U.S. patent number 3,837,555 [Application Number 05/291,301] was granted by the patent office on 1974-09-24 for powering instrument for stapling skin and fascia.
This patent grant is currently assigned to United States Surgical Corporation. Invention is credited to David T. Green.
United States Patent |
3,837,555 |
Green |
September 24, 1974 |
POWERING INSTRUMENT FOR STAPLING SKIN AND FASCIA
Abstract
A disposable staple cartridge housing a plurality of staples on
a flexible belt and adapted to inject and form the staples, singly,
into the disunited skin or fascia of a patient. Downwardly
projecting flanges on a staple pusher act directly on the
forwardmost staple positioned between a pair of adjacent teeth in
the flexible belt and move the staple, the belt and its contents,
with each stroke of the pusher. The forwardmost staple, when acted
upon by the pusher, advances, rides out of the plane of the
flexible belt and into the plane of the pusher and is ejected and
bent around an anvil assembly. On the return stroke of the pusher,
the downwardly projecting flanges flex out of the plane of the next
successive staple, moving over that staple, and then take a
position in readiness for the following stapling operation. The
cartridge is provided with means for preventing the retraction of
the staple housing belt during the rearward stroke of the pusher.
In a second embodiment of the disposable cartridge, a plurality of
staples are advanced as described above, but the number of
disposable elements are reduced. With this embodiment, an inventive
adaptor serves to associate the cartridge with a powering
instrument. Also disclosed is a novel and simplified gas activated
powering unit which develops a rectilinear thrust for advancing and
forming staples. In one embodiment of the instrument, the nose is
rotatable to facilitate alignment of the cartridge with the
incision to be sutured.
Inventors: |
Green; David T. (Norwalk,
CT) |
Assignee: |
United States Surgical
Corporation (Baltimore, MD)
|
Family
ID: |
26793851 |
Appl.
No.: |
05/291,301 |
Filed: |
September 22, 1972 |
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
97995 |
Dec 14, 1970 |
3717294 |
Feb 20, 1973 |
|
|
Current U.S.
Class: |
227/130; 227/19;
222/DIG.1 |
Current CPC
Class: |
A61B
17/0684 (20130101); Y10S 222/01 (20130101); A61B
2017/00544 (20130101) |
Current International
Class: |
A61B
17/068 (20060101); A61B 17/00 (20060101); B25c
001/04 () |
Field of
Search: |
;227/19,130 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Custer, Jr.; Granville Y.
Attorney, Agent or Firm: Fleit, Gipple & Jacobson
Parent Case Text
REFERENCE TO PRIOR APPLICATIONS
This application is a continuation-in-part of my prior U.S. Patent
Application Ser. No. 97,995, entitled Cartridge and Powering
Instrument for Stapling Skin and Fascia, filed on Dec. 14, 1970,
now U.S. Pat. No. 3,717,294, issued Feb. 20, 1973.
Claims
What is claimed is:
1. A gas-powered driving unit for converting gas pressure into
rectilinear motion, the unit comprising: an elongated casing unit;
a gas inlet port at one end of said elongated casing for the
introduction of pressurized gas into the body of said main casing;
a first piston chamber continuous with said gas inlet port, of a
diameter substantially larger than that of said gas inlet port, and
extending along the length of said elongated casing unit; a
piston-like valve seat slidably mounted in said first piston
chamber, said valve seat having a bore therethrough for
communicating said first piston chamber with the extremity of said
valve seat remote from said gas inlet port; an abutment block
positioned adjacent said piston-like valve seat, fixed with respect
to said elongated casing unit and positioned on the side of said
valve seat remote from said gas inlet port, said abutment block
having a bore extending from one end thereof to the other, thereby
defining uninterrupted communication between the end of the block
remote from said gas inlet port and the bore in said valve seat; a
seating piston mounted for reciprocation in a second piston chamber
defined in said casing unit, and positioned intermediate said valve
seat and said abutment block a driving piston mounted for
reciprocation in a third piston chamber defined in said elongated
casing unit, adjacent said abutment block and located on the side
thereof remote from said gas inlet port; first biasing means for
biasing said piston-like valve seat away from said abutment block
and against said gas inlet port; second biasing means for biasing
said seating piston away from said piston-like valve seat; and
third biasing means for biasing said driving piston toward said
abutment block.
2. A gas-powered driving unit recited in claim 1, and further
comprising: trigger means for moving said piston-like valve seat
away from said gas inlet port, thereby allowing the passage of
pressurized gas from said inlet port into said first piston chamber
and thereby initiating a drive stroke of said driving unit.
3. The gas-powered driving unit recited in claim 2, wherein said
seating piston is idle until after the initiation of the driving
stroke and after the pressure in the elongated casing unit have
equalized; and wherein said seating piston then serves to abut
against said valve seat and to drive said valve seat into
communication with said gas inlet port, thereby sealing off the
source of pressurized gas from said first piston chamber.
4. The gas-powered driving unit set forth in claim 3, wherein said
seating piston is driven toward said valve seat, after pressure
equalization, by gas pressure and against the biasing force
developed by said second biasing means.
5. The gas-powered driving unit recited in claim 4, wherein the
first biasing means is of sufficient strength to maintain the
piston-like valve seat against the gas inlet port in opposition to
the gas pressure developed in said gas inlet port, but is of
strength insufficient to move the valve seat toward the gas inlet
port in opposition to the gas pressure developed in said first
piston chamber.
6. The gas-powered driving unit described in claim 4, wherein said
piston-like valve seat, after triggering of the driving unit and
the equalization of pressures in the casing unit, is driven toward
said gas inlet port by the combined combined forces exerted by said
seating piston and said first biasing means.
7. The gas-powered driving unit recited in claim 6, wherein said
first and second biasing means take the form of coil springs.
8. The gas-powered driving unit recited in claim 2, wherein said
trigger means is in the form of an impact device; wherein the
operation of said impact device is mechanically initiated by an
operator; and wherein said piston-like valve seat is moved off of
said gas inlet port by an impact delivered by said impact
device.
9. The gas-powered driving unit recited in claim 1, and further
comprising a cartridge mount for associating a staple-housing
cartridge with said driving unit, said cartridge mount attached to
said elongated casing unit on the side adjacent said third piston
chamber and remote from said gas inlet port.
10. The gas-powered driving unit recited in claim 9, wherein said
cartridge mount is defined by a stationary element rigidly attached
to said elongated casing unit and a movable element rotatably
attached to said stationary element.
11. The gas-powered driving unit recited in claim 10, wherein said
movable element is adapted to rotate about an axis parallel to the
longitudinal center line of said staple-housing cartridge as
oriented when associated with said driving unit.
12. The gas-powered driving unit recited in claim 10, wherein said
movable element is adapted to rigidly receive said staple-housing
cartridge.
13. The gas-powered driving unit recited in claim 12, and further
comprising drive means rigidly attached to said driving piston for
associating with and driving said staple-housing cartridge, wherein
said drive means and said staple-housing cartridge rotate as said
movable element is rotated.
14. A surgical stapling instrument for applying sterilized staples
to the disunited skin of a patient for effecting the joining of the
skin, the instrument being adapted to accept a staple-housing
cartridge and comprising: a main body portion defining abutment
means; mounting means rotatably mounted to said main body portion
at the forward end of said main body portion for releasably rigidly
holding said staple-housing cartridge and associating same with
said surgical stapling instrument; and driving means for delivering
power from said instrument to said cartridge for ejecting staples
from said cartridge and clinching same in the disunited skin of the
patient, said driving means including an elongated shaft having a
coupling element at the forward end and a piston at the rear end,
said mounting means comprising a nose defining a threaded extension
which fits inside said abutment means and nut means secured to said
threaded extension to abut the rear face of said abutment means so
that said mounting means is rotatably associated with said main
body portion in such a manner that said staple-housing cartridge
rigidly associated with said mounting means can be rotated relative
to said main body portion.
Description
BACKGROUND OF THE INVENTION
The basic principle of ejecting and forming surgical staples in the
disunited skin or facia of a patient is disclosed in U.S. Pat. No.
3,643,851, issued Feb. 22, 1972, and assigned to the present
assignee. In this patent and in U.S. Pat. No. 3,662,939, issued May
16, 1972, also assigned to the present assignee, the staples housed
in their respective cartridges are driven by helical screws which
are, in turn, rotated by a complex gearbox arrangement integral
with the powering instrument.
More recently, in the development of the skin and fascia staper, as
evidenced in U.S. Pat. No. 3,618,842, issued Nov. 9, 1972, and U.S.
Pat. No. 3,638,847, issued Feb. 1, 1972, each assigned to the
present assignee, cartridges have been designed which eliminate the
requirement for the complex gearing once needed in the powering of
the instrument. In these issued patents, the output shaft of the
powering instrument need only have rectilinear thrust capabilities.
The staples are advanced by means designed into the cartridges
themselves. In the first of these patents, the advancing pusher,
integral with the cartridge, rotates a pair of staple-driving
screws by means of cams formed in the rear portions of the screws.
In the second of these patents, the staples are driven forward by
the interaction of pairs of opposing ratchet teeth integral with
the cartridge.
As with the known cartridges, gas powering units have been the
subject matter of several patent applications in the past few
years. Gas powering units have been described in the first of the
issued patents noted above and in several of the subsequent patents
also noted above. Further, a gas powering unit is described in U.S.
Pat. No. 3,613,507, issued Oct. 19, 1971, entitled POWER PACK UNIT,
also assigned to the present assignee. These units, while having
proven themselves in actual usage tend to be somewhat more complex
than is necessary. And, while the hydraulic actions of these units
have been adequate for the intended purposes, there are areas
wherein improvement is possible.
While the art of ejecting and forming staples in the skin or fascia
of a patient has come a long way since its inception, both
instruments and cartridges still tend to be somewhat complex in the
manufacture and in operation. Accordingly, the costs associated
with known cartridges and instruments tend to be high.
It is toward the provision of a cartridge and a powering instrument
which are simplified both in design and in manufacture, and hence
are reduced in cost, that the present invention is directed.
SUMMARY OF THE INVENTION
The present invention relates to two embodiments of a novel
cartridge for carrying a plurality of surgical staples and adapted
to form these staples in the disunited skin or fascia of a patient.
The second embodiment of the inventive cartridge does not mount
directly on a powering instrument, and hence the present invention
also relates to a novel adaptor for associating the cartridge with
the instrument. Still further, the present invention relates to a
novel and simplified powering instrument, activated by gas under
pressure, and adapted to mate with each embodiment of the invention
cartridge for providing the rectilinear thrust capabilities
necessary to actuate the cartridges.
In the first embodiment of the inventive cartridge, a flexible
toothed belt is moveably housed in a main body. Staples are guided
and are advanced by association with spaced teeth pf the flexible
belt. The cartridge is equipped with an anvil integral with the
main body and a pusher which serves the functions of advancing the
staples and singly ejecting and forming same. On the forward face
of the pusher element, are a pair of downwardly projecting flanges
extending into the plane of the staples. With each forward stroke
of the pusher, the flanges engage the forwardmost staple and
advance same along a guide track in the cartridge. With the initial
movement of the forwardmost staple, the flexible belt is advanced
in the cartridge, thereby advancing each staple associated with the
belt. With the advanced movement of the pusher, the forwardmost
staple engages a ramp assembly and rides out of the plane of the
flexible belt and into the plane of the pusher. The continued
forward motion of the pusher ejects the forward staple from the
cartridge and forms same about the anvil assembly.
On the return stroke of the pusher, with the flexible belt
restrained against rearward movement, the downwardly projecting
flanges ride over the next successive staple and then drop into the
plane of that staple, thereby readying the cartridge for another
staple ejecting operation.
With the invention cartridge, the surgeon is always apprised of the
fullness of the cartridge. The number of staples remaining in the
cartridge may easily be ascertained by inspecting the clear plastic
bottom thereof. As the flexible belt moves into the region of the
cartridge bottom, with each staple ejection, the line of the belt
passes a set of numbers. The alignment of the belt end with a
number is indicative of the remaining staples.
In the second embodiment of the invention cartridge, the staples
are housed in and guided by a flexible belt and are ejected and
formed much in the same manner as described above. However the
second embodiment of the cartridge is much smaller than the first,
is less costly to produce, and hence results in a savings when one
remembers that the cartridge is disposable. The second embodiment
of the cartridge takes the form of a main body in which is
positioned a moveable flexible belt loaded with staples. A small
pusher element, the forward face of which is constructed as
described above, is slidably mounted in the main body.
The second embodiment of the inventive cartridge is designed to
mate with an adaptor unit which connects the cartridge to the
powering instrument. The adaptor takes the form of an elongate body
in which is slidably mounted an arm for connecting the drive shaft
of the instrument to the pusher of the cartridge, and on which is
provided an anvil assembly. It should be apparent, therefore that
the adaptor mates with the second embodiment of the cartridge in
such a manner that the cartridge has each of the elements and
functions possessed by the first embodiment of the cartridge. The
difference, however, is that with the second embodiment of the
cartridge, only a small pusher unit, rather than the elongated unit
of the first embodiment, is disposable. Further, there is no
disposable anvil assembly in the second embodiment.
The inventive instrument takes the form of a substantially
cylindrical body housing a trigger unit, a gas supply chamber, a
power pack unit and an output shaft. The instrument is designed to
mate either with the first embodiment of the inventive cartridge or
with the adaptor unit.
The power pack unit, or the portion of the inventive instrument
which converts gas pressure into rectilinear motion, is similar, in
many respects, to the power pack of U.S. Pat. No. 3,613,507 issued
Oct. 19, 1971, noted above. Gas pressure originates in a standard
CO.sub.2 tank and is maintained in the tank until the instrument is
triggered. At that time, a spring biased gas seal is unseated,
thereby allowing gas to flow into a first pressure chamber. Then
the gas flows into a large pressure chamber and ultimately drives a
piston integral with the output shaft of the instrument. Once the
piston is driven, the gas seal is reseated by the action of the
biasing spring, and the power pack unit is readied for the next
driving operation.
Basically, the inventive powering unit differs from each of the
units known to the prior art in that the prior art units require
pressure differentials to reseat the gas seal. As a consequence of
this, when the pressure in the CO.sub.2 tank changes from one
firing to the next, so too does the required pressure for closing
the gas seal. Therefore, the known gas powering units, while
reliable, fail to operate with a constant set of parameters and
hence may operate with slight variations between one firing and the
next. In contradistinction to this, the inventive gas powering unit
depends upon the constant forces developed by springs to reseat the
gas seal. Hence, while pressure changes affect the operation of the
unit to some extent, there is significantly less operational
variance exhibited by the inventive unit than is exhibited by each
of the units known to the prior art.
In one form of the invention, the nose of the instrument serving as
a mount for the cartridge is rotatable with respect to the power
pack unit. The output shaft of the power pack unit terminates in a
cylindrical region adapted to rotatably associate with an extension
which directly drives the pusher of the cartridge. In this manner,
the extension, cartridge and mounting nose are free to rotate with
respect to the remainder of the instrument, and hence the surgeon
can easily align the forward force of the cartridge with the
incision to be sutured.
Accordingly, it is one object of the present invention to provide a
novel and simplified cartridge for housing a plurality of staples
and having the capability of ejecting and forming staples singly in
the disunited skin or fascia of a patient.
It is a further object of the present invention to provide a novel
staple housing cartridge whose pusher element advances a plurality
of staples and ejects and forms such staples singly, requiring only
rectilinear motion from a power source.
Yet a further object of the invention is to provide a novel staple
carrying cartridge housing a plurality of staples within the teeth
of a flexible belt.
Still a further object of the present invention is to provide a
staple carrying cartridge housing a plurality of staples along a
flexible belt and equipped with a pusher element for advancing each
of the staples and the belt and for simultaneously ejecting from
said cartridge the forwardmost staple.
Yet another object of the present invention is to provide a
compact, inexpensive and disposable cartridge for carrying a
plurality of staples and for associating with a powering
instrument, the cartridge and instrument serving, together, to join
the disunited skin of the patient by means of surgical staples.
A further object of the present invention is to provide a novel and
disposable cartridge housing a plurality of staples and designed to
associate with an adaptor having anvil means and pusher means, and
serving to connect the cartridge to a powering instrument.
Another object of the present invention is to provide a novel
staple housing cartridge having simplified means for displaying the
number of staples remaining in such cartridge.
A further object of the present invention is to provide a staple
housing cartridge having a pusher element whose forward face is
stepped in such a manner as to minimize the forces required for
forming a surgical staple.
Still a further object of the present invention is to provide a
novel adaptor to connect a disposable staple housing cartridge to a
powering instrument.
Yet another object of the present invention is to provide a novel
and simplified instrument for developing a rectilinear thrust for
ejecting staples from an associated cartridge.
A further object of the present invention is to provide a novel gas
powered instrument having a simplified power pack assembly.
A further object of the present invention is to provide a novel gas
powered instrument having a novel hammer-type trigger assembly.
Still another object of the invention is to provide a novel and
simplified stapling instrument which allows for easy assembly of
the staples with the incision to be sutured.
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 of the inventive gas-powered surgical
instrument showing its association with a cartridge;
FIG. 2 is a cross-section through the body of a staple carrying
cartridge constructed in accordance with the first embodiment of
the present invention;
FIG. 3 is a bottom view of the cartridge illustrated in FIG. 2;
FIG. 4 is an enlarged top view of the forward portion of the
cartridge illustrated in FIG. 2;
FIG. 5 is a cross-section similar to FIG. 2, illustrating the
manner in which the staples change planes of travel during the
staple driving operation.
FIG. 6 is a view similar to FIG. 5 showing the cartridge at a later
time during the staple driving operation;
FIG. 7 is a view similar to FIG. 5 showing the cartridge during the
return stroke of the pusher;
FIG. 8 is a view similar to FIG. 7, but showing an alternate
arrangement for preventing retracting of the flexible belt;
FIG. 9 is an enlarged perspective of the forward end of the novel
pusher;
FIG. 10 is a front view, partially in section, illustrating the
cartridge shown in FIG. 2;
FIG. 11 is a schematic showing an early stage of staple formation
in the skin of a patient;
FIG. 12 is a view similar to FIG. 11, but showing a later stage of
staple formation;
FIG. 13 is a cross-section through the inventive power pack
unit;
FIG. 14 is a side view, partially in section, illustrating the
inventive adaptor unit and the second embodiment of the inventive
cartridge unit;
FIG. 15 is a partial cross-section illustrating the interaction
between the adaptor and the second embodiment of the cartridge;
FIG. 16 is a top view of the nose of the inventive adaptor, with
its cover removed;
FIG. 17 is a front view of the second embodiment of the cartridge;
and
FIG. 18 is a cross-sectional view through the front end of the
inventive gas powered surgical instrument when provided with a
freely rotatable nose assembly.
DETAILED DESCRIPTION OF THE DRAWINGS
With reference now to the figures, and particularly with reference
to FIGS. 1 through 10, the first embodiment of the inventive
cartridge will be described. The cartridge is shown generally at 10
and, in FIG. 1 is shown mounted on a CO.sub.2 power instrument 12.
The cartridge 10 comprises, basically, a main body 14 having a pair
of side walls 16 and 18, a front wall 20, and a rear wall 22. A
solid projection 24, which may connect the side walls 16 and 18, is
centrally positioned in the main body 14. A metallic cover 26
encloses the main body at the top thereof and a transparent plate
28 encloses the main body at its bottom. An anvil 44 is made
integral with the forwardmost region of the cover 26.
A flexible belt or guide track 30, as of Lexan, polypropylene, or
similar material, is fit in the main body 14 and is adapted to
slide between the central projection 24 and the cover 26, and to
slide between the projection 24 and the bottom plate 28. The
flexible belt is substantially planar in configuration but also has
a plurality of teeth 32 on one side thereof, between which teeth 32
are defined a plurality of staple carrying grooves or contact
surfaces 34. For reasons which will be explained below, every third
groove 34 is continuous at the central region 35 of the belt 30,
extending entirely through the body of the belt. A staple 36 is
housed in and is guided by every third groove 34 of the flexible
belt 30. It can be seen that the staples are housed in other than
the continuous grooves of the belt 30. A substantially planar and
flexible staple pusher 38 is positioned intermediate the flexible
belt 30 and the cover 26, and is adapted for linear motion along
the length of the cartridge 10. As best seen in FIGS. 2, 4, 9 and
10, while the major portion of the pusher 38 lies above the plane
of the staples 36, a pair of downwardly projecting flanges 40, at
the forward outermost regions of the pusher 38, are adapted to
project into the plane of the staples. The downwardly projecting
flanges 40 of the pusher 38 are oriented outside the transverse
limits of the flexible belt 30, but associate with the staples 36
through the means of the cross-pieces thereof.
The forward face of the pusher 38 is stepped. The deepest step
defines a base 42, of a width equal to the width of the anvil 44
plus slightly more than twice the diameter of a staple 36. The
steps defined in the pusher define what may be termed moment points
46, 48 and 50, which serve, as will be explained below, to assist
in singly bending the staples 36 around the anvil 44.
The inventive cartridge 10 is provided with means for preventing
the movement of the flexible belt 30 in a direction opposite to
that indicated by arrow 52 (FIG. 2). These means take the following
form. A body of material is removed from the central region of the
projection 24. The material is removed, however, so as to define a
thin flexible arm 54 having a projection 56, extending, when
relaxed, into the plane of the flexible belt 30. The upper surface
of the projection 56 is tapered at 58 so that when the flexible
belt 30 moves in the direction of arrow 52, the arm 54 is cammed
out of the plane of the belt by the full grooves 54.
As noted previously, the bottom plate 28 is formed from a
transparent material. Therefore, as can be seen with referencee to
FIG. 3, the lower portion of the flexible belt 30 is visible
through the transparent plate 28. The plate 28 is provided with a
set of indicia which is indicative of the number of staples
remaining in the cartridge 10. As the staples are expelled from the
cartridge, the belt 30 moves in the direction of arrow 59, with the
lead end of the belt aligning with a number on the bottom plate 28.
In this manner, the surgeon is always apprised of the need for
replacing an exhausted cartridge.
With reference now to FIGS. 4, 5 and 10, the staple guiding
mechanism of the inventive cartridge will be described. Over a
major portion of the length of the body 10, the arms of the staples
36 are guided along ledges 59 defined in the respective side walls
16 and 18. Near the front face 20 of the cartridge 10, the staples
are acted upon by two sets of ramps 60 and 62, respectively. The
ramps 60 are spaced apart so as to act on the cross-pieces of the
staples 36, while the ramps 62 are spaced apart so as to act on the
legs of the staples. The sets of ramps 60 and 62 are longitudinally
spaced apart so that when a staple 36 is advanced in the direction
of arrow 64 (FIG. 4), it simultaneously engages the sets of ramps
60 and 62 so that the cross-piece and the arms of the staple change
planes in unison.
With continuing reference to FIGS. 1 through 10, the operation of
the inventive cartridge will now be described. As seen best in FIG.
2, the drive element 55 of the powering instrument 12 extends
through a groove 68 in the rear of the pusher 38. As will be
explained below, each triggering of the instrument 12 advances the
drive element 66 toward the front of the cartridge 10. Therefore,
the cover 26 is slotted at 70. And, as in each of the related
copending patent applications described above, the movement of the
pusher 38 is positively controlled by the drive element 66 of the
powering instrument 12.
The cartridge 10 is shipped with the elements in the relative
positions illustrated in FIG. 2. When in the operating arena, the
pre-sterilized disposable cartridge 10 is removed from its sealed
package and is inserted on the instrument 12. As seen best in FIG.
1, the rear of the cartridge cover 26 is provided with at least one
upstanding tab 27 adapted to associate with a corresponding at
least one notch (not shown) in the body of the instrument 12. The
cartridge 10 is advanced toward the powering instrument 12 as shown
in solid lines in FIG. 1 and is then moved into the position
indicated in phantom. Finally, the U-shaped bracket 74 is moved
into the position shown in phantom and the screw 76 is tightened so
as to bear on the bottom plate 28 of the cartridge 10. The drive
element 66 of the instrument 12 now unites with the slot 68 in the
pusher 38 and the cartridge 10 is held fixed with respect to the
instrument 12.
When the instrument 12 is fired, the driving element 66 moves
forward relative to the cartridge 10. So, too, therefore, does the
pusher 38. When the pusher 38 moves toward the foreward face of the
cartridge 10, the downwardly extending flanges 40 come into contact
with the cross-piece of the forwardmost staple 36. With continued
forward movement of the pusher 38, the forwardmost staple 36 is
urged forwardly. And, as the forward staple 36 is maintained in its
groove 34 (held by the respective outer regions of the sides of the
cover 26), the flexible belt 30 is caused to move in the direction
of arrow 52. Therefore, each of the staples 36 is advanced in the
body of the cartridge 10.
Continued forward movement of the pusher 38, in the direction of
arrow 64, brings the cross-piece of the forwardmost staple 36 into
engagement with the set of ramps 60 and brings the legs of the
staple 36 into engagement with the set of ramps 62. Then, with
still further movement of the pusher 38, the forwardmost staple 36
moves in the direction of arrows 78 (FIG. 5), up the sets of ramps
60 and 62, and shifts from the plane of the flexible belt 30 into
the plane of the pusher 38. As the staple 36 rises from the plane
of the belt into the plane of the pusher, the cross-piece of the
staple slides along the respective forward faces of the downwardly
extending flanges 40.
During the time when the forwardmost staple rides within the
confines of its guiding groove 34, the flexible belt 30 moves in
the direction of arrow 52; this movement continues until the staple
rises out of its groove and into the plane of the pusher. Further
movement of the pusher 38 in the direction of arrow 64 results in
the expulsion of the forwardmost staple 36 from the cartridge 10
and the formation of that staple around the anvil 44.
When the pusher 38 is at the forwardmost portion of its stroke,
each of the staples 36 has been advanced in the body of the
cartridge 10 substantially one complete staple length. And, when
the pusher is in this position, the upstanding flange 56 on the
flexible arm 54 is in the plane of the flexible belt 30, entering
such plane through one of the continuous grooves 34.
After a staple 36 has been formed around the anvil 44, as shown in
FIG. 6, the drive element 66 and its integral pusher 38 reverse
their respective directions of travel. The pusher 38 begins to
retract and continues to do so, unimpeded in any way, until the
sloping walls 80 of the downwardly projecting flanges 40 come into
contact with the forwardmost staple 36 then remaining in the body
of the cartridge 10. As the pusher 38 moves in the direction of
arrow 82 (FIG. 7), the downwardly projecting flanges 40 are cammed,
by the forwardmost staple, out of the plane of the staples 36 and
ride over such forwardmost staple. To allow for this out-of-plane
flexing of the pusher 38, the cover 26 is provided with a central
raised region 84. Ultimately, the pusher 38 takes the position
shown in phantom in FIG. 7, with the flanges 40 lying behind and in
the plane of the forwardmost staple 36. This is precisely the
position illustrated in FIG. 2, and hence the cartridge is then
ready for the next firing operation.
During the movement of the pusher 38, in the direction of arrow 82,
and when the sloping or cam surfaces 80 of the flanges 40 are in
contact with the cross-piece of the forwardmost staple 36, forces
are generated which tend to reverse the movement of the flexible
belt 30 and hence the movement of each of the staples associated
therewith. Such reversed movement is, of course, undesirable and
hence precautions are taken to eliminate the same. It is for this
reason that the flexible arm 54, with its upwardly extending
projection 56, is fit in the cartridge 10.
As best seen in FIGS. 6 and 7, the projection 56 associates with a
continuous groove 34 in the belt 30 when the pusher 38 is in its
forwardmost position. In this manner, all reverse forces generated
in the belt 30 when the pusher 38 is cammed over the forward staple
36, are dissipated without actual reverse movement taking place in
the belt or staples. See FIG. 7. However, the arm 54 with its
projection 56 in no way retards the forward movement of the belt
and staples. When the pusher 38 drives the belt 30 so as to advance
the staples 36, the rear face of the associated continuous groove
cams the projection 56 out of the plane of the belt through the
action of the sloping wall 58 of such groove. See FIG. 5.
In FIG. 8, an alternate manner of preventing the retraction of the
belt 30 and its staples 36 is illustrated. Contrary to the
embodiment of the cartridge illustrated in FIGS. 1 through 7, where
every third groove 34 is continuous, the FIG. 8 embodiment has no
continuous grooves tending to weaken the belt 30. The belt grooves
extend only to the base of the belt. In this embodiment, unwanted
retraction of the belt 30 and its staples 36 is prevented by the
provision of a small spring 86 secured to the bottom plate 28 by a
pin 88. When the belt 30 is driven so as to advance the staples 36,
the rear faces of the grooves 34 cam the spring 86 out of the plane
of the belt. However, when the belt 30 attempts to reverse its
direction of travel, during the retraction of the pusher 38, the
forward face of the groove 34 in which the spring 86 is biased
contacts the spring 86 and prevents movement of the belt.
With reference now to FIGS. 11 and 12, the bending of the staples
36 about the anvil 44 will briefly be described. The staple 36,
when in the position illustrated in solid lines in FIG. 11, has
just left the domain of the main body 14 of the cartridge 10. The
alignment illustrated in this figure is maintained, however, due to
the rapid movement of the pusher 38 in the direction of arrow 64
and the association of the arms of the staple 36 with the skin of
the patient. Movement of the pusher 38 in the direction of arrow 64
from that position illustrated in solid lines causes the staple 36
to bend as shown in phantom in FIG. 11. The bending occurs as a
result of the interaction between the anvil 44 and the pusher 38
acting through moment points 46 of the stepped region thereof.
Further movement of the pusher 38 in the direction of arrow 64,
shown in phantom in FIG. 12, causes further bending of the staples
36. This further bending is a result of forces exerted on the
staple 36 by the anvil 44 and the moment points 48 of the stepped
region of the pusher 38. Still further movement of the pusher 38
causes the staple to take the shape illustrated in solid lines in
FIG. 12, the final bending of the staple being the result of forces
generated by the anvil 44 and the moment points 50.
The forward face of the pusher 38 is stepped for the following
reasons. The initial bending of the staple 36 is the most difficult
stage of the bending operation. There are substantial inertial
forces which must be overcome before the staple begins to bend; and
to facilitate the bending of the staple, a long moment arm is
employed. After the staple has begun to bend, the inertial forces
are in favor of bending, and hence a shorter moment arm is
employed. In this manner, when it is most difficult to bend the
staple, the bending forces are greatest; when it is easiest to bend
the staple, the bending forces are reduced. Therefore, a relatively
constant input force may be used to bend the staple even though the
necessary bending forces change during the bending operation.
With reference now to FIG. 13, the novel power pack forming a part
of the present invention will be described. The power pack is shown
generally at 100 and comprises the following elements. In the
specific embodiment disclosed, the main body takes the form of a
four-piece unit, comprising circular cylindrical elements 102, 104,
106 and 108, respectively. Unit 102 serves basically to house a
CO.sub.2 bottle 110. A piercing pin 112 with a bore 114 passing
therethrough is sealed, by O-ring 116, in the rear wall of the
cylindrical unit 104, mating with the bottle 110 in the unit 102. A
bore 118, extending from the forward face of the unit 104 into the
region of the piercing pin 112, is provided in the cylindrical unit
104. Forward of the bore 118 in the cylindrical unit 104 is a
piston housing 120 serving to slidably mount a cylindrical piston
122. An O-ring 124 seals the piston 122 against the piston housing
120.
Fixedly imbedded in the rear wall of the piston 122 is a flexible
sealing element 126, such as of Celcon. The function of the element
126 is to seat against the wall of the cylindrical unit 104 in
which the bore 118 is provided, thereby preventing the CO.sub.2 gas
from entering the region of the piston housing 120. A bore 127
passes through the body of the piston 122 and leads from the piston
housing 120 to the rear wall of the piston 122. A coil spring 128
biases the piston 122 so as to seat the element 126 against the
bore 118 in the cylindrical unit 104.
A cylindrical stop 130 is fixedly mounted in the unit 106 and
serves as an abutment for the end of the coil spring 128 remote
from the piston 122. A bore 132 passes through the center of the
stop 130, while a bore 134 is defined in an extension thereof
located intermediate the cylindrical units 106 and 108,
respectively.
The rearward nose of the cylindrical stop 130 is of a lesser
diameter than is the inner diameter of the cylindrical unit 106
adjacent such nose. A second piston 136 is slidably mounted between
the nose of the cylindrical stop 130 and the inner wall of the
cylindrical unit 106. The forward face of the piston 136 extends
into a ring-like projection 138. Between the projection 138 and the
inner wall of the cylindrical unit 106 is an O-ring 140; and
between the projection 138 and the nose of the cylindrical stop 130
is an O-ring 142. A coil spring 144 acts between the piston 136 and
the cylindrical unit 104, thereby biasing the piston 136 away from
the piston 122. At rest, the projection 138 of the piston 136 rests
against a rear wall of the cylindrical stop 130.
The internal wall of the cylindrical unit 108 defines a cylinder
146. A main piston 148 slides in the cylinder 146 and is sealed
against the wall thereof by an O-ring 150. A rod-like extension 152
is integral both with the main piston 148 and with the drive
element 66 (FIG. 2). A coil spring 154 biases the main piston 148
against the forward wall of the cylindrical stop 130.
In addition to the elements described above, the cylindrical unit
104 houses a triggering unit shown generally at 156. The unit 156
comprises a trigger 158 having an oblong bore 160, which trigger is
mounted on a pin 162 integral with the cylindrical unit 104. A
spring 164 surrounds the pin 162 and biases the trigger 158 in a
clockwise direction as shown in FIG. 13 with the lower region of
the oblong bore 160 in contact with the pin 162. Integral with the
trigger 158 is a tongue 166 extending into the body of the unit
104.
A hammer 168 is slidably mounted in the bore 170 defined in the
cylindrical unit 104. The forward face of the hammer 168 is
adapted, when at rest, to contact an upstanding flange 171 on the
piston 122. A groove 174, having a sloping wall 176 and a flat wall
178, is defined between the forward region of the hammer 168 and
the rear region thereof, and associates with the tongue 166 of the
trigger 158. A bore 180 extends into the rear of the hammer 168 and
accommodates a coil spring 172, biasing the hammer 168 toward the
flange 171 on the piston 122. The spring 172 is held in place by
means of a plug 174 threaded into the body of the cylindrical unit
104. As noted previously, the spring 164 serves to maintain the
base of the oblong bore 160 in contact with the spring 166. This is
made possible by contouring the surface of the trigger 158 so that
it confortably associates with the upper surface of the hammer 168.
A fulcrum is thus defined between the points (or surfaces) of
contact between the lower surface of the trigger and the upper
surface of the hammer.
The operation of the novel power pack unit is as follows. When the
trigger 158 is depressed by the surgeon, the bias of the spring 164
is overcome and the trigger is pivoted in a counterclockwise
direction. With the downwardly directed force acting on the trigger
158, the top of the oblong groove 160 is urged into contact with
the pin 162. With pivoting of the trigger 158 in the
counterclockwise direction, the tongue 166 abuts the wall 178 of
the hammer 168 and causes movement of the hammer 168 in opposition
to the bias of its spring 172. Such movement continues until the
bottom surface of the trigger 158 comes into contact with a pin 182
rigidly secured to the cylindrical unit 104. Then, with continued
force being exerted on the trigger 158, the oblong groove 160 moves
with respect to the fixed pin 162 until the base of the groove 160
again nears the surface of the pin 162. Before actual contact is
made, however, the tongue 166 exits the groove 174, thereby
releasing the hammer 168.
When the hammer 168 is released by the trigger 158, it moves under
the bias of its spring 172 and impacts the upstanding flange 171 of
the piston 122, causes movement of the piston against the bias of
its coil spring 128, and thereby unseats the element 126 from the
adjacent wall of the cylindrical unit 104. Immediately after the
element 126 is unseated, the piston 122 is acted upon by CO.sub.2
gas escaping through the bore 118 and into the piston housing 120.
The combined inertial forces of the moving piston 122 and the
forces exerted by the pressurized CO.sub.2 gas cause the piston 122
to seat against a flexible sealing element 184 integral with the
nose of the cylindrical stop 130. With the pressurized CO.sub.2 gas
free to escape from the bottle 110 into the piston housing 120, and
with the piston 122 seated against the cylindrical stop 130,
pressurized gas passes through the piston 122, via bore 127,
through cylindrical stop 130, via bore 132, and enters a small
volume chamber defined between the large area rear face of the main
piston 148 and the front face of the cylindrical stop 130. Acting
on the large area surface, the pressurized gas exerts a substantial
thrust against the main piston 148 causing the main piston to
rapidly travel in the direction of arrow 188. As noted previously,
such action activates the staple carrying cartridge.
With the main piston 148 executing a staple driving stroke, a
substantial pressure is generated in the cylinder or piston chamber
146. In response to such pressure, gas is caused to exit the
cylinder 146, through the port 134, and enter the region of the
slidable piston 136. Such gas pressure causes movement of the
piston 136 against the bias of its spring 144.
It will be remembered that during the forward stroke of the main
piston 148, the piston 122 seats against element 184. The
upstanding flange 171 contacts or comes in close proximity to the
forwardmost face of the piston 136. Therefore, movement of the
piston 136 to the right (FIG. 13) causes engagement between the
forwardmost face of such piston and the upstanding flange 171 of
piston 122. As a consequence of this, piston 122 moves to the
right, reseats itself against the adjacent wall of the cylindrical
unit 104, and prevents further escape of the CO.sub.2 gas into the
piston housing 120, biased by its coil spring 128.
With the port 118 sealed against the passage of CO.sub.2 gas, the
main piston 148 is free to return to its rest position, biased by
its spring 154. At the same time, the pressure is relieved on the
left side of the piston 136 via passage 134 and such piston moves
to the left in response to the bias of its coil spring 144. In this
manner, each of the elements of the power pack are returned to
their rest positions illustrated in FIG. 13.
The main advantage of the inventive power pack is that once the
piston 122 is reseated, sealing the port 118, the constant force
coil spring 128 maintains such seating. In contradistinction to
this, prior art power packs maintain the seating mainly by gas
pressure. And, because the gas pressure varies somewhat with the
number of cycles developed by the CO.sub.2 bottle, the reseating
mechanism of the prior art power packs tend to be somewhat
unpredictable in nature. However, with the positive and constant
force reseating mechanism of the present invention, positive and
predictable reseating results.
With reference now to FIGS. 14 through 17, the second embodiment of
the inventive cartridge, and the inventive adaptor, will be
described. The inventive cartridge is shown generally at 200 and
the inventive adaptor at 202.
The cartridge 200 comprises, basically, a main body 204 having a
central projection 206 (FIG. 15) similar to that shown at 24 in
FIG. 2. A flexible belt, elongated linkage or guide track 208 rides
within a fixed guide member 210 defined between the central
projection 206 and the body 204 of the cartridge 200. As with the
first embodiment of the present invention, the belt is toothed on
one side thereof, and ever third tooth houses and guides a staple.
A pusher 212 is contained between the top surface of the body 204
and the flexible belt 208. The forward face of the pusher 212 is
provided with a pair of downwardly projecting flanges 214 identical
to those described with reference to the first embodiment of the
present invention. A small opening 216 is provided in the rear of
the pusher 212 and is adapted, as will be explained below, to mate
with a downwardly projecting flange 218 integral with a pusher
extension 220 in the adaptor 202. As seen in FIGS. 14 and 17, the
forward face of the cartridge 200 is open, with the flexible belt
208 exiting the cartridge at theeupper region thereof, looping
around and reentering the cartridge in the lower region of the
guide member 210.
The cartridge 200 described above is adapted to house on the order
of 30 to 40 staples. It can be seen that as the flexible belt 208
substantially forms a closed circuit around the guide member 210,
such a substantial staple handling capacity results. If, on the
other hand, it is desired that only six to 12 staples be housed,
the body of the cartridge 200 may be made smaller, as indicated by
the dash-dot line 222 in FIG. 14. With this arrangement,
theestaples would be linearly housed within the body of the
cartridge.
The adaptor 202 comprises, basically, a main body 224, a cover
plate 226 rigidly mounted on the main body 224, a nose 228, a
cartridge lock 230, and a pusher extension 220. The rear region of
the cover 226 is provided with at least one upstanding tab 232 to
secure the adaptor 202 to the power instrument 12 (as in FIG. 1).
An anvil 234 is integral with the cover plate 226 and is provided
at the forwardmost end thereof.
As seen in FIGS. 14 and 15, the nose 228 of the adaptor 202 is
constructed so as to mate with the forward face of the cartridge
200. The cartridge 200 is associated with the adaptor 202 as
follows. First, the forward face of the cartridge 200 is advanced
toward the nose 228 of the adaptor 202 in the direction of arrow
236. Then, once the forward regions of the cartridge and adaptor
are in contact, the rear of the cartridge 200 is moved in the
direction of arrow 236 until the cartridge lock 230 snaps into a
detent 238 in the body of the cartridge 200. Then, the cartridge is
ready to be fired.
It should be noted that the disposable cartridge 200 is far more
simple than is the disposable cartridge 10 described above. The
pusher 212 is substantially smaller than is the pusher 38. There is
no elongated metal cover to associate with the cartridge 200, nor
is the cartridge 200 provided with an integral anvil. Further, and
as shown in FIG. 16, the sets of ramps 240 and 242 are integral
with the adaptor 202 rather than with the disposable cartridge 200.
These sets of ramps serve the same function as do the sets of ramps
60 and 62 of FIG. 4. Again, therefore, the design of the cartridge
200 is simplified. In all other respects, the operation of the
inventive cartridge 200 is identical with that of the inventive
cartridge 10.
A further embodiment of the inventive gas-powered surgical
instrument is illustrated in FIG. 18. In this embodiment, the
cylindrical body unit 108 is provided with a cylindrical abutment
282 at its forward end and is attached to cylindrical element 106
in the same manner as is illustrated in FIG. 13. A piston chamber
284 is defined by the interior of cylindrical unit 108 and serves
as a housing for the main piston 148 sealed in piston chamber 284
by O-ring 150.
A nose 290, shaped in the form of a truncated cone, is rotatably
attached to the leading end of cylindrical body unit 108. Nose 290
is provided with a threaded cylindrical extension 292 which fits
inside the forward cylindrical abutment 282 of unit 108. A nut 296
is threaded onto extension 292 and abuts the rear face of abutment
282. A slight clearance is maintained between nut 296 and the
adjacent face of cylindrical abutment 282 so that nose 290 can
freely rotate with respect to the cylindrical unit 108.
A preferably cylindrical channel 298 is bored axially through nose
290, and the lower portion of the truncated cone defining nose 290
is cut away so that the nose is sized and shaped to receive an
inventive cartridge in a manner described above with reference to
FIG. 1. The cut is made at 299 and opens the channel 298 for the
free passage of the drive element 66. The rod-like extension 152 is
located in channel 298 for driving the pusher of an associated
cartridge. In addition, nose 290 is provided with means such as a
bracket and screw (not shown) for holding the inventive cartridge
in a manner previously described. The rearward end of extension 152
is screw-fit into the forward surface of main piston 148 in piston
head 286.
With this design, nose 290, extension 152, and hence the associated
cartridge, carried by nose 290, can be freely rotated about a
longitudinal center line to any desired angle. This feature allows
great flexibility in the positioning of the cartridge, and hence
eases the task of the surgeon in those situations when the incision
to be sutured is not conveniently positioned.
Above, several embodiments of the present invention have been
described. It should be appreciated, however, that these
embodiments are described for purposes of illustration only and
that numerous alterations and modifications may be practiced by
those skilled in the art without departing from the spirit and
scope of the invention. Accordingly, it is the intent that the
invention not be limited by the above but be limited only as
defined in the appended claims.
* * * * *