U.S. patent number 3,740,994 [Application Number 05/080,450] was granted by the patent office on 1973-06-26 for three-stage medical instrument.
This patent grant is currently assigned to United States Surgical Corporation. Invention is credited to Alfred F. De Carlo, Jr..
United States Patent |
3,740,994 |
De Carlo, Jr. |
June 26, 1973 |
THREE-STAGE MEDICAL INSTRUMENT
Abstract
A cartridge and an instrument which, together serve to
mechanically suture and divide organic tubular structures, such as
blood vessels. The cartridge houses a plurality of staples and
operates in three stages. After the tubular structure is inserted
between the jaws of the cartridge, the cartridge jaws close, a pair
of pushers come forward and suture the organic structure in two
spaced locations with a pair of surgical staples, and a blade comes
forward and divides the tubular structure at a position
intermediate the two staples. The staples are indexed and readied
for discharge by means of a pair of leaf springs which act between
a fixed rail assembly and a movable wrap assembly. The instrument
is adapted to coact with the novel cartridge and depends upon the
interaction of three springs to bring about the three-stage
operation of the cartridge.
Inventors: |
De Carlo, Jr.; Alfred F.
(Stamford, CT) |
Assignee: |
United States Surgical
Corporation (Baltimore, MD)
|
Family
ID: |
22157464 |
Appl.
No.: |
05/080,450 |
Filed: |
October 13, 1970 |
Current U.S.
Class: |
72/407;
29/243.56; 227/19; 72/409.05 |
Current CPC
Class: |
A61B
17/128 (20130101); Y10T 29/53783 (20150115); A61B
17/32 (20130101) |
Current International
Class: |
A61B
17/12 (20060101); A61B 17/128 (20060101); A61B
17/32 (20060101); B21d 007/06 () |
Field of
Search: |
;72/407,409,410 ;227/19
;29/212,23H,23HC,23HM,23HT,243.56,243.57 ;128/305,325,326,318 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Lanham; Charles W.
Assistant Examiner: Keenan; M. J.
Claims
What is claimed is:
1. A surgical instrument adapted to associate with and operate a
staple-carrying cartridge having a three-stage operation and
including ligating means, suturing means and organic tubular
structure dividing means, the instrument comprising: a main boy
portion; first, second and third attachment means associated with
said main body portion and moveable with respect to said main body
portion and with respect to one another, said first attachment
means adapted to associate with said organic tubular structure
dividing means, said second attachment means adapted to associate
with said suturing means and said third attachment means adapted to
associate with said ligating means; trigger means moveably mounted
on said main body portion linking means operatively connecting said
trigger means to said first attachment means so that activation of
said trigger means causes said first attachment means to move
relative to said main body portion; biasing means associated with
said first, second and third attachment means for influencing the
movement of said first, second and third attachment means relative
to said main body portion and relative to each other, said first,
second and third attachment means and said biasing means
cooperating to provide three-stage operation of said instrument and
said three-stage operation of said cartridge on activation of said
trigger means.
2. The surgical instrument recited in claim 1, wherein at least a
portion of each of said first, second and third attachment means
lies, at rest, outside said main body portion; and further
comprising first rod means integral with said first attachment
means, extending from said first attachment means to the rear of
said surgical instrument, and associating, at the rear of said
surgical instrument, with said linking means.
3. The surgical instrument recited in claim 2, and further
comprising: second rod means integral with said second attachment
means, extending from said second attachment means toward the rear
of said surgical instrument, and being in the form of a hollow tube
extending about and slidably mounted with respect to said first rod
means.
4. The surgical instrument recited in claim 2, wherein said third
attachment means is in the form of a carrying ring extending about
and slidably mounted with respect to said second rod means.
5. The surgical instrument recited in claim 4, wherein said first,
second and third attachment means are farthest from, intermediate
and nearest said main body portion, respectively.
6. The surgical instrument recited in claim 5, wherein said biasing
means comprises, in part, first spring means for biasing said
second attachment means toward said main body portion.
7. The surgical instrument recited in claim 6, wherein said first
spring means surrounds said second rod means and abuts, under
compression, an inner wall of said main body portion and a flange
integral with the rearwardmost end of said second rod means.
8. The surgical instrument recited in claim 6, wherein said biasing
means comprises, in part, second spring means for biasing said
third attachment means toward said second attachment means and away
from said main body portion
9. The surgical instrument recited in claim 8, wherein said second
spring means surrounds said second rod means and abuts, under
compression, said third attachment means and an outer wall of said
main boby portion.
10. The surgical instrument recited in claim 8, wherein said
biasing means comprises, in part, third spring means for biasing
said second attachment means toward said first attachment
means.
11. The surgical instrument recited in claim 10, wherein said third
spring means surrounds said first rod means and abuts, under
compression, the rear portion of said first rod means and the rear
portion of said second rod means.
12. The surgical instrument recited in claim 10, wherein the force
required to compress said first spring means is greater than the
force required to compress said second spring means and is less
than the force required to compress said third spring means.
13. The surgical instrument recited in claim 1, and further
comprising: cam means intermediate said first attachment means and
said trigger means.
14. The surgical instrument recited in claim 13, wherein said cam
means is variable in a manner so as to respond to the activation of
said trigger means by a relatively constant force to deliver to
said first attachment means a force substantially equal to the
required input force necessary to bring about the three-stage
operation of said staple-carrying cartridge.
Description
BACKGROUND OF THE INVENTION
In copending U.S. Patent Application Ser. No. 64,749 entitled
METHOD AND CARTRIDGE FOR LIGATING ORGANIC TUBULAR STRUCTURES filed
Aug. 18, 1970, now U.S. Pat. No. 3,683,927, and assigned to the
present assignee, a novel method and cartridge for ligating,
suturing and dividing organic tubular structures by means of
surgical staples are disclosed. The copending patent application is
directed, in part, to a cartridge which accepts an organic tubular
structure and which mechanically encloses the tubular structure
between its jaws, advances a pair of U-shaped staples toward the
tubular structure by means of a pusher element and then surrounds
the structure by the staples and crimps the staples in such a
manner that the organic tubular structure is sealed at two spaced
locations. Once the tubular structure is so sealed, a
thumb-operated knife blade is moved forward to divide the structure
intermediate the staples.
In the copending U.S. patent application noted in the preceding
paragraph, a useful cartridge is disclosed. This cartridge,
however, is the result of initial thoughts directed to a new
concept. Accordingly, there are many areas where refinements of the
initial concept can be made. For example, in that cartridge, only
two staples can be housed, fed and crimped about the organic
tubular structure. Since, in practical circumstances, a number of
suturing and dividing operations must be made, it would be best if
a plurality of staple pairs could be housed in the cartridge.
Further, the dividing operation performed by the cartridge noted
above is done by means of a thumb-operated knife blade. Therefore,
with this cartridge, the surgeon is required to perform the
suturing and dividing operations in two independent stages. Again,
while such a configuration is workable it is not the best possible
configuration.
It is toward the refinement of the cartridge disclosed in the
copending U.S. patent application noted above, and the elimination
of the drawbacks associated therewith, that the present invention
is directed.
SUMMARY OF THE INVENTION
The present invention relates to a cartridge and an instrument
which, together are capable of mechanically and repetitiously
ligating, suturing and dividing organic tubular structures, such as
blood vessels and the like. The inventive cartridge houses a
plurality of staple pairs, on the order of fifteen, and derives its
power from the associated instrument.
The cartridge operates in three stages. Once the tubular structure
is inserted within the area of its jaws, the cartridge wrap, or
main body of the cartridge, is moved forward and toward an anvil
assembly fixed on the instrument, thereby enclosing the tubular
structure within the jaws of the cartridge. Then, a pair of pusher
elements are advanced along their respective fixed rail assemblies
and urge a pair of staples toward respective anvil assemblies. At
the forward portions of the pusher strokes, the respective staples
encircle the tubular structure at spaced locations and crimp about
the structure in such a manner that the tubular structure is sealed
at two locations. Finally, and with the pushers at the forwardmost
portions of their strokes, a knife blade advances and divides the
tubular structure intermediate the two staples. This three-stage
operation is performed by a surgeon by simply squeezing the handle
of the associated instrument.
The instrument, to operate the three-stage cartridge, is also of
three-stage design. The forward end of the instrument is provided
with three saddles which associate, respectively, with the
cartridge wrap, the pusher and the knife. The forward end of the
instrument is also provided with means for fixedly securing the
rail assemblies of the cartridge to the instrument.
Three spring elements are housed in the instrument and, in
conjunction with a cam and trigger element, operate the cartridge
wrap, the pushers and the knife through three saddle elements. The
instrument has a fixed handle and a handle pivotally mounted with
respect to the fixed handle. When the instrument handles are
squeezed together, the movable handle pivots with respect to and
moves toward the fixed handle. With a cartridge mounted on the
instrument, the initial squeezing of the handle moves the cartridge
wrap toward the fixed anvil assemblies, and the further squeezing
advances the pushers toward the respective anvils and ultimately
urges the knife toward the front of the instrument to effect a
cutting operation.
Because of the three-stage operation, depending upon the
interaction of three springs, the forces which need to be exerted
on the handle vary with the handle depression. Further causing
variance in the required operating forces are the distinct
operations of the cartridge. To eliminate the distinct "feel" in
the hand of the surgeon that differential forces are required of
him, the inventive instrument is provided with a variable cam
element operating between the power shafts of the instrument and
the handle thereof. The cam surface is contoured in such a manner
that the force required to operate the handle is relatively
constant notwithstanding variations in the required force inputs to
the cartridge. In this manner, the surgeon is unaware that three
distinct stages of operation occur each time he activates the
instrument.
The cartridge houses a plurality of staple pairs. When the
cartridge is operated by the instrument, the staple pairs are
indexed in a simple, effective and unique manner. When the
cartridge is shipped, the forwardmost two staples are housed in the
respective planes of the pushers, ready for ejection. The remaining
pairs of staples are housed in the respective planes of a pair of
guiding tracks. The staples are maintained in their respective
tracks by having their arms biased against the track walls.
The staples in the guiding tracks are held fixed in the cartridge
wrap during the first ligating, suturing and dividing operation.
Only the forwardmost two staples are affected by the first
operation, being ejected by the pushers. When, however, the
cartridge wrap retracts from the anvil assemblies, after the first
operation of the cartridge, a leaf spring assembly integral with
each rail assembly, in turn integral with each anvil assembly,
maintains the staples fixed with respect to the rail assemblies,
thereby, in relative terms, advancing the staples in the cartridge
wrap. During the retraction of the cartridge wrap, the forwardmost
two staples are shifted from the respective planes of the guiding
tracks to the respective planes of the pushers. When the cartridge
wrap returns to its rearwardmost position, the cartridge is ready
for another firing operation.
As noted previously, all but the forwardmost two staples are held
fixed in the cartridge wrap during the movement of the wrap toward
the anvil assemblies. When the cartridge wrap moves forward, the
staples are held fixed in the wrap by means of a second leaf spring
assembly integral with each side of the cartridge wrap.
The novel cartridge, as noted previously, is shipped with a pair of
staples ready for ejection. To ensure that the respective pushers
are maintained in proper alignment for insertion on a powering
instrument, and to prevent the respective pushers from accidentally
ejecting their associated staples, the pushers are rigidly secured
together and are held fixed with respect to the cartridge wrap
until acted upon by the instrument. Similarly, during shipment, the
knife is held fixed with respect to the wrap.
A further feature built into the inventive cartridge is an ejector
mechanism by which mechanism the organic tubular structure, after
having been sutured and divided, is forced out of the jaws of the
cartridge. To this end, an ejector plate positioned intermediate
the respective anvil assemblies, is made to move into the area of
the anvil, to contact both segments of the divided tubular
structure, and to urge the segments out of engagement with the
respective anvil assemblies. In this manner, the surgeon need not
make a conscious effort to ensure that the ligated and divided
tubular structures are out of the jaws of the cartridge before
retracting the cartridge from the operating arena.
Further to the above, the inventive cartridge is provided with
transparent windows either on the sides thereof or on the top
thereof, these windows being in the planes of the staples. In this
manner, the surgeon can easily inspect the cartridge to ascertain
the number of staple pairs remaining therein. The chance of a
"wasted" stroke is thereby greatly diminished.
Accordingly, it is one object of the present invention to provide a
cartridge for housing a plurality of staple pairs and adapted to
mechanically ligate, suture and divide organic tubular structures
with the aid of surgical staples.
A further object of the present invention is to provide a novel
cartridge capable of ligating, suturing and dividing organic
tubular structures and equipped with means for simply and reliably
indexing a plurality of staple pairs.
Yet a further object of the present invention is to provide a novel
cartridge for ligating, suturing and dividing organic tubular
structures and equipped with simple leaf spring assemblies for
advancing the staples in the cartridge.
A further object of the present invention is to provide a novel
cartridge for ligating, suturing and dividing organic tubular
structures and equipped with means to ensure that the cartridge may
be shipped without misalignment of its elements or accidental
discharge of its staples.
Still a further object of the present invention is to provide a
relatively inexpensive and disposable cartridge for ligating,
suturing and dividing organic tubular structures.
A further object of the present invention is to provide a novel
cartridge for ligating, suturing and dividing tubular organic
structures, the cartridge housing a plurality of staple pairs and
being provided with means for easily recognizing the number of
staple pairs remaining in the cartridge.
Yet another object of the present invention is to provide a
three-stage instrument adapted to associate with a cartridge and to
function, together with the cartridge, to ligate, suture and divide
tubular organic structures.
Yet a further object of the present invention is to provide a
simple hand operated instrument adapted for three-stage operation
with the aid of three independent spring assemblies.
Still a further object of the present invention is to provide a
novel instrument adapted to associate with a staple-housing
cartridge, the instrument and cartridge together serving to ligate,
suture and divide organic tubular structures, and the instrument
being provided with cam means whereby the mechanical advantage
associated with the instrument handle varies inversely with the
forces necessary to bring about the cartridge operation.
These and other objects of the present invention, as well as many
of the attendant advantages thereof, will become more readily
apparent when reference is made to the following description taken
in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side view, partially in section, of the surgical
instrument forming a part of the present invention with its
associated cartridge indicated in phantom;
FIG. 2 is a side view of the forward region of the inventive
surgical instrument showing portions of the instrument when its
trigger is in position 2 of FIG. 1;
FIG. 3 is a side view of the forward region of the inventive
surgical instrument showing portions of the instrument when its
trigger is in position 3 of FIG. 1;
FIG. 4 is a side view of the forward region of the inventive
surgical instrument showing portions of the instrument when its
trigger is in position 4 of FIG. 1;
FIG. 5 is a top view of the staple-carrying cartridge forming a
part of the present invention;
FIG. 6 is a side view of the cartridge illustrated in FIG. 5;
FIG. 7 is a cross-section of the inventive cartridge taken along
line 7--7 of FIG. 5;
FIG. 8 is a cross-section of the inventive cartridge taken along
line 8--8 of FIG. 5;
FIG. 9 is a front view of the inventive cartridge;
FIG. 10 is a cross-section of the inventive cartridge taken along
line 10--10 of FIG. 5;
FIG. 11 is a cross-section of the inventive cartridge taken along
line 11--11 of FIG. 10; and
FIG. 12 is a side view of the ratchet assemblies when in the
respective positions shown in FIG. 11.
DETAILED DESCRIPTION OF THE DRAWINGS
Before beginning an explanation of the inventive surgical
instrument, and to enhance the understanding of the operation of
the same, there follows a brief description of the operation of the
inventive staple-carrying cartridge. As noted previously, the
cartridge serves to successively ligate, suture and divide organic
tubular structures. The main cartridge includes a main body portion
slidable on a pair of fixed rail and anvil assemblies, a pair of
pusher elements, and a knife blade. In carrying out its three-stage
operation after the organic tubular structure is in position
between the main body portion and the fixed anvil assemblies, the
main body portion is moved forward until it abuts the fixed anvil
assemblies and completely encircles the tubular structure within
the jaws of the cartridge. Then, the pushers are activated, thereby
ejecting a pair of staples from the main body and forming the
staples about the organic tubular structure. After the staples are
formed, the knife blade moves forward and divides the tubular
structure at a position intermediate the staple locations.
During the cartridge operation described in the preceding
paragraph, three distinct forces are required. First, the main body
portion of the cartridge must be moved forward with respect to the
fixed rail and anvil assemblies. Second, after the main body
portion is in abuttment with the anvil assemblies, the pushers must
be driven forward to eject and form a pair of staples. And, third,
once the staples are formed and the pushers are in their
forwardmost positions of travel, the knife blade must be
advanced.
With this background, the requirements of operation of the
inventive instrument should be clear and the manner in which these
requirements are met will be clear from the following. The
inventive instrument is shown generally at 10 and has mounted
thereon a cartridge 12. The instrument is defined by a main body
portion 14 having a fixed handle 16, a handle 18 mounted for
pivotable movement about a pin 20, a barrel 22 and a nose 24. Three
saddle members 26, 28 and 30, respectively, extend from the nose 24
of the instrument 10 and are adapted to associate, respectively,
with the cartridge knife, the cartridge pushers, and the cartridge
main body. The forwardmost saddle 26 is integral with a solid tube
32 extending from the saddle 26 to the rear portion of the barrel
22. On the end of the tube 32 is a cap 34, the function of which
will become clear from the following. The saddle 28 is integral
with a hollow rod 36 which extends from the saddle 28 toward the
rear portion of the barrel 22, terminating in a ring-like flange
38. The saddle 30 takes the form of a spool surrounding the hollow
rod 36 and is free to slide therealong.
To bring about the three-stage operation of the instrument 10, in
response to the required three-stage operation of the
staple-carrying cartridge 12, the three saddles 26, 28 and 30 are
controled by the operation of the cartridge 12 and the interaction
of three springs. A first spring 40 surrounds the hollow rod 36 and
is maintained in compression between the ring-like flange 38
integral with the tube 36 and an inner wall 42 of nose 24. Spring
40 thereby biases the saddle 28 toward the nose 24 of the
instrument 10. A second spring 44, in compression, surrounds the
hollow tube 36, and acts between the rear wall of the saddle 30 and
a front wall 46 of the nose portion 24. Spring 44 thereby serves to
bias the saddle 30 away from the nose 24. The third spring 48 is
located in the rear portion of the barrel 22 and acts in
compression between the cap 34 integral with the rod 32 and the
ring-like flange 38 integral with the rod 36 thus biasing the
saddles 26 and 28 toward one another. Preferably, springs 40 and 44
are coil springs, whereas springs 48 take the form of Belvill
washers, or disc springs. In view of their desired functions, the
spring forces must be related as follows. Spring 44 exerts the
least spring force, in the present example on the order of four
pounds. Spring 40 exerts an intermediate amount of force, in the
specific example on the order of eight pounds. And, spring 48 is
adapted to exert a force of on the order of sixty pounds.
As noted previously, the operation of the staple-carrying
cartridge, and thus of the inventive instrument, is carried out in
three-stages. And, due to the varying functions of the cartridge
elements, distinct and varying forces are required to bring about
each function. That is, while relatively little force is required
to move the main body of the cartridge toward the fixed anvil
assemblies, relatively large forces are required to bring about the
formation of the staples. Again, only a small force is needed to
advance the knife. In addition to the above, and because it is
necessary to ensure that the three-stage operation of the
staple-carrying cartridge follows the proper sequence, the spring
forces associated with springs 40, 44 and 48 are not constant.
As a consequence of the above, the three stages of operation of the
instrument, when associated with the cartridge, result in
variations in input requirements. It should be apparent, therefore,
that if no correcting provisions were made, the instrument would
have peculiar characteristics from the standpoint of feel. To avoid
these peculiar characteristics, the inventive surgical instrument
is provided with a variable cam associated with a moveable handle
18, which cam is designed so that the three-stage operation of the
cartridge is carried out with a relatively uniform input force
exerted by the operating surgeon.
With continuing reference then to FIG. 1, it can be seen that an
arm 50 continuous with the moveable handle 18 extends into the main
body 14. A wheel, or disc, 52 is rotatably mounted on the end of
the arm 50 and defines a cam follower. The cam follower 52 is
adapted to roll along the camming surface 54 of a cam plate 56
pivotably mounted about a pin 58. While not shown, the upper region
of the cam plate 56 is adapted to grip an extension associated with
the cap 34 integral with the rod 32. These features are not shown,
in order to avoid obscuring pertinent details of the instrument but
are fully illustrated and disclosed in copending U.S. Patent
Application Ser. No. 32,247, assigned to the present assignee.
Suffice it to say that the cam plate 56 is biased in what may be
termed a clockwise direction about its pin 58 by means of the
interaction of the respective springs 40 and 48.
In operation, as the moveable handle 18 is urged in the direction
of arrow 60, the arm 50 integral with the handle is caused to pivot
about pin 20. As a result, the cam follower 52 is made to roll
along the surface 54 of the cam plate 56 while the cam plate pivots
about pin 58. This movement takes place against the continuous
resistance developed by the respective springs 40 and 48. As can be
seen in FIG. 1, the cam follower 52 engages the lower portion of
the cam plate 56 when the moveable handle 18 is in the position 1.
Then, the cam follower advances along the surface 54 until the
moveable handle 18 is in its final position, position 4, at which
time the cam follower 52 engages the upper portion of the camp
plate 56.
As seen in FIG. 1, the surface 54 of the cam plate 56 has three
main transitions. These transitions enable the instrument 10 to
operate in such a manner that a relatively uniform input force may
be exerted on the moveable handle 18 and so that this relatively
uniform force may be transformed to forces of varying degrees of
intensity to carry out the three-stage operation of the cartridge
12 without the surgeon being aware of such three-stage operation.
Therefore, the distances between the transitions are set in such a
manner as to correspond to the desired length of thrust of the
saddles 26, 28 and 30. Similarly, the shape and slope of the
transitions are designed so that the mechanical advantage
associated with the handle-cam-drive rod assembly varies the forces
delivered to the cartridge 12 under conditions of uniform force
delivery to the handle 18.
Now, with continuing reference to FIGS. 1 through 4, the operation
of the inventive instrument 10 will be described. With the moveable
handle in the position 1, the ring-like flange 38 lies in its
rearwardmost position in the barrel 22, and the instrument is
relaxed. When, however, a force is exerted on the moveable handle
18, causing the handle 18 to pivot into position 2, the cap 34,
integral with the rod 32 and connected to the upper region of the
cam plate 56, moves toward the nose 24 of the instrument 10. In
view of the relatively large force exerted between the cap 34 and
the ring-like flange 38, by the sixty pound spring 48, the
ring-like flange 38 moves with the cap 34 into position 2. Hence,
the spring 40 is compressed. At the same time, due to the action of
the spring 44 which urges the saddle 30 away from the nose of the
instrument 10, the saddle 30 moves with the saddles 26 and 28 away
from the nose 24. In this manner, the cartridge main body portion,
the pushers and the knife move, in unison, away from the nose
24.
As is fully explained in copending U.S. Patent Application Ser. No.
32,247, noted above, the rail assemblies and anvils of the
cartridge 12 are fixedly secured to the nose 24 of the instrument
10 by means of a pin 62 integral with the rail assemblies and
anvils, which pin fits into groove 64 in the nose 24 and is secured
therein by a thumb-operated lock 66. With the rails and anvil
assemblies held fixed with respect to the instrument 10, and with
the cartridge main body portion, the pushers and the knife moving
away from the nose 24, the main body portion of the cartridge 12
closes upon the fixed anvil assemblies as will be described below.
Position 2 of FIG. 1 shows the instrument when the main body
portion just touches the anvil assemblies.
When the main body portion of the cartridge 12 comes into contact
with the fixed anvil assemblies, no further movement of the saddle
30 may take place. Then, further rotation of the moveable handle 18
in the direction of arrow 60 results in the saddles 26 and 28
moving, in unison, away from the then fixed saddle 30. In its
extreme position during this stage of operation, the handle moves
into position 3 shown in FIG. 1, and the respective saddles take
the positions shown in FIG. 3.
The elements move into position 3 as follows. As noted previously,
when the main body portion of the cartridge 12 contacts the fixed
anvil assemblies, no further relative motion between these elements
is allowed to take place. Therefore, all relative motion between
the nose 24 of the instrument 10 and the saddle 30 is terminated.
However, with further rotation of the moveable handle 18, a force
is exerted on the cap 34 and is directed toward the nose 24 of the
instrument 10. This force moves against the spring 40 and results
in continued movement of the saddles 26 and 28. There is no
relative movement between these saddles because the large spring
48, requiring 60 pounds of compression, remains fully extended,
with the eight pound spring 40 then being compressed.
When the instrument is in position 3, the knife associated with the
saddle 26 and the pushers associated with the saddle 28 have moved
toward the fixed anvil assemblies of the cartridge 12, with the
pushers then having completed the bending of the respective
staples. At this time, the pushers have reached their forwardmost
stroke, having fully crushed the respective staples and now in
effect abutting the fixed anvil assemblies. Accordingly, both
saddles 28 and 30 are in their fully extended positions. Further
rotation of the moveable handle 18 in the direction of arrow 60
accordingly acts against the 60 pound spring 48 and causes the
saddle 26 to move away from the saddle 28. In its ultimate
position, position 4, the knife has moved to its full forward
position and has divided the already ligated organic tubular
structure. The ultimate positions of the respective saddles are
shown in FIG. 4.
From the above, it should now be appreciated that the forces
required to operate the elements of the staple carrying cartridge
12 in their proper sequence, control the movement of the respective
saddles in response to forces exerted on the moveable handle 18.
And, since the surface 54 of the cam plate 56 is developed as
described above, the differential forces associated with the three
springs and the three operations of the cartridge are substantially
masked from the standpoint of the surgeon. Therefore, with the
inventive instrument, a surgeon is able to automatically, easily
and comfortably carry out three distinct surgical operations in a
minimum amount of time.
With reference now to FIGS. 5 through 12, the construction and
operation of the novel staple-carrying cartridge will be described.
The cartridge 12 comprises a main body portion 100 which is
slidably mounted on a pair of rail assemblies 102 adapted to be
fixedly secured to the instrument 10. A curved anvil assembly 104
is defined in the forwardmost region of each rail assembly 102. A
pair of pusher elements 106, rigidly secured together by means of a
bridge 108, slide within the main body portion 100. A knife 110,
centrally located in the main body portion 100 slides between the
respective pushers 106 and is adapted to divide the organic tubular
structure after the pushers 106 have completed their strokes and
have effected the suturing of such structure. As can be seen best
in FIGS. 6 through 8, the respective saddles 26, 28 and 30
positively control the movements of the knife 110, the pushers 106
and the main body portion 100 with respect to the rail assemblies
102 rigidly secured to the surgical instrument 10 by means of the
pin 62 and the thumb-operated lock 66. Thus far, except for the
automatic operation of the knife 110, the cartridge 12 functions in
a manner identical with the operation of the cartridge disclosed in
copending U.S. Patent Application Ser. No. 32,247, noted above.
As seen best in FIG. 11, a plurality of staples 112 are guided in
one of two guide tracks on each side of the cartridge 12. For
simplicity of description, only one side of the cartridge will be
mentioned, but it should be understood that the cartridge is
symmetrical about its centerline.
A number of staples 112 lie along the major portion of the length
of the cartridge 12 in what may be termed an index guide rail 114.
It is in the index guide rail 114 that the staples are, in unison,
advanced toward the anvil assemblies 104 in readiness for ejection.
Near the forward end of the cartridge 12, the staples 112 are
transferred to an ejection guide rail 116. For purposes of
transferring the staples from the index guide rail 114 to the
ejection guide rail 116, the main body portion 100 is provided with
a first ramp 118 which acts on the individual staples at their
respective cross-pieces and a second ramp 120 which acts on the
individual staples at the respective forward ends thereof. As can
best be seen in FIG. 11, each pusher 106 is guided by and rides in
the ejection guide rail 116.
The cartridge 12 is provided with a novel staple feeding
arrangement. As seen best in FIG. 11, the novel staple feeding
arrangement takes the form of a pair of interacting leaf spring
assemblies. A first leaf spring assembly is designated 122, is
fixedly secured to the main body portion 100, and has its leaves
extending into the plane of an index guide rail 114. The second
leaf spring assembly is designated 124, is fixedly secured to the
rail assembly 102, and has its leaves also extending into the plane
of an index guide rail 114. The forwardmost leaf 126 of the leaf
spring assembly 122 is spring biased into the plane of the ejection
guide rail 116, for reasons which will become clear from the
following. Similarly, the forwardmost leaf 128 of the leaf spring
assembly 124 is formed into an "L" and extends into the plane of
the ejection guide rail 116. And, as can be seen best in FIG. 12,
the leaves of the leaf spring assembly 124 are adapted to contact
the staples 112 at positions lower than the leaves of the leaf
spring assembly 122.
The operation of the inventive staple-drive mechanism is as
follows. When the cartridge 12 is shipped, the forwardmost two
staples are positioned as shown in FIG. 11. As noted previously,
during shipment, the main body portion 110 is retracted and spaced
from the anvil assembly 104. Upon initial activation of the
associated surgical instrument 10, the main body portion 100 moves
in the direction of arrow 130. With such movement of the main body
portion 100, the respective leaves of the leaf spring assembly 122
come into contact with the individual staples 112 and carry such
staples forward in unison with the main body portion 100. During
this movement, the staples 112 remain in the plane of the index
guide rail 114.
It will be noted that a staple 112 is shipped in each ejection
guide rail 116, in the plane of the pusher 106 and is thus in
readiness for ejection and forming around the anvil assembly 104.
After the main body portion 100 has come into contact with the
anvil assembly 104, as mentioned above, the pushers 106 begin their
forward movement relative to the main body portion 100 and contact
the respective forwardmost staples 112, eject the same from the
main body portion 100 and form same around the organic tubular
structure housed within the jaws of the cartridge 12. Then, once
the organic tubular structure is sutured, the knife 110 is made to
advance and to divide such structure intermediate the pair of
suturing staples 112. During this forward movement of the pushers
106 relative to the main body portion 100, all staples but he
forwardmost staples remain fixed in the main body portion.
Once a pair of staples have been ejected and formed, and the
organic tubular structure has been divided, the knife, the pushers
and the main body portions are ready to be retracted from the
region of the anvil assemblies. First, the knife retracts, then the
pushers retract and finally the main body portion retracts.
Before continuing, it should be noted that the forwardmost staple
in the main body portion 100, save for the staple which was
ejected, was advanced by the leaf 127, immediately behind the leaf
126 of the leaf spring assembly 122 to a position beyond the leaf
128 of the leaf spring assembly 124. The reference numeral 112'
shows the position of the forwardmost staple in the main body
portion 100, save for the staple having been ejected, after the
completed movement of the main body portion 100 in the direction of
arrow 130. The arrow 132 is provided to indicate the movement of
the secondmost forward staple in the main body portion 100 during
the forward stroke of the main body portion.
After the forward stroke of the pusher 106, the forwardmost staple
residing in the main body portion 100 is the staple 112'. After the
knife and the pushers have retracted, the main body portion 100
begins to retract. At this occurrence, the first ramp 118 comes
into contact with the cross-piece of the staple 112' while the
second ramp 120 comes into contact with the forward arms of such
staple. While the main body portion 100 is retracting, the staple
112 is held against the leaf 128 of the leaf spring assembly 124.
Similarly, the remaining staples in the cartridge are held against
respective leaves of the leaf spring assembly 124. With continued
rearward movement of the main body portion 100, and with the
forwardmost staple 112 held against the front face of the leaf 128,
and being acted upon by the respective ramps 118 and 120, the
staple 112 is caused to transfer, in the direction of arrow 134,
from the index guide rail 114 to the ejection guide rail 116. Once
the main body portion 100 has returned to its rearwardmost
position, the individual elements of the assembly take the
positions shown in FIG. 11. Then the cartridge is ready for the
next stapling operation.
As noted previously, the forwardmost leaves 126 and 128 of the
respective leaf spring assemblies 122 and 124 extend into the plane
of the ejection guide rail 116 and thus extend into the plane of
the pusher 106. For this reason, and as best seen in FIG. 10, the
pushers 106 are notched at 136, in this way avoiding interference
with the leaves of the respective leaf spring assemblies. And, as
best seen in FIGS. 7, 10 and 11, the forward face of each pusher
106 is provided with sets of flats 138 serving to reduce the
vertical diameter of the pushers with respect to the dimensions of
the staples, thereby avoiding undesirable interference between the
pushers and the tip of ramp 120.
With continuing reference to FIGS. 5 through 10, some additional
features of the inventive cartridge will be described. As seen best
in FIGS. 5, 8, 9 and 10, an ejector plate 140 is positioned
intermediate the anvil assemblies 104. The ejector plate 140
functions to eject the organic tubular structure from the jaws of
the cartridge 12 after the completion of the suturing and dividing
operations. During the forward motion of the main body portion 100,
the ejector plate is carried with said main body portion and is
moved out of the area of the anvil assemblies 104. Then, the
pushers 106 and the knife 110 perform their respective functions
and begin to retract. When the main body portion 100 retracts, the
ejector plate 140 is carried with said main body portion into the
area of the anvil assemblies 104, as a result of the interaction
between the rear portion of the knife and the rear portion of the
ejector plate. In this manner, the surface of the ejector plate 140
facing the ligated and sutured tubular organic structure urges such
structure out of the area of the anvil assemblies 104 and hence
facilitates the expulsion of the divided tubular structure from the
jaws of the cartridge. While not shown, the ejector plate 140 is
limited in its movement with respect to the fixed rail assemblies
102. On the bottom of each rail assembly, there is provided a
downwardly extending flange. And, surrounding each such flange is a
slot provided in the bottom portion of the ejector plate. The width
of the ejector plate slot is made slightly greater than the width
of the downwardly projecting flange, thereby allowing slight
relative movement between the rail assemblies, and hence the anvil
assemblies, and the ejector plate.
As noted previously, certain elements of the inventive cartridge 12
are held fixed with respect to the main body portion 100 until
acted upon by the associated surgical instrument. This is desirable
for two distinct and important reasons. First, it is advantageous
to maintain the rail assemblies, the main body portion, the
pushers, and the knife in the respective positions facilitating
insertion of the cartridge on the associated surgical instrument.
And, second, it is necessary to prevent the pushers from
accidentally ejecting a pair of staples from the cartridge and to
prevent the knife from accidentally travelling forward in the
cartridge before such cartridge is mounted on the associated
instrument. Therefore, the inventive cartridge 12 is provided with
means to releasably lock the knife, pusher and rail assemblies
fixed with respect to said main body portion.
The knife 110 and pushers 106 are releasably locked with respect to
the main body portion 100 as follows. On the upper surface of the
knife 110, there is provided a notch 142. And, provided on the
upper surface of the main body portion 100 is a detent 144. The
detent 144 is resiliently biased into the plane of the notch 142
and is aligned therewith. Therefore, when the knife 110 is in its
rearwardmost position, with the cartridge ready to be inserted on
the associated surgical instrument, the detent 144 fits within the
notch 142 and locks the knife 110 in position with respect to the
main body portion 100. On the upper surface of the knife 110 is
also provided an elongated depression 147. Adapted to slide within
the depression 147 is the bridge 108 rigidly securing one pusher
element 106 to the other. In this manner, when the knife 110 is
locked in position with respect to the main body portion 100, so
too are the pushers 106.
In a manner similar to that described above, the main body portion
100 is releasably locked in place with respect to the rail
assemblies 102. A plastic spacer bar 146 is provided at the rear of
the rail assemblies 102. And, at the forward portion of the spacer
bar 146, there is provided a detent 148 resiliently biased into the
plane of the bottom of the main body portion 100. A notch 150 is
located in the main body portion 100 and is adapted to align with
the detent 148 when the respective positions of the rail assemblies
102 and the main body portion 100 are suitable for insertion on an
associated surgical instrument.
Above, there has been described a novel cartridge and instrument
for ligating, suturing and dividing an organic tubular structure.
It should be appreciated, however, that the above description is
given for purposes of illustration only and that a number of
modifications and alterations may be practiced by those skilled in
the art without departing from the spirit or scope of the
invention. It is the intent, therefore, that the invention not be
limited to the above but be limited only as defined in the appended
claims.
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