U.S. patent application number 15/850505 was filed with the patent office on 2019-06-27 for stapling instrument comprising a tissue drive.
The applicant listed for this patent is Ethicon LLC. Invention is credited to Gregory J. Bakos, Jason L. Harris, Jerome R. Morgan, Frederick E. Shelton, IV, Janna B. Volz, Lauren S. Weaner, Mark S. Zeiner.
Application Number | 20190192148 15/850505 |
Document ID | / |
Family ID | 68699102 |
Filed Date | 2019-06-27 |
View All Diagrams
United States Patent
Application |
20190192148 |
Kind Code |
A1 |
Shelton, IV; Frederick E. ;
et al. |
June 27, 2019 |
STAPLING INSTRUMENT COMPRISING A TISSUE DRIVE
Abstract
A surgical stapler for stapling the tissue of a patient is
disclosed. The surgical stapler comprises a handle, a shaft
extending from the handle, a plurality of staple cartridges, and an
end effector comprising a tissue compression surface and an anvil
comprising staple forming pockets, wherein the anvil is movable
toward the tissue compression surface during a closing motion. The
surgical stapler further comprises an anvil closing system
configured to move the anvil through the closing motion, a staple
firing system configured to deploy the staple cartridges along a
path, and means for gripping the patient tissue and creating
relative movement between the end effector and the patient tissue
to re-position the end effector along the path.
Inventors: |
Shelton, IV; Frederick E.;
(Hillsboro, OH) ; Morgan; Jerome R.; (Cincinnati,
OH) ; Harris; Jason L.; (Lebanon, OH) ;
Weaner; Lauren S.; (West Chester, OH) ; Volz; Janna
B.; (West Chester, OH) ; Bakos; Gregory J.;
(Mason, OH) ; Zeiner; Mark S.; (Mason,
OH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Ethicon LLC |
Guaynabo |
PR |
US |
|
|
Family ID: |
68699102 |
Appl. No.: |
15/850505 |
Filed: |
December 21, 2017 |
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/0042 20130101;
G06F 3/044 20130101; A61B 2017/00022 20130101; A61B 2017/00734
20130101; A61B 2017/07271 20130101; A61B 17/1155 20130101; A61B
2017/0046 20130101; A61B 2017/00039 20130101; A61B 2017/00818
20130101; A61B 2017/308 20130101; A61B 2090/037 20160201; A61B
17/3403 20130101; A61B 90/361 20160201; A61B 2017/07214 20130101;
A61B 2017/2902 20130101; A61B 17/068 20130101; A61B 17/07207
20130101; A61B 17/1626 20130101; A61B 46/40 20160201; A61B
2017/00473 20130101; A61B 17/072 20130101; A61B 34/10 20160201;
A61B 2017/00128 20130101; A61B 2017/00207 20130101; A61B 2017/2908
20130101; A61B 2017/07285 20130101; A61B 17/0644 20130101; A61B
2017/00199 20130101; A61B 2017/07264 20130101; A61B 2017/2929
20130101; A61B 2034/301 20160201; A61B 2090/371 20160201; A61B
2017/00004 20130101; A61B 2017/07235 20130101; A61B 2017/2927
20130101; A61B 2090/366 20160201; A61F 5/0083 20130101; A61B
2017/07257 20130101; A61B 2090/365 20160201; A61B 17/0682 20130101;
A61B 17/28 20130101; A61B 34/25 20160201; A61B 90/37 20160201; A61B
2017/00061 20130101; A61B 2017/306 20130101; A61B 2034/107
20160201; A61B 34/70 20160201; A61B 34/74 20160201; A61B 2017/00367
20130101; A61B 2090/0811 20160201; A61B 34/30 20160201; A61B
2017/00057 20130101; A61B 2090/3954 20160201; A61B 2017/00349
20130101; A61B 2017/00561 20130101; A61B 2090/3958 20160201; A61B
17/105 20130101; A61B 2017/00119 20130101; A61B 2017/00398
20130101; A61F 5/0036 20130101; G06F 3/011 20130101; A61B 17/34
20130101; A61B 2017/07221 20130101; A61B 17/0483 20130101; A61B
18/14 20130101; A61B 50/30 20160201; A61B 2034/2065 20160201; G06F
3/0446 20190501; A61B 2017/00017 20130101; A61B 2017/00424
20130101; A61B 2017/00951 20130101; A61B 2017/07228 20130101; A61B
17/29 20130101; A61B 17/3462 20130101; A61B 2017/00115 20130101;
A61B 2034/2051 20160201; A61B 2034/252 20160201; G06F 2203/04103
20130101; G06F 2203/04106 20130101; A61B 17/16 20130101; A61B
2017/07278 20130101; A61B 17/0684 20130101; A61B 46/10 20160201;
A61B 2017/00876 20130101; A61B 2017/00827 20130101; A61B 2090/3912
20160201; G06F 3/0393 20190501; G06F 3/04144 20190501; A61B
2017/00106 20130101; A61B 2017/0725 20130101; A61B 2017/2903
20130101; A61B 2018/1452 20130101; A61B 2090/372 20160201; A61B
2017/003 20130101; A61B 90/30 20160201; A61B 2017/00477 20130101;
A61B 2034/2055 20160201; A61B 2017/00221 20130101; A61B 2090/364
20160201; G06F 3/041 20130101; G06F 3/0418 20130101; A61B
2017/00353 20130101; A61B 2034/742 20160201; G06F 3/0416
20130101 |
International
Class: |
A61B 17/072 20060101
A61B017/072; A61B 17/064 20060101 A61B017/064; A61B 17/068 20060101
A61B017/068; A61B 17/10 20060101 A61B017/10 |
Claims
1. A surgical stapler for stapling the tissue of a patient,
comprising: a handle; a shaft extending from said handle; an end
effector, comprising: a tissue compression surface; and an anvil
comprising staple forming pockets, wherein said anvil is movable
toward said tissue compression surface during a closing motion; an
anvil closing system configured to move said anvil through said
closing motion; and a propulsion system, comprising: a first foot
configured to engage the patient tissue and move said end effector
relative to the patient tissue during a first propulsion stroke;
and a second foot configured to engage the patient tissue and move
said end effector relative to the patient tissue during a second
propulsion stroke.
2. The surgical stapler of claim 1, wherein said propulsion system
is configured to repetitively sequence said first propulsion stroke
and said second propulsion stroke, whereby said propulsion system
can walk said end effector relative to the patient tissue.
3. The surgical stapler of claim 1, wherein said propulsion system
is configured to complete said first propulsion stroke before
beginning said second propulsion stroke.
4. The surgical stapler of claim 1, wherein said propulsion system
is configured to at least partially complete said first propulsion
stroke before beginning said second propulsion stroke.
5. The surgical stapler of claim 1, wherein said propulsion system
comprises means for synchronizing said first propulsion stroke and
said second propulsion stroke.
6. The surgical stapler of claim 1, wherein said end effector
further comprises a staple cartridge comprising a plurality of
staples.
7. The surgical stapler of claim 6, further comprising a staple
firing system configured to deploy said staples during a staple
firing stroke.
8. The surgical stapler of claim 7, wherein said propulsion system
comprises synchronizing means for performing said closing motion
after said first propulsion stroke and said second propulsion
stroke have both been performed.
9. The surgical stapler of claim 8, wherein said synchronizing
means performs said staple firing stroke after said closure stroke
has been performed.
10. The surgical stapler of claim 9, wherein said synchronizing
means includes a mechanism.
11. The surgical stapler of claim 9, wherein said synchronizing
means comprises a controller including a microprocessor.
12. The surgical stapler of claim 1, wherein said propulsion system
is configured to perform said first propulsion stroke and said
second propulsion stroke at the same time.
13. The surgical stapler of claim 1, wherein said propulsion system
is configured to perform said first propulsion stroke to steer said
end effector in a first direction and said second propulsion stroke
to steer said end effector in a second direction.
14. The surgical stapler of claim 1, further comprising a vacuum
system in communication with at least one of said first foot and
said second foot, wherein said vacuum system is configured to hold
the patient tissue within said end effector utilizing said vacuum
system.
15. The surgical stapler of claim 1, wherein said first foot
comprises a first rotatable element and said second foot comprises
a second rotatable element.
16. The surgical stapler of claim 1, wherein said first foot
comprises a first set of teeth configured to grip the patient
tissue and said second foot comprises a second set of teeth
configured to grip the patient tissue.
17. The surgical stapler of claim 1, wherein said first foot
comprises a first translatable element and said second foot
comprises a second translatable element.
18. The surgical stapler of claim 1, wherein said first foot
comprises a first base and a first extendable portion which is
extendable relative to said first base, and wherein said second
foot comprises a second base and a second extendable portion which
is extendable relative to said second base.
19. A surgical stapler for stapling the tissue of a patient,
comprising: a handle; a shaft extending from said handle; an end
effector, comprising: a tissue compression surface; and an anvil
comprising staple forming pockets, wherein said anvil is movable
toward said tissue compression surface during a closing motion; an
anvil closing system configured to move said anvil through said
closing motion; and a tissue advancement system comprising a foot
configured to engage the patient tissue and pull the patient tissue
relative to said end effector during a tissue advancement
stroke.
20. A surgical stapler for stapling the tissue of a patient,
comprising: a handle; a shaft extending from said handle; a
plurality of staple cartridges; an end effector, comprising: a
tissue compression surface; and an anvil comprising staple forming
pockets, wherein said anvil is movable toward said tissue
compression surface during a closing motion; an anvil closing
system configured to move said anvil through said closing motion; a
staple firing system configured to deploy said staple cartridges
along a path; and means for gripping the patient tissue and
creating relative movement between said end effector and the
patient tissue to re-position said end effector along said path.
Description
BACKGROUND
[0001] The present invention relates to surgical instruments and,
in various arrangements, to surgical stapling and cutting
instruments and staple cartridges for use therewith that are
designed to staple and cut tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
[0002] Various features of the embodiments described herein,
together with advantages thereof, may be understood in accordance
with the following description taken in conjunction with the
accompanying drawings as follows:
[0003] FIG. 1 is a perspective view of a surgical stapling
instrument in accordance with at least one embodiment;
[0004] FIG. 2 is a cross-sectional view of the stapling instrument
of FIG. 1 taken along line 2-2 in FIG. 1;
[0005] FIG. 3 is a partial perspective view of a drive system of
the stapling instrument of FIG. 1;
[0006] FIG. 4 is a plan view of the drive system of FIG. 3;
[0007] FIG. 5 is an elevational view of the drive system of FIG. 3
illustrated in a first operational configuration;
[0008] FIG. 6 is a side elevational view of the drive system of
FIG. 3 illustrated in the first operational configuration of FIG.
5;
[0009] FIG. 7 is a side elevational view of the drive system of
FIG. 3 illustrated in a second operational configuration;
[0010] FIG. 8 is a partial perspective view of a surgical stapling
instrument in accordance with at least one embodiment;
[0011] FIG. 9 is a partial perspective view of a surgical stapling
instrument in accordance with at least one embodiment;
[0012] FIG. 10 is a perspective view of a handle housing of the
stapling instrument of FIG. 8;
[0013] FIG. 11 is a perspective view of a battery in accordance
with at least one embodiment;
[0014] FIG. 12 is a perspective view of a handle of the stapling
instrument of FIG. 1;
[0015] FIG. 13 is a partial perspective view of a surgical stapling
instrument including a display in accordance with at least one
embodiment;
[0016] FIG. 14 depicts a status control on the display of FIG.
13;
[0017] FIG. 15 depicts a speed control on the display of FIG.
13;
[0018] FIG. 16 depicts a fault threshold control on the display of
FIG. 13;
[0019] FIG. 17 depicts a direction control on the display of FIG.
13;
[0020] FIG. 18 depicts the display of FIG. 13 and the speed control
of FIG. 15;
[0021] FIG. 19 depicts the display of FIG. 13 and a speed
control;
[0022] FIG. 20 depicts the display of FIG. 13 and a staple path
control being used to alter the staple firing path of the stapling
instrument;
[0023] FIG. 21 depicts the display of FIG. 13 and the staple path
control of FIG. 21 being used to control the staple firing path of
the stapling instrument;
[0024] FIG. 22 depicts the display of FIG. 13 and a control for
stopping the stapling instrument along the staple firing path;
[0025] FIG. 23 depicts a surgical instrument system including an
external, or off-board, display in accordance with at least one
embodiment;
[0026] FIG. 24 depicts a display of a surgical stapling instrument
in accordance in at least one embodiment;
[0027] FIG. 25 depicts the display of FIG. 24 being used to change
a staple firing path when creating a stomach sleeve during a
stomach reduction procedure;
[0028] FIG. 26 depicts a joystick being used to change a staple
firing path on the display of FIG. 24;
[0029] FIG. 27 depicts the stapling instrument being guided along a
staple firing path;
[0030] FIG. 28 depicts the stomach of a patient;
[0031] FIG. 29 is a cross-sectional view of the stomach of a
patient;
[0032] FIG. 30 is a cross-sectional view of a target inserted into
the stomach of FIG. 29;
[0033] FIG. 31 is a cross-sectional view of the stomach of a
patient which is thinner than the stomach of FIG. 29;
[0034] FIG. 32 is a cross-sectional view of a target inserted into
the stomach of FIG. 31;
[0035] FIG. 33 depicts various anatomical features which can be
referenced during a stomach sleeve procedure;
[0036] FIG. 34 is a partial elevational view of a surgical stapling
instrument comprising a shaft, an end effector, and an articulation
joint in accordance with at least one embodiment;
[0037] FIG. 35 is a partial elevational view of the stapling
instrument of FIG. 34 illustrating the end effector in an
articulated position;
[0038] FIG. 36 is a bottom cross-sectional view of an end effector
of a surgical stapling instrument in accordance with at least one
embodiment;
[0039] FIG. 37 is a partial cross-sectional view of a surgical
stapling instrument comprising a tissue drive system in accordance
with at least one embodiment;
[0040] FIG. 38 is a partial cross-sectional view of the stapling
instrument of FIG. 37 illustrating the tissue drive system engaged
with the tissue of a patient;
[0041] FIG. 39 is a partial cross-sectional view of the stapling
instrument of FIG. 37 illustrating the tissue drive system pushing
the patient tissue in a first direction;
[0042] FIG. 40 is a partial cross-sectional view of the stapling
instrument of FIG. 37 illustrating the tissue drive system pushing
the patient tissue in a second direction;
[0043] FIG. 41 is a partial cross-sectional view of the stapling
instrument of FIG. 37 illustrating the tissue drive system being
disengaged from the patient tissue;
[0044] FIG. 42 is a partial elevational view of a drive system
including a synchronizing mechanism in accordance with at least one
embodiment;
[0045] FIG. 43 illustrates the synchronizing mechanism of FIG. 42
actuating an end effector drive system;
[0046] FIG. 44 illustrates a drive system configured to
reciprocatingly drive a plurality of end effector drive system;
[0047] FIG. 45 depicts plots of two synchronized end effector
drives;
[0048] FIG. 46 is a table illustrating the synchronization of four
end effector drives;
[0049] FIGS. 47A-47G illustrate the operational steps of a surgical
stapling instrument in accordance with at least one embodiment;
[0050] FIG. 48 is a table illustrating the synchronization of the
end effector drives of a surgical stapling instrument in accordance
with at least one embodiment;
[0051] FIG. 49 is a module for operating a surgical stapling
instrument in accordance with at least one embodiment;
[0052] FIG. 50 is a partial perspective view of an end effector
including a tissue drive system in accordance with at least one
embodiment illustrated being extended;
[0053] FIG. 51 is a partial perspective view of the tissue drive
system of FIG. 50 being retracted;
[0054] FIG. 52 is a partial cross-sectional view of the end
effector of FIG. 50 illustrating the tissue drive system in a
retracted configuration;
[0055] FIG. 53 is a partial cross-sectional view of the end
effector of FIG. 50 illustrating the tissue drive system in a
lowered configuration;
[0056] FIG. 54 is a partial cross-sectional view of the end
effector of FIG. 50 illustrating the tissue drive system being
extended;
[0057] FIG. 55 is a partial cross-sectional view of the end
effector of FIG. 50 illustrating teeth of the tissue drive system
in a protruded configuration;
[0058] FIG. 56 is a partial cross-sectional view of the end
effector of FIG. 50 illustrating the drive system being
retracted;
[0059] FIG. 57 is a partial perspective view of a tissue drive
system in accordance with at least one embodiment;
[0060] FIG. 58 is a partial perspective view of the tissue drive
system of FIG. 57 in an extended configuration;
[0061] FIGS. 59A-59D illustrate the operational steps of a tissue
drive system of a surgical stapling instrument in accordance with
at least one embodiment;
[0062] FIGS. 60A-60D further illustrate the operational steps of
the tissue drive system of FIGS. 59A-59D;
[0063] FIG. 61 is a partial perspective view of a surgical stapling
instrument including a tissue drive system in accordance with at
least one embodiment;
[0064] FIG. 62 is a partial perspective view of the tissue drive
system of FIG. 61 in an extended configuration;
[0065] FIG. 63 is a partial cross-sectional perspective view of a
surgical stapling instrument comprising a tissue drive system in
accordance with at least one embodiment;
[0066] FIG. 64 is a bottom cross-sectional plan view of the
stapling instrument of FIG. 63;
[0067] FIG. 65 is a partial cross-sectional view of a surgical
stapling instrument including a vacuum system in accordance with at
least one embodiment;
[0068] FIG. 66 is a partial detail view of a tissue drive system of
the stapling instrument of FIG. 65;
[0069] FIG. 67 is a partial cross-sectional view of the stapling
instrument of FIG. 65 illustrating tissue being pulled into the end
effector of the stapling instrument;
[0070] FIG. 68 is a partial detail view of the tissue drive system
of FIG. 66;
[0071] FIG. 69 is a partial cross-sectional view of the stapling
instrument of FIG. 65 illustrating the tissue being released;
[0072] FIG. 70 is a partial cross-sectional view of a surgical
stapling instrument comprising a vacuum system in accordance with
at least one embodiment;
[0073] FIG. 71 is a partial cross-sectional view of the stapling
instrument of FIG. 70 illustrating first and second drive feet of
the stapling instrument in a retracted configuration;
[0074] FIG. 72 is a partial cross-sectional view of the stapling
instrument of FIG. 70 illustrating the first drive foot in an
extended position;
[0075] FIG. 73 is a vacuum manifold of the stapling instrument of
FIG. 70 in fluid communication with the first drive foot;
[0076] FIG. 74 is a partial perspective view of a surgical stapling
instrument in accordance with at least one embodiment;
[0077] FIGS. 75A-75D depict the operational steps of a surgical
stapling instrument in accordance with at least one embodiment;
[0078] FIG. 76 is a partial cross-sectional perspective view of a
surgical stapling instrument in accordance with at least one
embodiment;
[0079] FIGS. 77A-77D depict the operational steps for steering the
stapling instrument of FIG. 76;
[0080] FIG. 78 is a cross-sectional end view of a surgical stapling
instrument in accordance with at least one embodiment;
[0081] FIG. 79 is a partial elevational view of a surgical stapling
instrument in accordance with at least one embodiment comprising a
tissue drive;
[0082] FIG. 79A illustrates the position of a foot of the tissue
drive corresponding with FIG. 79;
[0083] FIG. 80 is a partial elevational view of the stapling
instrument of FIG. 79 illustrating the foot being extended;
[0084] FIG. 80A illustrates the position of the foot of the tissue
drive corresponding with FIG. 80;
[0085] FIG. 81 is a partial elevational view of the stapling
instrument of FIG. 79 illustrating the foot in an extended
configuration;
[0086] FIG. 81A illustrates the position of the foot of the tissue
drive corresponding with FIG. 81;
[0087] FIG. 82 is a partial elevational view of the stapling
instrument of FIG. 79 illustrating the foot being retracted;
[0088] FIG. 82A illustrates the position of the foot of the tissue
drive corresponding with FIG. 82;
[0089] FIG. 83 is a partial cross-sectional view of the tissue
drive of the stapling instrument of FIG. 79;
[0090] FIG. 84 illustrates the kinematics of the tissue drive of
the stapling instrument of FIG. 79;
[0091] FIG. 85 illustrates a cam capable of producing the
kinematics of FIG. 84;
[0092] FIG. 86 is a perspective view of a cam capable of producing
the kinematics of FIG. 84;
[0093] FIG. 87 is a partial perspective view of a surgical stapling
instrument including a tissue drive in accordance with at least one
embodiment;
[0094] FIG. 88 depicts a tissue drive of a surgical stapling
instrument in accordance with at least one embodiment;
[0095] FIG. 89 depicts the tissue drive of FIG. 88 in an extended
configuration;
[0096] FIGS. 90A-90D depict the operational steps of a surgical
stapling instrument including a tissue drive in accordance with at
least one embodiment;
[0097] FIGS. 91A-91D depict the operational steps of a surgical
stapling instrument including a tissue drive in accordance with at
least one embodiment;
[0098] FIG. 92 depicts a tissue drive of a surgical stapling
instrument in accordance with at least one embodiment;
[0099] FIG. 93 depicts the tissue drive of FIG. 92 in an extended
configuration;
[0100] FIG. 94 is a partial cross-sectional perspective view of a
surgical stapling instrument in accordance with at least one
embodiment;
[0101] FIG. 95 is a partial elevational view of a surgical stapling
instrument comprising a tissue cutting member in accordance with at
least one embodiment;
[0102] FIG. 96 depicts the tissue cutting member of FIG. 95 being
moved through a tissue cutting stroke;
[0103] FIG. 97 is partial perspective view of a surgical stapling
instrument in accordance with at least one embodiment;
[0104] FIG. 98 is a perspective view of two connected staples in
accordance with at least one embodiment;
[0105] FIG. 99 is a partial perspective view of the staples of FIG.
98 being separated;
[0106] FIG. 100 is a partial cross-sectional view of a staple
firing system of the stapling instrument of FIG. 97 including a
staple firing chamber in accordance with at least one
embodiment;
[0107] FIG. 101 illustrates a staple being fired by the staple
firing system of FIG. 100;
[0108] FIG. 102 illustrates another staple being loaded into the
staple firing chamber of FIG. 100;
[0109] FIG. 103 is a bottom cross-sectional end view of the
stapling instrument of FIG. 97;
[0110] FIG. 104 is a partial cross-sectional perspective view of a
surgical stapling instrument in accordance with at least one
embodiment;
[0111] FIGS. 105A-105D depict the operational steps of the stapling
system of FIG. 104;
[0112] FIG. 106 is a partial perspective view of a surgical
stapling instrument in accordance with at least one embodiment;
[0113] FIG. 107 is an exploded perspective view of a staple clip
for use with the stapling instrument of FIG. 106;
[0114] FIG. 108 is a plan view of a staple clip in accordance with
at least one embodiment;
[0115] FIG. 109 is an end view of the staple clip of FIG. 108
positioned in a surgical stapling instrument;
[0116] FIG. 110 is a perspective view of the staple clip of FIG.
108;
[0117] FIG. 111 is an end view of a staple clip in accordance with
at least one embodiment positioned in a surgical stapling
instrument;
[0118] FIG. 112 is a perspective view of the staple clip of FIG.
111;
[0119] FIG. 113 is an end view of a staple clip in accordance with
at least one embodiment positioned in a surgical stapling
instrument;
[0120] FIG. 114 is a perspective view of the staple clip of FIG.
113;
[0121] FIG. 115 is a partial plan view of a staple strip in an
unfolded configuration in accordance with at least one
embodiment;
[0122] FIG. 116 is an end view of the staple strip of FIG. 115 in
its unfolded configuration;
[0123] FIG. 117 is an end view of the staple strip of FIG. 115 in a
folded configuration;
[0124] FIG. 118 is a perspective of the staple strip of FIG. 115
being deployed;
[0125] FIG. 119 is a perspective view of a staple cluster in
accordance with at least one embodiment;
[0126] FIG. 120 is a partial perspective view of the staple cluster
of FIG. 119 being loaded into a surgical stapling instrument;
[0127] FIG. 121 is a partial perspective view of a surgical
stapling instrument comprising deployable staple clusters in
accordance with at least one embodiment;
[0128] FIG. 122 is a partial perspective view of a surgical
stapling instrument comprising a tissue drive in accordance with at
least one embodiment;
[0129] FIG. 123 is a partial perspective view of the stapling
instrument of FIG. 122 illustrating the tissue drive in an extended
configuration;
[0130] FIG. 124 depicts a cross-sectional width of a distal head of
the stapling instrument of FIG. 122;
[0131] FIG. 125 is a cross-sectional view of a tissue gripping
surface of the tissue drive of FIG. 122;
[0132] FIG. 126 is a cross-sectional end view of a surgical
stapling instrument including a tissue drive in accordance with at
least one embodiment illustrated in an extended configuration;
[0133] FIG. 127 is a cross-sectional end view of the stapling
instrument of FIG. 126 illustrating the tissue drive in a retracted
configuration;
[0134] FIG. 128 depicts a firing drive of a surgical stapling
instrument in accordance with at least one embodiment illustrated
in an unfired configuration;
[0135] FIG. 128A depicts a tissue drive of the stapling instrument
of FIG. 128 illustrated in an extended configuration;
[0136] FIG. 129 depicts the firing drive of FIG. 128 illustrated in
a fired configuration;
[0137] FIG. 129A depicts the tissue drive of FIG. 128A in a
retracted configuration;
[0138] FIG. 130 depicts the firing drive of FIG. 128 illustrated in
its unfired configuration;
[0139] FIG. 130A depicts the tissue drive of FIG. 128A in its
retracted configuration;
[0140] FIG. 131 is a perspective view of a staple loading system of
a surgical stapling instrument in accordance with at least one
embodiment;
[0141] FIG. 132 is a plan view of the staple loading system of FIG.
131;
[0142] FIG. 133 is a partial elevational view of the staple loading
system of FIG. 131;
[0143] FIG. 134 is a partial cross-sectional view of the stapling
instrument of FIG. 131 illustrated in an unfired configuration;
[0144] FIG. 135 is a partial cross-sectional view of the stapling
instrument of FIG. 131 illustrated in a fired configuration;
[0145] FIG. 136 is a partial cross-sectional view of the stapling
instrument of FIG. 131 being retracted into its unfired
configuration;
[0146] FIG. 137 is a partial cross-sectional view of the stapling
instrument of FIG. 131 illustrated in its unfired
configuration;
[0147] FIG. 138 depicts a staple pattern that can be produced by a
surgical stapling instrument in accordance with at least one
embodiment;
[0148] FIG. 139 depicts a staple pattern that can be produced by a
surgical stapling instrument in accordance with at least one
embodiment;
[0149] FIG. 140 illustrates a surgical stapling instrument in
accordance with at least one embodiment;
[0150] FIG. 141 illustrates the operational steps that the stapling
instrument of FIG. 140 uses to manufacture and deploy staples;
[0151] FIG. 142 depicts a staple firing line in the stomach of a
patient;
[0152] FIG. 143 depicts a progression of staple firings in
accordance with at least one embodiment;
[0153] FIGS. 144-146 illustrate the stapling instrument of FIG. 1
being used during a surgical procedure;
[0154] FIG. 147 illustrates a surgical stapling instrument in
accordance with at least one embodiment being used during a
surgical procedure;
[0155] FIG. 148 is a partial elevational view of the surgical
stapling instrument of FIG. 147;
[0156] FIG. 149 is a partial perspective view of the stapling
instrument of FIG. 147 in a first configuration;
[0157] FIG. 150 is a partial perspective view of the stapling
instrument of FIG. 147 in a second configuration;
[0158] FIG. 151 depicts a potential outcome of a stomach sleeve
procedure using the surgical stapling instruments disclosed
herein;
[0159] FIG. 152 depicts a guide inserted into the stomach of a
patient;
[0160] FIG. 153 depicts a guide being used to define a staple
firing path in the patient's stomach;
[0161] FIG. 154 depicts the guide of FIG. 153 being used to create
a stomach sleeve during a gastric bypass procedure;
[0162] FIG. 155 is a partial cross-sectional view of the guide of
FIG. 153;
[0163] FIG. 156 is a partial cross-sectional view of a guide in
accordance with at least one embodiment illustrated with some
components removed;
[0164] FIG. 157 is a schematic of the guide of FIG. 153;
[0165] FIG. 158 is a perspective view of a surgical stapling system
comprising loadable staple cartridges in accordance with at least
one embodiment;
[0166] FIG. 159 depicts certain operational components of the
stapling system of FIG. 158;
[0167] FIG. 160 is an end view of a surgical stapling instrument
comprising a projector system including two lenses in accordance
with at least one embodiment;
[0168] FIG. 161 illustrates the stapling instrument of FIG. 160
being used during a surgical procedure;
[0169] FIG. 162 illustrates a surgical stapling system including a
projector in accordance with at least one embodiment;
[0170] FIG. 163 illustrates a surgical stapling system comprising a
vision system and a projection system in accordance with at least
one embodiment;
[0171] FIG. 164 illustrates the projector system of the stapling
system of FIG. 163 being used;
[0172] FIG. 165 illustrates a projected image on the tissue of a
patient in accordance with at least one embodiment;
[0173] FIG. 166 illustrates a staple firing path projected onto the
tissue of a patient in accordance with at least one embodiment;
[0174] FIG. 167 illustrates a surgical stapling instrument
comprising a first projector configured to project a first part of
a staple firing path onto the tissue of a patient and a second
projector configured to project a second part of the staple firing
path onto the tissue of a patient in accordance with at least one
embodiment;
[0175] FIG. 168 is a partial elevational view of a surgical
stapling instrument comprising an articulatable end effector in
accordance with at least one embodiment;
[0176] FIG. 169 is a partial elevational view of the surgical
stapling instrument of FIG. 168;
[0177] FIG. 170 is a partial elevational view of a surgical
stapling instrument comprising an articulatable end effector and a
dampener configured to reduce unintentional movement of the end
effector in accordance with at least one embodiment;
[0178] FIG. 171 is a partial elevational view of a surgical
stapling instrument including an end effector dampener in
accordance with at least one embodiment;
[0179] FIG. 172 illustrates the stapling instrument of FIG. 171
being used in a surgical procedure;
[0180] FIG. 173 illustrates the stapling instrument of FIG. 171
being used in a surgical procedure;
[0181] FIG. 174 illustrates a staple firing path created by a
surgical stapling instrument comprising a longitudinal end
effector;
[0182] FIG. 175 illustrates a staple firing path created by a
surgical stapling instrument disclosed herein;
[0183] FIG. 176 illustrates a staple firing path created by a
surgical stapling instrument comprising a longitudinal end
effector;
[0184] FIG. 177 illustrates a staple firing path created by a
surgical stapling instrument disclosed herein;
[0185] FIG. 178 illustrates a staple firing path created by a
surgical stapling instrument comprising a longitudinal end
effector;
[0186] FIG. 179 illustrates a staple firing path created by a
surgical stapling instrument disclosed herein;
[0187] FIG. 180 is a perspective view of a handle of a surgical
instrument in accordance with at least one embodiment;
[0188] FIG. 181 is a perspective view of the handle of the surgical
instrument of FIG. 180 enclosed in a sterile barrier;
[0189] FIG. 182 is a partial cross-sectional view of the sterile
barrier and a touch-sensitive display of the handle of FIG.
181;
[0190] FIG. 183 is a plan view of the touch-sensitive display of
FIG. 182 illustrating a grid of electrodes, wherein a plurality of
pixels is activated; and
[0191] FIG. 184 is a graph depicting a relationship between the
location of the active pixels of FIG. 183 and the capacitance
detected by the touch-sensitive display of FIG. 182.
[0192] Corresponding reference characters indicate corresponding
parts throughout the several views. The exemplifications set out
herein illustrate various embodiments of the invention, in one
form, and such exemplifications are not to be construed as limiting
the scope of the invention in any manner.
DETAILED DESCRIPTION
[0193] Applicant of the present application owns the following U.S.
patent applications that were filed on even date herewith and which
are each herein incorporated by reference in their respective
entireties:
[0194] U.S. patent application Ser. No. ______, entitled CONTINUOUS
USE SELF-PROPELLED STAPLING INSTRUMENT; Attorney Docket No.
END8299USNP/170206M;
[0195] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING SPEED CONTROL; Attorney Docket No.
END8300USNP/170208;
[0196] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING A PROJECTOR; Attorney Docket No.
END8310USNP/170207;
[0197] U.S. patent application Ser. No. ______, entitled STAPLE
INSTRUMENT COMPRISING A FIRING PATH DISPLAY; Attorney Docket No.
END8301 USNP/170209;
[0198] U.S. patent application Ser. No. ______, entitled
SELF-GUIDING STAPLING INSTRUMENT; Attorney Docket No.
END8311USNP/170210;
[0199] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT CONFIGURED TO DETERMINE FIRING PATH; Attorney Docket No.
END8302USNP/170211;
[0200] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING AN END EFFECTOR DAMPENER; Attorney Docket No.
END8304USNP/170212;
[0201] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING SYNCHRONIZED DRIVE SYSTEMS; Attorney Docket
No. END8305USNP/170213;
[0202] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING A TISSUE GRASPING SYSTEM; Attorney Docket No.
END8307USNP/170215;
[0203] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING SEQUENCED SYSTEMS; Attorney Docket No.
END8308USNP/170216;
[0204] U.S. patent application Ser. No. ______, entitled STAPLING
INSTRUMENT COMPRISING A STAPLE FEEDING SYSTEM; Attorney Docket No.
END8309USNP/170217;
[0205] U.S. patent application Ser. No. ______, entitled SURGICAL
STAPLER COMPRISING STORABLE CARTRIDGES HAVING DIFFERENT STAPLE
SIZES; Attorney Docket No. END8330USNP/170233;
[0206] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT HAVING A DISPLAY COMPRISING IMAGE LAYERS; Attorney
Docket No. END8331USNP/170235;
[0207] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING A DISPLAY; Attorney Docket No.
END8332USNP/170236;
[0208] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING AN ARTICULATABLE DISTAL HEAD; Attorney Docket
No. END8333USNP/170232; and
[0209] U.S. patent application Ser. No. ______, entitled SURGICAL
INSTRUMENT COMPRISING A PIVOTABLE DISTAL HEAD; Attorney Docket No.
END8334USNP/170234.
[0210] Applicant of the present application owns the following U.S.
patent applications that were filed on Dec. 19, 2017 and which are
each herein incorporated by reference in their respective
entireties:
[0211] U.S. patent application Ser. No. 15/847,306, entitled METHOD
FOR DETERMINING THE POSITION OF A ROTATABLE JAW OF A SURGICAL
INSTRUMENT ATTACHMENT ASSEMBLY;
[0212] U.S. patent application Ser. No. 15/847,297, entitled
SURGICAL INSTRUMENTS WITH DUAL ARTICULATION DRIVERS;
[0213] U.S. patent application Ser. No. 15/847,325, entitled
SURGICAL TOOLS CONFIGURED FOR INTERCHANGEABLE USE WITH DIFFERENT
CONTROLLER INTERFACES;
[0214] U.S. patent application Ser. No. 15/847,293, entitled
SURGICAL INSTRUMENT COMPRISING CLOSURE AND FIRING LOCKING
MECHANISM;
[0215] U.S. patent application Ser. No. 15/847,315, entitled
ROBOTIC ATTACHMENT COMPRISING EXTERIOR DRIVE ACTUATOR; and
[0216] U.S. Design patent application Ser. No. 29/630,115, entitled
SURGICAL INSTRUMENT ASSEMBLY.
[0217] Applicant of the present application owns the following U.S.
patent applications that were filed on Dec. 15, 2017 and which are
each herein incorporated by reference in their respective
entireties:
[0218] U.S. patent application Ser. No. 15/843,485, entitled SEALED
ADAPTERS FOR USE WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS;
[0219] U.S. patent application Ser. No. 15/843,518, entitled END
EFFECTORS WITH POSITIVE JAW OPENING FEATURES FOR USE WITH ADAPTERS
FOR ELECTROMECHANICAL SURGICAL INSTRUMENTS;
[0220] U.S. patent application Ser. No. 15/843,535, entitled
SURGICAL END EFFECTORS WITH CLAMPING ASSEMBLIES CONFIGURED TO
INCREASE JAW APERTURE RANGES;
[0221] U.S. patent application Ser. No. 15/843,558, entitled
SURGICAL END EFFECTORS WITH PIVOTAL JAWS CONFIGURED TO TOUCH AT
THEIR RESPECTIVE DISTAL ENDS WHEN FULLY CLOSED;
[0222] U.S. patent application Ser. No. 15/843,528, entitled
SURGICAL END EFFECTORS WITH JAW STIFFENER ARRANGEMENTS CONFIGURED
TO PERMIT MONITORING OF FIRING MEMBER;
[0223] U.S. patent application Ser. No. 15/843,567, entitled
ADAPTERS WITH END EFFECTOR POSITION SENSING AND CONTROL
ARRANGEMENTS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL
INSTRUMENTS;
[0224] U.S. patent application Ser. No. 15/843,556, entitled
DYNAMIC CLAMPING ASSEMBLIES WITH IMPROVED WEAR CHARACTERISTICS FOR
USE IN CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS;
[0225] U.S. patent application Ser. No. 15/843,514, entitled
ADAPTERS WITH FIRING STROKE SENSING ARRANGEMENTS FOR USE IN
CONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS;
[0226] U.S. patent application Ser. No. 15/843,501, entitled
ADAPTERS WITH CONTROL SYSTEMS FOR CONTROLLING MULTIPLE MOTORS OF AN
ELECTROMECHANICAL SURGICAL INSTRUMENT;
[0227] U.S. patent application Ser. No. 15/843,508, entitled
HANDHELD ELECTROMECHANICAL SURGICAL INSTRUMENTS WITH IMPROVED MOTOR
CONTROL ARRANGEMENTS FOR POSITIONING COMPONENTS OF AN ADAPTER
COUPLED THERETO;
[0228] U.S. patent application Ser. No. 15/843,682, entitled
SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER FIRING RATE OF
A SURGICAL INSTRUMENT;
[0229] U.S. patent application Ser. No. 15/843,689, entitled
SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER; and
[0230] U.S. patent application Ser. No. 15/843,704, entitled
METHODS OF OPERATING SURGICAL END EFFECTORS.
[0231] Applicant of the present application owns the following U.S.
patent applications that were filed on Jun. 29, 2017 and which are
each herein incorporated by reference in their respective
entireties:
[0232] U.S. patent application Ser. No. 15/636,829, entitled CLOSED
LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL
INSTRUMENT;
[0233] U.S. patent application Ser. No. 15/636,837, entitled CLOSED
LOOP VELOCITY CONTROL TECHNIQUES BASED ON SENSED TISSUE PARAMETERS
FOR ROBOTIC SURGICAL INSTRUMENT;
[0234] U.S. patent application Ser. No. 15/636,844, entitled CLOSED
LOOP VELOCITY CONTROL OF CLOSURE MEMBER FOR ROBOTIC SURGICAL
INSTRUMENT;
[0235] U.S. patent application Ser. No. 15/636,854, entitled
ROBOTIC SURGICAL INSTRUMENT WITH CLOSED LOOP FEEDBACK TECHNIQUES
FOR ADVANCEMENT OF CLOSURE MEMBER DURING FIRING; and
[0236] U.S. patent application Ser. No. 15/636,858, entitled SYSTEM
FOR CONTROLLING ARTICULATION FORCES.
[0237] Applicant of the present application owns the following U.S.
patent applications that were filed on Jun. 28, 2017 and which are
each herein incorporated by reference in their respective
entireties:
[0238] U.S. patent application Ser. No. 15/635,693, entitled
SURGICAL INSTRUMENT COMPRISING AN OFFSET ARTICULATION JOINT;
[0239] U.S. patent application Ser. No. 15/635,729, entitled
SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO;
[0240] U.S. patent application Ser. No. 15/635,785, entitled
SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO;
[0241] U.S. patent application Ser. No. 15/635,808, entitled
SURGICAL INSTRUMENT COMPRISING FIRING MEMBER SUPPORTS;
[0242] U.S. patent application Ser. No. 15/635,837, entitled
SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE TO A
FRAME;
[0243] U.S. patent application Ser. No. 15/635,941, entitled
SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE BY A
CLOSURE SYSTEM;
[0244] U.S. patent application Ser. No. 15/636,029, entitled
SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A HOUSING
ARRANGEMENT;
[0245] U.S. patent application Ser. No. 15/635,958, entitled
SURGICAL INSTRUMENT COMPRISING SELECTIVELY ACTUATABLE ROTATABLE
COUPLERS;
[0246] U.S. patent application Ser. No. 15/635,981, entitled
SURGICAL STAPLING INSTRUMENTS COMPRISING SHORTENED STAPLE CARTRIDGE
NOSES;
[0247] U.S. patent application Ser. No. 15/636,009, entitled
SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A CLOSURE TUBE
PROFILE;
[0248] U.S. patent application Ser. No. 15/635,663, entitled METHOD
FOR ARTICULATING A SURGICAL INSTRUMENT;
[0249] U.S. patent application Ser. No. 15/635,530, entitled
SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITH AXIALLY
SHORTENED ARTICULATION JOINT CONFIGURATIONS;
[0250] U.S. patent application Ser. No. 15/635,549, entitled
SURGICAL INSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLY
MOVABLE FIRING MEMBER THAT IS INITIALLY PARKED IN CLOSE PROXIMITY
TO THE JAWS PRIOR TO FIRING;
[0251] U.S. patent application Ser. No. 15/635,559, entitled
SURGICAL INSTRUMENTS WITH JAWS CONSTRAINED TO PIVOT ABOUT AN AXIS
UPON CONTACT WITH A CLOSURE MEMBER THAT IS PARKED IN CLOSE
PROXIMITY TO THE PIVOT AXIS;
[0252] U.S. patent application Ser. No. 15/635,578, entitled
SURGICAL END EFFECTORS WITH IMPROVED JAW APERTURE ARRANGEMENTS;
[0253] U.S. patent application Ser. No. 15/635,594, entitled
SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVIL WITH A
TISSUE LOCATING ARRANGEMENT IN CLOSE PROXIMITY TO AN ANVIL
PIVOT;
[0254] U.S. patent application Ser. No. 15/635,612, entitled JAW
RETAINER ARRANGEMENT FOR RETAINING A PIVOTABLE SURGICAL INSTRUMENT
JAW IN PIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICAL
INSTRUMENT JAW;
[0255] U.S. patent application Ser. No. 15/635,621, entitled
SURGICAL INSTRUMENT WITH POSITIVE JAW OPENING FEATURES;
[0256] U.S. patent application Ser. No. 15/635,631, entitled
SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER;
[0257] U.S. patent application Ser. No. 15/635,521, entitled
SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT;
[0258] U.S. Design patent application Ser. No. 29/609,087, entitled
STAPLE FORMING ANVIL;
[0259] U.S. Design patent application Ser. No. 29/609,083, entitled
SURGICAL INSTRUMENT SHAFT; and
[0260] U.S. Design patent application Ser. No. 29/609,093, entitled
SURGICAL FASTENER CARTRIDGE.
[0261] Applicant of the present application owns the following U.S.
patent applications that were filed on Jun. 27, 2017 and which are
each herein incorporated by reference in their respective
entireties:
[0262] U.S. patent application Ser. No. 15/634,024, entitled
SURGICAL ANVIL MANUFACTURING METHODS;
[0263] U.S. patent application Ser. No. 15/634,035, entitled
SURGICAL ANVIL ARRANGEMENTS;
[0264] U.S. patent application Ser. No. 15/634,046, entitled
SURGICAL ANVIL ARRANGEMENTS;
[0265] U.S. patent application Ser. No. 15/634,054, entitled
SURGICAL ANVIL ARRANGEMENTS;
[0266] U.S. patent application Ser. No. 15/634,068, entitled
SURGICAL FIRING MEMBER ARRANGEMENTS;
[0267] U.S. patent application Ser. No. 15/634,076, entitled STAPLE
FORMING POCKET ARRANGEMENTS;
[0268] U.S. patent application Ser. No. 15/634,090, entitled STAPLE
FORMING POCKET ARRANGEMENTS;
[0269] U.S. patent application Ser. No. 15/634,099, entitled
SURGICAL END EFFECTORS AND ANVILS; and
[0270] U.S. patent application Ser. No. 15/634,117, entitled
ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS.
[0271] Applicant of the present application owns the following U.S.
patent applications that were filed on Dec. 21, 2016 and which are
each herein incorporated by reference in their respective
entireties:
[0272] U.S. patent application Ser. No. 15/386,185, entitled
SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIES
THEREOF;
[0273] U.S. patent application Ser. No. 15/386,230, entitled
ARTICULATABLE SURGICAL STAPLING INSTRUMENTS;
[0274] U.S. patent application Ser. No. 15/386,221, entitled
LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS;
[0275] U.S. patent application Ser. No. 15/386,209, entitled
SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF;
[0276] U.S. patent application Ser. No. 15/386,198, entitled
LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE
TOOL ASSEMBLIES;
[0277] U.S. patent application Ser. No. 15/386,240, entitled
SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR;
[0278] U.S. patent application Ser. No. 15/385,939, entitled STAPLE
CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES
THEREIN;
[0279] U.S. patent application Ser. No. 15/385,941, entitled
SURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGEMENTS FOR SHIFTING
BETWEEN CLOSURE SYSTEMS WITH CLOSURE STROKE REDUCTION FEATURES AND
ARTICULATION AND FIRING SYSTEMS;
[0280] U.S. patent application Ser. No. 15/385,943, entitled
SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS;
[0281] U.S. patent application Ser. No. 15/385,950, entitled
SURGICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUCTION
FEATURES;
[0282] U.S. patent application Ser. No. 15/385,945, entitled STAPLE
CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES
THEREIN;
[0283] U.S. patent application Ser. No. 15/385,946, entitled
SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS;
[0284] U.S. patent application Ser. No. 15/385,951, entitled
SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASING A JAW
OPENING DISTANCE;
[0285] U.S. patent application Ser. No. 15/385,953, entitled
METHODS OF STAPLING TISSUE;
[0286] U.S. patent application Ser. No. 15/385,954, entitled FIRING
MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATURES FOR SURGICAL END
EFFECTORS;
[0287] U.S. patent application Ser. No. 15/385,955, entitled
SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOP
ARRANGEMENTS;
[0288] U.S. patent application Ser. No. 15/385,948, entitled
SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS;
[0289] U.S. patent application Ser. No. 15/385,956, entitled
SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES;
[0290] U.S. patent application Ser. No. 15/385,958, entitled
SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTING
FIRING SYSTEM ACTUATION UNLESS AN UNSPENT STAPLE CARTRIDGE IS
PRESENT;
[0291] U.S. patent application Ser. No. 15/385,947, entitled STAPLE
CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES
THEREIN;
[0292] U.S. patent application Ser. No. 15/385,896, entitled METHOD
FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT;
[0293] U.S. patent application Ser. No. 15/385,898, entitled STAPLE
FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF
STAPLES;
[0294] U.S. patent application Ser. No. 15/385,899, entitled
SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CONTROL;
[0295] U.S. patent application Ser. No. 15/385,901, entitled STAPLE
CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRISING WINDOWS DEFINED
THEREIN;
[0296] U.S. patent application Ser. No. 15/385,902, entitled
SURGICAL INSTRUMENT COMPRISING A CUTTING MEMBER;
[0297] U.S. patent application Ser. No. 15/385,904, entitled STAPLE
FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND/OR SPENT CARTRIDGE
LOCKOUT;
[0298] U.S. patent application Ser. No. 15/385,905, entitled FIRING
ASSEMBLY COMPRISING A LOCKOUT;
[0299] U.S. patent application Ser. No. 15/385,907, entitled
SURGICAL INSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUT AND A
FIRING ASSEMBLY LOCKOUT;
[0300] U.S. patent application Ser. No. 15/385,908, entitled FIRING
ASSEMBLY COMPRISING A FUSE;
[0301] U.S. patent application Ser. No. 15/385,909, entitled FIRING
ASSEMBLY COMPRISING A MULTIPLE FAILED-STATE FUSE;
[0302] U.S. patent application Ser. No. 15/385,920, entitled STAPLE
FORMING POCKET ARRANGEMENTS;
[0303] U.S. patent application Ser. No. 15/385,913, entitled ANVIL
ARRANGEMENTS FOR SURGICAL STAPLE/FASTENERS;
[0304] U.S. patent application Ser. No. 15/385,914, entitled METHOD
OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGES
WITH THE SAME SURGICAL STAPLING INSTRUMENT;
[0305] U.S. patent application Ser. No. 15/385,893, entitled
BILATERALLY ASYMMETRIC STAPLE FORMING POCKET PAIRS;
[0306] U.S. patent application Ser. No. 15/385,929, entitled
CLOSURE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SURGICAL
INSTRUMENTS WITH SEPARATE AND DISTINCT CLOSURE AND FIRING
SYSTEMS;
[0307] U.S. patent application Ser. No. 15/385,911, entitled
SURGICAL STAPLE/FASTENERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND
FIRING SYSTEMS;
[0308] U.S. patent application Ser. No. 15/385,927, entitled
SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CARTRIDGES;
[0309] U.S. patent application Ser. No. 15/385,917, entitled STAPLE
CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAMPING BREADTHS;
[0310] U.S. patent application Ser. No. 15/385,900, entitled STAPLE
FORMING POCKET ARRANGEMENTS COMPRISING PRIMARY SIDEWALLS AND POCKET
SIDEWALLS;
[0311] U.S. patent application Ser. No. 15/385,931, entitled
NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FOR SURGICAL
STAPLE/FASTENERS;
[0312] U.S. patent application Ser. No. 15/385,915, entitled FIRING
MEMBER PIN ANGLE;
[0313] U.S. patent application Ser. No. 15/385,897, entitled STAPLE
FORMING POCKET ARRANGEMENTS COMPRISING ZONED FORMING SURFACE
GROOVES;
[0314] U.S. patent application Ser. No. 15/385,922, entitled
SURGICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES;
[0315] U.S. patent application Ser. No. 15/385,924, entitled
SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS;
[0316] U.S. patent application Ser. No. 15/385,912, entitled
SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED
AXIS AND INCLUDE SEPARATE AND DISTINCT CLOSURE AND FIRING
SYSTEMS;
[0317] U.S. patent application Ser. No. 15/385,910, entitled ANVIL
HAVING A KNIFE SLOT WIDTH;
[0318] U.S. patent application Ser. No. 15/385,906, entitled FIRING
MEMBER PIN CONFIGURATIONS;
[0319] U.S. patent application Ser. No. 15/386,188, entitled
STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES;
[0320] U.S. patent application Ser. No. 15/386,192, entitled
STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING
FEATURES;
[0321] U.S. patent application Ser. No. 15/386,206, entitled STAPLE
CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES;
[0322] U.S. patent application Ser. No. 15/386,226, entitled
DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLIES OF
SURGICAL STAPLING INSTRUMENTS;
[0323] U.S. patent application Ser. No. 15/386,222, entitled
SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITH POSITIVE
OPENING FEATURES;
[0324] U.S. patent application Ser. No. 15/386,236, entitled
CONNECTION PORTIONS FOR DISPOSABLE LOADING UNITS FOR SURGICAL
STAPLING INSTRUMENTS;
[0325] U.S. patent application Ser. No. 15/385,887, entitled METHOD
FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICAL INSTRUMENT AND,
ALTERNATIVELY, TO A SURGICAL ROBOT;
[0326] U.S. patent application Ser. No. 15/385,889, entitled SHAFT
ASSEMBLY COMPRISING A MANUALLY-OPERABLE RETRACTION SYSTEM FOR USE
WITH A MOTORIZED SURGICAL INSTRUMENT SYSTEM;
[0327] U.S. patent application Ser. No. 15/385,890, entitled SHAFT
ASSEMBLY COMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE
SYSTEMS;
[0328] U.S. patent application Ser. No. 15/385,891, entitled SHAFT
ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO ADAPT THE OUTPUT OF A
ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEMS;
[0329] U.S. patent application Ser. No. 15/385,892, entitled
SURGICAL SYSTEM COMPRISING A FIRING MEMBER ROTATABLE INTO AN
ARTICULATION STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL
SYSTEM;
[0330] U.S. patent application Ser. No. 15/385,894, entitled SHAFT
ASSEMBLY COMPRISING A LOCKOUT;
[0331] U.S. patent application Ser. No. 15/385,895, entitled SHAFT
ASSEMBLY COMPRISING FIRST AND SECOND ARTICULATION LOCKOUTS;
[0332] U.S. patent application Ser. No. 15/385,916, entitled
SURGICAL STAPLING SYSTEMS;
[0333] U.S. patent application Ser. No. 15/385,918, entitled
SURGICAL STAPLING SYSTEMS;
[0334] U.S. patent application Ser. No. 15/385,919, entitled
SURGICAL STAPLING SYSTEMS;
[0335] U.S. patent application Ser. No. 15/385,921, entitled
SURGICAL STAPLE/FASTENER CARTRIDGE WITH MOVABLE CAMMING MEMBER
CONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES;
[0336] U.S. patent application Ser. No. 15/385,923, entitled
SURGICAL STAPLING SYSTEMS;
[0337] U.S. patent application Ser. No. 15/385,925, entitled JAW
ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCEMENT OF A FIRING
MEMBER IN A SURGICAL END EFFECTOR UNLESS AN UNFIRED CARTRIDGE IS
INSTALLED IN THE END EFFECTOR;
[0338] U.S. patent application Ser. No. 15/385,926, entitled
AXIALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR APPLYING CLOSURE
MOTIONS TO JAWS OF SURGICAL INSTRUMENTS;
[0339] U.S. patent application Ser. No. 15/385,928, entitled
PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN A
MOVABLE JAW AND ACTUATOR SHAFT OF A SURGICAL INSTRUMENT;
[0340] U.S. patent application Ser. No. 15/385,930, entitled
SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERATING OPENING
FEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS;
[0341] U.S. patent application Ser. No. 15/385,932, entitled
ARTICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFT
ARRANGEMENT;
[0342] U.S. patent application Ser. No. 15/385,933, entitled
ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLE
LINKAGE DISTAL OF AN ARTICULATION LOCK;
[0343] U.S. patent application Ser. No. 15/385,934, entitled
ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR IN AN
ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE
SYSTEM;
[0344] U.S. patent application Ser. No. 15/385,935, entitled
LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN
END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATED
CONFIGURATION; and
[0345] U.S. patent application Ser. No. 15/385,936, entitled
ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE
AMPLIFICATION FEATURES.
[0346] Applicant of the present application owns the following U.S.
patent applications that were filed on Jun. 24, 2016 and which are
each herein incorporated by reference in their respective
entireties:
[0347] U.S. patent application Ser. No. 15/191,775, entitled STAPLE
CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES;
[0348] U.S. patent application Ser. No. 15/191,807, entitled
STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPED STAPLES;
[0349] U.S. patent application Ser. No. 15/191,834, entitled
STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME;
[0350] U.S. patent application Ser. No. 15/191,788, entitled STAPLE
CARTRIDGE COMPRISING OVERDRIVEN STAPLES; and
[0351] U.S. patent application Ser. No. 15/191,818, entitled STAPLE
CARTRIDGE COMPRISING OFFSET LONGITUDINAL STAPLE ROWS.
[0352] Applicant of the present application owns the following U.S.
patent applications that were filed on Jun. 24, 2016 and which are
each herein incorporated by reference in their respective
entireties:
[0353] U.S. Design patent application Ser. No. 29/569,218, entitled
SURGICAL FASTENER;
[0354] U.S. Design patent application Ser. No. 29/569,227, entitled
SURGICAL FASTENER;
[0355] U.S. Design patent application Ser. No. 29/569,259, entitled
SURGICAL FASTENER CARTRIDGE; and
[0356] U.S. Design patent application Ser. No. 29/569,264, entitled
SURGICAL FASTENER CARTRIDGE.
[0357] Applicant of the present application owns the following
patent applications that were filed on Apr. 1, 2016 and which are
each herein incorporated by reference in their respective
entirety:
[0358] U.S. patent application Ser. No. 15/089,325, entitled METHOD
FOR OPERATING A SURGICAL STAPLING SYSTEM, now U.S. Patent
Application Publication No. 2017/0281171;
[0359] U.S. patent application Ser. No. 15/089,321, entitled
MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY, now U.S.
Patent Application Publication No. 2017/0281163;
[0360] U.S. patent application Ser. No. 15/089,326, entitled
SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A
RE-ORIENTABLE DISPLAY FIELD, now U.S. Patent Application
Publication No. 2017/0281172;
[0361] U.S. patent application Ser. No. 15/089,263, entitled
SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP
PORTION, now U.S. Patent Application Publication No.
2017/0281165;
[0362] U.S. patent application Ser. No. 15/089,262, entitled ROTARY
POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT
SYSTEM, now U.S. Patent Application Publication No.
2017/0281161;
[0363] U.S. patent application Ser. No. 15/089,277, entitled
SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC
DRIVE MEMBER, now U.S. Patent Application Publication No.
2017/0281166;
[0364] U.S. patent application Ser. No. 15/089,296, entitled
INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SURGICAL END EFFECTOR
THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS, now U.S. Patent
Application Publication No. 2017/0281168;
[0365] U.S. patent application Ser. No. 15/089,258, entitled
SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION, now
U.S. Patent Application Publication No. 2017/0281178;
[0366] U.S. patent application Ser. No. 15/089,278, entitled
SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVE CUTTING OF
TISSUE, now U.S. Patent Application Publication No.
2017/0281162;
[0367] U.S. patent application Ser. No. 15/089,284, entitled
SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT, now U.S.
Patent Application Publication No. 2017/0281186;
[0368] U.S. patent application Ser. No. 15/089,295, entitled
SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSION LOCKOUT,
now U.S. Patent Application Publication No. 2017/0281187;
[0369] U.S. patent application Ser. No. 15/089,300, entitled
SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT, now U.S.
Patent Application Publication No. 2017/0281179;
[0370] U.S. patent application Ser. No. 15/089,196, entitled
SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT, now U.S.
Patent Application Publication No. 2017/0281183;
[0371] U.S. patent application Ser. No. 15/089,203, entitled
SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT, now
U.S. Patent Application Publication No. 2017/0281184;
[0372] U.S. patent application Ser. No. 15/089,210, entitled
SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGE LOCKOUT, now
U.S. Patent Application Publication No. 2017/0281185;
[0373] U.S. patent application Ser. No. 15/089,324, entitled
SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM, now U.S.
Patent Application Publication No. 2017/0281170;
[0374] U.S. patent application Ser. No. 15/089,335, entitled
SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS, now U.S.
Patent Application Publication No. 2017/0281155;
[0375] U.S. patent application Ser. No. 15/089,339, entitled
SURGICAL STAPLING INSTRUMENT, now U.S. Patent Application
Publication No. 2017/0281173;
[0376] U.S. patent application Ser. No. 15/089,253, entitled
SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OF
STAPLES HAVING DIFFERENT HEIGHTS, now U.S. Patent Application
Publication No. 2017/0281177;
[0377] U.S. patent application Ser. No. 15/089,304, entitled
SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET, now
U.S. Patent Application Publication No. 2017/0281188;
[0378] U.S. patent application Ser. No. 15/089,331, entitled ANVIL
MODIFICATION MEMBERS FOR SURGICAL STAPLE/FASTENERS, now U.S. Patent
Application Publication No. 2017/0281180;
[0379] U.S. patent application Ser. No. 15/089,336, entitled STAPLE
CARTRIDGES WITH ATRAUMATIC FEATURES, now U.S. Patent Application
Publication No. 2017/0281164;
[0380] U.S. patent application Ser. No. 15/089,312, entitled
CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUE SUPPORT,
now U.S. Patent Application Publication No. 2017/0281189;
[0381] U.S. patent application Ser. No. 15/089,309, entitled
CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM, now U.S.
Patent Application Publication No. 2017/0281169; and
[0382] U.S. patent application Ser. No. 15/089,349, entitled
CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL, now U.S. Patent
Application Publication No. 2017/0281174.
[0383] Applicant of the present application also owns the U.S.
patent applications identified below which were filed on Dec. 30,
2015 which are each herein incorporated by reference in their
respective entirety:
[0384] U.S. patent application Ser. No. 14/984,488, entitled
MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE IN POWERED
SURGICAL INSTRUMENTS, now U.S. Patent Application Publication No.
2017/0189018;
[0385] U.S. patent application Ser. No. 14/984,525, entitled
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED
SURGICAL INSTRUMENTS, now U.S. Patent Application Publication No.
2017/0189019; and
[0386] U.S. patent application Ser. No. 14/984,552, entitled
SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROL
CIRCUITS, now U.S. Patent Application Publication No.
2017/0189020.
[0387] Applicant of the present application also owns the U.S.
patent applications identified below which were filed on Feb. 9,
2016 which are each herein incorporated by reference in their
respective entirety:
[0388] U.S. patent application Ser. No. 15/019,220, entitled
SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLATABLE END
EFFECTOR, now U.S. Patent Application Publication No.
2017/0224333;
[0389] U.S. patent application Ser. No. 15/019,228, entitled
SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS,
now U.S. Patent Application Publication No. 2017/0224342;
[0390] U.S. patent application Ser. No. 15/019,196, entitled
SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY
CONSTRAINT, now U.S. Patent Application Publication No.
2017/0224330;
[0391] U.S. patent application Ser. No. 15/019,206, entitled
SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLY
ARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY, now U.S.
Patent Application Publication No. 2017/0224331;
[0392] U.S. patent application Ser. No. 15/019,215, entitled
SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION
ARRANGEMENTS, now U.S. Patent Application Publication No.
2017/0224332;
[0393] U.S. patent application Ser. No. 15/019,227, entitled
ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATION LINK
ARRANGEMENTS, now U.S. Patent Application Publication No.
2017/0224334;
[0394] U.S. patent application Ser. No. 15/019,235, entitled
SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEN
ARTICULATION SYSTEMS, now U.S. Patent Application Publication No.
2017/0224336;
[0395] U.S. patent application Ser. No. 15/019,230, entitled
ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAM
ARRANGEMENTS, now U.S. Patent Application Publication No.
2017/0224335; and
[0396] U.S. patent application Ser. No. 15/019,245, entitled
SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTION ARRANGEMENTS,
now U.S. Patent Application Publication No. 2017/0224343.
[0397] Applicant of the present application also owns the U.S.
patent applications identified below which were filed on Feb. 12,
2016 which are each herein incorporated by reference in their
respective entirety:
[0398] U.S. patent application Ser. No. 15/043,254, entitled
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED
SURGICAL INSTRUMENTS;
[0399] U.S. patent application Ser. No. 15/043,259, entitled
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED
SURGICAL INSTRUMENTS;
[0400] U.S. patent application Ser. No. 15/043,275, entitled
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED
SURGICAL INSTRUMENTS; and
[0401] U.S. patent application Ser. No. 15/043,289, entitled
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED
SURGICAL INSTRUMENTS.
[0402] Applicant of the present application owns the following
patent applications that were filed on Jun. 18, 2015 and which are
each herein incorporated by reference in their respective
entirety:
[0403] U.S. patent application Ser. No. 14/742,925, entitled
SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS, now
U.S. Patent Application Publication No. 2016/0367256;
[0404] U.S. patent application Ser. No. 14/742,941, entitled
SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES,
now U.S. Patent Application Publication No. 2016/0367248;
[0405] U.S. patent application Ser. No. 14/742,914, entitled
MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLE SURGICAL
INSTRUMENTS, now U.S. Patent Application Publication No.
2016/0367255;
[0406] U.S. patent application Ser. No. 14/742,900, entitled
ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAM
STRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION
SUPPORT, now U.S. Patent Application Publication No.
2016/0367254;
[0407] U.S. patent application Ser. No. 14/742,885, entitled DUAL
ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLE SURGICAL
INSTRUMENTS, now U.S. Patent Application Publication No.
2016/0367246; and
[0408] U.S. patent application Ser. No. 14/742,876, entitled
PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLE SURGICAL
INSTRUMENTS, now U.S. Patent Application Publication No.
2016/0367245.
[0409] Applicant of the present application owns the following
patent applications that were filed on Mar. 6, 2015 and which are
each herein incorporated by reference in their respective
entirety:
[0410] U.S. patent application Ser. No. 14/640,746, entitled
POWERED SURGICAL INSTRUMENT, now U.S. Pat. No. 9,808,246;
[0411] U.S. patent application Ser. No. 14/640,795, entitled
MULTIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWERED SURGICAL
INSTRUMENTS, now U.S. Patent Application Publication No.
2016/02561185;
[0412] U.S. patent application Ser. No. 14/640,832, entitled
ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURE RATES FOR
MULTIPLE TISSUE TYPES, now U.S. Patent Application Publication No.
2016/0256154;
[0413] U.S. patent application Ser. No. 14/640,935, entitled
OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO
MEASURE TISSUE COMPRESSION, now U.S. Patent Application Publication
No. 2016/0256071;
[0414] U.S. patent application Ser. No. 14/640,831, entitled
MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTOR FOR
POWERED SURGICAL INSTRUMENTS, now U.S. Patent Application
Publication No. 2016/0256153;
[0415] U.S. patent application Ser. No. 14/640,859, entitled TIME
DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINE STABILITY, CREEP,
AND VISCOELASTIC ELEMENTS OF MEASURES, now U.S. Patent Application
Publication No. 2016/0256187;
[0416] U.S. patent application Ser. No. 14/640,817, entitled
INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS, now
U.S. Patent Application Publication No. 2016/0256186;
[0417] U.S. patent application Ser. No. 14/640,844, entitled
CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITHIN MODULAR SHAFT
WITH SELECT CONTROL PROCESSING FROM HANDLE, now U.S. Patent
Application Publication No. 2016/0256155;
[0418] U.S. patent application Ser. No. 14/640,837, entitled SMART
SENSORS WITH LOCAL SIGNAL PROCESSING, now U.S. Patent Application
Publication No. 2016/0256163;
[0419] U.S. patent application Ser. No. 14/640,765, entitled SYSTEM
FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A
SURGICAL STAPLE/FASTENER, now U.S. Patent Application Publication
No. 2016/0256160;
[0420] U.S. patent application Ser. No. 14/640,799, entitled SIGNAL
AND POWER COMMUNICATION SYSTEM POSITIONED ON A ROTATABLE SHAFT, now
U.S. Patent Application Publication No. 2016/0256162; and
[0421] U.S. patent application Ser. No. 14/640,780, entitled
SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING, now U.S.
Patent Application Publication No. 2016/0256161.
[0422] Applicant of the present application owns the following
patent applications that were filed on Feb. 27, 2015, and which are
each herein incorporated by reference in their respective
entirety:
[0423] U.S. patent application Ser. No. 14/633,576, entitled
SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION, now
U.S. Patent Application Publication No. 2016/0249919;
[0424] U.S. patent application Ser. No. 14/633,546, entitled
SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCE
PARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE
PERFORMANCE BAND, now U.S. Patent Application Publication No.
2016/0249915;
[0425] U.S. patent application Ser. No. 14/633,560, entitled
SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONE OR MORE
BATTERIES, now U.S. Patent Application Publication No.
2016/0249910;
[0426] U.S. patent application Ser. No. 14/633,566, entitled
CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A
BATTERY, now U.S. Patent Application Publication No.
2016/0249918;
[0427] U.S. patent application Ser. No. 14/633,555, entitled SYSTEM
FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TO BE SERVICED,
now U.S. Patent Application Publication No. 2016/0249916;
[0428] U.S. patent application Ser. No. 14/633,542, entitled
REINFORCED BATTERY FOR A SURGICAL INSTRUMENT, now U.S. Patent
Application Publication No. 2016/0249908;
[0429] U.S. patent application Ser. No. 14/633,548, entitled POWER
ADAPTER FOR A SURGICAL INSTRUMENT, now U.S. Patent Application
Publication No. 2016/0249909;
[0430] U.S. patent application Ser. No. 14/633,526, entitled
ADAPTABLE SURGICAL INSTRUMENT HANDLE, now U.S. Patent Application
Publication No. 2016/0249945;
[0431] U.S. patent application Ser. No. 14/633,541, entitled
MODULAR STAPLING ASSEMBLY, now U.S. Patent Application Publication
No. 2016/0249927; and
[0432] U.S. patent application Ser. No. 14/633,562, entitled
SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFE PARAMETER,
now U.S. Patent Application Publication No. 2016/0249917.
[0433] Applicant of the present application owns the following
patent applications that were filed on Dec. 18, 2014 and which are
each herein incorporated by reference in their respective
entirety:
[0434] U.S. patent application Ser. No. 14/574,478, entitled
SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END
EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING
MEMBER, now U.S. Pat. No. 9,844,374;
[0435] U.S. patent application Ser. No. 14/574,483, entitled
SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS, now U.S.
Patent Application Publication No. 2016/0174969;
[0436] U.S. patent application Ser. No. 14/575,139, entitled DRIVE
ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS, now U.S. Pat.
No. 9,844,375;
[0437] U.S. patent application Ser. No. 14/575,148, entitled
LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITH
ARTICULATABLE SURGICAL END EFFECTORS, now U.S. Patent Application
Publication No. 2016/0174976;
[0438] U.S. patent application Ser. No. 14/575,130, entitled
SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLE ABOUT
A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE, now
U.S. Patent Application Publication No. 2016/0174972;
[0439] U.S. patent application Ser. No. 14/575,143, entitled
SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS, now U.S.
Patent Application Publication No. 2016/0174983;
[0440] U.S. patent application Ser. No. 14/575,117, entitled
SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE
FIRING BEAM SUPPORT ARRANGEMENTS, now U.S. Patent Application
Publication No. 2016/0174975;
[0441] U.S. patent application Ser. No. 14/575,154, entitled
SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED
FIRING BEAM SUPPORT ARRANGEMENTS, now U.S. Patent Application
Publication No. 2016/0174973;
[0442] U.S. patent application Ser. No. 14/574,493, entitled
SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION
SYSTEM, now U.S. Patent Application Publication No. 2016/0174970;
and
[0443] U.S. patent application Ser. No. 14/574,500, entitled
SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION
SYSTEM, now U.S. Patent Application Publication No.
2016/0174971.
[0444] Applicant of the present application owns the following
patent applications that were filed on Mar. 1, 2013 and which are
each herein incorporated by reference in their respective
entirety:
[0445] U.S. patent application Ser. No. 13/782,295, entitled
ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR
SIGNAL COMMUNICATION, now U.S. Pat. No. 9,700,309;
[0446] U.S. patent application Ser. No. 13/782,323, entitled ROTARY
POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS, now U.S. Pat.
No. 9,782,169;
[0447] U.S. patent application Ser. No. 13/782,338, entitled
THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS, now U.S.
Patent Application Publication No. 2014/0249557;
[0448] U.S. patent application Ser. No. 13/782,499, entitled
ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT,
now U.S. Pat. No. 9,358,003;
[0449] U.S. patent application Ser. No. 13/782,460, entitled
MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS,
now U.S. Pat. No. 9,554,794;
[0450] U.S. patent application Ser. No. 13/782,358, entitled
JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS, now U.S. Pat.
No. 9,326,767;
[0451] U.S. patent application Ser. No. 13/782,481, entitled SENSOR
STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR, now U.S.
Pat. No. 9,468,438;
[0452] U.S. patent application Ser. No. 13/782,518, entitled
CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMENT
PORTIONS, now U.S. Patent Application Publication No.
2014/0246475;
[0453] U.S. patent application Ser. No. 13/782,375, entitled ROTARY
POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM, now
U.S. Pat. No. 9,398,911; and
[0454] U.S. patent application Ser. No. 13/782,536, entitled
SURGICAL INSTRUMENT SOFT STOP, now U.S. Pat. No. 9,307,986.
[0455] Applicant of the present application also owns the following
patent applications that were filed on Mar. 14, 2013 and which are
each herein incorporated by reference in their respective
entirety:
[0456] U.S. patent application Ser. No. 13/803,097, entitled
ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, now
U.S. Pat. No. 9,687,230;
[0457] U.S. patent application Ser. No. 13/803,193, entitled
CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT,
now U.S. Pat. No. 9,332,987;
[0458] U.S. patent application Ser. No. 13/803,053, entitled
INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL
INSTRUMENT, now U.S. Patent Application Publication No.
2014/0263564;
[0459] U.S. patent application Ser. No. 13/803,086, entitled
ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK,
now U.S. Patent Application Publication No. 2014/0263541;
[0460] U.S. patent application Ser. No. 13/803,210, entitled SENSOR
ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL
INSTRUMENTS, now U.S. Pat. No. 9,808,244;
[0461] U.S. patent application Ser. No. 13/803,148, entitled
MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT, now U.S. Patent
Application Publication No. 2014/0263554;
[0462] U.S. patent application Ser. No. 13/803,066, entitled DRIVE
SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, now
U.S. Pat. No. 9,629,623;
[0463] U.S. patent application Ser. No. 13/803,117, entitled
ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS,
now U.S. Pat. No. 9,351,726;
[0464] U.S. patent application Ser. No. 13/803,130, entitled DRIVE
TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, now
U.S. Pat. No. 9,351,727; and
[0465] U.S. patent application Ser. No. 13/803,159, entitled METHOD
AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT, now U.S. Patent
Application Publication No. 2014/0277017.
[0466] Applicant of the present application also owns the following
patent application that was filed on Mar. 7, 2014 and is herein
incorporated by reference in its entirety:
[0467] U.S. patent application Ser. No. 14/200,111, entitled
CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, now U.S. Pat. No.
9,629,629.
[0468] Applicant of the present application also owns the following
patent applications that were filed on Mar. 26, 2014 and are each
herein incorporated by reference in their respective entirety:
[0469] U.S. patent application Ser. No. 14/226,106, entitled POWER
MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, now U.S.
Patent Application Publication No. 2015/0272582;
[0470] U.S. patent application Ser. No. 14/226,099, entitled
STERILIZATION VERIFICATION CIRCUIT, now U.S. Pat. No.
9,826,977;
[0471] U.S. patent application Ser. No. 14/226,094, entitled
VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT, now
U.S. Patent Application Publication No. 2015/0272580;
[0472] U.S. patent application Ser. No. 14/226,117, entitled POWER
MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP
CONTROL, now U.S. Patent Application Publication No.
2015/0272574;
[0473] U.S. patent application Ser. No. 14/226,075, entitled
MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT
ASSEMBLIES, now U.S. Pat. No. 9,743,929;
[0474] U.S. patent application Ser. No. 14/226,093, entitled
FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL
INSTRUMENTS, now U.S. Patent Application Publication No.
2015/0272569;
[0475] U.S. patent application Ser. No. 14/226,116, entitled
SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION, now U.S. Patent
Application Publication No. 2015/0272571;
[0476] U.S. patent application Ser. No. 14/226,071, entitled
SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR, now
U.S. Pat. No. 9,690,362;
[0477] U.S. patent application Ser. No. 14/226,097, entitled
SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS, now U.S. Pat.
No. 9,820,738;
[0478] U.S. patent application Ser. No. 14/226,126, entitled
INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS, now U.S.
Patent Application Publication No. 2015/0272572;
[0479] U.S. patent application Ser. No. 14/226,133, entitled
MODULAR SURGICAL INSTRUMENT SYSTEM, now U.S. Patent Application
Publication No. 2015/0272557;
[0480] U.S. patent application Ser. No. 14/226,081, entitled
SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT, now U.S.
Pat. No. 9,804,618;
[0481] U.S. patent application Ser. No. 14/226,076, entitled POWER
MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE
PROTECTION, now U.S. Pat. No. 9,733,663;
[0482] U.S. patent application Ser. No. 14/226,111, entitled
SURGICAL STAPLING INSTRUMENT SYSTEM, now U.S. Pat. No. 9,750,499;
and
[0483] U.S. patent application Ser. No. 14/226,125, entitled
SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT, now U.S. Patent
Application Publication No. 2015/0280384.
[0484] Applicant of the present application also owns the following
patent applications that were filed on Sep. 5, 2014 and which are
each herein incorporated by reference in their respective
entirety:
[0485] U.S. patent application Ser. No. 14/479,103, entitled
CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE, now U.S. Patent
Application Publication No. 2016/0066912;
[0486] U.S. patent application Ser. No. 14/479,119, entitled
ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION, now
U.S. Pat. No. 9,724,094;
[0487] U.S. patent application Ser. No. 14/478,908, entitled
MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION, now
U.S. Pat. No. 9,737,301;
[0488] U.S. patent application Ser. No. 14/478,895, entitled
MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT
OR INTERPRETATION, now U.S. Pat. No. 9,757,128;
[0489] U.S. patent application Ser. No. 14/479,110, entitled
POLARITY OF HALL MAGNET TO DETECT MISLOADED CARTRIDGE, now U.S.
Patent Application Publication No. 2016/0066915;
[0490] U.S. patent application Ser. No. 14/479,098, entitled SMART
CARTRIDGE WAKE UP OPERATION AND DATA RETENTION, now U.S. Patent
Application Publication No. 2016/0066911;
[0491] U.S. patent application Ser. No. 14/479,115, entitled
MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE, now U.S. Pat.
No. 9,788,836; and
[0492] U.S. patent application Ser. No. 14/479,108, entitled LOCAL
DISPLAY OF TISSUE PARAMETER STABILIZATION, now U.S. Patent
Application Publication No. 2016/0066913.
[0493] Applicant of the present application also owns the following
patent applications that were filed on Apr. 9, 2014 and which are
each herein incorporated by reference in their respective
entirety:
[0494] U.S. patent application Ser. No. 14/248,590, entitled MOTOR
DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS, now
U.S. Pat. No. 9,826,976;
[0495] U.S. patent application Ser. No. 14/248,581, entitled
SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRING DRIVE
OPERATED FROM THE SAME ROTATABLE OUTPUT, now U.S. Pat. No.
9,649,110;
[0496] U.S. patent application Ser. No. 14/248,595, entitled
SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE
OPERATION OF THE SURGICAL INSTRUMENT, now U.S. Pat. No.
9,844,368;
[0497] U.S. patent application Ser. No. 14/248,588, entitled
POWERED LINEAR SURGICAL STAPLE/FASTENER, now U.S. Patent
Application Publication No. 2014/0309666;
[0498] U.S. patent application Ser. No. 14/248,591, entitled
TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT, now U.S. Patent
Application Publication No. 2014/0305991;
[0499] U.S. patent application Ser. No. 14/248,584, entitled
MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES
FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS,
now U.S. Pat. No. 9,801,626;
[0500] U.S. patent application Ser. No. 14/248,587, entitled
POWERED SURGICAL STAPLE/FASTENER, now U.S. Patent Application
Publication No. 2014/0309665;
[0501] U.S. patent application Ser. No. 14/248,586, entitled DRIVE
SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT, now U.S.
Patent Application Publication No. 2014/0305990; and
[0502] U.S. patent application Ser. No. 14/248,607, entitled
MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION
ARRANGEMENTS, now U.S. Pat. No. 9,814,460.
[0503] Applicant of the present application also owns the following
patent applications that were filed on Apr. 16, 2013 and which are
each herein incorporated by reference in their respective
entirety:
[0504] U.S. Provisional Patent Application Ser. No. 61/812,365,
entitled SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A
SINGLE MOTOR;
[0505] U.S. Provisional Patent Application Ser. No. 61/812,376,
entitled LINEAR CUTTER WITH POWER;
[0506] U.S. Provisional Patent Application Ser. No. 61/812,382,
entitled LINEAR CUTTER WITH MOTOR AND PISTOL GRIP;
[0507] U.S. Provisional Patent Application Ser. No. 61/812,385,
entitled SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS
AND MOTOR CONTROL; and
[0508] U.S. Provisional Patent Application Ser. No. 61/812,372,
entitled SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A
SINGLE MOTOR.
[0509] Numerous specific details are set forth to provide a
thorough understanding of the overall structure, function,
manufacture, and use of the embodiments as described in the
specification and illustrated in the accompanying drawings.
Well-known operations, components, and elements have not been
described in detail so as not to obscure the embodiments described
in the specification. The reader will understand that the
embodiments described and illustrated herein are non-limiting
examples, and thus it can be appreciated that the specific
structural and functional details disclosed herein may be
representative and illustrative. Variations and changes thereto may
be made without departing from the scope of the claims.
[0510] The terms "comprise" (and any form of comprise, such as
"comprises" and "comprising"), "have" (and any form of have, such
as "has" and "having"), "include" (and any form of include, such as
"includes" and "including"), and "contain" (and any form of
contain, such as "contains" and "containing") are open-ended
linking verbs. As a result, a surgical system, device, or apparatus
that "comprises," "has," "includes", or "contains" one or more
elements possesses those one or more elements, but is not limited
to possessing only those one or more elements. Likewise, an element
of a system, device, or apparatus that "comprises," "has,"
"includes", or "contains" one or more features possesses those one
or more features, but is not limited to possessing only those one
or more features.
[0511] The terms "proximal" and "distal" are used herein with
reference to a clinician manipulating the handle portion of the
surgical instrument. The term "proximal" refers to the portion
closest to the clinician and the term "distal" refers to the
portion located away from the clinician. It will be further
appreciated that, for convenience and clarity, spatial terms such
as "vertical", "horizontal", "up", and "down" may be used herein
with respect to the drawings. However, surgical instruments are
used in many orientations and positions, and these terms are not
intended to be limiting and/or absolute.
[0512] Various exemplary devices and methods are provided for
performing laparoscopic and minimally invasive surgical procedures.
However, the reader will readily appreciate that the various
methods and devices disclosed herein can be used in numerous
surgical procedures and applications including, for example, in
connection with open surgical procedures. As the present Detailed
Description proceeds, the reader will further appreciate that the
various instruments disclosed herein can be inserted into a body in
any way, such as through a natural orifice, through an incision or
puncture hole formed in tissue, etc. The working portions or end
effector portions of the instruments can be inserted directly into
a patient's body or can be inserted through an access device that
has a working channel through which the end effector and elongate
shaft of a surgical instrument can be advanced.
[0513] Various surgical instruments are disclosed herein which are
configured to fasten the tissue of a patient. As discussed in
greater detail below, such surgical instruments comprise an end
effector and a plurality of drive systems configured to perform
various end effector functions. Such drive systems can include an
anvil drive system configured to clamp the tissue within the end
effector, a staple firing system configured to deploy staples into
the tissue, and/or a tissue cutting system configured to cut the
tissue, for example. Such drive systems can also include an
articulation drive system configured to articulate the end
effector, a tissue drive system configured to move the end effector
relative to the tissue, and/or a staple loading system configured
to reload the end effector with staples, for example. As also
discussed in greater detail below, two or more of these drive
systems can be operably coupled to a common drive system such that
they are operated synchronously.
[0514] A stapling instrument 1000 is illustrated in FIG. 1. The
stapling instrument 1000 comprises a handle 1100, a shaft assembly
1200 extending from the handle 1100, and an end effector 1300
extending from the shaft assembly 1200. The handle 1100 comprises a
frame 1110 and gripping portions 1120 positioned on opposite sides
of the frame 1110. The handle 1100 further comprises a plurality of
electric motors configured to operate the drive systems of the
stapling instrument 1000. Three electric motors 1130, 1140, and
1150 are depicted, but the surgical instrument 1000 can include any
suitable number of electric motors. Each electric motor is operably
coupled with a rotatable output. For instance, the electric motor
1130 is operably coupled to a rotatable output 1135, the electric
motor 1140 is operably coupled to a rotatable output 1145, and the
electric motor 1150 is operably coupled to a rotatable output 1155.
The handle 1100 further comprises batteries 1160, for example,
which supply power to the electric motors 1130, 1140, and 1150.
Referring to FIG. 11, the batteries 1160 comprise lithium 18650
batteries, for example, but can comprise any suitable battery.
Referring primarily to FIG. 12, the batteries 1160 are positioned
in a battery compartment 1115 defined in the handle frame 1110, but
can be stored in any suitable location. The batteries 1160 are also
configured to supply power to a control system and/or display of
the handle 1110, which are described in greater detail below.
[0515] A handle 1100' is illustrated in FIGS. 8 and 10. The handle
1100' is similar to the handle 1100 in many respects, most of which
will not be discussed herein for the sake of brevity. The handle
1100' comprises a battery compartment which is accessible through a
door 1115'. The door 1115' permits the batteries in the battery
compartment to be replaced. A handle 1100'' is illustrated in FIG.
9. The handle 1100'' is similar to the handle 1100 in many
respects, most of which will not be discussed herein for the sake
of brevity. The handle 1100'' comprises a plug 1115'' configured to
supply power to the handle 1100'' from a generator and/or wall
outlet, for example. In various instances, the handle 1100'' can be
powered from an internal source, such as by the batteries 1160, for
example, and an external source, such as by the plug 1115'', for
example.
[0516] Referring again to FIG. 1, the handle frame 1110 comprises a
connector 1170. The shaft assembly 1200 comprises an outer housing
1210 which includes a shaft connector 1270 configured to be engaged
with the handle connector 1170 to couple the shaft assembly 1200 to
the handle 1100. The shaft connector 1270 and the handle 1170
comprise a rotatable bayonet interconnection; however, any suitable
interconnection could be used. The shaft assembly 1200 further
comprises a rotatable input 1235 configured to be operably coupled
with the rotatable output 1135 when the shaft assembly 1200 is
assembled to the handle 1100. Similarly, the shaft assembly 1200
also comprises a rotatable input 1245 configured to be operably
coupled with the rotatable output 1145 and a rotatable input 1255
configured to be operably coupled with the rotatable output 1155
when the shaft assembly 1200 is assembled to the handle 1100.
[0517] Further to the above, the outer shaft housing 1210 further
comprises a distal connector 1290. The end effector 1300 comprises
a shaft portion 1310 which includes an end effector connector 1390
configured to be engaged with the distal connector 1290 to couple
the end effector 1300 to the shaft assembly 1200. The end effector
connector 1390 and the distal shaft connector 1290 comprise a
rotatable interconnection; however, any suitable interconnection
could be used. The end effector 1300 further comprises a first
drive configured to be operably coupled to the shaft input 1235
when the end effector 1300 is assembled to the shaft assembly 1200.
Similarly, the end effector 1300 comprises a second drive
configured to be operably coupled to the shaft input 1245 and a
third drive configured to be operably coupled to the shaft input
1255 when the end effector 1300 is assembled to the shaft assembly
1200.
[0518] In various instances, the shaft assembly 1200 and/or the end
effector 1300 comprises one more sensors and/or electrically-driven
components. Referring to FIG. 2, the stapling instrument 1000
comprises at least one electrical circuit extending through the
handle 1100, the shaft assembly 1200, and the end effector 1300.
The electrical circuit comprises conductors in the handle 1100, the
shaft assembly 1200, and the end effector 1300 which are placed in
electrical communication with one another when the shaft assembly
1200 is assembled to the handle 1100 and the end effector 1300 is
assembled to the shaft assembly 1200. FIG. 2 illustrates four
conductors 1280 in the shaft assembly 1200 which are part of two
separate electrical circuits; however, any suitable number of
conductors and/or circuits can be used. The handle connector 1170
and the shaft connector 1270 comprise electrical contacts which are
rotated into engagement when the shaft assembly 1200 is rotatably
assembled to the handle 1100. Similarly, the distal shaft connector
1290 and the end effector connector 1390 comprise electrical
contacts which are rotated into engagement when the end effector
1300 is assembled to the shaft assembly 1200.
[0519] Referring again to FIG. 1, the end effector 1300 further
comprises a distal head 1320 rotatably connected to the shaft
portion 1310 about an articulation joint 1370. The end effector
1300 also comprises an articulation drive system configured to
articulate the distal head 1320 relative to the shaft portion 1310.
The distal head 1320 comprises an anvil 1360 which is movable
between an open position and a closed position. In use, the anvil
1360 is movable toward a tissue compression surface 1325 by an
anvil drive system in order to clamp, or compress, tissue within
the end effector 1300. As will be discussed in connection with
FIGS. 3-7 below, the tissue compression surface 1325 is defined on
a tissue drive system which is configured to engage the patient
tissue and move the stapling instrument 1000 relative to the
patient tissue.
[0520] Referring primarily to FIG. 3, the end effector 1300
comprises a rotatable drive shaft 1330 which is usable to
selectively open the anvil 1360, operate the tissue drive system
(FIGS. 4-6) to re-position the distal head 1320 relative to the
patient tissue, and close the anvil 1360 (FIG. 7) before the
stapling instrument 1000 performs a staple firing stroke. The drive
shaft 1330 is driven by an electric motor and, moreover, the drive
shaft 1330 is translatable between a first position in which a key
1332 extending from the drive shaft 1330 is operably engaged with
the tissue drive system (FIGS. 4-6) and a second position in which
the key 1332 is operably engaged with the anvil drive system (FIG.
7). When the drive shaft 1330 is in its first position, the key
1332 is positioned within a key slot 1333 defined in a drive gear
1331 of the tissue drive system. When the drive shaft 1330 is in
its second position, the key 1332 is positioned within a key slot
1363 defined in a drive collar 1361 of the anvil drive system.
[0521] Referring to FIGS. 4-6, the tissue drive system comprises a
first foot 1380a and a second foot 1380b. The feet 1380a, 1380b are
extendable to engage the patient tissue and then retractable to
pull the distal head 1320 of the end effector 1300 relative to the
patient tissue. The tissue drive system is configured to extend the
first foot 1380a while retracting the second foot 1380b and,
similarly, extend the second foot 1380b while retracting the first
foot 1380a. FIG. 4 illustrates the first foot 1380a in an extended
position and the second foot 1380b in a retracted position. As a
result of the above, the tissue drive system can be configured to
walk the end effector 1300 across the tissue to create a staple
firing path within the tissue. In various alternative embodiments,
the tissue drive system can be configured to extend the first foot
1380a and second foot 1380b simultaneously and/or retract the first
foot 1380a and second foot 1380b simultaneously.
[0522] Further to the above, the tissue drive system comprises a
first gear train configured to transfer the rotation of the drive
shaft 1330 to the first gear 1380a and a second gear train
configured to transfer the rotation of the drive shaft 1330 to the
second gear 1380b. The first gear train comprises a spur gear 1381a
operably intermeshed with the drive gear 1331, a transfer gear
1382a operably intermeshed with the spur gear 1381a, and a spur
gear 1383a operably intermeshed with the transfer gear 1382a such
that the rotation of the shaft 1330 is transferred to the spur gear
1383a. The first gear train further comprises a shaft gear 1384a
operably intermeshed with the spur gear 1383a. Referring primarily
to FIGS. 5 and 6, the shaft gear 1384a is fixedly mounted to a
transfer shaft 1385a such that the rotation of the spur gear 1383a
is transferred to the transfer shaft 1385a. The first gear train
further comprises a bevel gear 1386a fixedly mounted to the
transfer shaft 1385a, a side bevel gear 1387a operably intermeshed
with the bevel gear 1386a, and a pinion gear 1388a fixedly mounted
to the side bevel gear 1387a such that the pinion gear 1388a
rotates with the side bevel gear 1387a. Referring primarily to FIG.
6, the pinion gear 1388a is operably intermeshed with a rack 1389a
mounted to the first foot 1380a which converts the rotational input
motion to translational motion of the first foot 1380a.
[0523] The second gear train is similar to the first gear train in
many respects except that the second gear train does not include a
transfer gear intermediate the two spur gears, as discussed below.
The second gear train comprises a spur gear 1381b operably
intermeshed with the drive gear 1331 and a spur gear 1383b operably
intermeshed with the spur gear 1381b such that the rotation of the
shaft 1330 is transferred to the spur gear 1383b. The second gear
train further comprises a shaft gear 1384b operably intermeshed
with the spur gear 1383b. Referring primarily to FIG. 5, the shaft
gear 1384b is fixedly mounted to a transfer shaft 1385b such that
the rotation of the spur gear 1383b is transferred to the transfer
shaft 1385b. The second gear train further comprises a bevel gear
1386b fixedly mounted to the transfer shaft 1385b, a side bevel
gear 1387b operably intermeshed with the bevel gear 1386b, and a
pinion gear 1388b fixedly mounted to the side bevel gear 1387b such
that the pinion gear 1388b rotates with the side bevel gear 1387b.
The pinion gear 1388b is operably intermeshed with a rack 1389b
mounted to the second foot 1380b which converts the rotational
input motion to translational motion of the second foot 1380b.
[0524] The presence of a transfer gear 1382a in the first gear
train and the absence of a corresponding transfer gear in the
second gear train cause the first foot 1380a and the second foot
1380b to move in opposite directions in response to the rotation of
the drive shaft 1330. For instance, the first foot 1380a is
extended and the second foot 1380b is retracted when the drive
shaft 1330 is rotated in a first direction. Correspondingly, the
first foot 1380a is retracted and the second foot 1380b is extended
when the drive shaft 1330 is rotated in a second, or opposite,
direction. As discussed above, the first and second feet 1380a,
1380b are configured to grasp and pull the end effector 1300
relative to the tissue as they are extended and retracted. While
the motion of the feet 1380a, 1380b may be linear, other
embodiments are disclosed herein which provide different motions,
such as an arcuate motion, for example.
[0525] Once the end effector 1300 has been suitably moved relative
to the tissue by the tissue drive system, the drive shaft 1330 is
translated longitudinally out of engagement with the tissue drive
system and into engagement with the anvil drive system, as
illustrated in FIG. 7. In various instances, the rotation of the
drive shaft 1330 can be stopped before it is disengaged from the
tissue drive system. In other instances, the drive shaft 1330 can
continue to rotate as it is disengaged from the tissue drive system
and translated into engagement with the drive collar 1361. In
either event, the drive collar 1361 comprises a threaded aperture
1362 defined therein including threads 1365. The anvil 1360
comprises a push rod 1364 extending therefrom which includes an end
threadably engaged with the threads 1365 in the aperture 1366. When
the drive collar 1361 is rotated in a first direction by the drive
shaft 1330, the drive collar 1361 pushes the anvil 1360 away from
the feet 1380a and 1380b to open the anvil 1360. Once the anvil
1360 has been sufficiently opened, the drive shaft 1330 can be
shifted to engage the tissue drive system and move the end effector
1300 relative to the tissue. The drive shaft 1330 can then be
re-engaged with the anvil drive system. When the drive collar 1361
is rotated in a second, or opposite, direction, at such point, the
drive collar 1361 pulls the anvil 1360 toward the feet 1380a and
1380b to close or clamp the anvil 1360, as illustrated in FIG. 7.
Once the anvil 1360 has been closed, the staple firing system of
the stapling instrument 1000 can be actuated. At such point, the
anvil 1360 is re-opened by the anvil drive system and the
above-described cycle can be repeated.
[0526] Notably, the drive shaft 1330 extends along a longitudinal
axis 1339 which is collinear with a longitudinal axis 1369
extending through the push rod 1364 of the anvil drive system. Such
an arrangement allows the drive shaft 1330 to be operably linked to
the push rod 1334 through the drive collar 1361. Also, notably, the
drive collar 1361 comprises a proximal flange 1367 and a distal
flange 1368 extending therefrom. The flanges 1367 and 1368 act as
stops which limit the longitudinal travel of the anvil 1360 in the
proximal and distal directions, respectively. As such, the flanges
1367 and 1368 define the limits of the opening and closing strokes
of the anvil 1360. The anvil 1360 comprises a tissue clamping face
which extends orthogonally, or at least substantially orthogonally,
to the longitudinal axis 1369 and moves longitudinally relative to
the distal head 1320. The anvil 1360 comprises a movable jaw and
the feet 1380a and 1380b of the tissue drive system comprise
another movable jaw positioned opposite the anvil 1360.
[0527] Referring again to FIG. 3, a longitudinal gap is present
between the drive gear 1331 of the tissue drive system and the
drive collar 1361 of the anvil drive system. As a result, a dwell
in operation may be present when shifting between the tissue drive
system and the anvil drive system. A shorter gap can result in
shorter dwells while a longer gap can result in longer dwells.
Other embodiments are envisioned in which no, or very little, gap
is present between the drive gear 1331 and the drive collar 1361
and, as a result, the operational dwell can be eliminated.
[0528] Referring again to FIG. 1, the end effector 1300 comprises a
plurality of staple cartridges 1400 stored therein. The stapling
instrument 1000 comprises a cartridge drive system configured to
push a staple cartridge 1400 into the end effector 1300. As a
result, the cartridge drive system can be used to reload the end
effector 1300 without having to remove the stapling instrument 1000
from the surgical site. Once the supply of staple cartridges 1400
in the end effector 1300 have been depleted, however, the stapling
instrument 1000 may have to be removed from the surgical site to be
reloaded unless the stapling instrument 1000 comprises a system for
loading cartridges during the operation of the stapling instrument
1000. Such a system is described in greater detail below. In any
event, the end effector 1300 can be detached from the shaft
assembly 1200 and an unspent end effector 1300 can then be attached
to the shaft assembly 1200 to reload the stapling instrument
1000.
[0529] Referring again to FIG. 1, each end effector 1300 is
intended for as many uses as there are staples or staple cartridges
stored in the end effector 1300. The shaft assembly 1200 is
intended for more uses than an end effector 1300. As a result, a
spent end effector 1300 can be replaced with another end effector
1300 without having to replace the shaft assembly 1200. In at least
one instance, each end effector 1300 is intended for 10 uses while
the shaft assembly is intended for 100 uses, for example. The
handle 1100 is intended for more uses than the shaft assembly 1200
and/or an end effector 1300. As a result, a used shaft assembly
1200 can be replaced without having to replace the handle 1100. In
at least one instance, the shaft assembly 1200 is intended for 100
uses while the handle 1100 is intended for 500 uses, for
example.
[0530] As discussed above, the stapling instrument 1000 comprises a
drive system configured to reciprocatingly open, or unclamp, an
anvil, create relative motion between the end effector and the
patient tissue, and then clamp the anvil once again. FIGS. 42 and
43 illustrate an exemplary embodiment of another reciprocating
drive system that could be used. The drive system 2800 comprises a
rotatable drive shaft 2830 and a drive gear 2831 fixedly mounted to
the drive shaft 2830. The drive system 2800 further comprises a
spur gear 2832 operably intermeshed with the drive gear 2831 such
that the rotation of the drive shaft 2830 is transmitted to the
spur gear 2832. The drive system 2800 further comprises a bevel
gear 2833 that is mounted to and rotates with the spur gear 2832, a
side bevel gear 2834 operably intermeshed with the bevel gear 2833,
and a spur gear 2835 operably intermeshed with a gear mounted to a
face of the bevel gear 2834. The drive system 2800 further
comprises a pinion gear 2836 that is fixedly mounted to and rotates
with the spur gear 2835, an output gear 2837 operably intermeshed
with the pinion gear 2836, and a cam 2838 that is fixedly mounted
to and rotates with the output gear 2837. As a result of the above,
the rotation of the drive shaft 2830 rotates the cam 2838 which, as
described below, is converted to reciprocating motion of the drive
shaft 2830.
[0531] Further to the above, the drive system 2800 comprises a
rotatable shifter 2840 including a cam arm 2848 and a shifter arm
2849 which is rotatable about a pivot 2841. In use, the cam 2838 is
configured to engage the cam arm 2848 of the shifter 2840 and
rotate the shifter 2840 between a first position (FIG. 43) and a
second position (FIG. 42). When the shifter 2840 is rotated into
its second position, as illustrated in FIG. 42, the cam arm 2848
engages a shoulder 2839 defined on the drive shaft 2830 and pushes
the drive shaft 2830 upwardly. A spring 2820 is positioned between
the shoulder 2839 and a frame 2819 of the stapling instrument which
is compressed when the drive shaft 2830 is moved into its second
position and stores potential energy therein. As the cam 2838
continues to rotate, the cam 2838 disengages from the cam arm 2848
and the spring 2820 resiliently returns the drive shaft 2830 back
into its first position, illustrated in FIG. 43. This reciprocating
movement of the drive shaft 2830 between its first and second
positions can be used to operate a reciprocating drive system in
the end effector of the stapling instrument.
[0532] FIG. 44 illustrates another exemplary embodiment of a
reciprocating drive system. The drive system 2900 comprises an
electric motor 2930, a first drive system 2940 operably coupled
with the electric motor 2930, and a second drive system 2950
operably coupled with the electric motor 2930. The electric motor
2930 comprises a rotatable output shaft 2931 and a drive gear 2932
fixedly mounted to the output shaft 2931. The first drive system
2940 comprises an input gear 2942 operably intermeshed with the
drive gear 2932. The input gear 2942 is fixedly mounted to a drive
shaft 2943 such that the drive shaft 2943 rotates with the input
gear 2942. The first drive system 2940 further comprises a barrel
cam 2944 that is slidably mounted to the drive shaft 2943 and
rotates with the drive shaft 2943. The barrel cam 2944 comprises an
aperture 2945 defined therein that comprises a non-circular
profile, for example, that is configured to transfer rotation
between the drive shaft 2943 and the barrel cam 2944, yet permit
relative translation therebetween. The barrel cam 2944 further
comprises a cam slot 2949 defined therearound which interacts with
a cam pin 2919 mounted to a frame 2910 such that, when the barrel
cam 2944 is rotated, the barrel cam 2944 is also translated. The
barrel cam 2944 is translated distally when the barrel cam 2944 is
rotated in a first direction and translated proximally when the
barrel cam 2944 is rotated in a second, or opposite, direction. The
first drive system 2940 further comprises a drive shaft 2946
extending from the barrel cam 2944 that is configured to drive a
first end effector function.
[0533] The second drive system 2950 comprises an input gear 2952
operably intermeshed with the drive gear 2932. The input gear 2952
is fixedly mounted to a drive shaft 2953 such that the drive shaft
2953 rotates with the input gear 2952. The second drive system 2950
further comprises a barrel cam 2954 that is slidably mounted to the
drive shaft 2953 and rotates with the drive shaft 2953. The barrel
cam 2954 comprises an aperture 2955 defined therein that comprises
a non-circular profile, for example, that is configured to transfer
rotation between the drive shaft 2953 and the barrel cam 2954, yet
permit relative translation therebetween. The barrel cam 2954
further comprises a cam slot 2959 defined therearound which
interacts with a cam pin 2919 mounted to the frame 2910 such that,
when the barrel cam 2954 is rotated, the barrel cam 2944 is also
translated. The barrel cam 2954 is translated distally when the
barrel cam 2954 is rotated in a first direction and translated
proximally when the barrel cam 2954 is rotated in a second, or
opposite, direction. The second drive system 2950 further comprises
a drive shaft 2956 extending from the barrel cam 2954 that is
configured to drive a second end effector function.
[0534] When the electric motor 2930 of the drive system 2900 is
rotated in a first direction, the first drive shaft 2946 is
advanced distally and the second drive shaft 2956 is retracted
proximally. Correspondingly, the first drive shaft 2946 is
retracted proximally and the second drive shaft 2956 is advanced
distally when the electric motor 2930 is operated in a second, or
opposite, direction. Other embodiments are envisioned in which the
drive shafts 2946 and 2956 are advanced distally at the same
time.
[0535] Referring to FIGS. 92 and 93, a stapling instrument 4500
comprises a tissue drive 4590 including a first foot 4580a and a
second foot 4580b. The first foot 4580a comprises a rack of teeth
4583a defined thereon, the second foot 4580b comprises a rack of
teeth 4583b defined thereon, and the tissue drive 4500 further
comprises a pinion gear 4593 meshingly engaged with the racks 4583a
and 4583b. The pinion gear 4593 is rotatable back and forth about
an axis to reciprocatingly extend and retract the feet 4580a and
4580b and, as a result, drive the stapling instrument relative to
the tissue of a patient. The tissue drive 4590 further comprises a
first actuator 4592 pinned to the pinion gear 4593 at a pivot joint
4591 and a second actuator 4594 pinned to the pinion gear 4593 at a
pivot joint 4595. In use, the first actuator 4592 is pushed and/or
the second actuator 4594 is pulled to rotate the pinion gear 4593
in a first direction, extend the second foot 4580b, and retract the
first foot 4580a. Correspondingly, the first actuator 4592 is
pulled and/or the second actuator 4594 is pushed to rotate the
pinion gear 4593 in a second direction, extend the first foot
4580a, and retract the second foot 4580b. Notably, the feet 4580a
and 4580b are displaced linearly and in opposite directions. That
said, the feet 4580a and 4580b are configured such that, when one
of the feet 4580a and 4580b is being retracted to pull the tissue,
the other foot slides, or slips, relative to the tissue as it is
extended.
[0536] As discussed above, the feet 1380a and 1380b of the stapling
instrument 1000 are extended and retracted along linear paths. In
such instances, the feet 1380a and 1380b may slide over the tissue
as they are being extended and then grab and pull the tissue as
they are being retracted. The feet 1380a and 1380b can comprise
teeth extending therefrom which have profiles which facilitate the
feet 1380a and 1380b to slide relative to the tissue when moved in
one direction and grab the tissue when moved in the opposite
direction. In at least one instance, the teeth are substantially
triangular, for example, but comprise a shallow angle on a first
side and a steeper angle on the other side. In such instances, the
shallow angle permits the first side to slide relative to the
tissue, whereas the steeper angle on the second side bites or grabs
the tissue when the feet 1380a and 1380b are retracted.
[0537] As discussed above, the feet 1380a and 1380b are driven
along a linear path by the racks 1389a and 1389b defined thereon.
In some instances, the linear motion of the feet 1380a and 1380b
can be tightly guided with little, if any, float or deviation from
the linear motion. In various embodiments, referring now to FIGS.
88 and 89, the feet of a tissue drive system can comprise one or
more joints which provide at least one additional degree of freedom
which allows the feet to deviate from a purely linear path. The
tissue drive system 4200 comprises a first foot 4280a and a second
foot 4280b which are movably connected by a link 4282. The link
4282 is coupled to the first foot 4280a at a pivot joint 4281a and
the second foot 4280b at a pivot joint 4281b. The feet 4280a and
4280b are moved proximally and distally by an input 4290 which
includes a drive shaft 4292 connected to the link 4282 at a pivot
joint 4283. The pivot joints 4281a, 4281b, and 4283 allow the feet
4280a and 4280b to lift or float upwardly when extended across the
tissue.
[0538] As discussed above, the stapling instruments disclosed
herein comprising a tissue drive system are configured to drive, or
march, themselves across the tissue of a patient as they staple and
cut the patient tissue along a staple firing path. In various
instances, the thickness of the tissue can change along the length
of the staple firing path. Stated another way, the tissue can
increase and/or decrease in thickness in a forward-to-back
direction and/or a lateral side-to-side direction. Referring again
to FIGS. 88 and 89, the degrees of freedom provided by the pivot
joints 4281a, 4281b, and 4283 allow the feet 4280a and 4280b to
tilt in response to these changes in tissue thickness. For
instance, the feet 4280a and 4280b can tilt in a forward-to-back
direction and/or in a side-to-side direction. Moreover, the feet
4280a and 4280b can tilt independently of one another. As such, the
feet 4280a and 4280b can tilt in the same direction or in different
directions. That said, alternative embodiments are envisioned in
which the feet 4280a and 4280b tilt in the same direction. Such an
arrangement could have a simpler drive system. In any event, the
feet 4280a and 4280b can self-level in response to changes in
tissue thickness and can have a desired traction on the tissue.
[0539] Referring now to FIG. 87, a stapling instrument 4100
comprises a distal stapling head 4120 which, similar to the
stapling instrument 1000, comprises a tissue drive system 4190
including feet 4180. The tissue drive system 4190 comprises a
rocker link 4192 rotatably mounted within the stapling head 4120
about a pivot pin 4124. The rocker link 4192 comprises legs 4193
and the pivot pin 4124 extends through apertures 4194 defined in
the legs 4193. Each of the legs 4193 is pivotably connected to a
foot 4180 about a pivot pin 4195. In use, the tissue drive system
4190 rocks the rocker link 4192 back and forth to extend and
retract the feet 4180 along a non-linear, or curved, path. The feet
4180 are extended and retracted together, although embodiments are
envisioned in which they are moved in opposite directions.
Moreover, further to the above, the feet 4180 can tilt about the
pivot pints 4195 in order to adapt to changes in tissue thickness.
In various instances, the tissue drive system 4190 can lift the
feet 4180 away from the tissue for at least part of the tissue
drive stroke, such as at the end of the tissue drive stroke, for
example.
[0540] Referring now to FIGS. 37-41, a surgical instrument 2700
comprises a distal head 2720 including an anvil 2760, a tissue
drive foot 2780, and a tissue drive 2790. The tissue drive 2790
comprises a positioning rod 2791 attached to the drive foot 2780 at
a pivot joint 2781. The positioning rod 2791 is displaceable along
a longitudinal axis to engage (FIG. 38) and disengage (FIG. 41) the
drive foot 2780 from the patient tissue T. When the drive foot 2780
is disengaged from the tissue and withdrawn into the distal head
2720, referring to FIG. 37, a distal tip 2785 of the drive foot
2780 is positioned within, and does not extend from, the distal
head 2720. Moreover, the drive foot 2780 is locked in position, or
prevented from being rotated, when the drive foot 2780 is withdrawn
into the distal head 2720. More specifically, the distal head 2720
comprises a control slot 2724 defined therein and the foot 2780
comprises two control pins 2784 slidably positioned in the control
slot 2724 which are configured to prevent the drive foot 2780 from
rotating when the drive foot 2780 is in its withdrawn position
(FIGS. 37 and 41) and to permit the drive foot 2780 to rotate when
the drive foot 2780 is in its engaged position (FIGS. 38-40), which
is discussed below.
[0541] Referring to FIGS. 38-40, the drive foot 2780 is configured
to engage the patient tissue T and drive the distal head 2720
relative to the tissue in order to re-position the distal head 2720
relative to the tissue. The tissue drive 2790 comprises a first
driver 2792 and a second driver 2793 configured to rotate the foot
2780 about the pivot joint 2781. The first driver 2792 comprises a
push end positioned within a first socket 2782 defined in the drive
foot 2780 and the second driver 2793 comprises a push end
positioned within a second socket 2783 defined on the opposite side
of the drive foot 2780. Referring to FIG. 40, the first driver 2792
is displaceable toward the tissue to rotate the drive foot 2780 in
a first direction. Referring to FIG. 39, the second driver 2793 is
displaceable toward the tissue to rotate the drive foot in a
second, or opposite, direction. In use, the drive foot 2780 is
rotatable back and forth by the tissue drive 2790 to create
relative motion between the distal head 2720 and the tissue in the
forward or backward directions.
[0542] Referring now to FIGS. 78-85, a stapling instrument 3900
comprises a distal head 3920 which includes, a staple firing system
3950 configured to staple the tissue of a patient, an anvil 3960
configured to clamp the patient tissue against a tissue compression
surface 3925 and deform the staples deployed by the staple firing
system 3950, and feet 3980 configured to generate relative movement
between the distal head 3920 and the tissue when the anvil 3960 is
in an unclamped position. The stapling instrument 3900 further
comprises a tissue drive 3990 configured to extend and retract the
feet 3980. Referring primarily to FIGS. 83 and 84, the tissue drive
3990 comprises a rotatable drive shaft 3992 and a worm gear 3993
fixedly mounted to the drive shaft 3992 such that the worm gear
3993 rotates with the drive shaft 3992. The worm gear 3993 is
meshingly engaged with a gear face 3995 defined on one side of a
drive wheel 3994. The drive wheel 3994 is rotatably mounted about a
pin 3991 which is mounted to the distal head 3920. As a result of
the above, the drive wheel 3994 rotates in response to the rotation
of the drive shaft 3992.
[0543] Further to the above, referring to FIGS. 79-82, the tissue
drive 3990 further comprises a coupler bar 3996 comprising a first
end slidably positioned in a cam slot 3999 (FIGS. 83 and 85)
defined in a second side, or face, of the drive wheel 3994. In at
least one instance, the coupler bar 3996 comprises a pin that rides
in the cam slot 3999. The coupler bar 3996 further comprises a
second end pivotably mounted to the feet 3980 at pivot joints 3998.
When the drive wheel 3994 is rotated, the sidewalls of the cam slot
3999 push the first end of the coupler bar 3996 through a path, or
motion, indicated in FIG. 84. This path is also illustrated in
FIGS. 79A, 80A, 81A, and 82A which track the motion of the tissue
drive 3990 and the feet 3980 depicted in FIGS. 79, 80, 81, and 82,
respectively. FIG. 79 illustrates the feet 3980 in a retracted
position and FIG. 79A shows a dot P on the foot motion path FM that
represents the position of the feet 3980 along the foot motion path
FM. FIG. 80 illustrates the feet 3980 being extended and FIG. 80A
shows the dot P advanced along the foot motion path FM. FIG. 81
illustrates the feet 3980 in a fully-extended position and the dot
P advanced further along the foot motion path FM. FIG. 82
illustrates the feet 3980 returned to their retracted position. At
such point, the motion of the feet 3980 can be repeated, or
reciprocated.
[0544] Further to the above, the coupler bar 3996 comprises a
longitudinal slot 3997 defined therein and the staple head 3920
comprises a pin 3927 extending into the longitudinal slot 3997
which co-operate to limit or constrain the motion of the coupler
bar 3996. FIGS. 84 and 85 map three corresponding positions,
labeled 1, 2, and 3, along the cam slot 3999 and the firing motion
path FM. The position 1 corresponds to the point P in FIG. 79A, the
position 2 corresponds to the point P in FIG. 80A, and the position
3 corresponds to point P in FIG. 81A. In various instances, the
tissue drive 3990 comprises a four-bar linkage in which the feet
3980 are lofted when then they are extended. In order to facilitate
this motion, each foot 3980 comprises a slot 3981 defined therein,
the sidewalls of which slide relative to a pin 3921 extending into
the slot 3981. The pin 3921/slot 3981 arrangements permit the feet
3980 to translate and rotate during the tissue drive stroke
cycle.
[0545] FIG. 86 illustrates an alternative embodiment of a cam path
4099 which comprises shoulders which prevent back motion of the
coupler bar 3996 within the slot 3999. For instance, the cam path
4099 comprises a first shoulder 4091 which corresponds to the
position 1 and FIG. 79A and, once the coupler bar 3996 has passed
this point, the coupler bar 3996 cannot backtrack past the position
1. The cam path 4099 comprises a second shoulder 4092 which
corresponds to the position 2 and FIG. 80A and, once the coupler
bar 3996 has passed this point, the coupler bar 3996 cannot
backtrack past the position 2. The cam 4099 also comprises a third
shoulder 4093 which corresponds to the position 3 and FIG. 81A and,
once the coupler bar 3996 has passed this point, the coupler bar
3996 cannot backtrack past the position 3.
[0546] Referring to FIGS. 50-56, a stapling instrument 3100
comprises a distal head 3120 including an anvil 3160 and tissue
drive feet 3180. Referring to FIG. 50, the drive feet 3180 are
extendable to engage the tissue of a patient and then, referring to
FIG. 51, retractable to move the distal head 3120 relative to the
patient tissue. Each drive foot 3180 comprises a rack, or an array,
of teeth 3193 configured to engage the patient tissue which is also
movable between extended and retracted positions. FIG. 51
illustrates that the teeth 3193 extend from the drive feet 3180
when the drive feet 3180 are being retracted from an extended
position. More specifically, the teeth 3193 protrude from tissue
compression surfaces 3125 defined on the drive feet 3180 when the
drive feet 3180 are being retracted from their fully-extended
position. On the other hand, referring to FIG. 50, the teeth 3193
do not protrude from the tissue compression surfaces 3125 as the
drive feet 3180 are being extended which allows the drive feet 3180
to slide relative to the patient tissue while being extended.
[0547] Referring to FIGS. 52-56, the stapling instrument 3100
comprises a tissue drive 3190 configured to extend and retract the
drive feet 3180 and, also, extend and retract the teeth 3193. The
tissue drive 3190 comprises an input bar 3191 that extends into,
and is movable within, a cavity 3181 defined in each drive foot
3180. The input bar 3191 moves the drive feet 3180 through a
circuitous, non-linear path which includes a raised, retracted
position (FIGS. 52 and 56), a lowered, retracted position (FIG.
53), a lowered, extended position (FIG. 54), and a raised, extended
position (FIG. 55). The input bar 3191 comprises pins 3192
extending therefrom which extend into slots 3182 defined in the
drive feet 3180. As discussed in greater detail below, the
interaction between the pins 3192 and the sidewalls of the slots
3182 transfers the motion of the input bar 3191 to the drive feet
3180. Each of the slots 3182 extend along an axis which is
transverse to and non-parallel to a longitudinal axis of the distal
head 3120 which, as a result, creates the desired motion of the
drive feet 3180 and teeth 3193.
[0548] When the input bar 3191 is in a fully-retracted position, as
illustrated in FIG. 52, the input bar 3191 positions the drive feet
3180 in their raised, retracted position. In this position, the
teeth 3193 protrude through windows 3183 defined in the drive feet
3180. As the input bar 3191 is moved out of its fully-retracted
position, referring to FIG. 53, the pins 3192 interact with the
sidewalls of the slots 3182 and cam the drive feet 3180 downwardly.
At such point, the teeth 3193 no longer protrude through the
windows 3183. As the input bar 3191 is moved further away from its
fully-retracted position, the input bar 3191 begins to extend the
drive feet 3180 as illustrated in FIG. 54. Notably, the teeth 3193
do not protrude through the windows 3183 as the drive feet 3180 are
being extended. However, once the input bar 3191 is retracted, as
illustrated in FIG. 55, the pins 3192 interact with the sidewalls
of the slots 3182 to raise the drive feet 3180 which causes the
teeth 3193 to protrude through the windows 3183. As a result, the
teeth 3193 can engage or grab the patient tissue and pull the
tissue relative to the distal head 3120 until the drive feet 3180
are fully retracted, as illustrated in FIG. 56. At such point, the
tissue can be stapled and/or incised. The above-described process
can be repeated to move the stapling instrument 3100 along an
entire staple firing path.
[0549] Referring to FIGS. 57-59D, a stapling instrument 3200
comprises a distal stapling head 3220 including tissue drive feet
3270 which are extended outwardly and retracted inwardly along the
same path by a tissue drive system, such as the tissue drive system
of the stapling instrument 1000, for example. That said, the
stapling head 3220 further comprises lateral drive feet 3280 which
move with the drive feet 3270 but can also move laterally relative
to the drive feet 3270, as illustrated in FIGS. 57 and 58. As a
result, the lateral drive feet 3280 can be extended along one path,
as illustrated in FIGS. 59A and 59B, extended laterally, and then
retracted along a different path, as illustrated in FIGS. 59C and
59D. Moreover, the drive feet 3270 and 3280 can pull the distal
head 3220 relative to the patient tissue in two different
directions, which provides greater control over the relative
movement between the distal stapling head 3220 and the patient
tissue.
[0550] Referring primarily to FIGS. 57 and 58, the drive feet 3270
and 3280 are rotatably coupled in pairs. Each pair comprises an
actuator plate 3260, a first link 3272 pivotably coupled to the
drive foot 3270 about a pivot 3271, and a second link 3282
pivotably coupled to the lateral drive foot 3280 about a pivot
3281. When a downward force is applied to the actuator plate 3260,
referring to FIG. 58, the actuator plate 3260 pushes on a joint
3213 rotatably connecting the first link 3272 and the second link
3282, which causes the lateral foot 3280 to displace outwardly.
Moreover, the distal head 3220 constrains the lateral movement of
the drive foot 3270 and, as a result, the drive foot 3270 does not
move laterally when the lateral drive foot 3280 is extended
laterally. However, referring to FIGS. 60A-60D, alternative
embodiments are envisioned in which the drive foot 3270 can also
move laterally. In either event, a biasing member, such as a
torsion spring positioned in and/or coupled to the joint 3213, for
example, can retract the drive feet laterally after the pushing
force is removed from the actuator plate 3260. FIGS. 59A-59D depict
a sequence of steps that can be repeated by the surgical instrument
3200 to move the stapling instrument 3200 along a staple firing
path. FIGS. 60A-60D also depict a sequence of steps that can be
repeated by the surgical instrument 3200 to move the stapling
instrument 3200 along a staple firing path.
[0551] Referring to FIGS. 61 and 62, a surgical instrument 3300
comprises a distal head 3320 and laterally-extendable drive feet
3380. The drive feet 3380 are coupled to distal head 3320 via
flexible connectors 3375 and actuators 3370. When a compressive
force is applied to an actuator 3370, the actuator 3370 is
displaced and/or compressed which causes the connectors 3375 to
extend laterally and push the corresponding drive foot 3380
laterally. When the compressive force is removed from the actuator
3370, the connectors 3375 resiliently contract and pull the drive
foot 3380 inwardly. The drive feet 3380 can include tissue gripping
features defined thereon which are configured to push and/or pull
the patient tissue when the drive feet 3380 are being moved
laterally. As a result, the drive feet 3380 can create relative
movement between the distal head 3320 and the patient tissue.
[0552] Referring to FIGS. 91A-91D, a stapling instrument 4400
comprises a distal head 4420 which includes a tissue cutting drive
4440, a staple firing drive 4450, and a tissue drive including feet
4480. Each foot 4480 is rotatably mounted to the distal head 4420
about a pivot pin 4481 and is rotatable to drive the distal head
4420 relative to the patient tissue. FIG. 91 illustrates the feet
4480 in a retracted position. FIG. 91B illustrates the feet 4480
being extended. FIG. 91C illustrates the feet 4480 in their
fully-extended position. FIG. 91D illustrates the feet 4480 being
retracted. When the feet 4480 are extended, the feet 4480 drive the
distal head 4420 relative to the patient tissue. Notably, the feet
4480 are synchronized such that they are extended and retracted
together and, in such instances, the feet 4480 can drive the distal
head 4420 along a straight, or at least substantially straight,
line. That said, one of the feet 4480 can be extended while the
other foot 4480 is retracted. In such instances, the feet 4480 can
turn the distal head 4420 along a curved path.
[0553] Referring to FIGS. 76 and 77A-77D, a stapling instrument
3800 comprises a distal head 3820 including a staple firing system
3850, an anvil 3860, and a tissue drive system. The tissue drive
system comprises a first foot 3880a and a second foot 3880b and is
configured to selectively extend and retract the feet 3880a and
3880b to move the stapling instrument 3800 along a staple firing
path FP. The tissue drive system is configured to move, or march,
the stapling instrument 3800 along straight and/or curved staple
firing paths. Referring to FIGS. 77A and 77B, the tissue drive
system is configured to simultaneously extend and retract the first
foot 3880a and the second foot 3880b an equal, or an at least
nearly equal, amount to move the distal firing head 3220 along a
straight firing path. Referring to FIGS. 77C and 77D, the tissue
drive system is also configured to extend and retract only one of
the feet 3880a and 3880b to turn the distal firing head 3220. For
instance, referring to FIG. 77C, the tissue drive system can extend
and retract the first foot 3880a, while not extending and
retracting the second foot 3880b, to turn the distal head 3820 in a
first direction. Similarly, referring to FIG. 77D, the tissue drive
system can extend and retract the second foot 3880b, while not
extending and retracting the first foot 3880a, to turn the distal
head 3820 in a second direction.
[0554] As discussed above, the tissue drive system is configured to
turn the distal head 3820 of the stapling instrument 3800 by
operating one of the feet 3880a and 3880b, but not the other.
Alternatively, the tissue drive system can be configured to turn
the distal head 3820 by extending one of the feet 3880a and 3880b
less than the other. The distal head 3820 could be gradually turned
in such instances. The tissue drive system can also be configured
to turn the distal head 3820 by moving the feet 3880a and 3880b in
opposite directions. In such instances, the distal head 3820 could
follow small, or tight, radiuses of curvature in the staple firing
path FP.
[0555] Referring to FIGS. 63 and 64, a stapling instrument 3400
comprises a distal head 3420 including a staple firing system 3450,
an anvil 3460, and a tissue drive system. The tissue drive system
comprises two drive wheels 3480 and a shaft 3481, which is
rotatably supported by mounts 3482, extending through apertures
defined in the center of the drive wheels 3480. The drive wheels
3480 are fixedly mounted to the pin 3481 such that the drive wheels
3480 rotate together. Each drive wheel 3480 comprises an array of
teeth extending therearound and at least one of the drive wheels
3480 is meshingly engaged with a drive shaft of an electric motor.
The teeth extending around the drive wheels 3480 are also suitably
configured to engage and grip the patient tissue. In use, the
electric motor can be operated to turn the drive wheels 3480 to
create relative movement between the distal head 3420 and the
patient tissue and move the distal head 3420 along a staple firing
path.
[0556] Referring to FIG. 94, a stapling instrument 4600 comprises a
distal head 4620 including a staple firing system 4650, an anvil
4660, and a tissue drive system. The tissue drive system comprises
drive two drive wheels 4680 which are each rotatably supported by a
separate pin extending through the center thereof. As a result, the
drive wheels 4680 can be rotated independently. Each drive wheel
4680 comprises an array of teeth extending therearound which is
meshingly engaged with a drive shaft of an electric motor. Stated
another way, the tissue drive system comprises two electric motors
which are configured to rotate the drive wheels 4680 separately.
Similar to the above, the teeth extending around the drive wheels
4680 are also suitably configured to engage and grip the patient
tissue. In use, the electric motors can be operated to turn the
drive wheels 4680 to create relative movement between the distal
head 4620 and the patient tissue and move the distal head 4620
along a staple firing path, as described in greater detail
below.
[0557] Further to the above, the tissue drive system is configured
to rotate the drive wheels 4680 in the same direction at the same
speed to move the distal head 4620 along a straight staple firing
path. The tissue drive system is also configured to rotate the
wheels 4680 in the same direction, but at different speeds, to turn
the distal head 4620 along a curved staple firing path. The distal
head 4620 can make gradual turns in such instances. The tissue
drive system is also configured to turn only one of the drive
wheels 4680, while not turning the other drive wheel 4680, to turn
the distal head 4620 along a curved staple firing path. Moreover,
the tissue drive system is further configured to rotate the drive
wheels 4680 in opposite directions to turn the distal head 4620
along curved staple firing paths having a small, or tight, radius
of curvature.
[0558] The tissue drive system further comprises lateral drive
wheels 4670 which are positioned laterally with respect to the
drive wheels 4680. Similar to the above, each lateral drive wheel
4670 is operably coupled to a different electric motor. As a
result, the tissue drive system of the stapling instrument 4600
comprises four electric motors which are operable at the same time
or at different times. The lateral drive wheels 4670 are operable
independently of the drive wheels 4680, although they could be
operated at the same time as one or both of the drive wheels 4680.
Moreover, the lateral drive wheels 4670 are operable independently
with respect to each other. Similar to the drive wheels 4680, the
tissue drive system is configured to turn the lateral drive wheels
4670 together at the same speed, at different speeds, and/or in
different directions to move the distal head 4620 along a staple
firing path. Moreover, the tissue drive system is configured to
turn any suitable combination of the drive wheels 4670 and 4680 in
any suitable direction and at any suitable speed to move the
stapling instrument 4600 along a desired staple firing path.
[0559] Referring to FIG. 36, a stapling instrument 2600 comprises a
distal head 2620 including a staple firing system 2650, an anvil
2660, and a tissue drive system. The tissue drive system comprises
two drive wheels 2670 and two drive wheels 2680 which can be
rotated independently, at the same time or at different times, to
move the distal head 2620 along a staple firing path. Each drive
wheel 2670 is rotatable about an axis 2671 and each drive wheel
2680 is rotatable about an axis 2681; however, the axes 2671 are
not parallel to the axes 2681. In fact, the axes 2671 and 2681 are
orthogonal, but can be oriented in any suitable direction. The
tissue drive system comprises four electric motors which are
configured to rotate the drive wheels 2670 and 2680 separately;
however, the tissue drive system can have any suitable number of
electric motors to drive the drive wheels 2670 and 2680. In use,
the electric motors can be operated to turn the drive wheels 2670
and 2680 to create relative movement between the distal head 2620
and the patient tissue and move the distal head 2620 along a staple
firing path.
[0560] Referring now to FIGS. 75A-75D, a stapling instrument 3700
comprises a distal head 3720 including an anvil 3760 and a tissue
drive system including a tissue drive foot 3780. The stapling
instrument 3700 is similar to the stapling instrument 1000 in many
respects, most of which will not be discussed herein for the sake
of brevity. The anvil 3760 is movable relative to the foot 3780
between a closed, or clamped, position (FIGS. 75A and 75D) and an
open, or unclamped, position (FIGS. 75B and 75C). While the anvil
3760 is being opened, referring to FIG. 75B, the drive foot 3780
can be extended to engage and grip tissue. Referring to FIG. 75C,
the drive foot 3780 is then retracted to create relative motion
between the distal head 3720 and the patient tissue. Referring to
FIG. 75D, the anvil 3760 is movable toward its closed position
while the drive foot 3780 is being retracted and/or after the drive
foot 3780 has been retracted. The drive foot 7580 can have teeth
which grips the tissue and/or any suitable means for gripping and
pulling the tissue. In various instances, the drive foot 7580 is
configured to apply a vacuum to the tissue in order to grip and
pull the tissue. In at least one such instance, the vacuum system
is off during the operational steps depicted in FIGS. 75A and 75B
and on during the operational steps depicted in FIGS. 75C and 75D,
for example. In such instances, the vacuum can also hold the tissue
in the distal head 7520 as the anvil 7560 is being closed, although
other embodiments are envisioned in which the vacuum is off during
the operation step depicted in FIG. 75D.
[0561] Referring now to FIGS. 65-69, a stapling instrument 3500
comprises a distal head 3520 including an anvil 3560 and a tissue
drive system including a vacuum supply line 3570, two vacuum
graspers 3580, and two grasper extenders 3590. The vacuum supply
line 3570 comprises a manifold 3571 configured to deliver a vacuum
pressure differential to the two grasper extenders 3590 and the two
vacuum graspers 3580. Each grasper extender 3590 comprises a
bellows 3591 in communication with the manifold 3571 which
contracts and extends when a vacuum is communicated to the inner
plenum of the bellows 3591. When the bellows 3591 contract, they
extend the graspers 3580 to the position illustrated in FIG. 65.
Each bellows 3591 is in fluid communication with a cavity 3581
defined in a grasper 3580 which allows a vacuum pressure
differential to be communicated to grasper holes 3582 defined in a
tissue engaging surface 3585 of the grasper 3580. This vacuum
pressure differential at the grasper holes 3582 can hold the
patient tissue against the tissue engaging surface 3585.
[0562] As discussed above, the extension of the graspers 3580
graspers corresponds with the application of a vacuum pressure
differential to the tissue. When the vacuum supply line 3570 no
longer supplies a vacuum pressure differential to the bellows 3591,
the bellows 3591 will resiliently re-expand and contract and,
correspondingly, retract the graspers 3580, as illustrated in FIG.
67. Similarly, the bellows 3591 may also re-expand and retract the
graspers 3580 when the vacuum pressure differential is reduced. In
either event, the vacuum pressure differential at the grasper holes
3582 may lessen as the graspers 3580 are being retracted. In some
instances, the remaining vacuum pressure differential at the
grasper holes 3582 may be sufficient to pull the patient tissue
into a tissue chamber 3525 in the distal head 3520. In other
instances, the remaining vacuum pressure differential at the
grasper holes 3582, alone, may not be sufficient to pull the
patient tissue into the tissue chamber 3525. With this in mind, the
graspers 3580 comprise flexible teeth 3586 extending from the
tissue engaging surfaces 3585 thereof. When the graspers 3580 are
being extended, referring to FIG. 66, the flexible teeth 3586 slide
over the patient tissue without snagging, or at least significantly
snagging, on the patient tissue. This relative movement is also
facilitated by the transverse angle in which the teeth 3586 extend
from the tissue engaging surface 3585. When the graspers 3580 are
being retracted, referring to FIG. 68, the teeth 3586 bite into the
patient tissue and pull the patient tissue into the tissue chamber
3525. Again, this is facilitated by the angle of the teeth 3586 and
can compensate for a loss of vacuum pressure differential at the
grasper holes 3582.
[0563] Once the patient tissue is positioned in the tissue chamber
3525, the tissue can be stapled and/or incised. The supply line
3570 does not supply a vacuum pressure differential during the
stapling and/or cutting operations as doing so may extend the
graspers 3580 and move the tissue. That said, the vacuum supply
could be turned on during the stapling and/or cutting operations if
there was, for example, another way to hold the tissue in place. In
either event, the anvil 3560 can thereafter be re-opened, the
distal head 3520 can be moved relative to the tissue, and the
vacuum supply can be used to re-extend the tissue graspers 3580 so
that the above-described process can be repeated, as illustrated in
FIG. 69.
[0564] Referring to FIGS. 70-73, a stapling instrument 3600
comprises a distal stapling head 3620 including a staple firing
system 3650, an anvil 3660, a tissue cutting system 3640 and, also,
a tissue grasping system that utilizes vacuum pressure
differentials. The stapling instrument 3600 is similar to the
stapling instrument 3500 in many respects, most of which will not
be discussed herein for the sake of brevity. That said, the tissue
grasping system comprises two separate and distinct vacuum supply
lines--a first supply line 3670a in communication with a first
bellows 3690a which is in fluid communication with a first tissue
drive foot 3680a via a foot manifold 3685a and, also, a second
supply line 3670b in communication with a second bellows 3690b
which is in fluid communication with a second tissue drive foot
3680b via a foot manifold 3685b. The foot manifold 3685a comprises
an array of manifold apertures 3686 which are in communication with
foot apertures 3682 defined in the first foot 3680a and communicate
a vacuum pressure differential to the foot apertures 3682 when a
vacuum is supplied to the first supply line 3670a. The foot
manifold 3685b comprises an array of manifold apertures 3686 which
are in communication with foot apertures 3682 defined in the second
foot 3680b and communicate a vacuum pressure differential to the
foot apertures 3682 when a vacuum is supplied to the second supply
line 3670b. The stapling instrument 3600 further comprises a
control system configured to selectively apply a vacuum to the
first supply line 3670a and the second supply line 3670b such that
the first drive foot 3680a and the second drive foot 3680b can be
selectively extended and retracted. In some instances, the feet
3680a and 3680b are synchronized and simultaneously extended and
retracted together while, in other instances, the feet 3680a and
3680b are extended and retracted at different times.
[0565] An alternative embodiment of a stapling instrument 3600' is
illustrated in FIG. 74. The stapling instrument 3600' is similar to
the stapling instrument 3600 in many respects. That said, the
instrument 3600' comprises larger tissue drive feet 3680' that have
more vacuum holes 3682 defined therein as compared to the tissue
drive feet 3680 of the stapling instrument 3600.
[0566] Referring now to FIGS. 47A-47G, a stapling instrument 3000
comprises a distal head 3020 including a staple firing system, an
anvil closure system including an anvil 3060, a tissue drive
including at least one drive foot 3080, and a tissue gripper 3070
configured to releasably hold the tissue. Referring to FIG. 47A,
the anvil 3060 is movable from a clamped position to an unclamped
position to unclamp the patient tissue T. Referring to FIG. 47B,
the tissue gripper 3070 is engageable with the patient tissue T to
hold the tissue in place while the drive foot 3080 is extended,
which is illustrated in FIGS. 47C and 47D. The tissue gripper 3070
can be engaged with the tissue as the anvil 3060 is being opened
and/or after the anvil 3060 has been opened. In either event,
referring to FIG. 47E, the tissue gripper 3070 is disengaged from
the tissue before the drive foot 3080 is retracted to pull the
distal head 3020 relative to the tissue and position the distal
head 3020 at a new position along the staple firing path, as
illustrated in FIG. 47F. At such point, referring to FIG. 47G, the
patient tissue is clamped by the anvil 3060 and the staple firing
system is operated to staple the tissue. At such point, the
above-described cycle can be repeated.
[0567] As illustrated in FIGS. 47D-47F, the drive foot 3080 is in
fluid communication with a vacuum source 3090. Similar to the
above, the drive foot 3080 can utilize a vacuum pressure
differential from the vacuum source 3090 to grip the patient
tissue. Also similar to the above, the vacuum pressure differential
from the vacuum source 3090 can be used to extend the drive foot
3080. That said, the drive foot 3080 can be extended using any
suitable mechanism.
[0568] Referring again to FIG. 78, the stapling instrument 3900
further comprises tissue grippers 3970. The tissue grippers 3970
are useable in conjunction with the drive feet 3980 in the same, or
a similar manner, that the tissue grippers 3070 are used in
conjunction with the drive foot 3080.
[0569] FIGS. 45, 46, 48, and 49 depict the operational sequencing
of a stapling instrument which could be used with a stapling
instrument disclosed herein, such as a stapling instrument 4000
and/or the stapling instrument 3900 discussed above, for example.
The stapling instrument 4000 is similar to the other stapling
instruments disclosed herein in many respects, most of which will
not be discussed herein for the sake of brevity. The stapling
instrument 4000 comprises an anvil drive system 4060, a staple
firing system 4050, a tissue cutting system 4040, a tissue gripping
system 4090, and a tissue drive system 4080 configured to move the
stapling instrument 4000 relative to the patient tissue. FIG. 49
depicts the operational steps of the stapling instrument 4000,
which occur in the order presented. For instance, step 4003 follows
step 4002 and step 4002 follows step 4001, and so forth. That said,
it should be understood that adjacent operational steps can occur
simultaneously, or with at least some amount of overlap, as
illustrated in FIG. 46 and discussed in greater detail below.
Moreover, the operational steps of FIG. 49 can be re-arranged in
any suitable order.
[0570] Referring again to FIG. 49, the operational step 4001
comprises loading a staple cartridge into the stapling instrument
4000 and/or pushing a staple cartridge into position within the
stapling instrument 4000. The operational step 4002 comprises
removing staples from the staple cartridge and the operational step
4003 comprises placing the staples in position within the staple
firing drive 4050. The operational step 4004 comprises articulating
the end effector of the stapling instrument 4000, if needed. That
said, the operational step 4004 can also occur before and/or during
the steps 4001, 4002, and/or 4003. The operational step 4005
comprises positioning the end effector on the patient tissue and
the operational step 4006 comprises operating the anvil drive
system 4060 to clamp the anvil on the tissue. The operational step
4005 can also occur before the operational step 4004.
[0571] Further to the above, the operational step 4007 comprises
forming the staples against the anvil and the operational step 4008
comprises deploying the knife of the tissue cutting system 4040.
The operational step 4007 occurs before the operational step 4008,
but the steps 4007 and 4008 could occur at the same time or with
some amount of overlap. The operational step 4009 comprises using
the tissue cutting system 4040 to retract the knife and it follows
the operational step 4008. The operational step 4010 comprises
gripping and holding the patient tissue positioned within the end
effector of the stapling instrument 4000 using the tissue gripping
system 4090. The operational step 4011 comprises unclamping the
anvil using the anvil drive system 4060. In such instances, the
stapling instrument 4000 can hold the tissue even though the anvil
is open as a result of the tissue gripping system. The operational
step 4012 comprises advancing the feet of the tissue drive system
4080. The operational step 4013 comprises actuating the tissue
gripping system 4090 to ungrip the tissue and the operational step
4014 comprises retracting the feet of the tissue drive system 4080
and advancing the stapling instrument 4000 relative to the
tissue.
[0572] Further to the above, FIG. 46 illustrates that certain
operational steps can occur at the same time or with some amount of
overlap. For instance, the step 4011 of opening the anvil and the
step 4001 of loading a staple cartridge into position can occur at
the same time or with at least some overlap. Similarly, the step of
4002 and/or 4003 comprising advancing staples into position within
the staple firing drive 4050 can occur at the same time as, or with
some overlap with, the step 4011 of opening the anvil, the step
4010 of gripping the tissue with the tissue gripping system 4090,
the step 4012 of extending the feet of the tissue drive system
4080, the step 4013 of releasing the tissue with the gripping
system 4090, and/or the step 4014 of retracting the feet of the
tissue drive system 4080, for example. Moreover, the step 4001 of
reloading another staple cartridge into position within the
stapling instrument 4000 can occur at the same time, or with some
overlap with, the step 4008 of cutting the tissue and/or the step
4009 of retracting the tissue cutting knife.
[0573] Further to the above, FIG. 45 illustrates the actuation
cycles of the anvil drive system 4060 and the tissue drive system
4080 of the stapling instrument 4000. The actuation cycles in FIG.
45 are plotted with respect to time t, wherein the 0, or zero,
demarcations on the horizontal time axes represent the beginning of
a cycle sequence of the stapling instrument 4000. Referring to the
actuation cycle of the anvil drive system 4060, the peak 4006
correlates with the step 4006, discussed above, which comprises
closing, or clamping, the anvil onto tissue. Similarly, the dwell
4011 correlates with the step 4011, discussed above, which
comprises opening, or unclamping, the tissue. Referring now to the
actuation cycle of the tissue drive system 4080, the peak 4012
correlates with the step 4012 which comprises extending the feet of
the tissue drive system 4080 and the peak 4014 correlates with the
step 4014 which comprises retracting the feet of the tissue drive
system 4080 and driving the stapling instrument 4000 relative to
the patient tissue. Upon comparing the actuation cycles for the
anvil drive system 4060 and the tissue drive system 4080, it can be
seen that the anvil is open, or is being opened, when the feet are
being extended. Moreover, it can be seen that the anvil is open
when the feet are being retracted and that the anvil is closed at
the beginning of the next cycle of the stapling instrument
4000.
[0574] As discussed above, it can be desirable to perform certain
operational steps of the stapling instrument 4000 sequentially and
other operational steps at the same time. In some instances,
however, it may not be desirable to perform certain operational
steps at the time. As such, the stapling instrument 4000 is
configured to lockout certain drive systems and prevent them from
being operated while other drive systems of the stapling instrument
4000 are being operated. Lockouts can include mechanical lockouts
and/or electrical lockouts, for example. All of the drive systems
of the stapling instrument 4000 are motorized and in communication
with the controller of the stapling instrument 4000 and, as such,
the controller can be used to lockout the drive systems. The
controller comprises a microprocessor, for example, which is
configured to electronically lockout one or more drive systems
during the operation of one or more other drive systems. FIG. 48 is
a chart which illustrates which operational steps are prevented
from being performed during the performance of other operational
steps. For instance, during the step 4001 in which a staple
cartridge is loaded into position, all of the other operational
steps are locked out, or prevented from happening, other than the
step 4004 which articulates the end effector of the stapling
instrument 4000, the step 4005 which positions the stapling
instrument 4000 relative to the tissue, and the step 4011 which
unclamps the anvil. In this example, the staple firing system 4050,
the tissue drive system 4080, and the tissue gripping system 4090
are locked out. This is just one example. Other steps could be
unlocked during the step 4001 if it was determined that doing so
was not detrimental, or unacceptably detrimental, to the operation
of the stapling instrument 4000.
[0575] Referring to FIGS. 90A-90D, a stapling instrument 4300
comprises a distal head 4320 including a staple firing system 4350,
an anvil drive system including an anvil 4360, and a tissue cutting
system 4340. The stapling instrument 4300 is similar to the
stapling instrument 1000 and stapling instrument 4400 in many
respects, most of which will not be discussed herein for the sake
of brevity. The stapling instrument 4300 further comprises upper
feet 4370a and 4370b and lower feet 4380a and 4380b. Similar to the
feet 4480 of the stapling instrument 4400, the feet 4370a, 4370b,
4380a, and 4380b are rotatable between extended (FIG. 90A) and
retracted (FIGS. 90B-D) positions to move the distal head 4320
relative to the patient tissue T. Referring to FIG. 90A, the feet
4370a and 4380a comprise a first synchronized pair of feet that
move together and grab the patient tissue when they are moved into
their extended position. In such instances, the feet 4370a and
4380a are moved toward one another to apply a compressive force or
pressure to the tissue. When the feet 4370a and 4380a are
retracted, referring to FIG. 90B, the feet 4370a and 4380a pull on
the tissue to move the distal head 4320 relative to the tissue.
Once the feet 4370a and 4380a have been retracted, referring to
FIG. 90C, the staple firing system 4350 and tissue cutting system
4340 staple and cut the patient tissue. The staple firing system
4350 and tissue cutting system 4340 are operated simultaneously;
however, the staple firing system 4350 could be operated before the
tissue cutting system 4340. That said, cutting the tissue before
stapling it may result in unnecessary bleeding. Notably, though,
the feet 4370a and feet 4380a apply a clamping pressure to the
tissue while the stapling instrument 4300 staples and cuts the
tissue. Once the tissue has been stapled and incised, referring to
FIG. 90D, the feet 4370a and 4380a are moved away from the tissue
to unclamp the tissue.
[0576] As discussed above, the feet 4370a and 4380a are operably
coupled together such that they move together as a pair. They
rotate together as a pair, they clamp together as a pair, and they
unclamp together as a pair. Various alternative embodiments are
envisioned in which only one of the feet 4370a and 4380a moves to
clamp and unclamp the tissue; however, the feet 4370a and 4380a
would still rotate together as a pair. A second synchronized pair
of feet including feet 4370b and 4380b move in the same manner as
the first synchronized pair of feet including feet 4370a and 4380a
and, as such, a discussion of their motion will not be repeated for
the sake of brevity. That said, the motion of the first pair of
feet is synchronized with the motion of the second pair of feet.
More specifically, the second pair of feet are extended at the same
time that the first pair of feet are extended, the second pair of
feet are clamped to grip the tissue at the same time that the first
pair of feet are clamped, the second pair of feet are retracted at
the same time that the first pair of feet are retracted, and the
second pair of feet are unclamped at the same time that the first
pair of feet are unclamped. In certain instances, the motion of the
first pair of feet and the second pair of feet are not
synchronized, or entirely synchronized. In at least one such
instance, the first pair of feet is extended and retracted
independently of the second pair of feet to turn the distal head
4320 along a curved staple path.
[0577] As discussed above, the stapling instruments disclosed
herein are configured to staple the tissue of a patient. They are
also configured to cut the tissue. Referring to FIGS. 95 and 96, a
stapling instrument 5000 comprises a distal head 5020 including a
staple firing system, a tissue cutting system 5040, and an anvil
5060 configured to deform the staples deployed by the staple firing
system. The tissue cutting system 5040 comprises a knife bar 5042
which includes a knife edge 5045 defined at the distal end 5044
thereof. In use, the knife bar 5042 is translatable laterally
through the distal head 5020 during a tissue cutting stroke. The
tissue cutting stroke of the knife bar 5042 extends between a
first, unactuated position, illustrated in FIG. 95, and a second,
actuated, position. During the tissue cutting stroke, the knife
edge 5045 extends between a tissue compression surface 5025 and a
tissue compression surface 5065 defined on the anvil 5060. The
knife edge 5045 can also extend into the distal head 5020 and/or
the anvil 5060 during the tissue cutting stroke to assure that the
entire thickness of the tissue is transected.
[0578] Further to the above, the distal head 5020 defines a
longitudinal head axis HA. During the tissue cutting stroke, the
knife bar 5042 moves orthogonally relative to the longitudinal head
axis HA. The tissue cutting system 5400 further comprises a cutting
actuator 5046 configured to engage the knife bar 5042 and displace
the knife bar 5042 laterally. The cutting actuator 5046 comprises a
distal end 5047 which includes an angled cam surface configured to
engage a corresponding cam surface 5043 defined on the distal end
5044 of the knife bar 5042. The cutting actuator 5046 can also be
configured to push the knife bar 5042 in any suitable manner. In
other embodiments, the knife bar 5042 can be moved without a
cutting actuator 5046.
[0579] Referring to FIG. 98, a stapling instrument 5100 comprises a
distal head 5120 including a staple forming anvil 5160. The
stapling instrument 5100 further comprises a staple feeding system
5190, a staple alignment system 5180, and a staple firing system
5150. The staple firing system 5150 comprises staple drivers 5151
which are movable longitudinally to eject a set, or cluster, of
staples 5130 from the distal head 5120 during a staple firing
stroke. Referring to FIGS. 99 and 100, each staple 5130 comprises a
base 5131 and staple legs 5132 extending from the base 5131.
Referring to FIGS. 100 and 101, the staple drivers 5151 are
configured to push on the bases 5131 of the staples 5130 to push
the staples legs 5132 against forming pockets 5162 (FIG. 97)
defined in the anvil 5160 during staple firing stroke. At such
point, referring to FIG. 102, the staple drivers 5151 are returned
to the starting, or unfired, point of the staple firing stroke so
that another staple firing stroke can be performed.
[0580] As described above, the stapling instrument 5100 is
configured to deploy staples during each staple firing stroke.
Referring to FIG. 103, the stapling instrument 5100 further
comprises a tissue cutting knife 5140 configured to cut the tissue
during and/or after each staple firing stroke. The staple firing
system 5150 is configured to deploy a first group, or cluster, of
three staples 5130 positioned on a first side of a cutting path CP
created by the knife 5140 and a second group, or cluster, of three
staples 5130 positioned on a second side of the cutting path CP.
The staple firing system 5150 deploys the first and second staple
groups at the same time; however, embodiments are envisioned in
which the first group is deployed before the second staple group.
Alternative embodiments are envisioned in which a stapling
instrument does not comprise a tissue cutting system, or the tissue
cutting system of the stapling instrument can be deactivated. The
staple feeding system 5190 and the staple alignment system 5180
co-operate to reposition another set of staples 5130 in the distal
head 5120 after each staple firing stroke is performed so that
another staple firing stoke can be performed. In various instances,
the staples 5130 are reloaded during the tissue cutting stroke
and/or after the tissue cutting stroke.
[0581] Referring primarily to FIGS. 97, 100, and 102, the staple
feeding system 5190 comprises staple pushers 5191. Each staple
pusher 5191 is configured to push a staple 5130 into a staple
cavity 5121 defined in the distal head 5120. Further to the above,
the distal head 5120 comprises six staple cavities 5121 which are
each configured to receive a staple 5130 from the staple feeding
system 5190. The staples 5130 are arranged in six stacks, or
columns, which are aligned with the staple cavities 5121. The
staple pushers 5191 push on the bases 5131 of the proximal-most
staples 5130 in each staple stack in order to push the distal-most
staples 5130 of each staple stack into the staple cavities 5121
during a pushing stroke. The staple pushers 5191 load staples 5130
into the staple cavities 5121 at the same time, i.e., during a
common pushing stroke; however, in alternative embodiments, the
staple pushers 5191 can be configured to sequentially load the
staples 5130 into the staple cavities 5121. Referring to FIGS. 98
and 99, the staples 5130 within a staple stack are releasably
attached to one another by at least one adhesive 5135, for example.
As illustrated in FIG. 100, the staples 5130 of each staple stack
are adhered to one another at angle which is transverse to a firing
axis FA of a staple firing system driver 5151. The distal head 5120
comprises cam surfaces 5122 which orient and align the staples 5130
with the firing axes FA of the staple firing system drivers 5151
before the staple firing stroke of the staple firing system 5150 is
performed.
[0582] The staple drivers 5151 and the staple pushers 5191 move
parallel, or at least substantially parallel, to one another. Owing
to the design of the staple drivers 5151 and the staple pushers
5191, and/or other space constraints, referring to FIGS. 97 and
103, the stapling instrument 5100 further includes a staple
alignment system comprising staple pushers 5180 which are
configured to work with the staple pushers 5191 to align the
staples 5130 with the staple drivers 5151. The staple pushers 5191
push the staples 5130 longitudinally and the staple pushers 5180
push the staples 5130 laterally.
[0583] Referring to FIGS. 104-105D, a stapling instrument 5200
comprises a distal head 5220 including a staple firing system 5250
configured to deploy staples 5230, a tissue cutting system, and an
anvil 5260 including forming pockets configured to deform the
staples 5230. The staple firing system 5250 comprises rotatable
actuators 5252 configured to displace lateral staple drivers 5254
along linear, or at least substantially linear, lateral paths. Each
rotatable actuator 5252 comprises a cam 5253 configured to engage a
shoulder 5255 defined on the staple drivers 5254 and displace the
drivers 5254 laterally, as illustrated in FIG. 105B. The staple
firing system 5250 further comprises one or more springs 5224
positioned intermediate the lateral staple drivers 5254 and a frame
5222 of the distal head 5220. The springs 5224 are compressed as
the staple drivers 5254 are slid laterally by the rotatable
actuators 5252 until the cams 5253 disengage from the shoulders
5255 of the drivers 5254 during the continued rotation of the
actuators 5252, as illustrated in FIG. 105C. At such point,
referring to FIG. 105D, the springs 5224 resiliently return the
lateral staple drivers 5254 back into their unactuated
positions.
[0584] Referring to FIGS. 104 and 105A, the staple firing drive
5250 further comprises longitudinal staple drivers 5257 which are
driven along longitudinal staple firing paths by the lateral staple
drivers 5254. Each lateral staple driver 5254 comprises a drive
cavity 5256 defined therein which receives a portion of a
longitudinal staple driver 5257 therein. More specifically, each
longitudinal staple driver 5257 comprises a cam portion positioned
in a drive cavity 5256 which is driven longitudinally, as
illustrated in FIG. 105B, by a cam surface 5258 defined in the
drive cavity 5256 when the lateral staple drivers 5254 are move
laterally. As a result of the above, the rotational movement of the
rotatable actuators 5252 is converted to the lateral translation of
the lateral staple drivers 5254, which is converted to the
longitudinal translation of the longitudinal staple drivers 5257.
The longitudinal motion of the of staple drivers 5257 drives the
staples 5230 against the anvil 5260 to deform the staples 5230, as
illustrated in FIG. 105B. The longitudinal staple drivers 5257
comprise staple cradles 5251 defined therein which are configured
to support the staples 5230 as the staples 5230 are being
deformed.
[0585] Further to the above, referring to FIG. 105C, the return
lateral motion of the staple drivers 5254 withdraws the
longitudinal staple drivers 5257 back into their unactuated
positions. More specifically, the drive cavities 5256 further
comprise a cam surface 5258' configured to drive the longitudinal
staple drivers 5257 in an opposite direction until the staple
drivers 5257 are reset in their unactuated, or unfired, positions,
as illustrated in FIG. 105D. Notably, the anvil 5260 is moved into
an open position when the longitudinal staple drivers 5257 are
retracted. At such point, the distal head 5220 can be moved
relative to the tissue, staples 5230 can be reloaded into the
distal head 5220, and the anvil 5260 can be re-clamped onto the
tissue, as illustrated in FIG. 105A wherein another staple firing
stroke of the staple firing drive 5250 can be performed.
[0586] As described above, columns of connected staples can be used
to supply, and re-supply, the staple firing system of a stapling
instrument. In other instances, entire staple cartridges can be
used to supply, and re-supply, a staple firing system. Referring to
FIG. 106, a stapling instrument 5300 comprises a shaft 5310, a
distal head 5320, and an articulation joint 5370 rotatably
connecting the distal head 5320 to the shaft 5310. The stapling
instrument 5300 further comprises a plurality of staple cartridges
5330'' stored in the shaft 5310 and a cartridge pusher system
configured to push the staple cartridges 5330'' into the distal
head 5320. Once a staple cartridge 5330'' is positioned in the
distal head 5320, the staples 5330 (FIG. 107) contained in the
staple cartridge 5330'' can be separated and deployed by a staple
firing system, as discussed in greater detail below. In various
instances, the staple cartridge comprises a cartridge body which is
broken up and deployed with the staples, while in other instances,
the staples are ejected from the cartridge body and the cartridge
body is not implanted.
[0587] Further to the above, referring to FIG. 107, the staple
cartridge 5330'' comprises a cartridge body 5333 including an
aperture defined therein. The aperture includes a first side 5334
configured to receive and store a first group of staples 5330 and a
second side 5335 configured to receive and store a second group of
staples 5330. The first group of staples 5330 is deployed on a
first side of a tissue incision path created by a tissue cutting
knife and the second group of staples 5330 is deployed on a second
side of the tissue incision path. The staples 5330 are further
arranged in clusters 5330' of three staples which are deployed
together, although staple clusters can include any suitable number
of staples. Five staple clusters 5330' are stored in the first side
5334 of the cartridge body 5333 and five staple clusters 5330' are
stored in the second side 5335 of the cartridge body 5333, although
any suitable number of clusters could be used. A staple cluster
5330' is ejected from each side 5334 and 5335 of the cartridge body
5333 and deformed against an anvil 5360 during each staple firing
stroke of the stapling system. In various alternative embodiments,
the staple clusters 5330' can be sequentially deployed from the
first and second sides 5334 and 5335.
[0588] Further to the above, the staples 5330 of each staple
cluster 5330' are attached to one another by at least one adhesive;
however, the staple clusters 5330' themselves are not attached to
one another and are, instead, stored side-by-side in the cartridge
body 5333. In at least one alternative embodiment, the staples of
adjacent staple clusters are releasably attached to one another.
Referring now to FIG. 108, the cartridge body 5333, for example,
can be configured to releasably store a plurality of staple
clusters 5430' therein wherein each staple cluster 5430' comprises
three staples. The three staples 5430 of each staple cluster 5430'
are attached to one another by at least one adhesive 5435 and,
also, the staple clusters 5430' are attached to one another by at
least one adhesive 5435. In such embodiments, the staple clusters
5430' are attached to one another to form a staple strip 5430'',
wherein one or more staple clusters 5430' are detached from the
other staple clusters 5430' to load the distal head 5320 with
staples. Although the staple clusters of the embodiments described
above comprise three staples, a staple cluster can include any
suitable number of staples including two staples, for example, or
more than three staples.
[0589] Referring to FIGS. 109 and 110, a stapling instrument 5400
comprises a shaft 5410, a distal head, a staple loading system, a
staple firing system, a tissue cutting system, an anvil closure
system, and a system configured to move the distal head relative to
the tissue of a patient. The stapling instrument 5400 further
comprises the staple strip 5430'' of FIG. 108 stored in the shaft
5410. The staple strip 5430'' can be stored within the cartridge
body 5333, as described above, or it can be stored within the shaft
5410 without the cartridge body. The staple strip 5430'' can
comprise any suitable number of staples and/or staple clusters. In
at least one instance, the staple strip 5430'' comprises 588
staples, for example.
[0590] Referring to FIGS. 111 and 112, a stapling instrument 5500
comprises a shaft 5510, a distal head, a staple loading system, a
staple firing system, a tissue cutting system, an anvil closure
system, and a system configured to move the distal head relative to
the tissue of a patient. The stapling instrument 5500 further
comprises a first staple strip 5530a'' and a second staple strip
5530b'' stored in the shaft 5510. The staple strips 5530a'' and
5530b'' are comprised of staples 5430 which are arranged in staple
clusters 5430'. The staple strips 5530a'' and 5530b'' are nested
such that the bases of the staples 5430 face in opposite
directions.
[0591] Referring to FIGS. 113 and 114, a stapling instrument 5600
comprises a shaft 5610, a distal head, a staple loading system, a
staple firing system, a tissue cutting system, an anvil closure
system, and a system configured to move the distal head relative to
the tissue of a patient. The stapling instrument 5600 further
comprises a first staple strip 5630a'' and a second staple strip
5630b'' stored in the shaft 5610. The staple strips 5630a'' and
5630b'' are comprised of staples 5430 which are arranged in staple
clusters 5430'. The staple strips 5630a'' and 5630b'' are arranged
in a side-by-side manner such that the bases of the staples 5430
face the same direction.
[0592] Referring again to FIG. 106, the stapling instrument 5300
comprises a system for pushing a staple cartridge 5330'' from the
shaft 5310 into the distal head 5320. Notably, this cartridge
pushing system pushes the staple cartridges 5330'' through the
articulation joint 5370 into the distal head 5320. As a result, the
size of the staple cartridges 5330'', and/or staples 5330, may be
limited by the space constraints of the articulation joint 5370,
especially when the distal head 5320 is articulated. FIGS. 115-118
disclose a stapling instrument 5700 comprising flexible staple
strips which can feed staples into a distal head through an
articulation joint. The stapling instrument 5700 includes a first
staple strip 5730' comprising staples 5730 attached to a first
carrier 5760'. More specifically, the staples 5730 are attached to
the first carrier 5760' at tabs 5761'. Each staple 5730 comprises a
base 5731 and legs 5732 extending therefrom, wherein the base 5731
is connected to the first staple strip 5730' by a tab 5761'. The
stapling instrument 5700 further includes a second staple strip
5730'' comprising staples 5730 attached to a second carrier 5760''
at tabs 5761''. The carriers 5760' and 5760'' each comprise an
array of apertures 5762 which, as described in greater detail
below, are used to feed the staple strips 5730' and 5730'' into the
distal head of the stapling instrument 5700.
[0593] The staple strip 5730' is stored in a shaft of the stapling
instrument 5700. In its stored state, the staple strip 5730' is
planar, or at least substantially planar. More specifically,
referring to FIGS. 115 and 116, the staples 5730 are attached to
the first carrier 5760' such that they lie in-plane with the first
carrier 5760'. The stapling instrument 5700 further comprises a
staple feeding system including a drive wheel which is configured
to push the staple strip 5730' in the distal head of the stapling
instrument 5700. The drive wheel comprises an array of drive pins
extending therearound which are configured to engage the apertures
5762 of the first carrier 5760' and drive the first carrier 5760'
into the distal head. The second staple strip 5730'' is also stored
in the shaft of the stapling instrument 5700. In its stored state,
the staple strip 5730'' is planar, or at least substantially
planar. More specifically, referring to FIGS. 115 and 116, the
staples 5730 are attached to the second carrier 5760'' such that
they lie in-plane with the second carrier 5760''. Similar to the
above, a drive wheel of the staple feeding system is configured to
engage the apertures 5762 of the second carrier 5760'' and drive
the second carrier 5760'' into the distal head of the stapling
instrument 5700.
[0594] Referring to FIGS. 115 and 118, the staple strips 5730' and
5730'' are stored in a face-to-face arrangement such that the
carriers 5760' and 5760'' of the staple strips 5730' and 5730'' can
be engaged and driven on opposite sides by the staple feeding
system. As the staple strips 5730' and 5730'' are being fed into
the distal head, referring to FIG. 116, the staples 5730 are bent
downwardly about the tabs 5761' and 5761'' of the staple strips
5730' and 5730'', respectively. In at least one instance, the frame
of the distal head comprises cam surfaces configured to bend the
staples 5730 downwardly. In certain instances, the stapling
instrument 5700 comprises one or more actuators configured to bend
the staples 5730 downwardly about a mandrel positioned under the
tabs 5761' and 5761'', for example. Once displaced into their
downward positions, the staples 5730 are detached from the staple
strips 5730' and 5730''. In at least one instance, the frame of the
distal head comprises one or more shear surfaces, or knife edges,
configured to separate the staples 5730 from the tabs 5761' and
5761'' as the staple strips 5730' and 5730'' are advanced into the
distal head. In certain instances, the stapling instrument 5700
further comprises one or more shears that are actuated to separate
the staples 5730 from the staple strips 5730' and 5730''. In either
event, the separated staples are then positioned to be deployed by
the staple firing system of the stapling instrument 5700.
[0595] Further to the above, the stapling instrument 5700 is
configured to separate a cluster of staples from the staple strips
5730' and 5730'' and then advance the carriers 5760' and 5760'' of
the staple strips 5730' and 5730'' so that another cluster of
staples can be separated from the staple strips 5730' and 5730''.
Once the staples 5730 have been separated from the carriers 5760'
and 5760'', referring to FIG. 118, the empty, or stripped, portions
of the carriers 5760' and 5760'' are fed back into the shaft of the
stapling instrument 5700. As a result, the motion which feeds new
staples 5730 into the staple firing system also feeds the empty
carriers 5760' and 5760'' back into the shaft.
[0596] Referring to FIG. 119, a staple cluster 5830' comprises four
staples 5830 which are adhered together by at least one adhesive
5835. Each staple 5830 comprises a base 5831 and two staple legs
5832 extending from the base 5831. Notably, the legs 5832 are not
co-planar with the base 5831. Rather, the base 5831 is present in a
base plane and the legs 5832 are present in a leg plane. The base
plane is parallel, or at least substantially parallel, to the leg
plane, although embodiments are envisioned in which the base plane
and the leg plane are not parallel. In either event, two of the
staples 5830 of the staple cluster 5830' face inwardly while two of
the staples 5830 face outwardly. A staple 5830 faces outwardly when
its base plane is closer to the center of the staple cluster 5830'
than its leg plane. Correspondingly, a staple 5830 faces inwardly
when its leg plane is closer to the center of the staple cluster
5830' than its base plane.
[0597] Further to the above, the staple cluster 5830' comprises two
staples 5830 located on a first side of a centerline CL and two
staples 5830 located on a second side of the centerline CL. The
staples 5830 on the first side of the staple cluster 5830' are
connected by a first adhesive connector 5835 and the staples 5830
on the second side of the staple cluster 5830' are connected by a
second adhesive connector 5835. Moreover, a staple 5830 on the
first side of the staple cluster 5830' is connected to a staple
5830 on the second side of the staple cluster 5830' by an adhesive
connector 5835. That said, a staple cluster can comprise any
suitable number of adhesive connectors. The adhesive connectors
5835 releasably hold the staples 5830 together. The adhesive
connectors 5835 are broken before the staples 5830 are implanted
into the patient tissue; however, alternative embodiments are
envisioned in which the adhesive connectors 5835 are not broken
before the staples 5830 are implanted into the patient tissue. The
adhesive connectors 5835 are comprised of biocompatible and/or
bioabsorbable materials, such as bioabsorbable polymers, for
example.
[0598] Referring to FIG. 120, a stapling instrument 5900 comprises
a shaft, a distal head 5920, a staple feeding system, a staple
firing system, a tissue cutting system, an anvil closing system,
and a drive system configured to move the distal head 5920 relative
to the patient tissue. The distal head 5920 comprises a first
staple cavity 5921 and a second staple cavity 5921. Each staple
cavity 5921 is configured to store a staple cluster 5930', or a
column of staple clusters 5930', therein. Each staple cluster 5930'
comprises four staples 5930, although it can include any suitable
number of staples. Each staple 5930 comprises a base 5931 and two
staple legs 5932 extending therefrom. The base 5931 and the legs
5932 are co-planar, or at least substantially co-planar. The
staples 5930 are releasably connected to one another by at least
one adhesive.
[0599] Further to the above, each staple cluster 5930' comprises
one or more guides 5935. The guides 5935 are defined on the lateral
sides of the cluster 5930' and are configured to be received within
notches 5925 defined in the staple cavities 5921. More
specifically, the guides 5935 are closely received by the sidewalls
of the notches 5925 such that there is little, if any, relative
lateral movement between the clusters 5930' and the distal head
5920. To this end, the staple clusters 5930' remain aligned with
the forming pockets of the anvil as the staples 5930 are deployed.
The guides 5935 are comprised of a biocompatible and/or
bioabsorbable material, such as a bioabsorbable polymer, for
example, and are implantable with the staples 5930.
[0600] Referring to FIG. 121, a stapling instrument 6000 comprises,
among other things, a shaft, a distal head 6020 including an anvil
6060, and a staple firing system. In this embodiment, the staple
firing system loads staples 6030 into the distal head 6020 and
fires them by pushing them against the anvil 6060. The distal head
6020 comprises staple cavities 6021 defined therein which are
configured to store and guide the staples 6030 as they are being
pushed toward the anvil 6060.
[0601] Referring to FIGS. 122-125, a stapling instrument 6100
comprises a shaft, a distal head 6120, a staple loading system, a
staple firing system, an anvil drive system, a tissue gripping
system, and a tissue drive system configured to move the distal
head 6120 relative to the patient tissue. The drive system of the
stapling instrument 6100 comprises rotatable feet 6180 which,
similar to the above, are configured to grip the tissue of a
patient and pull the distal head 6120 relative to the tissue. Also
similar to the above, the tissue gripping system is configured to
hold the tissue as the feet 6180 are being extended and/or during
any suitable time during the operation of the surgical instrument
6100. Referring primarily to FIG. 125, the tissue gripping system
comprises a tissue holder 6170 configured to engage the tissue of a
patient. The tissue holder 6170 comprises a rectangular body 6172
and stems 6174 extending from the body 6172. The tissue holder 6170
defines a tissue engaging surface 6175 which is smaller than the
cross-sectional thickness 6125 of the distal head 6120, which is
illustrated in FIG. 124. Owing to the smaller area of the tissue
engaging surface 6175 as compared to the cross-sectional thickness
6125, the tissue holder 6170 can apply a larger gripping pressure
to the patient tissue than the distal head 6120 could for a given
clamping force. In at least one instance, the tissue engaging
surface 6175 has an area which is about 25% of the cross-sectional
thickness 6125.
[0602] Referring to FIGS. 126-137, a stapling instrument 6200
comprises a shaft, a distal head 6220, a staple firing system 6250,
a tissue cutting system, an anvil drive system, and a tissue drive
system configured to move the distal head 6220 relative to the
tissue of a patient. Referring to FIGS. 126 and 127, the tissue
drive system comprises rotatable feet 6280 which are moved into an
extended position (FIG. 126) and then retracted (FIG. 127) to grip
the patient tissue and move the distal head 6220 relative to the
tissue. FIG. 128A also illustrates one of the feet 6280 in its
extended position. The feet 6280 can be extended and then retracted
at the same time to move the distal head 6220 along a straight path
or extended and retracted separately to turn the distal head 6220,
but only one foot 6280 is shown in FIG. 128A for the purpose of
illustration. FIG. 128, which corresponds to FIG. 128A, depicts the
anvil 6260 in a sufficiently-clamped state so that the anvil 6260
and the feet 6280 co-operate to grip the patient tissue. Moreover,
FIG. 128 depicts an unformed staple 6230 positioned in a staple
cavity 6221 defined in the distal head 6220 and the staple firing
system 6250 in an unfired state.
[0603] FIG. 129A, similar to FIG. 127, depicts the feet 6280 in
their retracted position. FIG. 129, which corresponds to FIG. 129A,
depicts the anvil 6260 in a fully-clamped state and the staple
firing system 6250 in a fired state. As illustrated in FIG. 129,
the legs 6232 of the staple 6230 have been fully deformed into a
B-shaped configuration; however, other deformed configurations of
the staple 6230 may be suitable. Referring now to FIGS. 131 and
133, the staple firing system 6250 comprises a firing bar 6255 and
a plurality of staples 6230 stored within recesses 6252 defined in
the sides of the firing bar 6255. A first column of staples 6230 is
stored in a first side of the firing bar 6255 and a second column
of staples 6230 is stored in a second, or opposite, side of the
firing bar 6255. Each of the recesses 6252 is defined by a proximal
staple cradle 6251 configured to push on the base 6231 of the
staple 6230 positioned therein. FIG. 134 depicts two staples 6230
positioned in a staple cavity 6221 defined in the distal head 6220
and the firing bar 6255 of the staple firing system 6250 in an
unfired state.
[0604] Referring again to FIG. 134, the sides of the staple cavity
6221 comprises recesses 6222 defined therein. The sides of the
staple cavity 6221 also comprise drag surfaces 6223 positioned
intermediate the recesses 6222. When the firing bar 6255 is pushed
distally to fire a first group of staples 6230 positioned in the
staple cavity 6221 during a first staple firing stroke, the staples
6230 stored in the firing bar 6255 are pushed by the drag surfaces
6223. As the firing bar 6255 is retracted after the first firing
stroke, referring to FIG. 136, the staples 6230 catch on the drag
surfaces 6223 such that the firing bar 6255 slides relative to the
staples 6230. In such instances, as a result, the staples 6230
index into the next distal set of recesses 6252 defined in the
firing bar 6255, thereby presenting a new set of staples 6230 to be
ejected from the staple cavity 6221. FIGS. 130 and 130A depict the
surgical instrument 6200 as it is being re-opened to release the
patient tissue so that the distal head 6220 can be repositioned
relative to the patient tissue. Once the distal head 6220 has been
suitably re-positioned, referring to FIG. 137, the firing bar 6255
can be advanced distally to perform a second staple firing stroke.
This process can be repeated to deploy all of the staples 6230
stored in the firing bar 6255.
[0605] The stapling instruments disclosed herein can be configured
to deploy staples in a suitable staple pattern. FIG. 138 depicts
one exemplary staple pattern comprising staples 6330 and staples
6330' positioned on both sides of a tissue cut line 6340. Each side
of the tissue cut line 6340 comprises an inner row of staples 6330
facing away from the cut line 6340 and an outer row of staples 6340
facing toward the cut line 6340. FIG. 139 depicts another exemplary
staple pattern comprising staples 6330, staples 6330', and staples
6430''. The staples 6430'' are arranged in rows on both sides of
the tissue cut line 6340. More specifically, the staples 6430'' are
arranged in staple rows positioned intermediate both sets of inner
row of staples 6330 and outer row of staples 6330'.
[0606] Referring to FIGS. 140 and 141, a stapling instrument 6500
comprises a shaft 6510, a distal head 6520, and an articulation
joint 6270 rotatably connecting the distal head 6520 to the shaft
6510. The stapling instrument 6500 further comprises a staple
feeding system 6590 configured to manufacture and supply a
continuous feed of staples 6530 to the distal head 6520. The staple
feeding system 6590 comprises a spool 6592 operably coupled to an
electric motor. The spool 6592 comprises metal wire 6594 wrapped
around a central core. The wire 6594 is comprised of stainless
steel and/or titanium, for example. The wire 6594 is fed through a
passage 6514 defined in the shaft 6510 and the articulation joint
6570. In use, the motorized spool 6594 pushes the wire 6594 into
the distal head 6520. As described in greater detail below, the
distal head 6520 further comprises a forming mandrel configured to
deform the wire 6594 into a staple 6530. The mandrel is driven by
an electric motor and/or actuator, but could be actuated in any
suitable manner. As also described in greater detail below, the
distal head 6520 comprises a knife, or shearing member, configured
to cut the wire 6594. The shearing member is driven by an electric
motor and/or actuator, but could be actuated in any suitable
manner. Once the staple 6530 has been formed and separated from the
wire 6594, the staple 6530 can be deployed and deformed against an
anvil 6560 of the stapling instrument 6500.
[0607] Referring to FIG. 141, the surgical instrument 6500 further
comprises a staple forming system 6580 configured to create staples
6530 from the wire 6594. The staple forming system 6580 comprises a
forming mandrel 6582 positioned in a forming cavity 6522 defined in
the distal head 6520. The staple forming system 6580 further
comprises a forming actuator 6584 configured to engage the wire
6594 and deform the wire 6594 within the forming cavity 6522. At
such point, the forming mandrel 6582 is actuated to sever the
staple 6530 from the wire 6594. After the staple 6530 has been
deployed and/or moved out of the forming cavity 6522, another
staple 6530 can be formed within the cavity 6522. In certain
alternative embodiments, a wire segment is cut from the metal wire
6594 before the wire segment is formed into a staple 6530. In
either event, the staple 6530 can comprise a substantially U-shaped
configuration, for example. Alternatively, the wire segment can be
formed into a substantially V-shaped configuration. Moreover, the
stapling instrument 6500 can be configured to manufacture and
deploy any suitable fastener, such as tacks and/or clamps, for
example.
[0608] Referring to FIGS. 158 and 159, a stapling instrument 7300
comprises a shaft 7310, a distal head 7320, and an articulation
joint 7370 rotatably connecting the distal head 7320 to the shaft
7310. In use, the stapling instrument 7300 is inserted into a
patient P through a trocar TC. The trocar TC comprises a passage
extending there through which permits the distal head 7320, and a
portion of the shaft 7310, to be inserted into the patient. In
other instances, the distal head 7320 can be inserted into the
patient through an open incision without a trocar. In either event,
the stapling instrument 7300 is configured to deploy staples from a
staple cartridge inserted therein. The shaft 7310 comprises a
loading port 7312 which is in communication with a cartridge
passage, or channel, extending through the shaft 7310, the
articulation joint 7370, and the distal head 7320. In use, a staple
cartridge, such as staple cartridge 7330', for example, is inserted
into the shaft 7310 through the loading port 7312 and then pushed
into the distal head 7320. The stapling instrument 7300 further
comprises a cartridge pusher system configured to push the staple
cartridge 7330' into the end effector 7300.
[0609] In various instances, further to the above, staple
cartridges 7330' can be fed into the stapling instrument 7300 such
that the stapling instrument 7300 can be continuously operated
without having to be removed from the patient to be reloaded. Each
staple cartridge 7330' has staples stored therein which have a
first size, such as a first unfired height. In certain instances,
it is desirable to create a staple line with staples all having the
same size, or unfired height. Such instances can arise when the
tissue being stapled has a substantially uniform thickness. In
other instances, it is desirable to create a staple line with
staples having different sizes, or unfired heights. Such instances
can arise when the tissue being stapled does not have a uniform
thickness. For instance, stomach tissue transected during a stomach
reduction procedure usually does not have a consistent thickness.
In such instances, a first staple cartridge 7330' can be loaded
into the stapling instrument 7300 that has staples having a first
unfired height and a second staple cartridge 7330'' can be loaded
into the stapling instrument 7300 having a second unfired height.
The first unfired height is taller than the second unfired height,
but the first unfired height could be shorter than the second
unfired height. Similarly, a third staple cartridge 7330''' can be
loaded into the stapling instrument 7300 that has staples having a
third unfired height which is different than the first unfired
height and the second unfired height.
[0610] Further to the above, more than one staple cartridge can be
loaded into the stapling instrument 7300. The staple cartridges can
be inserted into the stapling instrument 7300 such that they are
used in a specific order. For instance, staple cartridges having
shorter unfired heights can be fired before staple cartridges
having taller unfired heights. Alternatively, staple cartridges
having taller unfired heights can be fired before staple cartridges
having shorter unfired heights. In any event, the distal-most
staple cartridge is used first and the proximal-most staple
cartridge is used last. Such an arrangement allows the surgical
procedure to be pre-planned with little, if any, lost time in
loading the stapling instrument 7300 during the surgical procedure.
Alternatively, the staple cartridges can be fed into the stapling
instrument 7300 one at a time. Such an arrangement provides a
clinician with an opportunity to change the order in which the
staple cartridges are ultimately used.
[0611] The loading port 7312 comprises an opening accessible from
the exterior of the shaft 7310, although the loading port 7312
could be defined in the handle of the stapling instrument 7300 or
in any other suitable location. In various instances, the stapling
instrument 7300 can further comprise a door configured to cover the
loading port 7312. In at least one instance, the door can be
sealed, when closed, to prevent or inhibit the ingress of fluids
and/or contaminants into the stapling instrument 7300. In such
instances, the door and/or the housing of the shaft 7310 can
comprise one or more seals.
[0612] Referring primarily to FIG. 159, the stapling instrument
7300 comprises a system for stripping off a cluster of staples,
such as staples 7330, for example, from the distal-most staple
cartridge. The stapling instrument 7300 further comprises a staple
firing system 7350 configured to deploy the staples 7330 and deform
the staples 7330 against an anvil 7360 during a staple firing
stroke. The stapling instrument 7300 further comprises a tissue
drive system 7380 configured to move the distal head 7320 relative
to the patient tissue after the staple firing stroke.
[0613] Referring to FIGS. 168 and 169, a stapling instrument 7900
comprises a shaft 7910, a distal head 7920, and an articulation
joint 7970 rotatably connecting the distal head 7920 to the shaft
7910. As described in greater detail below, the distal head 7920 is
pivotable in any suitable direction. Similar to the above, the
stapling instrument 7900 comprises a cartridge feeding system
configured to feed staple cartridges 7930' into the distal head
7920 through a cartridge passage 7914 that extends through the
shaft 7910, the articulation joint 7970, and the distal head 7920.
Also similar to the above, staples 7930 are stripped from the
distal-most staple cartridge 7930' and then fired against an anvil
7960. As described in greater detail below, the stapling instrument
7900 further comprises an articulation drive system 7980 configured
to articulate the distal head 7920.
[0614] Further to the above, referring again to FIGS. 168 and 169,
the distal head 7920 is articulatable in several directions
relative to the shaft 7910. The shaft 7910 extends along a
longitudinal shaft axis LA and the distal head 7920 extends along a
longitudinal head axis HA. The head axis HA is aligned, or at least
substantially aligned, with the shaft axis LA when the distal head
7920 is not articulated. When the distal head 7920 is articulated,
the head axis HA is transverse to the shaft axis LA. Referring to
FIG. 168, the distal head 7920 is articulatable laterally, or in a
side-to-side direction. In at least one such instance, the distal
head 7920 is articulatable within a range comprising about 15
degrees to a first side of the shaft axis LA and about 15 degrees
to a second side of the shaft axis LA, for example. The
articulation drive system 7980 is configured to drive, or actively
articulate, the distal head 7920 through this range of motion. The
articulation drive system 7980 comprises a first lateral driver
7982 mounted to the distal head 7920 and a second lateral driver
7984 mounted to the distal head 7920 on the opposite side of the
distal head 7920. In use, the first lateral driver 7982 is pushed
and/or the second lateral driver 7984 is pulled to articulate the
distal head 7920 in a first direction. Correspondingly, the first
lateral driver 7982 is pulled and/or the second lateral driver 7984
is pushed to articulate the distal head 7920 in a second direction.
In at least one instance, the first lateral driver 7982 comprises a
first guide wire and the second lateral driver 7984 comprises a
second guide wire. Such guide wires are suitable for pulling the
distal head 7920.
[0615] Referring to FIG. 169, the distal head 7920 is also
articulatable in a forward and/or backward direction. In at least
one such instance, the distal head 7920 is articulatable within a
range comprising about 25 degrees in a backward direction and about
25 degrees in a forward direction, for example. In certain
embodiments, although not illustrated, the articulation drive
system 7980 is configured to actively articulate the distal head
7920 in the forward and backward (FIG. 169) directions. In
alternative embodiments, the distal head 7920 can be passively
articulated in the forward and backward directions. In such
embodiments, the stapling instrument 7900 does not actively drive
the distal head 7920 relative to the shaft 7910. Instead, the
distal head 7920 can float in the forward-to-backward direction.
Similarly, the distal head 7920 can be passively articulated in the
side-to-side direction with or without the articulation drive
system 7980. In any event, the distal head 7920 is articulatable in
both the forward-to-back and side-to-side planes and can take a
compound angle with respect to the longitudinal axis LA of the
shaft 7910.
[0616] In various embodiments, the surgical instrument 7900 can
comprise a lock configured to hold the distal head 7920 in position
which can be released to allow the distal head 7920 to move
relative to the shaft 7910. In various instances, the distal head
7920 can be passively articulated by pushing the distal head 7920
against the patient tissue within the surgical site when the distal
head 7920 is unlocked. The distal head 7920 could also be actively
articulated when the distal head 7920 is unlocked. In either event,
the distal head 7920 can then be locked in its articulated position
once the distal head 7920 has been suitably positioned. In order to
return the distal head 7920 to its unarticulated position, the
distal head 7920 can be unlocked and then re-aligned with the shaft
axis LA. In at least one instance, the stapling instrument 7900
comprises one or more springs configured to bias the distal head
7920 into its unarticulated position. In any event, the
articulation lock can prevent, or at least inhibit, the
back-driving of the distal head 7920 in response to external and/or
internal forces and torques.
[0617] Further to the above, the articulation joint 7970 of the
stapling instrument 7000 permits the distal head 7920 to be
articulated about one or more axes. In various alternative
embodiments, the shaft of a stapling instrument comprises a first
articulation joint which permits a distal head to articulate about
a first articulation axis and a second articulation joint which
permits the distal head to articulate about a second articulation
axis. The first articulation axis and the second articulation axis
extend in planes which are orthogonal, but can extend in any
suitable transverse planes. In various instances, the first and
second articulation joints are passively articulated. In some
instances, the first and second articulation joints are actively
articulated. In at least one instance, the first articulation joint
is actively articulated and the second articulation joint is
passively articulated.
[0618] Referring to FIG. 170, a stapling instrument 8000 comprises
a dampening system 8080 configured to control, or slow, the
articulation of the distal head 7920. The dampening system 8080
comprises a first link 8082, a second link 8084, and a dashpot
8085. The first link 8082 is pinned to the distal head 7920 at a
pivot 8081. The first link 8082 is also pinned to the second link
8084 at a pivot 8083. The pivots 8081 and 8083 allow the dampening
system 8080 to accommodate the various articulation motions of the
distal head 7920. The dashpot 8085 comprises a housing 8087 mounted
to the shaft 7910 and a dampening medium 8088 contained in a
chamber defined in the housing 8087. The second link 8084 comprises
a piston 8086 defined on its proximal end which is positioned in
the housing aperture and is configured to move through the
dampening medium 8088 when the distal head 7920 is articulated. The
dampening medium 8088 flows through and/or around the piston 8086,
thereby permitting, but slowing, relative movement between the
piston 8086 and the housing 8097. Correspondingly, the dampening
medium 8088 permits, but slows, the movement of the distal head
7920 relative to the shaft 7910. Sudden movements of the distal
head 7920 may be hard for the clinician to control and/or
anticipate and may cause the distal head 7920 to strike the patient
tissue. The dampening medium 8088 can comprise any suitable medium,
such as dampening grease, for example.
[0619] Referring to FIG. 171, a stapling instrument 8100 comprises
a dampening system 8180 configured to control, or slow, the
articulation of the distal head 7920. The dampening system 8180
comprises a link 8182 and a dashpot 8185. The link 8182 is pinned
to the distal head 7920 at a pivot 8181. The first link 8082 is
flexible, thereby allowing the dampening system 8180 to accommodate
the various articulation motions of the distal head 7920. The
dashpot 8185 comprises a housing 8187 rotatably mounted to the
shaft 7910 and a dampening medium 8188 contained in a chamber
defined in the housing 8187. The link 8182 comprises a piston 8186
defined on its proximal end which is positioned in the housing
aperture and is configured to move through the dampening medium
8188 when the distal head 7920 is articulated. The dampening medium
8188 flows through and/or around the piston 8186, thereby
permitting, but slowing, relative movement between the 8186 and the
housing 8197. Correspondingly, the dampening medium 8188 permits,
but slows, the movement of the distal head 7920 relative to the
shaft 7910. Sudden movements of the distal head 7920 may be hard
for the clinician to control and/or anticipate and may cause the
distal head 7920 to strike the patient tissue. The dampening medium
8188 can comprise any suitable medium, such as dampening grease,
for example.
[0620] Referring to FIG. 172, the stapling instrument 8100 is
insertable into a patient P through a trocar TC and is movable
relative to the target tissue T. To a certain extent, the trocar TC
can be moved relative to the patient P and, also to a certain
extent, the stapling instrument 8100 can be moved relative to the
trocar TC. Such movement, however, may cause the shaft 7910 to move
through a wide range of angles. In order to keep the distal head
7920 aligned with the tissue as the distal head 7920 is progressed
along the staple line, the distal head 7920 can be progressively
articulated backwards, for example. Referring to FIG. 173, the
distal head 7920 can be progressively articulated forward and/or
backward to keep the axis of the distal head 7920 orthogonal, or at
least substantially orthogonal, to the target tissue T. In various
instances, the distal head 7920 is actively articulated by an
articulation drive system to adjust the angle between the distal
head 7920 and the shaft 7910. In certain instances, the distal head
7920 is passively articulated by an articulation drive system to
adjust the angle between the distal head 7920 and the shaft 7910.
In such instances, the distal head 7920 can adaptively float to
follow the staple firing path.
[0621] Referring to FIGS. 34 and 35, a stapling instrument 2500
comprises a shaft 2510, a distal head 2520, and an articulation
joint 2570 rotatably connecting the distal head 2520 to the shaft
2510. The shaft 2510 extends along a longitudinal shaft axis LA and
the distal head 2520 extends along a longitudinal head axis HA. The
shaft axis LA and the head axis HA are aligned when the distal head
2520 is not articulated, as illustrated in FIG. 34. Referring to
FIG. 35, the head axis HA is transverse to the shaft axis LA when
the distal head 2520 is articulated. The stapling instrument 2500
further comprises a dampening system 2580 configured to control, or
slow, the articulation of the distal head 2520. The dampening
system 2580 comprises a first link 2581, a second link 2582, and a
dashpot 2585. The first link 2581 is pinned to the distal head 2520
at a pivot 2584. The first link 2581 is also pinned to the second
link 2582 at a pivot 2583. The pivots 2583 and 2584 allow the
dampening system 2580 to accommodate the various articulation
motions of the distal head 2520. When the distal head 2520 is not
articulated, referring to FIG. 34, the first link 2581 is aligned
with the second link 2582 along a longitudinal axis. When the
distal head 2520 is articulated, referring to FIG. 35, the first
link 2581 is transverse to the second link 2582.
[0622] The dashpot 2585 comprises a housing mounted to the shaft
2510 and a dampening medium 2586 contained in a chamber defined in
the housing. The second link 2582 comprises a piston defined on its
proximal end which is positioned in the housing aperture and is
configured to move through the dampening medium 2586 when the
distal head 2520 is articulated. The dampening medium 2586 flows
through and/or around the piston, thereby permitting, but slowing,
relative movement between the piston and the housing.
Correspondingly, the dampening medium 2586 permits, but slows, the
movement of the distal head 2520 relative to the shaft 2510. The
dampening medium 2586 can comprise any suitable medium, such as
dampening foam, for example.
[0623] A stapling instrument 2000 is illustrated in FIG. 13 and is
similar to the stapling instrument 1000 and/or the other stapling
instruments disclosed herein in many respects, most of which will
not be discussed herein for the sake of brevity. The stapling
instrument 2000 comprises a handle 2100 including a housing 2110, a
grip 2120, and a display 2130. The housing 2110 comprises a
connector 2170 which is configured to connect a shaft assembly,
such as shaft assembly 1200, for example, to the handle 2100. The
handle 2100 further comprises a replaceable battery pack 2160 which
is releasably attached to the housing 2110 and removably positioned
within a cavity 2115 defined in the housing 2110. The battery pack
2160 supplies power to the display 2130 and/or the motor-driven
systems contained within the handle 2100. As discussed in greater
detail below, the display 2130 is configured to permit the user to
control the operation of the surgical instrument 2000.
[0624] Further to the above, the stapling instrument 2000 comprises
a staple firing system configured to apply a staple line in the
tissue of a patient and the display 2130 comprises controls for
evaluating the status of the staple firing system. The display 2130
also comprises controls for evaluating and/or altering the speed in
which the stapling instrument 2000 is applying the staple line, the
direction in which the staple line is being applied, and/or any
performance thresholds that have been met, exceeded, or are about
to be exceeded, for example. The display 2130 comprises a
capacitive touchscreen; however, any suitable screen could be
used.
[0625] Referring to FIG. 14, the display 2130 comprises a status
control 2140. The status control 2140 comprises a window 2141
including a window header 2142. The status control 2140 further
comprises an image window 2145 configured to display information
regarding the tissue being stapled, the staple firing path, and/or
any other information that the clinician may use to operate the
stapling instrument 2000. For instance, the image window 2145 is
configured to display the staple firing path 2143 that the stapling
instrument 2100 is currently moving along and/or an alternate
staple firing path 2143' which would guide the staple path around
certain anatomical features in the patient tissue T, such as a
blood vessel V, for example. The status control 2140 is a digital
control and/or display and is signal communication with a
controller of the stapling instrument 2000.
[0626] Referring to FIG. 17, the display 2130 further comprises a
direction control 2190 which is configured to control the direction
of the staple firing path. The direction control 2190 comprises a
window 2191 including a window header 2192 and an image window
2195. The image window 2195 is configured to display the
orientation of the distal head of the stapling instrument relative
to an original starting orientation. The image window 2195
comprises a plurality of orientation lines 2194 indicating certain
direction angles, such as 15 degrees, 30 degrees, and 45 degrees,
for example, relative to the starting orientation line 2194
demarcated as 0 degrees. The image window 2195 further comprises a
needle 2193 which represents the orientation of the distal head of
the stapling instrument relative to the starting orientation of the
stapling instrument. The direction control 2190 further comprises
an edit window 2198 which, once activated, allows the user to alter
the direction of the staple path by manipulating the needle 2193.
The direction control 2190 further comprises a save window 2199
which, once activated, allows the user to save the input provided
to the controller through the direction control 2190. At such
point, the stapling instrument 2000 can move along its new
orientation. The status control 2190 is a digital control and/or
display and is signal communication with the controller of the
stapling instrument 2000.
[0627] Referring to FIG. 15, the display 2130 further comprises a
speed control 2150 configured to control speed in which the
stapling instrument 2000 creates the staple path. The speed control
2150 comprises a window 2151 including a window header 2152 and an
image window 2155. The image window 2155 comprises an indicator
2153 configured to display the speed of the stapling instrument.
For instance, the indicator 2153 can display that number of staple
firing strokes that the stapling instrument 2000 is performing per
minute. The image window 2155 further comprises an up-arrow control
2156 which is actuatable to increase the rate of the staple firing
strokes and a down-arrow control 2157 which is actuatable to
decrease the rate of the staple firing strokes. The indicator 2153
can be configured to display the speed in which the stapling
instrument 2000 is being propelled across the patient tissue by the
tissue drive system. Other metrics for the speed of the stapling
instrument 2000 can be used and displayed. The status control 2150
is a digital control and/or display and is signal communication
with the controller of the stapling instrument 2000.
[0628] Referring to FIG. 16, the display 2130 further comprises a
fault threshold control 2180 which is configured to manage fault
thresholds of the stapling instrument 2000 as they arise. For
instance, a threshold for the force needed to perform a staple
firing stroke can be used to establish a fault condition which
requires input from the user. If the force needed to perform a
staple firing stroke exceeds the threshold, the controller of the
stapling instrument 2000 can warn the user via the fault threshold
control 2180 and/or stop the stapling instrument 2000. Certain
faults can be over-ridden, or otherwise managed, by the user which
can allow the stapling instrument 2000 to continue applying the
staple line. The fault threshold control 2180 permits the user to
manage these faults. Other faults may not be over-ridden. In such
instances, the fault threshold control 2180 is configured to
display to the user that the fault cannot be over-ridden and/or how
to resolve the fault such that the operation of the stapling
instrument 2000 can be continued. The fault threshold control 2180
comprises a window 2181 including a window header 2182 and an image
window 2185. The fault threshold control 2180 is a digital control
and/or display and is signal communication with the controller of
the stapling instrument 2000.
[0629] Turning now to FIG. 18, the stapling instrument 2000 further
comprises a vision acquisition system, discussed in greater detail
below, and the display 2130 further comprises an image window 2135
configured to display, among other things, a real-time video image
from the vision acquisition system. The display 2130 further
comprises a menu 2131 extending along the left side of the image
window 2135; however, the menu 2131 could be placed in any suitable
location on the display 2130. The menu 2131 includes the status
control 2140, the speed control 2150, the fault threshold control
2180, and the direction control 2190 discussed above. The menu 2131
also includes a settings control 2132 which can be used to select
and/or re-arrange the windows and/or controls on the display 2130.
The menu 2131 further includes a stop control 2136 which can
immediately stop the progression of the stapling instrument 2100
along the staple firing path. The menu 2131 is a digital control
and/or display and is signal communication with the controller of
the stapling instrument 2100.
[0630] Further to the above, referring again to FIG. 18, the
display 2130 further comprises a first view window 2133 and a
second view window 2134. The view windows 2133 and 2134 are
positioned along the right side of the image window 2135, but could
be placed in any suitable location on the display 2130. The view
windows 2133 and 2134 provide the user with alternate views of the
stapling instrument 2000. For instance, the first view window 2133
provides the user with a side view of the stapling instrument 2000
in the surgical site and the second view window 2134 provides the
user with a top view of the stapling instrument 2000 in the
surgical site. These additional views can be supplied by one or
more digital cameras on the stapling instrument 2000 and/or from
other surgical instruments, such as an endoscope, for example, in
the surgical site. In such instances, the other surgical
instruments are in signal communication with the controller of the
stapling instrument 2000 to provide these additional images. In
certain instances, the controller of the stapling instrument 2000
can interpret data provided to the controller and generate the
additional images for the windows 2133 and 2134 based on the
provided data.
[0631] As discussed above, the speed in which the staple firing
system and/or the tissue drive system of the stapling instrument
2000 is operated can be controlled by the speed control 2150 on the
display 2130. In various instances, as discussed above, the speed
can be controlled manually, or by an input from the user. In other
instances, the controller of the stapling instrument 2000 can
control the speed automatically. In such instances, the controller
is configured to evaluate the properties of the tissue being
stapled, such as its thickness and/or density, for example, and
adjust the speed of the staple firing system and/or the tissue
drive system accordingly. For instance, if the controller
determines that the tissue being stapled is thick, or is near, at,
or over a tissue thickness threshold, the controller can slow down
the speed of the stapling instrument 2000. Similarly, the
controller can slow down the speed of the stapling instrument 2000
if the controller determines that the tissue being stapled is
dense, or is near, at, or over a tissue density threshold, for
example. Correspondingly, the controller can speed up the speed of
the stapling instrument 2000 if the controller determines that the
tissue being stapled is thin or less dense than usual, for example.
Further to the above, referring to FIG. 19, the speed control 2150
of the stapling instrument 2000 comprises an option for the user to
select between an automatic speed control 2158 in which the
stapling instrument 2000 controls the speed of the stapling
instrument 2000 and a manual speed control 2159 in which the user
controls the speed of the stapling instrument 2000.
[0632] Referring to FIG. 20, a stapling instrument 2200 comprises a
display 2230. The stapling instrument 2200 is similar to the
stapling instrument 2000 in many respects and the display 2230 is
similar to the display 2130 in many respects, most of which will
not be discussed herein for the sake of brevity. The display 2230
comprises a menu 2231 and a center image window 2235. The center
image window 2235 displays an image of the patient tissue T being
stapled and a staple firing path 2243 along which the stapling
instrument 2200 is moving. The staple firing path 2243 is displayed
as a series of actuations, or staple firings, 2244. Each projected
actuation 2244 shows the path in which the tissue T will be incised
and the positions in which staple clusters 2245 will be deployed
into the tissue T relative to the tissue incision. The projected
actuation 2244 nearest to the distal head of the stapling
instrument 2200 is highlighted relative to the other projected
actuations 2244 so that the user can differentiate between the
upcoming staple firing and subsequent projected staple firings.
Such highlighting can include a different color and/or brightness
of color, for example, of the projected actuation 2244. In at least
one instance, the displayed actuations 2244 of the staple firing
path 2243 can be progressively less intense as they move away from
the distal head of the stapling instrument 2200.
[0633] Further to the above, the display 2230 is further configured
to display one or more alternative staple firing paths. For
instance, the display 2230 is configured to display an alternative
staple firing path 2243' in the center image window 2235. Similar
to the staple firing path 2243, the staple firing path 2243' is
displayed as a series of actuations, or staple firings, 2244'. Each
projected actuation 2244' shows the path in which the tissue T will
be cut and the positions in which the staple clusters 2245 will be
deployed in the tissue T. The menu 2231 comprises a staple line
control 2240 which can be actuated by the user of the stapling
instrument 2200 to edit the staple firing path 2243 to create the
alternate staple firing path 2243'. Once the alternate staple
firing path 2243' has been established, it can be saved and the
stapling instrument 2200 can be operated to follow the alternate
staple firing path 2243'. As illustrated in FIG. 20, the staple
line control 2240 comprises an actuatable edit sub-control 2241 and
an actuatable save sub-control 2242 to modify and save the staple
firing path as described above.
[0634] As described above, the staple firing path 2243 is
modifiable into an alternate staple firing path 2243'. The staple
firing path 2243 and the alternate staple firing path 2243' are
displayed in an image which overlays the video image from the
camera. The staple firing path 2243 and the alternate staple firing
path 2243' are displayed in the same image overlay, or layer, but
could be displayed in different image overlays, or layers. In at
least one such instance, the staple firing path 2243 is displayed
in a first image overlay, or layer, and the alternate staple firing
path 2243 is displayed in a second image overlay, or layer, which
is different than the first image overlay. The screen of the
display 2230 is configured to receive an input command from the
center image window 2235 which can drag the staple firing path 2243
and/or the alternate staple firing path 2243' within the image
overlay, or overlays. The screen of the display 2230 is configured
to be responsive to the finger of the user such that the staple
firing path can be modified by the user dragging their finger.
Referring to FIG. 21, the screen of the display 2230 is further
configured to be responsive to a stylus 2220, for example.
[0635] As discussed above, the display 2230 can be configured to
display the current, or intended, staple firing path and one or
more alternate staple firing paths. The controller of the stapling
instrument 2200 is configured to generate one or more alternate
staple firing paths and display these alternate staple firing paths
on the display 2230. In various instances, the controller can
determine the alternate staple firing paths based on one or more
attributes of the tissue T being stapled. For instance, the
controller can identify blood vessels within the tissue T and
provide, or offer, an alternate staple firing path which steers the
stapling instrument 2200 around the blood vessels.
[0636] Referring to FIG. 22, the display 2230 comprises a menu
including a plurality of controls which are configured to modify
the staple firing path while the stapling instrument 2200 is
deploying the staple path and/or after the stapling instrument 2200
has been stopped. The display 2230 comprises a menu 2231 including
a plurality of actuatable controls which are configured to be used
while the stapling instrument 2200 is performing its series of
staple firing strokes to create the staple path. The menu 2231
comprises a view control 2232 to change the video image displayed
in the center image window 2235, for example. In at least one such
instance, the video control can be used to toggle between different
video feeds. The menu 2231 further comprises the staple line 2240
control, discussed above, which is configured to modify the staple
firing path. The staple firing system of the stapling instrument
2200 can be started by the user actuating a stapling control 2234
in the menu 2231 and stopped by the user actuating a stop control
2236 in the menu 2231.
[0637] Further to the above, the shaft assembly attached to the
handle of the stapling instrument 2200 can be rotated relative to
the handle. The shaft assembly includes a rotatable slip joint
configured to permit the distal head of the shaft assembly to
rotate relative to the handle, although any suitable arrangement
can be used. As a result of this slip joint, the user of the
stapling instrument 2200 can selectively orient the display 2230
relative to the distal head of the stapling instrument 2200. In
such instances, the user can maintain the orientation of the
display 2230 with respect to the patient, for example, even though
the distal head is turning to follow the staple firing path.
Similarly, FIGS. 144-146 depict the stapling instrument 1000
inserted into a patient P through a trocar TC and, owing to a
rotatable interface between the handle display and shaft assembly
of the stapling instrument 1000, the handle display can be
maintained by the clinician C in a constant orientation relative to
themselves even though the shaft assembly is rotating to follow the
staple firing path FP.
[0638] Referring to FIGS. 147-150, a stapling instrument 7000
comprises a handle 7010 including a grip 7020 and a shaft assembly
1200 assembled to the handle 7010. The handle 7010 further
comprises a display 7030 rotatably attached to the handle 7010
about a rotation joint 7035. The display 7030 is similar to the
display 2230 in many respects, most of which will not be discussed
herein for the sake of brevity. In use, the display 7030 can be
rotated relative to the handle 7010 to maintain a suitable
orientation of the display 7030 relative to the clinician C and/or
any other frame of reference.
[0639] FIG. 180 depicts a handle 1500 of a surgical instrument 100
for use by a clinician during a surgical procedure. The handle 1500
comprises a central portion 110 bordered by one or more ergonomic
grips 120 to facilitate handling of the surgical instrument 100 by
the clinician. Each ergonomic grip 120 is configured to fit within
a hand of the clinician for enhanced control and comfort. The
handle 1500 comprises one or more interactive controls 180
configured to provide navigation commands to an end effector of the
surgical instrument 100. In various instances, one or more
interactive controls 180 are configured to provide a user command
corresponding to a selection of one or more items. The interactive
controls 180 are positioned on the handle 1500 in a location that
allows for easy operation by the clinician, such as in a location
within reaching distance of a clinician's thumb. In various
instances, the controls 180 are comprised of various types of
switches and/or buttons, for example. In various instances, the
interactive controls 180 comprise a toggle switch, an analog stick,
a rocker, a D-pad, and/or any other suitable interactive control
capable of facilitating the communication of a user command to the
controller of the surgical instrument 100, for example.
[0640] The handle 1500 further comprises a touch-sensitive display
1510. A portion of the touch-sensitive display 1510 displays a menu
bar 1512 to the clinician. The options of the menu bar 1512
represent various display modes of the surgical instrument 100
including, but not limited to, a view mode, a position mode, and/or
a staple mode. In the various display modes, data and/or images
relevant to the surgical procedure and/or the status of surgical
instrument 100 are displayed. In the view mode, the touch-sensitive
display 1510 displays a plurality of views of the surgical site,
including, for example, a side view and a top view. The side view
and the top view are displayed in separate frames 1514, 1516 of the
touch-sensitive display 1510, although they could be displayed in
any suitable manner. The clinician is able to focus on a particular
view by switching the desired view into an enlarged, centralized
frame 1518 using the interactive controls 180, as described above.
In various embodiments, the clinician can switch between views by
dragging the desired view toward the central frame 1518 with an
input device 1530, such as a stylus or a finger of the clinician,
for example. The input device 1530 is described in greater detail
below.
[0641] In order to create a sterile environment for the surgical
instrument 100, a sterile barrier 190 is draped over the handle
1500, as seen in FIG. 181. As will be discussed in greater detail
below, the sterile barrier 190 is comprised of a clear, elastic
material, such as plastic, for example. The sterile barrier 190
extends around the handle 1500 and onto a proximal portion of the
shaft 200. The sterile barrier 190 comprises one or more pre-molded
areas 192 configured to fit over the interactive controls 180. The
pre-molded areas 192 assist in aligning the sterile barrier 190
over the handle 1500 of the surgical instrument 100. The sterile
barrier 190 is stretched over the touch-sensitive display 1510 to
create a smooth, uniform barrier, or an at least substantially
smooth, uniform barrier. Attachment members 194, such as clips, for
example, secure the sterile barrier 190 in position around a
perimeter 193 of the touch-sensitive display 1510. The sterile
barrier 190 fits loosely around the remaining components of the
handle 1500, and the sterile barrier 190 is cinched around the
shaft 200 of the surgical instrument 100, although any suitable
arrangement can be used. Covering the handle 1500 with the sterile
barrier 190 protects various components of the handle 1500 from
exposure to bodily fluids and/or contaminants, for example. Draping
the sterile barrier 190 over the handle 1500 and the proximal
portion of the shaft 200 also provides a cost-effective and rapid
means for the handle 1500 of the surgical instrument 100 to be
sterilized and reused.
[0642] FIG. 182 depicts a touch-sensitive display assembly 500. The
touch-sensitive display assembly 500 comprises a sterile barrier
190 and a touch-sensitive display 1510. In certain instances, the
touch-sensitive display 1510 acts as a projected capacitive sensor.
The touch-sensitive display 1510 comprises an insulative layer 1511
comprised of an insulative material mounted on top of a sensing
mechanism 1513. In certain instances, the insulative layer 1511 is
mounted to the sensing mechanism 1513 by a bonding adhesive, such
as an optical bonding adhesive, for example. As discussed above,
the sterile barrier 190 is stretched over the touch-sensitive
display 1510 in a uniform, or nearly uniform, fashion. Attachment
members 194 (FIG. 181) retain the sterile barrier 190 in its
stretched position in a manner that creates a gap 1520 in between
the sterile barrier 190 and the insulative layer 1511. The gap 1520
spans a distance of a few millimeters between the insulative layer
1511 and the sterile barrier 190, and the gap 1520 is configured to
prevent the formation of contact bubbles should the sterile barrier
190 come into contact with the insulative layer 1511.
[0643] Conductive particles 191 are dispersed throughout the
sterile barrier 190, giving the sterile barrier 190 a particular
capacitance. The sensing mechanism 1513 of the touch-sensitive
display assembly 500 comprises a plurality of pixels 1515 and a
material, such as indium tin oxide, for example, configured to
create electrodes. In various instances, as discussed in more
detail with respect to FIG. 183, the electrodes are arranged in an
orthogonal grid, although any suitable arrangement can be used.
Among other things, the sensing mechanism 1513 is configured to
detect when the sterile barrier 190 is attached. More specifically,
the sensing mechanism 1513 detects attachment of the sterile
barrier 190 by the particular capacitance of the sterile barrier
190. When a clinician wants to utilize the functionality of the
touch-sensitive display 1510, the input device 1530, as mentioned
above, is brought into contact with the sterile barrier 190 at a
desired contact point. The sensing mechanism 1513 is configured to
detect the additional capacitance of the input device 1530 and
differentiate the capacitance of the input device 1530 from the
capacitance of the sterile barrier 190. Moreover, as the input
device 1530 is brought into contact with the sterile barrier 190,
the conductive particles 191 of the sterile barrier 190 are
compressed, or brought closer together. Such compression creates a
higher density of conductive particles 191 in the area surrounding
the contact point of the input device 1530, and thus, a higher
capacitance. Pixels 1515 of the sensing mechanism 1513 become
activated or energized in the vicinity of the contact point due to
the change in electrical charge at the contact point in the sensing
mechanism 1513.
[0644] The touch-sensitive display 1510 is configured to function
in the same and/or similar manner without the sterile barrier 190.
In certain instances, the input device 1530 is comprised of a
finger of the clinician enclosed by a latex glove, for example.
Medical latex gloves are typically thin enough so as not to impede
the conductive qualities of a clinician's finger. In instances
where a glove worn by the clinician is expected to dampen the
conductive qualities of the clinician's finger, settings of the
touch-sensitive display 1510 can be altered to increase sensitivity
of the sensing mechanism 1513.
[0645] FIG. 183 depicts the touch-sensitive display 1510 of FIG.
182 when an input device 1530 contacts the sterile barrier 190 of
the touch-sensitive display assembly 500. As mentioned above, in
various instances, the electrodes are arranged in an orthogonal
grid, although any suitable arrangement can be used. In such
instances, the electrodes comprise x-electrodes 1542 and
y-electrodes 1544. The touch-sensitive display 1510 comprises a
plurality of pixels 1515 arranged in a uniform, or nearly uniform,
fashion throughout the sensing mechanism 1513, although any
suitable arrangement can be used. FIG. 183 further depicts various
groupings of activated pixel clusters 1517 and 1519. During its
unactivated state, a low-level capacitance is present across all of
the pixels 1515 (FIG. 182) in the touch-sensitive display 1510.
When the input member 1530 (FIG. 182) contacts the sterile barrier
190 and activates the touch-sensitive display 1510, the pixels 1515
associated with pixel clusters 1517 and 1519 are activated with a
new, higher capacitance. The pixels 1515 in the pixel clusters 1517
and 1519 become activated as the input device 1530 continues to
make contact with the sterile barrier 190. The sensing mechanism
1513 detects the location of the active pixel clusters 1517, 1519
by scanning the matrix of x-electrodes 1542 and y-electrodes
1544.
[0646] FIG. 184 depicts a graphical representation 1550 of the
relationship between the location of active pixel clusters within
the x-electrodes 1542 of the touch-sensitive display 1510 and the
detected capacitance by the sensing mechanism 1513. A first
capacitance C.sub.1 is indicative of the low-level, or unactivated,
capacitance present across the pixels 1515 of the touch-sensitive
display 1510 prior to application of the sterile barrier 190. By
way of reference, capacitance C.sub.0 represents a detected
capacitance of zero, and capacitance C.sub.1 represents a
capacitance of more than zero. A second capacitance C.sub.2 is
indicative of a threshold capacitance. When the threshold
capacitance C.sub.2 is exceeded, the surgical instrument 100
recognizes that the sterile barrier 190 is attached to the
touch-sensitive display 1510. In the graphical representation 1550,
the sterile barrier 190 is attached to the touch-sensitive display
1510, as the detected capacitance is above the threshold
capacitance C.sub.2. A third capacitance C.sub.3 represents another
threshold capacitance. When the sensing mechanism 1513 detects a
capacitance that is greater than the threshold capacitance C.sub.3,
the surgical instrument 100 recognizes that the input device 1530
is in contact with the sterile barrier 190. In the graphical
representation 1550, the input device 1530 is in contact with the
sterile barrier 190 in two locations, as the detected capacitance
exceeds the threshold capacitance C.sub.3 twice. When the input
device 1530 is removed from the sterile barrier 190, the
capacitance detected by the pixels 1515 in clusters 1517 and 1519
returns to the capacitance to below C.sub.3, but above or equal to
C.sub.2. When the sterile barrier 190 is removed from the
touch-sensitive display 1510, the capacitance detected by the
pixels 1515 in clusters 1517 and 1517 returns to the capacitance to
below C.sub.2, but above or equal to C.sub.1.
[0647] Returning to FIG. 182, the touch-sensitive display 1510 is
alternatively a resistance-sensitive display. In at least one such
embodiment, the sterile barrier 190 is comprised of a flexible
material to allow the sterile barrier 190 to deflect in response to
a force F applied by the input device 1530. In such an embodiment,
the sensing mechanism 1513 of the touch-sensitive display 1510 is
configured to detect the location and pressure created from the
force F applied by the input device 1530. Various user commands are
associated with specific locations on the touch-sensitive display
1510, and the location of the detected pressure will correspond
with one of the various user commands.
[0648] Referring to FIG. 24, a surgical instrument 2400 comprises a
display 2430. The stapling instrument 2400 is similar to the
stapling instruments 2000 and 2200 in many respects and the display
2430 is similar to the displays 2130 and 2230 in many respects,
most of which will not be discussed herein for the sake of brevity.
The display 2430 comprises a touchscreen including an image display
2435. The image display 2435 provides an image of the patient
tissue T that is to be stapled. The user of the stapling instrument
2400 can use a stylus 2220, for example, to draw one or more
potential staple lines over the tissue T. For instance, the user
can draw a first staple line 2444 and a second staple line 2444'.
The controller of the stapling instrument 2400 can then require the
user to choose between the two different staple lines 2444 and
2444' that is to be followed. Similarly, the user of the stapling
instrument 2400 can use the stylus to modify a staple line 2444
into an alternate staple line 2444'.
[0649] Referring again to FIG. 24, the image of the tissue T can be
a substantially two-dimensional image of the top of the tissue T.
In such instances, the controller is configured to map a
two-dimensional staple firing path over the tissue T. Referring to
FIG. 25, the image of the tissue T can be a three-dimensional image
looking over the surface of the tissue T. In such instances, the
controller is configured to map a three-dimensional staple firing
path over the tissue T. In either event, the stylus 2220 and/or the
patient's finger can be used to establish and/or modify the staple
firing path. Referring now to FIGS. 26 and 27, the stapling
instrument 2400 further comprises a joystick 2450 configured to
modify the staple firing path 2444 of the stapling instrument 2400.
The joystick 2450 is mounted to the handle of the stapling
instrument 2400 and is rotatable about an axis. When the joystick
2450 is rotated to the right, or in a clockwise direction, the
staple firing path 2444 is curved to the right. Correspondingly,
the staple firing path 2444 is curved to the left when the joystick
2450 is rotated to the left, or in a counter-clockwise direction.
Other arrangements of a joystick are possible.
[0650] Referring again to FIGS. 26 and 27, the joystick 2450 can be
used to modify the staple firing path of the stapling instrument
2400 while the stapling instrument 2400 is paused, or not firing
staples. The joystick 2450 can also be used by the clinician to
steer the stapling instrument 2400 in real-time while the stapling
instrument 2400 is firing staples. In various instances, at least a
portion of the stapling instrument 2400 is visible on the display
2430 to assist the user in steering the stapling instrument 2400.
For instance, a shaft 2410 of the stapling instrument 2400 is
visible in the image display 2435. In various instances, a
graphically-created depiction of the stapling instrument 2400 can
be provided in one or more windows of the display 2430. For
instance, the shaft 2410 and/or distal head 2420 of the stapling
instrument 2400 can be depicted in the windows 2133 and 2134, for
example.
[0651] As described above, referring now to FIG. 23, the stapling
instrument 2100 comprises a handle 2110 including a grip 2120 and a
display 2130 mounted on the handle 2110. The display 2130 can
comprise any suitable configuration, but the size of the display
2130 may be limited owing to the space constraints of the handle
2110. In various instances, the stapling instrument 2100 can be
part of a surgical system 2300 which includes an off-board display
2330 in addition to or in lieu of the on-board display 2130. The
controller of the stapling instrument 2100 is in signal
communication with the displays 2130 and 2330. The controller is in
wireless communication with the off-board display 2330, but could
be in wired communication with the display 2330. In either event,
the controller is configured to provide the same information to the
displays 2130 and 2330. That said, the displays 2130 and 2330 can
be configured to arrange this information in different ways owing
to their different sizes and/or shapes. In other instances, one of
the displays 2130 and 2330 can display more information than the
other. In at least one such instance, the off-board display 2330
can display more information than the on-board display 2130 owing
to its larger size, for example.
[0652] Further to the above, the on-board display 2130 comprises a
touchscreen, but could be operated by controls positioned on the
handle 2110. Similarly, the off-board display 2330 also comprises a
touchscreen, but could be operated by other controls. Similar to
the above, the touchscreens of the displays 2130 and 2330 can be
used to manipulate the staple firing path of the stapling
instrument 2100. In various instances, a clinician can use their
finger to touch the touchscreens and drag the staple firing path of
the stapling instrument 2100 into a new position, for example. In
other instances, a tool, such as a stylus, for example, can be used
to touch the touchscreens and manipulate the staple firing path.
Moreover, both displays 2130 and 2330 are configured to control any
other operation of the stapling instrument 2100.
[0653] When a first overlay, or layer, is modified on one of the
displays 2130 and 2330, the controller of the stapling instrument
2100 modifies the first overlay on the other display. Similarly,
when a second overlay, or layer, is modified on one of the displays
2130 and 2330, the controller of the stapling instrument 2100
modifies the second overlay on the other display. Moreover, the
user of the stapling instrument 2100 can modify one overlay, or
layer, on a display without modifying the other overlays, or
layers, on the display or either display.
[0654] While the staple firing paths, and/or other images,
projected in the on-board and off-board displays described above
are very helpful to produce a desired staple firing path, a
stapling instrument can include one or more projectors configured
to display an image onto the patient tissue which can assist the
user of the stapling instrument with producing a desired staple
firing path. Referring to FIGS. 160 and 161, a stapling instrument
7400 comprises a shaft 7410, a distal head 7420, and a projector
7490 mounted to the distal head 7420. In at least one instance, the
projector 7490 is clamped to the distal head 7420. The projector
7490 is configured to project an image I onto the stomach S of the
patient P. The projector 7490 is sized and configured to be
inserted into the patient through a trocar TC, but could be
inserted into a patient through an open incision. The projector
7490 is positioned proximally with respect to an anvil 7460 of the
distal head 7420, but distally with respect to an articulation
joint rotatably connecting the distal head 7420 to the shaft 7410.
As a result, the projector 7490, and the image it projects, moves
with the distal head 7420.
[0655] Referring to FIG. 162, a stapling instrument 7500 comprises
a shaft 7510, a distal head 7520, and an articulation joint 7570
rotatably connecting the distal head 7520 to the shaft 7510. The
stapling instrument 7500 further comprises a projector 7590
extending alongside the shaft 7510. The projector 7590 comprises a
flexible tube mounted to the shaft 7510 and the distal head 7520
and is configured to bend when the distal head 7520 is articulated.
As a result, the image I projected by the projector 7590 tracks the
orientation of the distal head 7520 and can be projected distally
with respect to an anvil 7560 of the stapling instrument 7500. The
projector 7590 comprises one lens and is configured to project one
image I; however, various alternative embodiments are envisioned in
which a projector comprises more than one lens and/or can project
more than one image onto the patient tissue.
[0656] Referring again to FIG. 160, the projector 7490 comprises a
first lens 7492 and a second lens 7494. The first lens 7492 and the
second lens 7494 are in signal communication with the controller of
the stapling instrument 7400 and are configured to project at least
one image onto the patient tissue. In certain instances, the first
lens 7492 and the second lens 7494 project the same image. The
first lens 7492 and the second lens 7494 are fixedly mounted in the
projector 7490 such that they project the image at a common focal
point, although they could project an image, or images, at
different focal points. In various embodiments, the orientation of
the first lens 7492 and/or the orientation of the second lens 7494
can be adjusted to alter the focal point. In at least one such
embodiment, the projector 7490 comprises a first motorized actuator
system for changing the orientation of the first lens 7492 and a
second motorized actuator system for changing the orientation of
the second lens 7494.
[0657] In certain instances, further to the above, the first lens
7492 of the projector 7490 can be configured to project a first
image onto the patient tissue and the second lens 7494 can be
configured to project a second, or different, image onto the
patient tissue. The controller of the stapling instrument 7400 is
configured to supply, change, and/or alter the image projected by
the first lens 7492 and/or the second lens 7494. In various
instances, the images projected by the first lens 7492 and the
second lens 7494 can provide a two-dimensional image on the patient
tissue. In other instances, the images projected by the first lens
7492 and the second lens 7494 can provide a three-dimensional image
on the patient tissue. Projecting a three-dimensional image can be
facilitated by the lenses 7492 and 7494 being oriented, or
orientable, in different directions.
[0658] Referring to FIG. 165, a stapling instrument 7700 comprises
a distal head 7720 positioned on a first side of the patient tissue
T and an anvil 7760 positioned on a second side of the patient
tissue T. Similar to the other stapling instruments disclosed
herein, the stapling instrument 7700 is configured to deploy
staples 7730 into the tissue T and incise the tissue T along an
incision 7740 during a series of staple firing strokes. The
stapling instrument 7700 further comprises a projector 7770
configured to project an image I onto the tissue T. The image I in
FIG. 165 represents the location of the next firing stroke
including two lateral areas in which staple clusters will be
applied. Referring to FIG. 166, an image projected by the projector
7770 comprises a line designating the staple firing path FP and/or
a line designating an alternate staple firing path FP'. These lines
can be solid lines and/or dashed lines, for example. The lines can
be the same color or different colors.
[0659] Further to the above, the controller of the stapling
instrument 7700 is configured to modify the image projected by the
projector 7770 as the stapling instrument 7700 moves, or marches,
along a staple firing path. The controller can continuously
evaluate and determine where the next firing stroke should occur
and also continuously adapt the image projected by the stapling
instrument 7700. In various instances, the controller can update
the projected image after each firing stroke, for example. In some
instances, the controller can continuously project an image, or a
series of images, using the projector 7770 while, in other
instances, the controller can intermittently project an image, or a
series of images, using the projector 7770. In at least one
instance, the controller can use the projector 7770 to display an
image before the stapling instrument 7700 clamps the tissue. In
such instances, the user of the stapling instrument 7700 is
afforded an opportunity to pause or stop the stapling instrument
7700 before it makes another staple firing stroke.
[0660] Referring to FIG. 167, a stapling instrument 7800 comprises
a distal head 7820 positioned on a first side of the patient tissue
T and an anvil 7860 positioned on a second side of the patient
tissue T. Similar to the other stapling instruments disclosed
herein, the stapling instrument 7800 is configured to deploy
staples 7830 into the tissue T and incise the tissue T along an
incision 7840 during a series of staple firing strokes. The
stapling instrument 7800 further comprises a projector 7870
including a first lens 7872 and a second lens 7874. The first lens
7872 is configured to project a first image I.sub.1 onto the
patient tissue T and the second lens 7874 is configured to project
a second image I.sub.2 on the patient tissue T. The image I.sub.1
depicts the locations of the next staple clusters and the image
I.sub.2 depicts the cutting path of the stapling instrument 7800,
although any suitable images could be projected. The images I.sub.1
and I.sub.2 can be solid lines and/or dashed lines, for example.
The image I.sub.1 can be the same color as the image I.sub.2 or a
different color.
[0661] As discussed above, the stapling instruments disclosed
herein can comprise at least one projector for projecting images
onto the patient tissue and at least one camera for observing the
patient tissue. Referring to FIGS. 163 and 164, a stapling
instrument 7600 comprises a shaft, a distal head, and a video
system. The video system comprises at least one image projector
7690 and a camera system 7670 comprising at least one camera, such
as a first camera 7672 and a second camera 7674, for example, which
are in communication with the controller. The first camera 7672 is
pointed in a first direction and is focused on a first area F1 of
the patient tissue and the second camera 7674 is pointed in a
second direction and is focused on a second, or different, area F2
of the patient tissue. In various instances, the controller is
configured to present both images on the surgical instrument
display at the same time, or at different times such that the user
can toggle between the images. In certain instances, the controller
is configured to use the images from the first and second cameras
7672 and 7674 to generate a composite image and present the
composite image on the surgical instrument display.
[0662] Further to the above, the first camera 7672 comprises a
digital camera configured to supply a first digital video stream to
the controller while the second camera 7674 comprises a digital
camera configured to supply a second digital video stream. The
camera system 7670 further comprises a first actuator system
configured to move the first camera 7672 and/or a second actuator
system configured to move the second camera 7674. In other
embodiments, one or both of the orientations of the cameras 7672
and 7674 are fixed. In any event, the image I projected onto the
patient tissue by the projector 7690 can be captured by the first
camera 7672 and/or the second camera 7674 and is viewable by the
user of the surgical instrument 7600 through the surgical
instrument display.
[0663] Further to the above, the projector 7690, and/or any of the
projectors disclosed herein, are configured to emit light at any
suitable wavelength. In various instances, the projector 7690 emits
visible light, infrared light, and/or ultraviolet light, for
example. Among other things, visible light is useful for the
clinician to see the color of the tissue when the visible light
reflects off the tissue. Red or pink tissue indicates healthy,
vascularized tissue while dark or black tissue may indicate
unhealthy tissue. Also further to the above, the camera system 7670
is configured to capture visible light, infrared light, and/or
ultraviolet light, for example. Infrared light indicates the
presence of heat, such as from large blood vessels, for example.
Ultraviolet light indicates the presence of blood, or bleeding, for
example. In addition to or in lieu of the above, a projector can be
configured to emit sound waves, subsonic waves, and/or ultrasonic
waves and the surgical instrument can comprise one or more acoustic
sensors configured to detect the waves which reflect off of the
patient tissue and generate data which can be used by the
controller to generate a three-dimensional profile of the patient
tissue.
[0664] Referring to FIG. 142, the stapling instruments described
herein are configured to repeatedly fire staples into the tissue of
a patient, such as the patient's stomach S, for example. Many of
the stapling instruments disclosed herein are self-driving,
self-propelled, and/or self-steering in that they are sufficiently
motorized such that they can follow and propel themselves along an
intended, or modified, staple firing path FP while firing staples,
such as staples 6630, for example, into the patient tissue. The
staples are continuously ejected from the stapling instruments as
the stapling instruments move along the staple firing path FP. In
various instances, the staple firing system of a stapling
instrument enters into a dwell between staple firing strokes while
the stapling instrument is moved along the staple firing path. Such
dwells, however, are part of the continuous operation of the
stapling instrument. As discussed above, referring to FIG. 143,
many of the stapling instruments described herein are configured to
deploy a cluster of staples, such as staple clusters 6630', for
example, during each staple firing stroke. Such staple clusters can
include any suitable number of staples, but each of the staple
clusters 6630' depicted in FIG. 143 comprise three staples 6630 and
are deployed on both sides of a tissue incision 6640. In at least
one exemplary embodiment, seven staple clusters 6630' are deployed
on each side of the tissue incision 6640 for each inch of the
staple firing path. In such embodiments, 42 staples are deployed
per inch, although any suitable number can be used. The stapling
instrument can continue to deploy staples along the staple firing
path without having to remove the stapling instrument from the
patient so long as there are staples in the stapling instrument. In
at least one instance, a stapling instrument can be used between 84
and 98 firings, for example, before having to be reloaded. Such
firings can deploy between 504 and 588 staples, for example.
[0665] Further to the above, many of the stapling instruments
disclosed herein can at least partially turn between staple
firings. As a result, such stapling instruments can follow complex
and/or non-linear staple firing paths. Referring to FIG. 174,
previous stapling instruments were configured to deploy linear
staple line portions 8230' comprised of staples 8230, for example.
In order to turn the staple line within the tissue, an overlap
region 8235' in staple line portions 8230' was created. Such an
arrangement created a high density of staples 8230 in the overlap
region 8235', thereby highly compressing the tissue in the overlap
region 8235'. Moreover, the overlap region 8235' represents a sharp
turn in the staple firing path, which could create potential leak
paths in the staple line. Referring to FIG. 175, the stapling
instruments disclosed herein can make much more gradual turns
because they can turn after each firing stroke. For instance, a
stapling instrument can turn after deploying each staple cluster
7930' and can do so without creating overlap between the staple
clusters 7930'.
[0666] The stapling instruments disclosed herein can be used to
perform any suitable surgical procedure. For instance, referring to
FIG. 179, a stapling instrument disclosed herein can be used during
a gastric bypass procedure to produce a stomach pocket SP and,
thus, effectively reduce the size of the patient's stomach S. Owing
to the systems of the stapling instruments disclosed herein, these
stapling instruments can create a curved staple path 7930' which
creates a curved stomach pocket SP. Previous stapling instruments,
referring to FIG. 178, would generate a staple path including
linear portions 8230' which formed a square stomach pocket SP, or a
stomach pocket SP with a right angle corner. It is believed that
the curved stomach pocket SP produced by the stapling instruments
disclosed herein will leak less than the linear stomach pockets SP
produced by previous stapling instruments.
[0667] As described in greater detail herein, referring to FIG.
177, the stapling instruments disclosed herein can be used during a
stomach reduction procedure to produce a stomach sleeve SS and,
thus, effectively reduce the size of the patient's stomach S. Owing
to the systems of the stapling instruments disclosed herein, these
stapling instruments can create a curved staple path 7930' which
creates a curved stomach sleeve SS. Previous stapling instruments,
referring to FIG. 176, would generate a staple path including
linear portions 8230' which formed a linear stomach sleeve SS, or a
stomach sleeve SS with a right angle corner 8235'. It is believed
that the curved stomach sleeve SS produced by the stapling
instruments disclosed herein will leak less than the linear stomach
sleeves SS produced by previous stapling instruments. Additional
details for creating a stomach sleeve SS are illustrated in FIG.
151 wherein a staple firing path FP is used to cut the stomach
sleeve SS from the patient's stomach S.
[0668] Further to the above, gastric bypass procedures and gastric
sleeve procedures aid in weight loss and are used to treat severe
obesity. Both procedures serve to drastically decrease the size of
the stomach in order to limit food intake. Gastric bypass
procedures involve creating a small section within the stomach for
receiving food and blocking off the rest of the stomach. Among
other things, restricting the size of the stomach serves to limit
the amount of fat and calories absorbed into a patient's body.
Gastric bypass procedures create a direct path from the small
stomach section to the lower intestine. In such instances, as a
result, this direct path eliminates the use of the upper intestine
in digestion.
[0669] A gastric sleeve procedure involves creating a sleeve-like
path from the esophagus, through the stomach, and to the upper
intestine. Laparoscopic sleeve gastrectomy (LSG) is a type of
gastric sleeve procedure which involves the transection and sealing
off of a substantial portion of the stomach in order to create a
small gastric reservoir, or pocket. Unlike a gastric bypass
procedure, it has been found that a LSG procedure does not cause a
decrease in the absorption of nutrients and/or eliminate the use of
any portion of the intestines. A LSG procedure, however, still
functions to significantly reduce the size of the stomach in a
patient. In such LSG procedures, a long, thin, and flexible member,
i.e., a bougie, can be used as a measuring tool. More specifically,
a bougie can be used to determine or define the size and shape of
the stomach that becomes the gastric sleeve upon completion of the
LSG procedure. A bougie B is depicted in FIGS. 30 and 32. Bougies
are manufactured in a variety of sizes in order to accommodate
different stomach sizes. The appropriate size of a bougie is often
determined based on stomach size and the anticipated gastric sleeve
size. During the beginning steps of a LSG procedure, a surgeon
inserts the bougie through a patient's mouth, down the esophagus,
and through the esophageal sphincter to ultimately reach the
patient's stomach. Once the bougie reaches the patient's stomach,
the bougie is placed so that the end of the bougie reaches the
pyloric canal, which is the lower area of the stomach connected to
the pylorus.
[0670] FIG. 28 illustrates various parts of the stomach anatomy
involved during various steps of a LSG procedure. In particular,
FIG. 28 illustrates the stomach before a bougie B is inserted into
the stomach S during a LSG procedure. As seen in FIG. 28, the
omentum O, which is a double layer of fatty tissue, is connected to
the outer layer of the stomach S. The omentum O comprises two
portions--the greater omentum and the lesser omentum. The greater
omentum serves to store fat deposits and the lesser omentum
connects the stomach S and the intestines to the liver. The stomach
S comprises various areas of shadowing based on the tissue
thickness of the stomach S. The tissue thickness of the stomach S
creates a first shadow S.sub.1a and a second shadow S.sub.1b. The
size and location of the shadows S.sub.1a and S.sub.1b vary based
on the thickness of the stomach S. As further illustrated in FIG.
28, the first shadow S.sub.1a appears along the greater curvature
GC of the stomach S and the second shadow S.sub.1b appears along
the lesser curvature LC of the stomach S. As discussed in greater
detail below, the shadows S.sub.1a and S.sub.1b are used to
determine, or estimate, the thickness of the stomach S along the
greater curvature GC and the lesser curvature LC, respectively.
Once the thickness of the stomach S is determined, or estimate, it
is used to determine the appropriate size and placement of the
bougie B in relation to the calculated shading lines S.sub.L as
seen in FIG. 28.
[0671] FIG. 33 illustrates another view of the stomach anatomy in
accordance with various embodiments. Similar to the stomach anatomy
depicted in FIG. 28, the tissue thickness of the stomach S creates
a first shadow S.sub.1 and a second shadow S.sub.2. Similar to the
discussion above, the first shadow S.sub.1 occurs along the greater
curvature GC and the second shadow S.sub.2 occurs along the lesser
curvature LC. The first shadow S.sub.1 and the second shadow
S.sub.2 intersect at a point S.sub.3. During a stomach sleeve
procedure, the location of the pylorus P.sub.x and the point
S.sub.3 are used to determine the location of the cut line C.sup.1
which is offset from the pylorus P.sub.x at a distance A. As
illustrated in FIG. 33 and described in greater detail below, the
sleeve diameter D is determined based on the estimated tissue
thickness.
[0672] FIG. 152 illustrates various parts of the stomach which are
involved during various steps of a LSG procedure. In particular,
FIG. 152 illustrates the early steps of a LSG procedure wherein a
bougie B is inserted into the stomach S. At the beginning of the
LSG procedure, a surgeon inserts the bougie B through a patient's
mouth, down the esophagus E, and through the esophageal sphincter
to ultimately reach the patient's stomach. Once the bougie B
reaches the patient's stomach, the bougie B is positioned so that
the end of the bougie B rests in the pyloric canal PC and stops at
the pyloric sphincter PS. As also illustrated in FIG. 152, the
bougie B is configured to sit along the shape and length of the
stomach S along the angular notch AN of the lesser curvature LC. As
will be described in greater detail below with respect to FIG. 153,
a bougie 7210 can be used which comprises magnetic properties which
are configured to interact with and guide a stapling instrument
7100 along a predetermined path alongside the bougie 7210.
[0673] Referring again to FIG. 152, a distance D.sup.1 is measured
along the pyloric antrum PA of the greater curvature GC once the
bougie is placed in its final position. The distance D.sup.1 is
used to determine the location of the pylorus P.sub.x and is used
to determine the location of the cut line C.sup.1. The bougie 7210
illustrated in FIG. 153 creates one or more magnetic fields which
are used to guide the stapling instrument 7100 to the bougie 7210.
Thereafter, referring to FIG. 154, the stapling instrument 7100
follows the magnetic fields along a path adjacent to the bougie
7210 in order to create the cut line C.sup.1. As a result, the cut
line C' extends upward through the patient's stomach S along the
shape and curvature of both the stomach S and the bougie 7210. The
cut line C' then continues upward through the patient's stomach S
along the path adjacent to the bougie 7210 until reaching the Angle
of His AH. As the cut line C.sup.1 is established, the stapling
instrument 7100 applies staples, such as staples 7130, for example,
to the tissue along both sides of the cut line C.sup.1. The
remaining portion of the stomach S still in communication with the
esophagus is substantially the size and shape of the bougie 7210. A
substantial portion of the stomach S, which begins at the pyloric
antrum PA and ends at the Angle of His AH, is eliminated from
involvement in the digestive process. The eliminated portion of the
stomach S is shown in greater detail in FIG. 154 and includes the
greater curvature GC of the stomach S.
[0674] In some instances, a clinician can estimate an appropriate
staple firing path in the patient's stomach by observing certain
anatomical markers on the stomach and/or at other locations within
the surgical site. Referring to FIG. 152, the stapling instruments
disclosed herein, such as the stapling instrument 7100, for
example, are configured to sense anatomical markers within the
patient to determine the appropriate staple firing path. Further to
the above, the stapling instruments disclosed herein can comprise
one or more cameras configured to sense, or detect, one or more
anatomical markers and, also, a controller configured to calculate
a staple firing path based on the detected anatomical markers. In
at least one instance, the stapling instrument is configured to
detect the lesser curve of the stomach and calculate a staple
firing path in the stomach tissue which parallels, or at least
substantially parallels, the lesser curve. Other anatomical markers
of the patient's stomach that can be detected and used to determine
the staple firing path include the angular notch, the esophageal
sphincter, the angle of His, the pyloric sphincter, and/or the
pyloric antrum, for example.
[0675] As discussed above, the lesser curve of the stomach can be
used to determine the staple firing path. In various instances,
however, the lesser curve is at least partially obscured by fat
and/or connective tissue. That said, the lesser curve, the lesser
omentum, and any overlap between the lesser curve and the lesser
omentum, for example, can be visibly differentiated. More
specifically, the uncovered stomach tissue has a first color, the
lesser omentum has a second color which is different than the first
color, and the overlap between the two has a third color which is
different than the first color and the second color. These colors
are detectable by the stapling instruments to determine an
appropriate staple firing path. In certain instances, the color of
the stomach tissue under the lesser omentum creates a shadow which
is detectable by the stapling instrument. Other methods can be used
to determine the appropriate location for the staple firing
path.
[0676] Further to the above, a stomach sleeve SS created during a
gastric bypass procedure must have a sufficiently large enough
digestion passage defined therein in order for food to pass there
through. As a result, referring now to FIG. 29, the staple firing
path through the patient's stomach S must be sufficiently spaced
from the lesser curve of the stomach to create a sufficient
digestion passage D. The stapling instruments disclosed herein can
be configured to detect the lesser curve of the stomach and
calculate a staple firing path, such as staple firing path
SP.sub.1, for example, which is a distance X away from the edge of
the stomach S. In other instances, the stapling instruments
disclosed herein can be configured to detect the lesser omentum LO
which borders the lesser curve of the stomach and calculate the
staple firing path SP.sub.1, for example, as a preset or
predetermined distance X away from the edge of the stomach S.
[0677] As mentioned above, detecting the edge of the stomach S may
be difficult. In certain instances, the stapling instruments
disclosed herein can comprise a camera system configured to observe
the color of the stomach tissue and/or changes in the stomach
tissue color in order to determine the edge of the stomach S. In
various instances, the stapling instruments disclosed herein can be
configured to detect the edge of the stomach by evaluating the
thickness of the stomach tissue and/or changes in the stomach
tissue thickness. The tissue of a patient's stomach is typically
thinner around the perimeter, or edge, of the stomach than in the
middle of the stomach and it has been observed that the color of
stomach tissue is often a function of its thickness. Stated another
way, the tissue around the perimeter of the stomach seems to have a
shadow, or darker, color owing to its thinner thickness. This
shadow region S, is demarcated by distance Z.sub.1 in FIG. 29.
Distance Z.sub.1 also demarcates the transition from the thinner
tissue to the full tissue thickness region T.sub.1 of the stomach
S. In various instances, the surgical instruments disclosed herein
can be configured to determine the staple firing path SP.sub.1 by
establishing the staple firing path SP.sub.1 a certain distance
away from the shadow region S.sub.1, for example. In at least one
instance, the surgical instruments can establish the staple firing
path SP.sub.1 a certain distance away from the midpoint between the
lesser omentum LO and the edge of the shadow region S.sub.1, for
example.
[0678] Further to the above, the controller of the stapling
instruments disclosed herein can comprise an edge detection
algorithm. The edge detection algorithm is configured to sense a
first light intensity at a first location and a second light
intensity at a second location on the stomach tissue. The edge
detection algorithm is further configured to calculate a first
light intensity value for the first light intensity and a second
light intensity value for the second light intensity and then
compare the first light intensity value to the second light
intensity value. The light intensity values can be on a scale
between 1 and 100 where lower values represent darker tissue and
higher values represent lighter tissue, for example. The first
location and the second location establish a sample line along
which additional samples can be taken to establish an intensity
gradient. To this end, the edge detection algorithm is further
configured to sense a third light intensity at a third location
along the sample line, determine a third light intensity value at
the third location, and compare the third light intensity value to
the first light intensity value and the second light intensity
value. The first location, the second location, and the third
location are sequentially located along the sample line and, if the
algorithm determines that the first light intensity value is larger
than the second light intensity value and that the second light
intensity value is larger than the third light intensity value,
then the algorithm can determine that a shadow gradient exists
between the first location and the third location and that the
third location is closer to the edge of the stomach tissue than the
first location, for example. This methodology can be applied on a
very large scale to map the shadow gradient and/or color gradient
of the entire stomach tissue, or at least a portion of the stomach
tissue.
[0679] As discussed above, the thickness of the stomach tissue can
affect the color or shadow of the stomach tissue. Thus, stomachs
having thicker tissue (FIG. 29) will typically have different
colors and/or shadows than stomachs having thinner tissue (FIG.
31). The thinner tissue in FIG. 31 has a shadow region S.sub.2
demarcated by distance Z.sub.2. Distance Z.sub.2 also demarcates
the transition from the thinner tissue to the full tissue thickness
region T.sub.2 of the stomach S.sub.2. In various instances, the
surgical instruments disclosed herein can be configured to
determine the staple firing path SP.sub.2 by establishing the
staple firing path SP.sub.2 a certain distance away from the shadow
region S.sub.2, for example. In at least one instance, the surgical
instruments can establish the staple firing path SP.sub.2 a certain
distance away from the midpoint between the lesser omentum LO.sub.2
and the edge of the shadow region S.sub.2, for example.
[0680] The staple firing path SP.sub.1 establishes a first sleeve
profile and the staple firing path SP.sub.2 establishes a second
sleeve profile which is different than the first sleeve profile.
The first sleeve profile comprises a first width X and the second
sleeve profile comprises a second width Y, which is different than
the width X. Regardless of the sleeve profile that is generated by
a stapling instrument disclosed herein, the tissue drive system of
the stapling instrument is configured to propel the stapling
instrument along the staple firing path which creates the desired
stomach sleeve. Such a stapling instrument can be configured to
identify anatomical markers and steer itself toward, away from,
and/or parallel to one or more anatomical markers.
[0681] Further to the above, referring to FIG. 153, the stapling
instrument 7100 comprises a shaft 7110, a distal head 7120, and an
articulation joint 7170 rotatably connecting the distal head 7120
to the shaft 7110. The stapling instrument 7100 is incise the
patient's stomach along a path C1 and apply three rows of staples
7130 on each side of the path C1. As described above, the bougie
7210 is configured to guide the stapling instrument 7100 along a
staple firing path. More specifically, the bougie 7210 is
configured to emit one or more magnetic fields which can be
detected by the stapling instrument 7100 and then used by the
stapling instrument 7100 to determine the staple firing path. In at
least one instance, the bougie 7210 emits strong magnetic fields
SMF and weak magnetic fields WMF which, when emitted, are emitted
along the length of the bougie 7210. Notably, the weak magnetic
fields WMF are positioned intermediate the strong magnetic fields
SMF in an alternating manner.
[0682] Referring to FIG. 154, the stapling instrument 7100
comprises one or more sensors, such as Hall Effect sensors, for
example, which are configured to detect the strong magnetic fields
SMF and the weak magnetic fields WMF. The sensors are in
communication with the controller of the stapling instrument 7100
which can use data from the sensors to detect the arrangement of
the strong magnetic fields SMF and weak magnetic fields WMF and
align the staple firing path with the fields SMF and WMF such that
the stapling instrument 7100 follows the bougie 7210 to create the
desired stomach sleeve profile. In at least one instance, the
intensity of the strong magnetic fields SMF is twice as intense as
the weak magnetic fields WMF, for example. In other instances, the
intensity of the strong magnetic fields SMF is 50% more intense
than the intensity of the weak magnetic fields WMF, for
example.
[0683] Referring to FIGS. 155 and 157, the bougie 7210 comprises an
inner flexible core 7212 and a plurality of conductor windings
configured to emit the magnetic fields SMF and WMF discussed above.
The flexible core 7212 is comprised of a non-conductive material,
or an at least substantially non-conductive material, such as
rubber, for example. The flexible core 7212 is solid, but could
comprise a tube. The conductor windings include winding circuits
7214 which emit the weak magnetic fields WMF and winding circuits
7216 which emit the strong magnetic fields SMF. The winding
circuits 7214 have less windings than the winding circuits 7216 and
produce weaker magnetic fields than the winding circuits 7216 for a
given current. Each winding circuit 7214 comprises a conductive
wire that is wrapped around the inner flexible core 7212 and is in
communication with a controller of the bougie 7210. Each winding
circuit 7214 is separate and distinct from the other winding
circuits 7214 and, moreover, separate and distinct from the winding
circuits 7216. Similarly, each winding circuit 7216 is separate and
distinct from the other winding circuits 7216 and, moreover,
separate and distinct from the winding circuits 7214. Each
conductive wire comprises an inner conductive core and an
insulative jacket extending around the conductive core. In an
alternative embodiment, the conductive wires comprise conductive
cores embedded in the flexible core 7212. In either event, the
bougie 7210 comprises an outer jacket 7218 which is configured to
seal the contents therein to prevent, or inhibit, the ingress of
fluids into the bougie 7210.
[0684] In use, further to the above, a voltage source is applied to
the winding circuits 7214 and 7216. The voltage applied to each
winding circuit 7214 and 7216 is the same, or at least
substantially the same. Alternatively, a first voltage is applied
to the winding circuits 7214 and a second, or different, voltage is
applied to the winding circuits 7216. In various alternative
embodiments, the winding circuits 7214 are not separate circuits;
rather, they are part of one long circuit and a single current
flows through each of the winding circuits 7214. Similarly, in
various alternative embodiments, the winding circuits 7216 are not
separate circuits; rather, they are part of one long circuit and a
single current flows through each of the winding circuits 7216. In
any event, the winding circuits 7214 and 7216 emit magnetic fields
which extend around the entire perimeter of the bougie 7210 and, as
a result, the bougie 7210 can be oriented, or rotated, in any
suitable manner to perform the surgical procedure described
above.
[0685] As described above, the bougie 7210 utilizes electricity to
create magnetic fields. In various alternative embodiments, a
bougie can comprise permanent magnets which create magnetic fields.
In at least one instance, the bougie comprises strong permanent
magnets which create a strong magnetic field and weak permanent
magnets which create a weak magnetic field. In at least one such
instance, the strong permanent magnets and the weak permanent
magnets are arranged in an alternating manner to create the
alternating strong magnetic fields SMF and weak magnetic fields WMF
depicted in FIG. 154, for example. That said, a bougie can create
one or more magnetic fields in any suitable manner.
[0686] Referring to FIG. 156, a bougie 7310 comprises an inner
flexible core 7312 and a plurality of conductor windings configured
to emit the magnetic fields SMF and WMF discussed above. The
flexible core 7312 is comprised of a non-conductive material, or an
at least substantially non-conductive material, such as rubber, for
example. The conductor windings include winding circuits 7314 which
are configured to emit the weak magnetic fields WMF and winding
circuits 7316 which are configured to emit the strong magnetic
fields SMF. The winding circuits 7314 have less windings than the
winding circuits 7316 and will produce weaker magnetic fields than
the winding circuits 7316, for a given current. Each winding
circuit 7314 comprises a conductive wire that is wrapped around the
inner flexible core 7312 and is in communication with a controller
of the bougie 7310. The windings of the circuits 7314 are more
compact, or dense, than the windings of the circuits 7214. For
instance, the windings of the circuits 7214 extend longitudinally
as they wrap around the core 7212 while the windings of the
circuits 7314 do not extend longitudinally, or at least not
substantially so. Similarly, the windings of the circuits 7316 are
more compact, or dense, than the windings of the circuits 7216.
Dense or compact windings can create dense or compact magnetic
fields which may be more discernable to the stapling instrument
7100, for example.
[0687] The surgical instrument systems described herein are
motivated by an electric motor; however, the surgical instrument
systems described herein can be motivated in any suitable manner.
In certain instances, the motors disclosed herein may comprise a
portion or portions of a robotically controlled system. U.S. patent
application Ser. No. 13/118,241, entitled SURGICAL STAPLING
INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S.
Pat. No. 9,072,535, for example, discloses several examples of a
robotic surgical instrument system in greater detail.
[0688] The surgical instrument systems described herein have been
described in connection with the deployment and deformation of
staples; however, the embodiments described herein are not so
limited. Various embodiments are envisioned which deploy fasteners
other than staples, such as clamps or tacks, for example. Moreover,
various embodiments are envisioned which utilize any suitable means
for sealing tissue. For instance, an end effector in accordance
with various embodiments can comprise electrodes configured to heat
and seal the tissue. Also, for instance, an end effector in
accordance with certain embodiments can apply vibrational energy to
seal the tissue.
EXAMPLES
Example 1
[0689] A surgical stapler for stapling the tissue of a patient
comprising a handle, a shaft extending from the handle, and an end
effector comprising a tissue compression surface, and an anvil
comprising staple forming pockets, wherein the anvil is movable
toward the tissue compression surface during a closing motion. The
surgical stapler further comprises an anvil closing system
configured to move the anvil through the closing motion and a
propulsion system comprising a first foot configured to engage the
patient tissue and move the end effector relative to the patient
tissue during a first propulsion stroke and a second foot
configured to engage the patient tissue and move the end effector
relative to the patient tissue during a second propulsion
stroke.
Example 2
[0690] The surgical stapler of Example 1, wherein the propulsion
system is configured to repetitively sequence the first propulsion
stroke and the second propulsion stroke, whereby the propulsion
system can walk the end effector relative to the patient
tissue.
Example 3
[0691] The surgical stapler of Examples 1 or 2, wherein the
propulsion system is configured to complete the first propulsion
stroke before beginning the second propulsion stroke.
Example 4
[0692] The surgical stapler of Examples 1, 2, or 3, wherein the
propulsion system is configured to at least partially complete the
first propulsion stroke before beginning the second propulsion
stroke.
Example 5
[0693] The surgical stapler of Examples 1, 2, 3, or 4, wherein the
propulsion system comprises means for synchronizing the first
propulsion stroke and the second propulsion stroke.
Example 6
[0694] The surgical stapler of Examples 1, 2, 3, 4, or 5, wherein
the end effector further comprises a staple cartridge comprising a
plurality of staples.
Example 7
[0695] The surgical stapler of Example 6, further comprising a
staple firing system configured to deploy the staples during a
staple firing stroke.
Example 8
[0696] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, or 7,
wherein the propulsion system comprises synchronizing means for
performing the closing motion after the first propulsion stroke and
the second propulsion stroke have both been performed.
Example 9
[0697] The surgical stapler of Example 8, wherein the synchronizing
means performs the staple firing stroke after the closure stroke
has been performed.
Example 10
[0698] The surgical stapler of Examples 8 or 9, wherein the
synchronizing means includes a mechanism.
Example 11
[0699] The surgical stapler of Examples 8, 9, or 10, wherein the
synchronizing means comprises a controller including a
microprocessor.
Example 12
[0700] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, or 11, wherein the propulsion system is configured to perform
the first propulsion stroke and the second propulsion stroke at the
same time.
Example 13
[0701] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, or 12, wherein the propulsion system is configured to
perform the first propulsion stroke to steer the end effector in a
first direction and the second propulsion stroke to steer the end
effector in a second direction.
Example 14
[0702] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, or 13, further comprising a vacuum system in
communication with at least one of the first foot and the second
foot, wherein the vacuum system is configured to hold the patient
tissue within the end effector utilizing the vacuum system.
Example 15
[0703] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, 13, or 14, wherein the first foot comprises a first
rotatable element and the second foot comprises a second rotatable
element.
Example 16
[0704] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, 13, 14, or 15, wherein the first foot comprises a first
set of teeth configured to grip the patient tissue and the second
foot comprises a second set of teeth configured to grip the patient
tissue.
Example 17
[0705] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, 13, 14, 15, or 16, wherein the first foot comprises a
first translatable element and the second foot comprises a second
translatable element.
Example 18
[0706] The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, 13, 14, 15, 16, or 17, wherein the first foot comprises
a first base and a first extendable portion which is extendable
relative to the first base, and wherein the second foot comprises a
second base and a second extendable portion which is extendable
relative to the second base.
Example 19
[0707] A surgical stapler for stapling the tissue of a patient
comprising a handle, a shaft extending from the handle, and an end
effector comprising a tissue compression surface and an anvil
comprising staple forming pockets, wherein the anvil is movable
toward the tissue compression surface during a closing motion. The
surgical stapler further comprises an anvil closing system
configured to move the anvil through the closing motion and a
tissue advancement system comprising a foot configured to engage
the patient tissue and pull the patient tissue relative to the end
effector during a tissue advancement stroke.
Example 20
[0708] A surgical stapler for stapling the tissue of a patient
comprising a handle, a shaft extending from the handle, a plurality
of staple cartridges, and an end effector comprising a tissue
compression surface and an anvil comprising staple forming pockets,
wherein the anvil is movable toward the tissue compression surface
during a closing motion. The surgical stapler further comprises an
anvil closing system configured to move the anvil through the
closing motion, a staple firing system configured to deploy the
staple cartridges along a path, and means for gripping the patient
tissue and creating relative movement between the end effector and
the patient tissue to re-position the end effector along the
path.
[0709] The entire disclosures of:
[0710] U.S. Pat. No. 5,403,312, entitled ELECTROSURGICAL HEMOSTATIC
DEVICE, which issued on Apr. 4, 1995;
[0711] U.S. Pat. No. 7,000,818, entitled SURGICAL STAPLING
INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS,
which issued on Feb. 21, 2006;
[0712] U.S. Pat. No. 7,422,139, entitled MOTOR-DRIVEN SURGICAL
CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK,
which issued on Sep. 9, 2008;
[0713] U.S. Pat. No. 7,464,849, entitled ELECTRO-MECHANICAL
SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT
COMPONENTS, which issued on Dec. 16, 2008;
[0714] U.S. Pat. No. 7,670,334, entitled SURGICAL INSTRUMENT HAVING
AN ARTICULATING END EFFECTOR, which issued on Mar. 2, 2010;
[0715] U.S. Pat. No. 7,753,245, entitled SURGICAL STAPLING
INSTRUMENTS, which issued on Jul. 13, 2010;
[0716] U.S. Pat. No. 8,393,514, entitled SELECTIVELY ORIENTABLE
IMPLANTABLE FASTENER CARTRIDGE, which issued on Mar. 12, 2013;
[0717] U.S. patent application Ser. No. 11/343,803, entitled
SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES, now U.S. Pat.
No. 7,845,537;
[0718] U.S. patent application Ser. No. 12/031,573, entitled
SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES,
filed Feb. 14, 2008;
[0719] U.S. patent application Ser. No. 12/031,873, entitled END
EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, filed
Feb. 15, 2008, now U.S. Pat. No. 7,980,443;
[0720] U.S. patent application Ser. No. 12/235,782, entitled
MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, now U.S. Pat. No.
8,210,411;
[0721] U.S. patent application Ser. No. 12/249,117, entitled
POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY
RETRACTABLE FIRING SYSTEM, now U.S. Pat. No. 8,608,045;
[0722] U.S. patent application Ser. No. 12/647,100, entitled
MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR
DIRECTIONAL CONTROL ASSEMBLY, filed Dec. 24, 2009, now U.S. Pat.
No. 8,220,688;
[0723] U.S. patent application Ser. No. 12/893,461, entitled STAPLE
CARTRIDGE, filed Sep. 29, 2012, now U.S. Pat. No. 8,733,613;
[0724] U.S. patent application Ser. No. 13/036,647, entitled
SURGICAL STAPLING INSTRUMENT, filed Feb. 28, 2011, now U.S. Pat.
No. 8,561,870;
[0725] U.S. patent application Ser. No. 13/118,241, entitled
SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT
ARRANGEMENTS, now U.S. Pat. No. 9,072,535;
[0726] U.S. patent application Ser. No. 13/524,049, entitled
ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed
on Jun. 15, 2012, now U.S. Pat. No. 9,101,358;
[0727] U.S. patent application Ser. No. 13/800,025, entitled STAPLE
CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013,
now U.S. Pat. No. 9,345,481; U.S. patent application Ser. No.
13/800,067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR
SYSTEM, filed on Mar. 13, 2013, now U.S. Patent Application
Publication No. 2014/0263552;
[0728] U.S. Patent Application Publication No. 2007/0175955,
entitled SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE
TRIGGER LOCKING MECHANISM, filed Jan. 31, 2006; and
[0729] U.S. Patent Application Publication No. 2010/0264194,
entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END
EFFECTOR, filed Apr. 22, 2010, now U.S. Pat. No. 8,308,040, are
hereby incorporated by reference herein.
[0730] Although various devices have been described herein in
connection with certain embodiments, modifications and variations
to those embodiments may be implemented. Particular features,
structures, or characteristics may be combined in any suitable
manner in one or more embodiments. Thus, the particular features,
structures, or characteristics illustrated or described in
connection with one embodiment may be combined in whole or in part,
with the features, structures or characteristics of one ore more
other embodiments without limitation. Also, where materials are
disclosed for certain components, other materials may be used.
Furthermore, according to various embodiments, a single component
may be replaced by multiple components, and multiple components may
be replaced by a single component, to perform a given function or
functions. The foregoing description and following claims are
intended to cover all such modification and variations.
[0731] The devices disclosed herein can be designed to be disposed
of after a single use, or they can be designed to be used multiple
times. In either case, however, a device can be reconditioned for
reuse after at least one use. Reconditioning can include any
combination of the steps including, but not limited to, the
disassembly of the device, followed by cleaning or replacement of
particular pieces of the device, and subsequent reassembly of the
device. In particular, a reconditioning facility and/or surgical
team can disassemble a device and, after cleaning and/or replacing
particular parts of the device, the device can be reassembled for
subsequent use. Those skilled in the art will appreciate that
reconditioning of a device can utilize a variety of techniques for
disassembly, cleaning/replacement, and reassembly. Use of such
techniques, and the resulting reconditioned device, are all within
the scope of the present application.
[0732] The devices disclosed herein may be processed before
surgery. First, a new or used instrument may be obtained and, when
necessary, cleaned. The instrument may then be sterilized. In one
sterilization technique, the instrument is placed in a closed and
sealed container, such as a plastic or TYVEK bag. The container and
instrument may then be placed in a field of radiation that can
penetrate the container, such as gamma radiation, x-rays, and/or
high-energy electrons. The radiation may kill bacteria on the
instrument and in the container. The sterilized instrument may then
be stored in the sterile container. The sealed container may keep
the instrument sterile until it is opened in a medical facility. A
device may also be sterilized using any other technique known in
the art, including but not limited to beta radiation, gamma
radiation, ethylene oxide, plasma peroxide, and/or steam.
[0733] While this invention has been described as having exemplary
designs, the present invention may be further modified within the
spirit and scope of the disclosure. This application is therefore
intended to cover any variations, uses, or adaptations of the
invention using its general principles.
[0734] Any patent, publication, or other disclosure material, in
whole or in part, that is said to be incorporated by reference
herein is incorporated herein only to the extent that the
incorporated materials do not conflict with existing definitions,
statements, or other disclosure material set forth in this
disclosure. As such, and to the extent necessary, the disclosure as
explicitly set forth herein supersedes any conflicting material
incorporated herein by reference. Any material, or portion thereof,
that is said to be incorporated by reference herein, but which
conflicts with existing definitions, statements, or other
disclosure material set forth herein will only be incorporated to
the extent that no conflict arises between that incorporated
material and the existing disclosure material.
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