U.S. patent application number 15/772529 was filed with the patent office on 2019-03-14 for stapler anvil with compliant tip.
The applicant listed for this patent is Intuitive Surgical Operations, Inc.. Invention is credited to Jeffrey A. Smith.
Application Number | 20190076143 15/772529 |
Document ID | / |
Family ID | 58695055 |
Filed Date | 2019-03-14 |
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United States Patent
Application |
20190076143 |
Kind Code |
A1 |
Smith; Jeffrey A. |
March 14, 2019 |
STAPLER ANVIL WITH COMPLIANT TIP
Abstract
A surgical stapler is provided that includes a first jaw and a
second jaw. The first jaw includes a proximal end portion and a
distal end portion. The second jaw includes a proximal end portion
and a distal end portion. The proximal end portion of the first jaw
is pivotally mounted to the proximal end portion of the second jaw.
A flexible guide is secured to the distal end portion of the first
jaw.
Inventors: |
Smith; Jeffrey A.;
(US) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Intuitive Surgical Operations, Inc. |
Sunnyvale |
CA |
US |
|
|
Family ID: |
58695055 |
Appl. No.: |
15/772529 |
Filed: |
October 31, 2016 |
PCT Filed: |
October 31, 2016 |
PCT NO: |
PCT/US2016/059646 |
371 Date: |
April 30, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62255138 |
Nov 13, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 34/37 20160201;
A61B 34/30 20160201; A61B 17/07207 20130101; A61B 2034/305
20160201; A61B 2090/0807 20160201; A61B 2017/07257 20130101; A61B
2090/08021 20160201 |
International
Class: |
A61B 17/072 20060101
A61B017/072; A61B 34/37 20060101 A61B034/37 |
Claims
1. A surgical stapler comprising: a first jaw that includes a
proximal end portion and a distal end portion; a second jaw that
includes a proximal end portion and a distal end portion, wherein
the proximal end portion of the first jaw is pivotally mounted to
the proximal end portion of the second jaw; and a flexible guide
secured to the distal end portion of the first jaw.
2. The surgical stapler of claim 1, wherein the flexible guide
includes: a base portion secured to the distal end portion of the
first jaw; and a tip portion distally spaced apart from the distal
end portion of the first jaw.
3. The surgical stapler of claim 1, wherein the flexible guide
includes: a base portion secured to the distal end portion of the
first jaw; and a tip portion distally spaced apart from the distal
end portion of the first jaw, wherein the flexible guide has a
tapered contour between the base portion and the tip portion.
4. The surgical stapler of claim 1, wherein the flexible guide
includes: a base portion secured to the distal end portion of the
first jaw a tip portion distally spaced apart from the distal end
portion of the first jaw, wherein the tip portion is more flexible
than the base portion.
5. The surgical stapler of claim 1, wherein the flexible guide
includes: a base portion secured to the distal end portion of the
first jaw; a tip portion distally spaced apart from the distal end
portion of the first jaw, wherein a cross section of the tip
portion is narrower than a cross section of the base portion,
wherein a section of the tip portion comprises less mass than a
section of the base portion.
6. The surgical stapler of claim 1, wherein the first jaw includes
an anvil surface; and wherein the flexible guide includes: a base
portion secured to the distal end portion of the first jaw, and a
tip portion distally spaced apart from the distal end portion of
the first jaw, wherein the flexible guide has a contour between the
base portion and the tip portion that curves toward the anvil
surface.
7. The surgical stapler of claim 1, wherein the first jaw includes
an anvil surface and has a longitudinal central axis; and wherein
the flexible guide includes: a base portion secured to the distal
end portion of the first jaw, and a tip portion distally spaced
apart from the distal end portion of the first jaw in alignment
with the central axis, wherein the flexible guide has a contour
between the base portion and the tip portion that curves toward the
anvil surface.
8. The surgical stapler of claim 1, wherein the first jaw includes
an anvil surface and has a longitudinal central axis and a first
jaw height; and wherein the flexible guide includes: a base portion
secured to the distal end portion of the first jaw, and a tip
portion distally spaced apart from the distal end portion of the
first jaw in alignment with the central axis, wherein the flexible
guide has a contour between the base portion and the tip portion
that curves toward the anvil surface such that the tip portion is
spaced apart from the first jaw by a first distance in a direction
perpendicular to the central axis and the base portion is spaced
apart from the first jaw by a second distance in the direction
perpendicular to the central axis, and wherein the first distance
is greater than the second distance by an amount equal to or
greater than the first jaw height.
9. The surgical stapler of claim 1, wherein the first jaw includes
an anvil surface and has a longitudinal central axis and a first
jaw width; and wherein the flexible guide includes: a base portion
secured to the distal end portion of the first jaw; and a tip
portion distally spaced apart from the distal end portion of the
first jaw in alignment with the central axis, wherein the flexible
guide has a contour between the base portion and the tip portion
that curves toward the anvil surface such that the tip portion is
spaced apart from the first jaw by a first distance in a direction
perpendicular to the longitudinal central axis and the base portion
is spaced apart from the first jaw by a second distance in the
direction perpendicular to the central axis, and wherein the first
distance is greater than the second distance by an amount equal to
or greater than the first jaw width.
10. The surgical stapler of claim 1, wherein the first and second
jaws are rigid; and wherein the flexible guide includes a compliant
material.
11. The surgical stapler of claim 1, wherein the flexible guide
includes a compliant material having a durometer measure within a
range 30-60 Shore A.
12. The surgical stapler of claim 1, wherein the flexible guide
includes a compliant material having a durometer measure within a
range 40-50 Shore A.
13. The surgical stapler of claim 1, wherein the flexible guide
includes a medically inert material.
14. The surgical stapler of claim 1, wherein the first jaw includes
an anvil surface; the surgical stapler further including; a stapler
cartridge secured to the second jaw.
15. The surgical stapler of claim 14, wherein the flexible guide
includes: a base portion secured to the distal end portion of the
first jaw; and a tip portion distally spaced apart from the distal
end portion of the first jaw, wherein the flexible guide has a
contour between the base portion and the tip portion that curves
toward the anvil surface.
16. The surgical stapler of claim 15, wherein the first jaw has a
longitudinal central axis and a first jaw height; wherein the tip
portion is spaced apart from the first jaw by a first distance in a
direction perpendicular to the longitudinal central axis and the
end portion is spaced apart from the first jaw by a second distance
in the direction perpendicular to the longitudinal central axis;
and wherein the first distance is greater than the second distance
by an amount equal to or greater than the first jaw height.
17. The surgical stapler of claim 15, wherein the first jaw has a
longitudinal central axis and a first jaw width; wherein the tip
portion is spaced apart from the first jaw by a first distance in a
direction perpendicular to the longitudinal central axis and the
end portion is spaced apart from the first jaw by a second distance
in the direction perpendicular to the longitudinal central axis;
and wherein the first distance is greater than the second distance
by an amount equal to or greater than the first jaw width.
18. The surgical stapler of claim 1, wherein the first jaw includes
an anvil surface, the surgical stapler further including; a stapler
cartridge secured to the second jaw, wherein the flexible guide
includes a compliant material having a durometer measure within a
range 30-60 Shore A.
19. A surgical stapler comprising: a first jaw that includes a
proximal end portion, a distal end portion, and an anvil surface; a
second jaw that includes a proximal end portion and a distal end
portion, wherein the proximal end portion of the first jaw is
pivotally mounted to the proximal end portion of the second jaw;
and a flexible guide secured to the distal end portion of the first
jaw, wherein the flexible guide has a base portion and a tip
portion, wherein the tip portion is more flexible than the base
portion, and wherein the flexible guide is tapered and has a
contour that curves the tip portion towards the anvil surface
20. The surgical stapler of claim 19, wherein the first jaw
includes an anvil surface and has a jaw height and a jaw width;
wherein the tip portion is spaced apart from the first jaw by a
first distance in a direction perpendicular to a central axis of
the first jaw and the base portion is spaced apart from the first
jaw by a second distance in the direction perpendicular to the
central axis; and wherein the first distance is greater than the
second distance by an amount no less than a jaw dimension selected
from the group consisting of: the jaw height and the jaw width.
21. The surgical stapler of claim 19, wherein the flexible guide
includes a medically inert, compliant material having a durometer
measure within a range 30-60 Shore A.
22. A method of assembling a surgical stapler comprising a first
jaw and a second jaw, wherein a proximal end portion of the first
jaw is pivotally mounted to a proximal end portion of the second
jaw, the method comprising: securing a flexible guide to the first
jaw; and securing a stapler cartridge to the second jaw.
23. The method of claim 22, wherein the first jaw includes an anvil
surface that is rigid relative to the flexible guide; and wherein
the flexible guide includes a base portion and a tip portion,
wherein the tip portion is more flexible than the base portion,
wherein the flexible guide has a contour that is tapered and curves
the tip portion toward the anvil surface, and wherein the flexible
guide includes a medically inert, compliant material.
Description
RELATED APPLICATIONS
[0001] This patent application claims priority to and the benefit
of the filing date of U.S. Provisional Patent Application
62/255,138, entitled "STAPLER ANVIL WITH COMPLIANT TIP" filed Nov.
13, 2015, which is incorporated by reference herein in its
entirety.
BACKGROUND
[0002] Minimally invasive surgical techniques are aimed at reducing
the amount of extraneous tissue that is damaged during diagnostic
or surgical procedures, thereby reducing patient recovery time,
discomfort, and deleterious side effects. As a consequence, the
average length of a hospital stay for standard surgery may be
shortened significantly using minimally invasive surgical
techniques. Also, patient recovery times, patient discomfort,
surgical side effects, and time away from work may also be reduced
with minimally invasive surgery.
[0003] Minimally invasive teleoperated surgical systems have been
developed to increase a surgeon's dexterity when working on an
internal surgical site, as well as to allow a surgeon to operate on
a patient from a remote location (outside the sterile field). In a
teleoperated surgical system, the surgeon is often provided with an
image of the surgical site at a control console. While viewing a
three dimensional image of the surgical site on a suitable viewer
or display, the surgeon performs the surgical procedures on the
patient by manipulating master input or control devices of the
control console. Each of the master input devices controls the
motion of a servo-mechanically actuated/articulated surgical
instrument. During the surgical procedure, the teleoperated
surgical system can provide mechanical actuation and control of a
variety of surgical instruments or tools having end effectors that
perform various functions for the surgeon, for example, holding or
driving a needle, grasping a blood vessel, dissecting tissue,
stapling tissue, or the like, in response to manipulation of the
master input devices.
SUMMARY
[0004] In one aspect, a surgical stapler includes a first jaw that
includes a proximal end portion and a distal end portion and a
second jaw that includes a proximal end portion and a distal end
portion. The proximal end portion of the first jaw is pivotally
mounted to the proximal end portion of the second jaw. The flexible
guide secured to the distal end portion of the first jaw.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] Aspects of the present disclosure are best understood from
the following detailed description when read with the accompanying
figures. It is emphasized that, in accordance with the standard
practice in the industry, various features are not drawn to scale.
In fact, the dimensions of the various features may be arbitrarily
increased or reduced for clarity of discussion. In addition, the
present disclosure may repeat reference numerals and/or letters in
the various examples. This repetition is for the purpose of
simplicity and clarity and does not in itself dictate a
relationship between the various embodiments and/or configurations
discussed.
[0006] FIG. 1 is an illustrative plan view illustration of a
teleoperated surgical system in accordance with some
embodiments.
[0007] FIG. 2 is an illustrative perspective view of the Surgeon's
Console in accordance with some embodiments.
[0008] FIG. 3 is an illustrative perspective view of the
Electronics Cart in accordance with some embodiments.
[0009] FIG. 4 is an illustrative bock diagram diagrammatically
representing functional relationships among components of a
teleoperated surgery system in accordance with some
embodiments.
[0010] FIGS. 5A-5B are illustrative drawings showing a Patient Side
Cart and a surgical tool 62, respectively in accordance with some
embodiments.
[0011] FIG. 6 is an illustrative drawing showing an example
surgical tool in accordance with some embodiments.
[0012] FIG. 7A is an illustrative perspective drawing of a surgical
tool assembly with a stapling device having first and second jaws
and having a compliant guide tip secured to the first jaw in
accordance with some embodiments.
[0013] FIG. 7B is an illustrative side view of the distal portion
of the surgical tool assembly with the stapling device jaws in a
closed position in accordance with some embodiments.
[0014] FIG. 8 is an illustrative exploded view of a detachable
stationary second jaw in accordance with some embodiments.
[0015] FIGS. 9A-9C are illustrative drawings showing positions of
the driver shuttle within the cartridge body during different
stages of staple deployment process in accordance with some
embodiments.
[0016] FIG. 10 is an illustrative perspective view of a flexible
guide secured to the distal end of the first jaw, in accordance
with some embodiments.
[0017] FIGS. 11A-11B are illustrative drawings showing
complementary attachment mechanisms formed in the far distal
portion of the first jaw (FIG. 11A) and in the proximal base
portion (FIG. 11B) of the flexible guide in accordance with some
embodiments.
[0018] FIGS. 12A-12B are illustrative simplified schematic drawings
of a side elevation view (FIG. 12A) and a top elevation view (FIG.
12B) used to explain certain relative dimensions of a stapler
device having a flexible tip in accordance with some
embodiments.
[0019] FIGS. 13A-13E are illustrative drawings of multiple
alternative flexible guide tips having different contours that may
be interchangeably secured to a far distal end portion of a first
jaw in accordance with some embodiments.
[0020] FIGS. 14A-14D are illustrative schematic diagrams showing
use of a flexible guide tip to guide an anvil jaw of a stapler
device among anatomical structures in accordance with some
embodiments.
[0021] FIG. 15 is an illustrative drawing showing a flexible tip
used to guide an anvil jaw between anatomical structures in
accordance with some embodiments.
DESCRIPTION OF EMBODIMENTS
[0022] The following description is presented to enable any person
skilled in the art to create and use a stapler anvil with compliant
tip for use in surgery. Various modifications to the embodiments
will be readily apparent to those skilled in the art, and the
generic principles defined herein may be applied to other
embodiments and applications without departing from the spirit and
scope of the inventive subject matter. Moreover, in the following
description, numerous details are set forth for the purpose of
explanation. However, one of ordinary skill in the art will realize
that the inventive subject matter might be practiced without the
use of these specific details. In other instances, well-known
machine components, processes and data structures are shown in
block diagram form in order not to obscure the disclosure with
unnecessary detail. Identical reference numerals may be used to
represent different views of the same item in different drawings.
Flow diagrams in drawings referenced below are used to represent
processes. A computer system may be configured to perform some of
these processes. Modules within flow diagrams representing computer
implemented processes represent the configuration of a computer
system according to computer program code to perform the acts
described with reference to these modules. Thus, the inventive
subject matter is not intended to be limited to the embodiments
shown, but is to be accorded the widest scope consistent with the
principles and features disclosed herein.
[0023] Referring now to the drawings, in which like reference
numerals represent like parts throughout the several views, FIG. 1
is an illustrative plan view of a teleoperated surgical system 10,
typically used for performing a minimally invasive diagnostic or
surgical procedure on a Patient 12 who is lying down on an
Operating table 14. The system can include a Surgeon's Console 16
for use by a Surgeon 18 during the procedure. One or more
Assistants 20 may also participate in the procedure. The
teleoperated surgical system 10 can further include a Patient Side
Cart 22 and an Electronics Cart 24. The Patient Side Cart 22 can
manipulate at least one removably coupled tool assembly 26
(hereinafter also referred to as a "tool") through a minimally
invasive incision in the body of the Patient 12 while the Surgeon
18 views the surgical site through the Console 16. An image of the
surgical site can be obtained by an imaging device 28 (also called
endoscope 28 in contexts where endoscopes may be used), such as a
stereoscopic endoscope, which can be manipulated by the Patient
Side Cart 22 to orient the endoscope 28. The Electronics Cart 24
can be used to process the images of the surgical site for
subsequent display to the Surgeon 18 through the Surgeon's Console
16. The number of surgical tools 26 used at one time will generally
depend on the diagnostic or surgical procedure and the space
constraints within the operating room among other factors.
[0024] FIG. 2 is an illustrative perspective view of the Surgeon's
Console 16. The Surgeon's Console 16 includes a left eye display 32
and a right eye display 34 for presenting the Surgeon 18 with a
coordinated stereo view of the surgical site that enables depth
perception. The Console 16 further includes one or more input
control devices 36, which in turn cause the Patient Side Cart 22
(shown in FIG. 1) to manipulate one or more tools. The input
control devices 36 can provide the same degrees of freedom as their
associated tools 26 (shown in FIG. 1) to provide the Surgeon with
telepresence, or the perception that the input control devices 36
are integral with the tools 26 so that the Surgeon has a strong
sense of directly controlling the tools 26. To this end, position,
force, and tactile feedback sensors (not shown) may be employed to
transmit position, force, and tactile sensations from the tools 26
back to the Surgeon's hands through the input control devices
36.
[0025] FIG. 3 is an illustrative perspective view of the
Electronics Cart 24. The Electronics Cart 24 can be coupled with
the endoscope 28 and can include a processor to process captured
images for subsequent display, such as to a Surgeon on the
Surgeon's Console, or on another suitable display located locally
and/or remotely. For example, where a stereoscopic endoscope is
used, the Electronics Cart 24 can process the captured images to
present the Surgeon with coordinated stereo images of the surgical
site. Such coordination can include alignment between the opposing
images and can include adjusting the stereo working distance of the
stereoscopic endoscope.
[0026] FIG. 4 is an illustrative bock diagram diagrammatically
representing functional relationships among components of a
teleoperated surgery system 50 (such as system 10 of FIG. 1). As
discussed above, a Surgeon's Console 52 (such as Surgeon's Console
16 in FIG. 1) can be used by a Surgeon to control a Patient Side
Cart (Surgical Robot) 54 (such as Patient Side Cart 22 in FIG. 1)
during a minimally invasive procedure. The Patient Side Cart 54 can
use an imaging device, such as a stereoscopic endoscope, to capture
images of the procedure site and output the captured images to an
Electronics Cart 56 (such as the Electronics Cart 24 in FIG. 1). As
discussed above, the Electronics Cart 56 can process the captured
images in a variety of ways prior to any subsequent display. For
example, the Electronics Cart 56 can overlay the captured images
with a virtual control interface prior to displaying the combined
images to the Surgeon via the Surgeon's Console 52. The Patient
Side Cart 54 can output the captured images for processing outside
the Electronics Cart 56. For example, the Patient Side Cart 54 can
output the captured images to a processor 58, which can be used to
process the captured images. The images can also be processed by a
combination the Electronics Cart 56 and the processor 58, which can
be coupled together to process the captured images jointly,
sequentially, and/or combinations thereof. One or more separate
displays 60 can also be coupled with the processor 58 and/or the
Electronics Cart 56 for local and/or remote display of images, such
as images of the procedure site, or other related images.
[0027] FIGS. 5A-5B are illustrative drawings showing a Patient Side
Cart 22 and a surgical tool 62, respectively in accordance with
some embodiments. The surgical tool 62 is an example of the
surgical tools 26. The Patient Side Cart 22 shown provides for the
manipulation of three surgical tools 26 and an imaging device 28,
such as a stereoscopic endoscope used for the capture of images of
the site of the procedure. Manipulation is provided by teleoperated
mechanisms having a number of robotic joints. The imaging device 28
and the surgical tools 26 can be positioned and manipulated through
incisions in the patient so that a kinematic remote center is
maintained at the incision to minimize the size of the incision.
Images of the surgical site can include images of the distal ends
of the surgical tools 26 when they are positioned within the
field-of-view of the imaging device 28.
[0028] FIG. 6 is an illustrative drawing showing an example
surgical tool 70 that includes a proximal chassis 72, an instrument
shaft 74, and a distal end effector 76 having a jaw 78 that can be
articulated to grip a patient tissue. The proximal chassis includes
input couplers that are configured to interface with and be driven
by corresponding output couplers of the Patient Side Cart 22. The
input couplers are drivingly coupled with drive shafts that are
disposed within the instrument shaft 74. The drive shafts are
drivingly coupled with the end effector 76.
[0029] FIG. 7A is an illustrative perspective drawing of a surgical
tool assembly 200 with a stapling device 210 (also "stapler device
210") having a compliant guide (also called flexible guide) 211
disposed at a distal end in accordance with some embodiments. The
stapling device includes rigid first and second jaws 214, 216 shown
in an open position. The compliant guide 211 is secured to the
first jaw 214 of the stapling device 210 to aid a surgeon in
guiding the first jaw 214 to an anatomical tissue structure that is
to be stapled that is located behind other anatomical features that
obscures the tissue structure from a surgeon's view. The tool
assembly 200 includes a proximal actuation assembly 202, a main
shaft 206, a two degree of freedom (2-dof) wrist 208, shown in
partial cutaway, and the stapling device 210. The stapling device
210 includes an end effector base 212 coupled to a distal side of
the 2-dof wrist 208, a first articulable jaw 214 and a stationary
second jaw 216. The first jaw 214, sometimes referred to as the
anvil jaw 214, has a distal end 214-1 and a proximal end 214-2. The
second jaw 216 also has a distal end 216-1 and a proximal end
216-2. The end effector base 212 includes a pivot pin 217 secured
between the end effector base 212 and a proximal end of the first
jaw 214, about which a proximal end of the first jaw 214 pivots to
achieve opening and closing movement of the first jaw 214 relative
to the second jaw 216. In an open position shown in FIG. 7A, the
first jaw 214 is rotated to a position in which distal ends 214-1,
216-1 of the first and second jaws 214, 216 are spaced apart so
that the jaws can be more easily maneuvered within a surgical site
to encompass anatomical tissue (not shown) between them without
actually clamping the tissue in place between them.
[0030] In many embodiments, the actuation assembly 202 is
operatively coupled with the wrist 208 so as to selectively
reorient the stapling device 210 relative to the main shaft 206 in
two dimensions, referred to as pitch and yaw, and is operatively
coupled with the stapling device 210 so as to actuate rotation of
the first jaw 214 about the pivot pin 217 to open and close the
first jaw 214 relative to the end effector base 212 and the second
jaw 216. In accordance with some embodiments, control cables (not
shown) extend through a bore in the main shaft 206 to interconnect
the actuation assembly 202 with the wrist 208. The actuation
assembly 202 imparts forces to the control cables that result in
pitch and yaw movement of the wrist 208 and the stapler device 210.
Details of a suitable cable control mechanisms that can be used are
disclosed in U.S. Pat. No. 8,852,174 (filed Nov. 12, 2010) issued
to Burbank, which is expressly incorporated herein in its entirety
by this reference. In accordance with some embodiments a
rotationally-driven clamping mechanism (not shown) actuates the
upper jaw 214 relative to the lower jaw 216 to securely clamp
tissue between the upper and lower jaws. The clamping mechanism is
rotationally driven by a drive shaft (not shown) disposed internal
to the main shaft 206. Details of a suitable drive shaft-driven
clamping mechanism that can be used are disclosed in U.S. Pat. No.
8,876,857 issued to Burbank (filed Nov. 12, 2010), the full
disclosure of which is hereby expressly incorporated herein by
reference. In alternative embodiments, suitable cables (not shown)
are used to impart forces to open or close the jaws 214, 216.
Details of a suitable cable-driven clamping mechanism that can be
used are disclosed U.S. Patent Application Ser. No. 62/255,123,
filed on Nov. 13, 2015 and entitled "Stapler with composite cardan
and screw drive,", the full disclosure of which is hereby expressly
incorporated herein by reference.
[0031] FIG. 7B is an illustrative side view of the distal portion
of the surgical tool assembly 200 with the jaws 214, 216 in a
closed position disposed parallel to each other spaced apart by an
amount to accommodate anatomical tissue (not shown) that may be
clamped between them in accordance with some embodiments. The first
jaw 214 includes an anvil 220 having a rigid metal anvil surface
220-1 that faces the second jaw 216. In operation, staples are
deformed against the anvil surface 220-1 to staple together tissue
(not shown) disposed between the first and second jaws 214, 216.
The second jaw 216 includes an elongated stapler cartridge body 218
seated within a rigid metal stapler cartridge body support channel
221 configured to support the cartridge body 218. The stapler
cartridge body 218 carries staples to be used to attach tissue
during a surgical procedure. The stapler cartridge body 218 defines
a central longitudinal knife slot 238 that extends through the
cartridge body 218 and extends along substantially its entire
length. The stapler cartridge body 218 also defines multiple
laterally spaced rows of staple openings 106 that each extends
longitudinally along the cartridge body 218. In some embodiments,
three rows of staple openings 106 extended along one side of the
knife slot 238, and three rows of staple openings extended along an
opposite side of the knife slot 238. Each staple retention slot 240
(also "staple opening 240") is sized to receive a staple.
[0032] FIG. 8 is an illustrative exploded view of a stationary
second jaw 216 in accordance with some embodiments. The second jaw
216 includes the cartridge body 218 received within a support
channel structure 221. The cartridge body 218 includes a proximal
end 218-1 and a distal end 218-2. The cartridge body 218 includes
cartridge outer sidewalls 234 and an upper surface 236. The upper
surface 236 faces the anvil 220-1 of the first jaw 214, which acts
as an anvil, when the second jaw is mounted to the end effector
base 212. The upper surface 236 of the cartridge 218 defines a
central first longitudinal cartridge slot 238 that extends through
the cartridge 218 when the cartridge body 218 is disposed within
the support channel structure 221. The upper surface 236 also
defines multiple rows of laterally spaced staple retention slots
240 that extend longitudinally along one side of the first
cartridge slot 238 and defines multiple rows of laterally spaced
staple retention slots 240 that extend longitudinally along an
opposite side of the first cartridge slot 238. Each staple
retention slot 240 is sized to receive a staple 242. A drive
shuttle 144 includes a plurality of inclined upstanding cam wedges
246 and a knife 248 upstanding between and proximal to the cam
wedges 246. The cartridge body 218 defines longitudinal slots (not
shown) in its underside along which the cam wedges 246 can slide
with the knife upstanding from and sliding within the first
cartridge slot 238.
[0033] FIGS. 9A-9C are illustrative drawings showing positions of
the drive shuttle 144 within the cartridge body 218 during
different stages of staple deployment process in accordance with
some embodiments. The cartridge body 218 defines an internal
central cavity 320 extending between its distal end 218-1 and its
proximal end 218-2. A lead screw 134 is mounted within the cavity
320 in engagement with complementary threads (not shown) located at
the drive shuttle 144 for rotation relative to the housing
cartridge body 218 and extends between the distal end 218-1 and its
proximal end 218-2 through the central cavity 620.
[0034] FIG. 9A shows the drive shuttle 144 located adjacent the
proximal end 218-2 of the cartridge body 218 at the beginning of a
stapling run. FIG. 9B shows the drive shuttle 144 disposed in a
middle portion of the cartridge body 218 during a stapling run.
FIG. 9C shows the drive shuttle 144 located adjacent the distal end
218-2 after stapling completion of a stapling run. In operation
during a stapling run using the stapler device 210, the drive
shuttle 144 translates through the longitudinal pusher slots 239-1,
239-2, formed in an underside of the cartridge 218 to advance the
cam wedges 246 into sequential contact with drive shuttle 144
within the longitudinally spaced retention slots 240, to cause
drive shuttle 144 to translate vertically within retention slots
240, and to urge staples 242 from retention slots 240 into the
staple deforming cavities (not shown) formed within the anvil 220
of the first jaw 214. As the drive shuttle 144 translates
longitudinally, it pushes up fasteners staples, which are
deformation against the anvil 220. Meanwhile, the knife 248
upstands through the first cartridge slot 238 and cuts tissue
between tissue regions stapled through action of the cam wedges
246, fasteners staples and the anvil 220. U.S. Pat. No. 8,991,678
(filed Oct. 26, 2012) issued to Wellman et al., which is
incorporated herein in its entirety by this reference, discloses a
surgical stapler cartridge and its operation.
[0035] FIG. 10 is an illustrative perspective view of a flexible
guide 211 secured to the distal end 214-1 of the first jaw 214, in
accordance with some embodiments. The distal end of the first jaw
includes a far distal portion 266. The anvil surface 220-1 includes
multiple rows of staple deformation indents 260 configured to have
staples deflected against them during dispensing of the staples
242. The far distal portion 266 of the first jaw 214 is disposed
distal to the portion of the first jaw 214 in which the indents 260
are formed. The indents 260 are positioned to align with staple
openings 240 formed in the cartridge body 218, when the staple
device 210 jaws 214, 216 are disposed in a closed position parallel
to one another. In accordance with some embodiments, the anvil
surface 220-1 includes a centerline region 262 with three rows of
indents 260 on each side of it. The three rows of indents 260 are
aligned with three rows of staple openings 240 formed on opposite
sides of the knife slot 238 when the jaws are closed. Thus, it will
be appreciated that the distal end 214-1 is wide enough to
accommodate the multiple rows of deformation indents 260. The
flexible guide 211 includes a proximal base portion 211-2 secured
to the distal end 214-1 of the first jaw 214 and includes a distal
tip portion 211-1. The flexible guide 211 has a tapered shape that
is wider at its proximal base 211-2 and narrower at its distal tip
211-1. The flexible guide 211 and the distal end 214-1 of the first
jaw 214 have complementary outer surface contours that cooperate to
provide a continuous smooth surface that includes the surface of
the far distal portion 266 and the outer surface of the flexible
guide 211.
[0036] FIGS. 11A-11B are illustrative drawings showing
complementary attachment mechanisms formed in the far distal
portion 266 of the first jaw 214 (FIG. 11A) and in the proximal
base portion 211-2 (FIG. 11B) of the flexible guide 211 in
accordance with some embodiments. Referring to FIG. 11A, the far
distal portion 266 of the first jaw 214 includes a substantially
rectangular distal end face 268 that defines an end face opening
270 surrounded by a retainer surface 272 (in this case, also a
"proximal end face 272"). Referring to FIG. 11B, the proximal base
portion 211-2 of the flexible guide 211 includes a substantially
rectangular proximal end face 272. A beam 274 upstands proximally
from the proximal end face 272. The beam 274 includes an outward
projecting flange 276. The end face opening 270 is sized to permit
passage of the flange 276 through it. More particularly, the beam
274 and its flange 276 are formed of a flexible material that is
sufficiently deformable for the flange 276 to be pushed through the
end face opening 270. Moreover, the retainer surface 272 and the
flange 276 have complementary surfaces that interact to secure the
guide 211 in place once the flange 276 is received within the end
face opening 270. Thus, to secure the guide 211 to the first jaw
214, a user may apply a force to push the flange 276 to deform it
sufficiently to squeeze through the end face opening 270 so that
the flange 276 engages the retainer surface 272. Conversely, a user
may apply a force to pull the flange 276 out of engagement with the
retainer surface 272 so that the upstanding beam 274 and the flange
276 can be removed through the end face opening 270.
[0037] The flexible guide 211 is used by a surgeon working manually
or using a teleoperated minimally invasive surgical system to guide
the first jaw 214, also referred to as the anvil jaw, of a stapler
device 210 into a position in which the first and second jaws
214-216 can be closed to clamp anatomical tissue between them for
stapling. The flexible guide 211 has a tapered contour that
smoothly changes over its length between a small-dimension distal
tip portion 211-1 and a greater dimension proximal base portion
211-2 that matches the dimension of the far distal portion 266 of
the first jaw 214. The taper contour of the flexible guide 211 aids
a surgeon in using the flexible guide to locate an unseen passage
between anatomical structures that the first jaw 214, which is
secured to the flexible guide 211, can follow.
[0038] In accordance with some embodiments, the flexible tip 211 is
formed from a material that is sufficiently compliant so that the
flexible guide 211 flexes in response to abutting against delicate
anatomical tissue likely to be encountered in the course of its
passage unseen by a surgeon behind other anatomical structures. In
accordance with some embodiments, the material is sufficiently
compliant that it is likely to comply with and conform to the
contour of such anatomical structures so as to avoid deforming
their shape and possibly causing damage. likely to be encountered
while the tip is out of view of a surgeon guiding the tip due to
passage of the guide 211 behind other anatomical structures.
[0039] More specifically, in accordance with some embodiments, the
flexible guide 211 is formed from a medically inert material, i.e.
a material that does not interact chemically with tissue structures
of a surgical site, having a durometer hardness measure that
preferably is in a range 30-60 Shore A, and that is even more
preferably in a range 40-50 Shore A. Suitable materials include
Silicon, TPE, TPU, Ktryton, and Viton.
[0040] FIGS. 12A-12B are illustrative simplified schematic drawings
of a side elevation view (FIG. 12A) and a top elevation view (FIG.
12B) used to explain certain relative dimensions of a stapler
device 210 having a flexible tip 211 in accordance with some
embodiments. Referring to FIG. 12A, the pivot 217 rotatably secures
the first jaw 214 to the base 212. The second jaw 216 is fixedly
secured to the base 212. The jaws 214, 216 are shown in an open
position. Referring to FIGS. 12A-6B, the first jaw 214 and the
flexible guide 211 share a longitudinal central axis 280.
[0041] A flexible tip length (T.sub.L) refers to a length along the
central axis 280 between a length between the proximal base portion
211-2 and the distal tip portion 211-1 of the flexible tip 211. A
flexible tip height (T.sub.H) refers to a transverse length,
perpendicular to the central axis 280, between an upper portion 650
of the proximal base portion 211-2 and the distal tip portion 211-1
of the flexible guide 211. The upper portion 650 of the proximal
base portion 211-2 is disposed adjacent a back side surface 220-2
of the first jaw 214 that faces away from the anvil surface 220-1
when the flexible guide 211 is secured to the first jaw 214. A
flexible tip curvature (T.sub.C) is defined as the ratio of tip
height to tip length (T.sub.H/T.sub.L). In accordance with some
embodiments, the first jaw 214 has a generally rectangular shape in
which a first jaw length dimension extends parallel to the
longitudinal axis 280 and a first jaw width dimension extends
perpendicular to the longitudinal axis 280. Thus, a first jaw width
dimension (A1.sub.W) refers to a transverse distance, perpendicular
to the central axis 280, in a plane of the anvil surface 220-1.
Moreover, a first jaw height (A1.sub.H) refers to a distance
between the anvil surface 220-1 and the back side surface 220-2 of
the first jaw 214. Thus, the first jaw height dimension extends
perpendicular to the length and width dimensions and perpendicular
to the central axis 280.
[0042] FIGS. 13A-13E are illustrative drawings of multiple
alternative flexible guide tips having different contours that may
be interchangeably secured to a far distal end portion 266 of the
first jaw 214 in accordance with some embodiments. The flexible
guide tips 602-606 of FIGS. 13A-13C have different lengths and
similar gentle curvatures. The flexible guide tip 608 of FIGS.
13D-13E illustrates flexure of the flexible tip 608 upon contact
with tissue structure. Each of the example curvatures extends in a
direction toward the second jaw 216 and within the diameter of the
device from the second jaw 216 and toward from the anvil surface
220-1. Each of the alternative flexible tips 602-608 includes a
beam 274 and flange 276 for use for selective engagement with the
distal portion 214-1 of the first jaw 214. Different length guide
tips 608-608 are suitable for different surgical settings. The
wider the tissue structure behind which the first jaw 214 must
pass, the longer the flexible tip that may be employed. In
particular, for example, a surgeon may look for the tip to emerge
from behind the tissue structure as an indication that a passage
exists behind the structure through which the first jaw 214 can
safely pass. The wider the tissue structure, the longer the tip
that may be used.
[0043] Referring to FIGS. 13A-13C, respective first, second and
third flexible tips 602, 604, 606 each has a progressively longer
flexible tip length (T.sub.L) and each has a progressively
shallower flexible tip curvature (T.sub.C). However, each has the
substantially the same flexible tip height (T.sub.H). In accordance
with some embodiments, the flexible tip height (T.sub.H) is
selected to be at least as great as the first jaw height (A1.sub.H)
so that each of the first, second and third flexible tips 602-606
is suitable for use to explore for voids between anatomical
structures (not shown) that are sufficiently wide to accommodate
passage of the first jaw height (A1.sub.H) dimension. The different
length first, second and third flexible tips 602-606 are suitable
for different exploring different length passages between
anatomical structures (not shown). Moreover, the greater a flexible
tip's length dimension (T.sub.L) for a given flexible tip height
(T.sub.H), the more pliant its distal tip portion 211-1 it will be
narrower at its distal tip portion 211-1, and therefore, will
include less mass and will more easily comply with tissue
structures (not shown) that may be encountered during traversal of
an anatomical tissue region.
[0044] FIGS. 14A-14D are illustrative schematic diagrams showing
use of a flexible guide tip to guide an anvil jaw of a stapler
device among anatomical structures in accordance with some
embodiments. FIG. 14A shows the stapler jaws 214, 216 in an open
position, with the flexible guide 211 extending behind a large
tissue structure 302, such as lung tissue for example, so as to be
out of view from a perspective of a surgeon (not shown). A region
that is to be stapled, referred to as a staple target region 304,
indicated with dashed lines. First second and third individual
anatomical structures 306, 308, 310 are disposed nearby the staple
target region 304. For example, the first individual structure 306
may be a pulmonary artery; the second individual structure 308 may
be a pulmonary vein; and the third individual structure 310 may be
a main artery. In this example, the staple target region 304
crosses over the first individual anatomical structure 306.
Referring to FIG. 14B, it is assumed that the surgeon has caused
the first arm 214 and the flexible guide 211 to follow a path
behind the large tissue structure 302 in which the guide 211 abuts
the second individual anatomical structure 308. However, the
flexible guide 211 is sufficiently flexible that its shape bends in
compliance with the shape of the second individual anatomical
structure 308 that it has bumped into. Although the second
anatomical structure 308 is shown to have been slightly deformed
due to the contact, it is not deformed sufficiently to cause damage
to it. Assume that the surgeon recognizes that the guide 211 must
have contacted an unseen anatomical structure, since the guide 211
has not emerged from behind the large tissue structure 302, even
though it should have based upon how much of the tip's length is
hidden behind it. Referring to FIG. 14C, the surgeon it is assumed
that the surgeon now has inserted the anvil jaw 214 and the guide
211 behind the large tissue structure, but this time on a different
path that threads between the hidden anatomical tissue structures
306-310. The tip is shown poking out from a side of the large
tissue structure 302 that is opposite the side that it went in. The
surgeon determines that the first jaw 214 is properly aligned with
the staple target region 304. Referring to FIG. 14D, the jaws 214,
216 are rotated to a closed position clamping the staple target
region 304 between them, and the staples are dispensed.
[0045] FIG. 15 is an illustrative drawing showing a flexible guide
211 used to guide an anvil jaw 214 between anatomical structures in
accordance with some embodiments. Assume that a large tissue
structure 402 hides the flexible guide 211 and the distal portion
of the anvil jaw 214 from a surgeon's field view. Assume that the
large tissue structure includes ling tissue and that hidden behind
it are a pulmonary artery 406, a pulmonary vein 408 and a main
artery 410, Further assume that a staple target region 404
indicated by dashed lines is disposed on the pulmonary artery 406.
It can be seen that the guide 211 has passed behind the pulmonary
artery 406 and in front of the pulmonary vein 408. The guide 211 is
used by a surgeon to guide the anvil jaw, which follows behind it
into position to dispense staples at the staple target region
404.
[0046] The foregoing description and drawings of embodiments in
accordance with the present invention are merely illustrative of
the principles of the invention. Therefore, it will be understood
that various modifications can be made to the embodiments by those
skilled in the art without departing from the spirit and scope of
the invention, which is defined in the appended claims.
* * * * *