wherein
the first leg of has a first length and the second leg has a second
length that is different from the first length.
12. The surgical fastener applying apparatus of claim 11, wherein
the first length is less than the second length.
13. The surgical fastener applying apparatus of claim 10, wherein
the tissue contacting surface includes a slot configured to
accommodate longitudinal movement of a cutting element.
14. The surgical fastener applying apparatus of claim 13, wherein
the fastener retention slot is angled forming inner and outer ends
with respect to the slot.
15. The surgical fastener applying apparatus of claim 10, wherein
the formed surgical fastener includes a first loop defining the
first area and a second loop defining the second area.
16. The surgical fastener applying apparatus of claim 10, wherein
the first and second legs of the surgical fastener are connected by
a backspan that defines an angle with respect to the tissue
contacting surface.
17. The surgical fastener applying apparatus of claim 10, wherein
the slope of the top surface of the pusher defines an angle with
respect to the tissue contacting surface.
18. The surgical fastener applying apparatus of claim 16, wherein
the backspan of the surgical fastener follows substantially the
same contour as the top surface the pusher.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 12/427,794, filed Apr. 22, 2009, which claims
priority to U.S. Provisional Patent Application Ser. No. 61/051,923
filed May 9, 2008, the contents of which is incorporated herein by
reference in its entirety.
BACKGROUND
[0002] 1. Technical Field
[0003] The present disclosure relates to surgical fastener applying
apparatus. More particularly, the present disclosure relates to a
surgical fastener cartridge that includes a plurality of surgical
fasteners configured so as to have areas of different sizes,
depending on the location of the tissue with respect to the
cartridge, and potentially to apply different compressive forces to
tissue, and methods of manufacturing and using the same.
[0004] 2. Background of the Related Art
[0005] Commercially available surgical fastening apparatus are well
known in the art, some of which are specifically adapted for use in
various surgical procedures including, but not limited to,
anastomosis. U.S. Pat. Nos. 5,915,616; 6,202,914; 5,865,361; and
5,964,394 each describe one or more suitable apparatus which may be
employed while performing one of these procedures.
[0006] In general, a surgical fastening apparatus will include an
anvil that is approximated relative to a fastener cartridge during
use. The anvil includes depressions that are aligned with, and/or
are in registration with slots defined in the cartridge, through
which the fasteners will emerge. To effectuate formation, the
fasteners emerge from the cartridge and are driven against the
anvil. The fastener cartridge typically has one or more rows of
fasteners disposed alongside a longitudinal slot that is configured
to accommodate a knife, or other such cutting element, such that
tissue can be simultaneously cut and joined together. Depending
upon the particular surgical fastening apparatus, the rows of
fasteners may be arranged in a linear or non-linear, e.g. circular,
semi-circular, or otherwise arcuate configuration.
[0007] Various types of surgical fasteners are well known in the
art, including but not limited to unitary fasteners and two-part
fasteners. Unitary fasteners have a pre-formed configuration and a
formed configuration. Unitary fasteners generally include a pair of
legs adapted to penetrate tissue and connected by a backspan from
which they extend. In use, subsequent to formation, certain types
of unitary fasteners have a "B" shaped configuration. Typically,
the two-part fastener includes legs that are barbed and connected
by a backspan which are engaged and locked into a separate retainer
piece that is usually located in the anvil. In use, the two-part
fastener is pressed into the tissue so that the barbs penetrate the
tissue and emerge from the other side where they are then locked
into the retainer piece. The retainers prevent the two-part
fastener from dislodging from the tissue. The two-part fasteners
are not intended to be unlocked or removable. They are generally
made of a bioabsorbable material.
[0008] A common concern in each of these procedures is hemostasis,
or the rate at which bleeding of the target tissue is stopped. It
is commonly known that by increasing the amount of pressure applied
to a wound, the flow of blood can be limited, thereby decreasing
the time necessary to achieve hemostasis. To this end, conventional
surgical fastening apparatus generally apply two or more rows of
fasteners about the cut-line to compress the surrounding tissue in
an effort to stop any bleeding and to join the cut tissue together.
Each of the fasteners will generally apply a compressive force to
the tissue sufficient to effectuate hemostasis, however, if too
much pressure is applied, this can result in a needless reduction
in blood flow to the tissue surrounding the cut-line. Accordingly,
the joining of tissue together in this manner may result in an
elevated level of necrosis, a slower rate of healing, and/or a
greater convalescence.
[0009] Consequently, it would be advantageous to provide a surgical
fastening apparatus capable of limiting the flow of blood in the
tissue immediately adjacent the cut tissue to effectuate hemostasis
and wound closure, while maximizing blood flow in the surrounding
tissue to facilitate healing. It may also be desirable to cut and
staple across tissue that varies in thickness. It would therefore
be advantageous to provide staples which could better accommodate
these resulting different tissue thicknesses.
SUMMARY
[0010] The present disclosure provides a surgical fastener
cartridge. The surgical fastener cartridge includes a cartridge
body that includes a tissue contacting surface. The tissue
contacting surface includes a plurality of fastener retention
slots. In embodiments, each of the plurality of fastener retention
slots are angled forming inner and outer ends with respect to the
slot. The cartridge body includes a plurality of surgical fasteners
disposed in the plurality of fastener retention slots; each of the
surgical fasteners having a first leg and a second leg. In
embodiments, the first leg of the surgical fastener includes a
length that is shorter than a length of the second leg of the
surgical fasteners. In embodiments, the first and second legs of
the surgical fastener are connected by a backspan that defines an
angle with respect to the tissue contacting surface. The cartridge
body includes a plurality of pushers operably associated with the
plurality of surgical fasteners; each pusher configured for
ejecting an associated surgical fastener towards a depression in an
anvil. One or more of the pushers may be configured such that, upon
formation of a corresponding surgical fastener, a first area
defined by the first leg is smaller than a second area defined by
the second leg. In embodiments, each of the formed surgical
fasteners includes a first loop defining the first area and a
second loop defining the second area. In embodiments, one or more
of the surgical fasteners includes a recess in the backspan
thereof, prior to formation. An actuation mechanism may be operably
associated with the plurality of pushers.
[0011] In embodiments, the tissue contacting surface includes a
slot configured to accommodate longitudinal movement of a cutting
element.
[0012] In embodiments, the surgical fastener has portions with
different diameters.
[0013] In embodiments, a top surface of the one or more pushers is
sloped.
[0014] In embodiments, the backspan of the surgical fastener
follows substantially the same contour as the top surface the at
least one pusher.
[0015] The present disclosure also provides surgical fastener
cartridge that includes a cartridge body that includes a tissue
contacting surface. The tissue contacting surface includes a
plurality of fastener retention slots and a knife slot configured
to accommodate longitudinal movement of a cutting element. In
embodiments, each of the plurality of fastener retention slots may
be angled forming inner and outer ends with respect to the knife
slot. The cartridge body includes a plurality of surgical fasteners
that are disposed in the plurality of fastener retention slots;
each surgical fastener having a first end that is closer to the
knife slot than a second end. In embodiments, the surgical fastener
includes a first leg at the first end and a second leg at the
second end. The first leg may include a length that is shorter than
a length of the second leg. In embodiments, the first and second
leg of each of the surgical fasteners is connected by a backspan
that defines an angle with respect to the tissue contacting
surface. In embodiments, one or more of the surgical fasteners may
include a recess in the backspan thereof, prior to formation. The
cartridge body includes a plurality of pushers operably associated
with the plurality of surgical fasteners; each pusher configured to
eject an associated surgical fastener towards a depression in an
anvil. One or more of the pushers includes a corresponding surgical
fastener and the one or more pushers may be configured such that,
upon formation, the first end of the corresponding surgical
fastener is smaller in height than the second end of the
corresponding surgical fastener. In embodiments, each of the formed
surgical fasteners includes a first loop and a second loop. An
actuation mechanism may be operably associated with the plurality
of pushers.
[0016] In embodiments, the surgical fastener has portions with
different diameters.
[0017] In embodiments, a top surface of the one or more pushers is
sloped.
[0018] In embodiments, the backspan of the surgical fastener
follows substantially the same contour as the top surface the at
least one pusher.
[0019] The present disclosure additionally provides a surgical
fastener applying apparatus. The surgical fastener applying
apparatus includes a handle assembly, an elongated shaft extending
distally from the handle assembly; and an operative tool adapted to
couple to the shaft. The operative tool includes a pair of opposed
jaws pivotally coupled to one another and respectively including an
anvil member and a non-reloadable surgical fastener cartridge that
are approximated relative to one another during use. In certain
embodiments, the non-reloadable surgical fastener cartridge
includes a cartridge body that includes a tissue contacting
surface. The tissue contacting surface includes a plurality of
fastener retention slots. In embodiments, each of the plurality of
fastener retention slots are angled forming inner and outer ends
with respect to the slot. The cartridge body includes a plurality
of surgical fasteners disposed in the plurality of fastener
retention slots; each of the surgical fasteners having a first leg
and a second leg. In embodiments, the first leg of the surgical
fastener includes a length that is shorter than a length of the
second leg of the surgical fasteners. In embodiments, the first and
second legs of the surgical fastener are connected by a backspan
that defines an angle with respect to the tissue contacting
surface. The cartridge body includes a plurality of pushers
operably associated with the plurality of surgical fasteners; each
pusher configured for ejecting an associated surgical fastener
towards a depression in an anvil. One or more of the pushers may be
configured such that, upon formation of a corresponding surgical
fastener, a first area defined by the first leg is smaller than a
second area defined by the second leg. In embodiments, each of the
formed surgical fasteners includes a first loop defining the first
area and a second loop defining the second area. In embodiments,
one or more of the surgical fasteners includes a recess in the
backspan thereof, prior to formation. An actuation mechanism may be
operably associated with the plurality of pushers.
[0020] In embodiments, the tissue contacting surface includes a
slot configured to accommodate longitudinal movement of a cutting
element.
[0021] In embodiments, the surgical fastener has portions with
different diameters.
[0022] In embodiments, a top surface of the one or more pushers is
sloped.
[0023] In embodiments, the backspan of the surgical fastener
follows substantially the same contour as the top surface the at
least one pusher.
BRIEF DESCRIPTION OF THE DRAWINGS
[0024] Various embodiments of the present disclosure are described
hereinbelow with references to the drawings, wherein:
[0025] FIG. 1 illustrates a surgical fastener applying apparatus
for use with a surgical fastener cartridge that employs surgical
fasteners in accordance with an embodiment of the present
disclosure;
[0026] FIG. 2 illustrates another type of surgical fastener device
that employs an alternate embodiment of a surgical fastener
cartridge in accordance with the present disclosure;
[0027] FIG. 3 illustrates another type of surgical fastener
instrument that employs an alternate embodiment of surgical
fastener cartridge in accordance with the present disclosure;
[0028] FIG. 4A is an enlarged top perspective view of the surgical
fastener cartridge configured for use with the surgical fastener
applying apparatus shown in FIG. 1;
[0029] FIG. 4B is a partially exploded view of an alternate
embodiment of a surgical fastener loading unit configured for use
with the surgical fastener applying apparatus depicted in FIG.
3;
[0030] FIG. 5A is a partial cross-sectional view of the surgical
fastener cartridge depicted in FIG. 4B with the surgical fastener
shown subsequent to formation;
[0031] FIG. 5B is an enlarged view of the area of detail
represented by 5B depicted in FIG. 5A;
[0032] FIG. 6 is a side perspective view of a surgical fastener
configured for use with the cartridge depicted in FIG. 4A prior to
formation;
[0033] FIGS. 7A-7E illustrate alternate embodiments of surgical
fasteners according to the present disclosure;
[0034] FIG. 8 is a side cross-sectional view of the surgical
fastener depicted in FIG. 6 shown subsequent to formation and
within adjacent tissue segments;
[0035] FIG. 9 is a side perspective view of a pusher configuration
depicted in FIG. 4B;
[0036] FIG. 10 illustrates the surgical fastener depicted in FIG. 6
being shown prior to and subsequent to formation (in phantom);
[0037] FIG. 11 is partial cross-sectional view taken along the line
segment "11-11" of FIG. 4A illustrating the surgical fastener
cartridge loaded with the surgical fasteners depicted in FIG. 6;
and
[0038] FIG. 12 illustrates another type of surgical fastener device
that may employ an alternate embodiment of surgical fastener
cartridge in accordance with the present disclosure.
DETAILED DESCRIPTION OF EMBODIMENTS
[0039] Various embodiments of the presently disclosed surgical
fastener cartridge will now be described in detail with reference
to the drawings wherein like reference numerals identify similar or
identical elements. In the drawings and in the description which
follows, the term "proximal" will refer to the end of the surgical
fastener cartridge that is closer to the operator during use, while
the term "distal" will refer to the end of the fastener cartridge
that is farther from the operator, as is traditional and
conventional in the art. In addition, the term "surgical fastener"
should be understood to include any structure formed of a
biocompatible material that is suitable for the intended purpose of
joining tissue together, including but not being limited to
surgical staples, clips, and the like.
[0040] The present disclosure provides a surgical fastener
cartridge adapted to house a plurality of surgical fasteners
configured so as to have areas of different sizes, depending on the
location of the tissue with respect to the cartridge, and
potentially to apply different compressive forces to tissue, such
that a hemostatic effect may be achieved. To this end, certain
embodiments have surgical fasteners each of which includes two legs
each configured to provide a different compression force to stapled
tissue when formed.
[0041] With reference to FIG. 1, a surgical fastener applying
apparatus 1000 that employs a surgical fastener cartridge 100 is
illustrated. Surgical fastener applying apparatus 1000 is used to
sequentially apply a plurality of surgical fasteners to a patient's
tissue. Surgical fastener apparatus 1000 may be configured for use,
subsequent sterilization and reuse, or may be configured for single
use. Surgical fastener applying apparatus 1000 includes a handle or
trigger 1002, an elongated shaft 1004 extending distally therefrom,
and an operative tool 1006 coupled to a distal end 1008 of the
elongated shaft 1004. In general, operative tool 1006 is adapted to
clamp, sequentially fasten together, and sever adjacent tissue
segments along a cut-line, or longitudinal slot 122. Operative tool
1006 includes a pair of opposed jaws 1012, 1010 pivotally coupled
to one another and respectively including an anvil member 1014 and
cartridge 100 that are approximated relative to one another during
use. The anvil 1014 includes an anvil plate 90 having depressions
91 (see FIG. 5A) that are aligned with, and/or are in registration
with fastener retention slots 126 (FIG. 4A) defined in the
cartridge 100, through which the fasteners 130 will emerge, to be
driven against anvil plate 90 (see FIGS. 5A and 5B). For a more
detailed discussion of the approximation and firing of surgical
fastener applying apparatus 1000, reference is made to commonly
owned U.S. Pat. Nos. 7,258,262 and 5,865,361 currently assigned to
Tyco Healthcare Group LP, the entire contents of which are hereby
incorporated herein by reference. The operative tool 1006 and/or
cartridge 100 may be a removable and/or replaceable loading unit
for the apparatus 1000.
[0042] While surgical fastener applying apparatus 1000 is depicted
as an apparatus suitable for use in laparoscopic procedures for
performing surgical anastomotic fastening of tissue, those skilled
in the art will appreciate that cartridge 100 may be adapted for
use with any surgical fastening instrument. For example, cartridge
100 may be adapted for use with an end-to-end anastomosis device
2000, as seen in FIG. 2, and/or a surgical stapling instrument
3000, as seen in FIG. 3, for use during an open gastro-intestinal
anastomotic stapling procedure, or, for example, any of the
surgical fastener applying apparatus discussed in U.S. Pat. Nos.
6,045,560; 5,964,394; 5,894,979; 5,878,937; 5,915,616; 5,836,503;
5,865,361; 5,862,972; 5,817,109; 5,797,538; and 5,782,396, which
are each hereby incorporated by reference herein in their entirety.
The cartridge in certain embodiments is removable and replaceable
with another loaded cartridge. In other embodiments, the operative
tool 1006 is removable and replaceable.
[0043] For the purposes of brevity, the structural and operational
features of cartridge 100 will be described in terms of use with
the surgical fastener applying apparatus 1000.
[0044] With reference to FIGS. 4A and 4B, and initially with
reference to FIG. 4A cartridge 100 is shown. Cartridge 100 extends
along a longitudinal axis "A-A" and includes a cartridge body 112
with a pair of opposed side walls 114, 116, a bottom wall 118, and
a tissue contacting surface 120. The tissue contacting surface 120
includes a longitudinal slot 122 that is configured to accommodate
longitudinal movement of a knife bar 601, or other suitable cutting
element, such that stapled tissue may be severed along a cut-line.
The tissue contacting surface 120 includes a plurality of fastener
retention slots 126 arranged into a plurality of rows 128 that
extend substantially the length of the cartridge 100. As shown in
FIG. 4A, the fastener retention slots 126 are arranged into rows
128 that are spaced laterally from the longitudinal slot 122.
Retention slots 126 are configured such that deployment of the
surgical fastener 130 and subsequent formation thereof, provides a
formed surgical fastener with an end that is closer to the cut-line
and an end that is farther from the cut-line, or longitudinal slot
122. To this end, retention slots 126 are angled with respect to
longitudinal slot 122, as best seen in FIG. 4A, such that inner
(closest to the longitudinal slot) and outer ends (farthest to the
longitudinal slot) 128.sub.A and 128.sub.B, respectively, are
formed. While the cartridge 100 is depicted as including pairs of
rows 128, it is within the purview of the present disclosure to
have more or fewer rows of the fastener retention slots 126
disposed on cartridge 100. Additionally, rows 128 may be annular,
as opposed to linear, and spaced radially from the cutting element;
such is the case when the fastening cartridge is employed with the
surgical fastening device depicted in FIG. 2. In addition, the
retention slots 126 could be aligned with a longitudinal axis of
the fastening cartridge.
[0045] With reference to FIG. 4B, each of the fastener retention
slots 126 is configured to receive one of a plurality of surgical
fasteners 130 therein such that the surgical fasteners 130 are
deployed in rows on opposite sides of the cut-line, or longitudinal
slot 122 created in the tissue during fastening, see FIG. 11 for
example. Pushers 150 are operatively associated and aligned with
fastener retention slots 126 and are sequentially contacted by one
or more cam wedges 644 (four cam wedges are shown) of an actuation
sled 600 as actuation sled 600 is driven distally through cartridge
100 by an axial drive assembly which includes knife bar 601 and an
abutment surface which engages the central support wedge 645 of
actuation sled 600. Axial drive assembly, among other things,
transmits the longitudinal drive forces exerted by a control rod
(not shown) disposed in elongated shaft 1004 to the actuation sled
600 disposed such that the actuation sled 600 engages the
respective pushers 150. Pushers 150 interact with the plurality of
surgical fasteners 130 housed within staple cartridge 100 to
sequentially eject the surgical fasteners 130 therefrom (FIG. 4B).
An example of a drive assembly is disclosed in commonly owned U.S.
Pat. No. 7,258,262, the contents of which are hereby incorporated
by reference in its entirety.
[0046] In order to move the anvil member between the open and
closed positions, surgical stapling instrument 1000 includes a
trigger or handle 1002 pivotally mounted to the handle assembly.
Handle 1002 controls the linear movement of a control rod (not
shown) which is mounted within the elongated tubular member 1004.
The control rod operates to move the knife bar 601 distally to
initially move the anvil member and/or slot 101 between the open
and closed positions. The knife bar also acts to move the sled (not
shown) distally through the staple cartridge 18 to eject staples.
The knife bar desirably includes a knife blade to cut tissue as the
knife bar translates through the staple cartridge 18, but the knife
bar may be configured as a series of cam bars and a separate
knife.
[0047] Although surgical stapling instrument 12 is shown with a
single movable handle 1002 which accomplishes both jaw closure and
firing of staples, it is further contemplated that the present
buttress release mechanism can also be used with surgical stapling
instruments of the type which utilize a clamping mechanism to close
the jaws which is separate from the firing mechanism. See, for
example, U.S. Pat. No. 5,476,206, the contents of which are
expressly incorporated herein by reference.
[0048] In operation, prior to firing stapling apparatus 1000,
actuation sled 600 is in a proximal-most position. At such a time,
knife bar 601 is disposed adjacent a proximal end of cartridge 100
and proximal to the sled 600. The knife bar 601 of the axial drive
assembly has an upper member that engages a slot 92 disposed within
the anvil member 90 and a lower member that engages the slot 101
that supports the cartridge 100 (see FIG. 11). The operative tool
1006 is first actuated to clamp onto tissue. Movable handle 1002 of
the handle assembly advances the control rod distally. The control
rod advances the knife bar so that the upper and lower members of
the knife bar engage the anvil member 90 and slot 101 respectively
to approximate the anvil member 90 and cartridge 100 with one
another. With tissue clamped between anvil member 90 and cartridge
100, the fasteners are fired from the apparatus into the tissue.
The handle 1002 is again operated to further advance the knife bar.
Accordingly, a drive bar drives actuation sled 600 distally through
cartridge 100. During its distal translation, the angled leading
surfaces of cam wedges 644 sequentially contact pushers 150, urging
them in a direction perpendicular to the direction of movement of
actuation sled 600 (FIG. 5A), toward the anvil. As a result,
pushers 150 push surgical fasteners 130 from their individual
slots, driving each surgical fastener 150 into a respective forming
depression 91 of anvil plate 90 (FIG. 5B). The forming depressions
are configured to form the surgical fasteners into the desired
shape. Sequential firing of the staples continues until actuation
sled 600 is advanced to the distal end of cartridge 100, at which
time, all of the staples once housed within cartridge 100 will have
been ejected. A more detailed description of the interaction
between actuation sled 600 and pushers 150 will be described
below.
[0049] With reference now to FIGS. 6 and 7A-7D, cartridge 100 may
loaded with one or more varieties of surgical fastener, represented
generally as surgical fastener 130. Surgical fastener 130 includes
two legs 132, a first leg 132.sub.A and a second leg 132.sub.B each
having different lengths and connected by a backspan 134 extending
therebetween. In the embodiment shown, backspan 134 is at an angle
with respect to both of legs 132 and follows substantially the same
contour as a top surface 152 of pusher 150, see FIG. 10 for
example. Backspan 134 may be slanted at any angle with respect to
each of legs 132.sub.A, 132.sub.B and top surface 152 of pusher
150. The thickness of the backspan 134 and the legs 132 may be
varied to fasten adjacent tissue segments "T.sub.1", "T.sub.2" of
varying thickness (see FIG. 8). In certain embodiments, the
backspan of the surgical fastener has a recess defined therein,
prior to formation. The recess generally reduces the interior space
or area of the formed surgical fastener, see FIG. 7E for
example.
[0050] The legs 132 and the backspan 134 may define a cross-section
having any suitable geometric configuration, including but not
limited to rectangular, oval, square, triangular, and trapezoidal.
The legs 132 and the backspan 134 may exhibit the same geometrical
configuration such that the cross-sectional configuration of the
surgical fastener 130 is substantially uniform, or, alternatively,
the legs 132 and the backspan 134 may exhibit different geometrical
configurations, e.g., the legs 132 may exhibit a rectangular
cross-section and the backspan 34 may exhibit an oval
cross-section, as shown in FIGS. 7A-7D. Backspan 134 and/or legs
132 may be formed by any suitable means known in the art including
but not limited to welding, braising, coining, casting, overmolding
and so on. Additionally, backspan 134 and/or legs 132 may be
treated by way of annealing, cold working, heat treating, and so
on. This may provide increased burst strength to the surgical
fastener. Moreover, backspan may include different configurations
of blocking and/or retainer material, tube, sleeve, collar, and/or
grommet.
[0051] As seen in FIG. 6, prior to the formation of surgical
fastener 130, legs 132 extend from the backspan 134 such that they
are substantially parallel. Alternatively, the legs 132 may
converge or diverge from the backspan. The present disclosure
contemplates that the surgical fastener 130 may also be configured
as a directionally biased staple, such as those described in
commonly owned U.S. patent application Ser. No. 11/253,493, filed
Oct. 17, 2005, the entire contents of which are incorporated by
reference herein.
[0052] Each of the legs 132 terminates in a penetrating end 136
that is configured to penetrate tissue (tissue segments "T.sub.1",
"T.sub.2" for example) and/or other suitable material (blocking
and/or retainer material for example). The penetrating ends 136 of
legs 132 can be tapered to facilitate the penetration of tissue
segments "T.sub.1", "T.sub.2", or alternatively, the penetrating
ends 136 may not include a taper. In various embodiments,
penetrating ends 136 may define a conical or flat surface, as
described in co-pending U.S. patent application Ser. No.
11/444,761, filed Apr. 13, 2003, the entire contents of which are
incorporated by reference herein. In embodiments, one or both of
legs 132 may be barbed. Having legs 132 configured in such a manner
may facilitate maintaining the surgical fastener 130 in a fixed
position within the tissue and/or blocking material. In certain
embodiments, each of legs 132 has different lengths. More
particularly, the leg 132 closer to the cut-line, or longitudinal
slot 122 (e.g., leg 132.sub.A) will have a shorter length than the
leg 132 farther from the cut-line, or longitudinal slot 122 (e.g.,
leg 132.sub.B). A more detailed description of the legs 132 will be
described below.
[0053] Turning now to FIG. 8, surgical fastener 130 is shown
subsequent to formation. Surgical fastener 130 is configured to
provide a compression force to stapled tissue occupied therein. To
this end, legs 132.sub.A and 132.sub.B cooperate with backspan 134
to maintain adjacent tissue segments or layers "T.sub.1", "T.sub.2"
in approximation and apply respective compressive forces "F.sub.1"
and "F.sub.2" thereto. The respective compressive forces "F.sub.1"
and "F.sub.2" applies pressure to the tissue segments "T.sub.1",
"T.sub.2", thereby restricting the flow of blood through the tissue
surrounding the surgical fastener 130 and facilitating hemostasis.
The amount of pressure that is applied to the tissue segments
"T.sub.1", "T.sub.2" is limited such that the flow of blood through
the tissue is not completely restricted. When formed, surgical
fastener 130 is generally "B" shaped having a first loop at a first
end of the surgical fastener with an overall height "H.sub.L1" and
a respective tissue compression space or area Tc.sub.1, and a
second loop at a second end of the surgical fastener with an
overall height "H.sub.L2" and a respective tissue compression space
Tc.sub.2 (each tissue compression space or area measured from the
outermost surface of the backspan 134 to the outermost curve of the
legs 132).
[0054] With reference to FIGS. 9 and 10, an initially with
reference to FIG. 9, pusher 150 is shown. As noted above, cartridge
100 is configured such that the leg 132 of the surgical fastener
130 deployed closer to the cut-line or slot 122 provides a greater
compression force to the stapled tissue than the leg 132 of the
surgical fastener 130 deployed farther from the cut line,
longitudinal slot 122. To this end, pusher 150 is configured such
that a portion 150a of the pusher 150 driving the leg 132 of the
surgical fasteners 130 closer to the cut-line or longitudinal slot
122 has greater height than a portion 150b of the pusher 150
driving the leg 132 of the surgical fasteners farther from the
cut-line or slot 122 (see FIG. 10, for example).
[0055] Pusher 150 includes a base 154 and two sidewalls 156, 158
extending in a generally orthogonal direction therefrom. Pusher 150
may include structure similar to conventional pushers known in the
art. While base 154 is shown having a generally linear
configuration, it is within the purview of the present disclosure
for base 154, or portion thereof, to be curved or angled. Having
base 154 curved or angled may facilitate operative interaction
between sled 600 and pusher 150. Base 154 of pusher 150 may have
any suitable width "W". Sidewall 156 supports corresponding leg
portion 132.sub.A and has a height "H.sub.1", while sidewall 158
supports corresponding leg portion 132.sub.B and has a height
"H.sub.2 (see FIG. 10). Height "H.sub.1" of sidewall 156 being
greater than height "H.sub.2" of sidewall 158. As noted above,
pusher 150 includes a top surface 152. Top surface 152 is oblique
or slanted and extends from sidewall 156 to sidewall 158. Having
pusher 150 configured in such a manner facilitates forming of
surgical fastener 130 against depressions 91 of anvil plate 90. Top
surface 154 may extend from the sidewalls 156, 158 at any suitable
angle ".alpha." (FIG. 9). More particularly, angle ".alpha." may be
equal to, less than, and/or greater than the angle or slant that
backspan 134 extends with respect to each of legs 132.sub.A,
132.sub.B. Pusher 150 also includes front and rear walls 160, 162,
respectively. In further embodiments, the top surface 152 may be
stepped, with two or more generally horizontal surfaces.
[0056] Those skilled in the art will appreciate that several
variations of the above described pusher configurations may be
employed to achieve the same or similar result. For example,
instead of having sidewalls 156, 158 with different heights,
sidewalls 156, 158, may have similar heights and include any number
of intents, detents, slits, slots, or other suitable structure
configured to raise or lower a corresponding leg of a surgical
fastener. Part of the pusher may comprise a collapsible or
compressible material to correspond to a portion of a fastener
having a larger compressive space.
[0057] As noted, in certain embodiments, the legs 132 supported by
sidewalls 156 (e.g., legs 132.sub.A), and thus closest to the
cut-line or longitudinal slot 122, are shorter and as a result are
intended to form a smaller loop. In operation, when cam wedges 644
contact and drive pushers 150, the corresponding legs 132.sub.A of
surgical fasteners 130 forms a loop, or other generally closed
shape, when it is urged against the anvil plate 90, thereby
restricting the flow of blood through the tissue surrounding the
surgical fastener 130 and facilitating hemostasis. As also noted,
the legs supported by sidewalls 158 (e.g., legs 132.sub.B), and
thus farther from the cut-line, are longer and as a result are
intended to form a larger loop, or generally closed shape. In
operation, when cam wedges 644 contact and drive pushers 150, the
corresponding legs 132.sub.B of surgical fasteners 130 forms a
larger loop when the surgical fastener 130 is urged against the
anvil plate 90, thereby allowing some blood to flow through the
tissue surrounding the surgical fastener 130 and facilitating
healing, as best seen in FIG. 5B.
[0058] With reference again to FIG. 10 formation of surgical
fastener 130 will be described. In the following description, cam
wedges 644 of sled 600 are configured to provide the driving force
for pushers 150 and surgical fasteners 130. As shown, surgical
fastener 130 has a diameter "D.sub.1" and includes legs 132.sub.A
and 132.sub.B that have respective lengths "L.sub.1" and "L.sub.2".
Legs 132.sub.A and 132.sub.E are substantially similar to each
other. The overall heights of the legs 132.sub.A, 132.sub.E in the
unformed condition (measured from the penetrating tip 136 of the
legs to the outermost surface of the backspan 134) are shown with
leg 132.sub.A being shorter than leg 132.sub.B. Surgical fasteners
130.sub.A are shown in their initial and formed conditions (in
phantom). The backspan 134 cooperates with each of 132.sub.A and
132.sub.E of the surgical fastener 130 to form two respective
tissue compressive spaces 140.sub.1, 140.sub.2 (FIG. 10). Sidewalls
156 and 158 are configured to support respective legs 132.sub.A,
132.sub.B. As noted, the legs of the surgical fasteners formed
farther from the cut-line, or slot 122 provide a loop with a larger
tissue compression zone 140.sub.2 and the legs of the surgical
fasteners formed closer to the cut-line, or longitudinal slot 122
provide a loop with a smaller tissue compression zone 140.sub.k,
see FIGS. 5A and 5B for example. Thus, because leg 132.sub.B has a
length "L.sub.2" that is greater than leg 132.sub.A and is
supported by a sidewall 158 with a height "H.sub.2" that is smaller
than sidewall 156, a larger loop is formed when urged against a
respective anvil portion. The resultant compression space or zone
140.sub.2 facilitates hemostatsis. However, because blood flow is
not completely restricted through tissue compression space
140.sub.2, unnecessary necrosis of the stapled tissue may be
prevented and/or impeded. Conversely, because leg 132.sub.A has a
length "L.sub.1" that is less than leg 132.sub.B and is supported
by a sidewall 136 with a height "H.sub.1" that is larger than
sidewall 132.sub.B, a smaller loop is formed when urged against a
respective anvil portion. The resultant compression space or zone
140.sub.1 further facilitates hemostatsis. Here, because blood flow
is substantially restricted through tissue compression space
140.sub.1, this results in facilitating and effectuating
hemostatsis.
[0059] The respective dimensions of sidewalls 156 and 158 and legs
132.sub.A, 132.sub.B, may be altered, which, in turn, may alter the
respective dimensions of the compressive spaces 140.sub.1 and
140.sub.2 occupied by stapled tissue segments "T.sub.1", "T.sub.2"
when the respective surgical fasteners 130.sub.A are in their
formed conditions. By altering the respective dimensions of
sidewalls 156 and 158, and/or legs 132.sub.A, 132.sub.B, any
desired level of hemostasis and blood flow in the stapled tissue
segments "T.sub.1", "T.sub.2" may be effectuated. Other various
attributes of the tissue (e.g., thickness or the presence of scar
tissue) may increase or diminish the level of hemostasis and blood
flow in the stapled tissue segments. In further embodiments, the
fasteners may have a smaller compression space adjacent the lateral
sides of the cartridge and a larger compression space adjacent the
longitudinal slot 122. In other embodiments, the heights of the
pushers, length of the legs, or both, differ to form a fastener
with compressive spaces that differ in size.
[0060] FIG. 11 illustrates the surgical fasteners 130 including
legs 132.sub.A and 132.sub.B, and respective pushers 150 having
sidewalls 156 and 158 loaded within the cartridge body 112 shown in
FIGS. 1 and 4. The surgical fasteners 130 and respective pushers
150 are arranged to define a pair of rows 128 of fastener retention
slots 126 formed in the top wall 120. The pair of rows 128 are each
spaced laterally from the longitudinal slot 122, on opposite sides
thereof, and include inner and outer ends 128.sub.A and 128.sub.B,
respectively, such that the surgical fasteners 130 will be deployed
on opposite sides of the cut-line, or longitudinal slot 122 created
in the tissue upon fastening. That is, the legs 132.sub.A of the
fasteners 130, which are driven by cam wedges 644 and are supported
by sidewall 156, provide a greater compressive force as there is a
shorter distance between the inner surface of the backspan and the
curve of the formed legs, and in the illustrated embodiment are
provided closer to the cut line, or longitudinal slot 122. The legs
132.sub.B of fasteners 130, which are also driven by cam wedges 644
and are supported by sidewall 158, provide a lesser compressive
force as there is a greater distance between the inner surface of
the backspan and the curve of the formed legs, and in the
illustrated embodiment are provided farther from the cut line, or
slot 122. It should be appreciated, however, that the fasteners can
be placed in rows that are configured differently than the
foregoing. For example, two or more rows are on either side of the
slot 122, with the outer rows having compressive spaces that differ
after forming, or having standard fasteners and/or some combination
thereof.
[0061] In further embodiments, the shape of the cartridge or anvil
or both applies a compression force to the tissue that varies
depending on the location with respect to the cartridge and anvil.
In certain embodiments, the cartridge or anvil or both are
configured to apply a compression force to the tissue that
corresponds to the compressive space or area of the fastener at
that location.
[0062] In certain embodiments, a staple having legs of
approximately the same length are formed using pushers configured
as pusher 150 so that one leg of the staple is crimped more than
the other.
[0063] In one particular embodiment, the rows 128, are comprised
solely of surgical fasteners 130 such that the flow of blood
through the tissue immediately surrounding the cut-line, or slot
122 is substantially restricted by formed legs 132.sub.A of
surgical fasteners 130, whereas the flow of blood through the
tissue surrounding areas away from the cut-line, or slot 122 is
less restricted by formed legs 132.sub.B of surgical fasteners 130.
Accordingly, the flow of blood is minimized in the tissue
immediately adjacent the cut-line, or longitudinal slot 122 and is
increased gradually as the lateral distance from the cut-line is
also increased. It should be appreciated that some of the fasteners
in cartridge 100 can have different configurations, e.g., the
diameters of the fasteners could be varied to accommodate tissue of
different thicknesses and to control tissue compression by the
fasteners. In addition, the formed configuration of the fasteners
can be varied to vary the tissue compression applied by the
fasteners. For example, the backspan of the fastener 130.sub.A may
be dimpled or crimped to decrease the compression space of the
formed fastener.
[0064] From the foregoing and with reference to the various figure
drawings, those skilled in the art will appreciate that certain
modifications can also be made to the present disclosure without
departing from the scope of the same. For example, the surgical
fasteners described herein above may be formed from a variety of
surgically acceptable materials including titanium, plastics,
bio-absorbable materials, etc. Additionally, any of the
aforementioned surgical fasteners may be treated, chemically or
otherwise, prior to being loaded into cartridge 100.
[0065] It is also contemplated that the backspan 134 of the
surgical fastener 130 may include one or more pockets (see FIG. 7C,
for example) that are positioned to engage (i.e., receive or bend)
the legs 132 during formation of the surgical fastener 130 and
configured to redirect the legs 132 such that they are coiled
toward the backspan 134, as discussed in commonly owned U.S. patent
application Ser. No. 11/444,664, filed Jun. 1, 2006, the entire
contents of which are incorporated by reference herein.
[0066] It is contemplated that in addition to varying the
respective heights and lengths of the pusher 150 and surgical
fastener 130, the thickness of the backspan 134 and the legs
132.sub.A and 132.sub.B may also be varied such that one leg of the
surgical fastener 130 provides a greater compression force to
stapled tissue occupied therein than the other leg of the surgical
fastener 130. For example, in the embodiment of FIGS. 6 and 8, the
backspan and legs are shown having a uniform diameter. It should be
appreciated that the diameter of the legs and backspan, or portions
thereof, can vary within the fastener. Examples of varying backspan
sizes are shown in FIGS. 7A-7B. In the embodiment of FIG. 7A, the
backspan is enlarged with respect to the legs and is an integral
element 234 in which the fastener legs 232 are embedded. In FIG.
7C, the backspan is 334 is integral with the fastener legs 332. In
the embodiments of FIGS. 7B and 7D, a separate backspan material is
attached to the fastener 430, 530, respectively, with backspan 434
of FIG. 7B including a cylindrical collar 435 encircling the
backspan portion 431 of the fastener 430 and the backspan 534 of
fastener 530 of FIG. 7D encompassing the backspan portion 531 of
the fastener and a portion of the fastener legs 532. In the
embodiment of FIG. 7E, a surgical fastener 730.sub.A is shown in
its formed condition. The surgical fastener 730.sub.A includes
recesses, humps or mounds 738.sub.A formed in the backspan
734.sub.A. Recesses extend inwardly from the backspan 734.sub.a
curving towards the penetrating ends 736 of the legs 732 and
defining a recess, hump or mound of a first height "H.sub.1". The
backspan material of FIGS. 7B and 7D can be composed of any
suitable material, by way of example, a resilient form, elastomer,
or molder plastic can be used. Varying the thickness or height of
these backspans or backspan materials can vary the compression
force of the formed staple by varying the distance between the
curved legs and inner portion of the backspan. This variation can
be provided in addition to the varying gap distances of the cam
wedges to accommodate varying tissue thicknesses. FIG. 7B
illustrates this varying backspan by showing in phantom a collar of
larger diameter (D2 compared to D1) to decrease the compression
area. Other backspan shapes and attachments to achieve the various
compression forces are also contemplated.
[0067] The surgical fastener applying apparatus according to
certain embodiments of the present disclosure includes a plurality
of cam bars for interacting with the pushers to deploy the surgical
fasteners. For example, the apparatus disclosed in U.S. Pat. No.
5,318,221, the disclosure of which is hereby incorporated by
reference herein, in its entirety, has a cam bar adapter that holds
a plurality of cam bars and a knife. A slot is advanced through
operation of the handle of the apparatus, which drives the cam bars
and knife forward. A clamp tube that surrounds the proximal end of
the anvil is advanced to clamp the anvil and cartridge together. In
another example, the apparatus disclosed in U.S. Pat. No.
5,782,396, the disclosure of which is hereby incorporated by
reference herein, in its entirety, has an actuation sled. An
elongated drive beam is advanced distally through operation of the
handle of the apparatus, driving the actuation sled forward. The
distal end of the drive beam engages the anvil and the slot that
supports the cartridge as the drive beam travels distally, to
deploy the staples and clamp the anvil and cartridge together. The
surgical fastener applying apparatus shown in U.S. Pat. No.
7,070,083 employs a pusher bar incorporating a plurality of pushers
that are advanced substantially simultaneously to deploy the
fasteners against an anvil. One or more of the pushers may
incorporate a deflectable portion, in certain embodiments of the
present disclosure.
[0068] The surgical fastening cartridge 100 may also be employed
with a surgical fastener applying apparatus 4000 (FIG. 12).
Apparatus 4000 has a drive bar that advances distally that is
typically used to simultaneously deploy a plurality of surgical
fasteners (surgical fasteners 130 for example) into a target
section of tissue (not explicitly shown). Here, a scalpel or other
such cutting element may be used to remove the target section of
tissue. Further details regarding the use and function of surgical
fastener applying apparatus 4000 may be obtained through reference
to U.S. Pat. No. 7,070,083 the entire contents of which having been
previously incorporated by reference herein. In an alternate
embodiment, the apparatus 4000 could include a cutting element as
in the other cartridges disclosed herein.
[0069] Although the illustrative embodiments of the present
disclosure have been described herein with reference to the
accompanying drawings, the above description, disclosure, and
figures should not be construed as limiting, but merely as
exemplary of various embodiments.
* * * * *